Gender differences in the order of appearance of elbow ossification centres.

BACKGROUND: The predictable order of appearance of elbow secondary ossification centres in children is important in interpreting elbow radiographs, most commonly in the context of trauma. The usual sequence of appearance of these ossification centres is given by the acronym CRITOL, but exceptions have been described and are recognised as normal variants. AIM: To investigate the extent to which the appearance of the elbow secondary ossification centres follows a predictable sequence, and to establish the incidence of exceptions to the usual CRITOL order. METHODS: Two-stage retrospective review of 421 elbow radiographs in children at our centre. RESULTS: Of 64 children with two visible ossification centres, there was a 23% overall variant incidence (49 CR, 15 CI). Twenty-eight children had four visible ossification centres, with an overall variant incidence of 32% (19 CRIT, 9 CRIO). The variants were significantly more common in girls than in boys ( p < 0.001). CONCLUSION: Whilst the majority of radiographs remained consistent with the described CRITOL sequence, variance in this order was seen in a quarter of children with two visible ossification centres, and a third of children with four visible ossification centres. Incidence of variance was much more common in girls, reaching statistical significance. Awareness of these normal variations, particularly in girls, should help to avoid misinterpretation.

Neonatal hip septic arthritis: ultrasound should not influence decision to aspirate.

An 18-week-old boy presented to the emergency department with 24-h history of fever and irritability with a painful left hip held in flexion. Blood tests showed an elevated ESR of 65 mm/h, but white cell count and C-reactive protein were in the reference range. Admission hip ultrasound identified a small effusion (<2 mm at the recess), not large enough to determine turbidity. Joint aspiration under general anaesthesia yielded frank pus and mandated open arthrotomy. Physicians must maintain a high index of suspicion of hip septic arthritis irrespective of ultrasound findings and have a low threshold for joint aspiration. Aspiration 'to dryness' would have left substantial pus within the joint and is consistent with advocating arthrotomy and washout in this age group, when the diagnosis of septic arthritis has been made.

Lateral condyle fracture of a child's humerus: the radiographic features may be subtle.

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.

Changing body position alters the location of the spinal cord within the vertebral canal: a magnetic resonance imaging study.

BACKGROUND: The influence of changes in body position relevant to neuraxial blockade on the location of the spinal cord and related neural structures has not been fully quantified. Our aim was to determine the changes, if any, that occur in the location of the spinal cord tip [equivalent to the tip of the conus medullaris (CM)] and nerve roots when an individual moves from the supine to the left lateral position with knees and hips flexed. METHODS: We used magnetic resonance imaging to determine movement of the spinal cord tip and associated structures in 30 adult volunteers. RESULTS: The tip shifted both anteriorly [average 6.3 mm, standard deviation (sd) 2.15 mm; P<0.001] and laterally towards the dependent side (average 1.63 mm, sd 1.19 mm; P<0.001). Although we observed anterior shift in all 30 volunteers, lateral movement did not occur in seven. Movement along the cranio-caudal axis was not statistically significant. CONCLUSIONS: 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.

Radiology cases from the Royal Hospital for Sick Children, Glasgow: biloma as a complication of hepatic transection due to a handlebar injury.

Handlebar type injuries are well documented in the paediatric population. We describe a case complicated by a biloma, which was successfully treated with percutaneous drainage, guided radiologically. The imaging findings including CT, MRI and nuclear medicine techniques are presented.

Currarino triad: characteristic appearances on magnetic resonance imaging and plain radiography.

The Currarino triad is a complex anomaly consisting of an anorectal malformation, a sacral bone defect and a presacral mass. It was first described in 1981 and since then, approximately 250 cases have been reported. Radiology has an important part to play in the diagnosis of this entity, as the imaging features are characteristic. We report a case of Currarino triad in an infant who presented with intractable constipation and discuss relevant MRI and plain radiography findings.

Interventional radiology cases from the royal hospital for sick children, glasgow: percutaneous metal biliary stent placement for palliation of intra-abdominal desmoplastic small round-cell tumour in a child.

Percutaneous placement of metal biliary stents for palliation of malignant processes affecting the porta hepatis is a well established technique in adults. We describe a case where the technique has been used successfully to treat obstructive jaundice in a ten-year-old boy suffering from intra-abdominal desmoplastic small round-cell tumour.

Interventional radiology cases from the Royal Hospital for Sick Children, Glasgow: transcatheter embolisation of post-traumatic hepatic artery pseudoaneurysm and arterioportal fistula.

Percutaneous transcatheter embolisation techniques are being increasingly used in the treatment of post-traumatic bleeding and arteriovenous fistula formation. We describe a case where the technique has been used successfully to treat a combined pseudoaneurysm and arterioportal fistula in the liver of a child following blunt trauma.

Patterns of prehistoric human mobility in polynesia indicated by mtDNA from the Pacific rat.

Human settlement of Polynesia was a major event in world prehistory. Despite the vastness of the distances covered, research suggests that prehistoric Polynesian populations maintained spheres of continuing interaction for at least some period of time in some regions. A low level of genetic variation in ancestral Polynesian populations, genetic admixture (both prehistoric and post-European contact), and severe population crashes resulting from introduction of European diseases make it difficult to trace prehistoric human mobility in the region by using only human genetic and morphological markers. We focus instead on an animal that accompanied the ancestral Polynesians on their voyages. DNA phylogenies derived from mitochondrial control-region sequences of Pacific rats (Rattus exulans) from east Polynesia are presented. A range of specific hypotheses regarding the degree of interaction within Polynesia are tested. These include the issues of multiple contacts between central east Polynesia and the geographically distinct archipelagos of New Zealand and Hawaii. Results are inconsistent with models of Pacific settlement involving substantial isolation after colonization and confirm the value of genetic studies on commensal species for elucidating the history of human settlement.