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Čepelík M, Hendrych J, Melínová H, Havránek P, Pešl T. Ultrasound imaging in diagnostics of Monteggia lesion in children. J Child Orthop 2022; 16:262-268. [PMID: 35992519 PMCID: PMC9382707 DOI: 10.1177/18632521221108602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/03/2022] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The aim of the study is to evaluate the use of ultrasound imaging in diagnostics of Monteggia lesion in children where conventional radiographs and the use of the radiocapitellar line fail to provide an accurate diagnosis. METHODS Prospective diagnostic study of 70 patients treated between May 2018 and July 2021 in a pediatric level 1 trauma center. In 20 patients with the confirmed radiographic diagnosis of Monteggia lesion, an ultrasound of the humeroradial joint was performed to determine signs of both normal and dislocated elbow joint. In 36 patients with suspected humeroradial dislocation on plain radiographs, ultrasound imaging was performed to determine the definitive diagnosis. Overall, 14 patients with elbow joint injury other than humeroradial dislocation were excluded from the study. RESULTS The "double-hump sign" and the "congruency sign" were determined as normal findings on ultrasound of the humeroradial joint. These signs were applied to patients with unclear findings on radiographs. In three patients, the dislocation of the humeroradial joint was confirmed by ultrasound. In two patients, "defect in congruency sign" was seen during reduction despite normal radiographs, which required re-reduction. In 31 patients, dislocation of the humeroradial joint was refuted. In 34 out of the 36 patients, the diagnosis determined by ultrasound was confirmed in follow-up. Two patients did not attend the follow-up examination. CONCLUSION Ultrasound imaging is an accessible, non-invasive, and dynamic point-of-care method that can be applied in children suffering from suspected humeroradial dislocation and/or subluxation. LEVEL OF EVIDENCE Level III-diagnostic study.
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Affiliation(s)
- Martin Čepelík
- Department of Pediatric and Trauma Surgery,
Third Faculty of Medicine, Charles University and Thomayer University Hospital, Prague,
Czech Republic,Martin Čepelík, Department of Pediatric and Trauma
Surgery, Third Faculty of Medicine, Charles University and Thomayer University Hospital,
Prokopova 10, 130 00 Prague, Czech Republic.
| | - Jan Hendrych
- Department of Pediatric and Trauma Surgery,
Third Faculty of Medicine, Charles University and Thomayer University Hospital, Prague,
Czech Republic
| | - Hana Melínová
- Department of Radiology, Thomayer University
Hospital, Prague, Czech Republic
| | - Petr Havránek
- Department of Pediatric and Trauma Surgery,
Third Faculty of Medicine, Charles University and Thomayer University Hospital, Prague,
Czech Republic
| | - Tomáš Pešl
- Department of Pediatric and Trauma Surgery,
Third Faculty of Medicine, Charles University and Thomayer University Hospital, Prague,
Czech Republic
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Wu Y, Lu R, Liao S, Ding X, Su W, Wei Q. Application of ultrasound in the closed reduction and percutaneous pinning in supracondylar humeral fractures. J Orthop Surg Res 2021; 16:588. [PMID: 34641943 PMCID: PMC8507188 DOI: 10.1186/s13018-021-02755-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/24/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Ultrasound examination can be applied to the diagnosis of pediatric elbow fracture. This study aims to analyze the application value of ultrasound in the surgical treatment of supracondylar humeral fractures. METHODS 64 children with supracondylar humeral fractures were treated with ultrasound-guided closed reduction and percutaneous pinning (CRPP), 31 patients were treated with CRPP under radiography guidence. The reduction effect of supracondylar humeral fractures was determined through the perioperative ultrasound images of the lateral, medial and posterior aspects of the elbow. Percutaneous pinning was performed after supracondylar humeral fractures were well reduced. A follow-up examination was performed and all the patients were evaluated according to Flynn's criteria. RESULTS The mean duration of surgery was 58.3 min (42-108 min) in the ultrasound group and 41.5 min (24-63 min) in the radiography group (P < 0.05). The mean carrying angle was 8.2° (0°-15°) in the ultrasound group and 9.4°(3°-16°) in the radiography group; The mean Baumann's angle was 75.5°(60°-85°) in the ultrasound group and 73.4°(62°-82°) in the radiography group; The mean lateral humerocapitellar angle was 38.4° (26°-54°) in the ultrasound group and 41.6°(29°-52°) in the radiography group; No significant differences were observed between the two groups. According to the Flynn's criteria, 49 (76.6%) patients had excellent, 10 (15.6%) patients achieved good, 3 (4.7%) patients showed fair results and 2 (3.1%) patients achieved poor results in the ultrasound group; 22 (70.9%) patients had excellent, 6 (19.4%) patients achieved good, 2 (6.5%) patients showed fair results and 1 (3.2%) patients achieved poor results in the radiography group; No statistically significant difference was noted between the results of these two groups (P > 0.05). After surgery, three patients had pin tract infection. One patient had ulnar nerve neurapraxia in the radiography group. No cases with Volkmann's contracture were reported. CONCLUSION Ultrasound-guided CRPP is a safe and reliable surgical treatment of pediatric supracondylar humeral fractures. Trial registration Retrospectively registered.
