Early MRI for Pediatric Wrist Injuries—Prospective Case Series of 150 Cases

Abstract

Background Pediatric carpal injuries are a clinical challenge due to their non-specific clinical features and occult nature on plain radiography. We hypothesized that early magnetic resonance imaging (MRI) will allow prompt diagnosis and treatment stratification, and that distal pole fracture of the scaphoid requires a shorter duration of immobilization. This study aims to assess the injury pattern and clinical outcomes of under-16-year-olds treated with acute post-traumatic wrist injuries in accordance with the unit's protocol.

Methods All patients under the age of 16 years treated for suspected pediatric wrist injuries in our tertiary pediatric hand and upper limb service were included. Prospectively collected data included patient demographics, radiological findings, treatment and adherence to the unit's protocol.

Results There were 151 patients with a mean age of 12 years. The majority (72%) had occult bony injury with radiological evidence of fracture on MRI. The sensitivity and specificity of plain film radiography were 42.7% and 71.4%, respectively. Almost one in four patients benefitted from early MRI demonstrating no injuries, permitting early mobilization and discharge. The scaphoid was the most commonly injured carpal bone. Non-displaced fractures of the distal pole of the scaphoid in patients over 10 years old were treated with 4 weeks' immobilization with no adverse outcome.

Conclusion Standardized care in our unit has yielded good results with low complication rate and fewer hospital appointments. Our results support the routine early use of MRI and a shorter duration of immobilization in fracture of the distal pole of the scaphoid at 4 weeks.

Level of Evidence This is a level IV, case series study.

Keywords

carpus - scaphoid - fracture - pediatric - MRI

Note

The study was undertaken at the Birmingham Women and Children's Hospital, Birmingham, United Kingdom.

Publication History

Received: 07 November 2021

Accepted: 13 June 2022

Article published online:
29 September 2022

• References

• 1 Bae DS, Gholson JJ, Zurakowski D, Waters PM. Functional outcomes after treatment of scaphoid fractures in children and adolescents. J Pediatr Orthop 2016; 36 (01) 13-18
• 2 Jørgsholm P, Thomsen N, Besjakov J, Abrahamsson S, Björkman A. MRI shows a high incidence of carpal fractures in children with posttraumatic radial-sided wrist tenderness. Acta Orthop 2016; 87 (05) 533-537
• 3 Kanavaki A, Draenert C, Ceroni D, Hanquinet S. Short MRI protocol for excluding traumatic lesions of the scaphoid bone in children. In Vivo 2016; 30 (04) 495-499
• 4 Ahmed I, Ashton F, Tay WK, Porter D. The pediatric fracture of the scaphoid in patients aged 13 years and under: an epidemiological study. J Pediatr Orthop 2014; 34 (02) 150-154
• 5 Goddard N. Carpal fractures in children. Clin Orthop Relat Res 2005; (432) 73-76
• 6 D'Arienzo M. Scaphoid fractures in children. J Hand Surg [Br] 2002; 27 (05) 424-426
• 7 Pretell-Mazzini J, Carrigan RB. Simultaneous distal radial fractures and carpal bones injuries in children: a review article. J Pediatr Orthop B 2011; 20 (05) 330-333
• 8 Evenski AJ, Adamczyk MJ, Steiner RP, Morscher MA, Riley PM. Clinically suspected scaphoid fractures in children. J Pediatr Orthop 2009; 29 (04) 352-355
• 9 Grenier G, Samora JB. What's new in pediatric wrist fractures?. Oper Tech Orthop 2019; 29 (01) 55-66
• 10 Eckert K, Tröbs RB, Schweiger B, Liedgens P, Radeloff E, Ackermann O. Diagnostically approach to pediatric carpal fractures: a retrospective analysis. Z Orthop Unfall 2016; 154 (01) 43-49
• 11 Wilson EB, Beattie TF, Wilkinson AG. Epidemiological review and proposed management of ‘scaphoid’ injury in children. Eur J Emerg Med 2011; 18 (01) 57-61
• 12 Mallee WH, Wang J, Poolman RW. et al. Computed tomography versus magnetic resonance imaging versus bone scintigraphy for clinically suspected scaphoid fractures in patients with negative plain radiographs. Cochrane Database Syst Rev 2015; (06) CD010023
• 13 Porter J, Chan K, Porter R. The predictive value of clinical scaphoid tenderness for fractures in children. Paediatr Child Health 2015; 20 (05) e92
• 14 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
• 15 Garala K, Taub NA, Dias JJ. The epidemiology of fractures of the scaphoid: impact of age, gender, deprivation and seasonality. Bone Joint J 2016; 98-B [phone]
• 16 Tataria R, Ting J, Jester A, Lindau TR, Oestreich K. Scaphoid fractures below the age of 10: case series and review of the literature. J Wrist Surg 2020; 9 (06) 458-464