Wu Dan,Chen Zhaoqiang,Xiao Hong,et al.Applications and advances of ultrasonography in diagnosing pediatric elbow fractures[J].Journal of Clinical Pediatric Surgery,,():1196-1200.[doi:10.3760/cma.j.cn101785-202508050-019]
Applications and advances of ultrasonography in diagnosing pediatric elbow fractures
- Keywords:
- Elbow Joint Fracture; Ultrasonography; Diagnosis; Child
- Abstract:
- Pediatric elbow fractures represent a common type of skeletal injury.However,a definite diagnosis via traditional imaging is frequently constrained by immature state of developing skeleton and individual differences in the appearance and fusion of its ossification centers.Conventional radiographs lack sensitivity for nondisplaced fractures and cartilaginous damage,computed tomography (CT) carries a high radiation burden and magnetic resonance imaging (MRI) remains limited in emergency and primary care settings due to its prohibitive expense and lengthy examination duration.Owing to its noninvasiveness,non-irradiation,real-time dynamic assessment capability and high resolution for cartilage and soft tissues,ultrasonography offers the potential of becoming a first-line screening tool for pediatric elbow fractures.This review systematically examines the value of ultrasound in diagnosing elbow fractures in children,with a particular focus on normal sonographic anatomy,an exploration of its diagnostic performance and extensive applications for such common injuries as supracondylar and lateral condyle fractures.It proved that ultrasound could reliably detect occult fractures through direct signs (cortical discontinuity) and indirect indicators (fat pad sign & joint effusion),thus avoiding unnecessary radiation exposure.Nevertheless,diagnostic accuracy of technique is contingent upon operator expertise and fracture complexity.Ultrasound is an ideal first-line screening modality for pediatric elbow trauma.Future imperatives include standardizing scanning protocols,formalized training for operators and explorations of such novel techniques as artificial intelligence-assisted diagnosis,ultrasonic elastography and three-dimensional ultrasound to offer more precise imaging data for clinical monitoring and assessment of treatment outcomes.
References:
[1] Tom JE,Eckhoff MD,Tadlock JC,et al.A 10-year national analysis of pediatric elbow fractures[J].Clin Pediatr (Phila),2023,62(5):433-440.DOI:10.1177/00099228221135525.
[2] Mubarak FS,Mohamed Anzar MA,Kanagratnam K.Descriptive study on epidemiology,clinical presentation,treatment,and outcome of supracondylar fractures treated in a base hospital of Sri Lanka:a single-center study[J].Cureus,2023,15(6):e40494.DOI:10.7759/cureus.40494.
[3] Klahs KJ,Dertinger JE,Mello GT,et al.Epidemiologic investigation of pediatric distal humerus fractures:an American insurance claims database study[J].World J Orthop,2024,15(1):52-60.DOI:10.5312/wjo.v15.i1.52.
[4] Iyer RS,Thapa MM,Khanna PC,et al.Pediatric bone imaging:imaging elbow trauma in children-a review of acute and chronic injuries[J].AJR Am J Roentgenol,2012,198(5):1053-1068.DOI:10.2214/AJR.10.7314.
[5] Joshi P,Dawadi P,Rana K,et al.Epidemiological and clinical pattern of pediatric supracondylar fracture of humerus in a provincial hospital:a descriptive cross-sectional study[J].JNMA J Nepal Med Assoc,2021,59(233):12-14.DOI:10.31729/jnma.6047.
[6] Raux S,Madelaine A.Sequelae of childhood elbow fracture[J].Orthop Traumatol Surg Res,2023,109(1S):103454.DOI:10.1016/j.otsr.2022.103454.
[7] DeFroda SF,Hansen H,Gil JA,et al.Radiographic evaluation of common pediatric elbow injuries[J].Orthop Rev (Pavia),2017,9(1):7030.DOI:10.4081/or.2017.7030.
[8] Afacan MA,Kilic KK,Temiz A,et al.Diagnostic accuracy of fat pad sign,X-ray,and computed tomography in elbow trauma:implications for treatment choices-a retrospective study[J].PeerJ,2025,13:e18922.DOI:10.7717/peerj.18922.
[9] Ricci PM,Boldini M,Bonfante E,et al.Cone-beam computed tomography compared to X-ray in diagnosis of extremities bone fractures:a study of 198 cases[J].Eur J Radiol Open,2019,6:119-121.DOI:10.1016/j.ejro.2019.01.009.
