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FIGURE 111.2 The Salter–Harris classification for physeal fractures The prognosis for growth disturbance worsens from type I through type V Salter –Harris type II fracture Type II fractures are the most common type of pediatric physeal fracture These fractures extend through both the physis and the metaphysis Like the type I injuries, these fractures generally carry a good prognosis and rarely cause functional deformity Salter –Harris type III and IV fractures Type III and IV injuries are growth plate injuries that involve the intra-articular surface In type III fractures, the fracture line typically extends from the epiphysis into the physis, resulting in a separation of the epiphysis and its associated growth plate from the rest of the epiphysis The fracture line in type IV injuries crosses through all three regions of the bone (epiphysis, physis, and metaphysis) Anatomic position must be reestablished to restore normal joint mechanics and prevent growth disturbance Because of these risks, which may result in functional disability, orthopedic consultation should be obtained while the patient is in the ED for all but the most minor type III and IV injuries Salter –Harris type V fracture Type V fractures are the least common physeal fracture, and most commonly occur at the knee and ankle These fractures are a crushing injury of the growth plate as a result of axial compression It is often difficult to diagnose these injuries during the ED presentation, but a high index of