Both the CM and associated nerve roots shift consistently and significantly anteriorly when moving from the supine to the lateral position with knees and hips flexed, which may provide a greater margin of safety during neuraxial blockade than might be predicted. However, the absence of significant cranial movement of the CM along the cranio-caudal axis still makes the spinal cord vulnerable to injury during lumbar neuraxial blockade.
The use of MRI in the assessment of the musculoskeletal system in children has important differences from its use in adults. Growth in children has significant impact on the epiphysis and growth plate, which are important structures in the growing child, and there are radiological features that differ from those in adults: disease may alter structures during a period of growth; the pathologies themselves are a distinct group of diseases at variance with adult arthritis and myositis, with a different spectrum of differential diagnoses; and many technical issues are different when imaging a child. These are important considerations in choosing the appropriate imaging. MRI is a powerful and valuable imaging technique in pediatric musculoskeletal pathologies, with considerable potential for future developments to enhance its role in diagnosis, management, and therapeutic intervention for these children.
Fractures of the lateral condyle of the humerus in children are relatively common and can be easily missed on initial plain radiographs especially in the younger age group. We present a case in which diagnosis of this fracture was delayed for five weeks and therefore presented more challenging surgical management. The salient features that were apparent on the initial radiograph at presentation are discussed as is the use of further imaging techniques that may help to clarify the initial diagnosis. This could significantly reduce the risk of serious complications such as chronic pain, deformity and nerve palsy.
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