Growth plate fractures of the distal tibia: is CT imaging necessary?

Comparison of conventional radiographs (CR) of distal tibial growth plate fractures [Salter–Harris (SH) fracture types I–V/triplane fractures I–III] with computed tomography (CT) as the reference standard and assessment of diagnostic benefit of CT imaging in the affected patients. We retrospectively evaluated all growth plate injuries of the distal tibia with complete pre-therapeutic imaging material (CR and CT including MPR) obtained between August 2001 and December 2006. The imaging material was randomised and presented to two radiologists. Fracture of metaphysis, epiphysis and epiphyseal line were noted separately for distal tibia. In case of fracture, involvement of the articular surface, articular dehiscence and ridge formation, subluxation and number of tibial fragments were evaluated. All fractures were classified as SH type I–V or triplane fractures type I–III. Sensitivity, specificity, positive and negative predictive value and overall accuracy of CR were compared to CT. Thirty-three patients (mean age 14 ± 2 years) were evaluated. CR showed significantly less tibial fragments as compared to CT (1.39 ± 0.75 vs. 1.61 ± 1.25; p = 0.023). The overall accuracy of CR was