Special Considerations in the Immature Skeleton

Abstract

Box 26.1. Standard radiography • Initial imaging modality for diagnosis of fractures, Salter-Harris fractures or apophyseal avulsion fracture • Knowledge of age-related anatomy of the patients and normal variants is mandatory for correct interpretation• Systematic contralateral views should be discouraged• Some type of stress fractures, particular in complex anatomical areas (e.g., sacrum) may be very diffi cult to detect on standard radiographs 26.1

Sports-related acute and chronic avulsion injuries in children and adolescents with special emphasis on tennis

“…Avulsions due to direct trauma are certainly possible, but the pathogenesis usually consists of an indirect trauma, due to the tearing action exerted by a sudden, violent concentric or eccentric muscle contraction 1 2 8 16 Table 1. summarises the most frequent sports activities responsible for each specific site of involvement: the highest number of lesions are found in soccer players, gymnasts and athletics, but other sports provoking avulsive injuries are tennis, fencing, handball, pentathlon, basketball and so on 2…”

“…Radiographically, areas of bony rarefaction, or even significant lysis can be seen, resembling a more aggressive lesion, such as an infectious or neoplastic process 4 16 27 28. In the healing phase, there can be a mixture of bony lysis and sclerosis 28 29.…”

Scaphoid Cortical Desmoid in a Snowboarder With Persistent Wrist Pain

“…The knowledge of this entity is of high clinical importance, as it may resemble more aggressive processes such as malignancy, leading to unnecessary procedures [3]. ACI is more commonly found in adolescents [4] at the medial supracondylar femur [5]; however, it has also been reported in the deltoid, latissimus dorsi [6], adductor magnus muscles [4], and ischial tuberosity [7]. Here, we report a unique case of scaphoid ACI found incidentally on magnetic resonance imaging (MRI) after a snowboarder experienced continued wrist pain upon falling on an outstretched hand.…”