Comparing wire-mesh sensor with neutron radiography for measurement of liquid fraction in foam.

The liquid fraction of foam is an important quantity in engineering process control and essential to interpret foam rheology. Established measurement tools for the liquid fraction of foam, such as optical measurement or radiography techniques as well as weighing the foam, are mostly laboratory-based, whereas conductivity-based measurements are limited to the global measurement without detailed spatial information of liquid fraction. In this work, which combines both types of measurement techniques, the conductivity-based wire-mesh sensor is compared with neutron radiography. We found a linear dependency between the liquid fraction of the foam and the wire-mesh readings with a statistical deviation less than 15%. However, the wire-mesh sensor systematically overestimates the liquid fraction, which we attribute to liquid bridge formation between the wires.

Oscillatory surface deformation of paramagnetic rare-earth solutions driven by an inhomogeneous magnetic field.

The deformation of the free surface of a paramagnetic liquid subjected to a nonuniform magnetic field is studied. A transient deformation of the surface caused by the interplay of gravity, magnetic field, and surface tension is observed when a permanent magnet is moved vertically downward to the free surface of the liquid. Different concentrations of rare-earth-metal salt (DyCl_{3}) are used and different magnet velocities are studied. The deformation of the interface is followed optically by means of a microscope and recorded with a high-speed camera. The experimental results are compared and discussed with complementary numerical simulations. Detailed results are given for the static shape of the deformed surface and the temporal evolution of the surface deformation below the center of the magnet. The frequency of the surface oscillations is found to depend on the concentration of the salt and is compared with analytical findings. Finally, a potential application of the effects observed is presented.

[Hedgehog fungi in a dermatological office in Munich : Case reports and review]. / Igelpilze in einer Münchner Hautarztpraxis : Fallbeschreibungen und Übersicht.

Patient 1: After contact to a central European hedgehog (Erinaceus europaeus), a 50-year-old female with atopy developed erythrosquamous tinea manus on the thumb and thenar eminence of the right hand. The patient had previously been scalded by hot steam at the affected site. The zoophilic dermatophyte Trichophyton erinacei could be cultured from the hedgehog as well as from scrapings from the woman's skin. Antifungal treatment of the hedgehog was initiated using 2 weekly cycles of itraconazole solution (0.1 ml/kg body weight, BW). In addition, every other day enilconazole solution was used for topical treatment. The patient was treated with ciclopirox olamine cream and oral terbinafine 250 mg daily for 2 weeks, which led to healing of the Tinea manus .Patient 2: An 18-year-old woman presented for emergency consultation with rimmed, papulous, vesicular and erosive crusted skin lesions of the index finger, and an erythematous dry scaling round lesion on the thigh. The patient worked at an animal care facility, specifically caring for hedgehogs. One of the hedgehogs suffered from a substantial loss of spines. Fungal cultures from skin scrapings of both lesions yielded T. erinacei. Treatment with ciclopirox olamine cream and oral terbinafine 250 mg for 14 days was initiated which led to healing of the lesions. Identification of all three T. erinacei isolates from both patients and from the hedgehog was confirmed by sequencing of the internal transcribed spacer (ITS) region of the ribosomal DNA, and of the translation elongation factor (TEF)-1-alpha gene. Using ITS sequencing discrimination between T. erinacei strains from European and from African hedgehogs is possible. T. erinacei should be considered a so-called emerging pathogen. In Germany the zoophilic dermatophyte T. erinacei should be taken into account as causative agent of dermatomycoses in humans after contact to hedgehogs.

[Nonretractable foreskin in boys without complaints : An indication for circumcision?] / Die nicht-retrahierbare Vorhaut bei beschwerdefreien Jungen : Eine Indikation zur Zirkumzision?

