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MDCT of the elbow in pediatric patients with posttraumatic elbow effusions
Vernon Chapman1, Brian Grottkau, Maurice Albright
1The Children's Hospital of Denver, 7136 S Hudson Ct., Centennial, CO 80122, USA. vernon.chapman@riaco.com
Insights
Multidetector CT (MDCT) effectively detects subtle elbow fractures in children with effusions, showing high sensitivity and negative predictive value. This imaging can alter clinical management for specific fracture types.
Area of Science:
- Pediatric Radiology
- Orthopedic Imaging
- Diagnostic Imaging
Background:
- Posttraumatic elbow effusions in children can obscure fractures on standard radiographs.
- Accurate fracture detection is crucial for appropriate orthopedic management in pediatric patients.
Purpose of the Study:
- To evaluate the performance of multidetector CT (MDCT) in identifying elbow fractures in children with posttraumatic effusions.
- To determine if MDCT findings influence clinical decision-making and patient management.
Main Methods:
- Prospective study of 31 children (20 months–16 years) with elbow effusions undergoing unenhanced MDCT.
- Independent blinded review of MDCT scans for fracture presence, with kappa statistic for interobserver agreement.
- Calculation of sensitivity, specificity, and predictive values using follow-up radiographs as the reference standard.
Main Results:
- MDCT detected fractures in 52% of children by consensus.
- Excellent interobserver agreement (kappa = 0.85) was observed.
- MDCT demonstrated high sensitivity (92%) and negative predictive value (92%) for fracture detection.
Conclusions:
- MDCT is a sensitive tool for detecting radiographically occult fractures in pediatric elbow injuries with effusions.
- The high negative predictive value of MDCT supports its use in ruling out fractures.
- MDCT findings can lead to changes in treatment for specific fractures, such as nondisplaced lateral condylar and radial head fractures.
Objective:
The purpose of this study was to determine the performance characteristics of MDCT in the detection of fractures in children with posttraumatic elbow effusions and to assess the effect of MDCT findings on clinical management.
Subjects And Methods:
Unenhanced MDCT of the elbow was prospectively performed without sedation on 31 children 20 months to 16 years old who had posttraumatic elbow effusions. Two blinded reviewers independently and in consensus characterized all MDCT scans as positive or negative for the presence of fracture. Level of interobserver agreement was determined with the kappa statistic. Sensitivity, specificity, positive predictive value, and negative predictive value of MDCT for fracture detection were determined for the consensus MDCT interpretations with follow-up radiographs as the reference standard. Patients were treated with casts and instructed to return in 2-3 weeks for clinical and radiographic follow-up unless a change in management was indicated on the basis of MDCT findings. The frequency of alteration of management was determined.
Results:
Both reviewers detected fractures in 15 (48%) of the patients individually and in 16 (52%) of the patients by consensus. Interobserver agreement for fracture detection with MDCT was excellent (kappa = 0.85). The sensitivity, specificity, positive predictive value, and negative predictive value of MDCT in the detection of fractures were 92%, 79%, 79%, and 92%, respectively. Four (13%) of the children had changes in management based on the MDCT findings.
Conclusion:
MDCT is a sensitive means of evaluating for radiographically occult fractures in children with posttraumatic elbow effusions. It has a high negative predictive value and a high level of interobserver agreement. MDCT findings may lead to alteration of treatment of children with nondisplaced lateral condylar and radial head fractures.
