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[Diagnostically Approach to Pediatric Carpal Fractures: a Retrospective Analysis].

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Diagnosing carpal fractures in children is challenging, often requiring MRI for accurate detection. Prompt immobilization and follow-up are crucial for managing these rare injuries and preventing complications.

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Area of Science:

  • Pediatric Orthopedics
  • Radiology
  • Musculoskeletal Imaging

Background:

  • Carpal fractures in children are uncommon but difficult to diagnose due to nonspecific symptoms and challenging X-ray interpretation.
  • Delayed diagnosis of carpal fractures, particularly scaphoid fractures, can lead to complications like non-union and avascular necrosis.

Purpose of the Study:

  • To discuss a diagnostic approach for pediatric carpal fractures based on a patient cohort.
  • To evaluate the effectiveness of imaging modalities and treatment strategies for suspected carpal fractures in children.

Main Methods:

  • Retrospective analysis of 61 children under 14 with clinically suspected carpal fractures.
  • Initial evaluation included standard X-rays; patients received cast immobilization. MRI was performed for persistent symptoms.
  • Data on fractured carpal bones, X-ray and MRI diagnoses, and recovery times were analyzed.

Main Results:

  • Initial X-rays revealed fractures in only 3.3% of patients, with suspicion in 9.8%.
  • MRI diagnosed carpal fractures in 63% of patients with persistent symptoms, identifying 14 scaphoid fractures and other carpal bone injuries.
  • Complete recovery took a mean of 56 days for fractures versus 15 days for non-fractures; no surgical interventions or complications were noted.

Conclusions:

  • Diagnosis of pediatric carpal fractures is often delayed and challenging, even with clinical suspicion.
  • Generous cast immobilization and early clinical follow-up (within 14 days) are essential.
  • MRI is the preferred imaging modality for persistent symptoms, offering high sensitivity for detecting carpal fractures and bone bruises, thus avoiding unnecessary interventions.