Enhancing the detection of paediatric ankle fractures with zero echo time imaging: A case of an occult salter-harris III ankle fracture.

Paediatric fractures are common in emergency settings, with accurate diagnosis crucial in preventing complications like malunion and early osteoarthritis. Computed Tomography (CT) is often the standard for fracture assessment but involves ionizing radiation, posing added risks for children. Zero Echo Time (ZTE) MRI produces CT-like bone imaging without radiation, offering a safer alternative for paediatric patients. We report the case of a 13-year-old boy presenting with lateral malleolar pain following an inversion injury. Although initial radiographs revealed a joint effusion, a convincing fracture was not identified. Subsequent ZTE MRI easily detected a fracture through the lateral tibial epiphysis and physis, consistent with a Salter-Harris III injury. This case highlights ZTE's capability in detecting radiographically occult fractures, making it a valuable tool for accurate paediatric fracture diagnosis without radiation exposure.