Ultrasound Evaluation of Pediatric Orthopaedic Patients

Jody Litrenta, MD; Karim Masrouha, MD; Amy Wasterlain, MD; Pablo Castaneda, MD


J Am Acad Orthop Surg. 2020;28(16):e696-e705. 

In This Article

Abstract and Introduction


Ultrasonography is a valuable tool that can be used in many capacities to evaluate and treat pediatric orthopaedic patient. It has the capability to depict bone, cartilaginous and soft-tissue structures, and provide dynamic information. This technique can be readily applied to a wide range of pediatric conditions, including developmental dysplasia of the hip, congenital limb deficiencies, fracture management, joint effusions, and many other musculoskeletal pathologies. There are many benefits of implementing ultrasonography as a regular tool. It is readily accessible at most centers, and information can be quickly obtained in a minimally invasive way, which limits the need for radiation exposure. Ultrasonography is a safe and reliable tool that pediatric orthopaedic surgeons can incorporate into the diagnosis and management of a broad spectrum of pathology.


Ultrasonography is a valuable imaging tool that can be used by pediatric orthopaedic surgeons to obtain quick information without exposing the patient to radiation. It can be used for diagnostic and therapeutic purposes in numerous orthopaedic conditions, from hip dysplasia to forearm fractures. Ultrasonography is typically readily accessible in most medical centers and is used in the emergency departments (EDs) and in private offices. Unlike many imaging modalities, it can be performed at the bedside.

Despite this, there is a commonly held perception among orthopaedic surgeons that ultrasonography is unreliable in obtaining an accurate diagnosis and is highly operator dependent. This has led to its limited use in clinical practice as a diagnostic modality. However, when combined with a detailed history and thorough physical examination, ultrasonography can frequently provide important information on a wide variety of conditions encountered by the pediatric orthopaedic surgeon. As such, ultrasonography has been dubbed "the orthopedic stethoscope."[1] For these reasons, it is beneficial to explore the role of sonographic imaging in the evaluation and treatment of pediatric orthopaedic patients.

That being said, it is important to have adequate training on the use and interpretation of ultrasonography. In particular, orthopaedic surgery residents should have formal training on ultrasonography incorporated into their residency programs, just as they do for the interpretation of radiographs and MRI. Indications, technical skills, and interpretation can be accomplished as part of training. Implementation of ultrasonography into clinical practice will vary by institution and should be done in close coordination with our radiology colleagues.