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Occult fractures in children

T Betts, S Ahmed, S Maguire, P Watts
PurposeTo identify the spectrum of non-vitreoretinal ocular injury due to child maltreatment.MethodsAll language search of MEDLINE, PsychINFO, EMBASE, AMED, Web of Science, and CINAHL databases, 1950-2015, was conducted. INCLUSION CRITERIA: explicit confirmation of injury aetiology, age <18 years, examination conducted by an ophthalmologist. Exclusion: post-mortem data, organic diseases, review articles. Standardised critical appraisal and narrative synthesis was conducted of included publications by two independent reviewers...
March 24, 2017: Eye
Manabu Maeda, Nana Maeda, Takanori Takaoka, Yasuhito Tanaka
In this series, we aimed to describe the sonographic findings of chondral avulsion fractures that develop concomitant with lateral ankle ligament injury in children. We performed stress sonography during a manual anterior drawer stress procedure of the ankle in 9 skeletally immature patients who had recently had a lateral ankle sprain. Echo videos were obtained through the course of treatment, and all videos were reviewed. We elucidated the common features of chondral avulsion fractures of the lateral ankle ligaments in the children...
February 2017: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
Yuki Fujihara, Masahiro Tatebe, Nasa Fujihara, Hiromasa Tanaka, Hitoshi Hirata
OBJECTIVE: The aim of this study was to verify the use of initial plain radiographs, specifically the presence of a longitudinal crack on the olecranon, for diagnosing olecranon occult fractures in children. METHODS: We retrospectively reviewed all patients younger than 16 years who were diagnosed with proximal radial fractures treated at our hospital between April 1, 2006 and September 31, 2014. We included 22 patients (9 boys and 13 girls) with a mean age of 8...
October 6, 2016: Pediatric Emergency Care
M Burnier, G Buisson, A Ricard, V Cunin, J P Pracros, F Chotel
INTRODUCTION: Among the various elbow injuries in children that initially have normal radiographs, a certain number of occult fractures are only diagnosed correctly after the fact, during a follow-up visit. PURPOSE: This study evaluated the diagnostic contribution of ultrasonography in the treatment of acute elbow injuries in children and the strategic and economic impact of using this tool alongside radiography. MATERIALS AND METHODS: During this prospective study performed between January 1 and April 1 2014, elbow ultrasonography was performed within 6 days in all children under 15 years of age with a suspected occult fracture...
September 30, 2016: Orthopaedics & Traumatology, Surgery & Research: OTSR
Nirav H Shelat, Georges Y El-Khoury
More children are participating in organized and recreational athletics at a younger age. It has been well documented that increased athletic specialization and year-round activities have resulted in higher incidences of overuse injuries, including stress fractures and stress reactions. Initially, stress fractures can be radiographically occult. Continued stress on the injured bone or cartilage can lead to progressive radiographic changes. Because of the prevalence of these injuries, both orthopedic surgeons and radiologists should be aware of the radiographic and magnetic resonance imaging (MRI) features of common stress fractures in children...
2016: Iowa Orthopaedic Journal
A Courvoisier, N Calvelli, E Bourgeois, A Eid, J Griffet
Elbow injuries are frequent but occult fractures are difficult to diagnose on x-rays. However, any delay in the diagnosis may severely impair the prognosis of some fractures. Simple tips may help the clinician read x-rays properly and avoid the classical pitfalls of elbow injuries in children. The chronology of appearance of ossification nuclei around the elbow is important to distinguish normal features from abnormality. Drawing simple geometric constructions on the x-rays may clarify most occult elbow fractures in children...
