Burnier M, Buisson G, Ricard A, Cunin V, Pracros J P, Chotel F
Service de Chirurgie orthopédique, Hôpital Femme Mère Enfant, Lyon, France.
Service de Radiologie, Hôpital Femme Mère Enfant, Lyon, France.
Orthop Traumatol Surg Res. 2016 Nov;102(7):839-843. doi: 10.1016/j.otsr.2016.07.009. Epub 2016 Sep 30.
Among the various elbow injuries in children that initially have normal radiographs, a certain number of occult fractures are only diagnosed correctly after the fact, during a follow-up visit.
This study evaluated the diagnostic contribution of ultrasonography in the treatment of acute elbow injuries in children and the strategic and economic impact of using this tool alongside radiography.
During this prospective study performed between January 1 and April 1 2014, elbow ultrasonography was performed within 6 days in all children under 15 years of age with a suspected occult fracture. The ultrasonography exam looked for lipohemarthrosis, the posterior fat pad sign and cortical disruption. If no fracture was visible on ultrasonography, a removable splint was given to the patient to relieve pain, and no radiological or clinical follow-up was scheduled. The patients were contacted again at least 15 days later to determine whether an undetected fracture was present. Lastly, we evaluated the cost of treatment with and without ultrasonography in the cases where no fracture was diagnosed.
In 13 cases, ultrasonography revealed lipohemarthrosis and a fat pat sign, with cortical disruption also present in 11 of these cases. In two cases, the diagnosis was made based solely on the presence of lipohemarthrosis and a fat pat sign. There were seven lateral condyle fractures, two medial epicondyle fractures and two supracondylar fractures. Among the 21 patients with normal ultrasonography, no fracture was diagnosed later on. In patients without a fracture, using ultrasonography resulted in a cost savings of €29.10 per patient versus not using it.
In our study, ultrasonography is a sensitive examination for the diagnosis of occult elbow fractures in children. When the radiography and ultrasonography are both normal, the possibility of fracture can be rule out definitively, which reduces the need for immobilization, follow-up and treatment costs. The findings of this preliminary study should be validated with a larger prospective study.
在儿童的各种肘部损伤中，最初X线片正常的情况下，一定数量的隐匿性骨折仅在随访时事后才被正确诊断。
本研究评估超声检查在儿童急性肘部损伤治疗中的诊断作用以及与X线检查联合使用该工具的策略和经济影响。
在2014年1月1日至4月1日进行的这项前瞻性研究中，对所有15岁以下疑似隐匿性骨折的儿童在6天内进行肘部超声检查。超声检查寻找脂肪血囊肿、后脂肪垫征和皮质中断。如果超声检查未发现骨折，则给患者佩戴可拆卸夹板以缓解疼痛，且不安排放射学或临床随访。至少15天后再次联系患者以确定是否存在未被发现的骨折。最后，我们评估了在未诊断出骨折的情况下使用和不使用超声检查的治疗成本。
13例中，超声检查显示脂肪血囊肿和脂肪垫征，其中11例还存在皮质中断。2例仅根据脂肪血囊肿和脂肪垫征做出诊断。有7例外侧髁骨折、2例内侧髁上骨折和2例髁上骨折。在超声检查正常的21例患者中，后来未诊断出骨折。在无骨折的患者中，使用超声检查与不使用相比，每位患者节省成本29.10欧元。
在我们的研究中，超声检查是诊断儿童隐匿性肘部骨折的敏感检查方法。当X线检查和超声检查均正常时，可以明确排除骨折的可能性，这减少了固定、随访和治疗成本。这项初步研究的结果应通过更大规模的前瞻性研究进行验证。
