Ultrasound vs X-Ray in Diagnosing Elbow Supracondylar Fractures Dissertation Sample

Introduction

Literature review refers to the piece of academic writing that emphasise on discussing and analysing published information related to a specific subject context. The present literature review will be based on comparing ultrasound and x-ray performance for diagnosis of elbow supracondylar Fracture. In -depth analysis will be done and detailed analysis would be undertaken for developing contextual insights.

PICO

PICO framework is widely used for structuring a Clinical Research Question [CRQ]. It captures detailed key domains which are important for developing a question (Kloda, Boruff and Cavalcante, 2020). In current research context, analyst has used PICO framework for generating significant RQ.

• Problem and Patient- Elbow Supracondylar Fracture in young children
• Intervention- Ultrasound and X-ray
• Comparison- Ultrasound VS X-ray
• Outcomes- Which one [Ultrasound or X-ray] is better for diagnosing Elbow Supracondylar Fracture

Research Strategy

Research strategy expounded as a technique that enables analyst to carry research practices. It is important to employ significant research strategy within study as this results in developing significant outcomes. Qualitative and Quantitative these are the two types of research strategies that are used for conducting studies (Al-Ababneh, 2020). The researcher has employed qualitative strategy in current context and accordingly, comparison between x-ray and ultrasound in relation to diagnosing Elbow Supracondylar Fracture. The major rationale behind approaching qualitative method associates with gaining deeper insights regarding the efficiency and complexities of ultrasound and x-ray. Furthermore, theoretical information is easy to understand and it is suitable for literature review as well. Therefore, qualitative research strategy has been adopted and accordingly literature review was conducted.

Studies

The studies included in the review was peer-reviewed articles that emphasising on elbow supracondylar fracture. Only those sources were taken that are published after 2019 for including latest information in the review. The detailed analysis of the study was done after considering their methodologies and findings. Consequently, information was included in the review. Primary focus implied on checking the reliability and and validity of studies and subsequently, insights has been gained by researcher for developing findings.

Quality Assessment Of Pulled Articles

 Quality assessment is a crucial process and it requires to be considered for selecting high-quality research articles. The researcher has focused on the quality assessment of selected articles for developing realistic and quality findings. The quality assessment was undertaken through CASP [Critical Appraisal Skills Programme] tool. This is concerned with the series of checklist that involves important prompt questions that supported researcher for evaluation of research studies (Long, French and Brooks, 2020). This has supported in assessing the quality of articles and based on this relevant information was included in the findings and discussion.

Literature Review [Findings]

Theme 1- Epidemiology and pathophysiology of Elbow Supracondylar fracture

Study of Azzam et al, (2020) elucidated that Elbow Supracondylar Fracture [Humerus Fracture] is one of the most common upper limb injuries among children, these elbow fractures typically occur due to fall on an outstretched hand which led to elbow joint hyperextension. Statistical information revealed that it typically accounts for 18% of all type of paediatric fracture. Auso-Perez and Rodríguez-Blanes (2020) stated that the mechanism comprised with severe complications such as vascular compromise and nerve injuries. The contextual information reflected that classification of fractures are aligned with Type I [Undisplaced], Type II [Displaced], Type IIa [No rotational deformity], Type IIb [Rotational deformity] and Type III [Whole Displacement]. The frequency of Humerus Fracture is high in children that requires urgent medical diagnosis, displaced fractures often require surgical treatment. As per the views of Barrie and Kent (2023) the epidemiology of Supracondylar humerus fractures [SCHF] entails with frequent occurring of fractures in children aged between 5-7 years of age that followed by hyper-extension of elbow which causes extension-type fractures. However, Storch, Schultz and Fitze (2022) revealed that Flexion-type fractures are increasing in older children and these injuries further develops in non-dominant upper-extremity areas. Considering this information, it can be said that the prevalence of SCHF is high in children and timely diagnosis is essential otherwise, this results in severe complications.

The qualitative study Pilla et al, (2020) emphasised on the pathophysiology of SCHF, article revealed that shape of distal humerus is of triangular pattern that is present within coronal plane, the base associated with lateral epicondyle, medial epicondyle and capitellum. Majority of the fractures occurs when children get fall down and olecranon process engages with olecranon fossa and develops an extent pressure on distal humerus. Due to this, posterior cortex might be influenced and lead to injury. Afterwards, it is essential to undertake physical assessment of limb for assessing the integrity of soft tissues mechanism along with distal neurovascular status. Other associated injuries must be documented while undertaking diagnosis procedure. Knight et al, (2023) articulated that arm becomes deformed, bruised or swollen, in case, bleeding around elbow recognised then, immediate assessment should be done. The careful assessment must be considered that specify about the function of median anterior interosseous and radical nerves. Clinical practices in these circumstances are aligned with documenting motor and sensory function for each of the nerves.

