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Ernst F, Osburg J, Tüshaus L. SonoBox: development of a robotic ultrasound tomograph for the ultrasound diagnosis of paediatric forearm fractures. Front Robot AI 2024; 11:1405169. [PMID: 39233849 PMCID: PMC11371668 DOI: 10.3389/frobt.2024.1405169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 07/16/2024] [Indexed: 09/06/2024] Open
Abstract
Introduction Paediatric forearm fractures are a prevalent reason for medical consultation, often requiring diagnostic X-rays that present a risk due to ionising radiation, especially concerning given the sensitivity of children's tissues. This paper explores the efficacy of ultrasound imaging, particularly through the development of the SonoBox system, as a safer, non-ionising alternative. With emerging evidence supporting ultrasound as a viable method for fracture assessment, innovations like SonoBox will become increasingly important. Materials and methods In our project, we want to advance ultrasound-based, contact-free, and automated cross-sectional imaging for diagnosing paediatric forearm fractures. To this end, we are building a technical platform that navigates a commercially available ultrasound probe around the extremity within a water-filled tank, utilising intelligent robot control and image processing methods to generate a comprehensive ultrasound tomogram. Safety and hygiene considerations, gender and diversity relevance, and the potential reduction of radiation exposure and examination pain are pivotal aspects of this endeavour. Results Preliminary experiments have demonstrated the feasibility of rapidly generating ultrasound tomographies in a water bath, overcoming challenges such as water turbulence during probe movement. The SonoBox prototype has shown promising results in transmitting position data for ultrasound imaging, indicating potential for autonomous, accurate, and potentially painless fracture diagnosis. The project outlines further goals, including the construction of prototypes, validation through patient studies, and development of a hygiene concept for clinical application. Conclusion The SonoBox project represents a significant step forward in paediatric fracture diagnostics, offering a safer, more comfortable alternative to traditional X-ray imaging. By automating the imaging process and removing the need for direct contact, SonoBox has the potential to improve clinical efficiency, reduce patient discomfort, and broaden the scope of ultrasound applications. Further research and development will focus on validating its effectiveness in clinical settings and exploring its utility in other medical and veterinary applications.
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Affiliation(s)
- Floris Ernst
- Institute of Robotics and Cognitive Systems, University of Lübeck, Lübeck, Germany
| | - Jonas Osburg
- Institute of Robotics and Cognitive Systems, University of Lübeck, Lübeck, Germany
| | - Ludger Tüshaus
- Department of Paediatric Surgery, University Hospital Schleswig-Holstein, Lübeck, Germany
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2
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Ackermann O, Fischer CA, Grosser K, Hauenstein C, Kluge S, Moritz JD, Berthold L, Kaisenberg CV, Tesch C. Fracture sonography-review of literature and current recommendations. Arch Orthop Trauma Surg 2024; 144:3025-3043. [PMID: 38953942 DOI: 10.1007/s00402-024-05396-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 05/29/2024] [Indexed: 07/04/2024]
Abstract
Over a span of more than two years, a collaborative expert group consisting of 9 professional societies has meticulously crafted the S2e guideline on fracture sonography. This publication encapsulates the essential insights pertaining to specific indications. A thorough and systematic literature search, covering the period from 2000 to March 2021, was conducted across PubMed, Google Scholar, and the Cochrane Database of Systematic Reviews, complemented by an evaluation of bibliographies. Inclusion criteria encompassed randomized controlled clinical trials, observational clinical trials, meta-analyses, and systematic reviews, while guidelines, conferences, reviews, case reports, and expert opinions were excluded. The SIGN grading system (1999-2012) was applied to assess evidence, and resultant SIGN tables were presented to the expert group. Specific recommendations for the application of fracture sonography were then derived through unanimous consensus after detailed discussions. Out of the initial pool of 520 literature sources, a meticulous screening and content assessment process yielded 182 sources (146 clinical studies and 36 meta-analyses and systematic reviews) for evaluation. The comprehensive analysis identified twenty-one indications that substantiate the judicious use of fracture sonography. Ultrasound emerges as a pragmatic and user-friendly diagnostic method, showcasing feasibility across a diverse range of indications.
