Ultrasound Secondary Signs for the Diagnosis of Pediatric Distal Forearm Fractures: A Diagnostic Study

Loading...
Thumbnail Image
File version

Version of Record (VoR)

Author(s)
Snelling, PJ
Jones, P
Bade, D
Gillespie, A
Keijzers, G
Ware, RS
Griffith University Author(s)
Primary Supervisor
Other Supervisors
Editor(s)
Date
2024
Size
File type(s)
Location
Abstract

Objective: To evaluate the diagnostic accuracy of ultrasound secondary signs of fractures in pediatric patients aged 5–15 y presenting to the emergency department with a clinically non-deformed distal forearm injury. Methods: This diagnostic study was conducted in South East Queensland, Australia. Emergency clinicians performed point-of-care ultrasound on eligible patients and recorded secondary signs of fractures (pronator quadratus hematoma [PQH] sign, periosteal hematoma, visible angulation) or physeal fractures (fracture-to-physis distance [FPD], physis alteration). The reference standard was the final fracture diagnosis determined by expert panel. The primary outcome was the diagnostic accuracy of secondary signs for cortical breach and physeal fractures. Diagnostic statistics were reported for each relevant secondary sign. Results: A total of 135 participants were enrolled. The expert panel diagnosed 48 “no” fracture, 52 “buckle” fracture and 35 “other” fracture. All “other” fractures were cortical breach fractures and included 15 Salter–Harris II fractures. The PQH sign demonstrated high sensitivity and moderate specificity to diagnose cortical breach fractures (91%, 95% Confidence Interval [CI] 78%–97% and 82%, 73%–88%). Poor sensitivity but high specificity was observed for the visible angulation and periosteal hematoma secondary signs. FPD <1cm showed perfect sensitivity and moderate specificity (100%, 80%–100% and 85%, 78%–90%) for diagnosis of Salter–Harris II fracture. Conversely, physis alteration showed poor sensitivity but excellent specificity (40%, 20%–64% and 99%, 95%–100%) for the diagnosis of Salter–Harris II fractures. Conclusion: Ultrasound secondary signs showed good diagnostic accuracy for both cortical breach fractures and Salter–Harris II fractures. Future research should consider optimal use of secondary signs to improve diagnostic accuracy.

Journal Title

Ultrasound in Medicine and Biology

Conference Title
Book Title
Edition
Volume
Issue
Thesis Type
Degree Program
School
Publisher link
Patent number
Funder(s)
Grant identifier(s)
Rights Statement
Rights Statement

© 2024 The Author(s). Published by Elsevier Inc. on behalf of World Federation for Ultrasound in Medicine & Biology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Item Access Status
Note

This publication has been entered in Griffith Research Online as an advance online version.

Access the data
Related item(s)
Subject

Clinical sciences

Persistent link to this record
Citation

Snelling, PJ; Jones, P; Bade, D; Gillespie, A; Keijzers, G; Ware, RS, Ultrasound Secondary Signs for the Diagnosis of Pediatric Distal Forearm Fractures: A Diagnostic Study, Ultrasound in Medicine and Biology, 2024

Collections