BACKGROUND: Removing boys' foreskins, even for medical reasons, is increasingly and critically discussed. The aim of this study is to retrospectively verify if the indication for the removal of boys' foreskins was justified. The study is based on the records of boys who underwent preputial operation in an outpatient medical office for pediatric surgery. METHODS: Preoperative clinical findings, complaints, applied conservative and/or surgical procedures and histological results of the resected foreskins of boys, who underwent preputial operation between 2013-2015, were retrospectively analyzed. RESULTS: A total of 176 boys (age 5 on average) underwent a preputial operation. In 85 % of the cases it was completely removed. Most frequent clinical findings (80 %) were that the prepuce was simply not retractable. 86 % of the boys were free of complaints. The most frequent histological findings were a discrete to moderately pronounced chronic fibrous posthitis (69 %) and subepithelial fibrosis (18 %), In the first case 78 % of the boys had been free of complaints, in the latter 72 %. CONCLUSION: The majority of the treated boys were free of complaints; however, most of them underwent a complete removal of their foreskin simply because it was nonretractable. The foreskin represents the most sensitive part of the male genital, preputiolysis is a natural process that can go on until early adolescence. Irreversible surgical procedures, such as a complete foreskin removal, should thus be restricted to a clear medical indication.

Self-Pinning on a Liquid Surface.

We report on the first experimental evidence of a self-pinning liquid drop on a liquid surface. This particular regime is observed for a miscible heavier oil drop (dichloromethane) deposited on an aqueous solution laden by an ionic surfactant (hexadecyltrimethylammonium bromide). Experimental characterization of the drop shape evolution coupled to particle image velocimetry points to the correlation between the drop profile and the accompanying flow field. A simple model shows that the observed pinned stage is the result of a subtle competition between oil dissolution and surfactant adsorption.

[Diagnostically Approach to Pediatric Carpal Fractures: a Retrospective Analysis]. / Diagnostisches Vorgehen bei Handwurzelknochenfrakturen im Kindesalter: eine retrospektive Analyse.

INTRODUCTION: Carpal fractures in children are rare, but can be missed, as their clinical symptoms are unspecific and discrete. Even X-ray diagnosis is difficult. Timely diagnosis and consistent therapy are especially important for scaphoid fractures, as they can help to avoid complications such as non-union or avascular necrosis. A diagnostic approach to paediatric carpal fractures will be discussed on the basis of the following group of patients. METHODS: Retrospective analysis of children under 14 years treated in our institution between 09/2010 and 02/2012 for clinically suspected carpal fracture. In the primary evaluation, all children underwent standard X-rays of the hand and/or wrist. All patients were treated by cast immobilisation until complete clinical recovery. All patients with clinical signs of carpal fracture were treated by cast immobilization, even with normal X-rays. The clinical follow-up examination was after 10 to 14 days. In patients with persistent complaints, MRI was performed. We retrospectively evaluated the records of all patients: the fractured carpal bone, and X-ray and MRI-diagnosis were stated. We calculated the mean difference between first presentation and MRI and the mean period for total recovery, in patients with fracture or non-fracture. RESULTS: 61 children (27 boys and 34 girls, mean age 11.5 y) were included in our study. The mean delay between accident and time of first presentation to our paediatric ED was 0.6 days. In primary X-rays, a carpal fracture was demonstrated in only in 2 (3.3 %) patients, but was suspected in only 6 (9.8 %) of patients. In 53 (87.9 %) patients, there was no radiographic evidence of carpal fracture. 14 patients underwent additional scaphoid views, but scaphoid fracture was confirmed in only 1 (7 %) of these patients. In 3 (21.4 %) patients, a scaphoid fracture was suspected and in 10 patients a carpal fracture could be excluded. After a mean time of 11.8 days, all patients underwent a clinical follow-up examination. 32 (54 %) patients had persistent symptoms and MRI was done after a mean time of 17 days. Carpal fracture was then excluded in 12/32 (37 %) patients and was diagnosed in another 20/32 (63 %) children. There were 14 scaphoid fractures, including 3× bone bruise lesions, 4 capitate fractures, 3 triquetral fractures, including 1× bone bruise lesion and 1 bone bruise lesion of the trapezoid. In patients with proven carpal fracture, it took a mean time of 56 days for complete recovery, in comparison with 15 days in patients with excluded carpal fracture. Surgical therapy was unnecessary in any of the patients, and there were no complications. CONCLUSION: In children with clinical and radiographic carpal fracture, diagnosis is difficult and often unsuccessful at first. Even in discrete clinical complaints, generous cast immobilization is essential and clinical follow up is recommended not later then 14 days. In patients with persistent clinical symptoms, MRI is the imaging method of choice, as it is capable of detecting carpal fractures and even bone bruise lesions with high sensitivity, thereby avoiding unnecessary diagnostic or therapeutic stress for the patients.

