title: Traumatic elbow effusions in pediatric patients: are occult fractures the rule?
abstract: OBJECTIVE
  Elbow joint effusion with no fracture seen on radiographs of pediatric patients after acute trauma has become synonymous with occult fracture. This study evaluates the incidence of occult fractures in such cases as determined by findings on follow-up radiographs.
  
  
  METHODS
  Initial and follow-up radiographs were reviewed for 54 children (mean age, 7 years) with a history of trauma who had joint effusion but no identifiable fracture on initial radiographs. The presence of periosteal reaction or bony sclerosis on follow-up radiographs was considered to be evidence of occult fracture. Mean time between initial and follow-up radiographs was 18 days (range, 14-50 days).
  
  
  RESULTS
  Only nine (17%) of the 54 patients showed evidence of a healing occult fracture on follow-up radiographs. However, we found a statistically significant relationship (p = .001) between persistent joint effusion on follow-up radiographs and occult fracture. Seventy-eight percent of cases with occult fracture, versus 16% of cases without occult fracture, had persistent effusions.
  
  
  CONCLUSIONS
  Joint effusion without visualized fracture on initial radiographs after trauma does not correlate with the presence of occult fracture in most cases (83%). Therefore, joint effusion as revealed by radiography should not be considered synonymous with occult fracture.
authors.affiliation: Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: L F
authors.initials: LF
authors.lastname: Donnelly
authors.forename: T T
authors.initials: TT
authors.lastname: Klostermeier
authors.forename: L A
authors.initials: LA
authors.lastname: Klosterman
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging; D002648:Child; D004551:Elbow Joint / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D017102:Fracture Healing; D005596:Fractures, Closed / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D011859:Radiography; D013997:Time Factors; D000092464:Elbow Injuries