gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

Sonographic diagnosis of closed pediatric finger injuries

Meeting Abstract

Suche in Medline nach

  • presenting/speaker Marcell Varga - Péterfy Hospital, National Trauma Center, Budapest, Hungary
  • Luca Tóth - Péterfy Hospital, National Trauma Center, Budapest, Hungary
  • Sándor Pintér - University of Szeged, Department of Traumatology, Szeged, Hungary

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-449

doi: 10.3205/19ifssh0608, urn:nbn:de:0183-19ifssh06089

Veröffentlicht: 6. Februar 2020

© 2020 Varga et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives/Interrogation: Closed injuries of the fingers are very common in childhood.

In the majority of cases, targeted two-planes X-rays can exclude or confirm the diagnosis of of possible fractures. High frequency ultrasound can have a diagnostic value similar to X-ray. In our presentation we report the results of 200 point of care sonographic examinations.

Methods: We included children under the age of 14 with closed, 1-3 days old finger injuries. We excluded children with open physeal plates, open injuries or non-traumatic hand complains.

Sonographic examinations were carried out immediately after physical survey by two orthopaedic surgeons skilled in pediatric trauma and musculoskeletal ultrasound.

Fingers were evaluated from four different standard longitudinal planes.

A comparative picture from the unaffected side was also made.

Ultrasound pictures were saved and analyzed.

The examinations were carried out with a 20MHz frequency linear transducer.

Standard two-planes x-rays were made immediately after physical and sonographic evaluations.

Results of X-rays and sonography were compared.

Results and Conclusions: Between 2017 and 2018 we evaluated 200 children.

We found 61 (30.5%)finger fractures out of 200 injuries by x-rays.

Distribution of fractures diagnosed by X-rays was the following: 20 (10%) basal phalangeal avulsions, 6 (3%) distal phalangeal avulsions, 7 (3.5%) epiphyseolysis, 5 (2.5%) diaphyseal fractures, 21 (9%) torus fractures,2 (1%) intraarticular displaced fractures.

We did not detect any false negative sonographic result.

We found five false positive sonographic cases.

Regarding bony cortex disruptions we found the following results of ultrasound tests compared to X-ray examinations: sensitivity 1, specificity 0.96, positive predictive value 0.92, negative predictive value 1.

Evaluation by examiners showed a minimal difference. Interobserver agreement was 95.08 %, Chohen's kappa value: 0.88.

In the case of negative sonographic findings X-rays may be omitted. In cases when the exact configuration of the fractures can be established by ultrasound the need for any X-rays should be considered. X-rays are indispensable with positive but uncertain sonographic findings. The use of the ultrasound can provide additional information of a particular injury.

Point of care high frequency sonography can be a valuable addition in the diagnostics of pediatric finger injuries.

The routine use and the accurately defined professional and legal background of the method are still the tasks of the future.