The Role of Ultrasound Imaging of Callus Formation in the Treatment of Long Bone Fractures in Children

Abstract

SummaryBackgroundIn the process of diagnosis and treatment of fractures, an X-ray study is typically performed. In modern medicine very important is the development of new diagnostic methods without adverse effects on the body. One of such techniques is ultrasound imaging. It has a high value in imaging most areas of the body, including the musculoskeletal system. Reports on the use of ultrasound in the evaluation of the callus are rare and this could be a method equivalent to or even better than standard radiographs. The aim of the study was to analyze the correlation of ultrasound with radiographs in imaging of callus formation after fractures of long bones in children and to analyze the correlation of vascular resistance index (RI) and the degree of vascularization of the callus with a subjective radiological assessment of the bone union quality.Material/MethodsThe prospective study was planned to qualify 50 children treated for long bones fractures of the arm, forearm, thigh and lower leg. Ultrasound diagnosis was carried out using a Philips iU22 camera equipped with a linear probe with 17-5-MHz resolution and MSK Superficial program. During ultrasound examination measurements of the callus were performed. Using the Power Doppler callus vascularity was visualized and vascular resistance index (RI) was measured. The same measurements were made within the corresponding area of the healthy limb. The results obtained by ultrasound were compared with radiograph measurements and with the subjective assessment of the callus quality.ResultsPreliminary results were developed on a group of 24 patients, where 28 fractured bones and 28 corresponding healthy bones were examined. Fifteen boys and 9 girls participated in the study. The average age at injury was, respectively, 11 and 9 years. In both groups fractures without displacement were the most frequent. A similar frequency was observed in fractures requiring reposition and subperiosteal fractures. In contrast, fractures with a slight displacement of the fragments, were 3 times more common in girls. Statistical analysis of the measurements of length and width of the callus demonstrated that the differences between results obtained in the ultrasound in comparison with X-rays were not statistically significant. Moreover, preliminary results showed a significantly higher degree of vascularization of the callus than of the healthy periosteum.ConclusionsPreliminary results indicate the high efficacy of ultrasound in the evaluation of callus formation after fractures of long bones in children and the possibility of its alternative use to X-ray examinations.

What is the role of ultrasound in fracture management?

“…32 More recently, a small study of 28 conservatively treated paediatric fractures compared radiographs with ultrasound assessment at the time of removal of cast. 33 They found that the measurement of callus formation and prediction of union was comparable between radiographs and ultrasound. However, the timing of radiographs and ultrasound was not clearly stated, nor was the reproducibility of ultrasound assessment adequately reported.…”

“…However, the timing of radiographs and ultrasound was not clearly stated, nor was the reproducibility of ultrasound assessment adequately reported. 33 Despite numerous publications over the last decade describing the early detection of callus on ultrasound prior to radiographs, all are limited by incomplete reporting of the reliability and reproducibility of their findings. 27-32…”

“…It has been suggested that neovascularization can be used to predict callus formation. 33,38-40 This relationship was explored by Caruso et al 39 with a series of 20 tibia shaft fractures managed using external fixators. New vessel formation within a maturing callus was followed by a decrease that was seen after approximately 100 days, with uneventful union in 18 patients.…”

Problem Solved

“…Serial follow‐up of pediatric distal forearm fractures has been described in the literature, 29 as has the evaluation and follow‐up of scaphoid fractures 30 . Wawrzyk et al 31 also suggested the use of ultrasound as an alternative to radiography in the evaluation of callus formation after fracture of long bones in children. It seems this could be similarly applied to the evaluation of heterotopic ossification in and around joints.…”

Ultrasonography as a Diagnostic, Therapeutic, and Research Tool in Orthopaedic Surgery

“…38 Similar results have been found with monitoring of long bone fractures in the pediatric population. 39…”