Ultrasound in the diagnosis of fractures in children

Abstract

We compared the results of primary ultrasonographic examination of 163 children with 224 suspected fractures with the subsequent radiological findings. The aim was to assess the value of ultrasound in the diagnosis of fractures in children. We found a good correlation for fractures of the long bones of the upper and lower limbs. Ultrasound was most reliable for the detection of simple femoral and humeral diaphyseal fractures and fractures of the forearm. It was less dependable for compound injuries and fractures adjacent to joints, lesions of the small bones of the hand and foot, non-displaced epiphyseal fractures (Salter-Harris type 1) or those with a fracture line of less than 1mm. We were able to distinguish several types of fracture in which the use of ultrasound alone gave reliable information and further radiography was unnecessary. We discuss the advantages and disadvantages of skeletal ultrasonographic studies in children.

Resuscitative Long-Bone Sonography for the Clinician: Usefulness and Pitfalls of Focused Clinical Ultrasound to Detect Long-Bone Fractures During Trauma Resuscitation

“…At least two longitudinal planes should be scanned, although an original description by Hü bner et al reported scanning in four longitudinal planes with transverse scans obtained as appropriate [23][24][25]. The cortex of the bone is seen as a homogenous, bright reflection of echoes with dorsal acoustic shadowing.…”

“…Finally, when time permits, the contra-lateral extremity should be carefully examined to both to detect injuries as well as to provide a normal control when uninjured. The clinician should attempt to detect an obvious cortical disruption, as this is the most reliable sign confirming a bony fracture, but other abnormalities should also be noted, including steps, axial deviations, periosteal lesions, hematomas, fluid collections, or any other softtissue changes [23]. The reported experience claims that there is no added distress or pain to the victim if care is taken by the examiner and US coupling gel is liberally applied [16,23].…”

“…A number of studies have described high overall accuracy rates in diagnosing pediatric long-bone fractures. Further, Hü bner et al [23] note that the cartilaginous nature of the pediatric joint and musculoskeletal system may actually make US a superior imaging modality compared to radiography. They examined 163 children with 224 suspected fractures and found that US delivered the highest (> 89%) accuracy for femoral and humeral diaphyseal fractures, as well as for the forearm injuries [23].…”

“…Further, Hü bner et al [23] note that the cartilaginous nature of the pediatric joint and musculoskeletal system may actually make US a superior imaging modality compared to radiography. They examined 163 children with 224 suspected fractures and found that US delivered the highest (> 89%) accuracy for femoral and humeral diaphyseal fractures, as well as for the forearm injuries [23]. Fractures of the small bones of the hands and feet were less dependably identified however [23].…”

Musculoskeletal Ultrasound in Pediatric Trauma

“…Color-coded duplex ultrasound or power Doppler ultrasound may be helpful in distinguishing symptomatic from noninflamed lesions. General Considerations Ultrasound evaluation of musculosceletal injuries represents an ideal supplementary investigation to radiography in children [37][38][39]. Many musculoskeletal injuries and disorders can be visualized using high-resolution sonography (Table 1).…”