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Affiliation(s)
- Yang Wu
- Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, Guangxi, China
| | - Rongbin Lu
- Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, Guangxi, China
| | - Shijie Liao
- Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, Guangxi, China
| | - Xiaofei Ding
- Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, Guangxi, China.
| | - Wei Su
- Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, Guangxi, China
| | - Qinjun Wei
- Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, Guangxi, China
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Agnollitto PM, de Araújo Braz G, Spirlandeli AL, de Paula FJA, Carneiro AAO, Nogueira-Barbosa MH. Ex vivo vibro-acoustography characterization of osteoporosis in an experimental mice model. Quant Imaging Med Surg 2021; 11:586-596. [PMID: 33532259 DOI: 10.21037/qims-20-610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Osteoporosis is a highly prevalent multifactorial osteometabolic disease, classically diagnosed, in vivo, by dual energy X-ray absorptiometry (DXA). This study evaluated osteoporosis, ex vivo, using vibro-acoustography (VA), an elastographic technique based on ultrasound radiation force. Methods Three groups of mice femurs were used: (I) control group (CG), (II) osteoporosis group (OG) and (III) treated osteoporosis group (TOG), in which the animals received pamidronate, an antiresorptive drug. Evaluation was performed in an acoustic tank, using two high frequency focused beams produced by a confocal ultrasonic transducer. A hydrophone registered the low frequency acoustic response (AR) of bone samples. We used micro-computed tomography (microCT) as the reference standard and evaluated the correlation between VA and microCT parameters. Results The spectral analyses of the ARs with estimated area under the curve (AUC) values (mean; st. dev.) were, respectively, 1.29e-07 and 9.32e-08 for the CG, 3.25e-08 and 2.16e-08 for the OG, and 1.50e-07 and 8.37e-08 for the TOG. VA differentiated the experimental groups (P<0.01) and the results were reproducible [interclass correlation coefficient (ICC): 0.43 (95% CI: 0.15-0.71)]. There was also a statistically significant association between VA and microCT connectivity (Conn.) (r=0.80; P<0.01) and connectivity density (Conn. D) (r=0.76; P<0.01). Conclusions These results encourage further studies aimed at evaluating the potential use of VA for the diagnosis of osteoporosis as a relatively low-cost and radiation-free alternative to DXA.
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Affiliation(s)
- Paulo Moraes Agnollitto
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.,Ribeirão Preto Medical School Musculoskeletal Imaging Research Laboratory, Ribeirão Preto, SP, Brazil
| | - Guilherme de Araújo Braz
- Physics Department, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | | | | | - Antonio Adilton Oliveira Carneiro
- Physics Department, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Marcello Henrique Nogueira-Barbosa
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.,Ribeirão Preto Medical School Musculoskeletal Imaging Research Laboratory, Ribeirão Preto, SP, Brazil
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Distal humeral epiphyseal separation in young children: an often-missed fracture-radiographic signs and ultrasound confirmatory diagnosis. AJR Am J Roentgenol 2015; 204:W192-8. [PMID: 25615780 DOI: 10.2214/ajr.14.12788] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. Distal humeral epiphyseal separation is rare and often misdiagnosed. The purpose of this study was to summarize an experience with radiography and ultrasound of distal humeral epiphyseal separation. MATERIALS AND METHODS. The records of all children younger than 36 months with the diagnosis of distal humeral epiphyseal separation from 2006 to 2013 were identified. Medical and imaging records were reviewed for diagnosis with radiography and ultrasound, cause, treatment, and follow-up. The initial diagnosis, relation of the radius and ulna to the distal humerus, presence of other fractures, and signs of elbow effusion were evaluated. RESULTS. Sixteen patients (10 boys, six girls; mean age, 8.6 months) were evaluated for distal humeral epiphyseal separation. All patients had elbow radiographs. Fifteen (94%) patients had medial and six (38%) had posterior displacement of the radius and ulna. The diagnosis was missed on radiographs of nine (56%) patients. Ultrasound was performed for 12 patients and showed distal humeral epiphyseal separation in all. In 10 (63%) patients, one or more additional humeral fractures were found: bucket-handle fractures in five patients and condylar avulsion fracture in six patients. In the six (38%) patients younger than 1 month, distal humeral epiphyseal separation was secondary to birth trauma. In 4 of the 10 (40%) older patients, nonaccidental trauma was diagnosed. All patients underwent follow-up with a pediatric orthopedist and had full range of motion. Two patients had mild varus deformities. CONCLUSION. The diagnosis of distal humeral epiphyseal separation is often missed on radiographs. Radiologists should be aware that posteromedial displacement of the radius and ulna in young children is highly suggestive of distal humeral epiphyseal separation and that the diagnosis can be confirmed with ultrasound.
