NDLI: Diagnostic value of ultrasonography in elbow trauma in children: Prospective study of 34 cases.

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Diagnostic value of ultrasonography in elbow trauma in children: Prospective study of 34 cases.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Burnier, M. Buisson, G. Ricard, A. Cunin, V. Pracros, J. P. Chotel, F.
Description	Author Affiliation: Burnier M ( Service de Chirurgie orthopédique, Hôpital Femme Mère Enfant, Lyon, France. Electronic address: marion.burnier@wanadoo.fr.); Buisson G ( Service de Radiologie, Hôpital Femme Mère Enfant, Lyon, France.); Ricard A ( Service d'Urgences pédiatriques Traumatologiques, Hôpital Femme Mère Enfant, Lyon, France.); Cunin V ( Service de Chirurgie orthopédique, Hôpital Femme Mère Enfant, Lyon, France.); Pracros JP ( Service de Radiologie, Hôpital Femme Mère Enfant, Lyon, France.); Chotel F ( Service de Chirurgie orthopédique, Hôpital Femme Mère Enfant, Lyon, France.)
Abstract	INTRODUCTION: Among the various elbow injuries in children that initially have normal radiographs, a certain number of occult fractures are only diagnosed correctly after the fact, during a follow-up visit. PURPOSE: This study evaluated the diagnostic contribution of ultrasonography in the treatment of acute elbow injuries in children and the strategic and economic impact of using this tool alongside radiography. MATERIALS AND METHODS: During this prospective study performed between January 1 and April 1 2014, elbow ultrasonography was performed within 6 days in all children under 15 years of age with a suspected occult fracture. The ultrasonography exam looked for lipohemarthrosis, the posterior fat pad sign and cortical disruption. If no fracture was visible on ultrasonography, a removable splint was given to the patient to relieve pain, and no radiological or clinical follow-up was scheduled. The patients were contacted again at least 15 days later to determine whether an undetected fracture was present. Lastly, we evaluated the cost of treatment with and without ultrasonography in the cases where no fracture was diagnosed. RESULTS: In 13 cases, ultrasonography revealed lipohemarthrosis and a fat pat sign, with cortical disruption also present in 11 of these cases. In two cases, the diagnosis was made based solely on the presence of lipohemarthrosis and a fat pat sign. There were seven lateral condyle fractures, two medial epicondyle fractures and two supracondylar fractures. Among the 21 patients with normal ultrasonography, no fracture was diagnosed later on. In patients without a fracture, using ultrasonography resulted in a cost savings of 29.10 per patient versus not using it. CONCLUSION: In our study, ultrasonography is a sensitive examination for the diagnosis of occult elbow fractures in children. When the radiography and ultrasonography are both normal, the possibility of fracture can be rule out definitively, which reduces the need for immobilization, follow-up and treatment costs. The findings of this preliminary study should be validated with a larger prospective study.
File Format	HTM / HTML
Issue Number	7
Journal	Orthopaedics & Traumatology: Surgery & Research
Volume Number	102
e-ISSN	18770568
Language	English
Publisher	Elsevier
Publisher Date	2016-11-01
Publisher Place	France
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Orthopedics Discipline General Surgery Discipline Traumatology
Content Type	Text
Resource Type	Article

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