Arthrography in the diagnosis of fractures of the distal end of the humerus in infants.

The value of MRI in the assessment of an elbow injury in a neonate

“…5 Some authors have described arthrography as the 'method of choice' for such investigations. 6 It is, however, an invasive procedure requiring general anaesthesia and considerable skill in locating the joint in such a small infant. Several studies have examined the role of MRI in the evaluation of skeletal injuries in children.…”

Definitive diagnosis of fracture-separation of the distal humeral epiphysis in neonates by ultrasonography

“…Before the advent of ultrasonography, fracture-separation of the distal humeral epiphysis in newborns was difficult to diagnose [12]. The clinical findings, such as swelling, deformity, instability, and limitation of elbow movements, with a normal grasp reflex, do not always allow a definitive diagnosis [1,14].…”

“…Thus, radiography is inconclusive in distinguishing between dislocation and fracture-separation [6,7,14,15]. Elbow arthrography, which delineates the cartilaginous epiphysis, may demonstrate the injury, but the investigation is invasive and there is a risk of infection [10,12,14,15]. Magnetic resonance imaging is costly and requires anesthesia.…”

Pediatric elbow fractures: MRI evaluation

“…It is concluded that MRI might play a role in the preoperative evaluation of pediatric patients presenting with elbow trauma when extension of the fracture cannot be determined with routine radiographic studies. Elbow injuries in children may be difficult to diagnose by routine clinical and radiographic techniques [1,4,12,14]. Diagnostic difficulty is due to the presence of multiple ossification centers of the distal humeral epiphysis and proximal radius and ulna; these are mostly cartilaginous until the age of 11-12 years and therefore invisible on radiographs.…”

“…Most elbow fractures suspected to be unstable by clinical and radiographic evaluation are operated upon without additional imaging. Occasionally, arthrography or computed arthrography are used to assess epiphyseal extension and cartilaginous malignment [1,3,4]. Because of its ability to depict cartilage, MRI provides a noninvasive means of gaining information regarding the nonossified epiphysis.…”