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Ackermann O, Fischer CA, Grosser K, Hauenstein C, Kluge S, Moritz JD, Berthold L, Kaisenberg CV, Tesch C. Fracture sonography-review of literature and current recommendations. Arch Orthop Trauma Surg 2024; 144:3025-3043. [PMID: 38953942 DOI: 10.1007/s00402-024-05396-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 05/29/2024] [Indexed: 07/04/2024]
Abstract
Over a span of more than two years, a collaborative expert group consisting of 9 professional societies has meticulously crafted the S2e guideline on fracture sonography. This publication encapsulates the essential insights pertaining to specific indications. A thorough and systematic literature search, covering the period from 2000 to March 2021, was conducted across PubMed, Google Scholar, and the Cochrane Database of Systematic Reviews, complemented by an evaluation of bibliographies. Inclusion criteria encompassed randomized controlled clinical trials, observational clinical trials, meta-analyses, and systematic reviews, while guidelines, conferences, reviews, case reports, and expert opinions were excluded. The SIGN grading system (1999-2012) was applied to assess evidence, and resultant SIGN tables were presented to the expert group. Specific recommendations for the application of fracture sonography were then derived through unanimous consensus after detailed discussions. Out of the initial pool of 520 literature sources, a meticulous screening and content assessment process yielded 182 sources (146 clinical studies and 36 meta-analyses and systematic reviews) for evaluation. The comprehensive analysis identified twenty-one indications that substantiate the judicious use of fracture sonography. Ultrasound emerges as a pragmatic and user-friendly diagnostic method, showcasing feasibility across a diverse range of indications.
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Affiliation(s)
- Ole Ackermann
- University of Bochum, Universitätsstr 1, 44780, Bochum, Germany.
| | - Christian A Fischer
- Christian A. Fischer, Arcus Klinik, Rastatter Str. 17-19, 75179, Pforzheim, Germany
| | - Kay Grosser
- Kay Grosser, Klinikum Kassel, Mönchebergstraße 41-43, 34125, Kassel, Germany
| | - Christina Hauenstein
- Christina Hauenstein, Universität Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Sebastian Kluge
- Sebastian Kluge, Handchirurgie Seefeld, Seefeldstrasse 27, 8008, Zurich, Switzerland
| | - Jörg D Moritz
- Jörg D. Moritz, Universität SH, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Lars Berthold
- Lars Berthold, Universität Giessen Und Marburg, Rudolf-Buchheim-Straße 8, 35392, Gießen, Germany
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Ackermann O, Berthold D, Fischer C, Grosser K, Hauenstein C, Kluge S, Moritz JD, Tesch C, V Kaisenberg C. Fracture sonography - Literature review and current recommendations. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2024; 45:269-276. [PMID: 38395059 DOI: 10.1055/a-2225-7320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
PURPOSE Over the course of more than two years, an expert group of 9 professional societies has created the S2e guidelines for fracture sonography. This publication summarizes the key points regarding the individual indications. MATERIALS AND METHODS A systematic literature search was performed in PubMed, Google Scholar, and the Cochrane Database of Systematic Reviews from 2000 to March 2021 with evaluation of the literature lists. Randomized controlled clinical trials, observational clinical trials, meta-analyses, and systematic reviews were included. Guidelines, conferences, reviews, case reports, and expert opinions were excluded. Evidence was graded using the SIGN grading system 1999-2012, and the SIGN tables were then presented to the expert group. These were used to develop specific recommendations for the use of fracture sonography. All recommendations were discussed in detail and finally unanimously agreed upon. RESULTS Of the 520 primary literature sources found, 182 sources (146 clinical studies and 36 meta-analyses and systematic reviews) were evaluated after screening and content assessment. 21 indications that allow reasonable application of fracture sonography were identified. CONCLUSION Ultrasound is a sensible, easy-to-use diagnostic method that is feasible for a large number of indications.
