Category: Orthopedics
Keywords: Elbow, fracture, ultrasound (PubMed Search)
Posted: 8/12/2020 by Brian Corwell, MD
(Updated: 11/21/2024)
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Diagnostic performance of Ultrasonography for detection of pediatric elbow fracture
Elbow fractures account for approximately 15% of pediatric fractures
Fat pads are traditionally taught as a marker of fracture
In a cadaveric study:
Elbow effusions of 1-3 mL could be identified with ultrasound
Elbow effusions of 5-10 mL could be identified with plain film
Pediatric plain films are sometimes challenging to obtain and interpret compared to adults
-More likely to be uncooperative in obtaining required views
-Non-ossified epiphyses
Ultrasound may be used to detect
-Cortical disruption and irregularity
-Growth plate widening
-Hematoma interposed between fracture fragments
-Elevated posterior fat pad
Absence of elbow fracture was indicated by
-Lack of cortical disruption
-Absence of posterior fat pad sign
Meta-analysis of 10 articles totaling 519 patients using ultrasonography to detect elbow fractures
Sensitivity 96%
Specificity 89%
False negative rate 3.7%
For comparison, plain radiographs
Interpreted by peds EM physicians (87.5% sensitive and 100% specific)
Interpreted by radiology (96% sensitive, 100% specific)
Consider using ultrasound as a noninvasive, radiation-free modality for accurate diagnosis of pediatric elbow fractures.
Lee SH, Yun SJ. Diagnostic Performance of Ultrasonography for Detection of Pediatric Elbow Fracture: A Meta-analysis. Ann Emerg Med. 2019;74(4):493-502.
