PRIMARY DIAGNOSIS: S89.021A: Salter-Harris type 2 physeal fracture of the right distal tibia. The Salter-Harris (SH) Classification System is a way to grade fractures that involve the growth plate (physis). Seventy-five % of lower extremity fractures in children are SH type 2. (Levine et al., 2022) When a Pt presents with ankle symptoms a detailed history and physical examination are crucial. Although a nurse practitioner may provide initial care and refer to a pediatric orthopedic specialist, obtaining details about the trauma may help narrow down the differentials and testing needed. In addition, a basic understanding of the pediatric anatomy can lead to a better understanding of the mechanism of injury. Bone growth is not complete for a male until somewhere between the ages of 14 to 17 years old. Growth plates are made of cartilage and as the child ages, the cartilage hardens into bone which is less flexible and rubbery. (Su & Larson, 2015) AC is 14 years old and because his growth plates are still primarily cartilage, the risk of SH fracture is high. AC presented with right ankle pain, swelling and bruising. On exam, his inability to walk/bear weight and the presence of right ankle bony tenderness make a fracture much more likely. (Levine et al., 2022)