■尽管对小儿内侧上髁骨折和上髁炎进行了充分的研究,在该人群中,肘关节内下phy撕脱和韧带损伤的模式值得研究,以告知最佳治疗策略。
■描述儿童和青少年肘部尺侧副韧带(UCL)撕脱伤和软组织损伤的发生和人口统计学相关性。
■横断面研究;证据水平,3.
■进行了机构审查委员会批准的审查,以确定2016年至2021年在三级儿科运动医学实践中连续治疗的内侧肘损伤患者。在损伤评估期间获得了射线照片,排除无移位的内侧上髁突炎和完全上髁骨折的患者,导致150例发生软组织损伤的患者发生在内侧上髁突(下突)远端进行研究。对X线片进行了评估,以评估从近端内侧上髁或远端尺骨上结节对UCL的骨性撕脱。没有骨性撕脱的影像学证据的损伤,但是临床检查结果与韧带损伤一致,被归类为放射学阴性的UCL损伤,如果检查中存在中度至重度肘部内侧肿胀或对内侧结构损伤的严重关注,则进行磁共振成像(MRI)以进一步评估这些损伤。评估这些MRI扫描以对UCL损伤进行分类并评估骨膜或软骨撕脱。
■总共150名患者(平均年龄,12.5±3.4岁;70名女性),55%(150/274)的整个内侧肘损伤人群,有一个下骨软骨损伤。在这些病人中,在X线片上检测到62岁的骨性撕脱,和88有一个影像学阴性损伤。除了62个射线照相撕脱,在影像学阴性损伤上获得的61次MRI扫描显示33次完整的UCL中断,导致63.3%(95/150)的患者完全韧带断裂。有了核磁共振扫描,诊断为UCL的软骨或骨膜撕脱37例(61%)。总的来说,所有150个骨下损伤中有66%有骨质,软骨,或骨膜UCL撕脱。软骨患者(平均年龄,10.3岁)和骨骼(平均年龄,10.6岁)的撕脱比中央韧带损伤的年轻(平均年龄,14.2岁)或骨膜(平均年龄,14.2年)撕脱(P=0.005)。损伤机制与MRI扫描中确定的UCL撕裂位置之间存在显着关联:创伤性跌倒与远端撕裂有关,投掷伤与近端撕裂有关(P<.001)。
■UCL中央韧带和撕脱性病变可在小儿肘关节内侧损伤后频繁诊断,其中大多数是完全受伤,并且可能需要MRI进行诊断。损伤的机制可以预测韧带损伤的位置,与UCL或骨膜的软组织损伤相比,在较年轻的年龄更容易出现骨软骨撕脱。这些损伤的患病率值得进一步研究非手术治疗或手术修复技术的最佳方案和结果。
UNASSIGNED: Although pediatric medial epicondylar fractures and apophysitis are well studied, patterns of subapophyseal
avulsion and ligamentous injuries of the medial elbow in this population merit investigation to inform optimal treatment strategies.
UNASSIGNED: To describe the occurrence and demographic correlates of ulnar collateral ligament (UCL) avulsion and soft tissue injuries of the pediatric and adolescent elbow.
UNASSIGNED: Cross-sectional study; Level of evidence, 3.
UNASSIGNED: An institutional review board-approved review was conducted to identify consecutive patients with medial elbow injuries treated in a tertiary pediatric sports medicine practice between 2016 and 2021. Radiographs were obtained during injury evaluation, and patients with nondisplaced medial epicondylar apophysitis and complete epicondylar fracture were excluded, resulting in 150 patients with soft tissue injuries occurring distal to the medial epicondyle apophysis (subapophyseal) for study. Radiographs were evaluated for bony
avulsion of the UCL from either the medial epicondyle proximally or the ulnar sublime tubercle distally. Injuries without radiographic evidence of bony avulsion, but with clinical examination findings consistent with ligamentous injury, were classified as radiographically negative UCL injuries, and magnetic resonance imaging (MRI) was performed to further evaluate these injuries if moderate to severe medial swelling of the elbow or significant concern for medial structural injury was present on examination. These MRI scans were evaluated to classify the UCL injury and assess for periosteal or cartilaginous avulsions.
UNASSIGNED: A total of 150 patients (mean age, 12.5 ± 3.4 years; 70 female), 55% (150/274) of the entire medial elbow injury population, had a subapophyseal injury. Of these patients, 62 had a bony
avulsion detected on radiograph, and 88 had a radiographically negative injury. In addition to the 62 radiographic avulsions, the 61 MRI scans obtained on those radiographically negative injuries revealed 33 complete UCL disruptions, resulting in 63.3% (95/150) of patients sustaining a complete ligamentous disruption. With the MRI scans, 37 (61%) cases of cartilaginous or periosteal
avulsion of the UCL were diagnosed. Overall, 66% of all 150 subapophyseal injuries had a bony, cartilaginous, or periosteal UCL
avulsion. Patients with cartilaginous (mean age, 10.3 years) and bony (mean age, 10.6 years) avulsions were younger than those with central ligament injury (mean age, 14.2 years) or periosteal (mean age, 14.2 years) avulsions (P = .005). There was a significant association between the mechanism of injury and the location of UCL tear identified on MRI scans: traumatic falls were associated with distal tears, and throwing injuries were associated with proximal tears (P < .001).
UNASSIGNED: UCL central ligament and avulsion lesions may be frequently diagnosed after injury to the pediatric medial elbow, the majority of which are complete injuries, and may require MRI for diagnosis. The mechanism of injury may predict the location of ligamentous injury, and osteocartilaginous avulsions are more likely to present at younger ages than injuries to the soft tissue of the UCL or periosteum. The prevalence of these injuries merits further investigation into best protocols of nonoperative treatment or surgical repair techniques and outcomes.