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Acute paediatric ankle trauma: MRI versus plain radiography.
M Lohman1, A Kivisaari, P Kallio
1Department of Radiology, Helsinki University Central Hospital, Finland.
Skeletal Radiology
|October 6, 2001
Summary
Plain radiographs are reliable for diagnosing acute physeal ankle fractures in children, with MRI confirming most findings. While some minor discrepancies exist, radiography remains the primary diagnostic tool for these injuries.
Area of Science:
- Pediatric Orthopedics
- Diagnostic Imaging
- Radiology
Background:
- Acute physeal ankle fractures are common in children.
- Accurate diagnosis is crucial for appropriate management and prognosis.
- Plain radiography is the initial imaging modality, but its accuracy for subtle fractures is debated.
Purpose of the Study:
- To evaluate the diagnostic accuracy of plain radiographs for acute physeal ankle fractures in children.
- To compare radiographic diagnoses with magnetic resonance imaging (MRI) findings, using MRI as the gold standard.
Main Methods:
- Sixty children with suspected ankle injuries underwent both plain radiography and MRI.
- Radiographic interpretations were compared with MRI findings by masked radiologists.
- Fracture diagnoses and Salter-Harris classifications from radiographs were assessed against MRI results.
Main Results:
- Plain radiography showed a 18% false-negative and 13% false-positive rate for fractures compared to MRI.
- Misclassifications included lateral ligament injuries mistaken for Salter-Harris type 1 fractures.
- Bone bruise patterns differed between ligament injuries and fractures, with specific locations noted on MRI.
Conclusions:
- Plain radiography has a low incidence of false negatives for physeal ankle fractures and does not miss complex fractures.
- The full extent of complex fractures may not always be apparent on radiographs.
- Despite discrepancies, routine MRI did not alter the management or prognosis in this series of mild ankle injuries, supporting radiography as the cornerstone of diagnosis.