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Those darn monkey bars
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Those darn monkey bars - March 27, 2005 9:55:00 PM
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Alex Brenner PT MPT OCS
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7 year old female fell from the monkey bars and landed on her right arm. She complains of global wrist and forearm pain. There are two views, here is the first. What are the findings?
All images obtained and used with permission.
[IMG]http://img.photobucket.com/albums/v85/brennerak/wristchild.jpg[/IMG]
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Alex Brenner, PT, MPT, OCS
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Re: Those darn monkey bars - March 28, 2005 1:53:00 AM
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JLS_PT_OCS
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OK, I'll go first...
I believe I see a distal radius fx at epiphyseal plate area and ?maybe one just proximal to that, but hard to be sure.
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Those darn monkey bars - March 28, 2005 2:34:00 AM
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SJBird55
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Without two views or at least a few views, it is difficult for me, especially with kids. The distal radius looks like it is shifted toward the head of the ulna but I can't easily see any fracture lines except maybe on the radius just proximal to the level of the styloid process of the ulna.
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Re: Those darn monkey bars - March 28, 2005 3:20:00 AM
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ehanso
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I agree there appears to be a Distal radial fracture. The next view I am sure will help us alot. Welcome back Alex.
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Re: Those darn monkey bars - March 28, 2005 3:31:00 AM
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Jeep
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My impression: distal radial fracture, proximal to the epiphysis. I am looking at the cortical borders of the radius for this impression. combined with translucency pattern in the same area. Appearance of a break in cortex at the medial aspect of radius, not as apparent on lateral cortical border..
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Re: Those darn monkey bars - March 28, 2005 5:21:00 AM
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jma
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I agree as well. Distal fracture of the radius. However, there seems to be a fragement at the proximal radius. Looks like a mini patella, which of course should not exist there. Does anyone else see it?
JMA
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Re: Those darn monkey bars - March 28, 2005 6:46:00 AM
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JLS_PT_OCS
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Due to the rounded appearance of the "mini patella" that jma mentions, I would think that would be an unfused ossification center or old trauma.
As old as you can get at 7 years old, that is, but perhaps this isn't the child's first fall from the evil monkey bars? Especially since there is no c/o pain there, don't think that's recent.
I find that wiping the petroleum jelly off those bars really helps reduce this type of injury...
:)
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Those darn monkey bars - March 28, 2005 9:20:00 AM
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Jeep
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My impression: Ossification center. It appears @ 3-5 yrs. and fuse @ 14-15 yrs.
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Re: Those darn monkey bars - March 28, 2005 4:53:00 PM
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FLAOrthoPT
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actually in evolutionary studies they have found 7% of the population has a as you call "mini patella" at the elbow like this, typically in females. Much like the presence of palmaris longus, etc, we have some changes in our bodies...
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Re: Those darn monkey bars - March 28, 2005 4:53:00 PM
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FLAOrthoPT
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i just made that up
i was bored
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Re: Those darn monkey bars - March 28, 2005 5:13:00 PM
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jma
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Is that the growth plate at the distal humerus? Or a fracture running transversly? One side looks more separated than the other side. It is not symmetrical on both sides? Interesting.
JMA
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Re: Those darn monkey bars - March 29, 2005 4:11:00 AM
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JLS_PT_OCS
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jma, you're right, that's her epiphysis.
Jeep, thanks for the details on the ossification center, I would have had to look that one up. :)
Unsure on just one view of the distal radius fx, but I have a feeling Alex is withholding the second view because it would be too obvious. This helps us focus more on details, I think.
I am concerned more about the distal radius due to her complaints of pain location, though certainly the distal humerus needs to be examined again when we look at the second view.
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Those darn monkey bars - March 29, 2005 8:20:00 AM
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UTDC
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Distal radius fracture.
Jeff
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Re: Those darn monkey bars - March 31, 2005 4:08:00 AM
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Alex Brenner PT MPT OCS
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View #2 with original view.
[IMG]http://img.photobucket.com/albums/v85/brennerak/WristChild.jpg[/IMG]
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Alex Brenner, PT, MPT, OCS
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Re: Those darn monkey bars - March 31, 2005 4:59:00 AM
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JLS_PT_OCS
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Well, there it is, then.
I think my overall unfamiliarity with pediatric radiology is an issue here...adults look so different.
Good case, thanks Alex.
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Those darn monkey bars - March 31, 2005 6:36:00 AM
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UTDC
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Jason,
I agree, peds imaging is tough. Growth plate (salter harris) injuries can be a very difficult call, I don't think I would attempt it without a radiologist's opinion.
Jeff
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Re: Those darn monkey bars - March 31, 2005 12:00:00 PM
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jma
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Is there a bone fragment in the lateral view just in front of the carpals?
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Re: Those darn monkey bars - March 31, 2005 2:42:00 PM
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Shill
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I believe the bone fragment is no fragment at all, but rather the pisiform.
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Re: Those darn monkey bars - March 31, 2005 5:17:00 PM
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jma
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The pisiform should be in contact with the triquetrum. However there is an apparent gap in the area, which appears very clear in the lateral view. Can a pisiform be displaced?
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Re: Those darn monkey bars - March 31, 2005 9:52:00 PM
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Alex Brenner PT MPT OCS
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Radiologist report: There is a transverse impacted fracture at the distal radial metaphysis with a minimal dorsal angulation.
[IMG]http://img.photobucket.com/albums/v85/brennerak/wristchildfx.jpg[/IMG]
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Alex Brenner, PT, MPT, OCS
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