[Monteggia lesions in children--a clinical trial]. / Monteggia-Verletzungen im Kindesalter.

BACKGROUND: The Monteggia lesion is a rare injury of the elbow in children. This lesion is defined as a shaft fracture of the ulna combined with a luxation of the radial head. The primary problem in this injury is the proper diagnosis because the misalignment of the radial head is often missed. The purpose of this study was to retrospectively analyse the results after Monteggia lesions in children. PATIENTS AND METHODS: Ten children between two and nine years of age (six boys and four girls) were clinically assessed using the Morrey score. They were treated in our department between December 1999 and October 2004. RESULTS: The Morrey score after 54 months (min.: 26/max.: 84) had a median value of 100 points with 100 being the maximum (min.: 95/max.: 100). We found two complications, a combined lesion of the radial and ulnar nerves which completely recovered after six months. In one case a k-wire dislocated, which was removed earlier. DISCUSSION: If the Monteggia lesion in children is correctly diagnosed and treated early enough, only good and very good results may be expected. After delayed diagnosis and treatment, the clinical results are not as good or even very poor.

[What is the value of the whole body spiral CT in the primary radiological imaging of severely injured children?]. / Welchen Stellenwert hat das Ganzkörper-Spiral-CT in der Primärdiagnostik polytraumatisierter Kinder?

AIM: Whole body spiral CT scans have become a routine method in the radiological imaging of severely injured patients in emergency rooms of an increasing number of hospitals. The routine use of CT scans is, however, still discussed controversially, especially with regard to its use in children. This is mainly due to the reportedly higher level of exposure to radiation of CT scans as compared to plain radiographs. The aim of the present study was to compare the dose of exposure to radiation of a whole body CT scan to that of a plain radiograph protocol in an animal model for severely injured children. MATERIAL AND METHODS: We chose 3 female pigs of different weights to serve as a model for children at different ages. 4 film radiation dosimeters (positioned on the eye, under the breast, paravertebrally on the thoracic spine and in the small pelvis, respectively) were implanted into every pig for each examination. Plain radiographs of the chest and the pelvis in one plane and of the skull and the complete spine in two planes were performed. The CT scan included skull, cervical spine and the whole body from the thorax to pelvis. RESULTS: The radiation dose of CT scans was 7 times higher as compared to the X-ray protocol, but the performance of CT scans was faster (8 vs. 18 min). The radiation dose of the whole body CT scan was at about 15 mSv. CONCLUSION: Based on our data and a review of the literature we will use whole body spiral CT scans as the preferred method in the primary radiological imaging of severely injured patients. In our opinion, the evident benefit of a reduced time of imaging in combination with superior image information outweighs the higher level of exposure to radiation.