title: [Ultrasound-based treatment of proximal humerus fractures in                     children].
abstract: BACKGROUND
  The treatment of juvenile proximal humerus fractures is based on the extent of the deformity. The standard diagnosis with X-ray images in 2 directions is error-prone and can lead to a suboptimal treatment. The aim of this study was to evaluate if ultrasound imaging can improve the measurement of the deformity of proximal humerus fractures.
  
  
  METHODS
  In a prospective, multicentre trial children aged 0-12 years with a suspected proximal humerus fracture were initially examined with a 10-MHz linear transducer in 4 directions and the maximum deformity was determined. Afterwards the standard X-rays were taken and the results of both methods compared. The certainty of both methods was compared with a standardised nominal scale.
  
  
  RESULTS
  From 8/2010 to 5/2011 6 consultants in 4 hospitals examined 30 patients (16 m, 14 f, mean age 7.9 years). In 15 cases the ultrasound showed a larger deformation than the X-rays and in 2 cases vice versa. In 11 cases the measurement was identical 6 of which were undisplaced. The mean difference of the measurement of the deformity was + 8.6°, with 14.2° in the displaced fractures. The certainty of the ultrasound was rated significantly higher (p < 0.05) than that of radiography.
  
  
  CONCLUSIONS
  With a correct technique the deformity cannot be overestimated by ultrasound means and the safeness is rated significantly higher in comparison to the X-ray imaging. It seems that ultrasound is a meaningful method to improve the measurement of the deformity of proximal humerus fractures in children. Deficiencies are found only in cases with massive deformities which demand a reduction and stabilisation.
authors: Orthopädie und Unfallchirurgie, Sana-Klinikum Duisburg, Klinik der Sana-Gruppe. dr.med.ackermann@gmx.de
authors: O
authors: O
authors: Ackermann
authors: K
authors: K
authors: Eckert
authors: C
authors: C
authors: Rülander
authors: S
authors: S
authors: Endres
authors: C
authors: C
authors: von Schulze Pellengahr
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005858:Germany; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012784:Shoulder Fractures / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014463:Ultrasonography / Q000379:methods*