Lower Extremity Injuries in Adults and Children: Evidence-Based Emergency Imaging

Chapter
Part of the Evidence-Based Imaging book series (Evidence-Based Imag.)

Abstract

This chapter focuses on imaging the child, adolescent, and adult presenting with lower extremity trauma from the hip to the toe, with specific attention on conditions that require imaging, as well as the most accepted imaging approach. Lower extremity injuries are common in patients of all ages, particularly in children who are active and involved in activities that place stress on their growing bones. Overuse injuries are far more common in the older child, adolescent, and young adult involved in organized athletic activities, particularly high-impact activities. Pediatric patients are at greater risk of overuse injuries compared to their adult counterparts because growing bones are relatively weak, particularly when the growth plates are unfused. There are a number of lower extremity injuries that are unique to children, which vary depending on the age of the patient and the mechanism of injury. Since there are not (yet) enough studies to support specific imaging recommendations of lower extremity injuries in pediatric patients, this chapter will describe pediatric injuries in more detail while it will discuss injuries affecting adults and older children, for which evidence-based imaging guidelines are available, only briefly.

Keywords

Lower extremity trauma Emergency imaging Evidence-based imaging Pediatric injuries Radiography CT MRI Hip Knee Long bone Ankle Foot 

References

  1. 1.
    Gill KG, Nemeth BA, Davis KW. Magn Reson Imaging Clin N Am. 2014;22:743–63.CrossRefPubMedGoogle Scholar
  2. 2.
    Lambers K, Ootes D, Ring D. Clin Orthop Relat Res. 2012;470:284–90.CrossRefPubMedGoogle Scholar
  3. 3.
    Polinder S, Meerding WJ, van Baar ME, et al. J Trauma. 2005;59:1283–91.CrossRefPubMedGoogle Scholar
  4. 4.
    Bancroft LW, Kransdorf MJ, Adler R, et al. J Am Coll Radiol. 2015;12(6):575–81.CrossRefPubMedGoogle Scholar
  5. 5.
    Mosher TJ, Kransdorf MJ, Adler R, et al. J Am Coll Radiol. 2015;12:221–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Tuite MJ, Kransdorf MJ, Beaman FD, et al. J Am Coll Radiol. 2015;12:1164–72.CrossRefPubMedGoogle Scholar
  7. 7.
    Ward RJ, Weissman BN, Kransdorf MJ, et al. J Am Coll Radiol. 2014;11:114–20.CrossRefPubMedGoogle Scholar
  8. 8.
    McCauley RG, Schwartz AM, Leonidas JC, et al. Radiology. 1979;131:95–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Vanhoenacker FM, Bernaerts A, Gielen J, et al. JBR-BRT. 2002;85:212–8.Google Scholar
  10. 10.
    Pandya NK, Edmonds DW, Roocroft JH, Mubarak SJ. J Pediatr Orthop. 2012;32:749–59.CrossRefPubMedGoogle Scholar
  11. 11.
    Crawford AH. J Pediatric Orthop. 2012;32:S69–73.CrossRefGoogle Scholar
  12. 12.
    Rosenbaum AJ, DiPreta JA, Uhl RL. Orthopedics. 2012;35:1046–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Naranja RJ Jr, Gregg JR, Dormans JP, et al. Clin Orthop Relat Res. 1997;342:141–6.CrossRefGoogle Scholar
  14. 14.
    Endele D, Jung C, Bauer G, Mauch F. Foot Ankle Int. 2012;33:1063–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Cho KH, Lee SM, Lee YH. Suh KJ. Korean J Radiol. 2010;11:84–94.CrossRefPubMedGoogle Scholar
  16. 16.
    Barata I, Spencer R, Suppiah A, et al. Pediatr Emerg Care. 2012;28:1154–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Rosenborg M, Mortensson W. Acta Radiol Diagn. 1986;27:85–9.CrossRefGoogle Scholar
