Naranja R J, Gregg J R, Dormans J P, Drummond D S, Davidson R S, Hahn M
Department of Orthopaedics, Children's Hospital of Philadelphia, PA, USA.
Clin Orthop Relat Res. 1997 Sep(342):141-6.
With an expanding application of magnetic resonance imaging in acute musculoskeletal injury, an increasing number of occult traumatic lesions of bone are being identified. The authors describe the entity of fracture without radiographic abnormality, which as the name suggests is a bony injury not apparent on plain radiographs. The clinical significance and potential sequelae have not been defined in the pediatric patient. Accordingly, the purpose of this study is to describe and classify the entity of the pediatric fracture without radiographic abnormality and delineate its importance and appropriate management. Twenty-five children were seen primarily or referred to The Children's Hospital of Philadelphia after having sustained an acute traumatic injury; all refused to bear weight or use their extremity, and all had initial plain radiographs that were interpreted as normal. Subsequent magnetic resonance images of all 25 children showed an occult fracture. These included Salter-Harris fracture Types II (two patients), III (one patient), and IV (three patients), intraosseous epiphyseal fractures (18 patients), and a metaphyseal diaphyseal fracture (one patient). Four patients with intraosseous epiphyseal fractures ultimately sloughed a portion of their articular cartilage, as observed at arthroscopy. The decision to proceed with magnetic resonance imaging in the evaluation of a child who refuses to use an extremity depends on many variables. However, magnetic resonance imaging has proven useful in revealing fractures without radiographic abnormality and in ruling out other pathosis.
随着磁共振成像在急性肌肉骨骼损伤中的应用不断扩大，越来越多隐匿性骨创伤性病变被发现。作者描述了无放射学异常的骨折这一实体，顾名思义，它是一种在平片上不明显的骨损伤。在儿科患者中，其临床意义和潜在后遗症尚未明确。因此，本研究的目的是描述和分类儿科无放射学异常的骨折实体，并阐明其重要性及恰当的处理方法。25名儿童在遭受急性创伤后首先就诊于或被转诊至费城儿童医院；所有患儿均拒绝负重或使用其肢体，且所有患儿最初的平片均被解读为正常。随后，这25名儿童的磁共振成像均显示存在隐匿性骨折。这些骨折包括Salter-HarrisⅡ型骨折（2例）、Ⅲ型骨折（1例）、Ⅳ型骨折（3例）、骨内骨骺骨折（18例）以及干骺端骨干骨折（1例）。在关节镜检查中观察到，4例骨内骨骺骨折患儿最终出现了部分关节软骨脱落。对于拒绝使用肢体的儿童，在评估时决定是否进行磁共振成像检查取决于许多因素。然而，磁共振成像已被证明在揭示无放射学异常的骨折以及排除其他病变方面很有用。
