Diagnostic Accuracy of Ultrasonography for Hand Bony Fractures in Paediatric Patients

Hand fractures are common in pediatric populations, and radiography is the standard diagnostic procedure. Ultrasound has been used to evaluate for bone injuries, although most prior studies of this application have involved the detection of adult long-bone fractures. The purpose of this study was to evaluate and confirm the safety and applicability of ultrasound as a diagnostic procedure when compared with x-ray diagnosis of pediatric hand fractures. This cross-sectional study from Italy enrolled a convenience sample of patients aged 2 to 17 years presenting to emergency departments with suspected hand fractures. Patients first underwent x-ray, and subsequently ultrasound examinations performed by two different operators; a radiologist and a trained emergency physician. Ultrasound and radiographic findings were then compared, and sensitivity and specificity were calculated. A total of 204 patients were enrolled in the study. Seventy-nine fractures were identified by standard radiography. When radiologists performed ultrasound imaging, 72 fractures were identified with a sensitivity of 91.1% and a specificity of 97.6%. When emergency physicians performed ultrasound, sensitivity and specificity were found to be 91.5% and 96.8%. Ultrasound imaging showed excellent sensitivity and specificity in the diagnosis of pediatric hand fractures. The study showed excellent agreement between the ultrasound results carried out by radiologists and those carried out by emergency physicians (κ = 0.9; p < 0.001). This suggests that ultrasound can be used by emergency physicians to identify hand fractures in a timely and accurate manner.