Ultrasound Assessment of Pediatric Fracture Healing With the PLUS Score

Overview

This observational study investigates whether ultrasound can safely and accurately monitor the healing of bone fractures in children, comparing it to standard X-rays. Currently, children with fractures often require multiple X-rays during their recovery, which exposes them to small amounts of ionizing radiation. Ultrasound, on the other hand, is completely radiation-free. The study aims to evaluate a specific ultrasound scoring system called the PLUS (Pediatric Long-bone Ultrasound Score) score. The study will include pediatric patients who are being treated conservatively (e.g., with a cast) for a long bone fracture, fractures of the sternum, patella and clavicle. During their regularly scheduled follow-up visits, participants will receive a brief ultrasound scan of the fracture site in addition to their standard clinical and X-ray examinations. The medical decisions regarding the patient's treatment will continue to be based entirely on standard care. The main goal is to determine if the ultrasound PLUS score strongly correlates with the X-ray findings. If proven accurate, this scoring system could help reduce the need for routine X-rays in the future, thereby minimizing radiation exposure and potentially streamlining outpatient workflow.

Routine monitoring of pediatric fracture healing relies heavily on conventional radiography. While effective, it exposes growing children to cumulative ionizing radiation. Point-of-care ultrasound (POCUS) represents a promising, radiation-free, and easily accessible alternative for assessing callus formation and bone bridging. To standardize this ultrasound evaluation, specific scoring systems, such as the PLUS score, have been developed. This prospective observational cohort study is designed to validate the clinical utility and diagnostic accuracy of the PLUS score in pediatric patients treated conservatively for long bone fractures, fractures of the sternum, patella and clavicle. Methodology: Patients presenting at the outpatient clinic with conservatively managed long bone fractures, fractures of the sternum, patella and clavicle will be consecutively enrolled. During their standard scheduled follow-up visits, patients will undergo routine care, including clinical evaluation and conventional radiography, to determine clinical and radiological union (e.g., indication for cast removal). Concurrently, an ultrasound examination will be performed to assess the fracture site and calculate the PLUS score. The study is purely observational. The ultrasound findings will not alter the standard of care; all clinical decisions regarding treatment and immobilization removal will remain strictly based on standard clinical and radiographic assessments. Data Collection and Analysis: Patient demographics, injury details, time spent in the waiting room, radiological findings, and ultrasound PLUS scores will be prospectively recorded into a secure REDCap database provided by Masaryk University. The primary objective is to evaluate the correlation between the PLUS score and the radiographic/clinical signs of bone union, ultimately determining the optimal cut-off value of the PLUS score that safely predicts sufficient healing. Secondary objectives include assessing the potential impact of ultrasound implementation on outpatient workflow efficiency and time management.