MRI manifestations of Soft Tissue Injuries in Adolescent Distal Tibial Epiphyseal Fractures: A Retrospective Study

Objective: Distal tibial epiphyseal fractures represent common yet challenging physeal injuries in children and adolescents, with a substantial risk of growth disturbance and articular surface involvement. This study aimed to analyze the magnetic resonance imaging (MRI) characteristics and associated injury patterns of distal tibial epiphyseal fractures to enhance diagnostic precision and inform treatment strategies. Method: The clinical and MRI data of 40 patients with acute distal tibial epiphyseal fractures in adolescents were retrospectively analyzed. Upon admission, all patients underwent MRI examinations within 72 h (3.0T, including T1-, T2-, and STIR-weighted sequences). Fracture types were classified according to the Salter-Harris classification, and the soft tissue injuries such as ligaments and tendons were systematically evaluated. Result: The mean age of the patients was 12.4 years. According to the Salter–Harris classification, fractures were predominantly type II (8 cases), type III (10 cases), and type IV (22 cases). MRI findings showed that the anterior talofibular ligament (ATFL) was the most frequently injured structure, with an incidence of 77.5% (31/40). Tendon injuries, primarily involving the flexor hallucis longus and posterior tibialis tendons, were detected in 75.0% (30/40) of cases. Injuries to the tibial talus ligament (TTL) and interosseous membrane (IM) were observed in 15.0% (6/40) and 17.5% (7/40) of cases, respectively. Conclusion: Distal tibial epiphyseal fractures in adolescents are frequently accompanied by significant soft tissue injuries. MRI provides precise and comprehensive visualization of associated ligamentous and tendinous damage and is therefore recommended as an essential imaging modality for evaluating these fractures.