Study: MRI may change ped ankle fracture diagnosis to sprain
MRI changed the diagnosis of 100 percent of children with a tentative diagnosis of Salter–Harris I fractures of the distal fibula (SH1DF) in a small prospective study published in the August issue of Injury.
In children, isolated lateral ankle injuries without radiograph-visible fractures are often diagnosed as SH1DF, explained Kathy Boutisa, MD, of the division of emergency medicine within the department of pediatrics at the Hospital for Sick Children and the University of Toronto and colleagues. The study authors sought to determine the rate of MRI-confirmed SH1DF among cases where the diagnosis was made based on clinical findings, as well as to detect the pathology in ankle injuries where there is no MRI evidence of SH1DF.
The researchers recruited 18 skeletally immature children between the ages of five and 12 with acute ankle injuries presenting with difficulty weight bearing and maximal tenderness and swelling over the distal fibular growth plate at the emergency department at the children’s hospital between September 2008 to August 2009.
Each patient underwent ankle radiographs during the initial emergency room visit and an MRI within one week of the injury, followed by repeat ankle radiographs at the four week follow-up mark. Each image was reviewed by two radiologists and an orthopedic surgeon, and any differences between reading physicians were resolved by consensus agreement, explained the authors.
Boutisa and colleagues found that none of the 18 patients showed evidence of SH1DF on MRI; however, patients often presented with more than one abnormal finding on MRI. Seventy-eight percent had evidence of ligamentous sprains, 61 percent had bony contusions, 6 percent had a subtle fibular avulsion fracture, and one patient was diagnosed with a minor articular cartilage injury.
At the four-week follow up, one patient's radiographs demonstrated a healing fracture, which corresponded with an avulsion fracture case. All patients had returned to full weight bearing by four weeks, wrote the authors.
“In this series, the clinical diagnosis of SH1DF was incorrect in 100 percent of cases. Instead, in almost 90 percent of these patients, MRI identified ligamentous sprains and/or bony contusions,” said Boutisa. The findings may influence the way children who present with this common clinical scenario are managed, as “the clinical diagnosis of SH1DF may often be a misnomer and may actually be extremely uncommon,” concluded the study.
In children, isolated lateral ankle injuries without radiograph-visible fractures are often diagnosed as SH1DF, explained Kathy Boutisa, MD, of the division of emergency medicine within the department of pediatrics at the Hospital for Sick Children and the University of Toronto and colleagues. The study authors sought to determine the rate of MRI-confirmed SH1DF among cases where the diagnosis was made based on clinical findings, as well as to detect the pathology in ankle injuries where there is no MRI evidence of SH1DF.
The researchers recruited 18 skeletally immature children between the ages of five and 12 with acute ankle injuries presenting with difficulty weight bearing and maximal tenderness and swelling over the distal fibular growth plate at the emergency department at the children’s hospital between September 2008 to August 2009.
Each patient underwent ankle radiographs during the initial emergency room visit and an MRI within one week of the injury, followed by repeat ankle radiographs at the four week follow-up mark. Each image was reviewed by two radiologists and an orthopedic surgeon, and any differences between reading physicians were resolved by consensus agreement, explained the authors.
Boutisa and colleagues found that none of the 18 patients showed evidence of SH1DF on MRI; however, patients often presented with more than one abnormal finding on MRI. Seventy-eight percent had evidence of ligamentous sprains, 61 percent had bony contusions, 6 percent had a subtle fibular avulsion fracture, and one patient was diagnosed with a minor articular cartilage injury.
At the four-week follow up, one patient's radiographs demonstrated a healing fracture, which corresponded with an avulsion fracture case. All patients had returned to full weight bearing by four weeks, wrote the authors.
“In this series, the clinical diagnosis of SH1DF was incorrect in 100 percent of cases. Instead, in almost 90 percent of these patients, MRI identified ligamentous sprains and/or bony contusions,” said Boutisa. The findings may influence the way children who present with this common clinical scenario are managed, as “the clinical diagnosis of SH1DF may often be a misnomer and may actually be extremely uncommon,” concluded the study.