An Unusual Case of Delayed Periosteum Physeal Interposition: Diagnosis and Surveillance by Imaging and its Role in Clinical Decision Making

One of the most serious complications of fractures involving the physis isfuture growth disturbance, resulting from transphyseal bar formation and/or premature physeal closure. An uncommon cause of bar formation is uncorrected interposition of soft tissue into the acutely fractured physis. We present the first case of delayed soft tissue interposition, which occurred following displacement across an initially nondisplaced fracture of the proximal tibia that was detected on serial radiographs and confirmed with magnetic resonance imaging (MRI).Although open surgical correction is recommended for acute interposition, our case was successfully managed with a combination of surveillance and guided-growth. This case illustrates the importance of serialsurveillanceandthe use of imaging to guide patient-centered care and achieveoptimal outcome.