![]() ![]() ![]() The prevalence of occult fractures in children has been reported to be 2–25% of reviewed cases ( 6). As a result, minor fractures or fractures that are not easily detected (occult fracture) may be missed.Īn occult fracture represents a type of fracture that cannot be detected by radiography or which shows subtle abnormalities that were missed on the initial radiograph, even if the fracture is visualized retrospectively or confirmed by other imaging methods ( 4, 5). ![]() However, interpretation of plain radiographic images of childhood AEI is challenging in comparison to adults, and plain radiographs may fail to reveal a fracture because of a child's developmental and anatomical characteristics, such as the presence of a secondary ossification center, additional areas of ossification, and an open physeal plate ( 3). Pediatric orthopedic surgeons traditionally use plain radiographs to exclude fractures when there is suspicion of a fracture in children with AEI, as whether there is a fracture is the primary concern of parents and clinicians. The diagnosis of fractures involves history and physical examination as well as radiographs. They may constitute up to 90% of orthopedic emergency department (ED) visits and comprise approximately 85% of all injuries to the musculoskeletal system in children ( 1, 2). The highest rate of occult fracture was distal epiphyseal fracture of the tibia and fibula (49/145, 33.8%), but these had a relatively lower prevalence of fractures (145/5,466, 2.65%).Ĭonclusions: We should be aware of the relative high prevalence of occult fractures in the extremities in children, especially when the injured site is in the high incidence area of occult fracture such as ankle.Īcute extremity injuries (AEI) are very common in children. Supracondylar fractures were the most prevalent (2,325/5,466, 42.5%) but had the lowest rate of occult fractures (117/2,325, 5.0%). The prevalence of occult fracture in the extremities was 10.1% (550/5,466). A total of 4,916 fractures of the extremities were confirmed by initial plain radiographs, and 550 occult fractures were confirmed by immediate MRI, immediate CT, or late radiographs. Results: A total of 43,560 pediatric patients meet the inclusion criteria. Prevalence and distribution of occult fracture were recorded. ![]() For patients with concerning history and physical examination but negative initial radiographs, we conducted the following three diagnostic strategies according to the choic of children's parents: immediate MRI scanning, immediate CT scanning, or empiric cast immobilization with orthopedic follow-up radiographs at 2 weeks post-injury (late radiographs). Methods: We conducted a retrospective study to review the medical records of all pediatric patients with AEI in the orthopedic emergency room from January 1, 2017, to December 31, 2019. This study was to assess the prevalence and distribution of occult fracture in children with acute extremities injuries (AEI) and clinical suspicion of fracture. Objective: Diagnosis of occult fractures by initial plain radiographs remains challenging in children in the emergency room. ![]()
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