Nondisplaced Fractures

MRI can be helpful in recognizing or characterizing nondisplaced fractures, and the imaging information may alter treatment. There are several types of fractures in which MRI can play a role. One is in identifying an otherwise radio-graphically occult fracture, such as a small radial head fracture (Fig. 6). MRI also can be helpful in avulsion fractures of the sublime tubercle in which it can help determine if the MCL is intact or if there is fibrous nonunion or a pseu-darthrosis [12]. Another fracture that can be seen on MRI images before radiographic changes are apparent is Little Leaguer's elbow, a repetitive stress injury of the physis at the medial epicondyle apophysis (Fig. 7) [13]. Finally, fatigue fractures can occur in athletes who generate high forces on the bones around the elbow. For example, throwers who work up to full activity too quickly can develop stress fractures of the olecranon process. Like stress fractures elsewhere in the body, they are not only easier to identify on MRI images but can be staged, which may be helpful in predicting time to recovery.

Radial Head Fracture

Fig. 6. Radiographically occult radial head fracture in a 30-year-old man. (A) Radial head view is normal. (B) Coronal T2-weighted image shows bone marrow edema in the radial head and neck (arrowhead). (C) Axial Tl-weighted image shows the fracture line (arrowhead) in the radial neck. (From Kijowski R, Tuite M, Sanford M. Magnetic resonance imaging of the elbow. Part I: Normal anatomy, imaging technique, and osseous abnormalities. Skeletal Radiol 2005;33:685-97; with permission.)

Fig. 6. Radiographically occult radial head fracture in a 30-year-old man. (A) Radial head view is normal. (B) Coronal T2-weighted image shows bone marrow edema in the radial head and neck (arrowhead). (C) Axial Tl-weighted image shows the fracture line (arrowhead) in the radial neck. (From Kijowski R, Tuite M, Sanford M. Magnetic resonance imaging of the elbow. Part I: Normal anatomy, imaging technique, and osseous abnormalities. Skeletal Radiol 2005;33:685-97; with permission.)

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