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