Acute fracture of the distal tibial physis: role of gradient-echo MR imaging versus plain film examination

AJR. American Journal of Roentgenology
P PetitP Devred

Abstract

Recent reports indicate that, compared with MR imaging, plain film radiography often underestimates the extent of injury in children with physeal fracture-separation. Such underestimation may have significant therapeutic and prognostic outcomes. We performed this study to assess the benefit of MR imaging compared with plain film radiography in the diagnosis and immediate treatment of acute fractures of the distal tibial physis. Twenty-nine patients with acute fractures, including 15 Salter-Harris II, four Salter-Harris III, four Salter-Harris IV, and six triplane fractures, were prospectively examined by MR imaging with gradient-echo sequences. The MR images were compared with plain film radiographs. All cases were reviewed in a blind fashion by two experienced radiologists to determine the Salter-Harris classification on the basis of first plain film radiographs and then MR images. Two experienced pediatric surgeons were asked to propose treatment on the basis of first plain film radiographs and then MR images. Both the radiologists and the surgeons were asked to rate the two techniques in terms of degree of confidence and overall diagnostic effectiveness. Only 1 or 29 fractures (3%) was misclassified by plain film radiography...Continue Reading

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