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E2333. “Crisis of the Physis”: Pre- and Post-Operative Imaging Assessment of Physeal Pathologies
Authors
  1. Alagiri Karikalan; Ganga Medical Centre and Hospital
  2. Pushpa Bahari; Ganga Medical Centre and Hospital
  3. Sabari Ramesh; Ganga Medical Centre and Hospital
  4. Rajarama Ravivarma N; Ganga Medical Centre and Hospital
  5. Venkata Kuna; Ganga Medical Centre and Hospital
Background
Physis or primary growth plate is an important component of an immature skeleton. Any disorder causing impairment or dysfunction of this structure during earlier stages of life can result in prolonged morbidity. The causes of physeal injuries can be divided into direct and indirect injury types. Early recognition of these disorders is crucial because, if not diagnosed and treated at the appropriate time they may result in altered biomechanics of the joint.

Educational Goals / Teaching Points
To familiarize the reader to spectrum of growth plate pathologies. To emphasize the importance of multimodality imaging approach in assessing growth plate pathologies. To describe the clinically relevant features in pre and postoperative evaluation of physeal disorders. To impart confidence to the reader while reporting physeal pathologies.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Plain radiographs are the first line imaging modality in both acute and chronic settings and also used for postoperative follow-up due to their availability and cost-effectiveness. They are used to assess healing, malalignment and growth disturbances. However, their utility is limited to evaluation of osseous structures as they cannot accurately assess radiolucent cartilages and physeal complex. On the other hand, cross-sectional imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) provide more detailed picture of the physis than radiography. CT can depict the extent and location of an osseous physeal bar however, fibrous scar and non-calcified cartilage cannot be assessed due to their low attenuation. Due to its multiplanar reconstruction capability CT has an advantage for assessing complex anatomy of the osseous bar. The use of CT is mainly limited by its high radiation dose. The role of MR imaging in evaluating physeal abnormalities has been well established. MR imaging offers high soft tissue contrast, spatial resolution, multiplanar imaging aiding in detailed evaluation of osseous structures as well as physeal and articular cartilages without using ionizing radiation. In addition, MRI provides the most relevant clinical information such as morphology, location and size of the physeal injury. Drawbacks of MRI include high cost, limited-availability, may require sedation and is more prone for metal susceptibility artefacts in postoperative patients.

Conclusion
Physeal injury can lead to growth disturbances with characteristic imaging appearances. Imaging plays a crucial role in the management of pediatric patients with physeal pathologies and a multimodality imaging approach is essential. MRI is superior for assessing the physis as it offers valuable information without the risk of radiation exposure. The radiologist should be familiar with the imaging findings and provide the clinician with most relevant clinical information which is pivotal in preoperative planning and management.