Magnetic resonance imaging of the proximal tibial epiphysis is suitable for statements as to the question of majority: a validation study in forensic age diagnostics

Determining majority plays a key role for forensic age diagnostics in living individuals. Recent data suggest that magnetic resonance imaging (MRI) of the proximal tibial epiphysis (PTE) may be a suitable alternative or at least an additional tool to clarify whether an individual has reached majority. However, the reference data situation is still sparse. Hence, the present dual center study retrospectively analyzed routine MRI of the knee in 413 cases (214 males and 199 females) of a Western Caucasian population aged between 12 and 25 years. MRI was performed at 1.5 and 3.0 T clinical scanners using T1- and T2-weighted sequences. The classification system by Vieth et al. (Eur Radiol 2018; 28:3255–3262) was applied for determining the ossification stages of the PTE. Intra-observer agreement was “very good” (κ = 0.931), and inter-observer agreement was “good” (κ = 0.798). Minimum ages above the age of 18 years were observed with the final stage (stage 6) in either sex (20.27 years in males and 18.55 years in females). The results are not in contradiction with the previous data and can be considered a strong and valuable support of the so far existing database. Therefore, the investigation of the PTE using routine MRI (either at 1.5 or 3.0 T) could be taken into consideration for application in forensic age estimation practice in near future.

Lower tibial shaft spiral fracture concurrent with distal tibial triplane fracture

Background: The clinical and imaging features of lower tibial shaft spiral fracture, concurrent with distal tibial triplane fracture, are not clear. Introduction: Consequently, this study was aimed to investigate these features for correct diagnosis, treatment, and prevention of possible premature physeal arrest or angular deformation. Method: Patients with lower tibial shaft spiral fracture concurrent with distal tibial triplane fracture were enrolled, and the clinical, imaging, treatment, and follow-up data were analyzed. Result: Five patients with lower tibial shaft spiral fracture concurrent with distal tibial triplane fracture were found, including four men and one woman with an age range of 12-15 years (mean 13.6). Injury to the distal tibial epiphysis was missed in the diagnosis in plain radiography reports, but careful reevaluation confirmed distal tibial epiphysis fracture in four cases, including Salter-Harris type II in three cases and type III in one case. The remaining case had no apparent distal tibial epiphysis injury in the plain radiograph. CT scan revealed that all five patients had distal tibial triplane fracture of the lateral type, including two fragments in three cases and three fragments in two cases. The fracture was divided into type I(within the articular weight-bearing line) in three cases, type II (outside the articular weight-bearing line) in two cases that were based on the involvement of the articular surface by the fracture line. For the lower tibial fracture, one patient was treated with closed reduction and fixation with an elastic nail, three patients had internal plate fixation, and the remaining patient had cast immobilization. Having followed up for 3-11 months (mean 7), all the distal tibial fractures and the triplane fractures were healed without varus or valgus deformity in the ankle. Conclusion : Distal tibial triplane fracture can be readily missed in plain radiography and should be suspected in patients with distal tibial spiral fracture, which should be evaluated with a computed tomographic scan.

Evaluation of surgical outcomes for fracture of the proximal tibial epiphysis

This work is based on a clinical and laboratory study of 121 patients who had surgery for fractures of the proximal tibia. The observation was carried out in the period after the operation from 3 months to 9 months from 2012 to 2019 in the Republican Specialized Scientific and Practical Medical Center and in the clinic of the National Center for Rehabilitation and Prosthetics of Disabled. Results of a comprehensive study are presented: clinical (orthopedic, neurological), radiological, MSCT, as well as physiological (electromyography) examinations. Clear indicators have been developed to assess the effectiveness of the surgery for fractures of the proximal tibia, as well as the duration of recovery after the surgery.