From the Guidelines
Physeal enhancement on MRI of a distal radius fracture is concerning for growth plate injury that may lead to growth arrest. When evaluating a child with a distal radius fracture, the presence of enhancement on MRI across the physis (growth plate) suggests vascular disruption and potential damage to the germinal cells responsible for bone growth. This finding warrants close monitoring as it may result in premature closure of the growth plate, leading to growth disturbances such as limb length discrepancy or angular deformity. Management typically involves careful fracture reduction, possible orthopedic consultation, and scheduled follow-up radiographs at 3-6 month intervals for at least a year to monitor for signs of growth arrest. Early identification of growth disturbances allows for timely intervention, which may include procedures such as epiphysiodesis of the contralateral limb or corrective osteotomy depending on the child's remaining growth potential and the severity of the deformity. The risk of growth arrest is higher with Salter-Harris type III, IV, and V fractures that directly involve the growth plate 1. Some key points to consider in the management of distal radius fractures include:
- The use of arthroscopic assistance for evaluation of the articular surface during operative treatment of distal radius fractures has been updated from limited evidence in support of its use to moderate evidence not in support of its use 1.
- The indication for fixation of distal radius fractures statement has been updated to reflect patients under the age of 65, with moderate support for operative fixation in the non-geriatric population in those with post reduction radial shortening >3mm, dorsal tilt >10 degrees, or intraarticular displacement or step off >2 mm 1.
- The statement designed to guide serial radiographic imaging for patients treated for distal radius fractures has been updated, with no difference exists in outcomes based on frequency of radiographic evaluation for patients treated for distal radius fractures 1. However, these points are not directly related to the concern of physeal enhancement on MRI of a distal radius fracture. The primary concern remains the potential for growth plate injury and the need for close monitoring and possible intervention to prevent long-term growth disturbances. In the context of real-life clinical medicine, it is essential to prioritize the potential risks and consequences of growth plate injury and to manage these cases with caution and careful consideration of the individual patient's needs and circumstances.
From the Research
Physeal Enhancement on MRI of Distal Radius Fracture
Physeal enhancement on MRI of a distal radius fracture is concerning for several potential complications, including:
- Growth arrest: Physeal fractures can lead to growth arrest, which can result in deformity or limb length discrepancy 2, 3, 4
- Physeal bar formation: A physeal bar is a bony bridge that can form across the growth plate, leading to growth disturbance and potential deformity 5, 6
- Ulnar overgrowth: Ulnar overgrowth can occur as a result of growth arrest or physeal bar formation, leading to distal radioulnar joint instability and degenerative changes in the carpus and triangular fibrocartilage complex 5, 4
- Radioulnar length discrepancy: Radioulnar length discrepancy can occur as a result of growth arrest or physeal bar formation, leading to potential functional problems and pain 3, 4
Factors Associated with Physeal Growth Arrest
Several factors have been associated with physeal growth arrest, including:
- Age: Older patients are more likely to experience growth arrest 2
- Initial displacement and angulation: Higher initial displacement and angulation rates are associated with an increased risk of growth arrest 2
- Fracture type: Certain types of fractures, such as Salter-Harris type 2 fractures, are more likely to result in growth arrest 3, 4
- Location of the fracture: Fractures located in the distal radius are more likely to result in growth arrest than fractures located in other areas 3, 4
Diagnosis and Treatment
Diagnosis of physeal growth arrest and associated complications can be made using a combination of radiographs, MRI, and clinical evaluation 5, 6. Treatment options for physeal growth arrest and associated complications include observation, bar resection, epiphysiodesis, ulnar shortening osteotomy, and distraction osteogenesis 5, 4.