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Irreducible isolated dislocation of the radial head in a skeletally mature teenager. A case report.

Isolated dislocation of the radial head is an uncommon injury. This injury has been reported in children; in the skeletally mature it is extremely rare. An irreducible dislocation has been previously reported in a young child, but no case has to date been reported in an adult. The present case is reported to demonstrate this rare injury and to suggest a possible explanation for the cause of the irreducibility.

Adolescent↗

Valgus extension overload syndrome and stress injury of the olecranon.

Basic science studies have improved our understanding of the pathomechanics for valgus extension overload and olecranon stress fractures. These disorders result from repetitive abutment of the olecranon into the olecranon fossa combined with valgus torques, resulting in impaction and shear along the posteromedial olecranon. The patient history and physical examination are similar for each disorder. Imaging studies including plain radiographs, computed tomography, MRI or bone scan may be necessary for accurate diagnosis. Clinical and basic science support mandatory and careful assessment of the medial collateral ligament when valgus extension overload is identified and limited debridement of the olecranon when surgery is indicated. For stress fractures that fail nonoperative management, treatment with internal fixation provides good results.

Athletic Injuries↗

Imaging of sports injuries of the upper extremity in children.

Competitive athletics in school-aged children has become the norm rather than the exception. The increased repetitive stresses placed on the upper extremity in a wide variety of sports result in a host of injuries unique to the skeletally immature athlete. This article focuses on a discussion of the more common upper extremity injuries encountered in the child athlete and the role of radiography and MRI in diagnosis and management.

Acute Disease↗

Imaging of upper extremity stress fractures in the athlete.

Although it is much less common than injuries in the lower extremities, an upper extremity stress injury can have a significant impact on an athlete. If an accurate and timely diagnosis is to be made, the clinician must have a high index of suspicion of a stress fracture in any athlete who is involved in a throwing, weightlifting, or upper extremity weight-bearing sport and presents with chronic pain in the upper extremity. Imaging should play an integral role in the work-up of these patients; if initial radiographs are unrevealing, further cross-sectional imaging should be strongly considered. Although a three-phase bone scan is highly sensitive in this regard, MRI has become the study of choice at most centers.

Arm Injuries↗

Upper extremity orthotics in performing artists.

Performing artists are an interesting group of patients with a need to maintain their activity at as high a functional level as possible. Their injuries generally are acute or chronic musculoskeletal overuse injuries, The underlying pathology of myositis, myofascial pain syndrome, tendonitis, capsulitis, and ligament sprain is essentially the same through the entire limb. The entire treatment of these injuries includes appropriate medications such as nonsteroidal anti-inflammatory drugs, proper therapeutic exercises, training in proper performance technique, and the judicious use of properly designed and manufactured othoses. When used as part of the whole treatment regimen, these devices will aid in decreasing pain, inflammation, and contracture formation, and aid in improving flexibility, range of motion, and, most importantly, healing time and full return to performance.

Bursitis↗

Radiology of sports-related injuries.

Participation in organized sports and fitness activity continues to increase in the United States. As a result, more acute bone and soft-tissue injuries are occurring in this patient population. Chronic overuse syndromes are also more common today. It is important for radiologists to understand the mechanism of injury so that they can properly approach the imaging of these patients. Although magnetic resonance imaging (MRI) is frequently the technique of choice, other imaging methods are also important and may, in certain cases, be preferred to MRI. In this review, we discuss extremity injuries by anatomic region. The spine is not included. A tailored imaging approach to each anatomic region and type of injury is discussed.

Ankle Injuries↗

Major replantation versus revision amputation and prosthetic fitting in the upper extremity: a late functional outcomes study.

The functional outcomes of amputated arms that were either replanted or had a prosthesis were compared. In addition, factors that influenced the functional outcome of replants were evaluated. The Carroll test was used to evaluate functional capacity of 22 successful upper extremity replantations at or proximal to the wrist as well as 22 amputees (at similar levels) fitted with a variety of prosthetic devices. The outcome was excellent or good in 8 (36%) replanted limbs. This proportion was statistically higher than those grades in the prosthetic group. When the groups were more closely matched (adults with below elbow injuries), the replantation group had 6 (50%) good or excellent outcomes and the prosthetic group had none. An analysis of covariance of the replantations demonstrated a statistical association between a better outcome in younger patients with more distal injuries. This study indicates that replantation produces superior functional results compared with amputation and a prosthesis.

Adolescent↗

[Fall from a height of 13.5 meters of a child without major injuries].

High-velocity traumas, especially falls from a height, are a major cause of morbidity and mortality in children. Despite the height of fall is a poor predictor of major injury, we must be aware of relevant injuries especially of the head and the musculoskeletal system. The aim is to recognize all relevant problems, or better to avoid the fall. We report a case from a fall of 13.5 meters with an ellbow-fracture and contusions of the head.

Female↗