August 2016: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
Anna Cohen-Rosenblum, Robert J Bielski
Nursemaid's elbow and elbow fractures are both common causes of acute elbow pain, but the mechanism of injury is quite different. In children, falls frequently go unwitnessed and children are often inaccurate when recounting the sequences of a fall, making the mechanism difficult to ascertain. A common clinical mistake is to treat all elbow injuries as a nursemaid's elbow. When the mechanism of injury is unknown, radiographs should be used to help make the diagnosis. Occult fractures, also known as "hairline" elbow fractures, may not be visible on initial X-rays, but clues to the diagnosis, especially the posterior fat pad, can be helpful in evaluation...
June 1, 2016: Pediatric Annals
Michael Elvey, S Patel, Erez Avisar, W J White, E Sorene
PURPOSE: The nonspecific terms "wrist sprain" and "suspected occult bony injury" are frequently documented as diagnoses in occult paediatric wrist injuries. To date, however, no one has accurately defined their true underlying pathology. The primary objective of this study was to identify the true pathoanatomy of occult acute paediatric wrist injuries. Our secondary objective was to compare our findings with existing adult data in order to determine any population differences that might be clinically relevant...
June 2016: Journal of Children's Orthopaedics
I Delgado Álvarez, I Barber Martínez de la Torre, É Vázquez Méndez
Child abuse or nonaccidental trauma is a major problem worldwide; in Spain, there are about 12,000 victims per year. The detection of specific lesions or findings that are incongruent with the reported mechanism of trauma mean that radiologists are often the physician responsible for sounding the alarm in cases of abuse. The triad consisting of subdural hematoma, metaphyseal fracture, and posterior rib fractures is very characteristic of the battered child syndrome. The finding of acute and chronic lesions in the same patient is highly specific for nonaccidental trauma...
May 2016: Radiología
Daniel M Lindberg, Brenda Beaty, Elizabeth Juarez-Colunga, Joanne N Wood, Desmond K Runyan
OBJECTIVE: Child physical abuse is commonly missed, putting abused children at risk for repeated injury and death. Several so-called sentinel injuries have been suggested to be associated with high rates of abuse, and to imply the need for routine testing for other, occult traumatic injuries. Our objective was to determine rates of abuse evaluation and diagnosis among children evaluated at leading children's hospitals with these putative sentinel injuries. METHODS: This is a retrospective secondary analysis of the Pediatric Health Information System database...
November 2015: Pediatrics
Nancy S Harper, Terri Lewis, Sonja Eddleman, Daniel M Lindberg
Skeletal survey is frequently used to identify occult fractures in young children with concern for physical abuse. Because skeletal survey is relatively insensitive for some abusive fractures, a follow-up skeletal survey (FUSS) may be undertaken at least 10-14 days after the initial skeletal survey to improve sensitivity for healing fractures. This was a prospectively planned secondary analysis of a prospective, observational study of 2,890 children who underwent subspecialty evaluation for suspected child physical abuse at 1 of 19 centers...
January 2016: Child Abuse & Neglect
K Eckert, O Ackermann
BACKGROUND: In clinically suspected fractures taking radiographs is the standard procedure but the indications should be strictly limited. Ultrasound offers a safe and radiation-free alternative for fracture diagnostics. OBJECTIVES: Sensitivity and specificity of sonographic fracture diagnostics and safety of sonographic algorithms for fracture evaluation. METHODS: Presentation of useful applications for sonographic fracture evaluation and establishment of sonographic algorithms for safe fracture diagnosis...
November 2015: Der Radiologe
Kathleen H Emery, Shannon N Zingula, Christopher G Anton, Shelia R Salisbury, Junichi Tamai
BACKGROUND: The three most common elbow fractures classically reported in pediatric orthopedic literature are supracondylar (50-70%), lateral condylar (17-34%), and medial epicondylar fractures (10%), with fractures of the proximal radius (including but not limited to fractures of the radial neck) being relatively uncommon (5-10%). Our experience at a large children's hospital suggests a different distribution. OBJECTIVE: Our goals were (1) to ascertain the frequency of different elbow fracture types in a large pediatric population, and (2) to determine which fracture types were occult on initial radiographs but detected on follow-up...
