Acute elbow trauma in children: spectrum of injury revealed by MR imaging not apparent on radiographs.
OBJECTIVE
The objective of this study is to evaluate the frequency and significance of unrecognized bone or soft-tissue injury in pediatric patients with elbow trauma assessed with radiographs alone.


METHODS
Fifty children (32 boys and 18 girls; mean age, 7.3 years; age range, 2-12 years) with acute elbow trauma were examined with radiography and MR imaging. Radiographs were categorized into those showing normal findings, an effusion, an equivocal fracture, or an unequivocal fracture. MR examinations were assessed for an effusion, fracture, transphyseal fracture extension, physeal injury, bone bruising, and ligament or muscle injury. Average clinical follow-up was 1.6 years (range, 6-28 months) after injury.


RESULTS
Radiographs showed normal findings in seven children (14%), an effusion only in 17 children (34%), and an unequivocal or equivocal fracture in 26 children (52%). MR imaging showed an effusion in 48 children (96%); unequivocal fracture in 37 children (74%), including transphyseal fracture in seven children (14%) and other physeal injury in three children (6%); bone bruising in 45 children (90%); ligament injury in six children (14%); and muscle injury in 19 children (38%). A less severe spectrum of injury occurred in children with normal findings on radiographs than in those with an effusion or fracture seen on radiography. Follow-up radiographs did not help in the detection of radiographically occult fractures. MR findings had no appreciable effect on patient treatment and no value in predicting duration of convalescence or clinical outcome at an average of 1.6 years after injury.


CONCLUSIONS
In children with elbow trauma, MR imaging reveals a broad spectrum of bone and soft-tissue injury beyond that recognizable radiographically. However, the additional information afforded by MR imaging has little bearing on treatment or clinical outcome.
Griffith
J F
JF
Department of Diagnostic Radiology and Organ Imaging, Chinese University of Hong Kong, Sha Tin, Hong Kong.
Roebuck
D J
DJ
Cheng
J C
JC
Chan
Y L
YL
Rainer
T H
TH
Ng
B K
BK
Metreweli
C
C
D000208:Acute Disease; D001842:Bone and Bones / Q000293:injuries; D002648:Child; D002675:Child, Preschool; D003288:Contusions / Q000175:diagnosis / Q000000981:diagnostic imaging; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis / Q000000981:diagnostic imaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011237:Predictive Value of Tests; D011859:Radiography; D012680:Sensitivity and Specificity; D017695:Soft Tissue Injuries / Q000175:diagnosis / Q000000981:diagnostic imaging; D000092464:Elbow Injuries