Little Jason T, Klionsky Nina B, Chaturvedi Abhishek, Soral Aditya, Chaturvedi Apeksha
From the Department of Imaging Sciences, University of Rochester Medical Center and Golisano Children's Hospital, 601 Elmwood Ave, Rochester, NY 14642 (J.T.L., N.B.K., Apeksha Chaturvedi); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (Abhishek Chaturvedi); and Department of Orthopedics, Rungta Hospital, Jaipur, India (A.S.).
Radiographics. 2014 Mar-Apr;34(2):472-90. doi: 10.1148/rg.342135073.
Injuries to the pediatric distal forearm and wrist have myriad manifestations. Growth plate injuries can occur in the skeletally immature child. An unfused growth plate is less robust than ligamentous complexes and therefore is more easily injured. The Salter-Harris fracture classification system is used to grade physeal injuries based on their imaging appearance. This grading has prognostic significance: higher grades imply an increased likelihood of eventual growth disturbance. A disrupted distal radioulnar joint characterizes Galeazzi-type injuries at all ages; however, before skeletal maturity is attained, a disrupted radioulnar joint can manifest as a distal ulnar physeal separation with associated epiphysiolysis of the distal ulna, termed a Galeazzi-equivalent fracture. Bone contusions can be diagnosed using fluid-sensitive fat-suppressed magnetic resonance imaging, and their detection can alter the prognosis. The unique cartilaginous cushion of the developing bony carpus imparts resilience to fracture and dislocation until carpal maturity is reached. Chronic compressive forces to the wrist in a skeletally immature gymnast can result in a distinct pattern of bone and soft-tissue injury referred to as gymnast wrist. If the distal radial physis fuses prematurely, ulnar growth will outpace radial growth, leading to positive ulnar variance and consequent chronic wrist pain from ulnar impaction.
小儿前臂远端和腕部损伤有多种表现形式。骨骼未成熟的儿童可能发生生长板损伤。未融合的生长板比韧带复合体更脆弱，因此更容易受伤。Salter-Harris骨折分类系统用于根据影像学表现对骨骺损伤进行分级。这种分级具有预后意义：分级越高，最终生长紊乱的可能性越大。桡尺远侧关节脱位是各年龄段盖氏骨折的特征；然而，在骨骼成熟之前，桡尺关节脱位可表现为尺骨远端骨骺分离并伴有尺骨远端骨骺溶解，称为类盖氏骨折。骨挫伤可通过液体敏感脂肪抑制磁共振成像诊断，其发现可改变预后。发育中的腕骨独特的软骨垫可赋予骨折和脱位弹性，直至腕骨成熟。骨骼未成熟的体操运动员手腕长期受到压力，可导致一种独特的骨和软组织损伤模式，称为体操运动员腕。如果桡骨远端骨骺过早融合，尺骨生长将超过桡骨生长，导致尺骨正向变异，并因尺骨撞击而产生慢性腕部疼痛。
