Ultrasound imaging of undisplaced partial forearm fractures in children

Objective: To check the value of ultrasonography in the diagnosis of undisplaced partial forearm fractures in children. Methods: A case series study was conducted in AL-Khansa'a and Al-Zahrawy teaching hospitals in Mosul over a period between November 2005 to October 2006. One hundred patients (54 male and 46 female) between the age of 2-15 years suffering from high clinical suspicion of non displaced forearm fractures were first examined by ultrasound (Sonoline SL 100, Siemens Nurnberg Germany) with 7.5MHZ linear array transducer by a radiologist who gave an immediate report. Standard two views radiography of the forearm then obtained. The radiographs were reported by another senior radiologist. Ultrasonographic and radiographic reports were then compared. Results: One hundred patients were examined, 54 male and 46 female with male/female ratio 1:1.7. The type of fractures found were 46 torus type, 48 greenstick and 6 were plastic deformity. Subperiosteal haematoma was encountered in 100% of the fractures, bending sign was 100% and finally reverberation echoes was shown in all the fracture types too. Conclusion: Ultrasound is a useful method in the diagnosis of undisplaced forearm fractures in children. It is an easy, safe , fast and in-expensive procedure. More studies are indicated to confirm its reliability in different pediatric fractures. ةصلاخلا : فدهلا : صيخشت يف ه يلع لوعي لكشب ةيتوصلا قو ف تاجوملاب صحفلا مادختسا ة يناكمإ مي يقتل ة يديهمت ةسارد لاو ةلمتكملا ريغلا روسكلا ريغ ةلصفنم لافطلأا دنع ) ةيقوطلا روسكلاو ءارضخلا اصعلا روسآ .( ميمصتلا : ةلسلستم تلااحل ةيفصو ةسارد . ثحبلا ءارجإ نامزو ناكم : ىفشتسم يف ا هنم مسقو لا فطلأل يميلعتلا ءاسنخلا ىفشتسم يف ثحبلا اذه زاجنا مت يناثلا نيرشت نم ةرتفلل يميلعتلا يوارهزلا ٢٠٠٥ لأا نيرشت ىلإ لو ٢٠٠٦ . نوآراشملا : ضيرم ةئام ) ٥٤ و ارآذ ٤٦ ىثنأ ( نيب رامعلأل ٢ ١٥ يريرس هابت شا مهيد ل نا آو مهت سارد م ت ةنس ريغو يلصفم ريغ رسآ دوجوب ديدش لصفنم ةربعكلا مظع يف . Annals of the College of Medicine Vol. 34 No. 1, 2008 © 2008 Mosul College of Medicine 10 ثحبلا ةقيرط : لاوأ ةيتوصلا قو ف تاجوملا ةطساوب مهصحف مت ىضرملا عيمج ) ينا ملأ سنميس زا هج مادختساب ملا لامعتسابو أشن راب سم ٧,٥ يلوط فص ة قاط لوحمو ز تره ا كيم ( ار يرقت يطعي نا آو ةعشأ بيبط ل بق نم ةروص ذخلأ ضيرملا لسري م ث نمو ضيرم لآ نع ايروف هيعاعش ة يبناجو ة يمامأ دعاسلل ة باتآ مت تو باصملا ت ةنراقم متي مث رخآ يصاصتخا ةعشأ بيبط لبق نم ةعشلأا ريراقت اق فلا تاجوملا رير ةعشلأا ريراقت عم ةيتوص قو ةيئاهنلا ةلاحلا تيبثتو . جئاتنلا : ضيرم ة ئام صحف مت باصم يف رسآ هابت شاب دعاسلا يف ةر بعكلا مظع ةباصإ ني بتو ٤٨ رسكب ة لاح و ءارضخلا اصعلا ٤٦ و يقوطلا رسكلاب ة لاح ٦ يطاطملا هوشتلاب تلااح . ي تلا ة مهملا تاملاعلا ةظحلام م تو ا جوملا صحف اهصخش ت قو ف ةب سنب قاحمسلا ءاشغ تحت يومد عمجت دوجو يهو ةيتوصلا ١٠٠ % لاعو م ة ةبسنب ةيجراخلا مظعلا ةرشق يف جاجوعلاا ١٠٠ % لاعو م ةبسنب دادترلاا ىدص ة ١٠٠ .% جاتنتسلاا : ماظع روسآ صيخشت يف ةيتوصلا قوف تاجوملا صحف ىلع دامتعلاا نكمي هنا نيبت ةساردلا هذه نم دعا سلا ر يغ صفنملا ة لمتكملا ر يغو ةل لا فطلأا ىد ل . ا يدام فلكم ر يغو عير سو لهسو ني مأو ميل س ءار جإ ه نا ، حصنيو ءارجإب ديدحتل ةيلبقتسم تاسارد ةيناكمإ ىدل ةفلتخملا روسكلا صيخشت يف صحفلا اذه ةردقو لافطلأا he hospital assessment of children with injuries present a particular problem. They are often in pain, scared and intimidated by their surroundings. Anxious parents often compound the fears of their children. Evaluation of an extremity trauma with clinical and roentgenographic examination is mandatory for the diagnosis of fractures. However, ionized radiation can be hazardous to the epiphyses in paediatric patients. Although