This radiograph shows a fracture of the distal tibia over the articular surface into the epiphysis and physis.

An SH-IV fracture is a contiguous fracture through the metaphysis, physis, and epiphysis. This fracture often involves the articular surface, making this ahigh-risk injury for chronic disability as in SH-III injuries.

This radiograph shows a fracture of the medial malleolus extending from the inferior articular surface of the tibial epiphysis through the physis and extending through the metaphysis.

An SH-V fracture is a crush injury of the physis. This may be radiographically visible as a narrowing of the growth plate lucency; however, it is most often not radiographically visible.