Neurovascular injuries found to be higher as it accounts for 49% and the vascular comprise reported around 10-20% in relation to displaced SCHF (Awwad et al, 2024). Micheloni et al, (2021) focused on different treatment options such as non-operative management, surgical procedure, closed reduction, percutaneous pinning, open reduction and vascular exploration. However, before preferring any kind of treatment procedure it is important to identify the severity of fracture and this can be done through Ultrasound and X-ray mechanism. In clinical context huge arguments are witnessed with regards to efficacy of ultrasounds and x-rays for diagnosis of SCHF. Both the mechanism entails with own benefits and limitations. This topic holds the notion of criticism due to varied perspectives of clinical experts. The next themes will be based on assessing the accuracy of both the methods for diagnosing Elbow Supracondylar Fracture.

Theme 2- Accuracy of ultrasound VS X-ray in diagnosing Elbow Supracondylar Fracture

Pilla et al, (2020) demonstrated that ultrasound is a type of technological scanning that associates with high-frequency sound waves for scanning the varied parts of body, it is significantly used for recognising the disruption under cortex domain. The important insights have been developed through findings and it was analysed that ultrasonography does not develop any kind of radiations and due to which it has been considered as a better option. The mechanism of ultrasound comprised with scanning the elbow within orthogonal planes that looks upon elevation of posteriors fad (Sato et al, 2025). The plain radiographs of elbow support in assessment of diagnosis and enable healthcare professional to take decisions regarding treatment. However, on the other hand, Qiu, Wang and Wang, (2022) stated that X-rays are profound mechanism that could be used for diagnosing SCHF, it provides detailed images of the bones and further enable clinical professionals to analyse the severity of fracture. There are different benefits associates with X-rays that makes it a suitable option and those are concerned with painless diagnosis, clear image and accurate analysis of fracture. For children, X-rays are suitable as they do not have to face any kind of pain during the assessment procedure and further, detailed images of bones enable professional to take significant decisions.

Raux and Madelaine, (2023) revelated that ultrasound proves to be a valuable tool but it is concerned with certain limitations; it generates soundwaves and there might be possibility that sound waves does not travel via bone or air. This clearly proves that ultrasound is less effective when it comes to generate the image of body part, it can often misguide professionals that creates drastic influence on treatment procedure. In the opinion of Sabharwal et al, (2021) radiography should be considered by healthcare providers so they can recognise about the displaced fracture and accordingly severe conditions could be witnessed. The sound waves are used for assessing the organs in sonography procedure whereas, radiations are developed through X-rays and it led to develop clear image of bone. Ultrasound widely used for imagining the soft tissues and X-rays are used for picturising bones. Hence, bone injuries can be easily detected via X-rays. Based on the presented information this can be said that X-rays are better in comparison to ultrasound due to their wider use for bones assessment. Also, it provides higher accuracy than ultrasound. Moreover, it falls under the category of traditional method due to which it is widely used.

As per the views of Shah and Agashe (2021) Basic radiographic evaluation is needed to undertake for SCHF, in children the elbow in consist of anteroposterior and lateral projections. The guidance from radiography and K-wire fixation supports in avoiding of ulnar nerve injury and focuses on improving the safety. Plain radiographs of the elbow are needed for diagnosing the severity of fracture. It is useful in identifying the displacement and comminution. There are different types of radiographs which can be used as per the type of fracture. In context of SCHF plain radiographs are suitable as this provides detailed image of the bone and accordingly actions can be taken which are important for diagnosing the fracture. Clear image of bone is needed so this can be identified whether fracture is severe or not and this can be done through radiographs. However, Shih et al, (2024) stated that X-rays lead to radiation which has enough potential in terms of causing damage to the DNA. The risk from exposure is high and findings have often shown that radiation from X-rays further develops risk related to cancer. Therefore, huge criticism related to using of X-ray for children has been witnessed. The risk for cancer can be increased for children in their later life due to which many practitioners does not consider this option.

Siu et al, (2023) stated that ultrasound possess advantage over x-ray, it is highly effective for visualising soft tissue changes and consequently, secondary signs of fracture could be evaluated. In real time period, ultrasound is considered as accurate. Hence, these signs contribute in supplementing primary findings along with increasing potential for diagnosis and therefore, ultrasound should be preferred. Ultrasound is further proven safe for children as it does not develop any kind of radiation that creates drastic impact on children, therefore, it is used for diagnosing SCHF. On a contrary note, Ekwedigwe et al, (2021) said that ultrasound does not provide effective results due to lack of potential in terms of travelling through bones or air. This can result in misguiding professionals and there might be possibility that at initial stage practitioners are not able to identify the severity of fracture. Based on this information it can be said that there are certain loopholes associated with ultrasound which might impact the treatment procedure. It is highly important to analyse varied domains that can create negative impacts while assessing the fracture and afterwards the assessment should be done.

