From the Guidelines
MRI is the best diagnostic approach for a suspected Salter-Harris type 1 fracture of the distal fibular physis in a 14-year-old male with a lateral ankle injury, where the growth plate is not visible on initial X-ray, and there is concern for potential fracture and displacement, particularly with regards to the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). The patient's age and mechanism of injury, combined with the clinical findings of point tenderness over the growth plate, strongly suggest a physeal injury that warrants definitive imaging for appropriate treatment planning. Key considerations in this case include:
- The need for accurate diagnosis to prevent potential long-term complications such as growth arrest or angular deformities
- The limitations of plain radiographs in visualizing growth plate injuries, particularly in cases where the fracture line runs through the physis without displacement
- The importance of assessing associated ligamentous injuries, such as those to the ATFL and CFL, which can impact treatment and prognosis
- The benefits of MRI in providing superior visualization of the physis and surrounding soft tissues without radiation exposure, as noted in the study by 1 MRI can detect bone marrow edema, physeal disruption, and associated ligamentous injuries that may not be visible on plain radiographs, making it the most appropriate diagnostic tool in this scenario. In contrast, while radiography may be useful in some cases of ankle injury, its limitations in visualizing growth plate injuries and associated ligamentous damage make it less suitable for this patient, as discussed in the study by 1. Ultimately, the use of MRI will allow for a more accurate diagnosis and effective treatment plan, minimizing the risk of long-term complications and optimizing outcomes for the patient.
From the Research
Diagnostic Approach for Suspected Salter-Harris Type 1 Fracture
- The initial step in diagnosing a suspected Salter-Harris type 1 fracture of the distal fibular physis is to obtain a thorough medical history and perform a physical examination 2, 3.
- Given that the growth plate is not visible on initial X-ray, further imaging studies such as magnetic resonance imaging (MRI) may be necessary to confirm the diagnosis 3, 4.
- MRI can help identify the presence of a fracture, as well as any associated ligamentous injuries, such as those to the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) 3, 4.
Importance of Accurate Diagnosis
- Accurate diagnosis is crucial in determining the appropriate treatment plan for the patient 2, 5.
- A misdiagnosis or delayed diagnosis can lead to premature physeal closure, fibular growth disturbance, syndesmotic instability, and medial (deltoid ligament) injury 2.
- Studies have shown that Salter-Harris type 1 fractures of the distal fibula are rare in children with radiograph-negative lateral ankle injuries, and that these children most commonly have ligament injuries (sprains) 3, 4.
Treatment Options
- Treatment options for a confirmed Salter-Harris type 1 fracture of the distal fibular physis may include closed reduction and internal fixation, or open reduction and internal fixation 2, 6.
- The choice of treatment will depend on the severity of the fracture, as well as the presence of any associated injuries 2, 5.
- In cases where the fracture is not displaced, treatment may involve immobilization and orthopedic follow-up 4.