The fundamental difference between children and adults is growth and development, and adolescents are the transition from childhood to adulthood, where they have both the physical characteristics of children and the initial characteristics of the adult motor system. The presence of the epiphysis is the most fundamental characteristic that distinguishes them from adults. The specificity of the diagnosis and treatment of epiphyseal injuries determines that children and adolescents can never be considered as smaller versions of adults! In a sense, even the future well-being of a child’s life is at stake. Growth and development are the most obvious features of children, and the presence of the epiphysis and epiphyseal plate is unique to the skeletal development of growing children and a weak area of the skeletal anatomy. Epiphyseal injury is a unique type of fracture in children, and the exact meaning should be a general term for injuries involving the longitudinal growth mechanism of the epiphysis, including injuries to the epiphyseal growth plate, epiphysis, and the periphyseal ring. Epiphyseal morphology and function can be affected by a variety of causes leading to limb shortening and angular deformity, including infection, tumors, blood flow disorders, nerve damage, metabolic abnormalities, frostbite, burns, etc., with trauma being the most common. Epiphyseal fractures are a very serious form of injury that can jeopardize growth and plastic potential. Epiphyseal injuries in children differ significantly from adult fractures in terms of mechanism of injury, injury staging, diagnosis, treatment selection, and prognostic assessment. The treatment of epiphyseal injuries in children may be highly unsatisfactory if the same principles and methods are used in adults, and sometimes the irremediable consequences of such medically induced injuries can be a lifelong “disaster” for the child. Regardless of specialty, orthopaedic surgeons should always consider the presence of epiphyseal growth plates when treating children’s fractures. Morbidity: Epiphyseal injuries increase in severity as children age and play more sports. As children become adolescents, the likelihood of injury shifts from the upper to the lower extremities. The same elbow injury in newborns and infants is more likely to be a separation of the distal humeral epiphysis; in children aged 3-8 years, epiphyseal fractures of the humeral epicondyle are more likely to occur; and in adolescents, intercondylar fractures of the humerus. The treatment of these injuries can be very different! High fall injuries can cause both symptomatic separation of the femoral epiphysis in children resulting in non-union and ischemic necrosis of the femoral epiphysis, and insidious compression fractures of the distal femoral epiphysis with distal femoral shortening and angular deformity. Adding risk and difficulty to clinical diagnosis and treatment. Diagnosis: Epiphyseal injury is a specific type of fracture in children and accounts for about 1/5 of all fractures in children and adolescents, especially since the joint ligaments in children and adolescents are significantly stronger than the epiphysis, so the possibility of epiphyseal injury should be considered first when symptoms such as swelling and pain occur in the joint area. For example, in adolescents with type I and type II distal femoral epiphyseal injuries, which are rare clinically, the epiphyseal fracture without displacement behaves much like an articular ligament injury and can only be confirmed by taking a radiograph in a stress position. The correct diagnosis is the basis for appropriate treatment and can be used to determine treatment modalities and pre-estimate the final outcome. Most Type I and Type II injuries can be treated conservatively, using the soft tissue lobe of the intact side to maintain stability of the fracture end and avoid the trauma of surgery. Type III and IV injuries are intra-articular fractures, which require a high degree of position and stability after repositioning, and most require treatment by incision and internal fixation. X-rays are an important basis for the diagnosis of epiphyseal injuries, but they are not the only means. The correct diagnosis can be made by carefully examining the history, analyzing the mechanism of trauma, carefully examining the local swelling and pressure pain of the affected limb, and the deformed position of the joint. If necessary, X-rays of the same part of the healthy side can be taken for comparison, or MRI can be performed to clarify the diagnosis. In particular, cartilage injuries that were difficult to diagnose in the past can be clearly visualized by MRI technology, providing a definite basis for treatment. The principles of treatment are: to obtain and maintain a satisfactory fracture position, and not to cause new injuries during the repositioning and maintenance operations. It is important to note that the results of treatment should not be evaluated on the basis of radiographic findings, as a satisfactory radiograph does not equate to a good outcome. Complications: The destruction of the epiphyseal growth cartilage by fracture can lead to limb growth disorders. These include angular deformities and limb shortening. The manifestation is abnormal bony connections within the epiphyseal growth plate, i.e., bone bridge formation. Central bridges primarily affect limb length, while marginal bridges result in angular deformity. The severity of the injury itself determines whether and where bridges are formed in the epiphyseal plate, and among the many possible causes of premature epiphyseal closure, fracture is clearly the leading cause of morbidity. The ideal treatment for formed bridges is resection of the bridge and restoration of the epiphyseal growth capacity.