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Affiliation(s)
- Ole Ackermann
- Orthopedic Surgery, Ruhr University Bochum, Bochum, Germany
| | - Daniel Berthold
- Pediatric radiology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | | | - Kay Grosser
- Pediatric surgery, Kassel Hospital, Kassel, Germany
| | | | - Sebastian Kluge
- Hand surgery, Hand Surgery Seefeld, Seefeld, Zurich, Switzerland
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Abstract
BACKGROUND Clinical examination after trauma, especially in young children, often proves difficult. As a result, the majority of images show unremarkable findings in the imaging workup of trauma by radiography. Sonography represents an imaging technique without the use of X-rays. As the quality of ultrasound equipment has increased over the past 20 years, numerous studies have demonstrated that fractures in children and adolescents can be detected with very high sensitivity and specificity by sonography. METHOD This paper reviews the results obtained so far in the literature. Based on these findings, the importance of sonographic fracture diagnosis in childhood and adolescence for the most important locations is demonstrated. RESULTS When examining with a high-frequency linear transducer, sensitivities and specificities of more than 90 % can be achieved for the detection of fractures. Dislocations are also reliably detected. In contrast to X-ray examination, sonography allows the diagnosis of cartilage and soft-tissue injuries. Sonography reveals callus formation earlier than radiographs. The examination causes less pain than X-ray examination. If sonographic clarification is limited purely to fracture detection or exclusion, less time is required compared to X-ray diagnosis. The procedure can be learned quickly. If the documentation follows a defined standard examination procedure, the results can also be reproduced by non-examiners. CONCLUSION So far, sonography has only been an additive procedure in fracture diagnosis. However, there are now initial recommendations for sonographic fracture diagnosis alone, such as in skull, clavicle and non-displaced distal forearm fractures. KEY POINTS · Sonography can be used to detect or rule out fractures very sensitively.. · Sonographic examination causes less pain than X-ray examination.. · Sonography is usually an additive procedure in fracture diagnosis.. · In the meantime, sonography alone may be sufficient for diagnosing individual fractures.. ZITIERWEISE · Moritz JD. Sonografische Frakturdiagnostik im Kindes- und Jugendalter. Fortschr Röntgenstr 2023; 195: 790 - 796.
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Affiliation(s)
- Jörg Detlev Moritz
- Radiology and Neuroradiology, Pediatric Radiology, UK-SH, Campus Kiel, Germany
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Kraus R, Dresing K. Rational Usage of Fracture Imaging in Children and Adolescents. Diagnostics (Basel) 2023; 13:538. [PMID: 36766642 PMCID: PMC9914862 DOI: 10.3390/diagnostics13030538] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/28/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
In this paper, authors introduce the basic prerequisite for rational, targeted, and above all, child-oriented diagnosis of fractures and dislocations in children and adolescents is in-depth prior knowledge of the special features of trauma in the growth age group. This review summarizes the authors' many years of experience and the state of the current pediatric traumatology literature. It aims to provide recommendations for rational, child-specific diagnostics appropriate to the child, especially for the area of extremity injuries in the growth age. The plain radiograph remains the indispensable standard in diagnosing fractures and dislocations of the musculoskeletal system in childhood and adolescence. Plain radiographs in two planes are the norm, but in certain situations, one plane is sufficient. X-rays of the opposite side in acute diagnostics are obsolete. Images to show consolidation after conservative treatment is rarely necessary. Before metal removal, however, they are indispensable. The upcoming diagnostical tool in pediatric trauma is ultrasound. More and more studies show that in elected injuries and using standardized protocols, fracture ultrasound is as accurate as plain radiographs to detect and control osseous and articular injuries. In acute trauma, CT scans have only a few indications, especially in epiphyseal fractures in adolescents, such as transitional fractures of the distal tibia or coronal shear fractures of the distal humerus. CT protocols must be adapted to children and adolescents to minimize radiation exposure. MRI has no indication in the detection or understanding of acute fractures in infants and children. It has its place in articular injuries of the knee and shoulder to show damage to ligaments, cartilage, and other soft tissues. Furthermore, MRI is useful in cases of remaining pain after trauma without radiological proof of a fracture and in the visualization of premature closure of growth plates after trauma to plan therapy. Several everyday examples of rational diagnostic workflows, as the authors recommend them, are mentioned. The necessity of radiation protection must be taken into consideration.
