The Journal of Bone and Joint Surgery, Vol 76, Issue 12 1804-1813, Copyright © 1994 by Journal of Bone and Joint Surgery, Inc
Ultrasonographic evaluation of the elbow in infants and young children after suspected trauma
RS Davidson, RI Markowitz, J Dormans and DS Drummond
Department of Orthopaedics, Children's Hospital of Philadelphia, Pennsylvania 19104.
Fractures and epiphyseal injuries in the region of the elbow are uncommon
in infants and young children, but they can be very difficult to diagnose
and delineate accurately. In addition to plain radiography, invasive or
costly procedures such as arthrography and magnetic resonance imaging
traditionally have been used to evaluate these injuries. We used
high-resolution real-time ultrasonography to evaluate a suspected injury of
the elbow in seven infants and one ten-year-old child. Three of the infants
had a physeal separation, two had a supracondylar fracture, and two had no
skeletal injury. The child had an avulsion fracture of the lateral
epicondyle of the humerus and an effusion in the joint. The
ultrasonographic findings were confirmed by arthrography in three patients,
by open reduction in one, and by follow-up radiographs in all. None of the
ultrasonographic studies were performed with the patient under general
anesthesia. Ultrasonography, a readily available, non-invasive technique,
can be used to evaluate the unossified epiphysis about the elbow of infants
and young children; to demonstrate dislocations, fractures, and physeal
separations; to identify a hinge of soft tissue at the site of a fracture;
to identify interposition of soft tissue between fracture fragments; and to
aid in the planning of closed and open reductions.
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