Significance of intraarticular fluid without visible fracture in children

The radiographs and clinical records of 128 patients with joint trauma and radiographic evidence of intraarticular fluid but no visible fracture were reviewed. The patients were divided into two groups: 63 with follow-up films and 65 with no follow-up films. Clinically, the latter group had less serious injuries and generally were instructed not to return unless symptoms worsened abruptly or if pain persisted for longer than 1 week. The group with follow-up films consisted of those patients with more serious injuries, and mandatory repeat radiographs were obtained 10-14 days after initial injury. Findings suggest that if a fracture was not seen on the first study, chances of its being present and missed in the ankle and elbow were small (7% and 15%) but were high (67%) in the wrist.