Ultrasound as a viable alternative to standard X-rays for the diagnosis of distal forearm fractures in children

• Published in: Zeitschrift fur Orthopadie und Unfallchirurgie Vol. 150; no. 4; p. 409
• Main Authors: Eckert, K, Ackermann, O, Schweiger, B, Radeloff, E, Liedgens, P
• Format: Journal Article
• Language: German
• Published: Germany 01-09-2012
• Subjects: Adolescent; Child; Child, Preschool; Female; Fractures, Bone - diagnostic imaging; Humans; Male; Radiography; Reproducibility of Results; Sensitivity and Specificity; Ultrasonography - methods; Wrist Injuries - diagnostic imaging
• ISSN: 1864-6743
• DOI: 10.1055/s-0032-1314974

Distal forearm fractures are very common in childhood. Radiography of the wrist is the standard diagnostic procedure. But because of higher sensitivity of growing bones to ionising radiation the diagnostic use of X-rays should be minimised as much as possible. Recent studies have shown that distal forearm fractures in children can be safely and reliably diagnosed using only ultrasound. The aim of our study was to evaluate and confirm the safety and applicability of the ultrasound diagnostic procedure in comparison to X-ray diagnosis under routine conditions of our paediatric emergency department.
We investigated 115 patients aged 2-14 years. After clinical assessment patients with suspected forearm fractures first underwent ultrasound examination of the metaphyseal forearm followed by standard two view radiographs of the wrist. Ultrasound and radiographic findings were then compared and sensitivity and specificity for ultrasound were calculated. In 9 patients with suspected displacements, sonographic and radiographic axis measurement were done and also compared.
Radiologically we found 62 patients with 78 distal forearm fractures. By ultrasound we also diagnosed 52 fractures. All patients with no fractures were correctly diagnosed as well. Referring to X-rays we calculated for ultrasound a sensitivity of 94.9 %, a specificity of 98 %, a negative predictive value of 97.4 % and a positive predictive value of 96.1 %. The mean difference of the deformities of the radius in the sagittal section measured sonographically and radiologically were 1.7° (SD 1.6°).
We confirm ultrasound is an applicable, rapid and safe alternative to X-rays in diagnosing metaphyseal forearm fractures in children. Even sonographic axis measurement seems to be a viable method. Thereby ultrasound potentially reduces the X-ray burden in children and additionally accelerates the diagnostic procedure.