Fracture sonography – Literature review and current recommendations

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.

Zusammenfassung

Einleitung In über 2-jähriger Arbeit hat eine Expertengruppe von 9 Fachgesellschaften die S2e-Leitlinie „Fraktursonografie“ erstellt. Die vorliegende Publikation fasst die zentralen Punkte zu den einzelnen Indikationen zusammen.

Methodik Es erfolgte eine systematische Literaturrecherche in PubMed, Google Scholar und der Cochrane Database of Systematic Reviews aus den Jahren 2000 bis zum März 2021 mit Auswertung der Literaturlisten. Es wurden randomisierte, kontrollierte klinische Tests, klinische Beobachtungsstudien, Meta-Analysen und systematische Reviews eingeschlossen. Ausgeschlossen wurden Leitlinien, Konferenzen, Reviews, Fallberichte und Expertenmeinungen. Die Evidenzbewertung erfolgte nach dem SIGN-Grading-System 1999–2012. Die so erhaltenen SIGN-Tabellen wurden dann der Expertengruppe vorgelegt, die hieraus konkrete Empfehlungen für die Anwendung der Fraktursonografie erarbeitete. Sämtliche Empfehlungen wurden ausführlich diskutiert und zuletzt einstimmig konsentiert.

Ergebnisse Von primär 520 gefundenen Literaturquellen konnten nach Sichtung und inhaltlicher Bewertung 182 Quellen (146 klinische Studien sowie 36 Meta-Analysen und systematische Reviews) ausgewertet werden. Es wurden 21 Indikationen identifiziert, die eine sinnvolle Anwendung der Fraktursonografie erlauben.

Schlussfolgerung Fraktursonografie ist eine sinnvolle Diagnostikmethode bei einer Vielzahl an Indikation.