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Affiliation(s)
- Ralf Kraus
- Department of Trauma and Orthopeadic Surgery, Klinikum Bad Hersfeld, 36251 Bad Hersfeld, Germany
| | - Klaus Dresing
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery of the University Medical Center Göttingen, 37075 Göttingen, Germany
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Abstract
In this article the basic principles of fracture sonography and meaningful areas of application in children and adults are explained. The sonographic fracture signs are presented and the typical areas of application, i.e. clavicular fracture, acromioclavicular (AC) joint dislocation, proximal humerus fracture, elbow fracture, wrist fracture, metacarpal 5 fracture, palmar plate, femoral bulge fracture, proximal tibia fracture, midfoot V fracture, toddler's fracture and march fracture, are outlined and known diagnostic algorithms are listed. When used correctly, fracture sonography is a safe, gentle and rapid diagnostic method.
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Affiliation(s)
- Ole Ackermann
- Orthopädie Ackermann, Raiffeisenstr. 58-60, 47259, Duisburg, Deutschland.
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Baek Md CH, Kim Md JG, Lee Md DH, Baek GR. Does Preservation of Coracoacromial Ligament Reduce the Acromial Stress Pathology Following Reverse Total Shoulder Arthroplasty? J Shoulder Elb Arthroplast 2021; 5:24715492211022171. [PMID: 34497968 PMCID: PMC8282135 DOI: 10.1177/24715492211022171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/14/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Acromial pathologies (AP), such as acromial stress reaction (ASR), acromial stress occult fracture (ASOF), and acromial stress fracture (ASF), are known as complications that deteriorate the clinical score and patient satisfaction after reverse total shoulder arthroplasty (RSA). Several factors that increase stress on the acromion have been reported as risk factors for AP, but this is also unclear. Thecoracoacromial ligament (CAL) is a structure that distributes the stress loading on such an acromion, although its importance has been mentioned, there is a lack of research. Therefore, we investigated the incidence of AP according to the preservation of the CAL and whether it is a risk factor. Methods The study was retrospectively conducted on patients who underwent RSA from 2016 and 2018. Patients with CAL transection was classified into group 1 and CAL preservation was classified into group 2. ASR and ASOF were identified through symptoms and ultrasound, and ASF identified through simple radiograph or computed tomography. The incidence of AP in each group was checked and compared. Results Of the total of 265 patients. Among 197 cases of group 1, 21 cases of ASR(10.7%), 28 cases of ASOF (14.2%),10 cases of ASF (5.1%), and 59 cases of total AP (29.4%). Among 68 cases in group 2, 2 cases (2.9%) of ASR, 6 cases of ASOF(8.8%), 1 case of ASF (1.5%), and 9 cases of total AP (13.2%). It was confirmed that ASR and ASOP were significantly decreased in the group preserving CAL. (P = .008) Conclusion In the case of preservation of CAL during surgery, it was confirmed that the incidence of ASR, ASOF was reduced. Therefore, preservation of CAL can be regarded as a modifiable risk factor that can reduce the risk of AP by distributing the stress applied to acromion after RSA surgery.
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Affiliation(s)
- Chang Hee Baek Md
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Jeollanam-do, Republic of Korea
| | - Jung Gon Kim Md
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Jeollanam-do, Republic of Korea
| | - Dong Hyeon Lee Md
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Jeollanam-do, Republic of Korea
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Long C, Xiang Z, Zhong G, Cen S, Kuang S, He C, Jiang T, Huang F. [Effectiveness of open reduction and locking compression hook plate in treatment of isolated humeral greater tuberosity fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:436-439. [PMID: 30983190 DOI: 10.7507/1002-1892.201810119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To observe the effectiveness of locking compression hook plate in treatment of humeral greater tuberosity fractures. Methods Between March 2014 and September 2017, 16 patients with isolated humeral greater tuberosity fractures were terated with open reduction and internal fixation with locking compression hook plates. There were 11 males and 5 females, with an average age of 38.4 years (range, 22-67 years). The cause of injury was falling injury in 13 cases and sport injury in 3 cases. All patients were closed fractures. Of all patients, 14 patients accompanied with shoulder joint dislocations. CT scan showed the average displacement of fragment was 12.6 mm (range, 8-21 mm) after reduction. All patients began passive functional exercise at 3 days after operation. Results Primary healing of the incisons achieved in all patients, without complications such as infection and nerve injury. All patients were followed up 12-20 months (mean, 15.3 months). At 3 months after operation, X-ray film showed that all fractures achieved bone union, all of which met the imaging anatomical reduction standard. According to the Neer scoring criteria, 11 cases were excellent and 5 cases were good at last follow-up. One patint presented slight pain of shoulder joint and mild activity limitation, which relieved after 1 year. Conclusion The method of open reduction and locking compression hook plate internal fixation for isolated humeral greater tuberosity fractures has advantages, such as less intraoperative hemorrhage, mild postoperative pain, firm fixation, and allowing patients to perform functional exercise earlier, which is conducive to shoulder functional recovery and obtain satisfactory effectiveness.