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Shen XT, Zhou ZG, Yu LS, Wu X, Chen XL, Xu Y, Sun J. Ultrasound assessment of the elbow joint in infants and toddlers and its clinical significance. Acta Radiol 2014; 55:745-52. [PMID: 24060815 DOI: 10.1177/0284185113505515] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Ultrasound can be used for the diagnosis of elbow injuries in infants and toddlers. However, ultrasound is highly operator-dependent and accurate ultrasound examinations require a complete understanding of the complex anatomy of the elbow joint. PURPOSE To report the normal ultrasound anatomy of the elbow, particularly of the humeroulnar joint, in infants and toddlers. MATERIAL AND METHOD Thirty subjects aged <3 years with no history of elbow injuries underwent ultrasound examinations of the elbow joint from six directions: (i) lateral to the humeroradial joint; (ii) anterior to the humeroradial joint; (iii) posterior to the humeroradial joint; (iv) medial to the humeroulnar joint; (v) anterior to the humeroulnar joint; and (vi) posterior to the humeroulnar joint. RESULTS The appearance of the humeroradial joint observed from three directions was similar and resembled a pair of double fists ("double-breast sign"). The appearance of the humeroulnar joint observed from three directions was different, which is related to the irregular morphology of the medial sides of the humerus and ulna. Anteroposteriorly, the coronoid and olecranon epiphyses and coronoid fossa appear anteriorly and the olecranon and trochlear epiphyses and olecranon fossa appear posteriorly, resembling a "check-mark sign". The medial epicondyle, cubital tunnel and distal humerus appear together ("double-hump sign"). The "anterior hump" is the medial epicondyle and is always higher than the "posterior hump", which is the bony protrusion on the articular surface of the distal humerus. The ultrasound signal of cortical bone in the metaphysis of the distal humerus is continuous with that of the epiphysis of the medial epicondyle. CONCLUSION Ultrasound is useful for the diagnosis of elbow injuries in infants and toddlers.
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Affiliation(s)
- Xian-tao Shen
- Department of Orthopedics, Children’s Hospital of Wuhan City, PR China
| | - Zhi-guo Zhou
- Department of Orthopedics, Children’s Hospital of Wuhan City, PR China
| | - Li-song Yu
- Department of Orthopedics, Children’s Hospital of Wuhan City, PR China
| | - Xing Wu
- Department of Orthopedics, Children’s Hospital of Wuhan City, PR China
| | - Xiao-liang Chen
- Department of Orthopedics, Children’s Hospital of Wuhan City, PR China
| | - Yang Xu
- Department of Orthopedics, Children’s Hospital of Wuhan City, PR China
| | - Jie Sun
- Department of Ultrasonics, Children’s Hospital of Wuhan City, PR China
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Eckert K, Ackermann O, Janssen N, Schweiger B, Radeloff E, Liedgens P. Accuracy of the sonographic fat pad sign for primary screening of pediatric elbow fractures: a preliminary study. J Med Ultrason (2001) 2014; 41:473-80. [PMID: 27278028 DOI: 10.1007/s10396-014-0525-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 01/30/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the diagnostic accuracy of the sonographic fat pad sign (FPS) as a predictor for pediatric elbow fractures. PATIENTS AND METHODS This is a prospective study of children under 14 years with suspected elbow fractures. All participants underwent at first ultrasonography focused on a FPS followed by standard elbow radiographs. US findings were compared to final fracture diagnosis. RESULTS 38 out of 79 children had an elbow fracture. A sonographic FPS predicted an elbow fracture with a sensitivity/specificity of 97.3/90.5 %, positive/negative likelihood ratios (LR) were 10.2/0.03 and correct/false classification rates were 93.7/6.3 %. Primary US findings were later reviewed by a blinded physician giving a congruity of 96.2 %. These secondary US findings predicted an elbow fracture with a sensitivity/specificity of 92.1/92.7 %, positive/negative LRs were 12.6/0.09 and correct/false classification rates were 92.4/7.5 %. CONCLUSION The sonographic FPS could serve as a useful screening tool in primary evaluation of pediatric elbow injuries. If a fracture is unlikely after clinical and US evaluation, additional radiographs are dispensable, thereby potentially minimizing the radiation burden in childhood and reducing the length of stay in the Emergency Department.
