Diagnostic accuracy of ultrasonography for diagnosis of elbow fractures in children

Abstract

BACKGROUND: 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. MATERIALS AND METHODS: 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. RESULTS: 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). CONCLUSION: 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.