[10] Kim HH,Gauguet JM.Pediatric elbow injuries[J].Semin Ultrasound CT MR,2018,39(4):384-396.DOI:10.1053/j.sult.2018.03.005.
[11] Al-Aubaidi Z,Torfing T.The role of fat pad sign in diagnosing occult elbow fractures in the pediatric patient:a prospective magnetic resonance imaging study[J].J Pediatr Orthop B,2012,21(6):514-519.DOI:10.1097/BPB.0b013e328355e5d8.
[12] Rabiner JE,Khine H,Avner JR,et al.Accuracy of point-of-care ultrasonography for diagnosis of elbow fractures in children[J].Ann Emerg Med,2013,61(1):9-17.DOI:10.1016/j.annemergmed.2012.07.112.
[13] Sinha TP,Bhoi S,Kumar S,et al.Diagnostic accuracy of bedside emergency ultrasound screening for fractures in pediatric trauma patients[J].J Emerg Trauma Shock,2011,4(4):443-445.DOI:10.4103/0974-2700.86625.
[14] Tokarski J,Avner JR,Rabiner JE.Reduction of radiography with point-of-care elbow ultrasonography for elbow trauma in children[J].J Pediatr,2018,198:214-219.e2.DOI:10.1016/j.jpeds.2018.02.072.
[15] Santamaria Barrena T,Ortiz de Mendivil Bernal E,Zabalza Gonzalez I,et al.Utility of point-of-care ultrasound for the diagnosis of elbow fractures in the pediatric emergency department[J].JSES Int,2025,9(3):907-911.DOI:10.1016/j.jseint.2025.01.016.
[16] Supakul N,Hicks RA,Caltoum CB,et al.Distal humeral epiphyseal separation in young children:an often-missed fracture-radiographic signs and ultrasound confirmatory diagnosis[J].AJR Am J Roentgenol,2015,204(2):192-W198.DOI:10.2214/AJR.14.12788.
[17] 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].J Med Ultrason (2001),2014,41(4):473-480.DOI:10.1007/s10396-014-0525-0.
[18] 周治国,陈小亮,李雄涛,等.超声对儿童肱骨远端Ⅰ型骨骺损伤的诊断价值[J].放射学实践,2017,32(9):977-980.DOI:10.13609/j.cnki.1000-0313.2017.09.018. Zhou ZG,Chen XL,Li XT,et al.Ultrasound diagnostic values of distal humeral type Ⅰ epiphyseal injuries in young children[J].Radiol Pract,2017,32(9):977-980.DOI:10.13609/j.cnki.1000-0313.2017.09.018.
[19] Basra HAS,Humphries PD.Juvenile idiopathic arthritis:what is the utility of ultrasound?[J].Br J Radiol,2017,90(1073):20160920.DOI:10.1259/bjr.20160920.
[20] 中国医师协会骨科医师分会小儿骨科专业委员会,中国医师协会骨科医师分会小儿骨科肢体矫形学组.儿童肘关节损伤术中X线造影技术专家共识[J].中华骨与关节外科杂志,2024,17(8):678-685.DOI:10.3969/j.issn.2095-9958.2024.08.02. Specialty Committee of Pediatric Orthopedic,Chinese Association of Orthopedic Surgeons; Group of Pediatric Orthopedic Limb Deformity Correction,Chinese Association of Orthopedic Surgeons:Expert Consensus on Radiographic Arthrography Techniques for Pediatric Elbow Injuries[J].Chin J Bone Joint Surg,2024,17(8):678-685.DOI:10.3969/j.issn.2095-9958.2024.08.02.
[21] Eckert K,Ackermann O,Schweiger B,et al.Ultrasound evaluation of elbow fractures in children[J].J Med Ultrason (2001),2013,40(4):443-451.DOI:10.1007/s10396-013-0446-3.
[22] Tsou PY,Ma YK,Wang YH,et al.Diagnostic accuracy of ultrasound for upper extremity fractures in children:a systematic review and meta-analysis[J].Am J Emerg Med,2021,44:383-394.DOI:10.1016/j.ajem.2020.04.071.
[23] Ashoobi MA,Homaie Rad E,Rahimi R.The diagnostic value of sonographic findings in pediatric elbow fractures:a systematic review and meta-analysis[J].Am J Emerg Med,2024,77:121-131.DOI:10.1016/j.ajem.2023.12.021.
[24] Lee SH,Yun SJ.Diagnostic performance of ultrasonography for detection of pediatric elbow fracture:a meta-analysis[J].Ann Emerg Med,2019,74(4):493-502.DOI:10.1016/j.annemergmed.2019.03.009.
