From the Guidelines
A pediatric orthopedic surgeon is generally better at interpreting growth plate fractures versus bone bruises on MRI. While both specialists have valuable expertise, orthopedic surgeons specialize in the musculoskeletal system and have extensive training in fracture management, particularly in the developing skeletal system of children 1. They regularly treat growth plate injuries and understand their clinical implications, potential complications, and treatment options.
Key Points to Consider
- Orthopedic surgeons have extensive training in fracture management, particularly in the developing skeletal system of children
- Radiologists have excellent training in image interpretation but may not have the same depth of clinical experience with pediatric fracture management
- The orthopedic surgeon combines imaging findings with clinical examination, patient history, and knowledge of growth plate injury patterns to make treatment decisions
Clinical Implications
In practice, the best approach often involves collaboration between both specialists, with the radiologist providing detailed image analysis and the orthopedic surgeon integrating these findings into a comprehensive treatment plan 1. This collaborative approach ensures accurate diagnosis and appropriate management of pediatric growth plate injuries.
Additional Considerations
- Pediatric orthopedic surgeons have completed a residency in orthopedics and completed an additional Accreditation Council for Graduate Medical Education–approved 1-year fellowship in pediatric orthopedics, making them highly specialized in treating pediatric musculoskeletal conditions 1
- The age group definitions used in the study, infant (0–1 year), child (2–12 years), and adolescent (13–18 years), are important to consider when evaluating growth plate injuries and development 1
From the Research
Comparison of Paediatrics Orthopaedics Surgeon and Radiologist
- Both paediatrics orthopaedics surgeons and radiologists play crucial roles in interpreting growth plate fractures and bone bruises on MRI, but their expertise and approaches may differ.
- Paediatrics orthopaedics surgeons, such as those discussed in 2, often focus on the treatment and management of growth plate fractures, with a deep understanding of the Salter-Harris classification and its implications for patient outcomes.
- Radiologists, on the other hand, are trained to interpret imaging studies, including MRI, and may be more familiar with the subtleties of growth plate injury and bone bruise diagnosis, as seen in 3, 4, and 5.
Diagnostic Accuracy
- Studies have shown that MRI can be a valuable tool in evaluating growth plate injuries, allowing for the detection of occult fractures and altering Salter-Harris staging, as noted in 3 and 4.
- MRI can also provide useful information on the appearance of the growth plate and changes in the metaphysis, affecting the prognosis and results of surgical procedures, as discussed in 5.
- However, the accuracy of MRI interpretation may depend on the expertise of the reader, whether a radiologist or an orthopaedics surgeon.
Role of MRI in Diagnosis
- MRI has been shown to be effective in diagnosing growth plate injuries and bone bruises, particularly in cases where conventional radiographs are unclear or inconclusive, as seen in 3 and 6.
- The use of MRI can lead to changes in patient management, including alterations in treatment plans and prognostic expectations, as noted in 3 and 5.
Expertise and Collaboration
- Ultimately, the interpretation of growth plate fractures and bone bruises on MRI may benefit from collaboration between paediatrics orthopaedics surgeons and radiologists, combining their respective expertise to provide accurate diagnoses and effective treatment plans, as informed by studies such as 2, 3, 4, 5, and 6.