Sonographic detection of an isolated cuboid bone fracture not visualized on plain radiographs

Enns, Peter K.; Pavlidis, Theodosios; Stahl, J.P.; Horas, U.; Schnettler, Reinhard

doi:10.1002/jcu.20009

Cited by 22 publications

(16 citation statements)

References 20 publications

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“…The physician/ultrasonographer should remain alert for the possibility of a fracture as reports have described the detection of an unsuspected fracture during the routine US examination of the wrist, ankle and foot (figure 16). 25 30 34 35 Characteristic of these areas are multiple small bones and joints with complex shapes in which fractures may be difficult to detect by standard radiography. Thus, careful scrutiny of the bone surfaces should be a routine part of ultrasonographic examination of these areas particularly when a history of trauma is present (figure 17).…”

Section: Introductionmentioning

confidence: 99%

Ultrasonography of fractures in sports medicine

Hoffman

Adams²,

Bianchi³

2014

Br J Sports Med

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High-resolution ultrasound is emerging as an important imaging modality in fracture assessment due to its availability, ease of use and multiplanar capabilities. Its usefulness includes injury assessment for the presence of a fracture when obtaining radiographs is not immediately available, detecting occult fractures not revealed on radiographs, and diagnosing bone stress injury before radiographic changes. Sonographic evaluation of bone, however, has limitations and should always be coupled with radiographs and possibly advanced imaging modalities such as CT and MR when clinically indicated.

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Section: Introductionmentioning

confidence: 99%

Ultrasonography of fractures in sports medicine

Hoffman

Adams²,

Bianchi³

2014

Br J Sports Med

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“…Wang et al 11 evaluated 268 patients who had ankle and foot injuries with highresolution ultrasonography and detected an occult fracture in 24 patients by demonstrating cortical discontinuity. Enns et al 12 reported a 4-year-old girl whose initial radiographic results were normal, but an isolated cuboid fracture was diagnosed on ultrasonography as a steplike discontinuity in the cortical bone. Stalder and Zanetti 13 described marked linear hypointense signal abnormality in the cuboid on sagittal magnetic resonance images in an 8-year-old boy.…”

Section: Discussionmentioning

confidence: 97%

Cuboid Fractures in Preschool Children

Şenaran

Mason²,

Pellegrin³

2006

Journal of Pediatric Orthopaedics

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The purpose of this study is to describe the clinical and radiographic presentation of cuboid fractures in children and to produce a guide for appropriate evaluation and treatment.Twenty-eight consecutive patients with cuboid fracture treated at the same institution between 1998 and 2004 were retrospectively analyzed. The mean age at presentation was 38.7 months (range, 14-74 months). All patients presented with an avoidance gait pattern, refusing to bear weight on the lateral side of the foot. There was no history of trauma in 8 patients, and the others had minor trauma such as a fall down a few steps on their feet or ankle sprain. Plain radiographs were the method of diagnosis in all but one of the patients. The feet of 21 patients were immobilized at initial presentation. The other 7 patients were observed clinically until symptoms resolved. All fractures healed completely with no complications, and patients were symptom free in 4.9 weeks (range, 2-13 weeks). Twenty-one patients, immobilized immediately after the first presentation, were symptom free in 4 weeks (range, 2-7 weeks). The remaining 7 patients, who were observed and followed up clinically with no immobilization, were symptom free in 7.9 weeks (range, 5-13 weeks). Six patients had associated ipsilateral fractures, and 8 patients had an associated genetic or systemic abnormality. An awareness of cuboid fractures in children can lead to an early diagnosis, treatment, and recovery without the use of a bone scan, and a focus on the possibility of an underlying genetic or medical disorder must be initiated.

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“…A variety of imaging methods such as CT (Adey et al 2007, You et al 2007, Stevenson et al 2012), bone scintigraphy (Beeres et al 2008, Querellou et al 2009, Cho et al 2010), MRI (Carey et al 1998, Stuart et al 1998, Launay et al 2008, Boutis et al 2010, Endele et al 2012, Gufler et al 2013), and US (Graif et al 1988, Singh et al 1990, Smeets et al 1990, Gleeson et al 1996, Lazovic et al 1996, Wang et al 1999, Ali et al 2001, Hauger et al 2002, Enns et al 2004, Hsu et al 2013) have been reported to be useful for detecting occult fractures. In children, bone scintigraphy is not favored for this purpose because intense physiological osteoblastic response concentrating radiopharmaceutical at the margin of the growth plate can mask an underlying fracture (Rogers and Poznanski 1994).…”

Section: Discussionmentioning

confidence: 99%

Prevalence and clinical significance of occult fractures in children with radiograph-negative acute ankle injury

Najaf-Zadeh

Nectoux²,

Dubos³

et al. 2014

Acta Orthopaedica

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Background and purpose Plain radiographs may fail to reveal an ankle fracture in children because of developmental and anatomical characteristics. In this systematic review and meta- analysis, we estimated the prevalence of occult fractures in children with acute ankle injuries and clinical suspicion of fracture, and assessed the diagnostic accuracy of ultrasound (US) in the detection of occult fractures.Methods We searched the literature and included studies reporting the prevalence of occult fractures in children with acute ankle injuries and clinical suspicion of fracture. Proportion meta-analysis was performed to calculate the pooled prevalence of occult fractures. For each individual study exploring the US diagnostic accuracy, we calculated US operating characteristics.Results 9 studies (involving 187 patients) using magnetic resonance imaging (MRI) (n = 5) or late radiographs (n = 4) as reference standard were included, 2 of which also assessed the diagnostic accuracy of US. Out of the 187 children, 41 were found to have an occult fracture. The pooled prevalence of occult fractures was 24% (95% CI: 18–31). The operating characteristics for detection of occult ankle fractures by US ranged in positive likelihood ratio (LR) from 9 to 20, and in negative LR from 0.04 to 0.08.Interpretation A substantial proportion of fractures may be overlooked on plain radiographs in children with acute ankle injuries and clinical suspicion of fracture. US appears to be a promising method for detection of ankle fractures in such children when plain radiographs are negative.

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Sonographic detection of an isolated cuboid bone fracture not visualized on plain radiographs

Cited by 22 publications

References 20 publications

Ultrasonography of fractures in sports medicine

Ultrasonography of fractures in sports medicine

Cuboid Fractures in Preschool Children

Prevalence and clinical significance of occult fractures in children with radiograph-negative acute ankle injury

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