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Affiliation(s)
- Kolja Eckert
- Department for Pediatric Surgery, Elisabeth Hospital Essen, Klara-Kopp-Weg 1, 45138, Essen, Germany.
| | - Ole Ackermann
- Department for Orthopaedics, Trauma- and Reconstructive Surgery, Evangelic Hospital Oberhausen, Virchowstrasse 20, 46047, Oberhausen, Germany
| | - Niklas Janssen
- Department for Pediatric Surgery, Elisabeth Hospital Essen, Klara-Kopp-Weg 1, 45138, Essen, Germany
| | - Bernd Schweiger
- Department for Diagnostical und Interventional Radiology and Neuroradiology, Universitary Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Elke Radeloff
- Department for Pediatric Surgery, Elisabeth Hospital Essen, Klara-Kopp-Weg 1, 45138, Essen, Germany
| | - Peter Liedgens
- Department for Pediatric Surgery, Elisabeth Hospital Essen, Klara-Kopp-Weg 1, 45138, Essen, Germany
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Boniface KS, Ajmera K, Cohen JS, Liu YT, Shokoohi H. Ultrasound-guided Arthrocentesis of the Elbow: A Posterior Approach. J Emerg Med 2013; 45:698-701. [DOI: 10.1016/j.jemermed.2013.04.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Revised: 04/18/2013] [Accepted: 04/30/2013] [Indexed: 11/24/2022]
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Ultrasound diagnosis of supracondylar fractures in children. Eur J Trauma Emerg Surg 2013; 40:159-68. [DOI: 10.1007/s00068-013-0306-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 05/19/2013] [Indexed: 01/08/2023]
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Ultrasound evaluation of elbow fractures in children. J Med Ultrason (2001) 2013; 40:443-51. [DOI: 10.1007/s10396-013-0446-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 03/12/2013] [Indexed: 10/27/2022]
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Musculoskeletal ultrasound of the upper extremity in children. Pediatr Radiol 2013; 43 Suppl 1:S48-54. [PMID: 23478919 DOI: 10.1007/s00247-012-2600-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 11/16/2012] [Accepted: 11/17/2012] [Indexed: 10/27/2022]
Abstract
Musculoskeletal US is becoming more widely performed in children. Although overlap between pediatric and adult pathology exists, particularly in older children who have a more mature skeleton, there are significant differences when assessing patients who have cartilaginous ossification centers, particularly in the context of trauma. Lack of ionizing radiation and dynamic imaging capabilities are significant advantages compared to CT and MRI. Although MRI provides excellent evaluation of soft tissues, the need for general anesthesia in a subset of patients is undesirable, particularly when US can provide similar information. Radiography is the primary modality to evaluate trauma; however, musculoskeletal US can be useful to assess alignment of unossified structures, fractures that extend to involve the unossified epiphyses, occult fractures, physeal separation, presence of intra-articular bodies (particularly those that are not ossified), ligamentous injury and the occasionally encountered periosteum trapped between fracture fragments. The purpose of this article is to review commonly encountered pathologies unique to the pediatric upper extremities that are ideally imaged with sonography. Some pathology that overlaps with the adult population such as infection and sports injuries are briefly covered.
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Lee WS, Kim YH, Chee HK, Lee SA. Ultrasonographic evaluation of costal cartilage fractures unnoticed by the conventional radiographic study and multidetector computed tomography. Eur J Trauma Emerg Surg 2011; 38:37-42. [DOI: 10.1007/s00068-011-0117-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Accepted: 05/05/2011] [Indexed: 11/28/2022]
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Complex carpal malformation without a cause. J Pediatr Orthop B 2009; 18:302-3. [PMID: 19701104 DOI: 10.1097/bpb.0b013e32832feee6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Carpal dislocation is an uncommon event. We present a 4-year-old male child who had the clinical appearance of a Madelung's deformity; however, he failed to fulfill the radiological criteria for a Madelung's deformity. The carpal bones had not yet ossified making it difficult to arrive at a diagnosis using radiograph alone. Magnetic resonance imaging was diagnostic because of the ability to delineate the carpal cartilaginous ossification centers. Chronic wrist dislocation should be considered in the differential diagnosis of a long-standing wrist deformity that clinically resembles a Madelung's deformity in a young child.
