Feasibility and technique of ultrasound traumatic elbow lesion assessment

Introduction: The present study aimed to describe the technique of ultrasound traumatic elbow lesion assessment performed by an orthopedic surgeon. Methods: Nine patients were included in a single-center study. Clinical examination assessed pain, ranges of elbow motion, neurovascular status and elbow ligament testing. Ultrasound was associated to radiography between days 7 and 15, screening for lesions of the bone, medial ligament (in 30-90 degrees flexion), lateral ligament (elbow at 90 degrees in cobra position) and epitrochlear and epicondylar muscle insertions. Ultrasound scanning time and echogenicity were assessed. Results: Four radial head osteochondral fractures were detected on ultrasound in addition to the 4 fractures seen on radiography, without significant difference (p = 0.071). Clinical examination found 2 cases of valgus laxity and 5 of varus laxity. Ultrasound, performed blind to radiography, found 1 medial collateral ligament anterior bundle lesion (in 1 of the 2 patients with valgus laxity) and 4 lateral collateral ligament ulnar bundle lesions (in 4 of the 5 patients with varus laxity). There were no epicondylar or epitrochlear tendon lesions. Scanning time decreased significantly over the study period, from a mean 30 minutes in the first 5 cases to a mean 24.8 minutes in the last 5 (p = 0.046). Three patients could not be put in the cobra position, and 3 showed poor echogenicity. Discussion: Ultrasound assessment of traumatic elbow lesions could be performed by an orthopedic surgeon on a well-defined protocol. Lesions on ultrasound matched clinical symptomatology. Inter- and intra-observer reproducibility remain to be assessed. (C) 2021 Published by Elsevier Masson SAS.