Revista de Medicina Desportiva (English) May 2018 | Page 22

15%, respectively) 15,16 , and Rainer et al
(80.3% and 23.7%, respectively). 16,17 It
is also a non-invasive exam, without
ionizing radiation and widely avail-
able 1,8-10 , particularly in the medical
departments of the clubs. 9
On the ultrasound, the ribs should
be evaluated on the orthogonal
planes, parallel and perpendicu-
lar to its long axis. The superficial
bone cortical appears as a continu-
ous and regular hyperechogenic
line. 1,5,9,10,14,15,18 The costal carti-
lage appears less hyperechogenic
compared to the bone. 7,10,14,15 The
fractures appear as a discontinu-
ity or deviation of the bone cortical
or costal cartilage. 1,9,10,15,18 It often
identifies an artifact of deep rever-
beration to the fracture, making it
easier to identify the injury. It may
also be associated with localized
hypoechogenic hematoma, swelling
or edema of the surrounding soft
tissues. 1,10,15,18 The progression of the
consolidation can also be accompa-
nied by the ultrasound, which shows
an increase in the echogenicity at
the site of the injury, which repre-
sents the formation of bone callus
at the site of the fracture. 10,18 The
presence of vascularity around the
fracture on the Doppler study is also
a sign of bone repair. 19
Aassociated with thoracic trauma
and rib fracture, injuries of intratho-
racic organs may occur, such as lung
contusion, hemothorax, pneumo-
thorax, myocardial contusion and
vascular lesion. 4,5,12,13 Also in these
cases, the ultrasound is more sensi-
tive than the conventional radiog-
raphy. 8 Traumas with suspicion of
intrathoracic complications, respira-
tory failure or hemodynamic insta-
bility impose a CT study. 5,12,13
As disadvantages of the ultra-
sound exam are the time required
and the pain caused to carry out
the examination 5 , the inability to
evaluate the retroscapular and the
infraclavicular portion (infrequent
fracture sites) 13-15 , and the limitation
on the evaluation of obese patients
or with large breast volume. 8-10,15
Despite the recommendations of
the American College of Radiology to
classify the use of the ultrasound as
Grade 1 exam (Usually not appropri-
ate) for minor thoracic trauma 12 , we
know that this method of imaging
allows a good evaluation of bone
20 may 2018 www.revdesportiva.pt
cortical and is sensitive in the
identification of fractures of coastal
arches. It should be noted that these
recommendations are defined for
the general population and not for a
specific population, such as profes-
sional athletes. 12 Due to their avail-
ability and absence of side effects,
the ultrasound exam is a useful
and easy-to-access tool for imme-
diate evaluation of bone lesions in
the medical departments of clubs,
especially when the bone cortical
has a superficial location. 14 In the
literature, it is described that in the
case of minor thoracic trauma, the
final diagnosis does not interfere
with the medical approach or with
the treatment itself 5,12,15 , since this is
mostly for symptomatic control. 2,5,13
However, at the level of professional
football, the prognosis and the fore-
cast of the recovery time for sporting
activity has a