Abstract
Purpose
Metaphyseal forearm fractures are a common pathology in any emergency department. The standard diagnostic procedure is an X-ray of the forearm and wrist. Former studies have shown that these fractures can be visualized by ultrasound. The intention of this study was to evaluate the safety and reliability of the ultrasound diagnostic procedure in comparison with X-ray diagnosis.
Methods
Patients aged 0–12 years with tentative diagnosis of forearm fracture in a physical examination were then examined, from six positions, with a 7.5-MHz linear array transducer. The diagnosis and the recommended treatment were noted, after which standard X-rays were taken. Finally, differences between diagnoses, the extent and direction of the deformity, and the treatment recommended after both diagnostic procedures were analysed.
Results
From January 2007 to May 2008, 93 patients were examined. We found 77 fractures in 64 patients (48 radius, 2 physeal fractures of the radius, 1 ulna, and 13 radius and ulna). The sensitivity of ultrasound in diagnosing forearm fractures was 94%, and the specificity was 99%. Difference between the means of the deformities were 1.6° (radius anterior–posterior direction), 1.6° (radius medial–lateral direction), 0.2° (ulna anterior–posterior direction), and 0.2° (ulna medial–lateral direction).
Conclusion
Ultrasound seems to be a valuable and safe alternative to X-ray diagnosis.
Similar content being viewed by others
References
von Laer L, Kraus R, Linhart WE. Frakturen und Luxationen im Wachstumsalter. Stuttgart, New York: Thieme; 2007.
Durston W, Seartzentruber R. Ultrasound guided reduction of pediatric forearm fractures in the ED. Am J Emerg Med. 2000;18:72.
Rathfelder F, Paar O. Einsatzmöglichkeiten der Sonographie als diagnostisches Verfahren bei Frakturen im Wachstumsalter. Unfallchirurg. 1995;98:645–9.
Williamson D, Watura R, Cobby M. Ultrasound imaging of forearm fractures in children: a viable alternative? J Accid Emerg Med. 2000;17:22–4.
Hehl G, Kiefer H, Bauer G, Voelck C. Posttraumatische Beinlängendifferenzen nach konservativer und operativer Therapie kindlicher Oberschenkelfrakturen. Unfallchirurg. 1993;96:651–5.
Fritz-Niggli H. Strahlengefährdung und Strahlenschutz: Ein Leitfaden für die Praxis. Bern, Stuttgart, Toronto: Huber; 1988.
Beir (Committe on the biological effects of ionising radiation). The effects on population of exposure to low levels of ionizing radiation. Washington DC: National Academy of Sciences National Research Council; 1980.
Fletcher EW, Baum JD, Draper G. The risk of diagnostic radiation of the newborn. Brit J Radiol. 1986;59:165–70.
Wolf K, Bohndorf K, Vollert K, Kopp J. Bildgebende Verfahren und Strahlenschutz in der Unfallchirurgie. Unfallchirurg. 1996;99:975–85.
Grechenig W, Clement HG, Schatz B, Grechenig M. Stellenwert der Sonographie am Stütz- und Bewegungsapparat—unter besonderer Berücksichtigung von Strahlenbelastung und Kostenreduktion. Biomed Tech Biomed Eng. 1997;42:132–7.
Dulchavsky SA, et al. Advanced ultrasonic diagnosis of extremity trauma: the FASTER Examination. J Trauma Injury Infect Crit Care. 2002;53:28–32.
Folwaczny EK, Yakisan D, Stürmer KM. Die Balser-Platte mit Bandnaht. Unfallchirurg. 2000;103:731–40.
Giardanbo R, et al. Phalangeal ultrasonography in forearm fracture discrimination. Biomed Pharmacother. 2002;56:332–8.
Huebner U, Schlicht W, Outzen S, Barthel M, Halsband H. Ultrasound in the diagnosis of fractures in children. J Bone Joint Surg. 2000;82:1170–3.
Lyon M, Blaivas M. Evaluation of extremity trauma with sonography. J Ultrasound Med. 2003;22:625–30.
Marshbun TH, et al. Goal-directed ultrasound in the detection of long-bone fractures. J Trauma Injury Infect Crit Care. 2004;57:329–32.
Tomer K, Kleinbaum Y, Heyman Z, Dudkiewicz I, Blankstein A. Ultrasound diagnosis of fractures in adults. Akt Traumatol. 2006;36:171–4.
Brooks AJ, et al. Handheld ultrasound diagnosis of extremity fractures. J Roy Army Med Corps. 2004;150:78.
Jank S, et al. Intrarater reliability in the ultrasound diagnosis of medial and lateral orbital wall fractures with a curved array transducer. J Oral Maxillofac Surg. 2006;64:68–73.
Mayr JM, Grechenig W, Höllwarth ME. Musculoskeletal ultrasound in pediatric trauma. Eur J Trauma. 2004;30:150–60.
Blankstein A, et al. Fracture of the Clavicle in the newborn—detection and follow-up by sonography. Akt Traumatol. 2001;31:27–9.
Mack A, Knorr P, Santos M. Wertigkeit der sonographischen Beurteilung des distalen Unterarmes bei Frakturverdacht im Kindesalter. In: Deutscher Kongress für Orthopädie und Unfallchirurgie; 2006.
Rixford E. On the mechanics of production of certain fractures: greenstick fractures, buckling fractures, flexion and torsion fractures. J Am Med Assoc. 1913;61:916–20.
Kittleso AC, Whitehou WM. Stress greenstick and impaction fractures. Radiol Clin North Am. 1966;4:277.
Schneider G, Burkart W. Gesundheitliche Risiken ionisierender Strahlung. Radiologe. 1998;38:719–25.
Graf J, Graf C, Koch KC, Hanrath P, Janssens U. Kostenanalyse und Prognoseabschätzung internistischer Intensivpatienten mittels des “Therapeutic Intervention Scoring System” (TISS und TISS-28). Med Klin. 2003;98:123–32.
Pape HC, et al. Entwicklung eines Modells zur Berechnung der Kosten der Versorgung schwer Verletzter—eine Initiative des Traumaregisters der DGU. Unfallchirurg. 2003;106:348–57.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Ackermann, O., Liedgens, P., Eckert, K. et al. Ultrasound diagnosis of juvenile forearm fractures. J Med Ultrasonics 37, 123–127 (2010). https://doi.org/10.1007/s10396-010-0263-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10396-010-0263-x