exposure to high dose ionizing radiation is known to be carcinogenic and teratogenic, the harmful effects of low dose ionizing radiation are debated. However it is widely held view that the effect of exposure are cumulative and may contribute to the development of significant problems over a lifetime, especially in children. The ability to diagnose fractures by ultrasonography in ossified and unossified region of the bones has been reported in the literature. In some of these studies, ultrasound was found to be even more sensitive than radiography for detection of fractures in such regions as sternum and forearm. Diagnostic ultrasonography has been well researched in bony imaging. The large difference in acoustic impedance at the junction of soft tissue and bone causes almost total reflection of sound energy providing a strong image of bone surface. Any imperfection (for example, steps, breaks etc), should therefore be easily visible. This technique is particularly applicable in children given their comparatively small soft tissue thickness and its non-invasive nature. The studies of fracture by ultrasound examination was tried by many people. Many other studies proved that high resolution sonography were reliable and accurate methods of evaluating occult fractures of scaphoid waist and undisplaced pediatric fractures (9 . Ultrasound has been receiving considerable attention in assessment of fractures due to its ease of use and lack of radiation. Interruption of cortical bone, T Annals of the College of Medicine Vol. 34 No. 1, 2008 © 2008 Mosul College of Medicine 11 paraosseous haematomas, bending signs and reverberating echoes have been defined as ultrasound finding in fractures . The ultrasound findings in paediatric fractures are many and the most important ones of these are, the subperiosteal haematoma, bending of the cortex, cortical disruption and reverberation echoes 17). Fractures of bone occur when there is break in the continuity of its contour. It may be either complete or incomplete fractures. Incomplete occur mostly in children where the bone resilience is the greatest, and are of three types, plastic fracture, torus fracture, green stick fracture. The aim of this study is to assess the value of ultrasound in the diagnosis of undisplaced partial forearm fractures in children and to analyse the ultrasound findings in different type of paediatric fractures. Patients and methods: From November 2005 to October 2006, one hundred child aged 2-15 years, with suspected forearm fracture were examined. They were referred to the orthopedic consultation clinic at ALKhansa'a and Al-Jamhory teaching hospitals in Mosul. The clinical findings were recorded, which included mainly swelling, and tenderness at the site of trauma on the forearm. Ultrasonographic examination at the site of the trauma was performed with (Sonoline SL 100), Siemens Nurnberg Germany) equipment using 7.5 linear high frequency transducers. The region with maximal tenderness in the forearm was evaluated by sagittal, longitudinal and transverse planes, both in supination and pronation. Uninjured contralateral bone was examined for comparison. After completing the ultrasound examination, the patients were examined by radiography taking two standard views for the bones (anteroposterior and lateral views). The result was recorded by another senior radiologist. The sonographic results were analysed and then compared to the radiographic findings. Some of the patients were advised to be rechecked by radiography 1-2 weeks later for follow up and to be compared with the sonographic results obtained.