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Affiliation(s)
- Ole Ackermann
- University of Bochum, Universitätsstr 1, 44780, Bochum, Germany.
| | - Christian A Fischer
- Christian A. Fischer, Arcus Klinik, Rastatter Str. 17-19, 75179, Pforzheim, Germany
| | - Kay Grosser
- Kay Grosser, Klinikum Kassel, Mönchebergstraße 41-43, 34125, Kassel, Germany
| | - Christina Hauenstein
- Christina Hauenstein, Universität Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Sebastian Kluge
- Sebastian Kluge, Handchirurgie Seefeld, Seefeldstrasse 27, 8008, Zurich, Switzerland
| | - Jörg D Moritz
- Jörg D. Moritz, Universität SH, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Lars Berthold
- Lars Berthold, Universität Giessen Und Marburg, Rudolf-Buchheim-Straße 8, 35392, Gießen, Germany
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Delniotis I, Bontinis V, Ktenidis K, Drakonaki EE, Galanis N. Diagnostic accuracy of ultrasound versus X-ray for distal forearm fractures in children and adolescents: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02451-9. [PMID: 38300283 DOI: 10.1007/s00068-024-02451-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/14/2024] [Indexed: 02/02/2024]
Abstract
PURPOSE Utilizing ultrasound for the detection of distal forearm fractures in children presents a potential safe and radiation-free alternative compared to X-ray. METHODS A systematic review was undertaken to compare the diagnostic accuracy of ultrasound in detecting distal forearm fractures in children with X-ray imaging within the period spanning January 2010 to August 2023. The electronic databases MEDLINE and Cochrane CENTRAL were utilized for data retrieval. The QUADAS-2 tool was employed to assess the quality of the included studies. Subsequent statistical analysis was performed to calculate pooled sensitivity and specificity, positive and negative likelihood ratios, as well as the diagnostic odds ratio. RESULTS Our meta-analysis included seventeen studies, encompassing a total of 2003 patients, 2546 ultrasound scans, and 1203 fracture cases as identified by the reference test (X-ray). The pooled sensitivity and specificity were 0.96 (95% CI: 0.93-0.98) and 0.96 (95% CI: 0.89-0.98), respectively. The positive likelihood ratio was 13.40 (95% CI: 7.97-21.50), the negative likelihood ratio was 0.06 (95% CI: 0.04-0.1), and the pooled diagnostic odds ratio was 209 (95% CI: 92.20-412.00). Our statistical analysis revealed low heterogeneity within our studied cohort. CONCLUSIONS Our study indicates that ultrasound exhibits exceptionally high accuracy in the detection of distal forearm fractures in children and adolescents. It can be employed safely to either confirm or rule out a fracture, thus circumventing the need for potentially harmful radiation exposure in this vulnerable population. Future research endeavors should focus on establishing a universally accepted protocol for training and scanning methods to standardize practices and eliminate disparities in diagnostic procedures.
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Affiliation(s)
- Ioannis Delniotis
- Aristotle University of Thessaloniki, Aristoteleio Panepistemio Thessalonikes, Thessaloniki, Greece.
