From the Guidelines
If a radiologist and pediatric orthopedic specialist interpret a child's ankle MRI differently, with the radiologist diagnosing a Salter-Harris type 1 growth plate fracture, you should defer to the pediatric orthopedic specialist's opinion. The orthopedic specialist has more specialized training in pediatric bone injuries and integrates clinical findings with imaging results, as noted in a study published in the Journal of the American College of Radiology 1. According to the American College of Radiology, MRI is the reference standard for ligamentous injury and assessment of stability, which is particularly important in athletes, and can help exclude Salter 1 fractures in the pediatric population 1.
Key Considerations
- The pediatric orthopedic specialist's opinion should be prioritized due to their specialized training and ability to integrate clinical findings with imaging results.
- Treatment for a Salter-Harris type 1 growth plate fracture typically involves immobilization with a cast or boot for 3-4 weeks, followed by gradual return to activities, as part of a comprehensive treatment plan that considers the child's overall health and well-being.
- Growth plate injuries require careful monitoring since they can potentially affect bone growth, and the pediatric orthopedic specialist is best equipped to provide this care.
Next Steps
- Arrange a follow-up appointment with the pediatric orthopedist to discuss their interpretation and treatment plan.
- Ensure your child follows weight-bearing restrictions as directed by the pediatric orthopedist.
- If the specialists strongly disagree, request that they consult directly with each other to reach a consensus diagnosis, or seek a third opinion from another pediatric orthopedist, to ensure the child receives the most accurate diagnosis and appropriate care.
From the Research
Interpreting Differences in Radiologist and Pediatric Orthopedic Specialist's Impressions
- When a radiologist and a pediatric orthopedic specialist interpret a child's ankle MRI differently, it can lead to confusion and uncertainty in diagnosis and treatment.
- In the case of a Salter-Harris 1 growth plate fracture, the radiologist's impression may be based on the appearance of the fracture on the MRI, which shows a fracture through the growth plate 2.
- However, the pediatric orthopedic specialist may have a different interpretation based on their expertise and evaluation of the child's symptoms and medical history.
Understanding Salter-Harris Classification
- The Salter-Harris classification is a system used to classify growth plate injuries, which aids in estimating both the prognosis and the potential for growth disturbance 2.
- The classification system includes five types of growth plate fractures:
- Type I: fracture through the growth plate
- Type II: fracture through the growth plate and metaphysis
- Type III: fracture through the growth plate and epiphysis
- Type IV: fracture through the growth plate, epiphysis, and metaphysis
- Type V: crush or compression injury of the growth plate
- A Type I Salter-Harris fracture, as diagnosed by the radiologist, indicates a fracture through the growth plate, which can be a relatively common injury in children 3.
Importance of Multidisciplinary Approach
- The difference in interpretation between the radiologist and pediatric orthopedic specialist highlights the importance of a multidisciplinary approach in managing complex injuries in children 3.
- A team of specialists, including radiologists, orthopedic specialists, and physical therapists, can work together to provide a comprehensive evaluation and treatment plan for the child.
- This approach can help ensure that the child receives the best possible care and outcomes, and can help prevent long-term complications associated with growth plate injuries.