Pediatric Radiology

, Volume 41, Issue 12, pp 1591–1594 | Cite as

MRI diagnosis of trapped periosteum following incomplete closed reduction of distal tibial Salter-Harris II fracture

  • Subha Raman
  • E. Christine WallaceEmail author
Case Report


Irreducible fracture of the distal tibial physis due to interposed soft tissue including periosteum is well documented in the orthopedic literature but is uncommon. This condition has been associated with subsequent growth disturbance and requires open reduction. There are very few prior reports of MRI depiction of soft tissue interposition and none of periosteal interposition in the distal tibial physis. This is a relatively common location of physeal injury and related growth disturbance. We present a case of periosteum trapped in the distal tibial physis, diagnosed on MRI, in a Salter-Harris II fracture and its management implications.


Distal tibial physeal injury Periosteal interposition Trapped periosteum Irreducible physeal fracture 


  1. 1.
    Ecklund K, Jaramillo D (2001) Imaging of growth disturbance in children. Radiol Clin North Am 39:823–841PubMedCrossRefGoogle Scholar
  2. 2.
    Barmada A, Gaynor T, Mubarak SJ (2003) Premature physeal closure following distal tibia physeal fractures: a new radiographic predictor. J Pediatr Orthop 23:733–739PubMedCrossRefGoogle Scholar
  3. 3.
    Phieffer LS, Meyer RA Jr, Gruber HE et al (2000) Effect of interposed periosteum in an animal physeal fracture model. Clin Orthop 376:15–25PubMedCrossRefGoogle Scholar
  4. 4.
    Leary JT, Handling M, Talerico M et al (2009) Physeal fractures of the distal tibia—predictive factors of premature physeal closure and growth arrest. J Pediatr Orthop 29:356–361PubMedCrossRefGoogle Scholar
  5. 5.
    McAnally JL, Eberhardt SC, Mlady GW et al (2008) Medial collateral ligament tear entrapped within a proximal tibial physeal separation: imaging findings and operative reduction. Skeletal Radiol 37:943–946PubMedCrossRefGoogle Scholar
  6. 6.
    Whan A, Breidahl W, Janes G (2003) MRI of trapped periosteum in a proximal tibial physeal injury of a pediatric patient. AJR 181:1397–1399PubMedGoogle Scholar
  7. 7.
    Grace DL (1983) Irreducible fracture-separations of the distal tibial epiphysis. J Bone Joint Surg Br 65:160–162PubMedGoogle Scholar
  8. 8.
    Peterson HA (2007) Anatomy and growth. In: Peterson HA (ed) Epiphyseal growth plate fractures, 1st edn. Springer, Berlin Heidelberg New York, pp 7–19Google Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Department of RadiologyUniversity of Massachusetts Memorial Medical Center, University of Massachusetts Medical SchoolWorcesterUSA
  2. 2.Division of Pediatric RadiologyUMass Memorial Medical CenterWorcesterUSA

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