Ultrasound in Detecting Metaphyseal Fractures in infants

• Research type

  Research Study

• Full title

  Diagnostic Accuracy of Ultrasound in Detecting Metaphyseal Fractures in Infants with Suspected Inflicted Injury

• IRAS ID

  307617

• Contact name

  Amaka C Offiah

• Contact email

  a.offiah@sheffield.ac.uk

• Sponsor organisation

  Sheffield Children’s NHS Foundation Trust

• Duration of Study in the UK

  1 years, 5 months, 29 days

• Research summary

  Metaphyseal fractures are considered highly specific injuries in the context of infant abuse.However they can be subtle and often difficult to diagnose particularly when acute and prior to the development of a healing response. In addition, they are rarely accompanied by clinical signs such as bruising so suspicion is often not raised. X-ray radiograph assessment is based on two sets of radiographs 11-14 days apart to detect the presence of a fracture healing response between the two time-points.

  Diagnosing Metaphyseal fracture is critical to protecting infants and young children from dangerous environments and thus alternative imaging modalities have thus been assessed to enhance the immediate diagnosis of metaphyseal fractures, but all have limitations. Magnetic resonance imaging (MRI) is not the optimal modality because it has a low sensitivity of only 31% . Computed tomography (CT) is also not recommended as it involves a high radiation dose exposure, which is to be avoided in this sensitive age group. Radionuclide imaging has been used to diagnose metaphyseal fractures; however, the uptake of the radionuclide is not specific to fractures and can occur due to other pathologies such as tumour and infection and normal growth.

  Ultrasound (US) is the imaging modality with the most potential for diagnosing metaphyseal fracture in suspected infant abuse. A recent study demonstrated that US is able visualise metaphyseal fractures as well as delineating other indirect signs such as thickening of the metaphyseal bone collar, deformity of the bone collar and irregularity of the zone of provisional calcification. To assess further. we plan a prospective study to assess the diagnostic accuracy of US for the detection of metaphyseal fractures in infants with suspected abuse against the reference standard of initial and follow-up skeletal survey.

• REC name

  London - Surrey Research Ethics Committee

• REC reference

  22/LO/0680

• Date of REC Opinion

  1 Feb 2023

• REC opinion

  Further Information Favourable Opinion