  18. 18.
    Sciarretta JD, Macedo FI, Chung EL, et al. J Trauma Acute Care Surg. 2014;76:1386–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Wojtowycz M, Starshak RJ, Sty JR. Radiology. 1980;136:647–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Jarrett DY, Kramer DE, Callahan MJ, Kleinman PK. Pediatr Radiol. 2013;43:S2–7.CrossRefPubMedGoogle Scholar
  21. 21.
    Hayashi D, Hamilton B, Guermazi A, et al. Insights Imaging. 2012;3:591–601.CrossRefPubMedCentralPubMedGoogle Scholar
  22. 22.
    Grant TH, Kelikian AS, Jereb SE, McCarthy RJ. J Bone Joint Surg Am. 2005;87:1788–94.PubMedGoogle Scholar
  23. 23.
    Khoury V, Guillin R, Dhanju J, Cardinal E. Sem Musculoskel Radiol. 2007;11:149–61.CrossRefGoogle Scholar
  24. 24.
    Stevens MA, El-Khoury GY, Kathol MH, et al. RadioGraphics. 1999;19:655–72.CrossRefPubMedGoogle Scholar
  25. 25.
    Sundar M, Carty H. Skeletal Radiol. 1994;23:85–90.CrossRefPubMedGoogle Scholar
  26. 26.
    Swischuk LE. Emerg Radiol. 2015;20:543–4.CrossRefGoogle Scholar
  27. 27.
    Rossi F, Dragoni S. Skeletal Radiol. 2001;30:127–31.CrossRefPubMedGoogle Scholar
  28. 28.
    De Paulis F, Cacchio A, Michelini O, et al. Eur J Radiol. 1998;27:S49–59.CrossRefPubMedGoogle Scholar
  29. 29.
    Wootton JR, Cross MJ, Holt KWG. J Bone Joint Surg Br. 1990;72:625–7.CrossRefPubMedGoogle Scholar
  30. 30.
    Davis K. Radiol Clin N Am. 2010;48:1213–35.CrossRefPubMedGoogle Scholar
  31. 31.
    Gholve PA, Cameron DB, Millis MB. Curr Opin Pediatr. 2009;21:39–45.CrossRefPubMedGoogle Scholar
  32. 32.
    Peck D. Am Fam Physician. 2010;82:258–62.PubMedGoogle Scholar
  33. 33.
    Aronsson DD, Loder RT, Breuer GJ, Weinstein SL. J Am Acad Orthop Surg. 2006;14:666–79.CrossRefPubMedGoogle Scholar
  34. 34.
    Causey AL, Smith ER, Donaldson JJ, et al. J Emerg Med. 1995;13:175–89.CrossRefPubMedGoogle Scholar
  35. 35.
    Pinkowsky GJ, Hennrikus WL. J Pediatr. 2013;162:804–7.CrossRefPubMedGoogle Scholar
  36. 36.
    Jarrett DY, Matheney T, Kleinman PK. Pediatr Radiol. 2013;43:S71–82.CrossRefPubMedGoogle Scholar
  37. 37.
    Dwek JR. Magn Reson Imaging Clin N Am. 2009;17:509–20.CrossRefPubMedGoogle Scholar
  38. 38.
    Blanchard C, Kushare I, Boyles A, et al.; J Pediatr Orthop 2015.; Epub ahead of print.Google Scholar
  39. 39.
    Hearty T, Swaroop VT, Gourineni P, Robinson L. J Orthop Trauma. 2011;25:e68–73.CrossRefPubMedGoogle Scholar
  40. 40.
    Mayer S, Stewart JR, Fadell MF, et al. Pediatr Radiol. 2015;45:1355–62.CrossRefPubMedGoogle Scholar
  41. 41.
    Laorr A, Greenspan A, Anderson MW, et al. Skeletal Radiol. 1995;24:239–45.CrossRefPubMedGoogle Scholar
  42. 42.
    Novais EN, Hear TC, Hill MK, Mayer SW. J Pediatr Orthop. 2015. Epub ahead of print.Google Scholar
  43. 43.
    Boardman MJ, Herman MJ, Buck B, Pizzutillo PD. J Am Acad Orthop Surg. 2009;17:162–73.CrossRefPubMedGoogle Scholar
  44. 44.
    Spence D, DiMauro JP, Miller PE, et al. J Pediatr Orthop. 2015. Epub ahead of print.Google Scholar
  45. 45.
    Shin AY, Morin WD, Gorman JD, et al. Am J Sports Med. 1996;24:168–76.CrossRefPubMedGoogle Scholar
  46. 46.
    Feldman F, Staron RB. AJR. 2004;183:323–9.CrossRefPubMedGoogle Scholar
  47. 47.
    Schultz E, Miller TT, Boruchov SD, et al. Radiology. 1999;211:237–40.CrossRefPubMedGoogle Scholar
  48. 48.
    Alam A, Willett K, Ostlere S. J Bone Joint Surg Br. 2005;87:1253–5.CrossRefPubMedGoogle Scholar
