From the Guidelines
Radiologists may misdiagnose a Salter-Harris type I lateral fracture on MRI due to the subtle nature of these fractures, variable appearance of the physis, and lack of a visible fracture line, as well as limitations in detecting edema and differentiating it from other conditions. The normal appearance of the physis can be variable with areas of increased signal intensity that may mimic fracture edema 1. Additionally, the complex anatomy of growth plates, particularly in areas like the ankle or wrist, can create interpretation difficulties. Misdiagnosis may also occur when there is minimal displacement or when edema is the only finding without a visible fracture line. Patient movement during imaging can further blur subtle findings.
Key Challenges in Diagnosing Salter-Harris Type I Fractures on MRI
- Subtle nature of the fractures, making them difficult to detect
- Variable appearance of the physis, which can mimic fracture edema
- Lack of a visible fracture line, making diagnosis reliant on edema and other indirect signs
- Limitations in detecting edema and differentiating it from other conditions, such as stress reactions or tumors
- Complex anatomy of growth plates, particularly in areas like the ankle or wrist
- Patient movement during imaging, which can blur subtle findings To improve diagnosis, correlation with clinical findings, comparison with the contralateral uninjured side, and follow-up imaging when symptoms persist despite negative initial findings are recommended approaches 1. Radiologists with less pediatric musculoskeletal experience might not be as familiar with the normal developmental variations of growth plates across different ages, highlighting the need for specialized training and expertise in pediatric musculoskeletal imaging.
From the Research
Radiologist Misdiagnosis of Salter Harris 1 Lateral Fracture on MRI
- Radiologists may misdiagnose a Salter Harris 1 lateral fracture on MRI due to various reasons, including the similarity in symptoms between Salter Harris 1 fractures and other injuries such as ligamentous sprains and bony contusions 2.
- A study found that in 18 patients with suspected Salter Harris 1 fractures of the distal fibula, none had evidence of fibular growth plate injury on MRI, while 78% had evidence of ligamentous sprains and 61% had bony contusions 2.
- The clinical diagnosis of Salter Harris 1 fracture was incorrect in 100% of cases, highlighting the importance of MRI in accurately diagnosing these injuries 2.
- Other studies have reported cases of Salter Harris fractures, including a type 1 Salter-Harris fracture of the proximal humerus in an adolescent gymnast, diagnosed using radiographs and MRI 3.
- The use of ultrasound as a diagnostic tool for Salter-Harris type 1 fractures has also been explored, with some studies suggesting that it may allow visualization of these fractures, but its sensitivity and specificity are not well established 4.
- In complex cases, such as a type 1 Salter-Harris fracture with lipohemarthrosis and concomitant grade II anterior cruciate ligament (ACL) tear, MRI can play a crucial role in diagnosis and management, highlighting the importance of a multidisciplinary approach in managing these injuries 5.