Magnetic resonance imaging in acute physeal injuries

Magnetic resonance imaging (MRI) permits noninvasive evaluation of the cartilage of the growth plate and epiphysis. This paper reports three cases where MRI was used to supplement conventional radiography in the assessment of acute physeal injuries. In the first patient, MRI was used for postoperative assessment of a radial neck fracture, avoiding further surgical exploration. In the second case, MRI was compared with ultrasonography in the diagnosis of proximal humeral epiphyseal separation in a neonate. In the third case MRI and computed tomography were compared in evaluation of a Salter-Harris type 4 distal femur fracture. In all cases MRI was diagnostic. MRI is the investigation of choice in acute complex physeal injuries, and is particularly appropriate for use prior to the appearance of the secondary ossification center.