| | - Vangelis Bontinis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - Kiriakos Ktenidis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - Elena E Drakonaki
- Department of Anatomy, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Nikiforos Galanis
- 1st Orthopaedic Department, Aristotle University of Thessaloniki, Papanikolaou General Hospital, Thessaloniki, Greece
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Hosseini Khameneh SM, Amani-Beni R, Ahadiat SA, Kahrizi MS, Jafari S, Seyedinnavade S, Rafie Manzelat AM, Mashatan N, Beheshtiparvar D, Moghadam Fard A, Lotfi H, Arhami H, Barati R, Hasanvand R, Boorboor S, Khodaei E, Dadashzadehasl D, Zamani F, Khorram R, Ebrahimpour M, Abdollahi Z, Shabani M, Latifi N, Vafadar R, Shah Hosseini S, Khodashenas M, Kazemi SM, Minaei Noshahr R, Ghayyem H, Farahani A, Saeidi D, Jadidi S, Goodarzy B, Farrokhi M. Diagnostic Accuracy of Ultrasonography for Identification of Elbow Fractures in Children; a Systematic Review and Meta-analysis. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2023; 11:e62. [PMID: 37840871 PMCID: PMC10568949 DOI: 10.22037/aaem.v11i1.2078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Introduction In spite of the results of previous studies regarding the benefits of ultrasonography for diagnosis of elbow fractures in children, the exact accuracy of this imaging modality is still under debate. Therefore, in this diagnostic systematic review and meta-analysis, we aimed to investigate the accuracy of ultrasonography in this regard. Methods Two independent reviewers performed systematic search in Web of Science, Embase, PubMed, Cochrane, and Scopus for studies published from inception of these databases to May 2023. Quality assessment of the included studies was performed using Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2). Meta-Disc software version 1.4 and Stata statistical software package version 17.0 were used for statistical analysis. Results A total of 648 studies with 1000 patients were included in the meta-analysis. The pooled sensitivity and specificity were 0.95 (95% CI: 0.93-0.97) and 0.87 (95% CI: 0.84-0.90), respectively. Pooled positive likelihood ratio (PLR) was 6.71 (95% CI: 3.86-11.67), negative likelihood ratio (NLR) was 0.09 (95% CI: 0.03-0.22), and pooled diagnostic odds ratio (DOR) of ultrasonography in detection of elbow fracture in children was 89.85 (95% CI: 31.56-255.8). The area under the summary receiver operating characteristic (ROC) curve for accuracy of ultrasonography in this regard was 0.93. Egger's and Begg's analyses showed that there is no significant publication bias (P=0.11 and P=0.29, respectively). Conclusion Our meta-analysis revealed that ultrasonography is a relatively promising diagnostic imaging modality for identification of elbow fractures in children. However, clinicians employing ultrasonography for diagnosis of elbow fractures should be aware that studies included in this meta-analysis had limitations regarding methodological quality and are subject to risk of bias. Future high-quality studies with standardization of ultrasonography examination protocol are required to thoroughly validate ultrasonography for elbow fractures.
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Affiliation(s)
- Seyed Mehdi Hosseini Khameneh
- Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University ofMedical Sciences, Tehran, Iran
| | - Reza Amani-Beni
- School ofMedicine, Isfahan University ofMedical Sciences, Isfahan, Iran
| | - Seyed-Amirabbas Ahadiat
- Department of Bimolecular and Biomedicine, University of Girona, Passeig Ave, Salt-Girona, 17190, Girona, Spain
| | | | - Sina Jafari
- Department of Prosthodontics, School of Dentistry, Iran University ofMedical Sciences, Tehran, Iran
| | | | | | - Noushin Mashatan
- Accident and Emergency Department, Southend Hospital NHS Trust,Westcliff-on-sea, United Kingdom
| | | | | | - Hamed Lotfi
- Department ofMedical Sciences, Faculty ofMedicine, Birjand University ofMedical Sciences, Birjand, Iran
| | | | - Reza Barati
- School ofMedicine, Iran University ofMedical Sciences, Tehran, Iran
| | | | | | - Elaheh Khodaei
- School ofMedicine, Tehran University ofMedical Sciences, Tehran, Iran
| | | | - Fatemeh Zamani
- Student Research Committee,Mazandaran University ofMedical Sciences, Sari, Iran
| | | | | | - Zeynab Abdollahi
- Department of Radiology, School ofMedicine, Ahvaz Jundishapur University ofMedical Sciences, Ahvaz, Iran
| | | | | | | | | | | | - Seyyed Morteza Kazemi
- Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University ofMedical Sciences, Tehran, Iran
| | - Reza Minaei Noshahr
- Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University ofMedical Sciences, Tehran, Iran
| | - Hani Ghayyem
