Accuracy and Reliability of Cortical Buckling or Bulging: A Reliable Indicator of Ultrasound in Diagnosing Buckle or Torus Fracture of Long Bones in Children

Abstract

Buckle fractures in children are non-displaced, incomplete compression fractures resulting in bulging or buckling of the bone cortex without disruption. Objective: To assess the diagnostic accuracy of ultrasound and the reliability of cortical buckling or bulging as an indicator of ultrasound in diagnosing buckle fractures of long bones in children while using radiography as the reference standard. Methods: A cross-sectional study conducted at the Radiology Department of the Trauma Centre of Saidu Group of Teaching Hospitals, Swat, from May 2022 to January 2023. The sample size consisted of 148 patients aged 0-18 years with 204 clinically suspected long bone fractures. Because specific clinical markers for isolating buckle fractures are lacking, a general population of patients with long bone injuries was considered. Sonographic scans of the suspected fractures were performed followed by the plain radiography and images of buckle fractures were saved on both modalities for comparison. Results: Sonographic buckling or bulging was found in 24 out of 25 total buckle fractures. One sonographic buckle fracture was also missed radiographically. The diagnostic accuracy of ultrasound in diagnosing buckle fractures was found 98.53% with a sensitivity and specificity of 96% and 99.10% respectively. PPV and NPV of ultrasound were found 96% and 99.10% respectively. Conclusions: Ultrasound can be used as the initial screening modality for diagnosing buckle fractures in long bones in children due to its high diagnostic accuracy and the reliability of cortical buckling or bulging as a sonographic indicator