ObjectiveTo report and assess the usefulness of ultrasound (US) findings for occult fractures of growing bones.Materials and MethodsFor six years, US scans were performed in children younger than 15 years who were referred with trauma-related local pain and swelling of the extremities. As a routine US examination, the soft tissue, bones, and adjacent joints were examined in the area of discomfort, in addition to the asymptomatic contralateral extremity for comparison. Twenty-five occult fractures in 25 children (age range, five months-15 years; average age, 7.7 years) were confirmed by initial and follow-up radiograms, additional imaging studies, and clinical observation longer than three weeks.ResultsThe most common site of occult fractures was the elbow (n = 9, 36%), followed by the knee (n = 7, 28%), ischium (n = 4, 16%), distal fibula (n = 3, 12%), proximal femur (n = 1, 4%), and humeral shaft (n = 1, 4%). On the retrograde review of the routine radiographs, 13 out of the 25 cases showed no bone abnormalities except for various soft tissue swelling. For the US findings, cortical discontinuity (direct sign of a fracture) was clearly visualized in 23 cases (92%) and was questionable in two (8%). As auxiliary US findings (indirect signs of a fracture), step-off deformities, tiny avulsed bone fragments, double-line appearance of cortical margins, and diffuse irregularity of the bone surfaces were identified.ConclusionPerforming US for soft tissue and bone surfaces with pain and swelling, with or without trauma history in the extremities, is important for diagnosing occult or missed fractures of immature bones in pediatric-aged children.

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Recent advances in radiological and serological techniques have enabled easier preoperative diagnosis of sparganosis. However, due to scarcity of cases, sparganosis has been often regarded as a disease of other etiologic origin unless the parasite is confirmed in the lesion. We experienced a case of sparganosis mimicking a varicose vein in terms of clinical manifestations and radiological findings. Sparganosis should be included among the list of differential diagnosis with the varicose vein.

Open reduction and internal fixation with multiple screws and plates is the treatment of choice in patients with complex acetabular fractures. Two cases of a misplaced acetabular screw were detected on post-operative imaging, and referred to us for CT-guided removal of the misplaced screw. With the patients in the decubitus position, preliminary images were obtained to determine the puncture site and angle of approach. A k-wire was advanced to the head of the screw, over which we inserted a cannulated screwdriver and removed the screw. At each step all procedures were monitored with CT. The average total procedure time was 30 min. We observed no significant complications during or after the procedure. CT-guided removal of a misplaced acetabular screw seems to be a simple and safe procedure.