- School ofMedicine, Shahid Beheshti University ofMedical Sciences, Tehran, Iran
| | | | - Diba Saeidi
- Students Research Committee, Faculty of Pharmacy and Pharmaceutical Sciences, Isfahan University ofMedical Sciences, Isfahan, Iran
| | - Sajedeh Jadidi
- Urology and Nephrology Research Center, Department of Urology, Shahid LabbafinejadMedical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Goodarzy
- School ofMedicine, Iran University ofMedical Sciences, Tehran, Iran
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Muacevic A, Adler JR, Quinonez J, Ruxmohan S. Snowed In: A Case Report on the Utilization of Ultrasound in the Diagnosis of Fractures. Cureus 2023; 15:e33758. [PMID: 36793839 PMCID: PMC9925033 DOI: 10.7759/cureus.33758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 01/15/2023] Open
Abstract
The standard convention for diagnosing bone fractures is through radiography. However, radiography can miss fractures depending on the type of injury or if human error is present. This may be due to improper patient positioning leading to superimposing bones being captured in the image, obscuring pathology. As of late, ultrasound has been gaining traction in terms of its utilization for diagnosing fractures, which radiography can miss at times. Here we present a case of a 59-year-old female who was diagnosed using ultrasound with an acute fracture that was initially missed on X-ray. We present a case of a 59-year-old female with a past medical history significant for osteoporosis who presented to an outpatient clinic for evaluation of acute left forearm pain. She reported sustaining a mechanical fall forward to the ground three weeks before bracing herself with her forearms, immediately developing left upper extremity pain lateralized to the forearm. Upon initial evaluation, forearm radiographs were obtained and showed no evidence of acute fractures. She then underwent a diagnostic ultrasound that showed an obvious fracture of the proximal radius, distal to the radial head. Upon reviewing initial radiograph films, it was evident that the proximal ulna was superimposed over the radius fracture as a proper neutral anteroposterior view of the forearm was not taken. The patient then underwent a computed tomography (CT) scan of her left upper extremity, which confirmed the presence of a healing fracture. We present a case in which ultrasound is an excellent adjunct when a fracture cannot be identified on plain film radiography. Its utilization should be well-known and considered more often in the outpatient setting.
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Affiliation(s)
| | | | - Jonathan Quinonez
- Neurology/Osteopathic Neuromusculoskeletal Medicine, Larkin Community Hospital, Miami, USA
| | - Samir Ruxmohan
- Division of Neurocritical Care, UT Southwestern Medical Center, Dallas, USA.,Neurology, Larkin Community Hospital, Miami, USA
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6
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Elloian J, Jadwiszczak J, Arslan V, Sherman JD, Kessler DO, Shepard KL. Flexible ultrasound transceiver array for non-invasive surface-conformable imaging enabled by geometric phase correction. Sci Rep 2022; 12:16184. [PMID: 36171424 PMCID: PMC9519534 DOI: 10.1038/s41598-022-20721-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/16/2022] [Indexed: 11/12/2022] Open
Abstract
Ultrasound imaging provides the means for non-invasive real-time diagnostics of the internal structure of soft tissue in living organisms. However, the majority of commercially available ultrasonic transducers have rigid interfaces which cannot conform to highly-curved surfaces. These geometric limitations can introduce a signal-quenching air gap for certain topographies, rendering accurate imaging difficult or impractical. Here, we demonstrate a 256-element flexible two-dimensional (2D) ultrasound piezoelectric transducer array with geometric phase correction. We show surface-conformable real-time B-mode imaging, down to an extreme radius of curvature of 1.5 cm, while maintaining desirable performance metrics such as high signal-to-noise ratio (SNR) and minimal elemental cross-talk at all stages of bending. We benchmark the array capabilities by resolving reflectors buried at known locations in a medical-grade tissue phantom, and demonstrate how phase correction can improve image reconstruction on curved surfaces. With the current array design, we achieve an axial resolution of ≈ 2 mm at clinically-relevant depths in tissue, while operating the array at 1.4 MHz with a bandwidth of ≈ 41%. We use our prototype to image the surface of the human humerus at different positions along the arm, demonstrating proof-of-concept applicability for real-time diagnostics using phase-corrected flexible ultrasound probes.
