Patterns of Premature Physeal Arrest
MR Imaging of 111 Children
Kirsten Ecklund1 and
Diego Jaramillo2
1
Department of Radiology, Children's Hospital, Harvard Medical School, 300
Longwood Ave., Boston, MA 02115.
2
Department of Radiology, Massachusetts General Hospital, Harvard Medical
School, 10 Fruit St., Boston, MA 02215.
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Fig. 1A. —Large, central distal femoral physeal bridge in 13-year-old
boy 6 months after Salter-Harris type 2 fracture. Coronal T1-weighted MR image
(TR/TE, 300/14) shows high-signal-intensity bridge (arrows) that is
isointense to fatty marrow.
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Fig. 1B. —Large, central distal femoral physeal bridge in 13-year-old
boy 6 months after Salter-Harris type 2 fracture. Coronal fat-suppressed
three-dimensional (3D) spoiled gradient-recalled echo MR image (21/2; flip
angle, 30°) shows central bridge (open arrow) as
low-signal-intensity interruption in normally high-signal-intensity physeal
cartilage (solid arrows).
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Fig. 1C. —Large, central distal femoral physeal bridge in 13-year-old
boy 6 months after Salter-Harris type 2 fracture. Reformatted coronal
fat-suppressed 3D spoiled gradient-recalled echo MR image from data set in
B. Lines indicate 10-mm strip of juxtaphyseal area that is isolated to
obtain maximum intensity projection shown in D.
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Fig. 1D. —Large, central distal femoral physeal bridge in 13-year-old
boy 6 months after Salter-Harris type 2 fracture. Axial
maximum-intensity-projection physeal map derived from C shows
predominately high-signal-intensity physeal area (outer trace) and
low-signal-intensity bridge area (inner trace). This bridge comprised 55% of
physeal area that is too large for resection. This patient underwent
contralateral epiphysiodesis to prevent further leg length discrepancy.
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Fig. 2. —Physeal quadrant diagram. Each bone bridge was assigned to
one or more physeal sections. 1 = center of physis, 2 = anterolateral physis,
3 = anteromedial physis, 4 = posterolateral physis, 5 = posteromedial
physis.
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Fig. 3A. —14-year-old boy with small, peripheral distal tibial physeal
bridge 1 year after Salter-Harris type 2 fracture. Anterior—posterior
radiograph shows sclerosis and premature fusion of medial distal tibial physis
(solid arrow) with angular deformity. Growth recovery line (open
arrows) and physis (arrowheads) converge at bridge.
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Fig. 3B. —14-year-old boy with small, peripheral distal tibial physeal
bridge 1 year after Salter-Harris type 2 fracture. Coronal T1-weighted MR
image (TR/TE, 300/14) shows low-signal-intensity medial physeal bridge
(white arrow). Linear low-signal-intensity growth recovery line
(black arrows) is tethered at bridge and shows differential growth
between medial and lateral physis (arrowheads) since time of
injury.
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Fig. 3C. —14-year-old boy with small, peripheral distal tibial physeal
bridge 1 year after Salter-Harris type 2 fracture. Coronal fat-suppressed
three-dimensional spoiled gradient-recalled echo MR image (21/2; flip angle,
30°) clearly shows peripheral bridge (arrow) as
low-signal-intensity obliteration of normally high-signal-intensity physeal
cartilage.
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Fig. 3D. —14-year-old boy with small, peripheral distal tibial physeal
bridge 1 year after Salter-Harris type 2 fracture. Axial
maximum-intensity-projection MR image of physis derived from data set in
C shows predominately high-signal-intensity physis (outer trace) and
low-signal-intensity anteromedial bridge (inner trace) that involves Kump's
bump. This bridge involved 19% of physeal area and was resected with
resumption of growth and correction of angular deformity. Low-signal-intensity
ridges in normal portions of physis probably represent small mamillary
undulations and are not likely to be confused with bridges.
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Fig. 4. —13-year-old boy with distal tibial physeal bridge 6 months
after Salter-Harris type 4 fracture. Sagittal fat-suppressed fast spin-echo
proton density-weighted MR image (TR/TE, 2,000/14) shows several sites
(arrows) of metaphyseal high signal intensity consistent with
cartilage extensions. Associated physeal bridge is suggested as area
(arrowheads) of physeal narrowing and diminished signal intensity.
Fat-suppressed three-dimensional spoiled gradient-recalled echo images (not
shown) showed clear bone bridge. Higher signal intensity linear focus noted
more superiorly in metadiaphysis is related to healing fracture line.
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Fig. 5. —12-year-old boy 5 months after distal tibial Salter-Harris
type 2 fracture. Coronal T1-weighted MR image (TR/TE, 300/14) reveals lateral
triangular-shaped area of peripheral low-signal-intensity sclerosis (black
arrows) and central high-signal-intensity fatty marrow (white
arrows) that corresponded to Thurston Holland metaphyseal fragment at
time of fracture. This is typical appearance of avascular necrosis in
devascularized metaphyseal fracture fragment. Large bridge involving entire
medial physis was shown on gradient-recalled echo images (not shown).
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Copyright © 2002 by the American Roentgen Ray Society.
