Usefulness of intraoperative arthrogram in the treatment of pediatric fractures.
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Published:
May 12, 2017
Keywords:
Arthrography, trauma, elbow, ankle, children.
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Abstract
The objective of this study is to assess the indications and complications of a consecutive series of children with fractures where intraoperative arthrogram was performed.MethodsWe retrospectively analyzed pediatric patients with fractures of the elbow or ankle treated with intraoperative arthrogram between January 2009 and July 2014. We assessed demographic data, postoperative clinical outcomes (Mayo Clinic and AOFAS scores), radiographic outcome and complications arising from the use of intra-articular contrast material.ResultsTwenty-five patients (16 boys, 9 girls) with an average age of 7.6 years (range 4-15) were evaluated. The average follow-up was 30.1 months. There were 15 patients with elbow fractures and 10 with ankle fractures. According to Mayo Clinic score, results were excellent in 14 patients and good in one patient (average 99; range 85-100). Ten patients with ankle fractures presented excellent results according to AOFAS score (average 98.5; range 95-100). There were no infections or adverse reactions related to the use of contrast. Three patients presented complications unrelated to the use of contrast.ConclusionArthrogram is a simple, low-cost procedure, adds short surgical time and allows better assessment of intraarticular structures for intraoperative decision-making. It is a useful tool that should be taken into account in the treatment of some pediatric fractures.
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Tourn, D. A., & Masquijo, J. J. (2017). Usefulness of intraoperative arthrogram in the treatment of pediatric fractures. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 82(2), 116-123. https://doi.org/10.15417/608
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Clinical Research
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References
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7. Munoz-Ortus JM, Downey-Carmona FJ, Tatay-Diaz A, Farrington DM. Physeal fracture of the distal femur in a newborn: role of arthrography. Am J Orthop (Belle Mead NJ).2013 Feb;42(2):E14-5.
8. Duran JA, Dayer R, Kaelin A, Ceroni D. Intraoperative Arthrography for the Evaluation of Closed Reduction and Percutaneous Fixation of Displaced MacFarland Fractures: An Alternative to Open Surgery. J Pediatr Orthop 2011;31:e1–e5
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10. Javed A, Guichet JM. Arthrography for reduction of a fracture of the radial neck in a child with a non-ossified radial epiphysis J Bone Joint Surg [Br] 2001;83-B:542-3.
11. Tang CW, Skaggs DL, Kay RM. Elbow aspiration and arthrogram: an alternative method. Am J Orthop (Belle Mead NJ) 2001 Mar;30(3):256.
12. Longo UG, Franceschi F, Loppini M. Rating systems for evaluation of the elbow Br Med Bull 2008; 87: 131–161.
13. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int1994;15:349–53.
14. De Jager LT, Hoffman EB. Fracture-Separation Of The Distal Humeral Epiphysis J Bone Joint Surg [Br]1991 ; 73-B:l43-6.
15. Mizuno K, Hirohata K, Kashiwagi D. Fracture-separation of the distal humeral epiphysis in young children. J Bone Joint Surg Am, 1979 Jun; 61 (4): 570 -573.
16. Pring ME. Pediatric radial neck fractures: when and how to fix. J Pediatr Orthop. 2012 Jun;32 Suppl 1:S14-21.
17. Lee DH, Han SB, Park JH, Park SY, Jeong WK, Lee SH. Elbow arthrography in children with an ulnar fracture and occult subluxation of the radial head. J Pediatr Orthop B. 2011 Jul;20(4):257-63
18. Kunkel S, Cornwall R, Little K, Jain V, Mehlman C, Tamai J. Limitations of the radiocapitellar line for assessment of pediatric elbow radiographs. J Pediatr Orthop. 2011 Sep;31(6):628-32. doi: 10.1097/BPO.0b013e3182210988.
19. Ramirez RN, Ryan DD, Williams J, Wren TA, Ibrahim D, Weiss JM, Kay RM, Lightdale-Miric N, Skaggs DL. A line drawn along the radial shaft misses the capitellum in 16% of radiographs of normal elbows. J Pediatr Orthop. 2014 Dec;34(8):763-7.
20. Fader LM, Laor T, Eismann EA, Cornwall R, Little KJ. Eccentric Capitellar Ossification Limits the Utility of the Radiocapitellar Line in Young Children. J Pediatr Orthop. 2015 Feb 26. [Epub ahead of print]
21. Nowicki PD, Duhn R. The Use of Arthrography in Pediatric Orthopaedic Surgery. J Am Acad Orthop Surg 2014;22: 472-481.
22. Lamdan R, Sadun A, Shamir MY. Near fatal air embolus during arthrography of the hip in a baby aged four months. J Bone Joint Surg Br 2007;89(2):240-241.
23. McCauley RG, Wunderlich BK, Zimbler S. Air embolism as a complication of hip arthrography. Skeletal Radiol 1981;6(1): 11-13.
24. Ocantos J, Ardusso LRF, Ballester S, Belloso WH, et Al. Utilización de Medios de Contraste Radiológicos Vasculares. Arch. alerg. inmunol. Clin. 2012;43(3):82-113.
25. Yates C, Sullivan JA. Arthrographic Diagnosis of Elbow Injuries in Children. J Pediatr Orthop. 1987 Jan-Feb; 7 (1): 54-60.
26. Bowakim J, Marti R, Curto A. Elbow septic arthritis in children: clinical presentation and management. J Pediatr Orthop B. 2010 May;19(3):281-4.
