Fujihara Yuki, Tatebe Masahiro, Fujihara Nasa, Tanaka Hiromasa, Hirata Hitoshi
From the *Inazawa Municipal Hospital, Inazawa City; †Hand and Microsurgery Center, Anjo Kosei Hospital, Anjo City; ‡Tsushima Municipal Hospital, Tsushima City; §Shizuoka Saiseikai General Hospital, Suruga Ward, Shizuoka City; and ‖Department of Hand Surgery, Nagoya University School of Medicine, Showaku, Nagoya City, Japan.
Pediatr Emerg Care. 2017 Nov;33(11):e105-e107. doi: 10.1097/PEC.0000000000000899.
The aim of this study was to verify the use of initial plain radiographs, specifically the presence of a longitudinal crack on the olecranon, for diagnosing olecranon occult fractures in children.
We retrospectively reviewed all patients younger than 16 years who were diagnosed with proximal radial fractures treated at our hospital between April 1, 2006 and September 31, 2014. We included 22 patients (9 boys and 13 girls) with a mean age of 8.5 years. Three hand surgeons were blinded to each other's results after examining all the initial radiographs of the injured elbows. To diagnose the fracture, we evaluated computed tomography scans in 9 cases and follow-up radiographs in the other 13 cases. Finally, we classified the fractured olecranon into 3 types: medial crack, posterior flat, and posterior crack.
Twelve cases (54.5%) had associated olecranon fractures. According to the fracture type of the olecranon, 3 cases were a medial crack, 5 were a posterior flat, and 3 were a posterior crack. Each type of fracture had characteristic findings on plain radiographs. The mean value for sensitivity was 97.2% (range, 91.7%-100%), and the specificity was 90.0% (90.0%).
Our data indicated that this easy, noninvasive use of plain radiographs for checking whether a longitudinal crack exists on the olecranon benefits the patient by preventing missed diagnoses of pediatric olecranon fractures.
本研究旨在验证初始X线平片，特别是尺骨鹰嘴纵向裂纹的存在，用于诊断儿童尺骨鹰嘴隐匿性骨折的效用。
我们回顾性分析了2006年4月1日至2014年9月31日在我院接受治疗的所有16岁以下诊断为桡骨近端骨折的患者。我们纳入了22例患者（9名男孩和13名女孩），平均年龄8.5岁。三名手外科医生在检查所有受伤肘部的初始X线片后，相互不知道对方的结果。为了诊断骨折，我们对9例患者进行了计算机断层扫描评估，对另外13例患者进行了随访X线片评估。最后，我们将骨折的尺骨鹰嘴分为3种类型：内侧裂纹、后侧扁平、后侧裂纹。
12例（54.5%）伴有尺骨鹰嘴骨折。根据尺骨鹰嘴的骨折类型，3例为内侧裂纹，5例为后侧扁平，3例为后侧裂纹。每种骨折类型在X线平片上都有特征性表现。敏感性的平均值为97.2%（范围91.7%-100%），特异性为90.0%（90.0%）。
我们的数据表明，这种简单、无创地使用X线平片检查尺骨鹰嘴是否存在纵向裂纹，通过防止漏诊小儿尺骨鹰嘴骨折，对患者有益。
