Evaluation of the accuracy of point-of-care ultrasonography in the diagnosis of growth line fractures

The aim of this thesis study is to demonstrate the effectiveness of Point of Care Ultrasound (POCUS) in the diagnosis of fractures and identification of fracture characteristics in pediatric patients with suspected growth line fracture on physical examination who presented to the emergency department due to trauma and compare it with plain radiography (XR). In this prospective thesis study, children aged 0-18 years who applied to the emergency department due to trauma, who were not in life-threatening condition, whose clinical findings were stable, and who had suspected growth line fractures on physical examination were included. The first physician who evaluated the patients performed POCUS examination and the second physician interpreted the XR images. The presence of fracture, extension to the physis, extension to the joint, angulation, stepping, fracture type, dislocation, and Salter Harris (SH) classification were evaluated in XR and POCUS images. ROC (Receiver operating characteristic) analysis and Kappa (κ) value were used to evaluate the accuracy of POCUS compared to XR. The agreement was graded according to the κ magnitude. A κ value greater than 0.75 was considered excellent agreement; between 0.75-0.40 was considered moderate agreement; and below 0.40 was considered poor agreement. 117 patients were included in this study. Fractures were detected in 85 of these patients. Compared to XR, POCUS had a sensitivity of 97% and specificity of 94% in detecting fractures, a sensitivity of 94% and specificity of 96% in detecting physis fractures, and a sensitivity of 60% and specificity of 71% in detecting fractures extending to the joint. Sensitivity was calculated as 100% for angulation, stepping, and adjacent bone fractures. The kappa value of POCUS in the typing of fractures according to XR was 0.881; and in the detection of dislocations, it was 0.742. Of the physis fractures detected on XR, 8 (50%) were SH type II, 3 (19%) were SH type III, and 5 (31%) were SH IV. The kappa value of POCUS compared to XR in SH classification was found to be 0.682. POCUS revealed tissue hematoma in 30 (26%) patients and hemarthrosis in 5 (4%) patients. POCUS has a high sensitivity in the visualization of trauma-related bone fractures in children and in the detection of fractures extending to the physis. Soft tissue injuries can also be visualized with POCUS. On the other hand, there is moderate agreement between XR and POCUS in the extension of the fracture into the joint, in the detection of dislocations and in SH classification. Keywords: Physis, fracture, children, plain radiography, POCUS