Physeal bar-Plain film & MRI

This is 7 yr old girl with unclear past history but had progressive genu on right side. X ray was done followed by MRI. The x ray showed linear metaphyseal and epiphyseal dense striations with a bony bridge across the right distal femoral growth plate.  This is a physeal bar and is seen to involve the lateral portion of metaphyses causing growth arrest and explaining the valgus. Similar striations were also seen in both proximal tibia.  MRI was done to evaluate the extent of the bar. It confirmed the findings and showed that <30% of the growth plate is involved. Case Submitted by Dr Prashant Gupta and Dr Himani Agarwal, Consultant Radiologists, Delhi

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LEARNING POINTS:

- Physeal bars are focal bony defects in growth plate that result in continuity of meta and epiphysis.

- Physeal bars occur either post infective(meningococcemia) or post traumatic(salter harris injury)

- Features that favor infective etiology - multiple sites, lesser involvement than post traumatic, associated epiphyseal irregularity, "flame shaped" striations on MRI.

- Management- if <30 % of physis- conservative, if between 30-50 % - excision with interposition of fat, >50%- require extensive surgery.