What is the diagnosis and prognosis of a patient with a suspected Salter-Harris (fracture of the growth plate) type 1 fracture of the distal fibular physis, as indicated by plain radiographs and confirmed by Magnetic Resonance Imaging (MRI) of the right ankle?

From the Guidelines

The patient's diagnosis is a Salter-Harris type 1 fracture of the distal fibular physis, confirmed by MRI, with a generally good prognosis due to the absence of ligament damage and proper bone alignment. The diagnosis is based on the combination of plain radiographs and MRI findings, which is consistent with the reference standard for assessing ligamentous injury and stability, as indicated by the American College of Radiology 1. The MRI findings are crucial in confirming the diagnosis, as it allows for high-resolution evaluation of the tendons and ligaments, and can distinguish between tendinopathy, sprain, and partial or complete tears 1. Key points to consider in the diagnosis and prognosis include:

• The presence of a fracture through the growth plate, which is characteristic of a Salter-Harris type 1 fracture 1
• The absence of ligament damage, which is a good prognostic indicator 1
• The proper alignment of the bone pieces, which suggests a non-displaced fracture 1
• The presence of bone marrow edema above the growth plate, which is consistent with a Salter-Harris type 1 fracture 1 The treatment for this type of injury typically involves immobilization to allow proper healing, and the prognosis is generally good with appropriate care, especially since the bones remain aligned and there's no ligament damage.

From the Research

Diagnosis of Salter-Harris Type 1 Fracture

• The diagnosis of a Salter-Harris type 1 fracture of the distal fibular physis can be indicated by plain radiographs and confirmed by Magnetic Resonance Imaging (MRI) of the right ankle 2.
• The Salter-Harris classification of growth plate injuries aids in estimating both the prognosis and the potential for growth disturbance, with type 1 being a fracture through the growth plate 3.
• Radiographic images, including plain radiographs and MRI, are essential for prompt diagnosis and to minimize negative health outcomes in patients with Salter-Harris fractures 4, 5.

Prognosis of Salter-Harris Type 1 Fracture

• The prognosis for Salter-Harris type 1 fractures is generally good, with most fractures healing without permanent deformity 3.
• However, there is a risk of complications, including growth arrest and subsequent deformity, particularly if the fracture is not adequately treated 3, 6.
• Patients with Salter-Harris type 1 fractures may be at risk for premature physeal closure, fibular growth disturbance, syndesmotic instability, and medial (deltoid ligament) injury 2.
• Surgical treatment may be necessary in some cases, particularly if there is significant displacement or if the patient has a condition that increases the risk of complications, such as sickle cell disease 4.