Bone bruising of the distal forearm and wrist in children
Department of Paediatric Orthopaedics, Aristotle University of Thessaloniki, P. Papageorgiou 3, 54635 Thessaloniki, Greece.Injury (Impact Factor: 2.14). 05/2009; 40(6):631-7. DOI: 10.1016/j.injury.2009.01.104
Bone bruising represents a new category of bone injury that can only be demonstrated by magnetic resonance imaging (MRI) with fat suppression. This study proposed the nature of non-radiographically evident injuries of the distal radius and wrist in children whose symptoms did not resolve after 5 weeks. We aimed to describe and classify the lesions and delineate the importance and potential complications of the injuries. Bone bruising was diagnosed in 20 patients (mean age: 11.6 years; range: 9-13 years). Bone bruises were classified according to anatomical location and whether they were solitary lesions or were combined with other injuries. Injuries of the distal radius were classified according to location: type 1 was localised to the metaphysis, close to the physeal plate; type 2 involved both the metaphysis and diaphysis; and type 3 extended on both sides of the distal radial growth plate. The type 1 injuries were consistent with complete, un-displaced Salter-Harris type I fractures, whilst type 3 lesions were potentially Salter-Harris type V injuries. Our data indicate that an MRI should be considered for a child with an injury to the distal radius or wrist whose symptoms do not resolve after 5 weeks of immobilisation.
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ABSTRACT: In den vergangenen Jahren revolutionierten technische Entwicklungen die Computertomographie (CT) und erweiterten ihr Einsatzspektrum. Größtes Problem ihrer Anwendung in der Kinderradiologie ist die Strahlenexposition, die deutlich über der konventioneller Röntgenaufnahmen liegt und das Potenzial einer Malignominduktion birgt. Der sinnvolle Einsatz der Multidetektorcomputertomographie (MDCT) beim Kind setzt eine dezidierte rechtfertigende Indikation voraus, wobei immer primär die Anwendung dosisfreier Verfahren [Sonographie, Magnetresonanztomographie (MRT)] erwogen werden sollte. Wenn eine pädiatrische MDCT durchgeführt wird, sollten die Akquisitionsparameter individuell adjustiert werden, um eine ausreichende Bildqualität bei möglichst niedriger Strahlendosis zu gewährleisten. Darüber hinaus sind bei Kindern und Jugendlichen Einschränkungen bei der Gabe von Kontrastmittel zu berücksichtigen. During the past decades technical innovations have improved image quality of multidetector computed tomography (MDCT) leading to an enormous expansion of clinical applications worldwide. The major drawback of MDCT is radiation exposure which might lead to induction of secondary malignancies thus limiting its use within the pediatric age group. Reasonable application of MDCT in pediatric radiology always presumes clinical justification and optimization of scanning protocols in order to lower radiation dose applied to the patient. Whenever possible, image procedures without radiation exposure including ultrasound and MRI should be preferred. If a pediatric MDCT study is indicated, individual adjustment of acquisition parameters should be warranted to ensure optimal balance of sufficient image quality and dose reduction. Moreover, application of contrast agents must be used with caution in the pediatric age group. SchlüsselwörterComputertomographie–Strahlendosis–Dosisreduktion–Karzinomrisiko, radiologisches–Kontrastmittel KeywordsTomography, X-ray computed–Radiation dosage–Dose reduction–Neoplasms, radiation-induced–Contrast agentsMonatsschrift Kinderheilkunde 04/2011; 159(4):343-349. DOI:10.1007/s00112-010-2321-2 · 0.23 Impact Factor
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ABSTRACT: Injuries to the pediatric distal forearm and wrist have myriad manifestations. Growth plate injuries can occur in the skeletally immature child. An unfused growth plate is less robust than ligamentous complexes and therefore is more easily injured. The Salter-Harris fracture classification system is used to grade physeal injuries based on their imaging appearance. This grading has prognostic significance: higher grades imply an increased likelihood of eventual growth disturbance. A disrupted distal radioulnar joint characterizes Galeazzi-type injuries at all ages; however, before skeletal maturity is attained, a disrupted radioulnar joint can manifest as a distal ulnar physeal separation with associated epiphysiolysis of the distal ulna, termed a Galeazzi-equivalent fracture. Bone contusions can be diagnosed using fluid-sensitive fat-suppressed magnetic resonance imaging, and their detection can alter the prognosis. The unique cartilaginous cushion of the developing bony carpus imparts resilience to fracture and dislocation until carpal maturity is reached. Chronic compressive forces to the wrist in a skeletally immature gymnast can result in a distinct pattern of bone and soft-tissue injury referred to as gymnast wrist. If the distal radial physis fuses prematurely, ulnar growth will outpace radial growth, leading to positive ulnar variance and consequent chronic wrist pain from ulnar impaction.Radiographics 03/2014; 34(2):472-90. DOI:10.1148/rg.342135073 · 2.60 Impact Factor
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