0:00

Now here is the MR shoulder of

0:02

the plain radiographs I just

0:04

showed you on the last vignette.

0:06

I've brought only some selective sequences

0:08

down, uh, for illustrative purposes.

0:10

If you want to look at the entire series on

0:13

your own, they're available to you up here.

0:16

I've brought down a coronal T1-weighted

0:18

sequence and a coronal DESS sequence.

0:22

Again, remember that DESS, dual echo

0:23

steady state, is a gradient sequence.

0:26

So the trabeculae are black.

0:29

Uh, physis is usually white.

0:31

I'm going to concentrate mainly

0:33

on this sequence, which is, which

0:35

is the DESS right over here.

0:37

First of all, here's that little

0:39

piece of bone that we saw on the plain

0:40

radiograph that has fallen into the joint.

0:43

Uh, not quite sure where the donor

0:45

site is, maybe somewhere over here.

0:47

It's difficult to say, but it's important to

0:49

mention any loose bodies that we see, uh, and

0:52

where it is when we report this on the MRI.

0:55

Now look at the physis.

0:57

We suspected that there may have been

0:59

some widening at the very lateral

1:00

aspect of that physis and indeed,

1:02

there is some widening over here.

1:04

Uh, not so much over here.

1:06

And as we follow this, we notice that

1:08

there are sort of serpiginous areas of

1:11

darkness that traverse the metaphysis

1:14

from the region of the physis.

1:16

And here's one right over here,

1:18

and here's another one over here.

1:20

Let's go to the T1-weighted sequence.

1:22

All this area of darkness is marrow edema.

1:27

Marrow edema is sort of replacing the

1:28

normal white fatty structure, okay?

1:31

So as we look at this, again, we

1:32

notice the widening of the physis here.

1:34

We notice that there are some serpiginous

1:36

lines, edema extending into the metaphysis.

1:40

I think that can be better appreciated

1:42

on our gradient sequence over here.

1:46

So we indeed know that there

1:47

is a Salter-Harris injury.

1:49

The injury involves the lateral physis

1:51

and extends into the metaphysis.

1:54

So when we have a fracture involving

1:55

the physis and the metaphysis, it

1:58

is a Salter-Harris type 2 injury.