title: Ultrasound-guided diagnosis of fractures of the distal forearm in children.
abstract: OBJECTIVE
  Distal radius and forearm fractures are injuries that are frequently seen in trauma surgery outpatient clinics. Usually, the wrist is X-rayed in 2 planes as standard diagnostic procedure. In contrast, we evaluate in our study the accuracy of ultrasonography (US) in diagnosing these fractures.
  
  
  METHODS
  This prospective study includes the patients who presented at two trauma surgery clinics with a presumptive diagnosis of distal radius or forearm fracture between January and December 2012. After a clinical examination, US imaging of the distal forearm was first carried out on 6 standardized planes followed by radiographs of the wrist made in two planes. The age limit was set at the end of 11 years.
  
  
  RESULTS
  In total, 201 patients between 4 and 11 years of age were recruited with an average age of 9.5 years at the time of the trauma. There were 104 (51.7%) fractures distributed as follows: 89 (85.9%) injuries of the distal radius, 9 (8.7%) injuries of the distal ulna, and 6 (5.8%) combined injuries (radius and ulna). Sixty-five greenstick fractures were detected. Surgery was necessary in 34 cases. Specificity and sensitivity of ultrasound diagnosis were 99.5%.
  
  
  CONCLUSIONS
  Ultrasound imaging is suitable to demonstrate fractures of the distal forearm. It is a highly sensitive procedure in detecting distal forearm fractures. In our opinion, a negative result in ultrasound may reduce the need for further radiographs in children with distal forearm lesions. But in any doubtful situation the need for conventional radiographs remains.
authors.affiliation: University Clinic RWTH Aachen, Department for Trauma and Reconstructive Surgery, Pauwelsstraße 30, 52074 Aachen, Germany. Electronic address: cherren@ukaachen.de.
authors.forename: C
authors.initials: C
authors.lastname: Herren
authors.affiliation: Medizinisches Zentrum StädteRegion Aachen GmbH, Centre for Orthopaedic and Trauma Surgery, Mauerfeldchen 25, 52146 Würselen, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Sobottke
authors.affiliation: Medizinisches Zentrum StädteRegion Aachen GmbH, Centre for Orthopaedic and Trauma Surgery, Mauerfeldchen 25, 52146 Würselen, Germany.
authors.forename: M J
authors.initials: MJ
authors.lastname: Ringe
authors.affiliation: Städtisches Krankenhaus Heinsberg, Department for Surgery and Trauma Surgery, Auf dem Brand 1, 52525 Heinsberg, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Visel
authors.affiliation: Medizinisches Zentrum StädteRegion Aachen GmbH, Centre for Orthopaedic and Trauma Surgery, Mauerfeldchen 25, 52146 Würselen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Graf
authors.affiliation: University of Cologne, Department for Radiology, Kerpener Street 62, 50937 Cologne, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Müller
authors.affiliation: University of Cologne, Department for Orthopaedic and Trauma Surgery, Kerpener Street 62, 50937 Cologne, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Siewe
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005543:Forearm Injuries / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D011885:Radius Fractures / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D014458:Ulna Fractures / Q000000981:diagnostic imaging*; D014463:Ultrasonography
keywords: Childhood; Distal forearm; Fracture diagnosis; Pediatric fracture; Ultrasonography; Ultrasound imaging