Acute elbow trauma in children: role of ultrasonography

Zuazo, Iñaki; Bonnefoy, Olivier; Tauzin, C; Borocco, A.; Lippa, A; Legrand, Mathieu; Chateil, Jean‐François

doi:10.1007/s00247-008-0935-5

Cited by 41 publications

(33 citation statements)

References 14 publications

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“…Magnetic resonance imaging would be the most reliable and recommended imaging modality for this differentiation. Previous reports of sonography as a direct diagnostic tool for radiographically equivocal fractures in the upper extremity have focused on the scaphoid, 16 – 19 radial neck, 20 and pediatric elbow and wrist 21 – 23 …”

Section: Discussionmentioning

confidence: 99%

Sonographic Appearance of the Pronator Quadratus Muscle in Healthy Volunteers

Sato¹,

Ishii²,

Noguchi³

et al. 2014

J of Ultrasound Medicine

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Section: Discussionmentioning

confidence: 99%

Sonographic Appearance of the Pronator Quadratus Muscle in Healthy Volunteers

Sato¹,

Ishii²,

Noguchi³

et al. 2014

J of Ultrasound Medicine

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“…This demonstrates how subtle the radiographic signs of occult fractures may be and a negative radiographic result may provide a false sense of assurance. The absence of early management in these children may increase the complication rate (13). Thus, immobilization is critical for improving healing time, preventing potential growth arrest, fracture deformity, and to avoid discomfort (13, 19).…”

Section: Discussionmentioning

confidence: 99%

“…The absence of early management in these children may increase the complication rate (13). Thus, immobilization is critical for improving healing time, preventing potential growth arrest, fracture deformity, and to avoid discomfort (13, 19). However, the major limitation of this strategy is the undesirable over-treatment, resulting in unnecessary limitation of extremity motion, and a 1-2 week follow-up that is imposed on children without a fracture, as well as unnecessary visits for parents or guardians.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound Diagnosis of Either an Occult or Missed Fracture of an Extremity in Pediatric-Aged Children

Cho

Lee

et al. 2010

Korean J Radiol

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ObjectiveTo report and assess the usefulness of ultrasound (US) findings for occult fractures of growing bones.Materials and MethodsFor six years, US scans were performed in children younger than 15 years who were referred with trauma-related local pain and swelling of the extremities. As a routine US examination, the soft tissue, bones, and adjacent joints were examined in the area of discomfort, in addition to the asymptomatic contralateral extremity for comparison. Twenty-five occult fractures in 25 children (age range, five months-15 years; average age, 7.7 years) were confirmed by initial and follow-up radiograms, additional imaging studies, and clinical observation longer than three weeks.ResultsThe most common site of occult fractures was the elbow (n = 9, 36%), followed by the knee (n = 7, 28%), ischium (n = 4, 16%), distal fibula (n = 3, 12%), proximal femur (n = 1, 4%), and humeral shaft (n = 1, 4%). On the retrograde review of the routine radiographs, 13 out of the 25 cases showed no bone abnormalities except for various soft tissue swelling. For the US findings, cortical discontinuity (direct sign of a fracture) was clearly visualized in 23 cases (92%) and was questionable in two (8%). As auxiliary US findings (indirect signs of a fracture), step-off deformities, tiny avulsed bone fragments, double-line appearance of cortical margins, and diffuse irregularity of the bone surfaces were identified.ConclusionPerforming US for soft tissue and bone surfaces with pain and swelling, with or without trauma history in the extremities, is important for diagnosing occult or missed fractures of immature bones in pediatric-aged children.

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“…However, all errors (n = 5) occurred in the first quartile of the study suggesting a steep learning curve, with no errors in the remainder of the study. When present, lipohemarthrosis (clip 5 and 6) within an elevated fat pad increases the likelihood of an elbow fracture [9], and is not identifiable by X-ray. In a small study of 14 patients by Zuazo [9], finding lipohemarthrosis correlated to elbow fractures (7 out of 7) seen on magnetic resonance imaging (MRI) but not seen by X-ray; when only an elevated fat pad or elbow effusion without lipohemarthrosis was visualized, only one out of seven of these cases had an elbow fracture detected by MRI.…”

Section: Discussionmentioning

confidence: 99%

“…The posterior fat pad sign seen on radiography can also be rapidly and easily identified by ultrasound at the point-of-care [8]. The finding of lipohemarthrosis with an elevated posterior fat pad by ultrasonography may also provide further evidence of fracture [9]. Furthermore, ultrasound can be performed without discomfort to the patient and without exposure to ionizing radiation [10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Rapid screening for the posterior fat pad sign in suspected pediatric elbow fractures using point-of-care ultrasound: a “FAST exam” for the traumatized elbow

Tsung

Blaivas

2010

Crit Ultrasound J

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Purpose Children with elbow injuries frequently present to the emergency department for evaluation. Fractures of the elbow are sometimes not visualized on plain radiographs and the only sign of an occult fracture is an elevated posterior fat pad that normally sits within the olecranon fossa. The elevated posterior fat pad sign is highly sensitive and its absence likely rules out fractures of the elbow and can be readily visualized by ultrasound. Lipohemarthrosis within an elevated fat pad can also be visualized by ultrasound, but not by X-ray. This finding with an elevated posterior fat pat adds additional specificity to rule in elbow fractures. Methods We report the use of point-of-care ultrasound to rapidly screen for the presence of the posterior fat pad sign and lipohemarthrosis in a series of children presenting with elbow injuries to the emergency department. Results Point-of-care ultrasound identified elevated and normal posterior fat pads that correlated with X-ray. Lipohemarthrosis within an elevated fat pad was also detectable by ultrasonography.Conclusions Knowledge of whether a posterior fat pad is elevated or not and noting the presence of lipohemarthrosis by using point-of-care ultrasound may be helpful to expedite diagnosis and treatment of these patients, especially in settings with no access to plain radiography.

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Acute elbow trauma in children: role of ultrasonography

Abstract: Posttrauma elbow joint effusion in children is not always related to a cortical fracture. US appears to be a reliable, accurate, widely available and effective low-cost tool in these cases. The diagnostic clue is the detection of a lipohaemarthrosis in the articular recess.

Cited by 41 publications

References 14 publications

Sonographic Appearance of the Pronator Quadratus Muscle in Healthy Volunteers

Sonographic Appearance of the Pronator Quadratus Muscle in Healthy Volunteers

Ultrasound Diagnosis of Either an Occult or Missed Fracture of an Extremity in Pediatric-Aged Children

Rapid screening for the posterior fat pad sign in suspected pediatric elbow fractures using point-of-care ultrasound: a “FAST exam” for the traumatized elbow

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