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Here is our 14-year-old

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boy who injured his knee.

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I showed you the radiograph before which

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suggested a Salter-Harris Type III injury that

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extended from the epiphysis, sort of separating

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the two condyles and entering the physis.

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Let's see how that looks on CT and on MRI.

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First of all, you're wondering maybe

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why did they get all three things?

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We got the X-ray that showed the

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injury with some comminution. CT is

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preferred by our orthopedic surgeons

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for surgical planning because multiple

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reconstructions can be made easily.

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They’re more comfortable with the bony

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anatomy and the 3D reconstructions

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I think really helped them.

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The MRI was obtained to look for additional

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injuries such as ligamentous and tendons. So with

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that out of the way, let’s see what we have.

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I’m showing you again the most salient sequences.

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You’re more than welcome to go up and look

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at any of the sequences that we have up here.

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For your viewing pleasure, we have

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plain films, CT, and MRI on this patient.

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Looking at the CT on the right, we have,

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again, that comminution here in the joint.

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Splitting of the condyles, the lateral

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medial condyles, with this vertically

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oriented fracture enters the physis

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probably somewhere around here.

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And look at this, the physis on the

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on this side, which is the—I have to orient

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myself again, see which is the lateral and which

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is the medial. So this lateral on this side.

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So here’s the medial side.

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Fracture extends to the medial physis,

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and that physis indeed is a little

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wider, isn’t it, on the other side.

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So we know there’s a physis injury, and there’s

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an injury of the physis that extends into

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the epiphysis, making it a Salter-Harris Type III.

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Had the fracture line also extended

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into the metaphysis, then it

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would have been a Salter-Harris Type IV.

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But this appears to be confined to the epiphysis and the physis.

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It looks like it’s confined to the epiphysis and the physis.

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Let’s jump over to the MRI, which basically

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shows very similar findings, but I think in many

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ways it gives us a little bit more information.

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It says that yes, we see the fracture

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line very well over here, and you can

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clearly follow. There is a widening

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of that space. It goes to the physis.

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The cartilage is indeed wider, uh, in many

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ways we can see that there is, uh,

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involvement of soft tissues around it.

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They’re very edematous.

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Look at the soft tissues here.

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Look at the soft tissues on this side.

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Um, if I were to be comprehensive in examining

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this, I would look at the ACL, the PCL, and the menisci.

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Collateral ligaments, make sure they’re intact.

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For the purposes of this vignette,

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however, this is a great example of a very

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classic Salter-Harris Type III injury.