Ultrasound in diagnosis of fractures in children: unnecessary harassment or useful addition to X-ray?
OBJECTIVE
Handling children with trauma is often very difficult, as the signs and the exact location of the fracture are sometimes unclear. The aim of this study was to compare ultrasound and X-ray for the identification of fractures.


METHODS
In this study 653 patients from newborn to 17 years old (mean age 4.4 years) with nonspecific clinical signs or clinically indistinct fracture location were examined initially with ultrasound. After identification of the fracture by ultrasound, an X-ray exam of the predefined region followed. In cases of negative ultrasound an X-ray exam was performed not focused on a predefined region.


RESULTS
Examinations of 726 parts of the body revealed 308 fractures. 266 fractures were identified by both ultrasound and X-ray, 20 exclusively by ultrasound, 21 exclusively by X-ray. One maxillary fracture was missed. The sensitivity was 92.9% for ultrasound and 93.2% for X-ray, and the specificity was 99.5% (ultrasound) and 99.8% (X-ray). Ultrasound was superior to X-ray on the clavicle, but the opposite was true in the lower limb. In 8.4% of the patients ultrasound helped us to reduce the number of X-rays.


CONCLUSIONS
Ultrasound is comparable to X-ray for the detection of fractures. Ultrasound should be the first imaging method in children with trauma and nonspecific clinical signs or indistinct location of pain, followed by X-ray exams of the predefined region.
Department of Pediatric Radiology, UK-SH, Campus Kiel. joerg.d.moritz@rad.uni-kiel.de
J D
JD
Moritz
L D
LD
Berthold
S F
SF
Soenksen
G F
GF
Alzen
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D050723:Fractures, Bone / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011859:Radiography; D012680:Sensitivity and Specificity; D014463:Ultrasonography