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Accuracy of the sonographic fat pad sign for primary screening of pediatric elbow fractures: a preliminary study

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Abstract

Purpose

The purpose of this study was to evaluate the diagnostic accuracy of the sonographic fat pad sign (FPS) as a predictor for pediatric elbow fractures.

Patients and methods

This is a prospective study of children under 14 years with suspected elbow fractures. All participants underwent at first ultrasonography focused on a FPS followed by standard elbow radiographs. US findings were compared to final fracture diagnosis.

Results

38 out of 79 children had an elbow fracture. A sonographic FPS predicted an elbow fracture with a sensitivity/specificity of 97.3/90.5 %, positive/negative likelihood ratios (LR) were 10.2/0.03 and correct/false classification rates were 93.7/6.3 %. Primary US findings were later reviewed by a blinded physician giving a congruity of 96.2 %. These secondary US findings predicted an elbow fracture with a sensitivity/specificity of 92.1/92.7 %, positive/negative LRs were 12.6/0.09 and correct/false classification rates were 92.4/7.5 %.

Conclusion

The sonographic FPS could serve as a useful screening tool in primary evaluation of pediatric elbow injuries. If a fracture is unlikely after clinical and US evaluation, additional radiographs are dispensable, thereby potentially minimizing the radiation burden in childhood and reducing the length of stay in the Emergency Department.

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References

  1. Bache E. Elbow injuries. In: Johnson KJ, Bache E, editors. Imaging in pediatric skeletal trauma. 1st ed. Berlin: Springer; 2008. p. 257–80.

    Chapter  Google Scholar 

  2. Hell A, Weinberg AM, Kraus R, et al. Kapitel 14 Ellbogen. In: Weinberg AM, Tscherne H, editors. Unfallchirurgie im Kindesalter. Berlin: Springer; 2006. p. 253–95.

    Google Scholar 

  3. Alzen G, Duque-Reina D, Urhan R, et al. Radiological examinations after trauma in children: clinical and medico-legal considerations about their indications. Dtsch Med Wschr. 1992;117:363–7.

    Article  PubMed  CAS  Google Scholar 

  4. Alzen G, Benz-Bohm G. Radiation protection in pediatric radiology. Dtsch Arztebl Int. 2011;108:407–14.

    PubMed  PubMed Central  Google Scholar 

  5. Brenner DJ, Dollc R, Goodheadd DT, et al. Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. PNAS. 2003;100:13761–6.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  6. Brix G, Nekolla E, Griebel J. Radiation exposure of patients from diagnostic and interventional X-ray procedures. Facts, assessment and trends. Radiologe. 2005;45:340–9.

    Article  PubMed  CAS  Google Scholar 

  7. Fletcher EW, Baum JD, Draper G. The risk of diagnostic radiation of the newborn. Br J Radiol. 1986;59:165–70.

    Article  PubMed  CAS  Google Scholar 

  8. Linet MS, Kim K, Rajaraman P. Children’s exposure to diagnostic medical radiation and cancer risk: epidemiologic and dosimetric considerations. Pediatr Radiol. 2009;39:S4.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Donnelly LF, Klostermeier TT, Klosterman LA. Traumatic elbow effusions in pediatric patients: are occult fractures the rule? AJR. 1998;171:243–5.

    Article  PubMed  CAS  Google Scholar 

  10. Fick DS, Lyons TA. Interpreting elbow radiographs in children. Am Fam Physician. 1997;55:1278–82.

    PubMed  CAS  Google Scholar 

  11. Kraus R, Berthold LD, von Laer L. Efficient imaging of elbow injuries in children and adolescents. Klin Padiatr. 2007;219:282–7.

    Article  PubMed  CAS  Google Scholar 

  12. Major NM, Crawford ST. Elbow effusions in trauma in adults and children: is there an occult fracture? AJR. 2002;178:413–8.

    Article  PubMed  Google Scholar 

  13. Norell HG. Roentgenologic visualization of the extracapsular fat; its importance in the diagnosis of traumatic injuries to the elbow. Acta Radiol. 1954;42:205–10.

