X-ray of fractures in children

From radlines.org
Jump to navigation Jump to search

Author: Mikael Häggström [notes 1]
In patients with remaining growth plates:

Detection

edit
Even if there's an initial obvious fracture, evaluate:

  • Bone contours for disruptions
  • Bone areas for unusual lines that are either hypoattenuating (in case of separation) or hyperattenuating (in case of compression)

Growth plate fractures

Growth plate fractures are also called Salter-Harris fractures.

SALTER mnemonic for classification

Salter-Harris fracture types

The mnemonic "SALTER" can be used to help remember the first five types.[1][2][3]

This mnemonic requires the reader to imagine the bones as long bones, with the epiphyses at the base.

  • I – S = Slip (separated or straight across). Fracture of the cartilage of the physis (growth plate)
  • II – A = Above. The fracture lies above the physis, or Away from the joint.
  • III – L = Lower. The fracture is below the physis in the epiphysis.
  • IV – TE = Through Everything. The fracture is through the metaphysis, physis, and epiphysis.
  • V – R = Rammed (crushed). The physis has been crushed.

Follow-up of fractures

In children, the following timeline of radiologic features is expected:

Features and when they appear (and percentage of individuals having the feature in that period or at that time point)[4]
Resolution of soft tissues 7-10 days (or 2-21 days)
Gap widening 4-6 weeks (56%)
Periosteal reaction 7 days - 7 weeks
Marginal sclerosis 4-6 weeks (85%)
First callus 4-7 weeks (100%)
Radiodensity of callus > cortex 13 weeks (90%)
Bridging callus 2.6 - 13 weeks
Periosteal incorporation 14 weeks
Remodeling 9 weeks (50%)

See also

Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.

References

  1. Davis, Ryan (2006). Blueprints Radiology . ISBN 9781405104609. Retrieved on March 3, 2008. 
  2. . Salter-Harris Fractures. OrthoConsult. Retrieved on 5 February 2017.
  3. Tidey, Brian. Salter-Harris Fractures. Retrieved on March 3, 2008.
  4. Unless otherwise specified in boxes, reference is:
    - Prosser, Ingrid; Lawson, Zoe; Evans, Alison; Harrison, Sara; Morris, Sue; Maguire, Sabine; Kemp, Alison M. (2012). "A Timetable for the Radiologic Features of Fracture Healing in Young Children ". American Journal of Roentgenology 198 (5): 1014–1020. doi:10.2214/AJR.11.6734. ISSN 0361-803X. 
    - Data is taken from scientific studies, notably Islam et al. where data is contradictory to radiology textbooks:
    Islam, Omar; Soboleski, Don; Symons, S.; Davidson, L. K.; Ashworth, M. A.; Babyn, Paul (2000). "Development and Duration of Radiographic Signs of Bone Healing in Children ". American Journal of Roentgenology 175 (1): 75–78. doi:10.2214/ajr.175.1.1750075. ISSN 0361-803X.