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Chan SSW. Emergency bedside ultrasound for the diagnosis of rib fractures. Am J Emerg Med 2009; 27:617-20. [DOI: 10.1016/j.ajem.2008.04.013] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Revised: 03/22/2008] [Accepted: 04/13/2008] [Indexed: 11/16/2022] Open
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Dendane A, Amrani A, El Fellous El Alami Z, Gourinda H. [Supra and intercondylar elbow fractures in children]. ACTA ACUST UNITED AC 2009; 28:138-42. [PMID: 19427254 DOI: 10.1016/j.main.2009.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Revised: 02/23/2009] [Accepted: 03/15/2009] [Indexed: 11/19/2022]
Abstract
Supra- and intercondylar elbow fractures are rare in children. The treatment of these fractures is controversial. The purpose of this report is to discuss diagnosis and treatment of this unusual injury. Our study looked at nine patients between six and 15 years old (average age: 11.5). In four patients, the fracture was T-condylar and in five patients, the fracture was epiphyseal-diaphyseal. Communition was noted in five cases. All fractures are secondary to high-energy trauma. All patients were treated by open reduction and internal fixation. Three patients had associated nervous lesions. Patients were reviewed at an average of 30 months follow-up and the results evaluated according to the criteria of Flynn. The results were good or excellent in six patients, fair in two patients and poor in one. Cubitus varus and limitation of elbow motion were the main complication. Supra- and intercondylar elbow fractures should be differentiated from the more common supracondylar humerus fractures. We recommended open reduction with internal fixation. Complications are due to the severity of the initial trauma and sometimes to defective treatment especially in the case of complex fracture.
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Affiliation(s)
- A Dendane
- Service de traumato-orthopédie pédiatrique, hôpital d'Enfants, CHU Avicenne, Madinat-Al-Irfane, Rabat, Maroc.
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Ultrasonography for non-displaced and mini-displaced humeral lateral condyle fractures in children. Chin J Traumatol 2008; 11:297-300. [PMID: 18822194 DOI: 10.1016/s1008-1275(08)60060-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To evaluate the value of ultrasonography in non-displaced and mini-displaced humeral lateral condyle fractures in children. METHODS Nine children aged 2-9 years with non-displaced or mini-displaced humeral lateral condyle fractures were examined by high-resolution ultrasonography. The fracture line through the joint surface was visualized by ultrasonography in 6 case, in which closed reduction and percutaneous pinning was performed on 3 patients and other 3 patients did not receive the treatment because of patients'or their parents'refusal. In the remaining 3 children, ultrasonography did not reveal the cartilaginous trochle involvement at the joint surface and conservative treatment was adopted. RESULTS The average follow-up period was 8 months. The sonographic findings were confirmed by magnetic resonance imaging in one child who received conservative treatment and another child who received percutaneous pinning. The elbow function and fracture healing were good in cases received closed reduction and percutaneous pinning. Among the three cases who refused to receive closed reduction and internal fixation, re-displacement occurred in 1 case and delayed union in 1 case. All three cases receiving conservative treatment had good results both in elbow function and fracture healing. CONCLUSION High-resolution ultrasonography enable to reveal non-displaced and mini-displaced humeral lateral condyle fractures as well as to ascertain whether the cartilaginous trochlea humeri was involved. For these cases, arthrography or magnetic resonance imaging is unnecessary.
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Zuazo I, Bonnefoy O, Tauzin C, Borocco A, Lippa A, Legrand M, Chateil JF. Acute elbow trauma in children: role of ultrasonography. Pediatr Radiol 2008; 38:982-8. [PMID: 18626636 DOI: 10.1007/s00247-008-0935-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Revised: 05/03/2008] [Accepted: 05/26/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND The diagnosis of occult elbow fracture in children is often challenging due to equivocal or negative repeated radiographic findings. OBJECTIVE To evaluate the potential diagnostic role of US in children who have sustained elbow trauma with an elbow joint effusion but no fracture seen on initial radiographs. MATERIALS AND METHODS The study included 14 consecutive children (age range 5-15 years) with elbow trauma whose elbow radiographs showed an effusion without fracture who underwent emergency imaging (within the first 72 h) with US and MRI. The aim of US was to demonstrate a lipohaemarthrosis in relation to a cortical fracture. MR imaging was used as the reference to differentiate fracture from bone or muscle contusions. RESULTS In seven children US demonstrated a lipohaemarthrosis, and MRI demonstrated a cortical fracture in all these children. Conversely, among the seven children with simple haemarthrosis seen on US, MRI did not identify a cortical fracture in six and demonstrated a cortical fracture in one. CONCLUSION 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.