Irianto et al, (2021) demonstrated that Supracondylar Fracture can be diagnosed within Emergency department via radiographs. Type II to IV fractures can be assessed through X-rays. However, in case of Type I, X-rays are not able to witness the assess the fractured linked and therefore, this is not used for diagnosing SCHF. In order to determine about the treatment procedure, it is essential for service providers to detect the fracture and based on the injury further, actions are taken (Wang and Liu, 2020). For Type I fracture ultrasound in preferred so that accurate assessment could be done and consequently, treatment procedure can be undertaken. Whereas, Khan et al, (2021) revealed that both of the techniques X-rays and ultrasound has its own benefits and limitations. For some purpose X-rays are beneficial while for other context ultrasound is preferred. On the basis of present situation and circumstances decision related to using X-ray or Ultrasound has been taken and accordingly, treatment procedure is undertaken. Scanning internal parts of the body during SCHF can help in knowing whether there are chances of severe injury or not. X-rays often provides wrong information in many cases that ultimately lead to create issues while taking decision related to treatment. Therefore, it is not easy to witness whether X-ray or Ultrasound which one is effective, both of them have different mechanism that are suitable for different types of situations arises in SCHF.

Teo et al, (2020) depicted that while undertaking X-ray a series of steps must be followed that considered with anteroposterior and further cross views of elbow requires to be assessed so that pain and tenderness can be identified. Hence, detailed assessment can be undertaken and accordingly, evidence-based decisions are preferred. In comparison to X-rays ultrasound are proven cost effective which means it is affordable tool. Research has shown that when X-rays are used in proper manner then, it provides accurate information related to displacement. On the other hand, Nguyen et al, (2024) disclosed that surgery duration with ultrasound is 41.5 and it is safe and reliable process Type III needs close assistance and it cannot be undertaken without Ultrasound. There are repeated images needs to be taken for assessing the severeness of injury and ultrasound has been proven effectual in this area. When there is severe damage occurred due to SCHF then, it is important to prefer ultrasound so that accurate assessment can be done and subsequently, evidence-based decision making could be undertaken (Scheier et al, 2023). Hence, this proves that ultrasound in highly effective for diagnosing Elbow Supracondylar Fracture.

In the findings of Shih et al, (2024) it was recognised that ultrasonography provides elbow images from all directions that makes it easy for practitioner to recognise the injury. Ultrasonography provides 100% sensitivity related to lipohemarthrosis along with assuring 100% sensitivity about fat pad sign. Clinical decision making is accompanied by evidences and ultrasound works on accurate evidences therefore, it is considerable options for diagnosing the Elbow Supracondylar Fracture. Thus, on the basis of presented information this can be said that plain radiography is suitable in certain cases while ultrasound proves to be effective for taking accurate decision and further in case of Type I and Type III X-rays does not work and practitioners need to opt for ultrasound.

Theme 3 Identification of safe option for diagnosing Elbow Supracondylar Fracture

As said by Ackermann et al, (2024) Ultrasound is best and safer option that should be consider for diagnosing Elbow Supracondylar Fracture. On comparing ultrasound and X-rays important insights have been developed. The image resolution of X-ray is fine and for ultrasound it is not highly effective. But ultrasound provides repeated images of elbow from all direction that makes it easy for practitioner to diagnose the injury. The capabilities in terms of acquiring video sequence proves to be effective in both X-rays and ultrasound. However, Azizkhani et al, (2022) said that X-rays create harmful radiation on human body that increases the chances of cancer in later life. Whereas, Ultrasound does not develop any harmful radiations and it is safe to use. The frame rate of X-ray is 10-30 fps and for ultrasound it is 300 fps which depicts about high quality. Henceforth, this clearly proves that ultrasound provides significant results by undertaking in-depth assessment of elbow and contributes in evidence-based decision making. Therefore, it should be considered and accordingly, effectual decision must be taken.

Li and Tan (2022) elucidated that medical imaging playing pivotal role in diagnosing and monitoring of varied types of medical complexities. From all the available techniques, X-rays and ultrasounds are most popular for diagnosing SCHF as it supports in developing valuable insights related to human body. Both the mechanism; X-rays and ultrasound differs in terms of implication, principles and safety profiles. Ultrasound imagining that is further known as sonography primarily relies on the sound waves for developing real time image of internal structures. The working mechanism of ultrasound comprised with sound waves in which a small handheld device that is further known as transducer emits develops a high-sound frequency in the body. Afterwards, these sound waves recognise varied organs and tissues within body and reflect on the density and consequently the image has been formatted in the system. This image process data for developing dynamic images towards screen.

