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Comparing ultrasonography with plain radiography in the diagnosis of paediatric long-bone fractures

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Abstract

Purpose

Paediatric long-bone fractures are commonly seen in the emergency department, and diagnosis is usually confirmed by conventional radiographs. This entails exposure to ionizing radiation with its attendant possible carcinogenic and teratogenic effects. Ultrasonography provides a potentially safer diagnostic alternative and may be cheaper, more readily available, and user-friendly. This study aimed to establish the applicability of ultrasound scanning compared with plain radiography in fracture diagnosis.

Methods

This prospective observational study documented fracture characteristics using plain radiographs and compared these with findings on ultrasound assessment of same fractures at the time of injury. Scans were repeated at week three and week six to monitor treatment in those whom the mode of treatment did not preclude scanning. Outcome measures were compared for relationships including sensitivity and specificity as well as overall predictive values.

Results

The age range of the 62 subjects enrolled was one to 15 years and the male to female ratio was 1.8:1. Plain radiographs diagnosed 52 fractures and 50 of these were recognized on ultrasound. The two false-negative ultrasound scans were noted in metaphyseal humeral fractures. Overall sensitivity, specificity, and positive and negative predictive values for ultrasonography were 96.2%, 100%, 100%, and 83.3% respectively. Ultrasound scans were also noted to identify callus formation significantly earlier than plain radiographs.

Conclusion

Ultrasound shows potential as a tool in diagnosis of paediatric fractures but may be limited in fractures around metaphyseal bone. Due to the ability to detect callus formation much earlier, ultrasonography may be very useful in monitoring of fracture healing.

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References

  1. Adesunkanmi AK, Oginni LM, Oyelami AO, Badru OS (1998) Epidemiology of childhood injury. J Trauma Acute Care Surg 44(3):506–511

    Article  CAS  Google Scholar 

  2. Alpern ER, Stanley RM, Gorelick MH, Donaldson A, Knight S, Teach SJ et al (2006) Epidemiology of a pediatric emergency medicine research network: the PECARN Core Data Project. Pediatr Emerg Care 22(10):689–699

    Article  PubMed  Google Scholar 

  3. Marshburn TH, Legome E, Sargsyan A, Li SM, Noble VA, Dulchavsky SA et al (2004) Goal-directed ultrasound in the detection of long-bone fractures. J Trauma Acute Care Surg 57(2):329–332

    Article  Google Scholar 

  4. World Health Organization Report. Essential health technologies strategy 2004–2007; (2003). http://www.who.int/eht/en/EHT_strategy_2004-2007.pdf

  5. Hill CK, Kumar P (2011) Radiation carcinogenesis. In: Encyclopedia of Cancer, pp 3134–3137

    Chapter  Google Scholar 

  6. Barata I, Spencer R, Suppiah A, Raio C, Ward MF, Sama A (2012) Emergency ultrasound in the detection of pediatric long-bone fractures. Pediatr Emerg Care 28(11):1154–1157

    Article  PubMed  Google Scholar 

  7. Alzen G, Duque-Reina D, Urhahn R, Solbach G (1992) Radiographic examination of injuries in children. Clinical and legal considerations about indications. Dtsch Med Wochensch 117(10):363–367

    Article  CAS  Google Scholar 

  8. Bentohami A, Walenkamp MM, Slaar A, Beerekamp MS et al (2011) Amsterdam wrist rules: a clinical decision aid. BMC Musculoskelet Disord 12(1):238

    Article  PubMed  PubMed Central  Google Scholar 

  9. Heyworth J (2003) Ottawa ankle rules for the injured ankle. Br J Sports Med 37(3):194–194

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. McGinn TG, Guyatt GH, Wyer PC, Naylor CD et al (2000) Evidence-based medicine working group. Users’ guides to the medical literature: XXII: how to use articles about clinical decision rules. JAMA 284(1):79–84

    Article  CAS  PubMed  Google Scholar 

  11. Stiell IG, Greenberg GH, Wells GA, McDowell I et al (1996) Prospective validation of a decision rule for the use of radiography in acute knee injuries. JAMA 75(8):611–615

    Article  Google Scholar 

  12. Hubner U, Schlicht W, Outzen S, Barthel M et al (2000) Ultrasound in the diagnosis of fractures in children. JBJS(Br) 82(8):1170–1173

    CAS  Google Scholar 

  13. Williamson D, Watura R, Cobby M (2000) Ultrasound imaging of forearm fractures in children: a viable alternative? J Accid Emerg Med 17(1):22–24

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Grechenig W, Clement HG, Fellinger M, Seggl W (1998) Scope and limitations of ultrasonography in the documentation of fractures–an experimental study. Arch Orthop Trauma Surg 117(6–7):368–371

    Article  CAS  PubMed  Google Scholar 

  15. Weinberg ER, Tunik MG, Tsung JW (2010) Accuracy of clinician-performed point-of-care ultrasound for the diagnosis of fractures in children and young adults. Injury 41(8):862–868

    Article  PubMed  Google Scholar 

  16. Levin DC, Rao VM, Maitino AJ, Parker L, Sunshine JH (2004) Comparative increases in utilization rates of ultrasound examinations among radiologists, cardiologists, and other physicians from 1993 to 2001. J Am Coll Radiol 1(8):549–552