[Effects of Behaviour-oriented Exercise Interventions as Supplement within Structured Health-care Programmes for Diabetes Mellitus Type 2 - A Quasi-experimental Multicentre Intervention Study]. / Verhaltensorientierte Bewegungsangebote in strukturierten Behandlungsprogrammen für Diabetes mellitus Typ 2 - Eine multizentrische, quasi-experimentelle Interventionsstudie.

Exercise programs do not belong to standard treatment within disease management programmes for diabetes mellitus type 2, up to now. For these reason the effects of a 10-week behaviour-oriented exercise programme have been evaluated focusing on change in activity behaviour and health-related qualitiy of life. 202 patients took part in the investigation. There were significant inbetween group differences in some aspects of the outcome parameters. The study presents useful information on how to modify existing DMPs successfully for improving patient treatment.

[Sonographic fracture diagnostics]. / Sonographische Frakturdiagnostik.

BACKGROUND: In clinically suspected fractures taking radiographs is the standard procedure but the indications should be strictly limited. Ultrasound offers a safe and radiation-free alternative for fracture diagnostics. OBJECTIVES: Sensitivity and specificity of sonographic fracture diagnostics and safety of sonographic algorithms for fracture evaluation. METHODS: Presentation of useful applications for sonographic fracture evaluation and establishment of sonographic algorithms for safe fracture diagnosis. RESULTS: In children distal forearm fractures can be diagnosed solely by ultrasound (sensitivity 96 % and specificity 97 %). The sonographic fat pad sign (SOFA) has been proven to be a useful primary screening tool for occult fractures of the pediatric elbow. A positive fat pad sign (SOFA+) is indicative of a fracture and radiographic diagnostics are necessary (sensitivity 97 % and specificity 91 %). Ultrasonography is also useful to exclude subcapital humeral fractures (sensitivity 94 % and specificity 100 %) and for correct estimation of displacement when present. CONCLUSIONS: Sonographic algorithms for fracture evaluation (SAFE) offer a safe diagnosis and guidance of the therapeutic course of certain pediatric fractures, thereby reducing unnecessary radiation exposure.

[Complete rupture of the peroneal nerve by knee distortion]. / Komplette N.-peronaeus-Ruptur bei Kniedistorsion.

This report describes a case of complete rupture of the peroneal nerve as a consequence of low velocity trauma. A 54-year-old physically fit patient suffered a complex trauma with complete nerve discontinuity as a result of knee joint distortion without external force. The initial medical findings were unremarkable, in particular neither the accident medical history nor the initial sensitivity impairment suggested the presence of serious knee damage; however, during clinical diagnostics a complex trauma with rupture of the peroneal nerve was found. Accordingly, an extensive revision with nerve suturing was carried out.

[Taking the anamnesis with a questionnaire - safe and effective]. / Die Anamneseerhebung mittels Fragebogen - sicher und effektiv.