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Affiliation(s)
- Cheng Long
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Zhou Xiang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
| | - Gang Zhong
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Shiqiang Cen
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Song Kuang
- Department of Orthopedics, the Second People's Hospital of Longquanyi District, Chengdu Sichuan, 610108, P.R.China
| | - Changchun He
- Department of Orthopedics, Sichuan HuaYingShan Guang Neng Ltd. General Hospital, Guangan Sichuan, 638600, P.R.China
| | - Tao Jiang
- Department of Orthopedics, Modern Hospital of Sichuan, Chengdu Sichuan, 610000, P.R.China
| | - Fuguo Huang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
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Isolated greater tuberosity fractures of the proximal humerus: anatomy, injury patterns, multimodality imaging, and approach to management. Emerg Radiol 2018; 25:235-246. [PMID: 29453500 DOI: 10.1007/s10140-018-1589-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 02/05/2018] [Indexed: 02/06/2023]
Abstract
The greater tuberosity is an important anatomic structure and its integrity is important for shoulder abduction and external rotation. Isolated fractures of the greater tuberosity are often subtle and may not be detected on initial radiographs. Clinically, these patients display symptoms which mimic a full thickness rotator cuff tear. It is important to differentiate these two entities, as their treatment is different (typically nonsurgical management for minimally displaced fractures versus rotator cuff repair for acute full thickness rotator cuff tears). When greater tuberosity fractures are significantly displaced and allowed to heal without anatomic reduction, they can lead to impingement. This article will review greater tuberosity anatomy and function, as well as the clinical presentation and multimodality imaging findings of greater tuberosity fractures. Imaging optimization, pitfalls, and clinical management of these fractures will also be discussed.
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Hedelin H, Tingström C, Hebelka H, Karlsson J. Minimal training sufficient to diagnose pediatric wrist fractures with ultrasound. Crit Ultrasound J 2017; 9:11. [PMID: 28484942 PMCID: PMC5422216 DOI: 10.1186/s13089-017-0066-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 04/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In children, non-fractured wrists generally need no treatment and those that are fractured may only require a 3-week cast without any clinical follow-up. The ability to perform a point-of-care triage decision if radiographs are needed could improve patient flow and decrease unnecessary radiographs. The aim of this study was to evaluate the role of ultrasound (US) as a point-of-care triage tool for pediatric wrist injuries with limited training. METHODS Physicians with no previous US experience attended a 1.5 h course in the use of US to diagnose distal radius fractures at the Emergency Department (ED). The physicians firstly used US to diagnose a potential fracture and, if the patient had a fracture, grouped the patient according to how they wanted him/her to be treated based on US. The physician then interpreted the subsequent radiographs and decided on a treatment based on this information. Consultant traumatologists and a senior radiologist established a gold standard for correct treatment and radiological diagnosis, respectively. RESULTS One hundred and sixteen injuries in 115 patients were included. The ED physician identified 75 fractures on radiographs. With the exception of a minimal buckle fracture, all were identified on US. US had a tendency to interpret complete fractures on radiographs as incomplete (n = 7) leading to incorrect treatment decisions. CONCLUSIONS In the hands of an US novice, US examination is comparable with radiographs as a point-of-care tool to distinguish a fractured wrist from a non-fractured one. US is not, however, as good as radiographs for placing fractured wrists into the correct treatment group. LEVEL OF EVIDENCE Level III. Diagnostic study of non-consecutive patients.
