Fracture sonography

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Fracture sonography
Purposeultrasound detects bone fractures.

Fracture sonography is the use of medical ultrasound to detect bone fractures. While medical ultrasound is used to visualize soft tissues like skin, organs, and blood vessels, fracture sonography is used to visualize fractures on only bone surfaces. It is useful for children aged 12 or younger because all fractures cause alterations of the bone surface, and joint fractures are uncommon at such ages. [1] For joint fractures that are common in adult bones and cannot be visualized properly, patients older than 12 years are not eligible for ultrasound fracture diagnosis. The method is feasible for detecting fractures of the wrist, elbow, shoulder and clavicle. The advantages of fracture sonography are the avoidance of radiation exposure, faster examinations, and the ability to use standard ultrasound devices, which are more widespread. [2] In the mentioned fields of application, ultrasound is as safe as X-ray diagnosis. [3] [4] [5]

Contents

Application

Physical basis

In fracture sonography, regular 4 to 12 MHz linear transducers are used in B-Mode (Medical ultrasonography) with standard ultrasound devices. The high-impedance difference between bone and soft tissue causes an almost complete reflection of the acoustic waves at the bone's surface. [6] As a result, the bone surface is seen, and the underlying structures are not seen.

Visualization and limitations

With fracture sonography, the surface of nearly all extremity bones [7] not covered by other bones can be seen. [8] [9] Thus, the joint facets cannot be accessed. Vertebral structures are not suitable for ultrasound fracture diagnosis.

The additional imaging of soft tissue like haematomas, joint effusion, and blood vessels is an advantage over to X-ray-imaging. [10]

Due to the size of the linear transducer, only a limited section of the bone can be visualized, so longer fractures may require step-by-step assessments. [11]

Diagnosis

Fracture sonography is suitable for the diagnosis of fractures of the shaft and metaphysis of bones. [12] Because only the cortical surface can be visualized, sonography is suitable only for specific fractures. Joint fractures cannot be assessed properly. Sonography is feasible only in the growing bone.

For adult patients, sonography can be used to rule out an increasing deformity of fractures. [13]

Applications

Wrist fractures

In patients younger than 12, wrist fractures cause specific alterations at the surface of the bone (bulge, angulation, offset or fracture gap), and through diagnosis and treatment can be identified without X-ray imaging. [14] Intra-articular fractures are rare and require X-ray imaging. The standard procedure is the wrist SAFE algorithm. [15] The sensitivity of the method in comparison with X-ray imaging is 96 percent, the specificity is 100 percent, the positive predictive value is 1, and the negative predictive value is 0.88. [16]

Elbow fractures

In patients younger than 12, intra-articular fractures of the elbow can be ruled out through sonography. Because intra-articular fractures cause a joint effusion, the dorsal fat pad sign is a reliable parameter for diagnosis of elbow fractures. [17] If a joint effusion is depicted in the ultrasound, two-plane X-ray imagery is necessary to diagnose the fracture. The standard procedure is the elbow-SAFE algorithm. [18] The sensitivity of the method in comparison with X-ray imaging is 97.9 percent, the specificity is 95 percent, the positive predictive value is 0.95, and the negative predictive value is 0.98. [18]

Proximal humerus fracture

In patients younger than 12, proximal humerus fractures can be visualized due to the changes at the bone surface. [15] Because bone tumors can appear at this location, X-ray imaging is necessary following a fracture diagnosis. The standard procedure is the shoulder-SAFE algorithm. [15] The sensitivity of the method in comparison with X-ray imaging is 94.4 percent, and the specificity is 100 percent. [19]

Clavicle fracture

In patients younger than 12, clavicle fractures are common. They can be visualized using sonography [20] and are mostly treated conservatively. [21] The clavicle's proximity to the throat and its curved shape can complicate an examination.

Risks

The side effects are identical to those of regular sonography. The examination causes no radiation exposure. [22]

In the case of an unstable fracture, the examination can disrupt the bones because the splint or cast must be removed beforehand.

Documentation

Thorough labeling is important because a specific bone cannot be identified on a printout. [14]

Alternatives

X-ray imagery is the primary alternative to sonography. Sonography is 25 minutes faster, and the pain is reduced from 1.7 to 1.2 (visual analog scale VAS 0–5). [23]

History

Fracture sonography's first papers were published in 1986 by Leitgeb. [24] Since then, numerous trials have been published. Sonography has not become the standard diagnostic procedure because X-ray facilities exist worldwide. However, fracture sonography's demonstrated sensitivity and specificity may boost its popularity in the future.[ citation needed ]

Related Research Articles

<span class="mw-page-title-main">Medical ultrasound</span> Diagnostic and therapeutic technique

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<span class="mw-page-title-main">Shoulder</span> Part of the body

The human shoulder is made up of three bones: the clavicle (collarbone), the scapula, and the humerus as well as associated muscles, ligaments and tendons.