INTRODUCTION: The anamnesis is essential for the treatment of any patient. On the other hand, the data are often of poor quality. The aim of the study was to work out whether a questionnaire which is filled out by the patient him-/herself is a reasonable tool for data acquisition. METHODS: In a level-IV trauma centre the data acquisition of 50 consecutive patients was performed with a questionnaire which was checked by a doctor. Excluding criteria were an age < 18 years, previous treatment in the clinic, a transfer from an external clinic or a caring institution and a dementia. The results were compared with the data of the 50 patients prior to the study start. RESULTS: We collected data about the general doctor, diseases, allergies, tobacco usage, drugs, operations and the familial situation. In all 7 fields the questionnaire raised more data than the oral survey; in 4 sections the difference was significant, in 3 (p > 0.05). DISCUSSION: A questionnaire is a reasonable, time-sparing tool for data acquisition of the individual anamnesis in a surgical clinic.

[Comparison of stability of plate fixateurs with parallel and oblique screw directions]. / Vergleich der Ausbruchfestigkeit winkelstabiler Plattensysteme bei paralleler und divergierender Schraubenlage.

INTRODUCTION: One of the main failure mechanisms of modern plate fixateurs is the tearing of the whole plate-screw construct out of the osteoporotic bone. The aim of this study was to show whether an oblique screw placement can improve the fixation of the plate to the bone. METHODS: A steel probe was fixed to a synthetic bone (Fa. Sawbones) with standard titanium fixed-angle screws in parallel and 55° oblique positioning. We tested the static tear force and the dynamic stability (force distance 1.4 or 1.6 mm, 610 and 900 N, frequency of force shift of 560 or 380/min). Endpoint was a visible tear of the artificial bone. In addition we performed a morphological analysis of the torn fragments. RESULTS: The maximal tear force was 2.04 kN (1.95-2.13) for oblique and 2.66 kN (2.55-2.77) for parallel placement (p < 0.05). With a parallel positioning a higher number of force shifts were performed before a visual tear appeared. With parallel positioning the screw canal was torn with an intact surrounding corticalis; in oblique positioning the threads remained intact, the corticalis was torn out with a wedge. DISCUSSION: An oblique screw positioning does not result in a higher tear force in modern plate fixateurs.

Dendrite fragmentation in alloy solidification due to sidearm pinch-off.

Dendrite sidebranch detachment is an important fragmentation mechanism during the solidification of alloys. The detachment occurs at the junction between a sidearm and its parent stem. While this pinching process is driven by capillarity, the presence of solidification opposes the instability. Using a simple numerical model of a single sidearm, we are able to capture the essential dynamics of dendrite sidebranch development and the resulting morphological transitions. While shortly before pinch-off the neck itself obeys well-known universal scaling relations, the overall evolution of the sidearm shape sensitively depends on its initial geometry and the rate of solidification. It is found that pinch-off only occurs over limited ranges of geometrical parameters and cooling rates and is generally bounded by sidearm retraction and coalescence regimes. Simple scaling relations are identified that provide the bounds for the pinch-off regime. Pinching at the branching point is shown to be faster than the Rayleigh-Plateau instability of an infinitely long cylinder.

[Sonographic fracture diagnosis in children]. / Fraktursonografie im Kindesalter.

X-rays are the standard imaging procedure for the diagnosis of pediatric long bone fractures. Recent studies show that ultrasound (US) imaging is also qualified to diagnose pediatric long bones fractures. Thus, the diagnosis and decision-making for the treatment of metaphyseal forearm fractures in children can be performed by solely using US. The sonographic fat pad sign has been proven to be a useful primary screening tool for pediatric elbow injuries. If there is a negative fat pad sign, a fracture is unlikely and taking additional radiographs is dispensable at this time. If there is a positive fat pad sign, a fracture is likely and radiographs should be taken. US is also useful to exclude subcapital humeral fractures and to estimate fracture displacement. If a fracture of the subcapital humerus is present, additional radiographs are necessary to avoid overlooking of pathologic fractures. For reliable sonographic fracture diagnosis in childhood, a detailed history und exact clinical examination are required.

Ultrasound diagnosis of supracondylar fractures in children.