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Affiliation(s)
- Henrik Hedelin
- Department of Orthopedics, Sahlgrenska University Hospital, Instititute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Barnortopeden Östra sjukhuset, Sahlgrenska Universitetssjukhuset, Smörslottsgatan 1, 416 78, Gothenburg, Sweden.
| | - Christian Tingström
- Department of Orthopedics, Sahlgrenska University Hospital, Instititute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hanna Hebelka
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jon Karlsson
- Department of Orthopedics, Sahlgrenska University Hospital, Instititute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Maeda M, Maeda N, Takaoka T, Tanaka Y. Sonographic Findings of Chondral Avulsion Fractures of the Lateral Ankle Ligaments in Children. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:421-432. [PMID: 28072472 DOI: 10.7863/ultra.15.09008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 04/29/2016] [Indexed: 06/06/2023]
Abstract
In this series, we aimed to describe the sonographic findings of chondral avulsion fractures that develop concomitant with lateral ankle ligament injury in children. We performed stress sonography during a manual anterior drawer stress procedure of the ankle in 9 skeletally immature patients who had recently had a lateral ankle sprain. Echo videos were obtained through the course of treatment, and all videos were reviewed. We elucidated the common features of chondral avulsion fractures of the lateral ankle ligaments in the children. The features of avulsion fractures on conventional sonography included absence of a fracture with hyperechoic spots (sonographic occult fracture type), cortical discontinuity with hyperechoic spots (cortical disruption fracture type), fracture line in the cortical bone (double-line fracture type), and a step-off deformity of the cortical bone with cartilage (displaced fracture type). In contrast, the features of chondral fractures on stress sonography included abnormal motion of the chondral lesions and mobility/fluidity of hyperechoic spots along the chondral fracture site. The presence of hyperechoic spots around the chondral lesion is an important sonographic sign for diagnosing chondral fractures concomitant with ankle lateral ligament injury. Hence, we believe that stress sonography should be considered for the detection of chondral fractures concomitant with radiographically negative ankle lateral ligament injuries in skeletally immature patients with lateral ankle pain and ankle sprains, if hyperechoic spots are present in the cartilage of the distal fibula.
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Affiliation(s)
| | | | | | - Yasuhito Tanaka
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
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Wang CC, Linden KL, Otero HJ. Sonographic Evaluation of Fractures in Children. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2017. [DOI: 10.1177/8756479316688897] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Fractures and suspected fractures are common causes for pediatric visits to the emergency department. Initial evaluation routinely includes imaging in the form of radiographs. Additional imaging modalities including sonography and magnetic resonance are used as problem-solving tools. Sonography has been reported to perform well when compared with radiography in multiple anatomies from the skull and nasal bones to the upper and lower extremities. In addition, sonography presents unique advantages including lack of ionizing radiation, cross-sectional coverage, evaluation of soft tissue injury, and the possibility of imaging the contralateral side. This article reviews the applications, advantages, disadvantages, technique, and performance of sonography in the imaging of fractures in children.