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Affiliation(s)
- Iñaki Zuazo
- Service d'Imagerie Anténatale, de la Femme et de l'Enfant, Hôpital Pellegrin, CHU Bordeaux, Bordeaux, France
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Haddad-Zebouni S, Abi Khalil S, Roukos S, Menassa-Moussa L, Smayra T, Aoun N, Ghossain M. [Limb fractures: ultrasound imaging features]. ACTA ACUST UNITED AC 2008; 89:557-63. [PMID: 18535496 DOI: 10.1016/s0221-0363(08)71481-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
US, a non-irradiating imaging modality, is complementary to radiographs in the evaluation of limb fractures. US may in some cases demonstrate or suggest the presence of a fracture without corresponding abnormality on radiographs, or confirm or exclude a possible fracture detected on radiographs. Knowledge of the US features of fractures is necessary. In this article, the different direct and indirect US findings of fractures will be reviewed, with radiographic correlation. Direct findings include cortical discontinuity or irregularity. Indirect findings include subperiosteal or juxtaphyseal hematoma suggesting cortical or physeal fractures respectively.
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Affiliation(s)
- S Haddad-Zebouni
- Service d'Imagerie Médicale, Hôtel-Dieu de France, rue Alfred Naccache, Beyrouth, Liban
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Schneidmueller D, Maier M, Mack M, Straub R, Marzi I. Therapeutische Relevanz der Magnetresonanztomographie bei Gelenkverletzungen im Kindesalter. Unfallchirurg 2005; 108:537-43. [PMID: 15870996 DOI: 10.1007/s00113-005-0936-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM In this retrospective study, we assessed whether the use of MRI in children provides additional, therapeutically relevant information to assist in the diagnosis of joint injuries. In addition, we determined whether the usefulness of this approach is dependant on age of the child and localisation of the trauma. METHOD MRI of 45 children aged between 3 and 16 years were analysed independently by four different investigators (two radiologists, two trauma surgeons) and assessed for their therapeutic relevance. RESULT MRI of the knee (n=18) gave additional information in 11 patients (61%) and led to a change in the recommended therapy involving arthroscopy in seven patients (39%). MRI of the ankle (n=21) provided additional information in 12 patients (57%) and the decision for further therapy was influenced in six patients (29%), however, the indication for surgery was not influenced. The diagnosis of injuries of the elbow (n=6) was changed in four patients (67%), but the therapeutic decision was not influenced. CONCLUSION MRI additional to conventional x-ray provides relevant information on the therapeutic procedure to be used for the knee, whereas for the ankle and the elbow MRI it rarely delivers additional information relevant to therapeutic decision making.
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Affiliation(s)
- D Schneidmueller
- Abteilung für Unfall, -Hand- und Wiederherstellungschirurgie der Johann-Wolfgang-Goethe-Universität Frankfurt.
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21
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Shabat S, Folman Y, Mann G, Kots Y, Fredman B, Banian M, Liberman N, Nyska M. The role of sonography in detecting radial head subluxation in a child. JOURNAL OF CLINICAL ULTRASOUND : JCU 2005; 33:187-189. [PMID: 15856520 DOI: 10.1002/jcu.20110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Injuries around the elbow joint in children can be difficult to diagnose on the basis of findings on physical examination and radiographs. We present the case of a 4-year-old girl with a probable subluxation of the radial head, based on the findings on physical examination and radiographs. Radiography raised the possibility of a radial head subluxation. Sonography demonstrated displacement of the cartilaginous head of the radius away from the capitellum in the affected elbow. The child underwent corrective surgery. During fluoroscopy, results of an ulnar stress test were positive for lateral ligament tears. The patient's arm was put in a cast for 6 weeks. At 1-year follow-up, the patient had full range of motion of the elbow without pain. We present the findings of sonographic studies used to confirm the diagnosis.
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Affiliation(s)
- Shay Shabat
- Department of Orthopaedic Surgery, Sapir Medical Center, Kfar-Saba, Israel
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22
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Cho KH, Lee YH, Lee SM, Shahid MU, Suh KJ, Choi JH. Sonography of bone and bone-related diseases of the extremities. JOURNAL OF CLINICAL ULTRASOUND : JCU 2004; 32:511-521. [PMID: 15558611 DOI: 10.1002/jcu.20066] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Kil-Ho Cho
- Department of Diagnostic Radiology, College of Medicine, Yeungnam University, 317-1, Daemyung-Dong, Nam-Ku, Daegu, 705-717, Korea
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23
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Finlay K, Ferri M, Friedman L. Ultrasound of the elbow. Skeletal Radiol 2004; 33:63-79. [PMID: 14714145 DOI: 10.1007/s00256-003-0680-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2002] [Revised: 06/15/2003] [Accepted: 06/16/2003] [Indexed: 02/02/2023]
Abstract
The elbow is an important synovial hinge joint of the upper extremity. This joint represents a common site of musculoskeletal symptomatology, affecting all age groups. The advantages of ultrasound imaging of the elbow include easy availability, multiplanar capability and the ability to assess structures dynamically. Patient symptomatology and site of maximal tenderness can be directly correlated with imaging findings. Comparison is easily made with the contralateral side. Particular strengths include the ability to assess para-articular structures, such as regional tendons and ligaments, in addition to assessment of joint effusions, loose bodies and regional bursae. With operator experience and excellent technique, ultrasound is a valuable imaging tool for assessment of disorders of the elbow joint.