PURPOSE: The objective of our study was to evaluate the safety and accuracy of ultrasound (US) compared to standard radiographs in diagnosing supracondylar fractures (SCFs) of the humerus in children. PATIENTS AND METHODS: A total of 106 children (aged between 1 and 13 years) with clinically suspected SCF of the humerus were primarily examined by US followed by standard two-plane radiographs of the elbow. US was conducted with a linear scanner viewing the distal humerus from seven standardized sectional planes. US fracture diagnosis was established either by a cortical bulging or cortical gap, or by a positive dorsal fat pad (dFP) sign. X-ray diagnosis was stated by an independent pediatric radiologist and, afterwards, compared to our US findings. Sonographic and radiographic findings were collected in a contingency table. The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) for US fracture diagnosis were calculated according to the radiographs. In addition, by identifying significant angulation and/or disrupture, SCFs were classified as non-operative/stable and operative/instable SCFs according to the AO Pediatric Fracture Classification System. RESULTS: By US, a SCF could be excluded in 43 patients and in 63 patients, a fracture was diagnosed. In contrast, by radiographs, an SCF could be excluded in 46 patients and in 60 patients, a fracture was diagnosed. For US fracture diagnosis in comparison to radiographs, we calculated a sensitivity of 100 %, a specificity of 93.5 %, an NPV of 100 %, and a PPV of 95.2 %. Thirty-nine SCFs were sonographically classified as stable grades 1/2 SCFs and confirmed in 37 patients by X-rays. All four operative/instable SCFs were correctly identified by US. CONCLUSION: By identifying a positive dFP sign and/or cortical lesions of the distal humerus, SCFs can be detected very sensitively by US. Even the estimation of fracture displacement seems to be possible. We suggest US as an applicable alternative method in the primary evaluation of suspected SCF in children, guiding further diagnostics, where appropriate. After minor injuries, if clinical assessment for an elbow fracture is low and US examination is negative for fracture, additional radiographs are dispensable. Thereby, the amount of X-ray burden during childhood can be reduced, without loss of diagnostic safety.

[Ultrasound-based treatment of proximal humerus fractures in children]. / Ultraschallbasierte Therapiesteuerung bei subkapitalen Humerusfrakturen im Wachstumsalter.

INTRODUCTION: The treatment of juvenile proximal humerus fractures is based on the extent of the deformity. The standard diagnosis with X-ray images in 2 directions is error-prone and can lead to a suboptimal treatment. The aim of this study was to evaluate if ultrasound imaging can improve the measurement of the deformity of proximal humerus fractures. MATERIAL AND METHODS: In a prospective, multicentre trial children aged 0-12 years with a suspected proximal humerus fracture were initially examined with a 10-MHz linear transducer in 4 directions and the maximum deformity was determined. Afterwards the standard X-rays were taken and the results of both methods compared. The certainty of both methods was compared with a standardised nominal scale. RESULTS: From 8/2010 to 5/2011 6 consultants in 4 hospitals examined 30 patients (16 m, 14 f, mean age 7.9 years). In 15 cases the ultrasound showed a larger deformation than the X-rays and in 2 cases vice versa. In 11 cases the measurement was identical 6 of which were undisplaced. The mean difference of the measurement of the deformity was + 8.6°, with 14.2° in the displaced fractures. The certainty of the ultrasound was rated significantly higher (p < 0.05) than that of radiography. DISCUSSION: With a correct technique the deformity cannot be overestimated by ultrasound means and the safeness is rated significantly higher in comparison to the X-ray imaging. It seems that ultrasound is a meaningful method to improve the measurement of the deformity of proximal humerus fractures in children. Deficiencies are found only in cases with massive deformities which demand a reduction and stabilisation.

[Uncertainty in the radiological evaluation of deformity in proximal humerus fractures]. / Unsicherheit bei der radiologischen Achsbestimmung proximaler Humerusfrakturen.