  49. 49.
    Galloway HR, Meikle GR, Despois M. Australas Radiol. 2004;48:21–4.CrossRefPubMedGoogle Scholar
  50. 50.
    Bogost GA, Lizerbram EK, Crues JV III. Radiology. 1995;197:263–7.CrossRefPubMedGoogle Scholar
  51. 51.
    Lee YP, Griffith JF, Antonio GE, et al. Hong Kong Med J. 2004;10:271–5.PubMedGoogle Scholar
  52. 52.
    Khan SK, Kalra S, Khanna A, et al. Injury. 2009;40:692–7.CrossRefPubMedGoogle Scholar
  53. 53.
    Stiell IG, Wells GA, Hoag RH, et al. JAMA. 1997;278:2075–9.CrossRefPubMedGoogle Scholar
  54. 54.
    Stiell IG, Greenberg GH, Wells GA, et al. Ann Emerg Med. 1995;26:405–12.CrossRefPubMedGoogle Scholar
  55. 55.
    Vijayasankar D, Boyle AA, Atkinson P. Emerg Med J. 2009;26:250–3.CrossRefPubMedGoogle Scholar
  56. 56.
    Bulloch B, Neto G, Plint A, et al. Ann Emerg Med. 2003;42:48–55.CrossRefPubMedGoogle Scholar
  57. 57.
    Moore BR, Hampers LC, Clark RD. J Emerg Med. 2005;28:257–61.CrossRefPubMedGoogle Scholar
  58. 58.
    Smith NC, Parker D, McNicol D. J Pediatr Orthop. 2001;21:600–3.PubMedGoogle Scholar
  59. 59.
    Butcher CC, Hoffman EB. J Pediatr Orthop. 2005;25:145–8.CrossRefPubMedGoogle Scholar
  60. 60.
    Carey J, Spence L, Blickman H, Eustace S. Skeletal Radiol. 1998;27:250–5.CrossRefPubMedGoogle Scholar
  61. 61.
    Close BJ, Strouse PJ. Pediatr Radiol. 2000;30:756–62.CrossRefPubMedGoogle Scholar
  62. 62.
    Lafrance R, Giordano B, Goldblatt J, et al. J Am Acad Orthop Surg. 2010;18:395–405.CrossRefPubMedGoogle Scholar
  63. 63.
    Kijowski R, Blankenbaker DG, Shinki K, et al. Radiology. 2008;248:571–8.CrossRefPubMedGoogle Scholar
  64. 64.
    Kessler JI, Weiss JM, Nikizad H, et al. Am J Sports Med. 2014;42:2165–71.CrossRefPubMedGoogle Scholar
  65. 65.
    Merrow AC, Reiter MP, Zbojniewicz AM, Laor T. Pediatr Radiol. 2014;44:1436–45.CrossRefPubMedGoogle Scholar
  66. 66.
    Jans L, Jaremko J, Ditchfield M, et al. Eur J Rad. 2012;81:3384–9.CrossRefGoogle Scholar
  67. 67.
    Jespersen E, Rexen CT, Franz C, et al. Scand J Med Sci Sports. 2015;25:251–8.CrossRefPubMedGoogle Scholar
  68. 68.
    Puig S, Kuruvilla JC, Ebner L, Endel G. Skeletal Radiol. 2015;44:1427–34.CrossRefPubMedGoogle Scholar
  69. 69.
    Goldman AB, Pavlov H, Rubenstein D. AJR. 1988;151:1163–7.CrossRefPubMedGoogle Scholar
  70. 70.
    Earhart C, Patel DB, White EA, et al. Emerg Radiol. 2013;20:11–23.CrossRefPubMedGoogle Scholar
  71. 71.
    Cannon SR, Pool CJ. Injury. 1983;15:156–8.CrossRefPubMedGoogle Scholar
  72. 72.
    Bennett FS, Zinar DM, Kilgus DJ. Clin Orthop Relat Res. 1993;296:168–77.Google Scholar
  73. 73.
    Müller ME. Unfallheilkunde. 1980;83:251–9.PubMedGoogle Scholar
  74. 74.
    Daffner RH, Weissman BN, Appel M, et al. ACR Appropriateness Criteria®. Stress (fatigue/insufficiency) fracture. http://www.acr.org.
  75. 75.
    Palmu SA, Auro S, Lohman M, et al. Acta Orthop. 2014;85:513–7.CrossRefPubMedCentralPubMedGoogle Scholar
  76. 76.
    Mashru RP, Herman MJ, Pizzutillo PD. J Am Acad Orthop Surg. 2005;13:345–52.CrossRefPubMedGoogle Scholar
  77. 77.
    Tenenbein M, Reed MH, Black GB. Am J Emerg Med. 1990;8:208–11.CrossRefPubMedGoogle Scholar
  78. 78.
    John SD, Moorthy CS, Swischuk LE. RadioGraphics. 1997;17:367–76.CrossRefPubMedGoogle Scholar
  79. 79.
    Hunter TB, Peltier LF, Lund PJ. RadioGraphics. 2000;20:819–36.CrossRefPubMedGoogle Scholar
  80. 80.
    Hinds RM, Tran WH, Lorich DG. Orthopedics. 2014;37:e1040–4.CrossRefPubMedGoogle Scholar
