E1856. Hide and Seek: Often Missed Pediatric Lower Extremity Fractures and How to Find Them
  1. Kyle Urbanczyk; Baystate Medical Center
  2. Oren Johnson; Baystate Medical Center
In pediatric imaging, radiologists are implored throughout training not to miss the toddler's fracture. However subtle lower extremity fractures abound in the pediatric population, and these may be often missed especially in the absence of clinical localization. The unique differences in pediatric bone can make imaging complicated, but knowledge of these differences can be used to identify important fractures that may be otherwise unnoticed. Early diagnosis of skeletal trauma can be key to preventing complications and getting kids back on their feet.

Educational Goals / Teaching Points
This exhibit is designed to provide a review of the pediatric lower extremity skeletal anatomy and pathology, which is crucial in understanding and anticipating patterns of fracture in the pediatric population. Subtle and often missed fractures will be reviewed with the goal of aiding radiologists in identifying the lesser-known subtleties of pediatric lower extremity imaging.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The importance of understanding pediatric skeletal anatomy cannot be overstated. Microscopic construction of the bone will be reviewed with an emphasis on how fractures may be overlooked if the radiologist is expecting a classic adult pattern of fracture. The exhibit will include recommendations on radiographic technique and how to improve diagnostic sensitivity. Subtle fractures and their clinical importance will be reviewed, with numerous examples including para-apophyseal fractures, Seymour fractures and Cozen fractures. The clinical significance of diagnosing these fractures as early as possible will be stressed; for example, in diagnosing slipped capital femoral epiphysis and avoiding dreaded avascular necrosis.

Identification and diagnosis of the multitude of pediatric lower extremity fractures is critical to achieving positive clinical outcomes. After reviewing the exhibit, readers should recognize the key imaging findings related to each of the discussed fractures and be prepared to communicate and make recommendations when appropriate.