Feasibility and technique of ultrasound traumatic elbow lesion assessment

The present study aimed to describe the technique of ultrasound traumatic elbow lesion assessment performed by an orthopedic surgeon.

Nine patients were included in a single-center study. Clinical examination assessed pain, ranges of elbow motion, neurovascular status and elbow ligament testing. Ultrasound was associated to radiography between days 7 and 15, screening for lesions of the bone, medial ligament (in 30-90° flexion), lateral ligament (elbow at 90° in cobra position) and epitrochlear and epicondylar muscle insertions. Ultrasound scanning time and echogenicity were assessed.

Four radial head osteochondral fractures were detected on ultrasound in addition to the 4 fractures seen on radiography, without significant difference (p=0.071). Clinical examination found 2 cases of valgus laxity and 5 of varus laxity. Ultrasound, performed blind to radiography, found 1 medial collateral ligament anterior bundle lesion (in 1 of the 2 patients with valgus laxity) and 4 lateral collateral ligament ulnar bundle lesions (in 4 of the 5 patients with varus laxity). There were no epicondylar or epitrochlear tendon lesions. Scanning time decreased significantly over the study period, from a mean 30minutes in the first 5 cases to a mean 24.8minutes in the last 5 (p=0.046). Three patients could not be put in the cobra position, and 3 showed poor echogenicity.

Ultrasound assessment of traumatic elbow lesions could be performed by an orthopedic surgeon on a well-defined protocol. Lesions on ultrasound matched clinical symptomatology. Inter- and intra-observer reproducibility remain to be assessed.

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