  81. 81.
    Hanson JA, Fotoohi M, Wilson AJ. AJR. 1999;173:702.CrossRefPubMedGoogle Scholar
  82. 82.
    Stiell IG, Greenberg GH, McKnight RD, et al. JAMA. 1993;269:1127–32.CrossRefPubMedGoogle Scholar
  83. 83.
    Bachman LM, Kolb E, Koller MT, et al. BMJ. 2003;326:417.CrossRefGoogle Scholar
  84. 84.
    Stiell I, Wells G, Laupacis A, et al. BMJ. 1995;311:594–7.CrossRefPubMedCentralPubMedGoogle Scholar
  85. 85.
    Leddy JJ, Kesari A, Smolinski RJ. Med Sci Sports Exerc. 2002;34:57–62.CrossRefPubMedGoogle Scholar
  86. 86.
    Myers A, Canty K, Nelson T. Arch Dis Child. 2005;90:1309–11.CrossRefPubMedCentralPubMedGoogle Scholar
  87. 87.
    Dowling SK, Wishart I. CJEM. 2011;13:333–8.CrossRefPubMedGoogle Scholar
  88. 88.
    Boutis K, Constantine E, Schuh S, et al. Acad Emerg Med. 2010;17:709–17.CrossRefPubMedGoogle Scholar
  89. 89.
    Boutis K, Komar L, Jaramillo D, et al. Lancet. 2001;358:2119–21.CrossRefGoogle Scholar
  90. 90.
    Plint AC, Bulloch B, Osmond MH, et al. Acad Emerg Med. 1999;6:1005–9.CrossRefPubMedGoogle Scholar
  91. 91.
    Clark KD, Tanner S. Pediatr Emerg Care. 2003;19:73–8.CrossRefPubMedGoogle Scholar
  92. 92.
    Dowling S, Spooner CH, Liang Y, et al. Acad Emerg Med. 2009;16:277–87.CrossRefPubMedGoogle Scholar
  93. 93.
    Al Omar MZ, Baldwin GA. Emerg Radiol. 2002;9:88–92.CrossRefPubMedGoogle Scholar
  94. 94.
    Bachmann LM, Kolb E, Koller MT. BMJ. 2003;326:417.CrossRefPubMedCentralPubMedGoogle Scholar
  95. 95.
    Rogers LF, Poznanski AK. Radiology. 1994;191:297–308.CrossRefPubMedGoogle Scholar
  96. 96.
    Kump WL. Radiology. 1966;97:676–81.Google Scholar
  97. 97.
    Blackburn EW, Aronsson DD, Rubright JH, Lisle JW. J Bone Joint Surg Am. 2012;94:1234–44.CrossRefPubMedGoogle Scholar
  98. 98.
    Pill SG, Hatch M, Linton JM, Davidson RS. J Bone Joint Surg Am. 2013;95(e115):1–6.Google Scholar
  99. 99.
    Leary JT, Handling M, Talerico M, et al. J Pediatr Orthop. 2009;29(4):356–61.CrossRefPubMedGoogle Scholar
  100. 100.
    Thawrani D, Kuester V, Gabos PG, et al. J Pediatr Orthop. 2011;31:745–50.CrossRefPubMedGoogle Scholar
  101. 101.
    Chung T, Jaramillo D. Radiology. 1995;194:227–32.CrossRefPubMedGoogle Scholar
  102. 102.
    Rachel JN, Williams JB, Sawyer JR, et al. J Pediatr Orthop. 2011;31:548–50.CrossRefPubMedGoogle Scholar
  103. 103.
    Kramer DE, Mahan ST, Hresko MT. J Pediatr Orthop. 2014;34:144–9.CrossRefPubMedGoogle Scholar
  104. 104.
    Park HJ, Cha SD, Kim SS, et al. Clin Radiol. 2012;67:313–8.CrossRefPubMedGoogle Scholar
  105. 105.
    Perrich KD, Goodwin DW, Hecht PJ, Cheung Y. AJR. 2009;193:687–95.CrossRefPubMedGoogle Scholar
  106. 106.
    Nikken JJ, Oei EH, Ginai AZ, et al. Radiology. 2005;234:134–42.CrossRefPubMedGoogle Scholar
  107. 107.
    Melenevsky Y, Mackey RA, Abrahams RB, Thomson NB III. RadioGraphics. 2015;35:765–79.CrossRefPubMedGoogle Scholar
  108. 108.
    Wu Y, Jiang H, Wang B, Miao W. J Pediatr Orthop. 2015. Epub ahead of print.Google Scholar
  109. 109.
    Ha AS, Porrino JA, Chew FS. AJR. 2014;203:492–500.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of RadiologyBoston Children’s HospitalBostonUSA
  2. 2.Department of Diagnostic, Interventional, and Pediatric Radiology, InselspitalUniversity Hospital Bern, University of BernBernSwitzerland
  3. 3.Department of Radiology and NeuroradiologyKlinik im Park, Hirslanden AGZurichSwitzerland

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