Download PDF
CC BY-NC-ND 4.0 · Ultraschall Med
DOI: 10.1055/a-2445-3611
Original Article

Ultrasonography can be more informative than computed tomography for diagnosing radial head fractures: An illustrative case series

Eine Ultraschalluntersuchung kann bei der Diagnose von Radiusköpfchen-Frakturen aussagekräftiger sein als eine Computertomografie: eine illustrative Fallserie
Eckehart Schöll 
1   ORTHO-NOTFALL, Merian Iselin Klinik fur Orthopadie und Chirurgie, Basel, Switzerland (Ringgold ID: RIN470718)
2   Forschung, Merian Iselin Forschung AG, Basel, Switzerland
,
Marcel Jakob
3   Research Department, Basel Academy for Quality and Research in Medicine, Basel, Switzerland (Ringgold ID: RIN598775)
,
Werner Vach 
3   Research Department, Basel Academy for Quality and Research in Medicine, Basel, Switzerland (Ringgold ID: RIN598775)
› Author Affiliations
Supported by: Merian Iselin Forschung AG
› Further Information
Also available at
  Permissions and Reprints

Abstract

Purpose

Ultrasonography is increasingly being discussed as an alternative to X-rays in emergency department settings. Systematic comparisons of the 2 modalities are often based on the use of computed tomography as a reference. When diagnosing patients with elbow trauma, the physicians at our emergency department experienced that ultrasonography can be more informative than cone beam computed tomography for identifying radial head fractures. Our goal is to share this experience with the scientific community.

Materials and Methods

All patients diagnosed with a radial head fracture in our emergency department between January 2021 and November 2022 were identified. The images of 18 cases in which both point-of-care ultrasonography and cone beam computed tomography had been used were reviewed by us. Eight examples were selected illustrating the variation in coincidence or discrepancy between ultrasonography and computed tomography.

Results

The 8 examples illustrate that ultrasonography can be more informative than cone beam computed tomography or vice versa.

Conclusion

The joint application of ultrasonography and computed tomography is advisable if a correct diagnosis of the extent and components of radial head fractures is of uttermost importance.

Zusammenfassung

Ziel

Die Sonografie wird zunehmend als Alternative zur Röntgenuntersuchung in der Notaufnahme diskutiert. Systematische Vergleiche der beiden Modalitäten basieren häufig auf der Verwendung der Computertomografie als Referenz. Bei der Diagnose von Patienten mit Ellenbogentrauma haben die Ärzte in unserer Notaufnahme die Erfahrung gemacht, dass der Ultraschall bei der Erkennung von Radiusköpfchen-Frakturen informativer sein kann als die Kegelstrahl-Computertomografie. Unser Ziel ist es, diese Erfahrung mit der wissenschaftlichen Gemeinschaft zu teilen.

Material und Methoden

Alle Patienten, bei denen in unserer Notaufnahme zwischen Januar 2021 und November 2022 eine Radiusköpfchen-Fraktur diagnostiziert wurde, wurden ermittelt. Die Bilder von 18 Fällen, bei denen sowohl Ultraschall als auch eine Kegelstrahl-Computertomografie angewandt worden waren, wurden von uns nachuntersucht. Acht Beispiele wurden ausgewählt, um die Variation in Übereinstimmung oder Diskrepanz zwischen Ultraschall und Computertomografie zu veranschaulichen.

Ergebnisse

Die 8 Beispiele zeigen, dass die Ultraschalluntersuchung informativer sein kann als die Kegelstrahl-Computertomografie oder umgekehrt.

Schlussfolgerung

Die gemeinsame Anwendung von Ultraschall und Computertomografie ist ratsam, wenn eine korrekte Diagnose des Ausmaßes und der Komponenten von Radiusköpfchen-Frakturen von größter Bedeutung ist.

