[Efficacy of x-ray assessment in emergency surgical departments: an evaluation in a level I trauma center]. / Qualität der Röntgenbefundung im traumatologischen Bereitschaftsdienst: Eine Einschätzung anhand einer Studie an einem Krankenhaus der Maximalversorgung.

BACKGROUND: The aim of the study was to ascertain the state of the art in x-ray assessment in an emergency surgical department. METHODS: From August 2008 to February 2009 a total of 1,588 plain x-rays of 658 patients from the emergency department were included in this study. The images were assessed by 3 experienced orthopedic surgeons and 1 experienced radiologist. The incidence of missed traumatic lesions and suspected lesions and the treatment of these patients were noted. RESULTS: A total of 136 pathological cases with 238 pathological x-ray findings were found. The mean rate of missed lesions was 13% of the assessed cases. Despite the fact that the rate of missed lesions varied from 9-25% depending on the level of experience, all patients were treated adequately. The quality of x-ray assessment improved with the level of training of the individual doctors. CONCLUSION: The present situation is in need of improvement but it is not critical. Junior medical staff should undergo a special training in x-ray assessment.

[Ultrasound diagnosis of forearm fractures in children: a prospective multicenter study]. / Sonographische Diagnostik von metaphysären Wulstbrüchen: Eine prospektive Multicenterstudie.

BACKGROUND: Metaphyseal forearm fractures are a common pathology in any emergency department. The standard diagnostic procedure involves X-rays of the forearm and wrist. As former studies have shown that these fractures can be visualized using ultrasound, we compared the accuracy of sonographic and X-ray diagnostics. METHODS: From January 2007 to May 2008, a total of 93 patients aged between 0 and 12 years with forearm trauma were initially examined using a 7.5-Mhz linear transducer. After diagnosis, axis deviation and treatment were fixed and standard X-rays were taken. The results of the two diagnostic procedures were compared. The examiners were doctors in training or consultants and underwent no specific training. RESULTS: We found 77 fractures in 64 patients (50 radius, 1 ulna, 13 radius and ulna). The sensitivity of ultrasound diagnostics was 94% and the specificity 99% compared with X-ray diagnosis. Mean axis deviation differences were 1.8 degrees (radius) and 0.7 degrees (ulna). CONCLUSION: Ultrasound seems to be a valuable and safe alternative to X-ray diagnosis. Patients with inconclusive findings should undergo X-ray diagnosis.