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MRI shows a high incidence of carpal fractures in children with posttraumatic radial-sided wrist tenderness

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ABSTRACT

Background and purpose: The epidemiology and optimal diagnostics of wrist injuries in children are not knotwn. We describe fractures revealed by magnetic resonance imaging (MRI) in a prospective population of children and adolescents with posttraumatic radial-sided wrist tenderness, and compare the diagnostic value of radiographs and computed tomography (CT) with that of MRI.

Patients and methods: From 2004 to 2007, patients less than 18 years of age who presented at our emergency department were included in the study. 90 wrists in 89 patients underwent clinical, radiographic, and low-field MRI investigation. If plain radiographs or MRI revealed a scaphoid fracture, a supplementary CT scan was performed. Sensitivity and specificity of radiographs and CT for diagnosis of scaphoid fractures was calculated using MRI as the reference standard.

Results: 74 fractures were diagnosed in 61 of 90 wrists using MRI; 48 wrists had a scaphoid fracture, 8 had a distal radius fracture, 7 had a capitate fracture, and 3 had a triquetrum fracture. The most common combination of fractures was scaphoid and capitate. The sensitivity of radiographs for visualization of scaphoid fractures was 54% and the specificity was 100%. The sensitivity for other fractures was <50%. The sensitivity of CT for visualization of scaphoid fractures was 96% and it was between 33% and 100% for other fractures.

Interpretation: MRI showed a high incidence of fractures in children and adolescents with posttraumatic radial wrist tenderness, and it led to the diagnosis of more fractures than plain radiographs and CT. A scaphoid fracture was the most common carpal injury, followed by fracture of the capitate.

No MeSH data available.


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The distribution of concomitant fractures of the scaphoid, capitate, and distal radius in 90 injured wrists.
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Figure 0002: The distribution of concomitant fractures of the scaphoid, capitate, and distal radius in 90 injured wrists.

Mentions: MRI diagnosed 74 fractures in 61 of the 90 wrists investigated: 48 scaphoid fractures, 12 fractures of other carpal bones, 8 distal radius fractures, and 6 metacarpal base fractures (Figure 1). A scaphoid fracture in combination with another fracture was found in 10 wrists. The most common fracture combination was a scaphoid fracture and a capitate fracture (n = 5) (Figure 2), followed by combined fracture of the scaphoid and the distal radius (n = 3) and the scaphoid and triquetrum (n = 2). In 1 wrist, a metacarpal fracture was combined with fractures of the capitate, hamate, and trapezoid—the latter carpal fractures being visible on MRI only. Finally, MRI revealed 1 wrist with bone bruise, located in the capitate. A comparison between radiographs and MRI showed that radiographs alone showed 34 of the 74 fractures, which corresponds to an overall sensitivity of 46%. Sensitivity in the diagnosis of scaphoid fractures reached 54%, distal radius fractures 50%, metacarpal fractures 50%, and triquetrum fractures 33%. Sensitivity for other carpal fractures was poor (Table 1). Radiographs did not show any false-positive scaphoid fractures compared to MRI, resulting in a specificity of 100% (CI: 92–100).


MRI shows a high incidence of carpal fractures in children with posttraumatic radial-sided wrist tenderness
The distribution of concomitant fractures of the scaphoid, capitate, and distal radius in 90 injured wrists.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5016915&req=5

Figure 0002: The distribution of concomitant fractures of the scaphoid, capitate, and distal radius in 90 injured wrists.
Mentions: MRI diagnosed 74 fractures in 61 of the 90 wrists investigated: 48 scaphoid fractures, 12 fractures of other carpal bones, 8 distal radius fractures, and 6 metacarpal base fractures (Figure 1). A scaphoid fracture in combination with another fracture was found in 10 wrists. The most common fracture combination was a scaphoid fracture and a capitate fracture (n = 5) (Figure 2), followed by combined fracture of the scaphoid and the distal radius (n = 3) and the scaphoid and triquetrum (n = 2). In 1 wrist, a metacarpal fracture was combined with fractures of the capitate, hamate, and trapezoid—the latter carpal fractures being visible on MRI only. Finally, MRI revealed 1 wrist with bone bruise, located in the capitate. A comparison between radiographs and MRI showed that radiographs alone showed 34 of the 74 fractures, which corresponds to an overall sensitivity of 46%. Sensitivity in the diagnosis of scaphoid fractures reached 54%, distal radius fractures 50%, metacarpal fractures 50%, and triquetrum fractures 33%. Sensitivity for other carpal fractures was poor (Table 1). Radiographs did not show any false-positive scaphoid fractures compared to MRI, resulting in a specificity of 100% (CI: 92–100).

View Article: PubMed Central - PubMed

ABSTRACT

Background and purpose: The epidemiology and optimal diagnostics of wrist injuries in children are not knotwn. We describe fractures revealed by magnetic resonance imaging (MRI) in a prospective population of children and adolescents with posttraumatic radial-sided wrist tenderness, and compare the diagnostic value of radiographs and computed tomography (CT) with that of MRI.

Patients and methods: From 2004 to 2007, patients less than 18 years of age who presented at our emergency department were included in the study. 90 wrists in 89 patients underwent clinical, radiographic, and low-field MRI investigation. If plain radiographs or MRI revealed a scaphoid fracture, a supplementary CT scan was performed. Sensitivity and specificity of radiographs and CT for diagnosis of scaphoid fractures was calculated using MRI as the reference standard.

Results: 74 fractures were diagnosed in 61 of 90 wrists using MRI; 48 wrists had a scaphoid fracture, 8 had a distal radius fracture, 7 had a capitate fracture, and 3 had a triquetrum fracture. The most common combination of fractures was scaphoid and capitate. The sensitivity of radiographs for visualization of scaphoid fractures was 54% and the specificity was 100%. The sensitivity for other fractures was <50%. The sensitivity of CT for visualization of scaphoid fractures was 96% and it was between 33% and 100% for other fractures.

Interpretation: MRI showed a high incidence of fractures in children and adolescents with posttraumatic radial wrist tenderness, and it led to the diagnosis of more fractures than plain radiographs and CT. A scaphoid fracture was the most common carpal injury, followed by fracture of the capitate.

No MeSH data available.


Related in: MedlinePlus