Role of Ultrasound Diagnostics in Elbow Injuries in Children
About the author:
Mironova Yu. A.
CLINICAL AND EXPERIMENTAL MEDICINE
Type of article:
The article presents the results of ultrasound diagnostics in 58 patients with injuries of the elbow in age from 3 to 16 years. Depending on the severity and localization of the traumatic injury the patients were divided into two subgroups: patients with combined bone and soft tissue injuries of the elbow joint and only soft tissue injuries of the structures of the elbow joint. We prove the necessity of using ultrasound examination for various injuries of the elbow joint in children for diagnostics of the soft tissue injuries of the elbow in children, without which the diagnosis is incomplete, because acute injuries of the elbow joint by ultrasound data patients in first subgroup (with combined injuries ) were 67.2 % & with isolated soft tissue injuries – 32.8 %. Among the combined injuries with damage to the bones t soft tissue damage elements were present, so we see that only on the basis of Xray method to reliably assess the condition of injured elbow is problematic, it indicates the need to improve and find the optimal combination of radiological methods, particularly those that have the greatest sensitivity to changes in soft tissue structural elements of the elbow joint. When ligaments, tendons and muscles are damaged the following ultrasound features are revealed: discontinuity course of fiber thickening, presence of hypoechoic and hyperechoic inclusions, presence of free fluid (blood) in joint cavity & it`s bursas. Hemarthrosis was the most common ultrasound sign of elbow injury (100 % of patients in Ia subgroup, 42.1 % of patients in Ib subgroup) and the presence of fluid in the olecranon bursa (84.2 % and 57.9 %, respectively). Ultrasound is helpful method when radial dislocation is suspected. Xray diagnostics may be difficult due to particularities of children anatomy of elbow joint & irregular ossification of the caput of the humerus, so that to estimate is the position of radial head normal or not is very problematic. Because of this hyperor hypodiagnostics of radial dislocation could happened. Ultrasound signs of violations radiocapetellar joint are the following: extension of the joint space more than 2 mm and increasing of its echogenicity indicates that dislocation / subluxation of radius is without breaking the annular ligament. Expansion of joint space more than 2 mm, increased echogenicity & presence of hyperechoic lines within the thickend of the annular ligament indicates that dislocation/subluxation of the radius with the annular ligament rupture is present. So, these two types of radius dislocations with & without annular ligament damage require different ways of treatment. Also the paper proves the high sensitivity of ultrasound diagnostics of physeal zones damages. As young children has the epiphysis more cartilage and nonconrtast on Xray image the Xray diagnosis of fractures in the area of growth (epiphyseolysis) could be mistaken, based only on indirect Xray signs, such as irregular expansion of physeal zone and displacement of center of ossification (epiphysis itself). If a traumatic injury is presented in the form of pure epiphyseolysis without dislocation of ossification center or when it is still missing, such a diagnosis is made only clinically without objective confirmation with radiological methods. So, ultrasonic method has advantages over Xray in physeal zones damage, and the accuracy of ultrasound method is 100 % because the comparison is contralateral limb is always performed. Ultrasound signs at epiphyseolisis & apophyseolisis are the following: irregular expansion of physeal zone when compared with the control group, the displacement of the ossification center, the presence of fluid in the joint cavity – hemarthrosis. Summarizing the results of the study it should be noted that ultrasound method is highly complementary imaging method that should be used in traumatic injuries of the elbow joint in children to make the diagnosis of traumatic injury more complicated & to provide proper treatment in time to avoid various complications.
children, elbow joint, trauma, ultrasound diagnostics
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Publication of the article:
«Bulletin of problems biology and medicine» Issue 3 part 2 (111), 2014 year, 189-194 pages, index UDK 616. 727:616073. 053