Purpose or Case Report: The overall incidence of birth trauma ranges from 2-3%, with the large majority consisting of superficial soft tissue injury. Musculoskeletal birth trauma tends to occur most commonly around the shoulder, with clavicle and brachial plexus injuries representing the majority of MSK trauma. Perinatal long bone fractures are quite rare, with most affecting the humeral/femoral diaphysis. Physeal fractures represent an even more uncommon entity and can be radiographically occult due to non-ossification of the epiphysis in neonates. In our educational poster, we present a variety of perinatal fractures of the physis which were initially occult on radiograph, but became evident on further workup with MR.
Methods & Materials: Several perinatal physeal fractures will be displayed, each with associated plain radiograph and MR images. Suspected mechanism of injury and subsequent operative management will also be presented.
Results: Each case presented initially on radiograph without overt fracture, but with suspected joint malalignment or periarticular soft tissue abnormalities. Upon further workup with MR, displaced physeal fractures were revealed, three of which occurred in the distal humeral physis and one which occurred in the distal femoral physis (an uncommon location).
Conclusions: Neonatal physeal fractures carry a high morbidity and are often occult on plain radiograph due to epiphyseal non-ossification. Radiologists should maintain a low threshold for MR imaging in patients who have clinical signs of fracture, joint malalignment, or periarticular soft tissue abnormalities on radiograph.