Salter-Harris II Injury
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Now let's move on to Salter-Harris
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type 2 injury, also involving the ankle.
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This time we're looking at the injury to
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the tibia versus Salter-Harris type 1 injury we
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saw before that involved the distal fibula.
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Take a look at the plain radiograph first.
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I'm going to blow this up
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to make it a little bigger.
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Again, adjacent physes are your friend.
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This time it is the physis of the distal
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tibia which is wider, more irregular
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than the physis of the distal fibula.
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What else do you notice?
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You notice that there's a little
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bit of periosteal reaction extending
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up the metaphysis on the lateral side.
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What does that mean?
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That means that the injury involves
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not only your physis, but also your
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metaphysis, even if you don't see it.
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Okay, so that virtually guarantees you're
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looking at a Salter-Harris type II injury.
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And what does that look like on plain film?
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I'm sorry, on MRI?
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Here's the MRI on your right.
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This is a fat-suppressed,
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fluid-sensitive sequence.
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And look what you see here.
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Indeed, look at the physis
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here of the distal fibula.
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Look at the irregular enlarged
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physis of your distal tibia.
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And here is the injury extending into the
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metaphysis and causing subperiosteal fluid
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formation and elevation of that periosteum.
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So this is what you're looking at on
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your plain radiograph, equivalent to
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a Salter-Harris type II injury.
Mahesh Thapa, MD, MEd, FAAP
Division Chief of Musculoskeletal Imaging, and Director of Diagnostic Imaging Professor
Seattle Children's & University of Washington
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