- 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:  

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.