Pediatric Growth Plate Injury S-H Classification

I Type	This type has no visible fracture line on X-rays. The injury completely involves the growth plate and epiphyseal plate, without affecting the metaphysis (clinically known as epiphyseal displacement). This injury is often caused by shearing forces and is more common in young infants because their growth plate is relatively thick.
II Type	This is the most common type of growth plate injury. It is characterized by epiphyseal separation with a partial metaphyseal fracture, which makes it easier to diagnose than Type I due to the triangular metaphyseal fracture fragment. The separation of the epiphyseal plate is similar to Type I. The mechanism of injury involves shearing forces combined with bending moments, and it is more common in children over 10 years old, when their growth plate is relatively thin.
III Type	This type of injury involves an intra-articular fracture through the growth plate, which is also an intra-articular fracture accompanied by epiphyseal separation. This injury is rare and is caused by intra-articular shearing forces, usually occurring at the distal tibia.
IV Type	This injury involves the joint surface, including the epiphysis, the entire epiphyseal plate, and part of the metaphysis, which is an intra-articular fracture along with a fracture of the epiphyseal plate and metaphysis.
V Type	Injury to the epiphyseal plate. This type of injury is often caused by strong compressive forces, leading to severe damage due to compression of the chondrocytes in the growth plate, resulting in a compressive fracture. It is less common but can have very serious consequences, often leading to bone growth deformities. Because there is no displacement in the injury, it is difficult to diagnose on X-rays. Therefore, for any pediatric limb injury or damage near the growth plate, where X-rays show no significant abnormalities but pain and swelling persist for a period, the possibility of an epiphyseal compression injury should be considered. Long-term follow-up is necessary, and the affected limb should not bear weight for 3 weeks to avoid exacerbating the injury.