Haillotte Gregory, Bachy Manon, Delpont Marion, Kabbaj Reda, Ducou le Pointe Hubert, Vialle Raphaël
From the Departments of *Pediatric Orthopaedics and †Pediatric Imaging, Armand Trousseau Hospital, Université Pierre et Marie Curie (Paris 6); and ‡The MAMUTH Hospital-University Department for Innovative Therapies in Musculoskeletal Diseases, Armand Trousseau Hospital, Paris, France.
Pediatr Emerg Care. 2017 Jan;33(1):21-25. doi: 10.1097/PEC.0000000000000996.
Fractures of the lateral humeral condyle are common in children. Nondisplaced fractures are managed with cast immobilization and frequent radiographic follow-up. Possibility of assessing the displacement and stability of such fractures may be helpful in planning the initial treatment and survey. Magnetic resonance imaging (MRI) could be a useful tool in determining the stability of lateral condyle in children. We propose to investigate the use of MRI in such indication.
Fourteen patients presenting with a minimally displaced or nondisplaced fracture were initially treated with a long arm cast and had an MRI within 5 days of injury.
The MRI showed that 10 patients had an incomplete fracture without disruption of the cartilage hinge and 4 patients had a complete fracture with extension of the fracture through the cartilaginous epiphysis into the elbow joint. Three patients with such complete fracture had no evidence of lateral condyle displacement on MRI, and 1 patient had a displacement of the lateral condyle. The patients with incomplete fractures had a conservative treatment. The patient with a complete and displaced fracture had an open reduction and internal fixation. The 3 patients with a complete fracture and no evidence of lateral condyle displacement on MRI had a control MRI, 6 to 10 days after cast application, to detect a secondary displacement of the fracture.
Because it seems difficult in minimally displaced or nondisplaced fractures to detect further displacement with radiographs, MRI was found mandatory to improve complete fracture visualization during the first phase of conservative treatment. In incomplete fractures, initial MRI investigation was consistent with a stable fracture and avoided further early radiographs or clinical survey. In such cases, we recommend a conservative treatment with late radiographs after long arm cast removal. We propose MRI routine use in the early evaluation of minimally displaced or nondisplaced lateral condyle fractures in children.
肱骨外侧髁骨折在儿童中较为常见。无移位骨折采用石膏固定并定期进行影像学随访。评估此类骨折的移位和稳定性对于规划初始治疗和复查可能会有所帮助。磁共振成像（MRI）可能是确定儿童外侧髁稳定性的有用工具。我们建议研究MRI在此类情况下的应用。
14例表现为轻度移位或无移位骨折的患者最初采用长臂石膏固定，并在受伤后5天内进行了MRI检查。
MRI显示，10例患者为不完全骨折，软骨铰链未中断，4例患者为完全骨折，骨折线通过软骨骨骺延伸至肘关节。3例此类完全骨折患者在MRI上无外侧髁移位迹象，1例患者有外侧髁移位。不完全骨折患者采用保守治疗。完全骨折且有移位的患者进行了切开复位内固定。3例完全骨折且在MRI上无外侧髁移位迹象的患者在石膏固定6至10天后进行了对照MRI检查，以检测骨折的继发移位。
由于在轻度移位或无移位骨折中，通过X线片似乎难以检测到进一步的移位，因此发现在保守治疗的第一阶段，MRI对于改善完全骨折的可视化是必不可少的。在不完全骨折中，初始MRI检查结果与稳定骨折一致，避免了进一步的早期X线片检查或临床复查。在这种情况下，我们建议在拆除长臂石膏后进行晚期X线片检查的保守治疗。我们建议将MRI常规用于儿童轻度移位或无移位外侧髁骨折的早期评估。
