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Skeletal Radiology

, Volume 44, Issue 10, pp 1547–1551 | Cite as

Imaging appearance of entrapped periosteum within a distal femoral Salter-Harris II fracture

  • Johnathan Chen
  • Mark F. Abel
  • Michael G. FoxEmail author
Case Report

Abstract

Salter Harris II fractures of the distal femur are associated with a high incidence of complications, especially premature physeal closure. Many risk factors for this high rate of premature physeal closure have been proposed. More recently, entrapment of periosteum within the physis has been suggested as an additional predisposing factor for premature physeal closure. The radiographic diagnosis of entrapped soft tissues, including periosteum, can be suggested in the setting of a Salter-Harris II fracture when the fracture does not reduce and physeal widening >3 mm remains. We report a patient who sustained a distal femoral Salter-Harris II fracture following a valgus injury. The patient had persistent distal medial physeal widening >5 mm following attempted reduction. A subsequent MRI revealed a torn periosteum entrapped within the distal femoral physis. Following removal of the periosteum, the patient developed a leg length discrepancy which required physiodesis of the contralateral distal femur. We present this case to raise awareness of the importance of having a high index of suspicion of periosteal entrapment in the setting of Salter-Harris II fractures since most consider entrapped periosteum an indication for surgery.

Keywords

Femoral fractures Periosteum Growth plate MRI Leg length inequality 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© ISS 2015

Authors and Affiliations

  • Johnathan Chen
    • 1
    • 3
  • Mark F. Abel
    • 2
  • Michael G. Fox
    • 1
    Email author
  1. 1.Department of Radiology and Medical ImagingUniversity of VirginiaCharlottesvilleUSA
  2. 2.Department of OrthopedicsUniversity of VirginiaCharlottesvilleUSA
  3. 3.Department of RadiologyChildren’s Hospital of Los AngelesLos AngelesUSA

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