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Supination External Rotation Frx in Children

- See: Adult SER Frx

- Stage I:
    - SH II frx of distal tibial physes w/ long spiral frx of distal tibia, which starts laterally at the growth plate, and progresses medially, proximally, and posteriorly;
    - metaphyseal fragment is localized posterio-medially;
          - on lateral radiographs, the SH II frx w/ the posteromedial metaphyseal fragment may resemble a supination-plantar flexion frx;
          - the distinction between the 2 frx is made on the AP view;

- Stage II:
    - if external rotational force continues, a spiral frx of fibula is seen, starting medially and running superiorly and posteriorly;

- Radiographs:  

Salter-Harris II Fractures of the Distal Tibia: Does Surgical Management Reduce the Risk of Premature Physeal Closure?

Premature Physeal Closure Following Distal Tibia Physeal Fractures: A New Radiographic Predictor

Roentgen stereophotogrammetric analysis of growth pattern after supination--eversion ankle injuries in children.

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