Article

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. PURPOSE:
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. METHODS: 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. RESULTS: 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 euro29.10 per patient versus not using it.
CONCLUSION: 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.
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Langue : ANGLAIS