Ischial tuberosity avulsion fractures, though not uncommon in adolescent athletes, are often overlooked or misdiagnosed. These fractures occur more frequently in males than females. Primary cause of this fracture type is usually a sudden eccentric load on the proximal hamstrings, typically seen during a kicking action in dance, football, or soccer. Due to the limited use of imaging in the evaluation of such injuries, these fractures often are misdiagnosed or underdiagnosed. Recent injuries warrant more conservative management, including rest and relative immobilization. In cases of late diagnosis, delayed healing, or persistent symptomatology, surgical intervention can be undertaken to restore normal anatomy, alleviate symptoms, and facilitate healing. Minimally invasive CT-guided percutaneous needle fenestration has been introduced for symptomatic delayed union ischial tuberosity fractures in adolescents. This percutaneous procedure involves the creation of multiple channels into the bone at the fracture site with an 18 gauge Chiba needle via image guided needle fenestration to enhance blood flow and promote healing of the target area. Following this, a tailored physical therapy program is implemented based on patient symptomatology, individual tissue healing rates, and the current literature related to proximal hamstring injuries. Outcomes to this minimally invasive approach have been promising including cases of complete pain relief, full functional recovery, and a return to sports without limitations. Outline of Teaching Points: Ischial tuberosity avulsion fractures are common in adolescent athletes, with a higher incidence in males, caused by sudden eccentric loads on proximal hamstrings during activities like dance, football, or soccer. Due to limited imaging use, these fractures are often overlooked or misdiagnosed, leading to delayed healing or persistent symptoms. Recent injuries may benefit from conservative management, involving rest and relative immobilization. Surgical intervention becomes necessary for late diagnoses, delayed healing, or persistent symptoms to restore normal anatomy and alleviate symptoms. Minimally invasive CT-guided percutaneous needle fenestration has shown promising outcomes, facilitating healing with complete pain relief and a return to sports without limitations. Read More

Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024

Authors: Malavia Mira, Rivard Douglas

Keywords: fracture, interventional radiology

Osteoid osteomas (OO) are benign osteoblastic tumors primarily afflicting individuals aged 5 to 30 years, ranking as the third most prevalent among benign bone tumors at around 10%. Patients typically present with persistent nighttime pain that responds positively to NSAIDs, along with potential complications like progressive discomfort, tenderness, swelling, and limited joint mobility with articular involvement. OO usually forms in the cortex of long bones, measuring less than 2 cm, exhibiting a central radiolucent nidus encased by surrounding sclerosis, best visualized using CT scans. The current standard-of-care entails CT-guided radiofrequency ablation (RFA), while surgery becomes an option for complex locations like the spine, extremities, or craniofacial bones. Moreover, advanced thermoprotective techniques have expanded RFA's applicability to previously unsuitable lesions. Cryoablation is a newly indicated for pediatric OO patients and involves controlled tumor freezing, preserving adjacent healthy tissue. It offers reduced pain, shorter recovery, and minimal scarring, enhancing the quality of life for young patients. This exhibit will discuss 3 cases that underscore the diverse management approaches required for osteoid osteomas in young patients. Case 1 featured initial relief with radiofrequency ablation (RFA) but recurrence, ultimately resolved with cryoablation. In Case 2, a CT-guided cryoablation was performed for an S2 osteoid osteoma, with limited follow-up data. Case 3 highlighted the complexity of treating a C1 osteoid osteoma, initially successful with intra-operative cryoablation, but it was followed by new neck muscular pain post-operation. Cryoablation's accuracy and less invasiveness make it a preferred choice in treating OO patients. Learning Objectives: Grasp cryoablation principles for pediatric osteoid osteoma. Recognize indications and contraindications. Assess benefits and risks in pediatric cases. Comprehend the pathophysiology of osteoid osteoma and cryoablation's role in treatment for pediatric patients. Read More

Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024

Authors: Malavia Mira, Le Viet, Rivard Douglas, Reading Brenton

Keywords: cancer, pain management, ablation

Minimally invasive procedures are common practice for pain management in pediatrics. The use of image guided therapies for axial skeletal pain management have been proven to not only be safe and effective, but also can be performed routinely in the interventional radiology (IR) department. The goal of this educational exhibit is to illustrate image guided techniques for pain management in pediatric patients. Specifically, techniques involving image-guided injections for treatment of headache, back pain, and other axial skeletal sources will be highlighted. Read More

Meeting name: SPR 2017 Annual Meeting & Categorical Course , 2017

Authors: Reading Brenton, Cully Brent, Theut Stephanie, Robinson Amie, Anderson John, Rivard Douglas

Keywords: Pain Management, Steroid Injection, Nerve Block

Ultrasound guided percutaneous liver biopsy is frequently performed in pediatric patients. Published post-biopsy complication rates range between 0.3 - 3.3% according to Society of Interventional Radiology Standards of Practice. Post-biopsy tract embolization has been prophylactically used to theoretically decrease the bleeding risk, but is not the current standard of care at our institution. The goal of this study is to determine if there is a need for prophylactic biopsy tract-embolization after ultrasound guided liver biopsy in the pediatric population. Read More

Meeting name: SPR 2018 Annual Meeting & Postgraduate Course , 2018

Authors: Gondi Keerthi, Robinson Amie, Cully Brent, Reading Brenton, Theut Stephanie, Hendrickson Richard, Reid Kimberly, Rivard Douglas

Keywords: Pediatric Liver Biopsy, Embolization

Gastro-Jejunostomy (GJ) tubes are commonly placed and exchanged by interventional radiologists (IR) in pediatric patients requiring transpyloric feeds. GJ tubes with slight variations are available from different manufacturers, most frequently used are Avanos Medical, Inc. (previously Halyard Medical Devices) and Applied Medical Technology (AMT). There is currently no published data available comparing complication rates between the different GJ tubes. The goal of this study is to compare complication rates at two different pediatric institutions and reasons for non-elective required exchange/replacement of GJ tubes manufactured by Avanos and AMT in pediatric patients. Read More

Meeting name: SPR 2020 Annual Meeting & Postgraduate Course , 2020

Authors: Murari Karthi, Reading Brenton, Hayatghaibi Shireen, Ashton Daniel, Buckley Jennifer, Robinson Amie, Noel-macdonnell Janelle, Rivard Douglas, Theut Stephanie, Cully Brent

Keywords: Gastrojejunostomy, G-tube, Complications