The diagnostic value of sonographic findings in pediatric elbow fractures: A systematic review and meta-analysis

Sonography is a beneficial imaging modality for detecting elbow fractures in children, considering the lack of radiation exposure and time efficiency. This systematic review aims to determine the diagnostic value and clinical applicability of sonography and each sonographic finding in detecting pediatric elbow fractures. Pubmed, Scopus, and WOS databases were searched for related original articles until February 25, 2023, and data related to diagnostic performance were extracted. We used the Bivariate model and hierarchic summary receiver operating characteristic (HSROC) approach to calculate pooled diagnostic values. Cochrane Q test and I-squared were performed to evaluate heterogeneity. We assessed heterogeneity with meta-regression. Eight studies were included, which involved a total number of 880 patients. According to meta-analysis, sonography demonstrated a pooled sensitivity of 97% (91–99%) and specificity of 90% (80–95%), positive likelihood ratio(LR+) of 9.82 (4.59–20.97), and negative likelihood ratio (LR–) of 0.03 (0.01–0.10). For the sonographic posterior fat pad sign as a sole diagnostic sign, we calculated a Pooled Sensitivity of 80% (70–88%), Specificity of 97% (87–99%), LR+ of 28.8 (6–139.3), and LR– of 0.2 (0.13–0.31). Also, lipohemarthrosis demonstrated a pooled sensitivity of 80% (70–88%), specificity of 97% (87–99%), LR+ of 28.8 (6–139.3), and LR– of 0.2 (0.13–0.31). The sensitivity of detecting fractures with cortical line disruption was significantly higher in studies that utilized a comprehensive technique compared to a conventional technique. Sonography is a valuable diagnostic tool for the assessment of pediatric elbow injuries, and it can be capable of confirmation or exclusion of the diagnosis.