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Affiliation(s)
- Crystal C. Wang
- Children’s National Health System, Department of Diagnostic Imaging and Radiology, Washington, DC, USA
| | - Kadine L. Linden
- Children’s National Health System, Department of Diagnostic Imaging and Radiology, Washington, DC, USA
| | - Hansel J. Otero
- Children’s National Health System, Department of Diagnostic Imaging and Radiology, Washington, DC, USA
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Cummings DL, Leggit JC, Quinlan JD. Point-of-Care Ultrasound in the Management of Acute Shoulder Injury. Curr Sports Med Rep 2016; 15:423-425. [PMID: 27841814 DOI: 10.1249/jsr.0000000000000316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Danielle L Cummings
- 1School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, 2Department of Family Medicine, Uniformed Services, University of the Health Sciences, Bethesda, MD
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Rath E, Alkrinawi N, Levy O, Debbi R, Amar E, Atoun E. Minimally displaced fractures of the greater tuberosity: outcome of non-operative treatment. J Shoulder Elbow Surg 2013; 22:e8-e11. [PMID: 23639834 DOI: 10.1016/j.jse.2013.01.033] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Revised: 01/11/2013] [Accepted: 01/30/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Minimally displaced (<3 mm) and non-displaced fractures of the proximal humerus are a common source of disability; nevertheless, there is no agreement on the recommended rehabilitation program in these patients. The purpose of this study was to evaluate the outcome of this group of patients and describe the rehabilitation protocol we have used for the treatment of this injury. METHODS We retrospectively analyzed the records of patients diagnosed with minimally displaced (<3 mm) fractures of the greater tuberosity who were admitted to our institute between June 2007 and May 2008. Patients were treated with a three-phase protocol. In the first phase, patients were immobilized in a sling for 3 weeks. In the second phase, pendular and active assisted exercises were begun 3 to 6 weeks after the injury. In the third phase, active exercises were commenced starting 6 weeks after injury. RESULTS Sixty-nine patients matched our inclusion and exclusion criteria. At an average follow-up of 31 months (range, 26-41 months), the average Constant score improved from 40 points (range, 33-58 points) to 95 points (range, 75-100 points). Average satisfaction score improved from 4.2 of 10 (range, 2-6) to 9.5 of 10 (range, 7-10). The reported average duration of pain and decreased range of motion from the time of injury was 8.1 months (range, 1-24 months). CONCLUSIONS When the diagnosis of a minimally displaced fracture of the proximal humerus is made, the patient can be reassured that a favorable outcome is anticipated with a staged rehabilitation protocol. Nevertheless, clinicians and patients should be aware that full recovery from the injury may take an average of 8 months.
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Affiliation(s)
- Ehud Rath
- Orthopaedic Division, Tel Aviv Souraski Medical Center, Tel Aviv, Israel.
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Sinha TP, Bhoi S, Kumar S, Ramchandani R, Goswami A, Kurrey L, Galwankar S. Diagnostic accuracy of bedside emergency ultrasound screening for fractures in pediatric trauma patients. J Emerg Trauma Shock 2011; 4:443-5. [PMID: 22090734 PMCID: PMC3214497 DOI: 10.4103/0974-2700.86625] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 05/27/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Bedside ultrasound (BUS) can effectively identify fractures in the emergency department (ED). AIM To assess the diagnostic accuracy of BUS for fractures in pediatric trauma patients. SETTING AND DESIGN Prospective observational study conducted in the ED. MATERIAL AND METHODS Pediatric patients with upper and lower limb injuries requiring radiological examination were included. BUS examinations were done by emergency physicians who had undergone a brief training. X-rays were reviewed for the presence of fracture and the results of BUS and radiography were compared. STATISTICAL ANALYSIS STATA version 11 was used for statistical analysis of the data. RESULTS Forty-one patients were enrolled in the study. The sensitivity of the BUS in detecting fracture was 89% [95% confidence interval (CI): 51% to 99%] and the specificity was 100% (95% CI: 87% to 100%). The positive predictive value of BUS was 100% and negative predictive value was 97%. CONCLUSION BUS can be utilized by emergency physicians after brief training to accurately identify long bone fractures in the pediatric age-group.
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Affiliation(s)
- Tej P Sinha
- Departments of Surgery, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Bhoi
- Department of Emergency Medicine, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Sudeep Kumar
- Department of Orthopedics, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Radhakrishna Ramchandani
- Departments of Surgery, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Ankur Goswami
- Department of Orthopedics, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Lalit Kurrey
- Department of Orthopedics, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Sagar Galwankar
- Department of Emergency Medicine, University of South Florida, Tampa, USA
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McCrady BM, Schaefer MP. Sonographic visualization of a scapular body fracture: a case report. JOURNAL OF CLINICAL ULTRASOUND : JCU 2011; 39:466-468. [PMID: 21626514 DOI: 10.1002/jcu.20839] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 03/31/2011] [Indexed: 05/30/2023]
Abstract
We report the case of a scapular body fracture that was visualized with ultrasound and confirmed with three-dimensional CT. Ultrasound examination showed a comminuted fracture along the lateral border of the left scapula. We suggest scanning of the scapula, particularly the lateral scapula border, in patients with a history of shoulder trauma who continue to have symptoms in the shoulder girdle.
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Affiliation(s)
- Bradley M McCrady
- Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland, OH 44109, USA.
