Table Of ContentImagingofPediatricBoneandJointTrauma
Fabio Martino .Claudio Defilippi .Roberto Caudana (Eds.)
Imaging of Pediatric Bone
and Joint Trauma
Forewordby
Carlo Masciocchi
~
Springer
Editors
Fabio Martino Claudio Defilippi
Radiology Department Pediatric RadiologyService
Policlinico -Giovanni XXI1IHospital Regina Margherita Children'sHospital
Bari,Italy Turin,Italy
Roberto Caudana
Medical Imaging Service
Milan,Italy
Thecontentsofthisbookarebasedon:
Imagingdeltraumaosteo-articolareinetapediatrica.F. Martino,C. Defilippi,R.Caudana(Eds.)
©Springer-Verlag Italia2009
ISBN978-88-470-1654-5 e-ISBN978-88-470-1655-2
DOl10.1007/978-88-470-1655-2
SpringerMilan Dordrecht HeidelbergLondonNewYork
LibraryofCongress ControlNumber:20I0924122
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Foreword
The role ofdiagnostic imaging in the evaluation of fractures and soft-tissue injuries in
skeletally immature patients continues to evolve as the techniques increasingly enable
detection and characterization ofabnormalities and provide results that affect decisions
about patientcare.
Written by the leaders in the field, Imaging of Pediatric Bone and Joint Trauma
answers the questions arising inthe diagnosis ofthese conditions, which are peculiar to
patientswho arestillgrowing,andoffersa valuableandcomprehensivetool toallthose
called to prevent the often disabling deformities that are secondary to these conditions,
andmaybeobserved inadults.
The chaptersareideallydividedintothreeparts,andofferanaccurate,complete,and
updatedanalysisofthedifferentlocations,multiplelesions,anddramaticconsequencesof
these injuries onother partsofthebody.
Forits didactic value, the volume will certainly meet the requirements of the reader
and willparticularlyappealto radiologists who willturn toitduring theirdailywork.
Mywarmestcongratulationsgototheauthorsandco-authorsforabookthatwillcer
tainlybeagreatsuccess.
L'Aquila,October2010 Carlo Masciocchi
Chiefofthe DepartmentofRadiology
Universityof1.,'Aquila
Past-Presidentofthe European SocietyofMusculoskeletal Radiology(ESSR)
v
Preface
Acute and chronic orthopedic injuries in children are unique in terms ofthe mecha
nisms ofinjury, pathophysiology, and healing. In fact, because ofthe dynamic state
ofgrowth anddevelopment,patternsofskeletalinjury in children arefrequently dif
ferent in type and presentation from those in adults, and so often require different
diagnostic and treatment algorithms.Theroleofdiagnostic imagingintheevaluation
of fractures and soft-tissue injuries in skeletally immature patients continues to
evolve,asthetechniquesincreasinglyenabledetection and characterization ofabnor
malities and provide resultsthat affect decisions about patient care.
Theaim ofthisvolume istouseapractical approachto providean up-to-dateand
comprehensive text on the all important aspects ofmusculoskeletal trauma imaging
in children and adolescents. Accidental trauma, chronic and sport-related injuries,
birth fractures, and battered child are described and illustrated, highlighting corre
sponding features in imaging,and providing anoverview offindingsinthedifferent
anatomical sites ofthe body.
Rome, October2010 Fabio Martino
Claudio Defilippi
Roberto Caudana
vii
Contents
MajorTraumatic Boneand Joint Injuries: Overview .
