Subscribe to RSS
DOI: 10.1055/s-0041-1723963
Pediatric Musculoskeletal Trauma: Upper Limb
Abstract
Pediatric upper extremity injuries, acute and chronic due to overuse, are commonly encountered in the clinical setting. However, interpretation of imaging studies is often challenging in pediatric patients because of changing postnatal skeletal development and the broad spectrum of pathology that can potentially occur. This article discusses normal skeletal development and the pathomechanics of skeletal injuries in pediatric patients. It also outlines a framework for imaging as it pertains to the pediatric upper extremity, with specific emphasis on acute and chronic injuries to the shoulder, elbow, forearm, and wrist.
Publication History
Article published online:
21 May 2021
© 2021. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Caine D, DiFiori J, Maffulli N. Physeal injuries in children's and youth sports: reasons for concern?. Br J Sports Med 2006; 40 (09) 749-760
- 2 Rogers LF. The radiography of epiphyseal injuries. Radiology 1970; 96 (02) 289-299
- 3 Micheli LJ, Fehlandt Jr AF. Overuse injuries to tendons and apophyses in children and adolescents. Clin Sports Med 1992; 11 (04) 713-726
- 4 Braithwaite KA, Marshall KW. The skeletally immature and newly mature throwing athlete. Radiol Clin North Am 2016; 54 (05) 841-855
- 5 Hébert KJ, Laor T, Divine JG, Emery KH, Wall EJ. MRI appearance of chronic stress injury of the iliac crest apophysis in adolescent athletes. AJR Am J Roentgenol 2008; 190 (06) 1487-1491
- 6 Delgado J, Jaramillo D, Chauvin NA. Imaging the injured pediatric athlete: upper extremity. Radiographics 2016; 36 (06) 1672-1687
- 7 Zember J, Vega P, Rossi I, Rosenberg ZS. Normal development imaging pitfalls and injuries in the pediatric shoulder. Pediatr Radiol 2019; 49 (12) 1617-1628
- 8 Roedl JB, Morrison WB, Ciccotti MG, Zoga AC. Acromial apophysiolysis: superior shoulder pain and acromial nonfusion in the young throwing athlete. Radiology 2015; 274 (01) 201-209
- 9 Zember JS, Rosenberg ZS, Kwong S, Kothary SP, Bedoya MA. Normal skeletal maturation and imaging pitfalls in the pediatric shoulder. Radiographics 2015; 35 (04) 1108-1122
- 10 Carson Jr WG, Gasser SI. Little Leaguer's shoulder. A report of 23 cases. Am J Sports Med 1998; 26 (04) 575-580
- 11 Nordqvist A, Petersson C. The incidence of fractures of the clavicle. Clin Orthop Relat Res 1994; (300) 127-132
- 12 Gao B, Dwivedi S, Patel SA, Nwizu C, Cruz Jr AI. Operative versus nonoperative management of displaced midshaft clavicle fractures in pediatric and adolescent patients: a systematic review and meta-analysis. J Orthop Trauma 2019; 33 (11) e439-e446
- 13 Cutts S, Prempeh M, Drew S. Anterior shoulder dislocation. Ann R Coll Surg Engl 2009; 91 (01) 2-7
- 14 Bishop JY, Flatow EL. Pediatric shoulder trauma. Clin Orthop Relat Res 2005; (432) 41-48
- 15 Longo UG, Salvatore G, Locher J. et al. Epidemiology of paediatric shoulder dislocation: a nationwide study in Italy from 2001 to 2014. Int J Environ Res Public Health 2020; 17 (08) 1-13
- 16 Gottlieb M. Current approach to the diagnosis and management of shoulder dislocation in children. Pediatr Emerg Care 2018; 34 (05) 357-362
