Role Of Ultrasound Imaging in Assessment of Growth Plate and Its Clinical Applications – A One Year Hospital Based Observational Study

Abstract

Introduction: The cartilaginous primary physis or growth plate is a critical component of the immature skeleton and is present at the end of long bones in children allowing for longitudinal bone growth. Plain radiography is currently the standard imaging choice for fractures in children but isolated physeal fractures are easily missed on radiographs making Ultrasound a potential modality in detecting such fractures. Objectives:1)To determine baseline measurements of physeal plate width and to assess variation in the measured widths among contralateral sides, age group and sex in the pediatric population. 2)Ultrasound assessment of physeal plate in normal uninjured children in order to detect any variations from the normal anatomy if present including physeal plate fracture, bridge and premature closure of the physis. Methodology: This is a hospital based observational study, conducted for a period of 1 year in children between 5 to 12 years referred for ultrasound imaging to the department of Radio-diagnosis, KLE’S Dr Prabhakar Kore Hospital. A total of 96 patients were included in this study. Children were subjected to B-Mode ultrasonography of distal end of long bones- radius, ulna, tibia and fibula using a 7.5–12 MHz high frequency linear array  transducer  on  GE VOLUSON machine (GE Healthcare, USA) and Philips HD-11Xe machine. Results: No significant statistical  difference could be elicitated in physeal plate width measurement in children of different gender and similar age group. The average physeal plate width found in distal end of fibula is 3.0 ± 0.22 mm with a mean difference of 0.11 ± 0.3 mm between contralateral sides. For tibia is 3.5 ± 0.28 mm with a mean difference of 0.1 0.31mm between contralateral sides. For radius is 2.88 ± 0.25 mm with a mean difference of 0.08 ± 0.31mm between contralateral sides. for ulna is

2.74 ± 0.24 mm with a mean difference of 0.1 ± 0.32 mm between contralateral sides. No statistical difference was  found in the physeal plate width between the contralateral sides for the long bones which were imaged in the study - radius, ulna, fibula or tibia. Conclusion: This study demonstrates that there is no statistically significant difference in physeal plate widths between contralateral extremities and between the two genders and age. The sonographic detection of significant disparities in physeal plate widths of injured children may have the potential for earlier detection of SH injuries with subsequent appropriate management.