![]() ![]() This fracture occurs when a force hits the growth plate separating the rounded edge of the bone from the bone shaft. The narrower part of the bone is called the metaphysis. The rounded bone edge is called the epiphysis. The growth plate is known as the physis, from the Greek word “to grow.” The growth plate is located between the rounded top of the bone and the bone shaft. The higher numbers have a higher risk of possible growth problems. There are five main types, distinguished by the way the injury impacts the growth plate and surrounding bone. However, only a few literatures reported MR imaging findings of trapped periosteum in physeal injury ( 3, 10).Salter-Harris fractures were first categorized in 1963 by Canadian doctors Robert Salter and W. MR imaging of ankle in our case also showed entrapped low signal intensity structures within the widened physis on T2-weighted images. Soft tissue entrapments, especially periosteal interposition in physeal fractures, can be demonstrated as linear low signal intensity structures within the widened physis on proton density weighted images with or with156out fat saturation and T2-weighted images ( 3, 10). Also, MR imaging has been used for detecting patterns of growth plate injury not depicted on a plain-film, particularly in S-H type I and V fractures ( 3). ![]() ![]() In a previous study, it has been reported that physeal injury was presented as a low signal intensity, which was similar to the normal physis, on T1-weighted imaging and as a high signal intensity, which was different from an intermediate signal intensity of the normal physis, on T2-weighted imaging ( 9). MR imaging can clearly demonstrate the morphology, signal intensity of the physis, as well as the relationship between the physis and surrounding structures ( 9). These lesions were interpreted as an entrapment of torn displaced periosteum within the fractured physis and the surrounding granulation tissues. MR imaging of the left ankle demonstrated a linear low signal structure on T2-weighted images extended into the widened physis of anteromedial portion of the distal tibia and surrounding intermediate to low signal lesion ( Fig. The possibility of soft tissue entrapment within the fractured physis of the distal tibia was considered, and MR imaging was performed. Subsequent plain radiographs showed physeal widening (4 mm width) of medial portion of the distal tibia one month later ( Fig. Closed reduction with immobilization was performed. Initial CT scans of the left ankle demonstrated a widening of the medial aspect of the distal tibial physis, which was consistent with Salter-Harris type I fracture and fracture of distal shaft of the fibula ( Fig. We report MR imaging findings of distal tibial S-H type I fracture with periosteal interposition, which underwent open surgical reduction.Ī 10-year-old girl was being presented with a distal lower left extremity injury by a traffic accident. Although irreducible fractures of the physis due to interposed soft tissues have been reported in the orthopedic literature, there are only a few reports concerning the preoperative magnetic resonance (MR) imaging diagnosis. Particularly, interposed periosteum in the physis has been reported as the most common cause of failed closed reductions ( 3- 5). However, although not commonly seen, soft tissue structures, including periosteum, tendons and ligaments, can be interposed in the physis, and it has been associated with subsequent growth disturbances and requires open surgical reductions to remove the entrapped structures ( 3- 5). Salter-Harris (S-H) type I fracture has been considered as a low-grade physeal injury and usually needs conservative management with closed reduction and immobilization ( 2). The distal tibia is the second most common site of physeal fracture, followed by the distal radius ( 1). ![]()
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