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Subtle fractures in children

Yasutaka Kuniyoshi, Azusa Kamura, Sumie Yasuda, Makoto Tashiro, Yoichiro Toriyabe
BACKGROUND: Serious isolated laryngeal injuries are uncommon in children. CASE REPORT: We describe the case of an 8-year-old boy with laryngeal injury and pneumomediastinum due to minor blunt neck trauma. He presented to the emergency department complaining of odynophagia and hoarseness, but without respiratory distress. Emphysema was seen between the trachea and vertebral body on initial cervical spine x-ray study, and flexible laryngoscopy revealed erythema and mild edema of both the right vocal cord and the arytenoid region...
November 3, 2016: Journal of Emergency Medicine
Justin Chak Yiu Lam, Ka Lok Ryan Lee, James F Griffith
Brachialis periosteal avulsion injury is an uncommon injury occurring in young children. The injury may be misinterpreted or overlooked because of misleading or subtle radiological findings. A case of 7-year-old child with post-traumatic elbow pain and subtle findings on elbow radiography is presented. The injury was initially misinterpreted as an avulsion fracture of the medial epicondyle. Following radiological review, a diagnosis of brachialis periosteal avulsion injury was made. The radiographic and magnetic resonance imaging (MRI) findings of this injury are presented to stress the value of comparing the radiographic findings with previous imaging and to increase awareness of this uncommon injury...
November 2016: Skeletal Radiology
Marguerite T Parisi, Rebecca T Wiester, Stephen L Done, Naomi F Sugar, Kenneth W Feldman
OBJECTIVES: Skull fractures can be difficult to recognize on radiographs and axial computed tomography (CT) bone windows. Missed findings may delay abuse diagnosis. The role of three-dimensional (3-D) reconstructions in child abuse evaluations was retrospectively evaluated. METHODS: Twelve exemplary cases between August 2006 and July 2009 are described. All, except 2 medical-legal cases, were clinical abuse consultations. With the use of a 1-to-3 scale, ease and accuracy of interpretation of findings between plain films, bone windows, and 3-D CT images were independently assessed by 2 radiologists...
November 2015: Pediatric Emergency Care
Michael L Moritz, Juan C Ayus
Hyponatremia is the most common electrolyte abnormality in both inpatient and outpatient settings. The condition primarily results from the combination of impaired free water excretion due to elevated vasopressin levels in conjunction with a source of free water intake. Recent studies have revealed that even mild and asymptomatic hyponatremia is associated with deleterious consequences. It is an independent risk factor for mortality and is also associated with increased length of hospitalization and hospital costs...
September 2014: Current Treatment Options in Neurology
Enno Stranzinger, Lars Leidolt, Georg Eich, Peter Michael Klimek
OBJECTIVE: Evaluation of the anterior tilt angle of the proximal tibia epiphyseal plate in young children, which suffered a trampoline fracture in comparison with a normal population. MATERIALS AND METHODS: 62 children (31 females, 31 males) between 2 and 5 years of age (average 2 years 11 months, standard deviation 11 months) with radiographs in two views of the tibia were included in this retrospective study. 25 children with proximal tibia fractures were injured with a history of jumping on a trampoline...
August 2014: European Journal of Radiology
Fred H Warkentine, Russ Horowitz, Mary Clyde Pierce
Occult fractures due to child abuse can be difficult to identify because there is usually no history of trauma, and chief complaints are vague. In addition, the osseous injuries are often subtle, becoming obvious only after healing begins. Missed injuries can lead to inappropriate disposition of a patient and can cause children to be placed at high risk for further injury and death. It is therefore imperative that these children be diagnosed as soon as possible. Ultrasound has some properties that are desirable for detecting fractures, especially in children...
January 2014: Pediatric Emergency Care
Jeffrey Cheng
Rarely do orthopedic injuries in children present with dysphagia. Acute onset dysphagia after falling or getting tackled with subtle symptoms or unremarkable physical examination findings should raise suspicion for posterior dislocation of the sternoclavicular joint (SCJ). A case is described and used to highlight an uncommon cause of dysphagia in children. It can be easily missed because the presenting symptoms and physical examination findings are subtle. Standard radiographs are not sufficient for diagnosis, and a high degree of suspicion is necessary to pursue further diagnostic studies...
