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MR Imaging of Acute Trauma of the Elbow

Lister Hospital Stevenage, Hertfordshire, SG1 4AB United Kingdom

We read with interest the recent article by Major and Crawford [1], describing the utility of MR imaging in diagnosing fractures of the elbow in both adults and children. All six of the adult patients described had radiographically occult fractures, and two required surgical treatment.

We have carried out a similar study in a larger group of adult patients and also testify to the usefulness of MR imaging (Burn PR et al., presented at the annual meeting of the Radiological Society of North America, 2000). We prospectively followed up 16 patients who were 16-59 years old. All had pain that persisted after elbow trauma and radiographic findings that showed only a joint effusion. MR imaging of the elbow was performed 1-20 days after injury (bilaterally in one patient) using T1-weighted coronal, T2^*-weighted gradient-echo axial and coronal, and short tau inversion recovery (STIR) coronal sequences. Findings on MR imaging included eight fractures (five radial head fractures, one with a common flexor tendon injury, and three radial neck fractures); one intraarticular loose body (no associated osteochondral injury); three isolated trabecular injuries; and three medial collateral ligament sprains. Findings were normal in two patients. Therefore, MR imaging detected occult fractures in 47% of patients and soft-tissue injury in 24% of patients in our study. Nine additional patients had been recruited for this study, but they failed to keep their appointments for MR imaging, possibly because of improvement in their symptoms. If MR imaging had been performed on the day of presentation in these patients, the overall sensitivity for fracture detection may have been less.

In contrast to Major and Crawford [1], we performed a T1-weighted MR imaging sequence in all subjects and found it to be the preferred sequence for fracture detection. The STIR sequence was optimal for detecting trabecular injury in our study. Our results thus support the utility of MR imaging in assessment of acute elbow trauma in adults, although proportionally fewer fractures were identified in our study compared with that of Major and Crawford.

References

1. Major NM, Crawford ST. Elbow effusions in trauma in adults and children: is there an occult fracture? AJR 2002;178:413 -418[Abstract/Free Full Text]

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Burn, P. R. Articles by Brooks, P. T. Search for Related Content PubMed PubMed Citation Articles by Burn, P. R. Articles by Brooks, P. T. Social Bookmarking                      What's this?