Fractures

Radiographically occult or equivocal fractures may be assessed with MRI. In general, the findings of bone injury may be subtle on proton-density, T2-weighted, and T2*-weighted sequences and are more conspicuous on T1-weighted, fat-suppressed T2-weighted, or STIR sequences.

FIGURE 4.7. A 16-year-old boy who fell on his outstreched arm now complains of painful limitation of elbow extension. A T2*-weighted gradient-echo sagittal image reveals increased signal (arrow) compatible with a strain of the bra-chialis muscle. Brachialis muscle injury is commonly seen after posterior subluxation or dislocation of the elbow.

FIGURE 4.7. A 16-year-old boy who fell on his outstreched arm now complains of painful limitation of elbow extension. A T2*-weighted gradient-echo sagittal image reveals increased signal (arrow) compatible with a strain of the bra-chialis muscle. Brachialis muscle injury is commonly seen after posterior subluxation or dislocation of the elbow.

Approximately 10% of elbow dislocations result in fractures of the radial head; conversely, about 10% of patients with a radial head fracture have an elbow dislocation.33 Displaced fractures of the radial head are best treated with internal fixation when there is ligamentous disruption and instability.34 CT is the technique of choice when additional information about the fracture morphology or degree of comminution is needed. MRI may detect and characterize radial head fractures and is useful for excluding associated collateral ligament injury that may contribute to instability. The integrity of the MCL is especially important if excision of the radial head is being considered.

MRI may identify or exclude supracondylar fractures in children when radiographic evidence of a joint effusion is present and a fracture is not visualized. In children, supracondylar fractures that do not involve the ph-ysis are more common than all physeal injuries about the elbow combined.35,36 However, the elbow is a relatively common site of physeal injury, occurring most frequently after distal radial and distal tibial physeal fractures are considered.37 Fractures of the lateral humeral condyle are the most common specific type of physeal injury about the elbow. Injury to the physis and the unossified epi-physeal cartilage may be assessed with arthrography or MRI in these cases (Fig. 4.8).37-39 This information is important as Salter-Harris type IV fractures of the lateral

FIGURE 4.8. Salter-Harris type IV fracture of the lateral humeral condyle. A T2*-weighted gradient-echo coronal image of a partially flexed elbow reveals the thin metaphyseal fracture fragment (small arrows) and extension of the fracture through the unossified trochlear epiphysis (large arrow). These fractures may require open reduction and internal fixation. C, capitellum. (Courtesy of Phoebe Kaplan, MD)

FIGURE 4.8. Salter-Harris type IV fracture of the lateral humeral condyle. A T2*-weighted gradient-echo coronal image of a partially flexed elbow reveals the thin metaphyseal fracture fragment (small arrows) and extension of the fracture through the unossified trochlear epiphysis (large arrow). These fractures may require open reduction and internal fixation. C, capitellum. (Courtesy of Phoebe Kaplan, MD)

humeral condyle tend to be unstable and require surgical intervention, whereas Salter-Harris type II fractures can be treated successfully with closed reduction.

Cure Tennis Elbow Without Surgery

Cure Tennis Elbow Without Surgery

Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.

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