[Usability of Ultrasonography in the Diagnosis of Pediatric Fractures].

Abstract

The study aims to evaluate the usability of ultrasonography in the diagnosis of pediatric fractures. Ultrasound examination of patients with fractures diagnosed using radiography at the Clinic of Pediatric and Trauma Surgery, Third Faculty of Medicine, Charles University and UTH between 27 May 2024 and 31 December 2024. We identified a total of 11 areas to be examined - clavicle, proximal humerus, elbow, forearm, metacarpal bones, fingers of the upper limb, sternum, femur, tibia, ankle, and metatarsal bones. The examination was performed independently by a surgeon and a radiologist, who selected the patients randomly during their treatment at the clinic. The entire bone was examined by ultrasound in all available projections, and signs of skeletal trauma (cortical bumping, cortical disruption, offset of bone fragments, chimney effect, or indirect signs such as joint effusion) were sought. A total of 61 patients were examined, of whom 24 girls (39%) and 37 boys (61%). The mean age of patients was 10 years (1-17 years). The overall agreement between ultrasound and radiologic examinations is 94%. Ultrasonography failed to visualize two fractures, namely a nondisplaced SH type II fracture of the distal fibula epiphysis and a nondisplaced SH type III fracture of the distal phalanx epiphysis. Two suspected fractures of the distal forearm detected by radiography were not observed by ultrasonography. The fracture was ruled out by a follow-up radiography, and the sonographic finding was found to be correct. Ultrasonography is a usable diagnostic method for skeletal trauma. The estimated sensitivity of this examination is around 97%. Our results indicate greater specificity of ultrasound in the forearm region. In agreement with literature, ultrasound can be considered usable for the diagnosis of fractures in all examined areas. In certain locations, it can also be used to measure displacement. The weak point of the study is the limited number of patients, therefore further investigation into these matters is necessary. Ultrasonography appears to be a useful screening method for skeletal trauma in children, serving as a basis for indication for radiography. This could help reduce the number of radiologic examinations performed by up to two-thirds, thereby reducing the radiation exposure in pediatric patients. Further research on these matters is needed, and diagnostic reliability indicators shall be defined. In the phase two of the study, we plan to determine the sensitivity, specificity, positive and negative predictive values for all anatomical regions. The secondary objective is to evaluate the results achieved by the surgeon and the radiologist, the painfulness of the examination, and the usability of portable ultrasound devices.