Keywords

Sonography - METHODS & TECHNIQUES - ultrasound - fracture - bone - diagnosis

Publication History

Received: 27 May 2023

Accepted after revision: 08 December 2023

Article published online:
23 February 2024

• References

• 1 Sapozhnikov VG. et al. Ultrasonic examination of children with fractures of the forearm bones. Khirurgiia (Mosk) 1987; 8: 111-113
• 2 Alexandridis G, Verschuuren EW, Rosendaal AV. et al. Evidence base for point-of-care ultrasound (POCUS) for diagnosis of skull fractures in children: a systematic review and meta-analysis. Emerg Med J 2020;
• 3 Gordon I, Sinert R, Chao J. The Utility of Ultrasound in Detecting Skull Fractures After Pediatric Blunt Head Trauma: Systematic Review and Meta-Analysis. Pediatr Emerg Care 2020;
• 4 Sprague J. Comparison Study: Point-Of-Care Ultrasonography vs. Plain Radiography to Diagnose Clavicular Fractures in The Pediatric Population. Accessed May 11, 2023 at: https://commons.pacificu.edu/work/sc/72b7451e-c7c7–4bfc-b7d6-dfa2199c2faf
• 5 Pogorzelski J, Beitzel K, Ranuccio F. et al. The acutely injured acromioclavicular joint – which imaging modalities should be used for accurate diagnosis? A systematic review. BMC Musculoskelet Disord 2017; 18: 515
• 6 Rutten MJCM, Jager GJ, de Waal Malefijt MC. et al. Double line sign: a helpful sonographic sign to detect occult fractures of the proximal humerus. Eur Radiol 2007; 17: 762-767
• 7 Ackermann O, Sesia S, Berberich T. et al. Sonographic diagnostics of proximal humerus fractures in juveniles. Unfallchirurg 2010; 113: 839-842
• 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 2020;
• 9 Lee SH, Yun SJ. Diagnostic Performance of Ultrasonography for Detection of Pediatric Elbow Fracture: A Meta-analysis. Ann Emerg Med 2019; 74: 493-502
• 10 Douma-den Hamer D, Blanker MH, Edens MA. et al. Ultrasound for Distal Forearm Fracture: A Systematic Review and Diagnostic Meta-Analysis. PLoS One 2016; 11: e0155659
• 11 Ackermann O, Wojciechowski P, Dzierzega M. et al. Sokrat II – An International, Prospective, Multicenter, Phase IV Diagnostic Trial to Evaluate the Efficacy of the Wrist SAFE Algorithm in Fracture Sonography of Distal Forearm Fractures in Children. Ultraschall in Med 2019; 40: 349-358
• 12 Kwee RM, Kwee TC. Ultrasound for diagnosing radiographically occult scaphoid fracture. Skeletal Radiol 2018; 47: 1205-1212
• 13 Carpenter CR, Pines JM, Schuur JD. et al. Adult scaphoid fracture. Acad Emerg Med 2014; 21: 101-121
• 14 Krastman P, Mathijssen NM, Bierma-Zeinstra SMA. et al. Diagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review update. BMC Musculoskelet Disord 2020; 21: 12
• 15 Zhao W, Wang G, Chen B. et al. The value of ultrasound for detecting hand fractures: A meta-analysis. Medicine (Baltimore) 2019; 98: e17823
• 16 Krastman P, Mathijssen NM, Bierma-Zeinstra SMA. et al. Diagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review update. BMC Musculoskelet Disord 2020; 21: 12
• 17 Saito S, Sawabe K, Suzuki Y. et al. Ultrasonographic characteristics of volar-lateral ligament constrains after proximal interphalangeal joint injuries. J Plast Surg Hand Surg 2016; 50: 216-221
• 18 Xue L, Zhang Y, Yan D. et al. The presence of effusions between the volar plate of the proximal interphalangeal joint and the flexor digitorum tendon is a common phenomenon: a single-center, cross sectional study. Medical Ultrasonography 2021; 23: 176-180
• 19 Yousefifard M, Baikpour M, Ghelichkhani P. et al. Comparison of Ultrasonography and Radiography in Detection of Thoracic Bone Fractures; a Systematic Review and Meta-Analysis. Emerg (Tehran) 2016; 4: 55-64
• 20 Battle C, Hayward S, Eggert S. et al. Comparison of the use of lung ultrasound and chest radiography in the diagnosis of rib fractures: a systematic review. Emerg Med J 2019; 36: 185-190
• 21 Carsen S, Doyle M, Smit K. et al. Point-of-care ultrasound in the emergency department may provide more accurate diagnosis of toddler fractures than radiographs: a pilot study. Orthopaedic Proceedings 2020; 102-B (Suppl. 07) 95-95
• 22 Ebrahimi M, Habibzadeh SR, Ahmadi SR. et al. Diagnostic Accuracy of Ultrasonography in Diagnosis of Metatarsal Bone Fracture; a Cross Sectional Study. Arch Acad Emerg Med 2019; 7: e49
• 23 Yesilaras M, Aksay E, Atilla OD. et al. The accuracy of bedside ultrasonography as a diagnostic tool for the fifth metatarsal fractures. Am J Emerg Med 2014; 32: 171-174
• 24 Wright AA, Hegedus EJ, Lenchik L. et al. Diagnostic Accuracy of Various Imaging Modalities for Suspected Lower Extremity Stress Fractures: A Systematic Review With Evidence-Based Recommendations for Clinical Practice. Am J Sports Med 2016; 44: 255-263
• 25 Akinmade A, Ikem I, Ayoola O. et al. Comparing ultrasonography with plain radiography in the diagnosis of paediatric long-bone fractures. Int Orthop 2019; 43: 1143-1153
• 26 Wawrzyk M, Sokal J, Andrzejewska E. et al. The Role of Ultrasound Imaging of Callus Formation in the Treatment of Long Bone Fractures in Children. Pol J Radiol 2015; 80: 473-478
• 27 Fischer C, Preuß EM, Amarteifio E. et al. CEUS ermöglicht die Quantifizierung der Pseudarthrosenperfusion und komplementiert die Infektdiagnostik. Ultraschall in Med 2015; 36: A142
• 28 Doll J, WaizeneggerSSchmidmaier G. et al. Contrast-enhanced ultrasound: a viable diagnostic tool in predicting treatment failure after non-union revision surgery for upper-and lower-limb non-unions. Ultrasound in Medicine & Biology 2021; 47: 3147-3158