Friday, 4 November 2022

Physeal bony bar MRI

History of trauma 5 years ago. Operated with nailing for fracture of distal end of radius. 
Now presented with swelling and pain in the region of ulnar styloid process. 

Multi planner multi echo MRI study has been performed. Sequences planned are sagittal, Coronal and Axial FSE T1W images, sagittal, Coronal and Axial FSE T2W images, sagittal, Coronal STIR images.
This MRI study of wrist joint with x-ray correlation shows:
Clinical marker on skin.
Under growth of distal end of radius relative to ulna due to bony physeal bar, leading to positive ulnar variance of measuring approximately 15 mm, partial distal radio ulnar subluxation, leading to increased prominence of ulnar styloid process.
Abnormal abrupt angulation of flexor carpi ulnaris tendon over the prominent ulnar styloid process leading to changes of tendinosis owing to ongoing friction in the flexor carpi ulnaris tendon against prominent ulnar styloid process.
The bony physeal bar is involving midportion of growth plate of distal radius. Total width of growth plate measuring approximately 32 mm on coronal with bony physeal bar measuring approximately 11 mm in width in the region of linear track with low signal intensity foci of previous intra medullary nailing for distal end of radius. Physeal bar is involving nearly 30% of the total growth plate. Radial one third and ulnar one third of the growth plate intact.
There is 11° radial tilt on coronal and 23° dorsal tilt on sagittal of distal articular surface of radius.
V-shaped” groove involving distal articular surface of radius, proximal partial herniation of proximal carpal row in the distal radial groove.
Dorsal tilt of lunate bone measuring approximately 40° with dorsal shift of capitate axis.
No signs of lunate avascular necrosis.
Bony physeal bar involving distal radius.