27. Petit CJ, Lee BM, Kasser JR, Kocher MS. Operative treatment of intraarticular calcaneal fractures in the pediatric population. J Pediatr Orthop. 2007 Dec;27(8):856-62.
2. Peterson JJ, Bancroft LW. History of Arthrography. Radiol Clin N Am 2009 May 47(3):373-86.
3. Marzo JM, d’Amato C, Strong M,Gillespie R. Usefulness and accuracy of arthrography in management of lateral humeral condyle fractures in children. J Pediatr Orthop 1990;10(3):317-321.
4. Abril JC, Berjano P, Díaz A. Concordance between hip ultrasonography and hiparthrography in the assessment of developmental dysplasia of the hip. J Pediatr Orthop B 1999;8(4):264-267.
5. Milani C, Dobashi ET. Arthrogram in Legg-Calvé-Perthes disease. J Pediatr Orthop 2011; 31(2, suppl):S156-S162.
6. Nowicki PD, Duhn R. The use of arthrography in pediatric orthopaedic surgery. J Am Acad Orthop Surg. 2014 Aug;22(8):472-81.
7. Munoz-Ortus JM, Downey-Carmona FJ, Tatay-Diaz A, Farrington DM. Physeal fracture of the distal femur in a newborn: role of arthrography. Am J Orthop (Belle Mead NJ).2013 Feb;42(2):E14-5.
8. Duran JA, Dayer R, Kaelin A, Ceroni D. Intraoperative Arthrography for the Evaluation of Closed Reduction and Percutaneous Fixation of Displaced MacFarland Fractures: An Alternative to Open Surgery. J Pediatr Orthop 2011;31:e1–e5
9. Zhu AF, Sponseller PD. An undiagnosed fracture of the radial neck in a young child: the radial neck fleck sign: a case report. JBJS Case Connector, 2013 Oct 09;3(4):e97.
10. Javed A, Guichet JM. Arthrography for reduction of a fracture of the radial neck in a child with a non-ossified radial epiphysis J Bone Joint Surg [Br] 2001;83-B:542-3.
11. Tang CW, Skaggs DL, Kay RM. Elbow aspiration and arthrogram: an alternative method. Am J Orthop (Belle Mead NJ) 2001 Mar;30(3):256.
12. Longo UG, Franceschi F, Loppini M. Rating systems for evaluation of the elbow Br Med Bull 2008; 87: 131–161.
13. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int1994;15:349–53.
14. De Jager LT, Hoffman EB. Fracture-Separation Of The Distal Humeral Epiphysis J Bone Joint Surg [Br]1991 ; 73-B:l43-6.
15. Mizuno K, Hirohata K, Kashiwagi D. Fracture-separation of the distal humeral epiphysis in young children. J Bone Joint Surg Am, 1979 Jun; 61 (4): 570 -573.
16. Pring ME. Pediatric radial neck fractures: when and how to fix. J Pediatr Orthop. 2012 Jun;32 Suppl 1:S14-21.
17. Lee DH, Han SB, Park JH, Park SY, Jeong WK, Lee SH. Elbow arthrography in children with an ulnar fracture and occult subluxation of the radial head. J Pediatr Orthop B. 2011 Jul;20(4):257-63
18. Kunkel S, Cornwall R, Little K, Jain V, Mehlman C, Tamai J. Limitations of the radiocapitellar line for assessment of pediatric elbow radiographs. J Pediatr Orthop. 2011 Sep;31(6):628-32. doi: 10.1097/BPO.0b013e3182210988.
19. Ramirez RN, Ryan DD, Williams J, Wren TA, Ibrahim D, Weiss JM, Kay RM, Lightdale-Miric N, Skaggs DL. A line drawn along the radial shaft misses the capitellum in 16% of radiographs of normal elbows. J Pediatr Orthop. 2014 Dec;34(8):763-7.
20. Fader LM, Laor T, Eismann EA, Cornwall R, Little KJ. Eccentric Capitellar Ossification Limits the Utility of the Radiocapitellar Line in Young Children. J Pediatr Orthop. 2015 Feb 26. [Epub ahead of print]
21. Nowicki PD, Duhn R. The Use of Arthrography in Pediatric Orthopaedic Surgery. J Am Acad Orthop Surg 2014;22: 472-481.
22. Lamdan R, Sadun A, Shamir MY. Near fatal air embolus during arthrography of the hip in a baby aged four months. J Bone Joint Surg Br 2007;89(2):240-241.
23. McCauley RG, Wunderlich BK, Zimbler S. Air embolism as a complication of hip arthrography. Skeletal Radiol 1981;6(1): 11-13.
24. Ocantos J, Ardusso LRF, Ballester S, Belloso WH, et Al. Utilización de Medios de Contraste Radiológicos Vasculares. Arch. alerg. inmunol. Clin. 2012;43(3):82-113.
25. Yates C, Sullivan JA. Arthrographic Diagnosis of Elbow Injuries in Children. J Pediatr Orthop. 1987 Jan-Feb; 7 (1): 54-60.
26. Bowakim J, Marti R, Curto A. Elbow septic arthritis in children: clinical presentation and management. J Pediatr Orthop B. 2010 May;19(3):281-4.
27. Petit CJ, Lee BM, Kasser JR, Kocher MS. Operative treatment of intraarticular calcaneal fractures in the pediatric population. J Pediatr Orthop. 2007 Dec;27(8):856-62.