Best Practice Case Studies-Distal radius fracture

Video Transcription

Hi, this is Sagar Wagle, one of the musculoskeletal radiology fellows at Stanford University.  We have a 14 year old high school football player with left wrist injury during a football game.  In this zoomed-in lateral radiograph of the wrist, this is distal radius,  this is distal ulna, we can see that the epiphysis of the distal radius has shifted posteriorly.  This oblique lucency going through the metaphysis indicates a fracture, so in this case the fracture  goes through the metaphysis and out through the physis and this fracture fragment has dislocated  slightly posteriorly. Growth plate, also called a physis, is the weakest point in a pediatric skeleton. Physial fractures are classified according to Salter-Harris classification.  In type 1, the fracture goes through the physis. In type 2, the fracture goes through the physis  out through metaphysis. In type 3, the fracture goes through the physis out through epiphysis.  And in type 4, the fracture goes through both metaphysis and epiphysis. This can be remembered  with the mnemonic SALT, which corresponds to type 1, type 2, type 3, and type 4 Salter-Harris fractures. S indicating the fracture going through the physis, A fracture going above  through the metaphysis, L for fracture going lower through epiphysis, and T representing fracture going through both metaphysis and epiphysis. So this is our original radiograph  and this is post-reduction radiograph and we can see that the displaced fracture fragment  has come slightly more anteriorly and there's improved alignment. This is two weeks follow-up,  this is four weeks follow-up, and in four weeks follow-up we can see some periosteal reaction.  This is six weeks follow-up and this is seven weeks follow-up and here too we can see some  periosteal reaction and some callus formation anteriorly. So this is our pre-reduction radiograph  and this is our radiograph at seven weeks. If there is high clinical suspicion for fracture and radiographs are negative, CT and MRI can both be considered. MRI has the highest  sensitivity for fracture, however it could be challenging to get MRI on time so CT is also a good alternative. Thank you for watching the video.

Video Summary

A 14-year-old football player sustained a wrist injury. The lateral radiograph revealed a Salter-Harris type 2 fracture of the distal radius, with the epiphysis shifted posteriorly and a fracture through the metaphysis. After reduction, follow-up radiographs over seven weeks showed improved alignment and healing with periosteal reaction and callus formation. If clinical suspicion for fracture exists but radiographs are negative, CT or MRI can be considered, with MRI offering higher sensitivity though posing potential delay challenges.

Meta Tag

Edition 3rd Edition

Related Case 3rd Edition, CASE 46

Topic Pediatric Issues

Keywords

3rd Edition, CASE 46

3rd Edition

Pediatric Issues

Salter-Harris type 2

distal radius fracture

wrist injury

MRI sensitivity

periosteal reaction