DOS BULLETIN - Dansk Ortopædisk Selskab

2010-378_DOS nr. 3 2010 29/09/10 10:08 Side 88
MRI findings in childrens wrists after trauma.
A pilot study
Tine Jochewet Ravn Dimon, Pernille Wied Greisen, Jan Schultz Hansen
OUH, Svenborg
Background: Every day we see children in the emergency room with
trauma of the wrist and distal radius. Standard x-ray findings are often
found without fractures despite direct and indirect tenderness of the distal
radius. No literature describing the MRI findings in this group of
patients has been published.
Purpose: Description of the pathology behind distal radius traumas in 7-
13 years old children with no signs of fractures in conventional x-rays by
the use of MRI- scan.
Methods: A pilot study with 21 7-13 years old children was carried out.
The median age was 12 years old. All children included in the study had
a relevant trauma of the wrist or distale radius, as well as direct and indirect
tenderness and no abnormal findings in standard X- rays. Within the
first two days they were offered MRI-scan. Both coronal and sagital T1
recordings and coronal STIR was performed to the traumatized wrist.
STIR/TIRM recordings were performed to the non-traumatizes wrist. In
this manner the non-traumatized wrist functioned as control group.
Findings: All children had normal MRI findings of their non traumatized
controlwrist. 7 children had no abnormalities in the traumatized
wrist. 3 children had undislocated fractures of the distal radius. 3 children
had undislocated os scaphoid fractures. 3 children had oedema of
the distal radius 3 children had oedema of os capitatum or trapezium and
2 had soft tissue oedema.
Conclusion: This pilot study shows that 6/ 21 children had unrecognized
fractures. Another 6/21 had bone oedema and 2/21 soft tissue oedema. It
seems surprising that more than half of the children in this pilot group
that would otherwise be diagnosed with no abnormalities have got bone
affections. We don’t know the clinical consequences of these findings.
Do they have any relevance at all? Are these the same children that
develop chronic wrist pains? Would the MRI- findings be the same in
other bones? And is MRI the golden standard of diagnosing clinical relevant
fractures in children at all? Further studies in the field seem necessary.
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