Keywords

ultrasound - Computed tomography - Radial head fracture


Publication History

Received: 13 May 2024

Accepted after revision: 14 October 2024

Accepted Manuscript online:
18 October 2024

Article published online:
18 December 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • References

  • 1 Pavić R, Margetić P, Hnatešen D. Diagnosis of occult radial head and neck fracture in adults. Injury 2015; 46: S119-124
    CrossrefPubMedSearch in Google Scholar
  • 2 Avcı M, Kozacı N, Beydilli İ. et al. The comparison of bedside point-of-care ultrasound and computed tomography in elbow injuries. Am J Emerg Med 2016; 34: 2186-2190
    CrossrefPubMedSearch in Google Scholar
  • 3 Malahias MA, Manolopoulos PP, Kadu V. et al. Bedside Ultrasonography for Early Diagnosis of Occult Radial Head Fractures in Emergency Room: A CT-Comparative Diagnostic Study. Arch Bone Jt Surg 2018; 6: 539-546
    PubMedSearch in Google Scholar
  • 4 Barret H, Gastaud O, Laumonerie P. et al. Feasibility and technique of ultrasound traumatic elbow lesion assessment. Orthop Traumatol Surg Res 2021; 107: 102836
    CrossrefPubMedSearch in Google Scholar
  • 5 Kessler T, Winkler H, Weiss C. et al. Sonographie des Ellenbogengelenks bei der Radiusköpfchenfraktur. Orthopäde 2002; 31: 268-270
    CrossrefPubMedSearch in Google Scholar
  • 6 Hübner U, Schlicht W, Outzen S. et al. Ultrasound in the diagnosis of fractures in children. J Bone Joint Surg Br 2000; 82: 1170-1173
    CrossrefPubMedSearch in Google Scholar
  • 7 Lee SH, Yun SJ. Diagnostic Performance of Ultrasonography for Detection of Pediatric Elbow Fracture: A Meta-analysis. Ann Emerg Med 2019; 74: 493-502
    CrossrefPubMedSearch in Google Scholar
  • 8 Tsou PY, Ma YK, Wang YH. et al. Diagnostic accuracy of ultrasound for upper extremity fractures in children: A systematic review and meta-analysis. Am J Emerg Med 2021; 44: 383-394
    CrossrefPubMedSearch in Google Scholar
  • 9 Pourmand A, Shokoohi H, Maracheril R. Diagnostic accuracy of point-of-care ultrasound in detecting upper and lower extremity fractures: An evidence-based approach. Am J Emerg Med 2018; 36: 134-136
    CrossrefPubMedSearch in Google Scholar
  • 10 Champagne N, Eadie L, Regan L. et al. The effectiveness of ultrasound in the detection of fractures in adults with suspected upper or lower limb injury: a systematic review and subgroup meta-analysis. BMC Emerg Med 2019; 19: 17
    CrossrefPubMedSearch in Google Scholar
  • 11 Bianchi S. Ultrasound and bone: a pictorial review. J Ultrasound 2020; 23: 227-257
    CrossrefPubMedSearch in Google Scholar
  • 12 Hanlon DP, Mavrophilipos V. The Emergent Evaluation and Treatment of Elbow and Forearm Injuries. Emerg Med Clin North Am 2020; 38: 81-102
    CrossrefPubMedSearch in Google Scholar
  • 13 Cocco G, Ricci V, Villani M. et al. Ultrasound imaging of bone fractures. Insights into Imaging 2022; 13: 189
    CrossrefPubMedSearch in Google Scholar
  • 14 Ackermann O, Fischer C, Grosser K. et al. AWMF 085–003 S2e Leitlinie, Fraktursonografie Deutsche Gesellschaft für Ultraschall in der Medizin (DEGUM). 2023
    PubMedSearch in Google Scholar
  • 15 Zech JR, Santomartino SM, Yi PH. Artificial Intelligence (AI) for Fracture Diagnosis: An Overview of Current Products and Considerations for Clinical Adoption, From the AJR Special Series on AI Applications. AJR Am J Roentgenol 2022; 219: 869-878
    CrossrefPubMedSearch in Google Scholar
  • 16 Zhang J, Boora N, Melendez S. et al. Diagnostic Accuracy of 3D Ultrasound and Artificial Intelligence for Detection of Pediatric Wrist Injuries. Children (Basel) 2021; 8: 431
    CrossrefPubMedSearch in Google Scholar
  • 17 Knight J, Zhou Y, Keen C. et al. 2D/3D ultrasound diagnosis of pediatric distal radius fractures by human readers vs artificial intelligence. Sci Rep 2023; 13: 14535
    CrossrefPubMedSearch in Google Scholar