Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgments
- Section 1 Brain, head, and neck
- Section 2 Spine
- Section 3 Thorax
- Section 4 Cardiovascular
- Section 5 Abdomen
- Section 6 Pelvis
- Section 7 Musculoskeletal
- Section 8 Pediatrics
- Case 89 Thymus simulating mediastinal hematoma
- Case 90 Foreign body aspiration
- Case 91 Idiopathic ileocolic intussusception
- Case 92 Ligamentous laxity and intestinal malrotation in the infant
- Case 93 Hypertrophic pyloric stenosis and pylorospasm
- Case 94 Retropharyngeal pseudothickening
- Case 95 Cranial sutures simulating fractures
- Case 96 Systematic review of elbow injuries
- Case 97 Pelvic pseudofractures: normal physeal lines
- Case 98 Hip pain in children
- Case 99 Common pitfalls in pediatric fractures: ones not to miss
- Case 100 Non-accidental trauma: neuroimaging
- Case 101 Non-accidental trauma: skeletal injuries
- Index
- References
Case 99 - Common pitfalls in pediatric fractures: ones not to miss
from Section 8 - Pediatrics
Published online by Cambridge University Press: 05 March 2013
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgments
- Section 1 Brain, head, and neck
- Section 2 Spine
- Section 3 Thorax
- Section 4 Cardiovascular
- Section 5 Abdomen
- Section 6 Pelvis
- Section 7 Musculoskeletal
- Section 8 Pediatrics
- Case 89 Thymus simulating mediastinal hematoma
- Case 90 Foreign body aspiration
- Case 91 Idiopathic ileocolic intussusception
- Case 92 Ligamentous laxity and intestinal malrotation in the infant
- Case 93 Hypertrophic pyloric stenosis and pylorospasm
- Case 94 Retropharyngeal pseudothickening
- Case 95 Cranial sutures simulating fractures
- Case 96 Systematic review of elbow injuries
- Case 97 Pelvic pseudofractures: normal physeal lines
- Case 98 Hip pain in children
- Case 99 Common pitfalls in pediatric fractures: ones not to miss
- Case 100 Non-accidental trauma: neuroimaging
- Case 101 Non-accidental trauma: skeletal injuries
- Index
- References
Summary
Imaging description
There are numerous pitfalls in pediatric musculoskeletal trauma, in large part due to the progressive ossification of the maturing skeleton. Three fractures unique to pediatric imaging will be discussed here: supracondylar humeral, toddler’s type 1, and the classic metaphyseal lesion.
Supracondylar fractures are the most common pediatric elbow fractures, comprising 50–70% of such injuries [1]. These fractures are shown to greatest advantage on the lateral view, usually showing posterior angulation of the distal fragment. These are covered in detail in Case 96.
Non-displaced or hairline spiral fracture of the tibial diaphysis is referred to as toddler’s type 1 fracture, the most common subtype (Figure 99.1) [2]. Impaction or buckle fracture of the proximal tibial diaphysis, or toddler’s type 2, is a recently described but less common variant [3]. Hairline fractures may be extremely difficult or impossible to identify on standard orthogonal views. Overlying soft tissue swelling may be variably present. If suspicious for this injury, one should perform an additional oblique projection of the lower leg to optimize detection. Toddler’s fractures may manifest either as sharp oblique lucent or sclerotic lines, depending on both acuity and projection [2]. If clinical suspicion remains high and three-view tibia/fibula radiographs are negative, a scintigraphic bone scan may be performed (Figure 99.2). These exams feature a wide field of view, do not require anesthesia, and are less expensive than MRI. Bone scans may also identify tarsal fractures, particularly the cuboid and calcaneus, which may mimic tibial injuries in toddlers [4].
- Type
- Chapter
- Information
- Pearls and Pitfalls in Emergency RadiologyVariants and Other Difficult Diagnoses, pp. 360 - 365Publisher: Cambridge University PressPrint publication year: 2013