Ultrasound is a safe and accurate alternative to X-ray for detecting metaphyseal forearm fractures in children, say researchers.
Although an individual X-ray involves exposure to a fairly low dose of radiation, there is still concern about how harmful such exposure may be in the long term. This is a particular concern in children due to the proliferative nature of their bone tissue.
Building on previous studies that have demonstrated a good accuracy of fracture diagnosis using ultrasound, Kolja Eckert (Elisabeth Hospital Essen, Germany) and colleagues compared ultrasound and radiographic imaging of 76 German children, aged from 1 to 14 years, with suspected forearm fracture.
All the children underwent ultrasound imaging before standard 2-view radiographs of the wrist being taken.
Using X-ray as the "gold standard," 53 metaphyseal forearm fractures were diagnosed in 42 children.
Ultrasound imaging performed well, also diagnosing all 52 fractures. In addition, all patients without fracture were diagnosed correctly using ultrasound. As confirmed by standard X-ray, ultrasound had a sensitivity of 96.1% and a specificity of 97.0%.
"Even very discrete fractures could be visualized" using ultrasound, note the authors in Pediatric Emergency Care.
When looking at axis deviation of displaced fractures, there was a mean difference of 2.1 degrees between sonographic and X-ray scores.
"Ultrasound as a dynamic examination allows single visualization of the radial and ulnar corticalis avoiding overlayering of bones commonly seen in radiographs," write Eckert et al. They also emphasize that "in problematic cases, ultrasound allows the comparative examination of the healthy contralateral wrist, avoiding additional ionizing radiation."
The team concludes that ultrasound is a viable alternative to X-ray in children with forearm fracture and say that, at least in their unit, "ultrasound accelerates the diagnostic procedure, because it is done immediately after clinical assessment, avoiding another waiting period to do the x-ray-examination."
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