Bone bruising of the distal forearm and wrist in children

Bone bruising represents a new category of bone injury that can only be demonstrated by magnetic resonance imaging (MRI) with fat suppression. This study proposed the nature of non-radiographically evident injuries of the distal radius and wrist in children whose symptoms did not resolve after 5 weeks. We aimed to describe and classify the lesions and delineate the importance and potential complications of the injuries. Bone bruising was diagnosed in 20 patients (mean age: 11.6 years; range: 9–13 years). Bone bruises were classified according to anatomical location and whether they were solitary lesions or were combined with other injuries. Injuries of the distal radius were classified according to location: type 1 was localised to the metaphysis, close to the physeal plate; type 2 involved both the metaphysis and diaphysis; and type 3 extended on both sides of the distal radial growth plate. The type 1 injuries were consistent with complete, un-displaced Salter–Harris type I fractures, whilst type 3 lesions were potentially Salter–Harris type V injuries. Our data indicate that an MRI should be considered for a child with an injury to the distal radius or wrist whose symptoms do not resolve after 5 weeks of immobilisation.