- See: Adult SER Frx
- 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: 
Salter-Harris II Fractures of the Distal Tibia: Does Surgical Management Reduce the Risk of Premature Physeal Closure?
Premature Physeal Closure Following Distal Tibia Physeal Fractures: A New Radiographic Predictor