What Is Unique And What Not To Miss In Paediatric Musculoskeletal Trauma


Professor of Radiology, Paediatric Radiologist. Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands


Fractures constitute 10-25% of all paediatric injuries. They are more common in boys. The most common injury is a fracture of the distal radius whereas femoral neck and trochanteric fractures are amongst the least common fractures. The relatively large and more extensive Haversian canals, together with increased elasticity of the paediatric skeleton often result in typical  paediatric fractures: Torus or buckle fractures, greenstick fractures, plastic bending/bowing fractures and  Toddler fractures. The growth plate is also unique for children. Therefore all fractures that have some relation to the growth plate also are unique for children, e.g.  Salter-Harris fractures, epiphyseal transitional fractures (triplane fractures and Tillaux fractures (figure)) and apophyseal avulsion fractures. A Monteggia fracture dislocation is a fracture of the ulnar shaft and a luxation of the radial head. If an ulnar fracture is present, no matter what type, one should look at the head of the radius for dislocation.The radiocapitellar line, drawn along the center of the radial shaft, should always pass the capitellum on the AP ánd lateral view in normal situations. A Galeazzi fracture dislocation is a fracture of the radial shaft in combination with a dislocation of the distal radioulnar junction. The radial fracture typically involves the middle or distal third of the radius. MRI features of ligamentous and meniscal injuries are more or less similar to those of adults However, meniscal tears are usually vertical in children. Stress along the anterior cruciate ligament that would have resulted in a tear of the ligament in adults may instead avulse the tibial eminence in children and adolescents. A discoid meniscus is a congenital abnormality where the meniscus covers the weight-baring part of the knee joint. It occurs more often at the lateral side and is bilateral in 20% of cases. A discoid meniscus is vulnerable to trauma. Osteochondritis dissecans is a more chronic variety of osteochondral injury and is probably due to repetitive micro-trauma, most frequently seen in boys between 10-15 years of age. In the knee most often the lateral side of the medial femoral condyle is affected. Other common sites are the talus and capitellum.