Sonographic diagnosis of supracondylar fractures of the humerus retrospective and prospective studies in children

Aim: The aim of this study is to evaluate whether sonography as a primary diagnostic tool can be used for the diagnosis of supracondylar fractures of the humerus within a screening regimen. Method: With standardized sonography, a total of 75 children with suspected fractures of the distal humerus were investigated. The initially retrospective study (learning phase) was followed by a prospective study. All examinations were counter-checked by radiography. Supplementary to the standard sections two new sectional planes had to be added and evaluated. Results: Of 65 children with fractures of the elbow, 43 had supracondylar fractures. All fractures could be visualized sonographically in the retrospective study and were diagnosed in the prospective examination. No supracondylar fracture was overlooked. Five results were falsely positive and would have been classified as undislocated supracondylar fractures type Baumann I. With the introduction of the two new sectional planes (dorsal radial and dorsal ulnar longitudinal section), rotatory deformity could be assessed. Conclusion: The longitudinal sections of the first compartment (standard sections) together with the two newly added dorsal radial and ulnar sections improved the diagnosis of supracondylar fractures of the humerus. The primarily unsatisfactory results could be improved by introduction of these additional sections, which are, now recommended as standard sections of ultrasound application. Having acquired sufficient experience, the method can be used as a screening method for primary diagnosis and documentation of supracondylar fractures.