[25] Korgan MB,Altunci YA,Uz I[DD(-*4]·,et al.Effectiveness of ultrasonography performed at the emergency department for pediatric elbow trauma cases[J].Injury,2023,54(11):111005.DOI:10.1016/j.injury.2023.111005.
[26] Kumar V,Singh A.Fracture supracondylar humerus:a review[J].J Clin Diagn Res,2016,10(12):RE01-RE06.DOI:10.7860/JCDR/2016/21647.8942.
[27] 王华梅.高频超声联合计算机X线摄影对小儿肘关节隐匿性骨折的诊断价值[J].医疗装备,2024,37(21):94-96.DOI:10.3969/j.issn.1002-2376.2024.21.024. Wang HM.Diagnostic value of high-frequency ultrasound combined with computed radiography for occult elbow fractures in children[J].Med Equip,2024,37(21):94-96.DOI:10.3969/j.issn.1002-2376.2024.21.024.
[28] Varga M,Papp S,Kassai T,et al.Standardized sonographic examination of pediatric elbow injuries is an effective screening method and improves diagnostic efficiency[J].Injury,2021,52(S1):S25-S30.DOI:10.1016/j.injury.2020.02.056.
[29] 包金云.儿童肱骨髁上骨折合并肱动脉血栓形成的超声分析[J].中国社区医师,2015,31(14):101-102.DOI:10.3969/j.issn.1007-614x.2015.14.62. Bao JY.Analysis of ultrasonic on supracondylar fracture of humerus in children combined with brachial artery thrombosis[J].Chin Community Doct,2015,31(14):101-102.DOI:10.3969/j.issn.1007-614x.2015.14.62.
[30] 马海龙,吴青杰,刘方,等.两种术式治疗儿童肱骨外髁骨折的疗效比较[J].中国修复重建外科杂志,2025,39(1):64-69.DOI:10.7507/1002-1892.202410046. Ma HL,Wu QJ,Liu F,et al.Comparison of effectiveness between two surgical approaches for humeral lateral condyle fractures in children[J].Chinese Journal of Reparative and Reconstructive Surgery,2025,39(1):64-69.DOI:10.7507/1002-1892.202410046.
[31] 沈先涛,陈小亮,李雄涛,等.婴幼儿肱骨远端骨折超声诊断及辅助治疗的临床意义[J].中华小儿外科杂志,2015,36(2):141-144.DOI:10.3760/cma.j.issn.0253-3006.2015.02.015. Shen XT,Chen XL,Li XT,et al.Ultrasonic diagnosis of distal humeral fracture in infants and toddlers and its clinical significance of ancillary treatment[J].Chin J Pediatr Surg,2015,36(2):141-144.DOI:10.3760/cma.j.issn.0253-3006.2015.02.015.
[32] Wu X,Li XT,Yang SW,et al.Determining the stability of minimally displaced lateral humeral condyle fractures in children:ultrasound is better than arthrography[J].J Orthop Surg Res,2021,16(1):32.DOI:10.1186/s13018-020-02174-8.
[33] Lee RC,Syed AN,Bowen MA,et al.Partial avulsion patterns in the pediatric humeral medial epicondyle[J].Am J Sports Med,2025,53(3):537-542.DOI:10.1177/03635465241310407.
[34] Jia GQ,Sun J.Application of ultrasound in the management of TRASH (the radiographic appearance seemed harmless) fractures in preschool children:a review[J].Medicine (Baltimore),2023,102(34):e34855.DOI:10.1097/MD.0000000000034855.
[35] Cho KH,Lee SM,Lee YH,et al.Ultrasound diagnosis of either an occult or missed fracture of an extremity in pediatric-aged children[J].Korean J Radiol,2010,11(1):84-94.DOI:10.3348/kjr.2010.11.1.84.
[36] Lee JE,Kim JB,Choi ES.Ultrasonography-guided reduction of pediatric radial neck fractures[J].BMC Musculoskelet Disord,2017,18(1):516.DOI:10.1186/s12891-017-1891-8.
[37] Brenner D,Elliston C,Hall E,et al.Estimated risks of radiation-induced fatal cancer from pediatric CT[J].AJR Am J Roentgenol,2001,176(2):289-296.DOI:10.2214/ajr.176.2.1760289.
Memo
收稿日期:2025-8-25。
基金项目:宁波市骨科与运动康复临床医学研究中心(2024L004)
通讯作者:段红波,Email:hongbod919@163.com