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Abstract
A short cut review was carried out to establish ultrasonography was as good as radiography at detecting fracture clavicles in children. 580 papers were found using the reported searches, of which 5 presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. It is that ultrasonography is sensitive at detecting clavicular fractures in children.
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Report by: Helen Willis, ST5 Emergency Medicine
Search checked by: Luke Ball, ST4 Emergency Medicine
Institution: Royal Cornwall Hospitals NHS Trust, Cornwall, UK
Clinical scenario
A 12-year-old boy presents to the Emergency Department (ED), with pain and swelling around his left clavicle which occurred during a game of rugby. You explain his clavicle might be broken and an x-ray is required to confirm the diagnosis. His father points out that he has multiple x-rays in the past for other sporting related injuries and asks if the x-rays are necessary? You wonder whether Ultrasound (US) would be an alternative means for diagnosing a fracture of this bone.
Three-part question?
In (children presenting to the ED with suspected clavicle fracture), is (Ultrasound scanning as good as radiography) at (correctly diagnosing fractures)?
Search strategy
Medline from 1950 and Embase from 1980 to April 16th 2012 (NHS Evidence): [{(Ultrasound) ti,ab} OR {(Ultrasonography) ti,ab} OR {exp Ultrasonography} or {(sonography) ti.ab} OR {(osteosonography) ti.ab}] AND [{(clavicle) ti,ab} OR {exp clavicle} OR {(fracture*) ti,ab} OR {exp Fractures, Bone} OR {(“Clavicle Fractur*”) ti,ab}]. Limits: Humans and (Age groups all children 0–18 years) and English Language.
The Cochrane Library April 2012: MeSH descriptor Clavicle explode all trees.
Search outcome
The search produced 580 results of which 40 abstracts were read. From these abstracts four papers were found to be relevant and one further paper was found through searching references. These papers are summarised in the table 2.
Relevant papers
Comments
A further paper by Hubner et al was excluded as the data on clavicle US was combined with skull US in their table of results, although they do describe ‘relatively good results’ for US of the clavicle. The authors of the paper by Weinberg et al were contacted for clarification on the ages of patients included for clavicle USA. Blab et al state that at the Department of Paediatric Surgery in Vienna, ‘osteosonography’ is the method of choice for diagnosing a suspected clavicle fracture. They feel that if Emergency Physicians can be trained in the use of US to assess the clavicle, x-ray could become a second line investigation in cases of uncertainty.
Clinical bottom line
Ultrasonography is sensitive at detecting clavicular fractures in children.
▶ Blab E, Geißler W, Rokitansky A. Sonographic management of infantile clavicular fractures. Pediatr Surg Int 1999;15:251–4.
▶ Moritz JD, Berthold LD, Soenksen SF, et al. Ultrasound in diagnosis of fractures in children: unnecessary harassment or useful addition to X-ray? Ultraschall Med 2008;29:267–74.
▶ Cross KP, Warkentine, FH, Kim IK, et al. Bedside ultrasound diagnosis of clavicle fractures in the pediatric Emergency Department. Acad Emerg Med 2010;17:687–93.
▶ Weinberg ER, TuniK MG, Tsung JW. Accuracy of clinician-performed point-of-care ultrasound for the diagnosis of fractures in children and young adults. Injury 2010;41:862–8.
▶ Chien M, Bulloch B, Garcia-Filion P, et al. Bedside ultrasound in the diagnosis of pediatric clavicle fractures. Pediatr Emerg Care 2011;27:1038–41.
▶ Hubner U, Schlicht W, Outzen S, et al. Ultrasound in the diagnosis of fractures in children. J Bone Joint Surg Br 2000;82:1170–3.
Linked Articles
- Best Evidence Topic reports
- Best Evidence Topic reports