Magnetic Resonance Imaging Findings of Periosteal Interposition in a Distal Tibial Salter-Harris Type I Fracture with Surgical Correlation: A Case Report

Abstract

The distal tibia is the second most common site of physeal fracture, followed by the distal radius (1). Salter-Harris (S-H) type I fracture has been considered as a low-grade physeal injury and usually needs conservative management with closed reduction and immobilization (2). However, although not commonly seen, soft tissue structures, including periosteum, tendons and ligaments, can be interposed in the physis, and it has been associated with subsequent growth disturbances and requires open surgical reductions to remove the entrapped structures (35). Particularly, interposed periosteum in the physis has been reported as the most common cause of failed closed reductions (3-5). Although irreducible fractures of the physis due to interposed soft tissues have been reported in the orthopedic literature, there are only a few reports concerning the preoperative magnetic resonance (MR) imaging diagnosis. We report MR imaging findings of distal tibial S-H type I fracture with periosteal interposition, which underwent open surgical reduction.