January 2014: International Journal of Pediatric Otorhinolaryngology
A Noelle Larson, Sumeet Garg, Amanda Weller, Nicholas D Fletcher, Jonathan R Schiller, Michael Kwon, Richard Browne, Lawson A Copley, Christine A Ho
BACKGROUND: Because of the changing referral patterns, operative pediatric supracondylar humerus fractures are increasingly being treated at tertiary referral centers. To expedite patient flow, type II fractures are sometimes pinned in a delayed manner. We sought to determine if delay in surgical treatment of modified Gartland type II supracondylar humerus fractures would affect the rate of complications following closed reduction and percutaneous pinning. METHODS: We performed a retrospective review of a consecutive series of 399 modified Gartland type II supracondylar fractures treated operatively at a tertiary referral center over 4 years...
June 2014: Journal of Pediatric Orthopedics
Leonard E Swischuk
The bones of infants and children are soft and so they tend to buckle and bend rather than frankly break. In addition, to accommodate growth, epiphyseal plates exist. These areas represent weak zones in the long bones and shearing/twisting forces cause fractures. All of this results in fractures different than what one sees in adults and this communication deals with how to identify these fractures, how to appreciate the more subtle of these fractures, and how to utilize comparative views for the subtle cases...
September 2013: Seminars in Musculoskeletal Radiology
Vinodan Paramanathan, Sam Brookfield, Dipen Menon
INTRODUCTION: Triceps avulsion fracture rupture is a rare tendon. Radiography remains the initial imaging modality of choice for evaluating a suspected triceps injury. However, in children the osseous insertion may not be visible on standard plain film imaging if it is partially ossified. PRESENTATION OF CASE: An 8-year-old child presented to Accident and Emergency complaining of localised pain over the right olecranon following a fall onto an outstretched hand...
2013: International Journal of Surgery Case Reports
Jacob L Jaremko, Zachary D Guenther, Lennart B O Jans, Peter J Macmahon
OBJECTIVE: Magnetic resonance imaging (MRI) findings in anterior cruciate ligament (ACL) injury are well known, but most published reviews show obvious examples of associated injuries and give little focus to paediatric patients. Here, we demonstrate the spectrum of MRI appearances at common sites of associated injury in adolescents with ACL tears, emphasising age-specific issues. METHODS: Pictorial review using images from children with surgically confirmed ACL tears after athletic injury...
June 2013: Insights Into Imaging
S Rammelt, W Schneiders, G Fitze, H Zwipp
Ankle fractures are the most frequent factures of weight-bearing joints in children while fractures of the hindfoot and midfoot are rare. Metatarsal fractures make up the greatest portion of foot fractures in children and mostly heal uneventfully. Generally, the fracture severity increases with increasing age and the fracture patterns in adolescents resemble those in adults but transitional fractures of the distal tibial epiphysis in adolescents between 12 and 14 years of age are an exception. A subtle clinical and radiographic examination is necessary to detect the injury pattern and to discriminate fractures from accessory bones, juvenile avascular necrosis and apophyses...
January 2013: Der Orthopäde
M S Gaston, G J Irwin, J S Huntley
Fractures of the lateral condyle of the humerus in children are relatively common and can be easily missed on initial plain radiographs especially in the younger age group. We present a case in which diagnosis of this fracture was delayed for five weeks and therefore presented more challenging surgical management. The salient features that were apparent on the initial radiograph at presentation are discussed as is the use of further imaging techniques that may help to clarify the initial diagnosis. This could significantly reduce the risk of serious complications such as chronic pain, deformity and nerve palsy...
August 2012: Scottish Medical Journal
E Bruyeer, E Geusens, F Catry, L Vanstraelen, F Vanhoenacker
We present three cases of fracture of the proximal tibia in young children who were jumping on a trampoline. The typical radiological findings and the underlying mechanism of trauma are discussed. The key radiological features are: a transverse hairline fracture of the upper tibia often accompanied by a buckle fracture of the lateral or medial tibial cortex, buckling of the anterior upper tibial cortex and anterior tilting of the epiphyseal plate. New types of injuries related to specific recreational activities are recognized...