    Article  PubMed  Google Scholar 

  17. Garra G, Singer AJ, Taira BR, Chohan J et al (2010) Validation of the Wong-Baker FACES pain rating scale in pediatric emergency department patients. Acad Emerg Med 17(1):50–54

    Article  PubMed  Google Scholar 

  18. Ibrahim T, Aldahamsheh OM, Hegazy A, Ghomrawi HM (2018) Applicability of the AAOS appropriate-use criteria for distal radius fractures in surgical practice. Int Orthop 42(1):197–202

    Article  PubMed  Google Scholar 

  19. Sinikumpu JJ, Pokka T, Victorzon S, Lindholm EL, Serlo W (2017) Paediatric lateral humeral condylar fracture outcomes at twelve years follow-up as compared with age and sex matched paired controls. Int Orthop 41(7):1453–1461

    Article  PubMed  Google Scholar 

  20. Swischuk LE, Hernandez JA (2004) Frequently missed fractures in children (value of comparative views). Emerg Radiol 11(1):22–28

    Article  PubMed  Google Scholar 

  21. Waterbrook AL, Adhikari S, Stolz U, Adrion C (2013) The accuracy of point-of-care ultrasound to diagnose long bone fractures in the ED. Am J Emerg Med 31(9):1352–1356

    Article  PubMed  Google Scholar 

  22. Rabiner JE, Khine H, Avner JR, Friedman LM, Tsung JW (2013) Accuracy of point-of-care ultrasonography for diagnosis of elbow fractures in children. Ann Emerg Med 61(1):9–17

    Article  PubMed  Google Scholar 

  23. de Neira JZ, Prada-Cañizares A, Marti-Ciruelos R, Pretell-Mazzini J (2015) Supracondylar humeral fractures in children: current concepts for management and prognosis. Int Orthop 39(11):2287–2296

    Article  Google Scholar 

  24. Tsung JW, Blaivas M (2010) Rapid screening for the posterior fat pad sign in suspected pediatric elbow fractures using point-of-care ultrasound a “FAST exam” for the traumatized elbow. Crit Ultrasound J 1(3):111–116

    Article  Google Scholar 

  25. Canavese F, Marengo L, Tiris A, Mansour M et al (2017) Radiological, clinical and functional evaluation using the quick disabilities of the arm, shoulder and hand questionnaire of children with medial epicondyle fractures treated surgically. Int Orthop 41(7):1447–1452

    Article  PubMed  Google Scholar 

  26. Schulz-Drost S, Oppel P, Grupp S, Taylor D et al (2016) The oblique fracture of the manubrium sterni caused by a seatbelt—a rare injury? Treatment options based on the experiences gained in a level I trauma centre. Int Orthop 40(4):791–798

    Article  PubMed  Google Scholar 

  27. AlKhatib N, Younis MH, Hegazy A, Ibrahim T (2018) Early versus late treatment of paediatric femoral neck fractures: a systematic review and meta-analysis. Int Orthop:p1–p9. https://doi.org/10.1007/s00264-018-3998-4

  28. Panigrahi R, Sahu B, Mahapatra AK, Palo N (2015) Treatment analysis of paediatric femoral neck fractures: a prospective multicenter theraupetic study in Indian scenario. Int Orthop 39(6):1121–1127

    Article  PubMed  Google Scholar 

  29. Drakonaki EE, Garbi A (2010) Metatarsal stress fracture diagnosed with high-resolution sonography. J Ultrasound Med 29(3):473–476

    Article  PubMed  Google Scholar 

  30. Marin JR, Zuckerbraun NS, Kahn JM (2012) Use of emergency ultrasound in United States pediatric emergency medicine fellowship programs in 2011. J Ultrasound Med (9):1357–1363

  31. Joshi N, Lira A, Mehta N, Paladino L, Sinert R (2013) Diagnostic accuracy of history, physical examination, and bedside ultrasound for diagnosis of extremity fractures in the emergency department: a systematic review. Acad Emerg Med 20(1):1–5

    Article  PubMed  Google Scholar 

  32. Moed BR, Subramanian S, van Holsbeeck M, Watson JT (1998) Ultrasound for the early diagnosis of tibial fracture healing after static interlocked nailing without reaming: clinical results. J Orthop Trauma 1998 12(3):206–213

    CAS  Google Scholar 

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Authors and Affiliations

  1. Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria

    Akinola Akinmade, Innocent Ikem, Oluwagbemiga Ayoola & Elkanah Orimolade

  2. Ondo State Trauma Centre, Ondo, Nigeria

    Adeolu Adeyeye

Authors
  1. Akinola Akinmade
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  2. Innocent Ikem
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  3. Oluwagbemiga Ayoola
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  4. Elkanah Orimolade
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  5. Adeolu Adeyeye
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Correspondence to Akinola Akinmade.

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Ethical approval was obtained from the Ethics and Research Committee of the institution.

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The authors declare that they have no conflicts of interest.

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Akinmade, A., Ikem, I., Ayoola, O. et al. Comparing ultrasonography with plain radiography in the diagnosis of paediatric long-bone fractures. International Orthopaedics (SICOT) 43, 1143–1153 (2019). https://doi.org/10.1007/s00264-018-4133-2

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  • DOI: https://doi.org/10.1007/s00264-018-4133-2

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