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Affiliation(s)
- Jeffrey Elloian
- Department of Electrical Engineering, Columbia University, 500 W 120th St., New York, NY, 10027, USA
| | - Jakub Jadwiszczak
- Department of Electrical Engineering, Columbia University, 500 W 120th St., New York, NY, 10027, USA
| | - Volkan Arslan
- Department of Electrical Engineering, Columbia University, 500 W 120th St., New York, NY, 10027, USA
| | - Jeffrey D Sherman
- Department of Electrical Engineering, Columbia University, 500 W 120th St., New York, NY, 10027, USA
| | - David O Kessler
- Department of Emergency Medicine, Morgan Stanley Children's Hospital of New York Presbyterian at Columbia University Medical Center, New York, 10032, USA
| | - Kenneth L Shepard
- Department of Electrical Engineering, Columbia University, 500 W 120th St., New York, NY, 10027, USA. .,Department of Biomedical Engineering, Columbia University, 1210 Amsterdam Avenue, New York, NY, 10027, USA.
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7
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Could Ultrasound Be Used as a Triage Tool in Diagnosing Fractures in Children? A Literature Review. Healthcare (Basel) 2022; 10:healthcare10050823. [PMID: 35627960 PMCID: PMC9141044 DOI: 10.3390/healthcare10050823] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/19/2022] [Accepted: 04/27/2022] [Indexed: 12/10/2022] Open
Abstract
Fracture is one of the most frequent causes of emergency department visits in children, conventional radiography being the standard imaging tool used for following procedures and treatment. This imagistic method is irradiating and harmful, especially for children due to their high cell division rate. For this reason, we searched the literature to see if musculoskeletal ultrasound is a good alternative for diagnostic and follow-up regarding fractures in the pediatric population. After searching the databases using MeSH terms and manual filters, 24 articles that compare X-ray and ultrasound regarding their specificity and sensitivity in diagnosing fractures were included in this study. In the majority of the studied articles, the specificity and sensitivity of ultrasound are around 90–100%, and with high PPVs (positive predictive values) and NPVs (negative predictive values). Although it cannot replace conventional radiography, it is a great complementary tool in fracture diagnosis, having a sensitivity of nearly 100% when combined with clinical suspicion of fracture, compared with X-ray.
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Abstract
In this article the basic principles of fracture sonography and meaningful areas of application in children and adults are explained. The sonographic fracture signs are presented and the typical areas of application, i.e. clavicular fracture, acromioclavicular (AC) joint dislocation, proximal humerus fracture, elbow fracture, wrist fracture, metacarpal 5 fracture, palmar plate, femoral bulge fracture, proximal tibia fracture, midfoot V fracture, toddler's fracture and march fracture, are outlined and known diagnostic algorithms are listed. When used correctly, fracture sonography is a safe, gentle and rapid diagnostic method.
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Affiliation(s)
- Ole Ackermann
- Orthopädie Ackermann, Raiffeisenstr. 58-60, 47259, Duisburg, Deutschland.
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9
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Rupp M, Walter N, Pfeifer C, Lang S, Kerschbaum M, Krutsch W, Baumann F, Alt V. The Incidence of Fractures Among the Adult Population of Germany – and Analysis From 2009 through 2019. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:665-669. [PMID: 34140088 DOI: 10.3238/arztebl.m2021.0238] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 03/11/2021] [Accepted: 05/12/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Detailed analyses of epidemiological data on fractures are an important resource for persons and institutions providing health care services, as they yield information on the effects of current treatment strategies and on the need for preventive measures. The epidemiology of fractures in Germany, however, is unknown. The goal of this study is to determine the nationwide fracture burden from 2009 through 2019, as a function of anatomical site, age, and sex. METHODS Annual compilations of ICD-10 diagnosis codes for the years 2009-2019 were made available to us by the German Federal Statistical Office. The prevalence and incidence of fractures at 30 different sites were quantified, and standardized sex and age distributions were calculated. RESULTS A total of 688 403 fractures was registered in 2019. From 2009 to 2019, the incidence of fractures rose by 14%, to 1014 fractures per 100 000 persons per year. The most common fracture types were femoral neck fractures (120 per 100 000 persons per year), pertrochanteric femural fractures (109 per 100 000 persons per year), and distal radius fractures (106 per 100 000 persons per year). All types were more common in women, with incidences that rose with age. The highest incidence was of pertrochanteric femoral fractures in women over age 90, with an incidence of 2550 per 100 000 persons per year. The largest rises in incidence were seen with regard to acetabular fractures (+ 58.16%) and clavicular fractures (+ 44.02%). CONCLUSION The increasing frequency of fractures, particularly among the elderly, presents a challenge to the health care system. Given the high frequency of geriatric fractures, prophylactic measures against fractures ought to be intensified.
