Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Alzahra Hospital, Isfahan, Iran.
Eur J Trauma Emerg Surg. 2022 Oct;48(5):3777-3784. doi: 10.1007/s00068-021-01648-6. Epub 2021 Mar 24.
Elbow injuries and fractures are a common pathology in the pediatric emergency unit. X-ray and CT scan of the elbow are the standard diagnostic procedures, which increase exposure to radiation in children. Previous studies have shown that fractures can also be visualized by ultrasound (US); thus, this study aimed to evaluate the diagnostic accuracy of elbow US compared with radiography for the diagnosis of elbow fracture in children.
This was a prospective observational study of patients aged 2-14 years that presented to emergency departments with a suspected elbow fracture requiring radiographic evaluation. Elbow US for diagnosing elevated posterior fat pad or lipohemarthrosis was performed. All patients underwent elbow radiography and received clinical follow-up. Initial or follow-up X-ray or CT scan was used as the reference standard for fracture diagnosis.
Seventy-five patients with a mean age of 6.51 ± 3.68 years were enrolled in the study. Twenty-eight (37.3%) patients had positive results for fracture. The sensitivity, specificity, and accuracy of US in the diagnosis of elbow fractures were 92.9% (95% CI 76.5-99.1%), 89.4% (95% CI 76.9-96.5%) and 90.7% (95% CI 81.7-96.2%). In patients with fracture, US demonstrated a lipohaemarthrosis in 20 patients (71.4%), elevated posterior fat pad in 19 patients (67.9%), cortical disruption in 10 patients (35.7%), and effusion in three patients (10.7%).
Our results showed high diagnostic accuracy for the ultrasonography diagnosis of an elbow fracture, which allows us to confirm ultrasonography imaging of the elbow as a safe alternative in the primary evaluation of pediatric elbow injuries.
肘部损伤和骨折是小儿急诊的常见病理。肘部的 X 射线和 CT 扫描是标准的诊断程序，但会增加儿童的辐射暴露。先前的研究表明，超声（US）也可以显示骨折；因此，本研究旨在评估肘部 US 诊断儿童肘部骨折的准确性与 X 射线相比。
这是一项对 2-14 岁因疑似肘部骨折需要放射学评估而就诊于急诊科的患者的前瞻性观察性研究。对肘部进行超声检查，以诊断抬高的后脂肪垫或脂肪血月肿。所有患者均进行肘部 X 射线检查，并进行临床随访。初始或随访 X 射线或 CT 扫描被用作骨折诊断的参考标准。
本研究共纳入 75 例平均年龄为 6.51±3.68 岁的患者。28 例（37.3%）患者的骨折结果为阳性。US 诊断肘部骨折的敏感性、特异性和准确性分别为 92.9%（95%CI 76.5-99.1%）、89.4%（95%CI 76.9-96.5%）和 90.7%（95%CI 81.7-96.2%）。在骨折患者中，US 显示 20 例（71.4%）患者有脂肪血月肿，19 例（67.9%）患者有抬高的后脂肪垫，10 例（35.7%）患者有皮质中断，3 例（10.7%）患者有积液。
我们的结果表明，超声诊断肘部骨折具有很高的准确性，这使我们能够确认肘部超声成像作为小儿肘部损伤初步评估的安全替代方法。