January 2016: Pediatric Radiology
Joanne N Wood, Benjamin French, Lihai Song, Chris Feudtner
OBJECTIVES: To examine variation across US hospitals in evaluation for occult fractures in (1) children <2 years old diagnosed with physical abuse and (2) infants <1 year old with injuries associated with a high likelihood of abuse and to identify factors associated with such variation. METHODS: We performed a retrospective study in children <2 years old with a diagnosis of physical abuse and in infants <1 year old with non-motor vehicle crash-related traumatic brain injury or femur fractures discharged from 366 hospitals in the Premier database from 2009 to 2013...
August 2015: Pediatrics
Berkeley L Bennett, Paul Steele, Cinnamon A Dixon, E Melinda Mahabee-Gittens, Jarrod Peebles, Kimberly W Hart, Christopher J Lindsell, Michael S Chua, Russel Hirsh
OBJECTIVE: To determine if troponin I is more often elevated in children with suspected nonaccidental trauma (NAT) compared with uninjured children of similar age, and describe associations between troponin I elevation and NAT injuries. STUDY DESIGN: Prospective 2-group study of children less than 2 years of age presenting to the emergency department with nonaccidental abdominal, thoracic, or intracranial injuries, and similarly aged uninjured children. Primary outcome was serum troponin I (≥ 0...
September 2015: Journal of Pediatrics
M Regauer, W Mutschler
BACKGROUND: Occult fractures in children and adults cannot by definition be diagnosed by conventional radiographs. These injuries are usually recognized as bone marrow edema by magnetic resonance imaging (MRI). There are no randomized controlled trials or prospective cohort studies concerning the correct management of occult fractures and, therefore, no evidence-based treatment guidelines can be drafted. OBJECTIVES: This article summarizes the current diagnostic and treatment concepts for occult fractures under special consideration of foot and ankle injuries...
March 2015: Der Unfallchirurg
Yoon-Hae Kwak, Jae-Young Lim, Min-Kyung Oh, Woo-Jin Kim, Kun-Bo Park
BACKGROUND: Skeletally immature children with ankle sprain are presumed to have distal fibula fracture than ligamentous injury. The purpose of this study is to determine the incidence of associated occult avulsion fracture in children with lateral ankle sprain and the efficacy of identifying fractures using anterior talofibular ligament view. METHODS: Patients who were diagnosed with distal fibular fracture in the initial ankle anteroposterior, lateral, and mortise were excluded and 78 patients (below 16 y of age) who had been initially diagnosed as ankle sprain were included...
June 2015: Journal of Pediatric Orthopedics
Abolfazl Najaf-Zadeh, Eric Nectoux, François Dubos, Laurent Happiette, Xavier Demondion, Magloire Gnansounou, Bernard Herbaux, Alain Martinot
BACKGROUND AND PURPOSE: Plain radiographs may fail to reveal an ankle fracture in children because of developmental and anatomical characteristics. In this systematic review and meta- analysis, we estimated the prevalence of occult fractures in children with acute ankle injuries and clinical suspicion of fracture, and assessed the diagnostic accuracy of ultrasound (US) in the detection of occult fractures. METHODS: We searched the literature and included studies reporting the prevalence of occult fractures in children with acute ankle injuries and clinical suspicion of fracture...
September 2014: Acta Orthopaedica
Marie Askenberger, Wilhelmina Ekström, Thröstur Finnbogason, Per-Mats Janarv
BACKGROUND: Hemarthrosis after acute knee trauma is a sign of a potentially serious knee injury. Few studies have described the epidemiology and detailed injury spectrum of acute knee injuries in a general pediatric population. PURPOSE: To document the current injury spectrum of acute knee injuries with hemarthrosis in children aged 9 to 14 years and to describe the distribution of sex, age at injury, type of activity, and activity frequency in this population. STUDY DESIGN: Descriptive epidemiology study...
July 2014: American Journal of Sports Medicine
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
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