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Affiliation(s)
- K Finlay
- McMaster University Department of Diagnostic Imaging, Hamilton Health Sciences, Henderson Hospital, 711 Concession Street E., L8V 1C3, Hamilton, Ontario, Canada
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24
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Pisacano RM, Miller TT. Comparing sonography with MR imaging of apophyseal injuries of the pelvis in four boys. AJR Am J Roentgenol 2003; 181:223-30. [PMID: 12818864 DOI: 10.2214/ajr.181.1.1810223] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to describe the sonographic appearance of avulsion of the apophyses of the anterosuperior and anteroinferior iliac spines of the pelvis. CONCLUSION Sonography can show apophyseal injuries of the pelvis and can be used instead of MR imaging.
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Affiliation(s)
- Robin Miller Pisacano
- Both authors: Department of Radiology, North Shore University Hospital, 825 Northern Blvd., Great Neck, NY 11021, USA
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25
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Abstract
Because of the often complex and sometimes poorly remembered history of trauma to the elbow, imaging beyond conventional plain film radiographs is often needed. Usually, this consists of high-resolution MR imaging to evaluate the articular cartilage, supporting ligaments, and tendons about the elbow. Sonography, however, can also be used, especially when there is a targeted clinical question as to the presence of epicondylitis, or to provide guidance for diagnostic or therapeutic injections.
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Affiliation(s)
- Carolyn M Sofka
- Department of Radiology and Imaging, Weill Medical College of Cornell University, Hospital for Special Surgery, New York, NY 10021, USA.
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26
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Abstract
The increased ratio of nonossified cartilage to bone in children makes ultrasound (US) a particularly suitable technique for evaluating pediatric musculoskeletal disorders. US allows the examiner to compare quickly and meticulously an affected to unaffected area of interest in different orthogonal planes without a need for sedation. Developmental dysplasia of the hip is the most common indication for pediatric musculoskeletal US. Sonography is also a cost-effective, useful, and complementary imaging tool for evaluating pediatric musculoskeletal trauma, inflammation-infection, and masses.
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Affiliation(s)
- R Bellah
- University of Pennsylvania School of Medicine, Department of Radiology, The Children's Hospital of Philadelphia, USA
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27
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May DA, Disler DG, Jones EA, Pearce DA. Using sonography to diagnose an unossified medial epicondyle avulsion in a child. AJR Am J Roentgenol 2000; 174:1115-7. [PMID: 10749262 DOI: 10.2214/ajr.174.4.1741115] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- D A May
- Department of Radiology, Virginia Commonwealth University, Medical College of Virginia, Richmond 23298-0615, USA
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28
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Abstract
To successfully examine the musculoskeletal system sonographically, one must understand the normal musculoskeletal anatomy and function and be aware of the abnormal processes that affect the musculoskeletal structures. The goal of this review article is to provide a systematic approach to sonographic examination of the musculoskeletal system. The general sonographic appearances of normal and abnormal muscles, tendons, ligaments, bursae, and nerves are reviewed. The article then applies this general information to specific clinical applications by reviewing the normal anatomy of and specific pathologic conditions that affect the shoulder, elbow, hand, wrist, hip, knee, ankle, and foot.
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Affiliation(s)
- B E Hashimoto
- Department of Radiology, Virginia Mason Medical Center, Seattle, Washington 98111, USA
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29
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Abstract
Numerous modalities are available for imaging the elbow. Radiographs should be the first imaging procedure performed for evaluation of an elbow abnormality. The use of advanced imaging modalities such as MR imaging, CT, and sonography also is discussed in this article.
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Affiliation(s)
- T T Miller
- North Shore Radiology, Great Neck, NY 11021, USA
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30
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Lazar RD, Waters PM, Jaramillo D. The use of ultrasonography in the diagnosis of occult fracture of the radial neck. A case report. J Bone Joint Surg Am 1998; 80:1361-4. [PMID: 9759823 DOI: 10.2106/00004623-199809000-00017] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- R D Lazar
- Department of Orthopaedic Surgery, Harvard Medical School, Children's Hospital, Boston, Massachusetts 02115, USA
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31
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Gordon AC, Friedman L, White PG. Pictorial review: magnetic resonance imaging of the paediatric elbow. Clin Radiol 1997; 52:582-8. [PMID: 9285417 DOI: 10.1016/s0009-9260(97)80249-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- A C Gordon
- Department of Radiology, Morriston Hospital NHS Trust, Swansea, UK
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32
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Abstract
Ultrasound is an extremely useful and versatile method of assessing soft tissue abnormality in rheumatological conditions. It is best performed as an extension of clinical examination. Ultrasound has the advantage of not only being able to demonstrate abnormalities but also allows transducer compression of those abnormalities to see if it reproduces the patient's characteristic symptoms. It is likely to find even greater use in the clinical setting over future years. In the near future skeletal ultrasound should develop into an essential tool for the extension of physical examination in rheumatology practise. It hopefully will become as vital to a rheumatologist as echocardiography is to a cardiologist. This will however require clinicians to be prepared to undergo sufficient training in order to avoid diagnostic errors. Probably it will only be at that time, when skeletal ultrasound has become a fundamental part of rheumatological diagnosis, that its full potential will be realized.
