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Defining occult injuries of the distal forearm and wrist in children

PURPOSE: The nonspecific terms “wrist sprain” and “suspected occult bony injury” are frequently documented as diagnoses in occult paediatric wrist injuries. To date, however, no one has accurately defined their true underlying pathology. The primary objective of this study was to identify the true p...

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Autores principales: Elvey, Michael, Patel, S., Avisar, Erez, White, W. J., Sorene, E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4909650/
https://www.ncbi.nlm.nih.gov/pubmed/27121641
http://dx.doi.org/10.1007/s11832-016-0735-7
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author Elvey, Michael
Patel, S.
Avisar, Erez
White, W. J.
Sorene, E.
author_facet Elvey, Michael
Patel, S.
Avisar, Erez
White, W. J.
Sorene, E.
author_sort Elvey, Michael
collection PubMed
description PURPOSE: The nonspecific terms “wrist sprain” and “suspected occult bony injury” are frequently documented as diagnoses in occult paediatric wrist injuries. To date, however, no one has accurately defined their true underlying pathology. The primary objective of this study was to identify the true pathoanatomy of occult acute paediatric wrist injuries. Our secondary objective was to compare our findings with existing adult data in order to determine any population differences that might be clinically relevant. METHODS: We performed a single-centre retrospective case series evaluating MRI findings in acute paediatric wrist injuries presenting to the hand injury unit between 2011 and 2014. All patients underwent standardised radiographs of the wrist and, where clinically indicated, of the scaphoid. Where no bony anomaly was identified, MRI scanning was offered. Cohen’s kappa coefficient was used to calculate the agreement between clinical and MRI diagnosis. RESULTS: 57 patients met the final inclusion criteria. Occult fractures and bony contusions comprised the majority of the pathologies, at 36.5 and 35.0 %, respectively. There were no cases of isolated soft-tissue injury. MRI effected management change in 35.1 % of cases. Paediatric wrists demonstrated differences in injury pattern and distribution when compared to an adult population. CONCLUSION: This study defines for the first time the true pathology of occult paediatric wrist injuries. The current definition of a wrist sprain was not applicable to a single case and therefore appears to be inappropriate for use in the paediatric population. A precise knowledge of the likely pathology facilitates accurate information delivery whilst reducing parental uncertainty and treatment variation.
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spelling pubmed-49096502016-07-01 Defining occult injuries of the distal forearm and wrist in children Elvey, Michael Patel, S. Avisar, Erez White, W. J. Sorene, E. J Child Orthop Original Clinical Article PURPOSE: The nonspecific terms “wrist sprain” and “suspected occult bony injury” are frequently documented as diagnoses in occult paediatric wrist injuries. To date, however, no one has accurately defined their true underlying pathology. The primary objective of this study was to identify the true pathoanatomy of occult acute paediatric wrist injuries. Our secondary objective was to compare our findings with existing adult data in order to determine any population differences that might be clinically relevant. METHODS: We performed a single-centre retrospective case series evaluating MRI findings in acute paediatric wrist injuries presenting to the hand injury unit between 2011 and 2014. All patients underwent standardised radiographs of the wrist and, where clinically indicated, of the scaphoid. Where no bony anomaly was identified, MRI scanning was offered. Cohen’s kappa coefficient was used to calculate the agreement between clinical and MRI diagnosis. RESULTS: 57 patients met the final inclusion criteria. Occult fractures and bony contusions comprised the majority of the pathologies, at 36.5 and 35.0 %, respectively. There were no cases of isolated soft-tissue injury. MRI effected management change in 35.1 % of cases. Paediatric wrists demonstrated differences in injury pattern and distribution when compared to an adult population. CONCLUSION: This study defines for the first time the true pathology of occult paediatric wrist injuries. The current definition of a wrist sprain was not applicable to a single case and therefore appears to be inappropriate for use in the paediatric population. A precise knowledge of the likely pathology facilitates accurate information delivery whilst reducing parental uncertainty and treatment variation. Springer Berlin Heidelberg 2016-04-27 2016-06 /pmc/articles/PMC4909650/ /pubmed/27121641 http://dx.doi.org/10.1007/s11832-016-0735-7 Text en © The Author(s) 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Clinical Article
Elvey, Michael
Patel, S.
Avisar, Erez
White, W. J.
Sorene, E.
Defining occult injuries of the distal forearm and wrist in children
title Defining occult injuries of the distal forearm and wrist in children
title_full Defining occult injuries of the distal forearm and wrist in children
title_fullStr Defining occult injuries of the distal forearm and wrist in children
title_full_unstemmed Defining occult injuries of the distal forearm and wrist in children
title_short Defining occult injuries of the distal forearm and wrist in children
title_sort defining occult injuries of the distal forearm and wrist in children
topic Original Clinical Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4909650/
https://www.ncbi.nlm.nih.gov/pubmed/27121641
http://dx.doi.org/10.1007/s11832-016-0735-7
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