Whereas, Li and Tan (2022) said that mechanism of X-rays comprised with producing radiation and accordingly detailed image of interior part has been developed. A machine has been emitted and consequently, X-ray radiation is developed that goes throughout the body. The dense structures such as bones absorbs it and present an X-ray image. The picture has been captured and presented on the system. This image supports in detecting about severeness of injury with respect to SCHF. Thus, this is the mechanism of X-ray that is undertaken for developing image of the bone, findings have shown that X-rays provide clear image related to bone and supports practitioner to take appropriate decision with regards to treatment procedure.

In the opinion of Ashoobi Rad and Rahimi (2023) it has been identified that application of ultrasound comprised with obstetrics, abdominal imaging, cardiac imaging and musculoskeletal imaging. For elbow Supracondylar Fracture, musculoskeletal imaging is appropriate and accordingly, it identify injury in the bones and tissues. By considering this, assessment can be done in appropriate manner and accordingly decision can be taken. On the other hand, Li et al, (2024) said that application of x-rays considered for Orthopedics, Dental, Chest Imaging and Mammography. For detecting SCHF, Orthopedics has been used as it is mainly used for detecting fractures, joint complexities and bone disease. Radiography is widely used for detecting fractures, from past years people prefer X-rays for assessing the severity of fractures. Therefore, in healthcare setting X-rays are considered as first choice due to clarity of image. However, increasing risk due to radiation shifted the attention of patient towards ultrasound. Still, ultrasound does not provide clear image that mislead the practitioners but apparently, due to safety people prefer this.

Eckert (2021) articulated that ultrasound does not cause any radiation and makes it safer option for children and X-rays creates issues for children and increases the risk of cancer. Ultrasound provides real rime image of bones which makes it suitable for assessing the severity of injury. Furthermore, ultrasound machines are portable due to which it is suitable for assessing SCHF. On a contrary note, Hell et al, (2021) said that Ultrasound is cost effective and X-rays are costly therefore, patient prefer this. However, the question is about diagnosis of SCHF its not about the cost. Therefore, this domain cannot be considered and emphasis requires to be made on accuracy of assessing diagnosis. Ultrasound and X-rays both are useful in diagnosis of Elbow Supracondylar Fracture. However, in certain cases such as Type I, Type III and displacement ultrasound needs to be considered instead of X-ray, in such circumstances ultrasonography provides information related to injury and damage in the tissue. Hence, based on this information it can be said that ultrasound proves to be safer option in comparison to X-rays as it does not create harmful radiation on children’s body and ensures a safer treatment. Henceforth, this is widely used for assessing children’s bones and identifying injury.

Discussion

From the findings’, varied insights have been developed that stating about effectiveness of X-rays and Ultrasound in diagnosing Elbow Supracondylar Fracture. Both of these methods have their own benefits and limitations which makes them subsequent for assessment. However, after undertaking an in-depth analysis it has been witnessed that Ultrasounds are safer options in comparison to X-rays. This does not create harmful radiation on children body and reduces the risk of cancer in later life (Knight et al, 2023). It is highly safe also for severe damages such as Type I and Type III ultrasound has been preferred by practitioner as it detect damage in tissue and bones. X-rays provides clear image and accordingly fracture can be identified therefore, it is widely used within clinical setting. Nevertheless, it does not provide repeated images and ultrasound provides consistent images in series due to which assessment becomes easy (Knight et al, 2023). Thus, there is no doubt in stating that ultrasound is an effectual option for diagnosing Elbow Supracondylar Fracture and subsequently, evidence-based decision related to treatment can be taken. Hence, based on the review this can be said that ultrasound is considerably effective and safer option for detecting SCHF. Therefore, it should be preferred specifically for children so no harm can be developed towards them.

Conclusion

Conclusively; this can be said that ultrasound is a safer and better option for detecting SCHF in children as it does not develop harmful radiations. Also, it developed repeated images that makes it easy for diagnosing Elbow Supracondylar Fracture. However, X-rays are also effective and plain radiographs are considered for identifying injury. Nevertheless, in severe cases such as Type I, Displacement and Type III ultrasound is needed for undertaking assessment due to higher accuracy. Healthcare setting focuses on evidence-based decision-making and therefore, ultrasound is preferred as it provides series of evidences by identifying injuries in bones and tissues. Consequently, treatment options related to surgery can be undertaken.

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