<span class="mw-page-title-main">Metacarpal bones</span> Bones of hand

In human anatomy, the metacarpal bones or metacarpus, also known as the "palm bones", are the appendicular bones that form the intermediate part of the hand between the phalanges (fingers) and the carpal bones, which articulate with the forearm. The metacarpal bones are homologous to the metatarsal bones in the foot.

<span class="mw-page-title-main">Penile fracture</span> Medical condition

Penile fracture is rupture of one or both of the tunica albuginea, the fibrous coverings that envelop the penis's corpora cavernosa. It is caused by rapid blunt force to an erect penis, usually during vaginal intercourse, or aggressive masturbation. It sometimes also involves partial or complete rupture of the urethra or injury to the dorsal nerves, veins and arteries.

<span class="mw-page-title-main">Joint dislocation</span> Medical injury

A joint dislocation, also called luxation, occurs when there is an abnormal separation in the joint, where two or more bones meet. A partial dislocation is referred to as a subluxation. Dislocations are often caused by sudden trauma on the joint like an impact or fall. A joint dislocation can cause damage to the surrounding ligaments, tendons, muscles, and nerves. Dislocations can occur in any major joint or minor joint. The most common joint dislocation is a shoulder dislocation.

<span class="mw-page-title-main">Gynecologic ultrasonography</span> Application of medical ultrasonography to the female pelvic organs

Gynecologic ultrasonography or gynecologic sonography refers to the application of medical ultrasonography to the female pelvic organs as well as the bladder, the adnexa, and the recto-uterine pouch. The procedure may lead to other medically relevant findings in the pelvis.This technique is useful to detect myomas or mullerian malformations.

<span class="mw-page-title-main">Nonunion</span> Failure of a bone to heal after breakage

Nonunion is permanent failure of healing following a broken bone unless intervention is performed. A fracture with nonunion generally forms a structural resemblance to a fibrous joint, and is therefore often called a "false joint" or pseudoarthrosis. The diagnosis is generally made when there is no healing between two sets of medical imaging, such as X-ray or CT scan. This is generally after 6–8 months.

<span class="mw-page-title-main">Subscapularis muscle</span> Large triangle muscle of the shoulder

The subscapularis is a large triangular muscle which fills the subscapular fossa and inserts into the lesser tubercle of the humerus and the front of the capsule of the shoulder-joint.

<span class="mw-page-title-main">Osteochondritis dissecans</span> Ischemic bone disease

Osteochondritis dissecans is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone. OCD usually causes pain during and after sports. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. Physical examination in the early stages does only show pain as symptom, in later stages there could be an effusion, tenderness, and a crackling sound with joint movement.

<span class="mw-page-title-main">Focused assessment with sonography for trauma</span> Fluid accumulation screening

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<span class="mw-page-title-main">Transient synovitis</span> Medical condition

Transient synovitis of hip is a self-limiting condition in which there is an inflammation of the inner lining of the capsule of the hip joint. The term irritable hip refers to the syndrome of acute hip pain, joint stiffness, limp or non-weightbearing, indicative of an underlying condition such as transient synovitis or orthopedic infections. In everyday clinical practice however, irritable hip is commonly used as a synonym for transient synovitis. It should not be confused with sciatica, a condition describing hip and lower back pain much more common to adults than transient synovitis but with similar signs and symptoms.

<span class="mw-page-title-main">Subacromial bursitis</span> Medical condition

Subacromial bursitis is a condition caused by inflammation of the bursa that separates the superior surface of the supraspinatus tendon from the overlying coraco-acromial ligament, acromion, and coracoid and from the deep surface of the deltoid muscle. The subacromial bursa helps the motion of the supraspinatus tendon of the rotator cuff in activities such as overhead work.

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<span class="mw-page-title-main">Humerus fracture</span> Medical condition

A humerus fracture is a break of the humerus bone in the upper arm. Symptoms may include pain, swelling, and bruising. There may be a decreased ability to move the arm and the person may present holding their elbow. Complications may include injury to an artery or nerve, and compartment syndrome.

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<span class="mw-page-title-main">Supracondylar humerus fracture</span> Medical condition

A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint. The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles. This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children. In children, many of these fractures are non-displaced and can be treated with casting. Some are angulated or displaced and are best treated with surgery. In children, most of these fractures can be treated effectively with expectation for full recovery. Some of these injuries can be complicated by poor healing or by associated blood vessel or nerve injuries with serious complications.

