Pediatric elbow fractures: MRI evaluation |
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Authors: | Javier Beltran MD Zehava S Rosenberg MD Moises Kawelblum MD Lourdes Montes MD A Gabrielle Bergman MD Alan Strongwater MD |
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Institution: | (1) Department of Radiology, Hospital for Joint Diseases, 301 East 17th Street, 10003 New York, New York, USA;(2) Department of Orthopaedic Surgery, Hospital for Joint Diseases, New York, New York, USA;(3) Department of Radiology, Beth Israel Medical Center, New York, New York, USA;(4) Department of Radiology, Stanford University School of Medicine, Sanford, California, USA |
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Abstract: | Magnetic resonance imaging (MRI) was performed in eight patients under the age of 8 years who suffered elbow fractures, to
assess possible fracture extension into the distal nonossified epiphysis of the humerus in seven cases and to determine the
displacement and location of the radial head in one case. MRI allowed accurate depiction of the fracture line when it extended
into the cartilaginous epiphysis. In four cases, MRI findings were confirmed at surgery. In five cases, surgery was obviated
because no articular extension of the fracture was seen on MRI (4 cases) or because no displacement was noted (1 case). In
one patient, the plain film diagnosis of a Salter type II fracture was changed to Salter type IV on the basis of the MRI findings.
It is concluded that MRI might play a role in the preoperative evaluation of pediatric patients presenting with elbow trauma
when extension of the fracture cannot be determined with routine radiographic studies.
Elbow injuries in children may be difficult to diagnose by routine clinical and radiographic techniques 1, 4, 12, 14]. Diagnostic
difficulty is due to the presence of multiple ossification centers of the distal humeral epiphysis and proximal radius and
ulna; these are mostly cartilaginous until the age of 11–12 years and therefore invisible on radiographs.
Following distal radial and distal tibial physeal fractures, epiphyseal elbow injuries are the most frequent epiphyseal injuries
8, 16]. These fractures tend to be unstable and often require surgical intervention. In addition, lasting sequelae such as
cubitus valgus and delayed ulnar nerve palsy can occur if these fractures are not treated properly 8]. Most elbow fractures
suspected to be unstable by clinical and radiographic evaluation are operated upon without additional imaging. Occasionally,
arthrography or computed arthrography are used to assess epiphyseal extension and cartilaginous malignment 1, 3, 4]. Because
of its ability to depict cartilage, MRI provides a noninvasive means of gaining information regarding the nonossified epiphysis.
The purpose of this article is to present our preliminary experience using magnetic resonance imaging (MRI) for the detection
of articular extension of elbow fractures and determination of displacement of fragments. |
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