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10
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Weston M, Elmer D, McIntosh S, Lundgreen Mason N. Using formalin embalmed cadavers to teach fracture identification with ultrasound. BMC MEDICAL EDUCATION 2020; 20:227. [PMID: 32682422 PMCID: PMC7368716 DOI: 10.1186/s12909-020-02148-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/10/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Ultrasound is being utilized more frequently to diagnose fractures in bone and track fracture reduction quickly, and without radiation exposure in the ED. Realistic and practical methods of teaching sonographic fracture identification to medical trainees are needed. The objective of this study is to determine the feasibility of using formalin-embalmed human cadavers in teaching medical trainees to use ultrasound to identify synthetic fractures in tibia, radius, and metacarpal bones. METHODS First-year medical students attended an orientation presentation and a 15-min scanning workshop, to evaluate fractures in cadaver bones with an instructor. Next participants independently scanned bones to determine if a fracture was present. Questionnaires were given that assessed participant self-confidence and ability to evaluate still ultrasound images for fracture and differentiate between tissue layers before, after, and 5 months following training. RESULTS Participants were collectively able to scan and differentiate between fractured and unfractured bone in 75% of 186 total bone scanning attempts (tibia: 81% correct, metacarpal: 68% correct, radius: 76% correct). When evaluating still ultrasound images for fracture, participants' scores rose significantly following training from an average score of 77.4 to 91.1% (p = 0.001). Five months post-training, scores fell slightly, to an average of 89.8% (p = 0.325). CONCLUSIONS Ultrasound images of formalin-embalmed cadaveric fractures are of sufficient quality to use in teaching fracture identification to medical trainees. With only 15 minutes of scanning experience, medical trainees can learn to independently scan and significantly increase their ability to identify fractures in still ultrasound images.
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Affiliation(s)
- Michael Weston
- Rocky Vista University College of Osteopathic Medicine - Southern Utah, 255 East Center Street, Ivins, UT, 84738, USA
| | - Dallin Elmer
- Rocky Vista University College of Osteopathic Medicine - Southern Utah, 255 East Center Street, Ivins, UT, 84738, USA
| | - Scott McIntosh
- Rocky Vista University College of Osteopathic Medicine - Southern Utah, 255 East Center Street, Ivins, UT, 84738, USA
| | - Nena Lundgreen Mason
- Rocky Vista University College of Osteopathic Medicine - Southern Utah, 255 East Center Street, Ivins, UT, 84738, USA.