    Article  PubMed  CAS  Google Scholar 

  14. O’Dwyer H, O’Sullivan P, Fitzgerald D, et al. The fat pad sign following elbow trauma in adults: its usefulness and reliability in suspecting occult fracture. J Comput Assist Tomogr. 2004;28:562–5.

    Article  PubMed  Google Scholar 

  15. Skaggs D, Pershad J. Pediatric elbow trauma. Pediatr Emerg Care. 1997;13:425–34.

    Article  PubMed  CAS  Google Scholar 

  16. Miles KA, Lamont AC. Ultrasonic demonstration of the elbow fat pads. Clin Radiol. 1989;40:602–4.

    Article  PubMed  CAS  Google Scholar 

  17. Rabiner JE, Khine H, Avner JR, et al. Accuracy of point-of-care ultrasonography for diagnosis of elbow fractures in children. Ann Emerg Med. 2013;61:9–17.

    Article  PubMed  Google Scholar 

  18. Barata I, Spencer R, Suppiah A, et al. Emergency ultrasound in the detection of pediatric long-bone fractures. Pediatr Emerg Care. 2012;28:1154–7.

    Article  PubMed  Google Scholar 

  19. Hübner U, Schlicht W, Outzen S. Ultrasound in the diagnosis of fractures in children. J Bone Joint Surg [Br]. 2000;82-B:1170–3.

    Article  Google Scholar 

  20. Moritz JD, Berthold LD, Soenksen SF, et al. Ultrasound in diagnosis of fractures in children: unnecessary harassment or useful addition to X-ray? Ultraschall Med. 2008;29:267–74.

    Article  PubMed  CAS  Google Scholar 

  21. Moritz JD, Hoffmann B, Meuser SH, et al. Is ultrasound equal to X-Ray in pediatric fracture diagnosis? Fortschr Röntgenstr. 2010;182:706–14.

    Article  CAS  Google Scholar 

  22. Patel DD, Blumberg SM, Crain EF. The utility of bedside ultrasonography in identifying fractures and guiding fracture reduction in children. Pediatr Emerg Care. 2009;25:221–5.

    Article  PubMed  Google Scholar 

  23. Rathfelder FJ, Paar O. Ultrasound as an alternative diagnostic measure for fractures during the growth phase. Unfallchirurg. 1995;98:645–9.

    PubMed  CAS  Google Scholar 

  24. Ackermann O, Liedgens P, Eckert K, et al. Sonographische Diagnostik von metaphysären Wulstbrüchen. Der Unfallchirurg. 2009;112:706–11.

    Article  PubMed  CAS  Google Scholar 

  25. Ackermann O, Sesia S, Berberich T, et al. Sonographische Diagnostik der subcapitalen Humerusfraktur im Wachstumsalter. Der Unfallchirurg. 2010;113:839–44.

    Article  PubMed  CAS  Google Scholar 

  26. Ackermann O, Sesia S, Berberich T, et al. Evaluation of proximal humerus fractures in children with ultrasonography a prospective multicenter study. Eur J Trauma Emerg Surg. 2011;37:322.

    Google Scholar 

  27. Chaar-Alvarez FM, Warkentine F, Keith Cross K. Bedside ultrasound diagnosis of nonangulated distal forearm fractures in the pediatric emergency department. Pediatr Emerg Care. 2011;27:1027–32.

    Article  PubMed  Google Scholar 

  28. Chien M, Bulloch B, Garcia-Filion P. Bedside ultrasound in the diagnosis of pediatric clavicle fractures. Pediatr Emerg Care. 2011;27:1038–41.

    Article  PubMed  Google Scholar 

  29. Eckert K, Ackermann O, Schweiger B, et al. Ultrasound as a viable alternative to standard X-rays for the diagnosis of distal forearm fractures in children. Z Orthop Unfall. 2012;150:409–14.

    PubMed  CAS  Google Scholar 

  30. Eckert K, Ackermann O, Schweiger B, et al. Sonographic diagnosis of metaphyseal forearm fractures in children: a safe and applicable alternative to standard X-rays. Pediatr Emerg Care. 2012;28:851–4.

