From the Guidelines
For a 14-year-old male with a suspected Salter-Harris type 1 fracture of the distal fibular physis, MRI is the most accurate diagnostic method, outperforming spaced X-rays, as it can directly visualize the growth plate injury and detect bone marrow edema, physeal disruption, and soft tissue injuries. When diagnosing a suspected Salter-Harris type 1 fracture, particularly in the pediatric population, it is crucial to prioritize imaging modalities that can accurately assess the growth plate and surrounding soft tissues.
- The growth plate is not visible on initial X-ray, making MRI a superior choice for detecting physeal injuries and excluding Salter 1 fractures 1.
- MRI provides high-resolution evaluation of tendons and ligaments, allowing for distinction between tendinopathy, sprain, and partial or complete tears, which is essential for treatment planning and return to sport assessment 1.
- The presence of bone bruise and adjacent soft-tissue edema on MRI has shown a higher association with acute ligamentous injuries and tendon abnormalities, even in patients with negative radiographs 1.
- While spaced X-rays might show periosteal new bone formation or widening of the physis after 7-10 days, MRI can immediately detect bone marrow edema, physeal disruption, and soft tissue injuries, making it a more timely and accurate diagnostic tool.
- In adolescents, accurate diagnosis of growth plate injuries is critical to prevent growth disturbances, emphasizing the need for advanced imaging like MRI over spaced X-rays.
From the Research
Diagnostic Methods for Salter-Harris Type 1 Fracture
- The most accurate diagnostic method for detecting a fracture in a 14-year-old male with a suspected Salter-Harris type 1 fracture of the distal fibular physis is Magnetic Resonance Imaging (MRI) 2, 3.
- Spaced x-rays may not be sufficient to detect the fracture, especially if the growth plate is not visible on initial x-ray 2, 3.
- MRI can help identify ligamentous sprains and/or bony contusions, which are common in children with radiograph-negative lateral ankle injuries 2, 3.
Comparison of Diagnostic Methods
- A study found that only 3.0% of children with clinically suspected Salter-Harris type 1 fracture of the distal fibula had MRI-confirmed fractures, while 80.0% had ligament injuries and 22.0% had isolated bone contusions 3.
- Another study found that none of the 18 patients with suspected Salter-Harris type 1 fracture of the distal fibula had evidence of fibular growth plate injury on MR imaging, and instead had ligamentous sprains and/or bony contusions 2.
Treatment and Management
- Children with fractures detectable only by MRI had a comparable recovery with those with sprains when treated with a removable ankle brace and self-regulated return to activities 3.
- Early treatment with closed reduction and fixation can achieve excellent long-term results in cases of Salter-Harris type 1 injuries to proximal tibial physis 4.