Iberoamerican Journal of Medicine
https://iberoamjmed.com/article/doi/10.53986/ibjm.2024.0014
Iberoamerican Journal of Medicine
Review

Usefulness of Ultrasonography and Radiography in the Evaluation of Distal Forearm Fractures in Children: A Narrative Review

Utilidad de la ecografía y la radiografía en la evaluación de las fracturas distales del antebrazo en niños: una revisión narrativa

Diego Alberto Pérez Pinzón, Carla Yaneth Pinzón Bernal, Charles Johan Saldarriaga Espinosa, Valentina Montoya Pérez, María Camila Taborda Mejía, Luis David Chavarria Granda, Laura Cristina López Figueroa, Miguel Andrés Vargas Riascos, Leonardo Bravo Villareal

Downloads: 2
Views: 110

Abstract

Pediatric fractures, especially distal forearm fractures, represent a significant global medical concern, affecting up to 50% of pediatric fracture cases. This narrative review aims to compare diagnostic modalities to determine which offers higher accuracy, minimizes radiation exposure, and is adaptable to diverse clinical settings. In the choice between ultrasound and X-ray for diagnosing distal forearm fractures in children, each modality has its merits. X-ray provides accuracy and value in well-equipped facilities, while ultrasound, being radiation-free, is effective in resource-limited areas and is essential for pediatric patients to avoid radiation exposure. Professional training and continual updates are crucial. Moreover, it underscores that alongside diagnostic imaging, comprehensive clinical assessment remains pivotal for making informed medical decisions. The choice of method should consider individual case factors and prioritize patient safety.

Keywords

Ultrasonography; Pediatrics; Radiography; Diagnostic screening

Resumen

Las fracturas pediátricas, especialmente las fracturas distales del antebrazo, representan una importante preocupación médica mundial y afectan hasta el 50% de los casos de fracturas pediátricas. Esta revisión narrativa tiene como objetivo comparar modalidades de diagnóstico para determinar cuál ofrece mayor precisión, minimiza la exposición a la radiación y es adaptable a diversos entornos clínicos. A la hora de elegir entre ecografía y rayos X para diagnosticar fracturas distales del antebrazo en niños, cada modalidad tiene sus ventajas. Los rayos X proporcionan precisión y valor en instalaciones bien equipadas, mientras que el ultrasonido, al no tener radiación, es eficaz en áreas con recursos limitados y es esencial para que los pacientes pediátricos eviten la exposición a la radiación. La formación profesional y la actualización continua son cruciales. Además, subraya que, junto con el diagnóstico por imágenes, la evaluación clínica integral sigue siendo fundamental para tomar decisiones médicas informadas. La elección del método debe considerar factores de cada caso individual y priorizar la seguridad del paciente.

