Ultrasound in diagnosis of fractures in children: unnecessary harassment or useful addition to X-ray?

PURPOSE: Handling children with trauma is often very difficult, as the signs and the exact location of the fracture are sometimes unclear. The aim of this study was to compare ultrasound and X-ray for the identification of fractures. MATERIALS AND METHODS: In this study 653 patients from newborn to 17 years old (mean age 4.4 years) with nonspecific clinical signs or clinically indistinct fracture location were examined initially with ultrasound. After identification of the fracture by ultrasound, an X-ray exam of the predefined region followed. In cases of negative ultrasound an X-ray exam was performed not focused on a predefined region. RESULTS: Examinations of 726 parts of the body revealed 308 fractures. 266 fractures were identified by both ultrasound and X-ray, 20 exclusively by ultrasound, 21 exclusively by X-ray. One maxillary fracture was missed. The sensitivity was 92.9% for ultrasound and 93.2% for X-ray, and the specificity was 99.5% (ultrasound) and 99.8% (X-ray). Ultrasound was superior to X-ray on the clavicle, but the opposite was true in the lower limb. In 8.4% of the patients ultrasound helped us to reduce the number of X-rays. CONCLUSION: Ultrasound is comparable to X-ray for the detection of fractures. Ultrasound should be the first imaging method in children with trauma and nonspecific clinical signs or indistinct location of pain, followed by X-ray exams of the predefined region.

[Assessment of bone density in children and adolescents by quantitative CT of one lumbar vertebra only]. / Messung der Knochendichte bei Kindern und Jugendlichen mittels quantitativer CT an nur einem Lendenwirbelkörper.

AIM: The aim of this study was to determine whether measuring the trabecular bone density in one lumbar vertebra (L) instead of three has an effect on the assessment of bone density in children. MATERIALS AND METHODS: Bone density was measured in 70 patients (38 male, 32 female), ages 1 to 22 years (mean age 12.4, median 13 years) using a Somatom Balance Scanner (Siemens). The trabecular bone density was measured (1-cm slice, 80 kV, 81 mAs) in L1 through L3. RESULTS: The mean bone density in the lumbar vertebrae was 139.9 mg/ml calcium-hydroxylapatite per ml bone in L1, 133.9 in L2, and 131.7 in L3, and the mean of all three vertebrae was 135.2 mg/ml. Measurements in L1 were 4.7 mg/ml (standard deviation [SD] 4.7 mg/ml) above the mean value of the three upper lumbar vertebrae. The density in L2 was 1.3 mg/ml below the mean (SD 3.1 mg/ml). On average, L3 was 3.5 mg/ml below the mean (SD 4.6 mg/ml). This minor systematic deviation in the measurement values for the individual vertebrae from the mean value was so low that there was no statistical evidence for a deviation from an ideal regression line. CONCLUSIONS: When using an adequate technique, especially accurate analysis of the topogram (scout view) and the tomogram, measurement of the bone density of one lumbar vertebra provides satisfactory information regarding the trabecular bone density in children, but the values differ in the three upper lumbar vertebrae. The bone density of L2 is close to the mean of the upper three vertebrae. In the case of pathologic values or a pathologic trabecular pattern, three vertebrae should be measured.