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11
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Schmid GL, Kühnast B, Heise M, Deutsch T, Frese T. Ultrasonography in assessing suspected bone fractures: a cross-sectional survey amongst German general practitioners. BMC FAMILY PRACTICE 2020; 21:9. [PMID: 31931750 PMCID: PMC6958739 DOI: 10.1186/s12875-020-1078-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 01/03/2020] [Indexed: 11/24/2022]
Abstract
Background Over the last two decades, ultrasonography (US) has been shown to be an accurate tool for the diagnosis of suspected bone fractures; however, the integration of this application of US into routine care and outpatient settings needs to be explored. In this study, we surveyed German general practitioners (GPs) to assess their knowledge, attitudes, and utilization of US for the diagnosis of suspected fractures. Methods Notification of the study, a self-designed questionnaire, and a reminder were mailed to 600 randomly selected GPs in Saxony and Saxony-Anhalt. Results The response rate was 47.7% (n = 286), and respondents did not differ from the population of all GPs in respect to sex and practice type. Among GPs surveyed, 48.6% used an US device in their practice. On average, GPs diagnosed six patients with suspected fractures per month, yet only 39.3% knew about the possibility of ultrasonographic fracture diagnosis, and only 4.3% of GPs using US applied it for this purpose. Among participants, 71.9% believed that US is inferior to conventional X-rays for the diagnosis of bony injuries. Users of US were better informed of and more commonly used US for fracture diagnosis compared to non-users. Conclusion The need to rule out possible fractures frequently arises in general practice, and US devices are broadly available. Further efforts are needed to improve the knowledge and attitudes of GPs regarding the accuracy of US for fracture diagnosis. Multicenter controlled trials could explore the safety, usefulness, and effectiveness of this still seldom used diagnostic approach for suspected fractures.
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Affiliation(s)
- Gordian Lukas Schmid
- Department of General Practice, Medical Faculty of the University of Leipzig, Philipp-Rosenthal-Str. 55, Leipzig, 04103, Deutschland. .,Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
| | - Beatrice Kühnast
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Marcus Heise
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Tobias Deutsch
- Department of General Practice, Medical Faculty of the University of Leipzig, Philipp-Rosenthal-Str. 55, Leipzig, 04103, Deutschland
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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12
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[Necessity for radiological examinations in children : Children in two levels]. Unfallchirurg 2019; 123:80-86. [PMID: 31679062 DOI: 10.1007/s00113-019-00734-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The diagnostics and treatment of pediatric skeletal trauma can be fundamentally different from adults. Based on in-house data the diagnostic approach to the most frequently encountered pediatric injury patterns is discussed. The necessity for a primary X‑ray imaging or computed tomography examination is questioned. Both diagnostic methods cause stochastic radiation damage. Therefore, it is important to perform the safest examination for the child while injuries are correctly diagnosed.
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13
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Ault DL, Jokerst AR, Kettner NW. Occult isolated fracture of the trapezoid diagnosed by ultrasonography. J Ultrasound 2018; 24:91-97. [PMID: 30008152 DOI: 10.1007/s40477-018-0308-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/21/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To describe a patient with an occult isolated trapezoid fracture of the wrist. Isolated trapezoid fractures are very difficult to detect without advanced radiological imaging, since the fragment displacement does not occur in the sagittal plane. A discussion regarding the investigation of trapezoid fractures utilizing multiple imaging modalities includes the first demonstration of its detection via ultrasonography (US). METHODS A 26-year-old male presented to a chiropractic teaching clinic with pain involving the left wrist, after vaulting over the handlebars of his bicycle 2 days prior. The mechanism of injury was hyperflexion of the left wrist. Left wrist pain, reduced range of motion, and dorsal soft tissue edematous changes were identified at examination. Although the initial radiographic examination was negative, elevated clinical suspicion triggered an US examination 4 days later. The US exam demonstrated an isolated 1.8 mm dorsal trapezoid fracture, which was minimally displaced by 0.7 mm. RESULTS Following the US diagnosis of an isolated trapezoid fracture, the wrist was immobilized. The patient elected to not pursue an orthopedic consultation. Conservative care included ice and Class IV therapeutic laser therapy. The patient reported complete alleviation of clinical symptoms after approximately 2 weeks of splinting and treatment. CONCLUSION We emphasize the limitations of radiography in the diagnosis of this fracture. To our knowledge, this is the first case to describe the use of US in the diagnosis of an isolated trapezoid fracture.
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Affiliation(s)
- Daniel L Ault
- Department of Radiology, Logan University, 1851 Schoettler Road, Chesterfield, MO, 63017, USA.
| | - Aimee R Jokerst
- Chiropractic Health Centers, Logan University, 1851 Schoettler Road, Chesterfield, MO, 63017, USA
| | - Norman W Kettner
- Department of Radiology, Logan University, 1851 Schoettler Road, Chesterfield, MO, 63017, USA
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