INTRODUCTION: The accurate measurement of the deformity of proximal humerus fractures is essential for a proper treatment, particularly in the growing bone. Due to the local pain the correct projection in standard X-rays is difficult to achieve and, in contrast to other joints, cannot be verified in the X-ray. Even with the correct projections a mismeasurement can occur when the rotation is 45° to both planes. The aim of this study was to objectify the error sources and reveal starting points for an improvement. MATERIAL AND METHODS: In a three-step study we initially developed a mathemathical formula in cooperation with the faculty of mathematics of the University of Duisburg-Essen. This formula was proved with X-ray imaging of a steel rod which was bent 120°, simulating a 60° deformity. X-ray images with different rotation and tilt were taken and compared with the values calculated with the above-mentioned formula. In the third step X-rays of a healthy shoulder in different rotation and tilt positions were presented to 2 orthopaedic and 3 radiological consultants. The aim was to determine the direction and amount of rotation and tilt. RESULTS: The first theoretical step resulted in a mathematical formula which describes the optical deformation based on real deformation, tilt and rotation. The evaluation showed a mean difference of 0.5° (0-1.2°) between the calculated and the measured values. In the third step, evaluation of the X-rays of a shoulder showed that two in 50 (4 %) of the values were correct, in additional 28 cases (56 %) the tendency of the direction of the rotation was correct, the extent of the rotation was missed by 19.6° (0-60°). Ante- and retroversion were evaluated correctly in nine cases (18 %), the extent was missed by a mean of 23° (0-50°). In seven cases (18 %) the tendency for rotation and ante-/retroversion was correct, in 11 cases (22 %) one or both aspects could not be evaluated, in additional 8 cases (16 %) the extent could not be estimated. DISCUSSION: Our results show that rotation and tilt of the proximal humerus cannot be estimated in shoulder X-rays and therefore a reliable measurement of the deformity of proximal humerus fractures is extremely unsafe. This problem is relevant for clinical practice because of the high likeliness of unaccurate projections in shoulder X-ray imaging after trauma. Especially for the growing bone the problem is evident, so that new ways of determining the deformity are mandatory.

Teratoma formation of human embryonic stem cells in three-dimensional perfusion culture bioreactors.

Teratoma formation in mice is today the most stringent test for pluripotency that is available for human pluripotent cells, as chimera formation and tetraploid complementation cannot be performed with human cells. The teratoma assay could also be applied for assessing the safety of human pluripotent cell-derived cell populations intended for therapeutic applications. In our study we examined the spontaneous differentiation behaviour of human embryonic stem cells (hESCs) in a perfused 3D multi-compartment bioreactor system and compared it with differentiation of hESCs and human induced pluripotent cells (hiPSCs) cultured in vitro as embryoid bodies and in vivo in an experimental mouse model of teratoma formation. Results from biochemical, histological/immunohistological and ultrastuctural analyses revealed that hESCs cultured in bioreactors formed tissue-like structures containing derivatives of all three germ layers. Comparison with embryoid bodies and the teratomas revealed a high degree of similarity of the tissues formed in the bioreactor to these in the teratomas at the histological as well as transcriptional level, as detected by comparative whole-genome RNA expression profiling. The 3D culture system represents a novel in vitro model that permits stable long-term cultivation, spontaneous multi-lineage differentiation and tissue formation of pluripotent cells that is comparable to in vivo differentiation. Such a model is of interest, e.g. for the development of novel cell differentiation strategies. In addition, the 3D in vitro model could be used for teratoma studies and pluripotency assays in a fully defined, controlled environment, alternatively to in vivo mouse models.

Introduction to the focus issue: chemo-hydrodynamic patterns and instabilities.

