Ultrasound Can Be Used to Diagnose Hand Fractures in Children

Cornelius W. Van Niel, MD

The accuracy of ultrasound is similar to that of radiography, even when performed by emergency physicians.

Ultrasound (US) can detect small cortical bone interruptions and has shown promise for detection of fractures. However, US might be limited for evaluation of short bones and the ends of bones because of irregular bony contours and the presence of growth plates. Nevertheless, researchers in Italy compared the accuracy of US to that of plain radiography (the gold standard) in 204 children (age range, 2–17 years) presenting to an emergency department with possible hand fractures.

Phalangeal or metacarpal fractures were detected by radiography in 79 patients (39%). Radiologists blinded to radiography results evaluated all patients' symptomatic hands with US (using a water bath technique to maximize visualization). Compared with radiography, US detected fractures with 91% sensitivity and 98% specificity. Pediatric emergency physicians blinded to the results received about 2 hours of hand US training and evaluated 153 of the children. Emergency physicians detected fractures by US with 92% sensitivity and 97% specificity, and were in excellent agreement with radiologists' findings (κ=0.9).

Citation(s):

Neri E et al. Diagnostic accuracy of ultrasonography for hand bony fractures in paediatric patients. Arch Dis Child 2014 Jun 20; ; [e-pub ahead of print].