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DOI:10.2214/AJR.09.2353
AJR 2009; 193:W540-W545
© American Roentgen Ray Society

Clinical Observations

Posterior Periosteal Disruption in Salter-Harris Type II Fractures of the Distal Femur: Evidence for a Hyperextension Mechanism

Supika Kritsaneepaiboon1,2, Rajvee Shah1, Martha M. Murray3 and Paul K. Kleinman1

1 Department of Radiology, Section of Musculoskeletal Imaging, Children's Hospital Boston and Harvard Medical School, 300 Longwood Ave., Boston, MA 02115.
2 Present address: Department of Radiology, Prince of Songkla University, Hat Yai, Thailand.
3 Department of Orthopedic Surgery, Division of Sports Medicine, Children's Hospital Boston and Harvard Medical School, Boston, MA.

OBJECTIVE. Patterns of periosteal disruption are important factors in assessing the mechanism of injury of radiologically evident Salter-Harris (SH) fractures. The purpose of this study is to assess the frequency of posterior periosteal disruption on MRI in radiographically occult or subtle SH type II fractures of the distal femur and to evaluate associated soft-tissue findings that support a hyperextension mechanism of injury.

CONCLUSION. We found that all children in our experience with occult or subtle SH type II fractures of the distal femur have posterior periosteal disruption and other MRI findings to indicate a hyperextension mechanism of injury. Direct indicators of fracture may be inconspicuous, and the presence of posterior periosteal disruption is a clue that should prompt a search for other features of this serious pediatric injury, which may be followed by limb shortening or angular deformity.

Keywords: hyperextension knee injuries • periosteal disruption • Salter-Harris type II fracture


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