Pattern forming instabilities are often encountered in a wide variety of natural phenomena and technological applications, from self-organization in biological and chemical systems to oceanic or atmospheric circulation and heat and mass transport processes in engineering systems. Spatio-temporal structures are ubiquitous in hydrodynamics where numerous different convective instabilities generate pattern formation and complex spatiotemporal dynamics, which have been much studied both theoretically and experimentally. In parallel, reaction-diffusion processes provide another large family of pattern forming instabilities and spatio-temporal structures which have been analyzed for several decades. At the intersection of these two fields, "chemo-hydrodynamic patterns and instabilities" resulting from the coupling of hydrodynamic and reaction-diffusion processes have been less studied. The exploration of the new instability and symmetry-breaking scenarios emerging from the interplay between chemical reactions, diffusion and convective motions is a burgeoning field in which numerous exciting problems have emerged during the last few years. These problems range from fingering instabilities of chemical fronts and reactive fluid-fluid interfaces to the dynamics of reaction-diffusion systems in the presence of chaotic mixing. The questions to be addressed are at the interface of hydrodynamics, chemistry, engineering or environmental sciences to name a few and, as a consequence, they have started to draw the attention of several communities including both the nonlinear chemical dynamics and hydrodynamics communities. The collection of papers gathered in this Focus Issue sheds new light on a wide range of phenomena in the general area of chemo-hydrodynamic patterns and instabilities. It also serves as an overview of the current research and state-of-the-art in the field.

Chemo-Marangoni convection driven by an interfacial reaction: pattern formation and kinetics.

A combined study devoted to chemo-Marangoni convection and the underlying kinetics is presented for a biphasic system in which surfactants are produced in situ by an interfacial reaction. The pattern formation studied in a Hele-Shaw cell in both microgravity and terrestrial environments initially shows an ensemble of chemo-Marangoni cells along a nearly planar interface. Soon, a crossover occurs to periodic large-scale interfacial deformations which coexist with the Marangoni cells. This crossover can be correlated with the autocatalytic nature of the interfacial reaction identified in the kinetic studies. The drastic increase in the product concentration is associated with an enhanced aggregate-assisted transfer after the critical micellar concentration is approached. In this context, it was possible to conclusively explain the changes in the periodicity of the interfacial deformations depending on the reactant concentration ratio.

[Ultrasound as a viable alternative to standard X-rays for the diagnosis of distal forearm fractures in children]. / Die Sonografie als sichere Alternative zur konventionellen Röntgendiagnostik bei distalen Unterarmfrakturen im Kindesalter.

AIM: Distal forearm fractures are very common in childhood. Radiography of the wrist is the standard diagnostic procedure. But because of higher sensitivity of growing bones to ionising radiation the diagnostic use of X-rays should be minimised as much as possible. Recent studies have shown that distal forearm fractures in children can be safely and reliably diagnosed using only ultrasound. The aim of our study was to evaluate and confirm the safety and applicability of the ultrasound diagnostic procedure in comparison to X-ray diagnosis under routine conditions of our paediatric emergency department. PATIENTS AND METHODS: We investigated 115 patients aged 2-14 years. After clinical assessment patients with suspected forearm fractures first underwent ultrasound examination of the metaphyseal forearm followed by standard two view radiographs of the wrist. Ultrasound and radiographic findings were then compared and sensitivity and specificity for ultrasound were calculated. In 9 patients with suspected displacements, sonographic and radiographic axis measurement were done and also compared. RESULTS: Radiologically we found 62 patients with 78 distal forearm fractures. By ultrasound we also diagnosed 52 fractures. All patients with no fractures were correctly diagnosed as well. Referring to X-rays we calculated for ultrasound a sensitivity of 94.9 %, a specificity of 98 %, a negative predictive value of 97.4 % and a positive predictive value of 96.1 %. The mean difference of the deformities of the radius in the sagittal section measured sonographically and radiologically were 1.7° (SD 1.6°). CONCLUSION: We confirm ultrasound is an applicable, rapid and safe alternative to X-rays in diagnosing metaphyseal forearm fractures in children. Even sonographic axis measurement seems to be a viable method. Thereby ultrasound potentially reduces the X-ray burden in children and additionally accelerates the diagnostic procedure.