Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Pediatr Radiol. 2021 Aug;51(9):1690-1695. doi: 10.1007/s00247-021-05052-5. Epub 2021 Mar 30.
Delayed diagnosis of scaphoid fractures can lead to long-term morbidity. While radiography is the preferred screening examination, there is a relative paucity of literature that examines fracture visibility in younger children, who have smaller ossification centers, an abundance of unossified cartilage and fractures that preferentially involve the distal scaphoid.
To characterize acute scaphoid fractures in younger children on radiographs with observer agreement and with respect to fracture location.
This institutional review board (IRB)-approved and Health Insurance Portability and Accountability Act (HIPAA)-compliant cross-sectional study included children (≤10 years of age) with acute scaphoid fractures (≤7 days), who underwent radiographic examinations at a tertiary children's hospital between December 2008 and June 2019. Three readers (two pediatric radiologists and one orthopedic surgeon) reviewed each examination to determine fracture visibility on each radiographic view and fracture location. Kruskal-Wallis, Fisher exact and Cochran-Armitage tests were used to compare fracture visibility and location, and Kappa tests were used to calculate observer agreement.
Twenty-eight children (15 boys, 13 girls; mean age: 9.5±0.6 years) with 10 (36%) distal corner, 11 (39%) distal body and 7 (25%) mid-body fractures, underwent 7 (25%) 4-view, 18 (64%) 3-view and 3 (11%) 2-view examinations. Twenty-six (93%) fractures were visible on at least one view with six (21%) fractures visible on all available views. No significant association was found between fracture visibility and fracture location (P=0.32). Observer agreement was substantial to almost perfect.
Only 7% of these acute scaphoid fractures in younger children are inconspicuous on the initial radiographic examination.
舟状骨骨折的延迟诊断可能导致长期发病。放射摄影是首选的筛查检查，但对于具有较小的骨化中心、大量未骨化软骨以及优先累及舟状骨远端的骨折的年幼儿童，相关文献相对较少。
通过观察者间的一致性以及骨折位置来描述年幼儿童急性舟状骨骨折的影像学特征。
本研究为机构审查委员会（IRB）批准且符合健康保险流通与责任法案（HIPAA）的横断面研究，纳入 2008 年 12 月至 2019 年 6 月期间在一家三级儿童医院接受放射学检查的急性舟状骨骨折（≤7 天）的≤10 岁儿童。3 位读者（2 位儿科放射科医生和 1 位骨科医生）对每一次检查进行评估，以确定每个放射影像视图上的骨折可视性和骨折位置。采用 Kruskal-Wallis、Fisher 确切检验和 Cochran-Armitage 检验比较骨折可视性和位置，采用 Kappa 检验计算观察者间的一致性。
28 例患儿（男 15 例，女 13 例；平均年龄 9.5±0.6 岁）中，10 例（36%）为远端角部骨折，11 例（39%）为远端体部骨折，7 例（25%）为中段体部骨折。7 例（25%）接受了 4 视图检查，18 例（64%）接受了 3 视图检查，3 例（11%）接受了 2 视图检查。26 例（93%）骨折至少在一个视图上可见，6 例（21%）骨折在所有可获得的视图上可见。骨折可视性与骨折位置之间无显著相关性（P=0.32）。观察者间的一致性为高度一致到几乎完全一致。
在这些年幼儿童的急性舟状骨骨折中，仅有 7%的骨折在初始放射学检查中不明显。