- 17 Lin KM, James EW, Spitzer E, Fabricant PD. Pediatric and adolescent anterior shoulder instability: clinical management of first-time dislocators. Curr Opin Pediatr 2018; 30 (01) 49-56
- 18 Shuster M, Abu-Laban RB, Boyd J. Prereduction radiographs in clinically evident anterior shoulder dislocation. Am J Emerg Med 1999; 17 (07) 653-658
- 19 Reid S, Liu M, Ortega H. Anterior shoulder dislocations in pediatric patients: are routine prereduction radiographs necessary?. Pediatr Emerg Care 2013; 29 (01) 39-42
- 20 Orloski J, Eskin B, Allegra PC, Allegra JR. Do all patients with shoulder dislocations need prereduction x-rays?. Am J Emerg Med 2011; 29 (06) 609-612
- 21 Nelson G, Brown C, Liu RW. No incidence of glenohumeral joint dislocation in a review of 220 paediatric proximal humerus fractures. J Child Orthop 2018; 12 (05) 493-496
- 22 Richards RD, Sartoris DJ, Pathria MN, Resnick D. Hill-Sachs lesion and normal humeral groove: MR imaging features allowing their differentiation. Radiology 1994; 190 (03) 665-668
- 23 Leroux T, Ogilvie-Harris D, Veillette C. et al. The epidemiology of primary anterior shoulder dislocations in patients aged 10 to 16 years. Am J Sports Med 2015; 43 (09) 2111-2117
- 24 Franklin CC, Weiss JM. The natural history of pediatric and adolescent shoulder dislocation. J Pediatr Orthop 2019; 39 (06) (Suppl. 01) S50-S52
- 25 Landin LA. Fracture patterns in children. Analysis of 8,682 fractures with special reference to incidence, etiology and secular changes in a Swedish urban population 1950–1979. Acta Orthop Scand Suppl 1983; 202: 1-109
- 26 Dobbs MB, Luhmann SL, Gordon JE, Strecker WB, Schoenecker PL. Severely displaced proximal humeral epiphyseal fractures. J Pediatr Orthop 2003; 23 (02) 208-215
- 27 Patel B, Reed M, Patel S. Gender-specific pattern differences of the ossification centers in the pediatric elbow. Pediatr Radiol 2009; 39 (03) 226-231
- 28 Jaramillo D, Waters PM. MR imaging of the normal developmental anatomy of the elbow. Magn Reson Imaging Clin N Am 1997; 5 (03) 501-513
- 29 Silberstein MJ, Brodeur AE, Graviss ER, Luisiri A. Some vagaries of the medial epicondyle. J Bone Joint Surg Am 1981; 63 (04) 524-528
- 30 Ho CA, Podeszwa DA, Riccio AI, Wimberly RL, Ramo BA. Soft tissue injury severity is associated with neurovascular injury in pediatric supracondylar humerus fractures. J Pediatr Orthop 2018; 38 (09) 443-449
- 31 John SD, Wherry K, Swischuk LE, Phillips WA. Improving detection of pediatric elbow fractures by understanding their mechanics. Radiographics 1996; 16 (06) 1443-1460 ; quiz 1463–1464
- 32 Iyer RS, Thapa MM, Khanna PC, Chew FS. Pediatric bone imaging: imaging elbow trauma in children—a review of acute and chronic injuries. AJR Am J Roentgenol 2012; 198 (05) 1053-1068
- 33 Skaggs DL, Mirzayan R. The posterior fat pad sign in association with occult fracture of the elbow in children. J Bone Joint Surg Am 1999; 81 (10) 1429-1433
- 34 Al-Aubaidi Z, Torfing T. The role of fat pad sign in diagnosing occult elbow fractures in the pediatric patient: a prospective magnetic resonance imaging study. J Pediatr Orthop B 2012; 21 (06) 514-519
- 35 Rogers LF, Malave Jr S, White H, Tachdjian MO. Plastic bowing, torus and greenstick supracondylar fractures of the humerus: radiographic clues to obscure fractures of the elbow in children. Radiology 1978; 128 (01) 145-150
