Home » Bones » Tibia and Fibula » Salter Harris IV Fracture of Distal Tibia Salter Harris IV Fracture of Distal Tibia - Discussed: - displaced SH III & IV frx of distal tibia require open reduction; - this frx is assoc w/ premature physeal closure unless anatomically reduced; - Diff Dx: - Two Part Triplane Frx - Tillaux Frx Salter-Harris Type-IV injuries of the distal tibial epiphyseal growth plate, with emphasis on those involving the medial malleolus.