Ultrasound imaging of forearm fractures in children: a viable alternative?

Objective—A pilot study to investigate whether ultrasonography can be reliably used to demonstrate uncomplicated greenstick and torus fractures in children. Method—Children between the ages of 2 and 14 years with a high clinical suspicion of a non-articular, undisplaced forearm fracture were included. Ultrasound imaging of the injury was performed by a consultant radiologist who gave an immediate report. Standard radiographs of the forearm were then obtained and the patient treated in the normal way. The radiograph was formally reported on at a later date. Results—26 patients were included. There was an absolute correlation between the ultrasound and radiographic findings. The procedure was well tolerated. Conclusion—Ultrasound seems effective for detecting uncomplicated forearm fractures in children. The procedure is easy to perform and the images easy to interpret. A larger study will now be undertaken to confirm these initial findings

Tuberculosis contact tracing: are the British Thoracic Society guidelines still appropriate?

The value of contact tracing in South Glamorgan for the period May 1987 to December 1989 was assessed. Tuberculosis was diagnosed in six (3.5%) of 170 close contacts. All were young and were detected in the initial screening. Tuberculosis was not found among 441 casual contacts. The value of follow up of contacts after the initial screening and of screening casual contacts in districts with a low prevalence of tuberculosis is questioned

Audit of a tuberculosis contact tracing clinic

OBJECTIVE--To determine the efficiency of tuberculosis contact tracing in South Glamorgan 1987-9. DESIGN--Review of records of contact tracing clinic and of data from the Mycobacterium Reference Unit. The clinic's practice was compared with 1983 British Thoracic Society's recommendations. SETTING--Health authority tuberculosis control programme. MAIN OUTCOME MEASURES--Proportion of contacts screened, follow up attendance rates, number of secondary cases detected, and quality of record keeping. RESULTS--101 index patients and 611 contacts were identified. 596 (97.5%) contacts were screened, of whom 139 should not have been. Of 356 contacts requiring a Heaf test, 237 were tested, seven refused the test, and 112 had chest radiography without a Heaf test. 95 contacts were unnecessarily tested. 87 contacts had chest radiography unnecessarily and seven should have had radiography but did not. 34 contacts were given follow up appointments inappropriately and seven were overlooked for follow up. Tuberculosis was diagnosed in five asymptomatic contacts, all at initial screening and all close contacts of index patients with pulmonary disease. CONCLUSION--Inadequacy of data, non-adherence to contact tracing guidelines, and failure to define the term highly infectious index case resulted in many contacts being unnecessarily screened or followed up. IMPLICATIONS--The efficiency of tracing contacts would be improved by specifying smear results and ethnic origin of the index case on the notification form, clearly classifying contacts as close or causal, and clearly defining the term highly infectious