Commonly missed subtle skeletal injuries in children: A pictorial review

Children are distinctive as compared to adults when it comes to musculoskeletal injuries. This is due to the relative elasticity of bones and the presence of epiphyseal plates. There are many subtle injuries which will be missed if the radiologist is not aware of them and is not actively searching for them. The common elusive injuries include: (1) plastic bending fractures, (2) sternoclavicular dislocation, (3) epiphyseal-metaphyseal injuries in older child, (4) buckle fractures, and (5) Toddler fracture types I and II. Detection of these injuries needs an accurate history, a good physical examination, and, in particular, a thorough search by the radiologist. In many cases, it is the radiologist who suggests likelihood of the injury and guides management. In this respect, the use of comparative views and, in some cases, additional imaging is warranted. Here, we review the elusive musculoskeletal injuries in children in pictorial form.