MR of physeal fractures of the adolescent knee

The aim of this study was to assess physeal fractures of the pediatric knee identified by MR imaging and to describe the MR findings of such fractures . The authors reviewed 315 consecutive pediatric knee MR examinations done to assess for traumatic injury. The MR images were reviewed for evidence of physeal fracture. Fractures were classified by the Salter-Harris system, a nd associated findings and injuries were noted. Plain radiographs and medic al records were reviewed. Seven distal femoral physeal fractures (Salter II , n = 6; Salter III, n = 1) and two proximal tibia physeal fractures (Salte r III, n = 1; complex Salter IV, n = 1) were identified. Magnetic resonance demonstrated widening of a portion of the physis with visualization of a m etaphyseal/epiphyseal fracture line. Periosteal elevation was observed in s ix cases. Four patients had associated ligamentous or meniscal injuries. Pl ain radiographs were available for review in eight patients. Bone abnormali ties suggesting fracture were evident in six of eight patients; however the fracture was fully delineated in only one patient. The diagnosis or confir mation of fracture by MR changed clinical management in seven of eight pati ents in whom follow-up was available. Physeal fractures of the pediatric kn ee are occasionally diagnosed by MR. Magnetic resonance provides improved d elineation of non-displaced physeal fractures of the knee, while simultaneo usly allowing for evaluation of soft tissue structures.