K Eckert1, O Ackermann2. 1. Klinik für Kinderchirurgie, Elisabeth-Krankenhaus Essen, Klara-Kopp-Weg 1, 45138, Essen, Deutschland. k.eckert@contilia.de. 2. Ruhr-Universität Bochum, Universitätsstrasse 150, 44801, Bochum, Deutschland. dr.med.ackermann@gmx.de.
Abstract
BACKGROUND: In clinically suspected fractures taking radiographs is the standard procedure but the indications should be strictly limited. Ultrasound offers a safe and radiation-free alternative for fracture diagnostics. OBJECTIVES: Sensitivity and specificity of sonographic fracture diagnostics and safety of sonographic algorithms for fracture evaluation. METHODS: Presentation of useful applications for sonographic fracture evaluation and establishment of sonographic algorithms for safe fracture diagnosis. RESULTS: In children distal forearm fractures can be diagnosed solely by ultrasound (sensitivity 96 % and specificity 97 %). The sonographic fat pad sign (SOFA) has been proven to be a useful primary screening tool for occult fractures of the pediatric elbow. A positive fat pad sign (SOFA+) is indicative of a fracture and radiographic diagnostics are necessary (sensitivity 97 % and specificity 91 %). Ultrasonography is also useful to exclude subcapital humeral fractures (sensitivity 94 % and specificity 100 %) and for correct estimation of displacement when present. CONCLUSIONS: Sonographic algorithms for fracture evaluation (SAFE) offer a safe diagnosis and guidance of the therapeutic course of certain pediatric fractures, thereby reducing unnecessary radiation exposure.
BACKGROUND: In clinically suspected fractures taking radiographs is the standard procedure but the indications should be strictly limited. Ultrasound offers a safe and radiation-free alternative for fracture diagnostics. OBJECTIVES: Sensitivity and specificity of sonographic fracture diagnostics and safety of sonographic algorithms for fracture evaluation. METHODS: Presentation of useful applications for sonographic fracture evaluation and establishment of sonographic algorithms for safe fracture diagnosis. RESULTS: In children distal forearm fractures can be diagnosed solely by ultrasound (sensitivity 96 % and specificity 97 %). The sonographic fat pad sign (SOFA) has been proven to be a useful primary screening tool for occult fractures of the pediatric elbow. A positive fat pad sign (SOFA+) is indicative of a fracture and radiographic diagnostics are necessary (sensitivity 97 % and specificity 91 %). Ultrasonography is also useful to exclude subcapital humeral fractures (sensitivity 94 % and specificity 100 %) and for correct estimation of displacement when present. CONCLUSIONS: Sonographic algorithms for fracture evaluation (SAFE) offer a safe diagnosis and guidance of the therapeutic course of certain pediatric fractures, thereby reducing unnecessary radiation exposure.
Entities:
Keywords:
Children; Elbow; Fat pad sign; Forearm; Proximal humerus
Authors: Ming Chien; Blake Bulloch; Pamela Garcia-Filion; Mostafa Youssfi; Michael W Shrader; Lee S Segal Journal: Pediatr Emerg Care Date: 2011-11 Impact factor: 1.454
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