Epiphyseal injuries are a specific type of fracture that occurs in children. The most common classification used today is the one based on how the fracture appears on radiographs. This classification depicts the extent of epiphysis, epiphyseal plate, and joint involvement. A type 1 fracture is simply a separation of the epiphysis past the epiphyseal plate with or without displacement, and stress radiographs are usually used to determine the presence of this type of fracture. A type 2 fracture is a triangular piece of epiphysis attached to the separated epiphysis with displacement through the epiphyseal plate. A type 3 fracture is a separation of the epiphyseal plate accompanied by an intra-articular epiphyseal fracture that creates an uneven articular surface during displacement. Type 4 fractures are through the epiphysis, the epiphyseal plate, and into the joint, and the articular surface may also be uneven. Type 5 fractures are compression fractures of the epiphyseal plate and can cause permanent damage to the epiphyseal plate.Canale et al. routinely used the Salter-Harris classification and concluded that epiphyseal injury can lead to growth disturbances, which are often prone to occur in Salter-Harris type 3, 4, and 5 fractures. Most type 1 and type 2 fractures can be treated with closed reduction, while type 3 and type 4 fractures often require incision and reduction to securely fix the bone fragments in anatomic position so that the epiphyseal plate can potentially continue to grow and the articular surface can remain flat, such as epicondylar humerus fractures (type 4 epiphyseal injuries), which almost always require incision and reduction for internal fixation. If not treated correctly, the fracture will not heal and can cause unevenness and angular deformity of the articular surface. type 5 fractures, where the chondrocytes of the epiphyseal plate are extruded, can also cause growth disturbances if treatment is not attended to. In fact, a type 5 fracture can only be diagnosed when a growth disorder is detected. If the fracture involves the epiphyseal plate (i.e., epiphyseal injury), parents should be informed in detail at the time of the fracture of the possibility of growth disturbance and angular deformity. All type 1 and 2 fractures are not necessarily well after closed reduction, and all type 3 and 4 fractures are not necessarily well after surgical reduction. Non-displaced type 3 and 4 fractures can also be treated with closure. However, Bright noted that these types of nondisplaced fractures can be displaced within the cast and can form epiphyseal bridges, so he suggested that all type 3 and 4 epiphyseal injuries should be incised and internally fixed. If possible, any form of fixation through the epiphyseal plate should be avoided. If possible, the nail should be made to pass through the epiphysis, which is preferable to passing through the epiphyseal plate. In older children, osteotomy can be performed for bridging or angular deformities; in younger children, methods of bridgework, fat- or inert-material insertion have been described, and Canale et al. successfully used a combination of bridgework and osteotomy. If the deformity is greater than 20 degrees, bridgework with osteotomy should be performed. In general, the upper extremity is more tolerant of larger deformities than the lower extremity, larger valgus deformities are more tolerable than valgus deformities, larger flexion deformities are more tolerable than extension deformities, and proximal deformities of the lower extremity are more tolerable than distal deformities.