    Article  PubMed  Google Scholar 

  31. Pountos I, Clegg J, Siddiqui A. Diagnosis and treatment of greenstick and torus fractures of the distal radius in children: a prospective randomised single blind study. J Child Orthop. 2010;4:321–6.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Williamson D, Watura R, Cobby M. Ultrasound imaging of forearm fractures in children: a viable alternative? J Accid Emerg Med. 2000;17:22–4.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  33. Davidson RS, Markowitz RI, Dormans J, et al. Ultrasonographic evaluation of the elbow in infants and young children after suspected trauma. J Bone Joint Surg Am. 1994;76:1804–13.

    PubMed  CAS  Google Scholar 

  34. Eckert K, Ackermann O, Schweiger B, et al. Ultrasound evaluation of elbow fractures in children. J Med Ultrason. 2013;40:443–51.

    Article  Google Scholar 

  35. Grechenig W, Clement HG, Schatz B, et al. Sonographic examination of trauma to the elbow and hand. Orthopäde. 2002;31:271–7.

    Article  PubMed  CAS  Google Scholar 

  36. Markowitz RI, Davidson RS, Harty MP, et al. Sonography of the elbow in infants and children. AJR. 1992;159:829–33.

    Article  PubMed  CAS  Google Scholar 

  37. Martinoli C, Bianchi S, Zamorani MP, et al. Ultrasound of the elbow. Eur J Ultrasound. 2001;14:21–7.

    Article  PubMed  CAS  Google Scholar 

  38. Pistor G, Graffstädt H. Sonographic diagnosis of supracondylar fractures of the humerus—retrospective and prospective studies in children. Ultraschall Med. 2003;24:331–9.

    Article  PubMed  CAS  Google Scholar 

  39. Tran N, Chow K. Ultrasonography of the elbow. Semin Musculoskelet Radiol. 2007;11:105–16.

    Article  PubMed  Google Scholar 

  40. Zhang JD, Chen H. Ultrasonography for non-displaced and mini-displaced humeral lateral condyle fractures in children. Chin J Traumatol. 2008;11:297–300.

    PubMed  Google Scholar 

  41. Zuazo I, Bonnefoy O, Tauzin C, et al. Acute elbow trauma in children: role of ultrasonography. Pediatr Radiol. 2008;38:982–8.

    Article  PubMed  Google Scholar 

  42. De Maeseneer M, Jacobson JA, Jaovisidha S, et al. Elbow effusions: distribution of joint fluid with flexion and extension and imaging implications. Invest Radiol. 1998;33:117–25.

    Article  PubMed  Google Scholar 

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Conflict of interest

None.

Human rights statements and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, revised in 2008. Informed consent was obtained from all patients for being included in the study.

Author information

Authors and Affiliations

  1. Department for Pediatric Surgery, Elisabeth Hospital Essen, Klara-Kopp-Weg 1, 45138, Essen, Germany

    Kolja Eckert, Niklas Janssen, Elke Radeloff & Peter Liedgens

  2. Department for Orthopaedics, Trauma- and Reconstructive Surgery, Evangelic Hospital Oberhausen, Virchowstrasse 20, 46047, Oberhausen, Germany

    Ole Ackermann

  3. Department for Diagnostical und Interventional Radiology and Neuroradiology, Universitary Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany

    Bernd Schweiger

Authors
  1. Kolja Eckert
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  2. Ole Ackermann
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  3. Niklas Janssen
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  4. Bernd Schweiger
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  5. Elke Radeloff
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  6. Peter Liedgens
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Corresponding author

Correspondence to Kolja Eckert.

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Cite this article

Eckert, K., Ackermann, O., Janssen, N. et al. Accuracy of the sonographic fat pad sign for primary screening of pediatric elbow fractures: a preliminary study. J Med Ultrasonics 41, 473–480 (2014). https://doi.org/10.1007/s10396-014-0525-0

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  • DOI: https://doi.org/10.1007/s10396-014-0525-0

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