Early MRI for Pediatric Wrist Injuries-Prospective Case Series of 150 Cases

Area of Science:

• Orthopedics
• Pediatric Hand and Upper Limb Surgery
• Radiology

Background:

• Pediatric carpal injuries present diagnostic challenges due to subtle clinical signs and often occult radiographic findings.
• This study investigates injury patterns and outcomes in patients under 16 with acute wrist trauma.
• The hypothesis posits that early MRI improves diagnosis and treatment stratification, and that distal pole scaphoid fractures require shorter immobilization.

Discussion:

• Plain film radiography demonstrates limited sensitivity (42.7%) and specificity (71.4%) for pediatric wrist fractures.
• Early MRI identified injuries in 72% of cases, enabling prompt treatment and preventing unnecessary immobilization.
• Nearly a quarter of patients with suspected injuries were cleared by MRI, allowing early mobilization and discharge.

Key Insights:

• The scaphoid bone is the most frequently injured carpal bone in pediatric patients.
• Non-displaced distal pole scaphoid fractures in patients over 10 years old healed successfully with 4 weeks of immobilization.
• Standardized care protocols resulted in low complication rates and reduced hospital appointments.

Outlook:

• Results support the routine early utilization of magnetic resonance imaging (MRI) for suspected pediatric wrist injuries.
• A shorter immobilization period of 4 weeks is recommended for non-displaced distal pole scaphoid fractures.
• Further research could explore long-term outcomes and refine treatment protocols for specific pediatric carpal injuries.