Musculoskeletal Ultrasound in Pediatric Trauma

Abstract

Background and Purpose: The radiologic evaluation of musculoskeletal injuries in young children is difficult due to the absent ossification of several secondary ossification centers, which therefore cannot be seen directly on plain radiographs. When relying on conventional radiographs, even severe cartilaginous or soft tissue injuries cannot be visualized, as there is no possibility to differentiate them from bruises or sprains. It is the aim of this review to present clinically relevant applications of ultrasound imaging in pediatric musculoskeletal trauma. Methods: Currently used ultrasound techniques for evaluation of typical pediatric fractures or joint dislocations, techniques for differentiation between stable and unstable intraarticular fractures, the use of sonography for monitoring reduced bone length in long bones after fracture, sonographic guidelines for evaluation of tendon injuries or lesions, and sonographic imaging techniques in arthritis and osteomyelitis are described. Conclusion: Musculoskeletal sonography -despite its inability to view through intact cortical bone and its accuracy being dependent on skill and experience of the investigator -provides important information about soft tissue, bony or cartilaginous injuries in children.

Ultrasound diagnosis of juvenile forearm fractures

“…Extension of this diagnostic means to other bones seems to be reasonable [5,8,10,11,15,[18][19][20][21], but there are no controlled studies in the literature. We would like to elucidate the difficulties with two examples.…”

“…Most studies included heterogeneous pathologies in a wide variety of locations. A review of these papers leads to the conclusion that in adults ultrasound diagnostics is limited to a few special cases [18,19] and should be utilized by trained specialists [20].…”

Assessing the cortical thickness of long bone shafts in children, using two-dimensional ultrasonic diffraction tomography

“…In the case of bone diseases, this technique is now proving to be an invaluable means of assessing painful traumatic and non traumatic disorders (such as hip dysplasia, knee trauma and stress fracture of the tibia). Cases where it is necessary to search for an intra articular joint effusion, an infectious periosteal apposition or a tumoral resurgence in contact with a stainless steel prosthesis or, more recently, for a traumatic ligament lesion, are just a few examples where the use of ultrasound is highly indicated (Falcini et al 2000;Rand et al 2001;Enns et al 2004;Halaba and Pluskiewicz 2004;Mayr et al 2004;May et al 2004). X-ray computed tomography, magnetic resonance imaging and/or bone scintigraphy, the other widely used methods available (Baert and Sartor 2002), have various disadvantages, depending on the type of examination for which they are used, such as their cost, the fact that they involve X-rays or require sedation and their lack of availability and accessibility.…”

Ultraschallbasierte Therapiesteuerung bei subkapitalen Humerusfrakturen im Wachstumsalter

“…Schon früher wurde der ergänzende Einsatz der Sonografie diskutiert [2], jedoch ohne systematischen Vergleich mit der Rönt-gendiagnostik. In den letzten Jahren wird auch der Einsatz des Ultraschalls bei der Akutdiagnostik von Frakturen [3][4][5][6][7], insbesondere auch bei der kindlichen subkapitalen Humerusfraktur [8][9][10] vermehrt empfohlen. Unsere Ergebnisse zeigen, dass sonografisch in der Hälfte der Fäl-le eine größere Achsabweichung ermittelt wurde als radiologisch, nur 2-mal umgekehrt.…”