The Resolution

Salter-Harris IV fracture of the ankle (Figure 2).

Note the fracture lines (arrows) through the epiphysis, growth plate, and metaphysis of the distal tibia. Salter-Harris IV fractures involve all three elements of the growing bone. Injuries of this type to the distal tibia are complex injuries and usually result from high-energy forces. Most of these require surgical fixation and require urgent referral to an orthopedic surgeon for treatment.

Clinical Challenge: October, 2015
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