F. Martino,L. Falcone, M.lndolfi,M. MatarazzoandG.Martino
1.1 Introduction. ............................................ I
1.2 Development andGrowth ofBones. .......................... 3
1.3 Characteristics oftheGrowing Skeleton. ...................... 6
1.4 Fracturesandthe Healing Process:Clinicaland
Radiological Evaluation .................................... 7
1.5 TypicalOsteo-traumatie Lesionsofthe ImmatureSkeleton 9
1.5.1 Complete Fractures 10
1.5.2 Plastic Deformation ....................................... 12
1.5.3 "Torus"-type Fracture ...................................... 13
1.5.4 "Green-stick" Fracture. .................................... 14
1.5.5 Metaphyseal-epiphyseal Fractures(ofthe Physeal Plate) 14
1.5.6 Apophyseal Detachments ................................... 21
1.6 Imaging inthe Follow-up ................................... 24
1.7 Fractureand/or Dislocation Reduction- Synthesis- Consolidation . 24
I.7.1 GrowthArrest ............................................ 27
1.8 The RoleofDiagnostic Imaging 28
1.8.1 ConventionalRadiology .................................... 28
1.8.2 Ultrasonography .......................................... 29
1.8.3 ComputedTomography(CT) .. .............................. 30
1.8.4 Magnetic Resonance Imaging 31
Suggested Readings 32
2 Micro-traumatic LesionsCaused byOveruse: Overview 35
C.Defilippi,P. PautassoandC.Faletti
2.1 Introduction. ............................................ 35
2.1.1 Stress Fractures 37
ix
Contents
2.1.2 OsteochondrosisandOsteochondritis Dissecans ................. 39
2.1.3 Osteochondritis. .......................................... 41
2.1.4 Chronic Lesionsofthe Physis 43
2.2 The Upper Limb. ......................................... 43
2.2.1 Little LeagueShoulder ..................................... 43
2.2.2 Osteochondrosisofthe HumeralCondyle(panner Disease) ........ 44
2.2.3 Osteochondritis DissecansoftheHumeralCondyle .............. 44
2.2.4 Little League ElbowSyndrome .............................. 45
2.2.5 OsteochondritisoftheOlecranonApophysis.................... 45
2.3 The LowerLimb. ......................................... 46
2.3.1 OsteochondrosisoftheEpiphysealNucleusoftheFemur
(Legg-Calve-Perthes Disease)............................... 46
2.3.2 EpiphysiolysisoftheEpiphysealNucleusoftheFemoralHead. .... 46
2.3.3 Osteochondritis Dissecansofthe FemoralCondyle
(KonigSyndrome) 46
2.3.4 OsteochondritisoftheInferiorPoleofthe Patella
(Sinding-Larsen-JohanssonSyndrome) 46
2.3.5 OsteochondritisoftheAnteriorTibialApophysis
(Osgood-SchlatterDisease) ................................. 47
2.3.6 ShinSplints 47
2.3.7 OsteochondritisDissecansoftheTalus ...... .... ... ...... ... .. 47
2.3.8 OsteochondritisoftheCalcanealApophysis (Sever Disease) .. .... . 47
2.3.9 OsteochondritisoftheApophysisofthe Baseofthe Fifth Metatarsal
(Iselin Disease) ........................................... 48
2.3.10 Osteochondrosisofthe Headofthe Second Metatarsal
(Freibergor KoehlerIIDisease) 48
Suggested Readings 48
3 OsteoarticularTraumain the PediatricAge:
Overview - ApophysealInjuries 49
M.Valle,A.Tagliafico,L.Oppezzi,N.Gandolfo,P.TomaandC. Martinoli
3.1 Introduction 49
3.2 Tendons................................................. 50
3.2.1 Pathophysiology .......................................... 50
3.2.2 Imaging................................................. 52
3.2.3 ChronicApophysealLesionsDuetoTendonTraction ............. 53
3.2.4 AcuteApophysealLesionsfromTendonTraction ................ 56
3.3 Ligaments ............................................... 64
3.3.1 Apophyseal InjuriesDueto LigamentTraction .................. 65
