ORIGINAL RESEARCH article
Front. Sports Act. Living
Sec. Injury Prevention and Rehabilitation
This article is part of the Research TopicLateral Ankle Sprain, Chronic Ankle Instability and Ankle Osteoarthritis: Unraveling Mechanisms and Exploring Management ApproachesView all 17 articles
MRI Identification of anatomical distribution of periosteal entrapment and its clinical outcomes in Pediatric Distal Tibial Salter-Harris Type II Fractures
Provisionally accepted
- 1Honghui Hospital, Xi'an, China
- 2Yan'an University, Yan'an, China
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Objective: This study aimed to characterize the spatial distribution and imaging features of periosteal entrapment in pediatric distal tibial Salter-Harris (S-H) type II fractures using magnetic resonance imaging (MRI) and to evaluate its clinical outcomes. Methods: This retrospective study analyzed 20 cases of distal tibial S-H type II fractures between 2015 and 2024. All patients underwent post-injury MRI examinations (including T1-weighted, T2-weighted, and proton density-weighted imaging sequences). The precise location of periosteal entrapment was recorded and mapped to the four quadrants of the epiphysis. All patients were divided into three groups according to the treatment method: the conservative treatment group, the closed reduction and percutaneous fixation (CR-PF) group, and the open reduction and internal fixation (ORIF) group. Outcomes evaluated included fracture healing, growth disturbances (including bone bridge formation, angular deformity, and limb-length discrepancy), and the American Orthopaedic Foot and Ankle Society (AOFAS) score at the final follow-up (≥6 months). Results: A total of 20 patients (16 boys and 4 girls) with an average age of 10.65±2.41 years (range: 2-13 years) were included in this study, and the mean follow-up period was 22.53 months. Post-injury MRI showed periosteal entrapment in all patients, with the anterolateral quadrant being the main entrapment site (15/20, 75%). During the follow-up period, 2 patients developed growth disturbances: one patient who underwent ORIF showed a bone bridge formation on imaging, while the other patient who received CR-PF presented with ankle varus deformity without evidence of bone bridge formation. At the final follow-up, the assessment of AOFAS scores revealed no significant difference in functional outcomes among the three groups (P=0.951). Conclusion: Distal tibial S-H type II physeal fractures are at high risk of concomitant periosteal entrapment, which is localized predominantly to the anterolateral corner of the distal tibial physis. Conservative management, CR-PF, and ORIF resulted in comparable functional outcomes without significantly increasing the risk of growth disturbances, indicating that residual entrapped periosteum may not adversely affect fracture healing or long-term prognosis.
Keywords: Distal tibia, Growth disturbance, MRI, periosteal entrapment, Physeal fractures
Received: 03 Nov 2025; Accepted: 05 Dec 2025.
Copyright: © 2025 Zhang, Wang, Yang, Tong, Dong and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Bing Wang
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