Notes

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Delayed diagnosis of scaphoid fractures can lead to long-term morbidity. read more 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 (≤10years of age) with acute scaphoid fractures (≤7days), 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±0.6years) 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.
Only 7% of these acute scaphoid fractures in younger children are inconspicuous on the initial radiographic examination.
Literature regarding medial collateral ligament (MCL) injuries is focused on adults with superficial MCL disruptions. However, children follow different injury patterns, with avulsion fractures at ligament attachment sites occurring commonly. Such avulsions have not been characterized for pediatric MCL injuries.

To elucidate imaging findings, and review management and outcomes of pediatric MCL avulsion fractures.

We conducted a 10-year retrospective review of knee magnetic resonance (MR) imaging reports for patients younger than 16years old diagnosed with acute MCL avulsion fracture. MR imaging was reviewed to confirm and characterize the components of the avulsion (perichondrium without or with cartilage, and/or bone) and to identify additional knee injuries. Radiographs, if available, from the time of injury were reviewed. Clinical management and patient outcomes were recorded.

Eighteen patients (13 boys, 5 girls) incurred an acute MCL avulsion fracture. All avulsions involved the deep MCL attachmencally occult. MR imaging may be required to recognize these avulsions, which can impact the duration of rest and knee bracing.
Acute screening of pediatric strangulation and hanging injuries has evolved at many institutions to include cervical arterial vascular imaging. As current standards in pediatric imaging support less radiation exposure and increased imaging appropriateness, it is questionable whether vascular arterial injury is a true risk in this population.

To determine the role of cervical vascular arterial imaging in the evaluation of pediatric hanging and strangulation injuries.

This is a retrospective study of patients who present at a Level 1 pediatric trauma center with a history of hanging and strangulation injuries. All relevant studies, including computed tomography (CT) angiography of the neck, contrast-enhanced neck CT, cervical magnetic resonance (MR) angiography, magnetic resonance imaging (MRI) and/or CT of the brain and cervical spine and associated clinical records, were reviewed.

Sixty-six patients were identified, 60 with vascular arterial imaging studies. No vascular injury was identified. Soft-tissue injury was noted in 20/66 (30%) patients and craniocervical injury was suspected in 2/66 (3%), but no cervical spine fracture was identified. Only 49 patients had brain imaging, with 7/49 (14%) demonstrating changes consistent with cerebral edema, which correlated negatively with survival (P<0.01).

Vascular arterial imaging, particularly with CT angiography, performed in the pediatric population after hanging and strangulation injury resulted in no positive studies for cervical arterial injury. This study supports the need to reevaluate routine screening CT angiography in this study population.
Vascular arterial imaging, particularly with CT angiography, performed in the pediatric population after hanging and strangulation injury resulted in no positive studies for cervical arterial injury. This study supports the need to reevaluate routine screening CT angiography in this study population.
Retrospective studies have demonstrated the efficacy and safety of pediatric and adolescent transjugular intrahepatic portosystemic shunt (TIPS), but long-term outcomes warrant further investigation.

To report on the development of hyperplastic hepatic nodular lesion development in children and young adults (<21 years) with TIPS patency >3years.

Eighteen children and young adults, including 10 (55.6%) females and 8 (44.4%) males, underwent TIPS creation with >3years' patency and follow-up evaluation at a tertiary children's hospital. The mean age at the time of TIPS creation was 12.5±5.1 years (range 1.5-20.0years). The mean model for end-stage liver disease (MELD) at the time of TIPS creation was 8.1±1.6 (range 6-11). Indications for TIPS creation included acute variceal bleeding (8/18, 44.4%), primary (1/18, 5.6%) or secondary (7/18, 38.9%) prevention of varices, portal vein thrombosis (1/18, 5.6%), and splenic sequestration (1/18, 5.6%). Technical successes, intra-procedural parameters, hemoplasia-like nodules. The mean follow-up duration was 5.7±2.9years (range 3.0-13.1 years).

Long-term (>3years) portosystemic shunting via TIPS is associated with the development of hepatic nodular lesions in children. Consequently, children with TIPS may need gray-scale assessment of hepatic parenchyma as part of routine ultrasound exams and extended imaging surveillance until more is understood regarding the natural history of induced nodularity.
3 years) portosystemic shunting via TIPS is associated with the development of hepatic nodular lesions in children. Consequently, children with TIPS may need gray-scale assessment of hepatic parenchyma as part of routine ultrasound exams and extended imaging surveillance until more is understood regarding the natural history of induced nodularity.
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