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<span class="mw-page-title-main">Hip pain</span>

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References

  1. ↑ Ingo Marzi: "Verletzungsformen" In: Kindertraumatologie Springer, Berlin/Heidelberg 2010. ISBN   978-3-642-00990-7, p 12.
  2. ↑ Peter Hallscheidt, Axel Haferkamp: „Niere" In: Urogenitale Bildgebung. Springer, Berlin/Heidelberg 2010. ISBN   978-3-642-10526-5, p 24.
  3. ↑ Kolja Eckert et al: Sonographische Frakturdiagnostik. In: Der Radiologe 55, 2015, pp 992–999; ISSN   0033-832X
  4. ↑ Ole Ackermann et al: Indikationen zur sonographischen Frakturdiagnostik von Frakturen im Wachstumsalter. In: Trauma Berufskrankh 17, 2015, pp 115–121; ISSN   1436-6274
  5. ↑ P Heller: "Schall schlägt Strahlen" In: Frankfurter Allgemeine Sonntagszeitung 10.2.2013, 2013, p 61; ISSN   0174-4909
  6. ↑ Harald Lutz: Physikalische Grundlagen. In: Ultraschallfibel Innere Medizin. Springer, Berlin/Heidelberg 2007. ISBN   978-3-540-29320-0, pp 1–8.
  7. ↑ Joshi et al: "Diagnostic Accuracy of History, Physical Examination, and Bedside Ultrasound for Diagnosis of Extremity Fractures in the Emergency Department: A Systematic Review". In: ACADEMIC EMERGENCY MEDICINE 20(1), 2013, pp 1–15 ISSN   1069-6563
  8. ↑ Dieter Weitzel et al.: Bewegungsapparat. In: Pädiatrische Ultraschalldiagnostik. Springer, Berlin/Heidelberg 1984. ISBN   978-3-642-69336-6, pp 226–230.
  9. ↑ JD Moritz et al: Kann Ultraschall das Röntgen in der pädiatrischen Frakturdiagnostik ersetzen? In: Ultraschall in Med. 30, 2009, V3_01; ISSN   0172-4614
  10. ↑ Francis A. Duck, A.C Baker, H.C Starritt: Ultrasound in Medicine. CRC Press 1998. ISBN   978-1-420-05037-0
  11. ↑ A. Brunner, W. Lang: Sonographische Diagnostik. In: Thomas Noppeney, Helmut Nüllen (Hrsg.): Diagnostik und Therapie der Varikose. Springer, 2010, ISBN   978-3-642-05366-5, pp 93–100.
  12. ↑ Ole Ackermann et al: Sonographische Diagnostik von metaphysären Wulstbrüchen. In: Der Unfallchirurg. 112, 2009, pp 706–711; ISSN   0177-5537
  13. ↑ Hennecke et al: Sonografische und röntgenologische Quantifizierung der Palmarabkippung von subkapitalen Frakturen der Metakarpalia IV und V. In: Handchirurgie· Mikrochirurgie· Plastische Chirurgie. 43, 2011, pp 39–45, ISSN   0722-1819.
  14. 1 2 Ole Ackermann, Kolja Eckert: Sonographische Frakturdiagnostik im Kindesalter. In: Rupprecht (Hrsg) Pädiatrische Ultraschalldiagnostik. Ecomed-Verlag, Landsberg. 31. Ergänzungslieferung. 2014 ISBN   978-3-609-71602-2
  15. 1 2 3 Kolja Eckert, Ole Ackermann: Fraktursonographie im Kindesalter. CME Fortbildung. In: Der Unfallchirurg 117, 2014, pp 355-368. ISSN   0177-5537
  16. ↑ Ole Ackermann et al: Ist die Sonographie geeignet zur Primärdiagnostik kindlicher Vorderarmfrakturen? In: Deutsche Zeitschrift für Sportmedizin. 60, 2009, pp 355–358, ISSN   0344-5925.
  17. ↑ Rabiner et al: Accuracy of point-of-care ultrasonography for diagnosis of elbow fractures in children. In: Annals of Emergency Medicine 61, 2013, pp 9–17 ISSN   0196-0644
  18. 1 2 Kolja Eckert et al.: Accuracy of the sonographic Fat Pad Sign for primary screening of pediatric elbow fractures: a preliminary study. In: Journal of Medical Ultrasonics 41, 2014, pp 473–480. ISSN   1346-4523
  19. ↑ Ole Ackermann et al: Sonographische Diagnostik der subcapitalen Humerusfraktur im Wachstumsalter. In: Der Unfallchirurg. 113, 2010, pp 83––844, ISSN   0177-5537.
  20. ↑ Klitscher, Weinberg: Klavikula. In: Tscherne : Unfallchirurgie. Springer, Berlin/Heidelberg 2014, ISBN   978-3-642-63754-4, pp 175–188.
  21. ↑ Annelie-Martina Weinberg, Harald Tscherne: "Klavikula" in: Unfallchirurgie im Kindesalter Teil 1. Springer Verlag 2006. ISBN   978-3-540-36006-3
  22. ↑ Truong et al: Stellenwert der Sonographie in der Diagnostic der Diverticulitis. In: Diverticulitis. Springer, Berlin/Heidelberg 2001, ISBN   978-3-642-59493-9, pp 169–175.
  23. ↑ Chaar-Alvarez et al: Bedside ultrasound diagnosis of nonangulated distal forearm fractures in the pediatric emergency department. In: Pediatric Emergency Care. 27 (11), 2011, pp 1027–1032. ISSN   0749-5161
  24. ↑ Leitgeb: A new noninvasive quantitative method for fracture diagnosis. In: Medical progress through technology. 11, 1986, pp 185–190. ISSN   0047-6552
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