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Salter-Harris 2 in the Shoulder

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Now here is the MR shoulder of

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the plain radiographs I just

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showed you on the last vignette.

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I've brought only some selective sequences

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down, uh, for illustrative purposes.

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If you want to look at the entire series on

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your own, they're available to you up here.

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I've brought down a coronal T1-weighted

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sequence and a coronal DESS sequence.

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Again, remember that DESS, dual echo

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steady state, is a gradient sequence.

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So the trabeculae are black.

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Uh, physis is usually white.

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I'm going to concentrate mainly

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on this sequence, which is, which

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is the DESS right over here.

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First of all, here's that little

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piece of bone that we saw on the plain

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radiograph that has fallen into the joint.

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Uh, not quite sure where the donor

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site is, maybe somewhere over here.

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It's difficult to say, but it's important to

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mention any loose bodies that we see, uh, and

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where it is when we report this on the MRI.

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Now look at the physis.

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We suspected that there may have been

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some widening at the very lateral

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aspect of that physis and indeed,

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there is some widening over here.

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Uh, not so much over here.

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And as we follow this, we notice that

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there are sort of serpiginous areas of

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darkness that traverse the metaphysis

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from the region of the physis.

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And here's one right over here,

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and here's another one over here.

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Let's go to the T1-weighted sequence.

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All this area of darkness is marrow edema.

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Marrow edema is sort of replacing the

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normal white fatty structure, okay?

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So as we look at this, again, we

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notice the widening of the physis here.

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We notice that there are some serpiginous

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lines, edema extending into the metaphysis.

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I think that can be better appreciated

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on our gradient sequence over here.

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So we indeed know that there

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is a Salter-Harris injury.

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The injury involves the lateral physis

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and extends into the metaphysis.

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So when we have a fracture involving

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the physis and the metaphysis, it

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is a Salter-Harris type 2 injury.

Report

Faculty

Mahesh Thapa, MD, MEd, FAAP

Division Chief of Musculoskeletal Imaging, and Director of Diagnostic Imaging Professor

Seattle Children's & University of Washington

Tags

Trauma

Pediatrics

Musculoskeletal (MSK)

MRI

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