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Sinha TP, Kumar S, Bhoi S, Goswami A, Bhasin A, Ramchandani R, Rodha MS, Gulati V. Accuracy of point-of-care ultrasound for identifying fractures in patients with orthopaedic trauma presenting to emergency department of the All India Institute of Medical Sciences, level 1 trauma centre. Crit Ultrasound J 2011. [DOI: 10.1007/s13089-011-0067-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Background
Radiography is the standard observation tool for examining orthopaedic injuries. Point-of-care ultrasonography may thus be a faster, non-invasive alternative to effectively identify bone fractures in the emergency department (ED) setting. The study compares the diagnostic utilities of BUS and radiography for identifying long bone fractures.
Methods
Prospective observation study with convenience sampling was conducted in ED in patients above 5 years, with post-traumatic upper and lower limb injuries requiring standard radiological examination after informed consent. The BUS examinations were done by emergency physician (EP) who had a brief training session to detect fractures. For every subject, radiographs were taken and reviewed for the presence of fracture by blinded orthopaedic specialist. Statistical analysis was done by SPSS.
Results
One hundred and thirty-three patients were enrolled in the study. Only 42 had fracture, out of which 36 were picked up by BUS. The overall sensitivity of the BUS in detecting fracture was 85.7% with a confidence interval (CI) of 0.70–0.94 and specificity of 100% with a CI (0.95–1.00).The positive predictive value (PPV) of USG was 100% with a CI (0.86–1.00) and negative predictive value (NPV) of 93.8% with a CI (0.86–0.97). There were six additional fractures which were recognised on X-ray and were not picked up by ultrasound.
Conclusion
Point-of-care ultrasonography can be utilised by emergency physicians after brief training to accurately identify long bone fractures. It may gain a more prominent role in pregnant and paediatric population as well as in mass casualty scenarios.
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Rutten MJCM, Collins JMP, de Waal Malefijt MC, Kiemeney LALM, Jager GJ. Unsuspected sonographic findings in patients with posttraumatic shoulder complaints. JOURNAL OF CLINICAL ULTRASOUND : JCU 2010; 38:457-465. [PMID: 20848574 DOI: 10.1002/jcu.20745] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PURPOSE To prospectively assess the frequency of abnormal sonographic findings in patients with posttraumatic shoulder pain and/or disability in whom ultrasound (US) was not considered and to assess the effect of sonographic findings on working diagnosis and therapeutic strategy, to analyze the possible role of US in the diagnostic workup of these patients. METHODS A survey was performed under general practitioners and orthopedic surgeons. They were requested to refer patients with persistent posttraumatic complaints for an US examination of the shoulder and to fill out a questionnaire concerning working diagnosis and therapy. In 50 patients examinations were performed separately by two radiologists. Findings were confirmed with additional radiographs and/or MRI and/or surgery. Four weeks after the US examination, the survey was repeated to inquire about changes in diagnosis and/or treatment that resulted from US. RESULTS US showed relevant pathology in 45 (90%) of 50 patients, a proximal humerus fracture in 25 (50%) patients, and a rotator cuff tear in 43 (86%) patients. Twenty-three (92%) fractures were accompanied by a rotator cuff tear, and 23 (54%) rotator cuff tears were accompanied by a fracture. Ten fractures were initially missed radiographically. US findings changed the working diagnosis and therapeutic strategy in 37 (74%) and 26 (52%) patients, respectively. CONCLUSION In patients with posttraumatic shoulder complaints, US showed a high rate (90%) of relevant pathology. This changed the initial working diagnosis in 74% of the patients and the therapeutic strategy in more than half of the patients. Active referral for US examination may identify these abnormalities in an earlier phase and improve clinical outcome.
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Abstract
The goals of this article are: 1) to review the different radiographic projections commonly used at the time of initial imaging evaluation of patients presenting with traumatic injuries of the shoulder; 2) to review the indications and findings of cross-sectional imaging modalities in the assessment of shoulder trauma; 3) to recognize the main anatomical lesions secondary to traumatic injuries of the shoulder.
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Affiliation(s)
- M L Despeyroux
- Service central d'imagerie médicale, Hôpital Purpan, 31059 Toulouse, France
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