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Ultrasound evaluation of elbow fractures in children
Kolja Eckert1, Ole Ackermann2, Bernd Schweiger3
1Klinik für Kinderchirurgie, Elisabeth-Krankenhaus Essen, Klara-Kopp-Weg 1, 45138, Essen, Germany. eckert.kolja@me.com.
Insights
Ultrasound (US) is a highly accurate tool for diagnosing pediatric elbow fractures, comparable to X-rays. This method can reduce the need for X-rays in children, minimizing radiation exposure without compromising diagnostic safety.
Area of Science:
- Pediatric Radiology
- Medical Imaging Technology
- Orthopedic Diagnostics
Background:
- Elbow fractures are common in children, with X-rays as the standard diagnostic method.
- Previous research suggests ultrasound (US) can visualize these fractures.
- Evaluating US diagnostic accuracy for pediatric elbow fractures is crucial.
Purpose of the Study:
- To assess the diagnostic accuracy of ultrasound (US) compared to X-rays for pediatric elbow fractures.
- To determine if US can serve as a primary screening tool for these injuries.
Main Methods:
- Sixty-seven children (1-13 years) with suspected elbow fractures underwent US followed by X-rays.
- US examinations utilized a 12-MHz linear probe on the distal humerus, radial head, and olecranon.
- Sonographic and radiological findings were compared to calculate sensitivity, specificity, and predictive values.
Main Results:
- X-rays identified 48 fractures; US identified 46.
- Ultrasound demonstrated high diagnostic accuracy: 97.9% sensitivity, 95% specificity, 97.9% positive predictive value, and 95% negative predictive value.
- A positive fat pad sign on US was a sensitive indicator of elbow joint fractures.
Conclusions:
- Ultrasound effectively visualizes typical pediatric elbow fractures.
- US is a valuable primary screening tool, potentially making X-rays unnecessary in certain cases.
- US can reduce radiation exposure in children without compromising diagnostic safety.
Purpose:
Elbow fractures are a common pathology in any pediatric emergency unit. X-ray of the elbow is the standard diagnostic procedure. Previous studies have shown that fractures can also be visualized by ultrasound (US). The aim of our study was to evaluate the diagnostic accuracy of US in comparison to X-rays in diagnosing pediatric elbow fractures.
Methods:
Sixty-seven patients aged 1-13 years with clinically suspected elbow fracture were first examined by US followed by standard two-plane radiographs. US examination was done with a 12-MHz linear probe from seven longitudinal positions across the distal humerus and additionally from longitudinal positions across the radial head and olecranon. The sonographic and radiological findings were compared in a contingency table, and sensitivity, specificity, and positive and negative predictive values of the US diagnostic procedure were calculated.
Results:
With X-ray, we found 48 patients with an elbow fracture and 19 patients with no fracture. With US, we found 46 patients with an elbow fracture and 21 patients with no fracture. In comparison to X-ray diagnosis, we calculated for US diagnosis a sensitivity of 97.9 %, a specificity of 95 %, a negative predictive value of 95 %, and a positive predictive value of 97.9 %.
Conclusion:
Typical elbow fractures in children could also be visualized by US. A positive fat pad sign, in particular, serves as a strong indicator for elbow joint fractures and can be identified very sensitively by US. We confirm US as a valuable primary screening tool for elbow injuries in children. In the absence of US signs of fracture and in sonographically confirmed non-displaced fractures, standard X-rays are dispensable, thereby minimizing the X-ray burden in children without loss of diagnostic safety.
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