Purpose
Paediatric hand fractures are common childhood injuries, but in 8% of cases they are misdiagnosed, with misinterpretation of epiphyses the leading cause [1]. Metacarpals have an epiphysis at one end, and on occasion a pseudoepiphysis at the other. These may be considered a normal variant of physeal ossification [2] and most commonly occur at the head of the first metacarpal, and base of the second and fifth metacarpals [3, 4].
The prevalence of metacarpal pseudoepiphyses amongst the paediatric population has been reported as high as...
Methods and materials
Our study examined the prevalence of metacarpal pseudoepiphyses amongst 112 serial paediatric radiographs. The study was performed across a 2-month period at a tertiary centre in Melbourne. All hand radiographs of children aged 17 years or younger were included. Incomplete radiographs were excluded.
Our proposal was consistent with NHMRC Ethical Considerations in Quality Assurance and Evaluation Activities (2014) guidelines.
Results
111 patients were identified in our initial search, of which 9 patients had bilateral hand radiographs. Of the 120 radiographs there were 8 incomplete studies. Indications for imaging ranged from acute to surveillance of congenital hand. Falling onto an outstretched hand and crush injuries were the most common acute indications.
Our findings report a 10.7% prevalence of metacarpal pseudoepiphyses, of which they were most commonly found at the first and second metacarpals (4.5% respectively). Our data did not identify pseuodepiphyses in the third and fourth...
Conclusion
Our radiological findings are reflective of current literature, and support the necessity of doctors familiarising themselves with the location of metacarpal pseuodepiphysis. Recognising such findings on radiological investigations could improve diagnostic accuracy and prevent fracture misdiagnosis. This is imperative, as inappropriate immobilisation or surgical management can impose long-term impacts on the growth and development of hands.
References
Chew EM, Chong AKS. Hand fractures in children: epidemiology and misdiagnosis in a tertiary referral hospital.J Hand Surg (Am).2012;37(8):1684–1688
Ogden JA, Ganey TM, Light TR, Greene TL, Belsole RJ. Nonepiphyseal ossification and pseudoepiphysis formation. J Pediatr Orthop. 1994 Jan-Feb;14(1):78-82.
Levine E. Notches in the non-epiphyseal ends of the metacarpals and phalanges in children of four South African populations. Am J Phys Anthropol. 1972 May;36(3):407-15.
Limb D, Loughenbury PR. The prevalence of pseudoepiphyses in the metacarpals of the growing hand. Journal of Hand Surgery (European Volume)....