- 36 Souder CD, Roocroft JH, Edmonds EW. Significance of the lateral humeral line for evaluating radiocapitellar alignment in children. J Pediatr Orthop 2017; 37 (03) e150-e155
- 37 Emery KH, Zingula SN, Anton CG, Salisbury SR, Tamai J. Pediatric elbow fractures: a new angle on an old topic. Pediatr Radiol 2016; 46 (01) 61-66
- 38 Landin LA, Danielsson LG. Elbow fractures in children. An epidemiological analysis of 589 cases. Acta Orthop Scand 1986; 57 (04) 309-312
- 39 Song KS, Kang CH, Min BW, Bae KC, Cho CH. Internal oblique radiographs for diagnosis of nondisplaced or minimally displaced lateral condylar fractures of the humerus in children. J Bone Joint Surg Am 2007; 89 (01) 58-63
- 40 Waters PM, Beaty J, Kasser J. Elbow “TRASH” (the radiographic appearance seemed harmless) lesions. J Pediatr Orthop 2010; 30: 77-81
- 41 Little KJ. Elbow fractures and dislocations. Orthop Clin North Am 2014; 45 (03) 327-340
- 42 Zorrilla S de Neira J, Prada-Cañizares A, Marti-Ciruelos R, Pretell-Mazzini J. Supracondylar humeral fractures in children: current concepts for management and prognosis. Int Orthop 2015; 39 (11) 2287-2296
- 43 Shah AS, Waters PM, Bae DS. Treatment of the “pink pulseless hand” in pediatric supracondylar humerus fractures. J Hand Surg Am 2013; 38 (07) 1399-1403 ; quiz 1404
- 44 Wingfield JJ, Ho CA, Abzug JM, Ritzman TF, Brighton BK. Open reduction techniques for supracondylar humerus fractures in children. J Am Acad Orthop Surg 2015; 23 (12) e72-e80
- 45 Roberts L, Strelzow J, Schaeffer EK, Reilly CW, Mulpuri K. Nonoperative treatment of type IIA supracondylar humerus fractures: comparing 2 modalities. J Pediatr Orthop 2018; 38 (10) 521-526
- 46 Mallo G, Stanat SJC, Gaffney J. Use of the Gartland classification system for treatment of pediatric supracondylar humerus fractures. Orthopedics 2010; 33 (01) 19
- 47 Weiss JM, Graves S, Yang S, Mendelsohn E, Kay RM, Skaggs DL. A new classification system predictive of complications in surgically treated pediatric humeral lateral condyle fractures. J Pediatr Orthop 2009; 29 (06) 602-605
- 48 Nicholson LT, Skaggs DL. Proximal radius fractures in children. J Am Acad Orthop Surg 2019; 27 (19) e876-e886
- 49 Smucny M, Kolmodin J, Saluan P. Shoulder and elbow injuries in the adolescent athlete. Sports Med Arthrosc Rev 2016; 24 (04) 188-194
- 50 Čepelík M, Pešl T, Hendrych J, Havránek P. Monteggia lesion and its equivalents in children. J Child Orthop 2019; 13 (06) 560-568
- 51 Rodríguez-Merchán EC. Pediatric fractures of the forearm. Clin Orthop Relat Res 2005; (432) 65-72
- 52 Herman MJ, Marshall ST. Forearm fractures in children and adolescents: a practical approach. Hand Clin 2006; 22 (01) 55-67
- 53 De Smet AA, Doherty MP, Norris MA, Hollister MC, Smith DL. Are oblique views needed for trauma radiography of the distal extremities?. AJR Am J Roentgenol 1999; 172 (06) 1561-1565
- 54 Jackson ME, Henderson JE. Following trauma, should adult wrist radiographic examinations be two or three projections?. Emerg Radiol 2010; 17 (02) 87-93
- 55 Moosikasuwan JB. The pronator quadratus sign. Radiology 2007; 244 (03) 927-928
- 56 Bae DS. Pediatric distal radius and forearm fractures. J Hand Surg Am 2008; 33 (10) 1911-1923
