PEDIATRIC ELBOW FRACTURES - MRI EVALUATION

Magnetic resonance imaging (MRI) was performed in eight patients under the age of 8 years who suffered elbow fractures, to assess possible f racture extension into the distal nonossified epiphysis of the humerus in seven cases and to determine the displacement and location of the radial head in one case. MRI allowed accurate depiction of the fractur e line when it extended into the cartilaginous epiphysis. In four case s, MRI findings were confirmed at surgery. In five cases, surgery was obviated because no articular extension of the fracture was seen on MR I (4 cases) or because no displacement was noted (1 case). In one pati ent, the plain film diagnosis of a Salter type II fracture was changed to Salter type IV on the basis of the MRI findings. It is concluded t hat MRI might play a role in the preoperative evaluation of pediatric patients presenting with elbow trauma when extension of the fracture c annot be determined with routine radiographic studies. Elbow injuries in children may be difficult to diagnose by routine clinical and radio graphic techniques [1, 4, 12, 14]. Diagnostic difficulty is due to the presence of multiple ossification centers of the distal humeral epiph ysis and proximal radius and ulna; these are mostly cartilaginous unti l the age of 11-12 years and therefore invisible on radiographs. Follo wing distal radial and distal tibial physeal fractures, epiphyseal elb ow injuries are the most frequent epiphyseal injuries [8, 16]. These f ractures tend to be unstable and often require surgical intervention. In addition, lasting sequelae such as cubitus valgus and delayed ulnar nerve palsy can occur if these fractures are not treated properly [8] . Most elbow fractures suspected to be unstable by clinical and radiog raphic evaluation are operated upon without additional imaging. Occasi onally, arthrography or computed arthrography are used to assess epiph yseal extension and cartilaginous malignment [1, 3, 4]. Because of its ability to depict cartilage, MRI provides a noninvasive means of gain ing information regarding the nonossified epiphysis. The purpose of th is article is to present our preliminary experience using magnetic res onance imaging (MRI) for the detection of articular extension of elbow fractures and determination of displacement of fragments.