Palabras clave

Ultrasonidos; Pediatría; Radiografía; Diagnóstico por imagen

References

1.Martínez-Cano JP, Zamudio-Castilla L, Mantilla JC, Caicedo DC, Vernaza Obando D, Martínez Rondanelli A. Fractures in children: experience in a high-complexity center in southwestern Colombia. Revista de la Universidad Industrial de Santander Salud. 2019; 51(4):309-15. doi: 10.18273/revsal.v51n4-2019004.
2.Ackermann O, Liedgens P, Eckert K, Chelangattucherry E, Ruelander C, Emmanouilidis I, et al. Ultrasound diagnosis of juvenile forearm fractures. J Med Ultrason (2001). 2010;37(3):123-7. doi: 10.1007/s10396-010-0263-x.
3.Rodríguez-Merchán EC. Pediatric fractures of the forearm. Clin Orthop Relat Res. 2005;(432):65-72.
4.Noonan KJ, Price CT. Forearm and distal radius fractures in children. J Am Acad Orthop Surg. 1998;6(3):146-56. doi: 10.5435/00124635-199805000-00002.
5.Jones CM, Morway GR, Gutowski CJ, Darvish K. Radiographic Comparison of Forearm Symmetry in Healthy Individuals and its Importance in the Diagnosis of Longitudinal Radioulnar Dissociation. J Hand Surg Am. 2023:S0363-5023(23)00553-1. doi: 10.1016/j.jhsa.2023.10.008.
6.Korup LR, Larsen P, Nanthan KR, Arildsen M, Warming N, Sørensen S, et al. Children's distal forearm fractures: a population-based epidemiology study of 4,316 fractures. Bone Jt Open. 2022;3(6):448-54. doi: 10.1302/2633-1462.36.BJO-2022-0040.R1.
7.Kramhøft M, Bødtker S. Epidemiology of distal forearm fractures in Danish children. Acta Orthop Scand. 1988;59(5):557-9. doi: 10.3109/17453678809148784.
8.Khosla S, Melton LJ 3rd, Dekutoski MB, Achenbach SJ, Oberg AL, Riggs BL. Incidence of childhood distal forearm fractures over 30 years: a population-based study. JAMA. 2003;290(11):1479-85. doi: 10.1001/jama.290.11.1479.
9.Jónsson B, Bengnér U, Redlund-Johnell I, Johnell O. Forearm fractures in Malmö, Sweden. Changes in the incidence occurring during the 1950s, 1980s and 1990s. Acta Orthop Scand. 1999;70(2):129-32. doi: 10.3109/17453679909011249.
10.Ryan LM, Teach SJ, Searcy K, Singer SA, Wood R, Wright JL, et al. Epidemiology of pediatric forearm fractures in Washington, DC. J Trauma. 2010;69(4 Suppl):S200-5. doi: 10.1097/TA.0b013e3181f1e837.
11.Park MS, Chung CY, Choi IH, Kim TW, Sung KH, Lee SY, et al. Incidence patterns of pediatric and adolescent orthopaedic fractures according to age groups and seasons in South Korea: a population-based study. Clin Orthop Surg. 2013;5(3):161-6. doi: 10.4055/cios.2013.5.3.161.
12.Mamoowala N, Johnson NA, Dias JJ. Trends in paediatric distal radius fractures: an eight-year review from a large UK trauma unit. Ann R Coll Surg Engl. 2019;101(4):297-303. doi: 10.1308/rcsann.2019.0023.
13.Goulding A, Jones IE, Taylor RW, Williams SM, Manning PJ. Bone mineral density and body composition in boys with distal forearm fractures: a dual-energy x-ray absorptiometry study. J Pediatr. 2001;139(4):509-15. doi: 10.1067/mpd.2001.116297.
14.Krabbe S, Christiansen C, Rødbro P, Transbøl I. Effect of puberty on rates of bone growth and mineralisation: with observations in male delayed puberty. Arch Dis Child. 1979;54(12):950-3. doi: 10.1136/adc.54.12.950.
15.Epema AC, Spanjer MJB, Ras L, Kelder JC, Sanders M. Point-of-care ultrasound compared with conventional radiographic evaluation in children with suspected distal forearm fractures in the Netherlands: a diagnostic accuracy study. Emerg Med J. 2019;36(10):613-6. doi: 10.1136/emermed-2018-208380.
16.Joshi N, Lira A, Mehta N, Paladino L, Sinert R. Diagnostic accuracy of history, physical examination, and bedside ultrasound for diagnosis of extremity fractures in the emergency department: a systematic review. Acad Emerg Med. 2013;20(1):1-15. doi: 10.1111/acem.12058.
17.Chaar-Alvarez FM, Warkentine F, Cross K, Herr S, Paul RI. Bedside ultrasound diagnosis of nonangulated distal forearm fractures in the pediatric emergency department. Pediatr Emerg Care. 2011;27(11):1027-32. doi: 10.1097/PEC.0b013e318235e228.
18.Patel DD, Blumberg SM, Crain EF. The utility of bedside ultrasonography in identifying fractures and guiding fracture reduction in children. Pediatr Emerg Care. 2009;25(4):221-5. doi: 10.1097/pec.0b013e31819e34f7.
19.Sinha TP, Bhoi S, Kumar S, Ramchandani R, Goswami A, Kurrey L, et al. Diagnostic accuracy of bedside emergency ultrasound screening for fractures in pediatric trauma patients. J Emerg Trauma Shock. 2011;4(4):443-5. doi: 10.4103/0974-2700.86625.
20.Chen L, Kim Y, Moore CL. Diagnosis and guided reduction of forearm fractures in children using bedside ultrasound. Pediatr Emerg Care. 2007;23(8):528-31. doi: 10.1097/PEC.0b013e318128f85d.
21.Kartikeswar GAP, Parikh TB, Pandya D, Pandit A. Ionizing Radiation Exposure in NICU. Indian J Pediatr. 2020;87(2):158-60. doi: 10.1007/s12098-019-03126-9.
22.Scott MV, Fujii AM, Behrman RH, Dillon JE. Diagnostic ionizing radiation exposure in premature patients. J Perinatol. 2014;34(5):392-5. doi: 10.1038/jp.2013.141.
23.Arízaga-Ballesteros V, Garza-Castillo R, Franco-Cabrera M del C, Estrada-Hernández C, Lara-Díaz VJ, Alcorta-García MR. Estimation of intentional exposure to ionizing radiation in patients in a Neonatal Intensive Care Unit. Rev Mex Pdiatr. 2021;88(3):96-100. doi: 10.35366/102189.
24.Fletcher EW, Baum JD, Draper G. The risk of diagnostic radiation of the newborn. Br J Radiol. 1986;59(698):165-70. doi: 10.1259/0007-1285-59-698-165.
25.Don S. Radiosensitivity of children: potential for overexposure in CR and DR and magnitude of doses in ordinary radiographic examinations. Pediatr Radiol. 2004 Oct;34 Suppl 3:S167-72; discussion S234-41. doi: 10.1007/s00247-004-1266-9.
26.Shu XO, Potter JD, Linet MS, Severson RK, et al JP, Trigg ME, Robison LL. Diagnostic X-rays and ultrasound exposure and risk of childhood acute lymphoblastic leukemia by immunophenotype. Cancer Epidemiol Biomarkers Prev. 2002;11(2):177-85.
27.Infante-Rivard C, Mathonnet G, Sinnett D. Risk of childhood leukemia associated with diagnostic irradiation and polymorphisms in DNA repair genes. Environ Health Perspect. 2000;108(6):495-8. doi: 10.1289/ehp.00108495.
28.Snelling PJ, Jones P, Bade D, Bindra R, Byrnes J, Davison M, et al. Ultrasonography or Radiography for Suspected Pediatric Distal Forearm Fractures. N Engl J Med. 2023;388(22):2049-57. doi: 10.1056/NEJMoa2213883.
29.Tarique U, Tang B, Singh M, Kulasegaram KM, Ailon J. Ultrasound Curricula in Undergraduate Medical Education: A Scoping Review. J Ultrasound Med. 2018;37(1):69-82. doi: 10.1002/jum.14333
30.Feilchenfeld Z, Dornan T, Whitehead C, Kuper A. Ultrasound in undergraduate medical education: a systematic and critical review. Med Educ. 2017;51(4):366-78. doi: 10.1111/medu.13211.


Submitted date:
02/16/2024

Reviewed date:
03/12/2024

Accepted date:
04/03/2024

Publication date:
04/07/2024

6612a4f7a953951d72722d24 iberoamericanjm Articles
Links & Downloads

Iberoam J Med

Share this page
Page Sections