- 57 Bae DS, Howard AW. Distal radius fractures: what is the evidence?. J Pediatr Orthop 2012; 32 (Suppl. 02) S128-S130
- 58 Pannu GS, Herman M. Distal radius-ulna fractures in children. Orthop Clin North Am 2015; 46 (02) 235-248
- 59 Randsborg PH, Sivertsen EA. Distal radius fractures in children: substantial difference in stability between buckle and greenstick fractures. Acta Orthop 2009; 80 (05) 585-589
- 60 Cannata G, De Maio F, Mancini F, Ippolito E. Physeal fractures of the distal radius and ulna: long-term prognosis. J Orthop Trauma 2003; 17 (03) 172-179 ; discussion 179–180
- 61 Abid A, Accadbled F, Kany J, de Gauzy JS, Darodes P, Cahuzac JP. Ulnar styloid fracture in children: a retrospective study of 46 cases. J Pediatr Orthop B 2008; 17 (01) 15-19
- 62 Little JT, Klionsky NB, Chaturvedi A, Soral A, Chaturvedi A. Pediatric distal forearm and wrist injury: an imaging review. Radiographics 2014; 34 (02) 472-490
- 63 Eberl R, Singer G, Schalamon J, Petnehazy T, Hoellwarth ME. Galeazzi lesions in children and adolescents: treatment and outcome. Clin Orthop Relat Res 2008; 466 (07) 1705-1709
- 64 Noonan KJ, Price CT. Forearm and distal radius fractures in children. J Am Acad Orthop Surg 1998; 6 (03) 146-156
- 65 Anz AW, Bushnell BD, Bynum DK, Chloros GD, Wiesler ER. Pediatric scaphoid fractures. J Am Acad Orthop Surg 2009; 17 (02) 77-87
- 66 Gholson JJ, Bae DS, Zurakowski D, Waters PM. Scaphoid fractures in children and adolescents: contemporary injury patterns and factors influencing time to union. J Bone Joint Surg Am 2011; 93 (13) 1210-1219
- 67 Jaramillo D, Laor T, Zaleske DJ. Indirect trauma to the growth plate: results of MR imaging after epiphyseal and metaphyseal injury in rabbits. Radiology 1993; 187 (01) 171-178
- 68 Laor T, Wall EJ, Vu LP. Physeal widening in the knee due to stress injury in child athletes. AJR Am J Roentgenol 2006; 186 (05) 1260-1264
- 69 Winfeld M, Rosenberg ZS, Wang A, Bencardino J. Differentiating os acromiale from normally developing acromial ossification centers using magnetic resonance imaging. Skeletal Radiol 2015; 44 (05) 667-672
- 70 Roedl JB, Nevalainen M, Gonzalez FM, Dodson CC, Morrison WB, Zoga AC. Frequency, imaging findings, risk factors, and long-term sequelae of distal clavicular osteolysis in young patients. Skeletal Radiol 2015; 44 (05) 659-666
- 71 Paz DA, Chang GH, Yetto Jr JM, Dwek JR, Chung CB. Upper extremity overuse injuries in pediatric athletes: clinical presentation, imaging findings, and treatment. Clin Imaging 2015; 39 (06) 954-964
- 72 Sugimoto H, Ohsawa T. Ulnar collateral ligament in the growing elbow: MR imaging of normal development and throwing injuries. Radiology 1994; 192 (02) 417-422
- 73 Kobayashi K, Burton KJ, Rodner C, Smith B, Caputo AE. Lateral compression injuries in the pediatric elbow: Panner's disease and osteochondritis dissecans of the capitellum. J Am Acad Orthop Surg 2004; 12 (04) 246-254
- 74 Klingele KE, Kocher MS. Little league elbow: valgus overload injury in the paediatric athlete. Sports Med 2002; 32 (15) 1005-1015
- 75 Marshall KW, Marshall DL, Busch MT, Williams JP. Osteochondral lesions of the humeral trochlea in the young athlete. Skeletal Radiol 2009; 38 (05) 479-491
- 76 Bado JL. The Monteggia lesion. Clin Orthop Relat Res 1967; 50: 71-86 . PMID 6029027