SUSPECTED SCAPHOID FRACTURES IN SKELETALLY IMMATURE PATIENTS - APPLICATION OF MRI

Purpose: The purpose of our study was to evaluate the MR findings in t he wrists of pediatric patients who have sustained acute wrist injurie s and to determine if this imaging method yields more information than combined serial radiographs and physical examinations. Method: Eighte en skeletally immature patients (11 boys and 7 girls, age range 8-15 y ears) who had presented to the emergency room within 2 days following acute wrist trauma underwent serial clinical, radiographic, and MR exa minations if there was a suspicion of a scaphoid fracture. Results: Te n patients had a scaphoid abnormality on MR images. Six had fractures and four had regional bone marrow edema. Initially, all but two fractu res were radiographically occult, although the other fractures eventua lly became evident on later studies. Those with marrow edema did not p rogress to fractures. Obliteration of the scaphoid fat stripe occurred in five patients with a scaphoid fracture and in six patients who did not have a fracture. Dorsal soft tissue swelling occurred in eight pa tients, five of whom had scaphoid fractures. Seven patients had eviden ce of extensor tenosynovitis on MRI. Conclusion: A normal initial MR i mage had a negative predictive value of 100%. Persistent snuffbox pain may represent injury to the scaphoid, extensor tendons, or dorsal sof t tissues. An outcome study evaluating the benefits of early applicati on of MR in the pediatric population is warranted.