Pediatric Distal Forearm and Wrist Injury: An Imaging Review

Abstract

Injuries to the pediatric distal forearm and wrist have myriad manifestations. Growth plate injuries can occur in the skeletally immature child. An unfused growth plate is less robust than ligamentous complexes and therefore is more easily injured. The Salter-Harris fracture classification system is used to grade physeal injuries based on their imaging appearance. This grading has prognostic significance: higher grades imply an increased likelihood of eventual growth disturbance. A disrupted distal radioulnar joint characterizes Galeazzi-type injuries at all ages; however, before skeletal maturity is attained, a disrupted radioulnar joint can manifest as a distal ulnar physeal separation with associated epiphysiolysis of the distal ulna, termed a Galeazzi-equivalent fracture. Bone contusions can be diagnosed using fluid-sensitive fat-suppressed magnetic resonance imaging, and their detection can alter the prognosis. The unique cartilaginous cushion of the developing bony carpus imparts resilience to fracture and dislocation until carpal maturity is reached. Chronic compressive forces to the wrist in a skeletally immature gymnast can result in a distinct pattern of bone and soft-tissue injury referred to as gymnast wrist. If the distal radial physis fuses prematurely, ulnar growth will outpace radial growth, leading to positive ulnar variance and consequent chronic wrist pain from ulnar impaction.

The Primary Physis

“…In some cases, the only finding may be soft tissue swelling centered at the level of the physis. 1,3,[8][9][10] It is for these reasons that the incidence of type I injuries is likely underestimated. Type I injuries carry a low complication rate and typically heal within a matter of weeks with immobilization.…”

“…The epiphysis is not involved. 1,3,5,[7][8][9][10] Type II injuries are the most common, with a relative incidence of 73%, and they usually occur in children > 10 years of age. 7,12 Due to the sometimes subtle nature of the Thurstan-Holland fragment, type II fractures can either be mistaken for type I fractures on radiographs or missed altogether.…”

“…7,12 Due to the sometimes subtle nature of the Thurstan-Holland fragment, type II fractures can either be mistaken for type I fractures on radiographs or missed altogether. 1,3,[8][9][10] As is the case with type I fractures, healing is generally rapid with appropriate closed reduction and immobilization. 11 Salter-Harris type III fractures involve vertical fracture at the intra-articular epiphyseal surface with forces then redirected horizontally through the physis 1,3,5,7-10 (►Fig.…”

Tissue engineering strategy using mesenchymal stem cell-based chitosan scafolds in growth plate surgery: A preliminary study in rabbits

“…Growth plate injury in growing children could produce major problems, causing limb growth arrest leading to limb length discrepancy, angular or rotational mal-alignments [1]. The bony bars produced in the physis may be removed, and then replaced by various materials to reconstitute the continuity of the growth plate [2].…”

Gyermekkori csuklótáji törések diagnosztikája ultrahanggal

“…A pontos diagnózis felállítása az esetek túlnyomó részében röntgen-(RTG-) képalkotással tör-ténik [4,5]. A hagyományos kétirányú RTG-felvétel elhanyagolható egészségügyi kockázatot jelent, ugyanakkor világszerte hangsúlyozott törekvés az ionizáló sugárzás lehetőség szerinti minimalizálása [6,7].…”