[Possibilities for using sonography as a diagnostic procedure in fractures during the growth period]

Alzen et al. found that of 2,006 X-rays taken to identify fractures in childhood, only 345 fractures could be verified. To minimize this discrepancy, the traumatology department at the RWTH in Aachen prefers performing ultrasound before taking an X-ray. We call this procedure "osteosonography". If one uses osteosonography, fractures can be recognized, interpreted and, in some cases, immediately treated without taking additional X-rays. Furthermore, it is then possible not to have to X-ray the extremities, resulting in a reduction in the amount of radiation to the gonads and epiphyses. Other advantages of osteosonography are that it is then possible to compare examinations of the contralateral side, interpret bone and tissue at the same time, and do the examination in the presence of the parents. After 180 children had been examined, it became apparent that in 53.3% of all children, the X-ray could be replaced by osteosonography. On the one hand, we had children with no ultrasonographic suggestion of fractures and, on the other, we had fractures with no indications for repositioning or operating (e.g. "bulge fractures"); these could be treated at once with cast. We are of the opinion that our experience with osteosonography justifies generally making this the first diagnostic measure before X-raying children during the growth phase. A this way, radiation can be minimized, resulting in a reduction in X-ray-induced damage.