From the Guidelines
MRI is the preferred diagnostic imaging method for diagnosing a potential Salter-Harris type 1 fracture of the distal fibular physis in a 14-year-old male, as it provides superior visualization of the physis and surrounding soft tissues. The growth plate is not visible on initial X-ray, and MRI can detect bone marrow edema indicative of fracture even when not visible on X-ray 1. While spaced X-rays may be useful in some cases, they often miss non-displaced Salter-Harris type 1 injuries since the fracture occurs through the growth plate without displacing bone fragments.
Some key points to consider in this case include:
- MRI is the reference standard for ligamentous injury and assessment of stability, which is particularly important in adolescents with open growth plates 1
- Ligament and tendon injuries can occur without fracture on radiography, and MRI can help exclude Salter 1 fractures in the pediatric population 1
- The presence of bone bruise and adjacent soft-tissue edema have shown a higher association with acute ligamentous injuries and tendon abnormalities in patients with negative radiographs 1
- Treatment decisions, including whether weight-bearing restrictions or immobilization are needed, can be more accurately determined with MRI findings, though cost and accessibility should be considered when making this imaging choice
In terms of the benefits of MRI in this case, it provides a comprehensive assessment of the physis, surrounding soft tissues, and any associated soft tissue injuries, which is particularly important in adolescents with open growth plates. Missed physeal injuries can lead to growth disturbances, and MRI can help identify these injuries and guide treatment decisions 1. Overall, MRI is the preferred diagnostic imaging method for diagnosing a potential Salter-Harris type 1 fracture of the distal fibular physis in a 14-year-old male.
From the Research
Diagnostic Imaging Methods
To diagnose a potential fracture and displacement in a 14-year-old male with a suspected Salter-Harris type 1 fracture of the distal fibular physis, the preferred diagnostic imaging method is a topic of consideration.
- Spaced X-rays are typically the initial imaging modality used to assess suspected fractures, including Salter-Harris type 1 fractures 2.
- However, in cases where the growth plate is not visible on initial X-ray, Magnetic Resonance Imaging (MRI) may be a more suitable option to confirm the diagnosis and assess the extent of the injury 3, 4.
MRI vs Spaced X-rays
- A study published in 2010 found that MRI was able to detect ligamentous sprains and bony contusions in patients with suspected Salter-Harris type 1 fractures of the distal fibula, whereas X-rays were unable to detect these injuries 3.
- Another study published in 2016 found that MRI-confirmed Salter-Harris type 1 fractures of the distal fibula were rare in children with radiograph-negative lateral ankle injuries, and that most children with these injuries actually had ligament injuries (sprains) or radiographically occult avulsion fractures 4.
- In contrast, spaced X-rays may not be able to detect growth plate injuries or other subtle abnormalities, and may require repeat imaging to confirm the diagnosis 2, 5, 6.
Clinical Implications
- The choice of diagnostic imaging method may have significant implications for the management and treatment of suspected Salter-Harris type 1 fractures of the distal fibular physis.
- MRI may be a more sensitive and specific imaging modality for detecting growth plate injuries and other subtle abnormalities, and may help to avoid unnecessary treatment or overtreatment of these injuries 3, 4.
- However, the use of MRI should be guided by clinical judgment and should be reserved for cases where the diagnosis is uncertain or where there is a high suspicion of a growth plate injury 2, 5, 6.