Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Dec;50(6):2641-2647.
doi: 10.1007/s00068-023-02379-6. Epub 2023 Oct 23.

Is cross-sectional imaging necessary for fractures of the distal lower leg in children and adolescents: results of a nationwide survey

Jonas Alexander Strohm  1 , Ilona Schubert  2 , Dorien Schneidmüller  3 , Peter Christian Strohm  4   2
Affiliations

Is cross-sectional imaging necessary for fractures of the distal lower leg in children and adolescents: results of a nationwide survey

Jonas Alexander Strohm et al. Eur J Trauma Emerg Surg. 2024 Dec.

Abstract

Purpose: In childhood and adolescence, cross-sectional imaging, most commonly computed tomography (CT), is often performed for advanced diagnosis of joint injuries of the distal lower leg and upper ankle. Due to radiation exposure, the need for CT remains controversial, as these injuries follow stereotypies and usually have a similar course. Alternatively, the performance of magnetic resonance imaging (MRI) is also discussed. Since radiation sensitivity at this young age is much higher than in adults, an effort must be to minimize radiation exposure according to as low as reasonably achievable (ALARA) principles. The aim of this survey is to evaluate the current procedure in Germany in the diagnosis of pediatric injuries of the distal lower leg and upper ankle.

Methods: For data collection, a survey entitled "CT in fractures of the ankle joint in childhood and adolescence: subject of the survey are injuries between 8 and 15 years of age" of the Section of Pediatric Traumatology in the German Association of Trauma Surgery was sent to all members via the distribution list of the German Society of Orthopedics and Traumatology and the distribution list of the German Society of Pediatric Surgery in a period from September 20, 2022-December 21, 2022. The survey included a total of 21 questions. Target groups were trauma and pediatric surgeons and orthopedic surgeons working in the hospital and in practice.

Results: A total of 525 participants took part in the survey: ultrasound diagnostics are used by almost 25% and the Ottawa Ankle Rules by over 50% always or in most cases. A conventional x-ray is always or most often used by over 90%. CT imaging is rarely used by 88.57%, mainly for surgical planning or analysis of fracture progression. 69.9% report that their radiology department uses a pediatric protocol for CT exams; 25.71% do not know if this is the case. MRI imaging is also used infrequently by 89.33%, mostly to identify associated injuries. Overall, CT imaging is chosen by 55.62% and MRI imaging by 35.24% as the sectional imaging modality for suspected fractures; 95.05% consider sectional imaging useful for a triplane fracture, 59.24% for a two-plane fracture, 41.71% for a Salter-Harris type III/IV injury, and 8% for a Salter-Harris type I/II injury.

Conclusion: The survey showed that the conventional X-ray is still the gold standard. Interestingly, more than half of the respondents regularly use the Ottawa Ankle Rules, and diagnostics using ultrasound are also used by almost a quarter. Awareness of radiation protection in children exists, although a quarter of all participants do not know the extent to which their radiology department has a specific pediatric protocol for CT imaging. Cross-sectional imaging is performed on a regular basis. Regarding the actual extent of imaging, there is a clear divergence between theory and practice.

Keywords: Adolescent; Ancle fracture; Children; Cross-sectional imaging; Distal lower leg.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflict of interest: The authors have no conflicts of interest to disclose. Ethical approval: Not applicable. Consent to participate: Not applicable. Consent to publish: Not applicable.

Figures

Fig. 1
Fig. 1
Case study 1 and 3
Fig. 2
Fig. 2
Case study 2
Fig. 3
Fig. 3
Case study 4
Fig. 4
Fig. 4
Case study 5
See this image and copyright information in PMC

References

    1. Su AW, Larson AN. Pediatric ankle fractures: concepts and treatment principles. Foot Ankle Clin. 2015;20(4):705–19. - PMC - PubMed
    1. Rammelt S, Godoy-Santos AL, Schneiders W, Fitze G, Zwipp H. Foot and ankle fractures during childhood: review of the literature and scientific evidence for appropriate treatment. Rev Bras Ortop. 2016;51(6):630–9. - PMC - PubMed
    1. Schneidmueller D, Saier T, Stuby F, Sommerfeldt D. Ankle fractures in children and adolescents. Unfallchirurg. 2020;123(9):731–9. - PubMed
    1. Schneidmüller D, Marzi I. Sprunggelenk. In: Marzi I, editor. Kindertraumatologie. Berlin: Springer; 2010. p. 317–38.
    1. Ackermann O. Fracture sonography of the extremities. Unfallchirurg. 2022;125(2):97–106. - PubMed