Title: Algorithm for diagnosis of fractures of the distal portion of the forearm in children with the use of ultrasound imaging


The technique of ultrasonographic imaging enjoys a permanent place in numerous medical specialties, including pediatrics and emergency medicine. Emergency medicine employs the FASTER procedure (Focused Assessment with Sonography in Trauma plus extremitas and respiratory evaluation), where, in addition to standard ultrasound examination searching for injuries involving the abdominal and thoracic cavity, a cursory assessment of the skeletal system is performed to detect possible fractures. In diagnostic management of the skeletal system, the basic diagnostics tool continues to be a rentgenogram.The objective of the dissertation was to evaluate the effectiveness of ultrasonographic diagnostic management in injuries of the distal forearm in children as compared to X-ray imaging performed in the Emergency Department (ED). If ultrasonography is an equivalent method to X-ray, in what situations and in what way should the examination be performed? What ultrasonographic properties characterize normal and fractured bones in various age groups? An important aspect is the form of image recording and providing information for other physicians participating in the therapeutic process, as well as desired properties of an ultrasonographic unit that would be beneficial in fracture diagnosing. A significant issue is the question addressing the method of teaching ultrasonographic diagnostic manag ; ement of the skeletal system to students of medicine and emergency medicine, as well as to residents in emergency medicine, surgery or orthopedics, since the tool belongs to ER physicians rather than to radiologists. When we adhere to principles of radiation protection, an important problem is whether a significant percentage of children will avoid exposure to ionizing radiation.I examined 255 children, whom I divided into three subgroups: Subgroup I - between 1 and 5 years of age - 44 children, Subgroup II- between 6 and 11 years of age - 125 children, and Subgroup III- between 12 and 18 years of age - 86 adolescents. In total, I found fractures with periosteum rupture in 32% of the children, subperiosteal fractures in 33% of the subjects and no fractures in as many as 35% of the children. I analyzed the results from the perspective of employing the Ackermann’s algorithm, where in selected extremity-involving trauma situations, ultrasonography or X-ray imaging is performed. I modified the algorithm to include ultrasound-controlled closed repositioning. I confirmed the 100% conformity of ultrasonographic imaging and X-ray imaging. The Ackermann’s algorithm may be successfully employed in diagnostic management of injuries of the distal forearm. Using the computer database I developed, I unambiguously described ultrasonographic properties of bones without and with fractures, taki ; ng into consideration the age of children. Data were recorded on DVDs or printed using a 1200 dpi printer. Sixty-seven percent of children with injuries of the distal forearm did not require X-rays; moreover, the group of children subjected to manual reposition was characterized by a decreased exposure to ionizing radiation due to the procedure including ultrasonography. Learning to use ultrasound in bone injuries predominantly requires from a student a certainty that what he sees is a fracture. The almost one hundred-year old history of a common use of X-ray in diagnostics management of fractures calls for patience to change the established practice and multi-center cooperation in replacing the said practice with methods that are not detrimental to health.In the future, extensive multi-center investigations on using ultrasonography in skeletal system injuries will most assuredly lead to elimination of ionizing radiation from excessively common employment. The activities of research groups, such as ALARA, aiming at elimination of X-radiation from medicine are already apparent.

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Level of degree:

2 - studia doktoranckie

Degree discipline:

traumatologia ; pediatria

Degree grantor:

Wydział Lekarski


Sułko, Jerzy

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Last modified:

Jun 26, 2023

In our library since:

May 11, 2016

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Edition name Date
ZB-124555 Jun 26, 2023


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