Department of Diagnostic Radiology, School of Medicine, Yeungnam University, Daegu 705-717, Korea.
Korean J Radiol. 2010 Jan-Feb;11(1):84-94. doi: 10.3348/kjr.2010.11.1.84. Epub 2009 Dec 28.
To report and assess the usefulness of ultrasound (US) findings for occult fractures of growing bones.
For six years, US scans were performed in children younger than 15 years who were referred with trauma-related local pain and swelling of the extremities. As a routine US examination, the soft tissue, bones, and adjacent joints were examined in the area of discomfort, in addition to the asymptomatic contralateral extremity for comparison. Twenty-five occult fractures in 25 children (age range, five months-15 years; average age, 7.7 years) were confirmed by initial and follow-up radiograms, additional imaging studies, and clinical observation longer than three weeks.
The most common site of occult fractures was the elbow (n = 9, 36%), followed by the knee (n = 7, 28%), ischium (n = 4, 16%), distal fibula (n = 3, 12%), proximal femur (n = 1, 4%), and humeral shaft (n = 1, 4%). On the retrograde review of the routine radiographs, 13 out of the 25 cases showed no bone abnormalities except for various soft tissue swelling. For the US findings, cortical discontinuity (direct sign of a fracture) was clearly visualized in 23 cases (92%) and was questionable in two (8%). As auxiliary US findings (indirect signs of a fracture), step-off deformities, tiny avulsed bone fragments, double-line appearance of cortical margins, and diffuse irregularity of the bone surfaces were identified.
Performing US for soft tissue and bone surfaces with pain and swelling, with or without trauma history in the extremities, is important for diagnosing occult or missed fractures of immature bones in pediatric-aged children.
报告并评估超声（US）检查在隐匿性生长骨骨折中的应用价值。
在六年的时间里，对因外伤相关的四肢局部疼痛和肿胀而就诊的 15 岁以下儿童进行了 US 扫描。作为常规 US 检查，在不适区域检查软组织、骨骼和相邻关节，同时对无症状的对侧肢体进行对比检查。通过初始和随访 X 射线、额外的影像学研究以及超过三周的临床观察，确认了 25 名儿童（年龄 5 个月至 15 岁；平均年龄 7.7 岁）的 25 处隐匿性骨折。
隐匿性骨折最常见的部位是肘部（9 例，36%），其次是膝关节（7 例，28%）、坐骨（4 例，16%）、腓骨下段（3 例，12%）、股骨近端（1 例，4%）和肱骨中段（1 例，4%）。对 25 例病例的常规 X 射线进行逆行回顾，除了各种软组织肿胀外，13 例无骨异常。对于 US 检查结果，23 例（92%）可清晰显示皮质连续性中断（骨折的直接征象），2 例（8%）可疑。作为辅助 US 发现（骨折的间接征象），可见台阶样畸形、微小撕脱骨碎片、皮质边缘双线征和骨表面弥漫性不规则。
对于有外伤史或无外伤史的四肢疼痛和肿胀的软组织和骨表面进行 US 检查，对于诊断儿童期未成熟骨骼的隐匿性或漏诊骨折非常重要。