January 2012: JBR-BTR: Organe de la Société Royale Belge de Radiologie (SRBR)
Caitlin Farrell, David M Rubin, Kevin Downes, John Dormans, Cindy W Christian
BACKGROUND AND OBJECTIVE: Delay in seeking medical care is one criterion used to identify victims of abuse. However, typical symptoms of accidental fractures in young children and the time between injury and the seeking of medical care have not been reported. We describe patient and injury characteristics that influence the time from injury to medical care. METHODS: Parental interviews were conducted for children <6 years old with accidental extremity fractures...
January 2012: Pediatrics
Aksel Seyahi, Serkan Uludag, Burak Altıntaş, Mehmet Demirhan
INTRODUCTION: The high incidence of transient synovitis in early childhood makes it the first suspected pathology in a limping child. Trauma, which has long been regarded as a causative factor for transient synovitis, may be underestimated in a non-cooperative toddler.After excluding most serious conditions, such as septic arthritis, a speculative diagnosis of transient synovitis can be made, and this can easily mask a subtle musculoskeletal injury. CASE PRESENTATIONS: We report the cases of three Caucasian patients (two boys, aged 20-months- and three-years-old, and one girl, aged two-years-old), with tibial torus and toddler's fractures which were late-diagnosed due to an initial misdiagnosis of transient synovitis of the hip...
2011: Journal of Medical Case Reports
Surjit Lidder, Nima Heidari, Florian Amerstorfer, Stephan Grechenig, Annelie M Weinberg
Monteggia fractures are rare in children, and subtle radial head dislocations, with minor plastic deformation of the ulna, may be missed in up to a third of cases. Complications of Monteggia fractures-dislocations include persistent radial head dislocation, forearm deformity, elbow stiffness, and nerve palsies at the time of presentation. An unusual case of median nerve palsy following elastic stable intramedullary nailing of a type I Monteggia lesion in a 6-year-old girl is presented, and we highlight that, although most nerve palsies associated with a Monteggia fracture-dislocations are treated expectantly in children, early intervention here probably provided the best outcome...
2011: Case Reports in Medicine
Gregory Kaltsas, Polyzois Makras
Structural and functional impairment of the skeletal system remains an important cause of morbidity and disability in patients with Cushing's syndrome (CS). Glucocorticoid (GC) excess inhibits bone formation and calcium absorption from the gut, increases bone resorption, and alters the secretion of gonadotropin and growth hormones, cytokines and growth factors influencing bone. Both overt and subtle endogenous hypercortisolism affect bone, leading to vertebral fractures in up to 70% of patients. Fracture risk is related to age at onset, duration and severity of the disease and individual susceptibility to GCs that is genetically determined...
2010: Neuroendocrinology
Kathy Boutis, Unni G Narayanan, Frederik F T Dong, Heather Mackenzie, Hanmu Yan, Derek Chew, Paul Babyn
OBJECTIVES: In skeletally immature children, isolated lateral ankle injuries without radiograph-visible fractures are often diagnosed with Salter-Harris I fractures of the distal fibula (SH1DF). However, recent magnetic resonance imaging (MRI) evidence in children suggests that sprains may be more common than previously thought. Thus, the main objective of this study was to determine the rate of MRI-confirmed SH1DF among cases where this diagnosis was made presumptively, based on clinical findings...
August 2010: Injury
J Yang, M G Cooper
We present two cases of children who developed compartment syndrome after upper limb fractures. Morphine patient-controlled analgesia was used in a bolus-only mode for analgesia (bolus 20 microg/kg, five minute lockout and hourly limit of 150 microg/kg). An increase in patient-controlled analgesia use was observed up to 12 hours before the decision was made to proceed to fasciotomy but neither child exceeded the hourly limit or had an excessive increase in pain scores. Clinical risk factors for compartment syndrome should be identified and appropriate monitoring instituted...
March 2010: Anaesthesia and Intensive Care
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