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33
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Nimkin K, Kleinman PK, Teeger S, Spevak MR. Distal humeral physeal injuries in child abuse: MR imaging and ultrasonography findings. Pediatr Radiol 1995; 25:562-5. [PMID: 8545192 DOI: 10.1007/bf02015796] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Distal humeral physeal injuries, in particular, fracture-separation of the distal humeral epiphysis, can be seen in abused infants. Detection of physeal injury in an infant or toddler may indicate the possibility of unsuspected abuse, particularly when an appropriate history explaining the circumstance of the fracture is lacking. In addition, the extent of injury can be difficult to characterize on plain radiographs. Ultrasonography (US) and MR imaging (MRI) may be of value in diagnosis and may obviate the need for intraoperative arthrography. We present MRI findings in three abused children with distal humeral physeal injuries. Sonographic correlation is also presented in one case.
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Affiliation(s)
- K Nimkin
- Department of Radiology, University of Massachusetts Medical Center, Worcester 01655, USA
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Lim-Dunham JE, Ben-Ami TE, Yousefzadeh DK. Septic arthritis of the elbow in children: the role of sonography. Pediatr Radiol 1995; 25:556-9. [PMID: 8545190 DOI: 10.1007/bf02015794] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Twelve children with suspected septic arthritis of the elbow were prospectively studied with plain-film radiography and ultrasound. Imaging data were correlated with clinical history and final diagnosis. Joint effusion was seen by sonography in six patients, four of whom underwent ultrasound-guided joint aspiration, confirming the diagnosis of septic arthritis in two patients and excluding it in two. Of nine patients whose plain films showed only soft tissue swelling, seven had one or more significant findings with sonography: joint effusion (without fat pad elevation on lateral plain films) in three patients, periosteal reaction in two, and epitrochlear mass in three. Sonography confirmed soft tissue swelling alone in two patients, thus excluding the diagnosis of septic arthritis and obviating unnecessary attempts at joint aspiration. Sonography of the elbow is an informative, easily performed examination, which is capable of showing both intra- and extra-articular abnormalities not apparent by plain radiography. Both the demonstration of pathologic changes and the failure to show joint fluid may affect clinical management.
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Affiliation(s)
- J E Lim-Dunham
- Department of Radiology, Wyler Children's Hospital, University of Chicago, Pritzker School of Medicine, IL 60637, USA
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35
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Davidson RS, Markowitz RI, Dormans J, Drummond DS. Ultrasonographic evaluation of the elbow in infants and young children after suspected trauma. J Bone Joint Surg Am 1994; 76:1804-13. [PMID: 7989385 DOI: 10.2106/00004623-199412000-00006] [Citation(s) in RCA: 86] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Fractures and epiphyseal injuries in the region of the elbow are uncommon in infants and young children, but they can be very difficult to diagnose and delineate accurately. In addition to plain radiography, invasive or costly procedures such as arthrography and magnetic resonance imaging traditionally have been used to evaluate these injuries. We used high-resolution real-time ultrasonography to evaluate a suspected injury of the elbow in seven infants and one ten-year-old child. Three of the infants had a physeal separation, two had a supracondylar fracture, and two had no skeletal injury. The child had an avulsion fracture of the lateral epicondyle of the humerus and an effusion in the joint. The ultrasonographic findings were confirmed by arthrography in three patients, by open reduction in one, and by follow-up radiographs in all. None of the ultrasonographic studies were performed with the patient under general anesthesia. Ultrasonography, a readily available, non-invasive technique, can be used to evaluate the unossified epiphysis about the elbow of infants and young children; to demonstrate dislocations, fractures, and physeal separations; to identify a hinge of soft tissue at the site of a fracture; to identify interposition of soft tissue between fracture fragments; and to aid in the planning of closed and open reductions.
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Affiliation(s)
- R S Davidson
- Department of Orthopaedics, Children's Hospital of Philadelphia, Pennsylvania 19104
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