Suggested Readings 67
xi
Contents
4 Major andMinor PediatricTraumatic Musculotendinous Injuries 69
E.Genovese,A.Leonardi,L. Callegari,M.G.Angeretti,
M.Albrizio,E.SpanoandC.Fugazzola
4.1 Introduction. ............................................ 69
4.2 The RoleofImaging inDetection ............................ 69
4.3 Muscolar Lesions. ........................................ 71
4.3.1 Muscular Distractive Lesions ... .... .... ... .... .... ..... .... . 71
4.3.2 Muscolar Contusions 74
4.3.3 Complicationsand Follow-up 74
4.4 Tendon Lesions........................................... 75
4.4.1 Tendinopathy. ........................................... 75
4.4.2 InsertionalTendinopathies(Enthesopathies) 76
4.4.3 Bursitis ................................................. 78
4.4.4 TendinousRuptures 78
4.5 AbnormalitiesofLigaments................................. 78
4.5.1 Extra-articularLigaments................................... 78
4.5.2 Intra-articular Ligaments 80
Suggested Readings 81
5 Traumatic Lesions ofthe Peripheral Nerves 83
E.Paeeiani, F.Randisi,C.Orazi,M.ValleandC.Martinoli
5.1 Introduction 83
5.2 UltrasoundScanning 84
5.3 MagneticResonance Imaging 89
Suggested Readings 95
6 Imaging of Regional Injuries:TheAxial Skeleton - the Skull,Vertebral
Column, andThoracic Cage ....................................... 97
C. Fonda,M.Mortilla,C.Cesarini and M.Basile
6.1 The Skull 97
6.1.1 Epidemiology ............................................ 97
6.1.2 OrbitalandNasoethmoid Fractures ........................... 103
6.1.3 Maxillofacial Fractures 105
6.1.4 Mandibular Fractures ...................................... 107
6.1.5 Zygomaticand Maxillary Fractures ........................... 108
6.2 The VertebralColumn 108
6.2.1 Epidemiology ............................................ 108
6.2.2 Radiological Examination 109
xii Contents
6.2.3 EvaluationofSpinalTrauma I10
6.2.4 Pathophysiology 112
6.2.5 Superior Cervical Spine Injuries 114
6.2.6 Occipito-atlanto-axiallnstability 114
6.2.7 Odontoid Process Fractures 115
6.2.8 ExtensionFracturesoftheAtlasandAxis. ..................... I17
6.2.9 FlexionTraumaofthe Inferior CervicalSpine 117
6.2.10 ExtensionTrauma ......................................... I19
6.2.1I Fractures oftheThoracolumbar Spine. ........................ I19
6.3 TheThoracicCage ........................................ 12I
6.3.1 ChestWallInjury ......................................... 121
Suggested Readings 123
7 The Upper Limbs 125
D.Barbuti,E.Pacciani,M.Cirillo,A.Magistrelli and L.Tanturri De Horatio
7.I TheShoulderandArm ..................................... 125
7.2 The Elbowand Forearm .................................... 13I
7.3 The Wrist and Hand 146
Suggested Readings ISO
8 The Pelvis and Lower Limbs lSI
D.Barbuti,E.Pacciani,A.Magistrelli,M.Cirillo,F.Fassariand
L.TanturriDe Horatio
8.1 The Pelvis,Hip,and Femur lSI
8.1.1 Fracturesofthe Pelvis 152
8.1.2 Sacro-coccygeal Fractures 158
8.1.3 Traumatic Luxation ofthe HipinChildren ..................... 159
8.1.4 Fracturesofthe Femur ..................................... 160
8.2 The Kneeand Leg 164
8.2.1 Fracturesofthe Distal Epiphysis ofthe Femur 164
8.2.2 Fracturesofthe Patella ..................................... 166
8.2.3 FracturesoftheTibia .. .................................... 166
8.3 TheAnkle and Foot 169
8.3.1 LesionsoftheAnkle Region 169
8.3.2 Fracturesofthe Foot 173
8.3.3 FracturesoftheAstragalus 174
8.3.4 Fracturesofthe Calcaneus 174
8.3.5 Fracture ofthe Scaphoid 175
8.3.6 Lisfranc Fracture 175
8.3.7 Fracturesofthe Metatarsalsand Phalanges 176
Suggested Readings 177
