Vernon Matthew Chapman MD, Presenter: Nothing to Disclose

Brian Grottkau MD, Abstract Co-Author: Nothing to Disclose

Maurice Albright MD, Abstract Co-Author: Nothing to Disclose

Diego Jaramillo MD, MPH, Abstract Co-Author: Nothing to Disclose

To evaluate the performance of multidetector CT (MDCT) in assessing for radiographically occult fractures in children with only joint effusions identified on radiographs performed for acute elbow trauma.

Unenhanced MDCT of the elbow with sagittal and coronal reformations was prospectively performed in 14 children (age range 1-14 years, average 7.5) with only joint effusions identified on radiographs performed for acute elbow trauma. All patients were treated according to the current standard of care with casting and follow-up at our orthopedics clinic in 2 to 3 weeks. Repeat radiographs were obtained at that time in 11 of the 14 patients. All 14 MDCT scans were reviewed independently by two blinded readers; reader 1 was a radiology resident and reader 2 was a senior pediatric musculoskeletal radiologist. Readers characterized MDCT studies as positive or negative for fracture. Level of interobserver agreement was determined using the kappa statistic. Both readers then reviewed the MDCT scans of the 11 patients with follow-up radiographs and in consensus characterized them as positive or negative. Follow-up radiographs were reviewed by both readers in consensus and characterized as positive or negative for evidence of a healing fracture. The sensativity and specificity of MDCT for fracture detection was determined in these 11 patients using follow-up radiographs as the reference standard.

Readers 1 and 2 detected fractures in 8 (57%) and 9 (64%) of the 14 total patients, respectively. Interobserver agreement for the detection of fracture using MDCT was excellent (kappa = 0.85). In the 11 patients with follow-up radiographs, the sensativity and specificity of MDCT for detecting fractures were 100% and 57%, respectively. Fractures identified by MDCT included three supracondylar, two radial neck, one lateral condylar, one olecranon and one radial head fracture.

Preliminary data suggest that MDCT of the elbow is an extremely sensitive means of evaluating for radiographically occult fractures in children with only joint effusions on radiographs following acute elbow trauma, with a high level of interobserver agreement among readers of widely varying experience.

Chapman, V, Grottkau, B, Albright, M, Jaramillo, D, Multidetector CT of the Elbow in Pediatric Patients with Post-traumatic Elbow Effusions.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4407622.html