Point‐of‐care Ultrasound for Nonangulated Distal Forearm Fractures in Children: Test Performance Characteristics and Patient‐centered Outcomes

Abstract

Our findings suggest that POCUS assessment of distal forearm injuries in children is accurate, timely, and associated with low levels of pain and high caregiver satisfaction.

Getting started in paediatric emergency medicine point‐of‐care ultrasound: Five fundamental applications

“…Most of these are distal forearm injuries and occur as the result of a fall onto an outstretched hand. POCUS can rapidly and accurately detect fractures at the time of clinical review . After judicious analgesia, copious gel is applied to the child’s forearm and a high‐frequency linear probe is placed longitudinally on the dorsal, lateral and volar aspects of both the radius and ulna bones and slid distally to the wrist joint to visualise the physis .…”

“…After judicious analgesia, copious gel is applied to the child’s forearm and a high‐frequency linear probe is placed longitudinally on the dorsal, lateral and volar aspects of both the radius and ulna bones and slid distally to the wrist joint to visualise the physis . The pain associated with POCUS has been demonstrated to be similar to conventional radiographs of the forearm, but care must still be taken to avoid excessive movement or pressure . Bone cortex appears as a bright echogenic line with posterior acoustic shadowing, as bone attenuates transmission and reflects the sound waves back to the transducer (Figure ).…”

“…POCUS can rapidly and accurately detect fractures at the time of clinical review. [29][30][31] After judicious analgesia, copious gel is applied to the child's forearm and a high-frequency linear probe is placed longitudinally on the dorsal, lateral and volar aspects of both the radius and ulna bones and slid distally to the wrist joint to visualise the physis. 32 The pain associated with POCUS has been demonstrated to be similar to conventional radiographs of the forearm, but care must still be taken to avoid excessive movement or pressure.…”

“…32 The pain associated with POCUS has been demonstrated to be similar to conventional radiographs of the forearm, but care must still be taken to avoid excessive movement or pressure. 29,30 Bone cortex appears as a bright echogenic line with posterior acoustic shadowing, as bone attenuates transmission and reflects the sound waves back to the transducer ( Figure 5). A buckle fracture is identified by an asymmetrical (compared with uninjured side) angulation or deformity of the cortex without disruption on any aspect.…”

“…Ultrasound cannot always determine the exact fracture subtype, particularly for fractures around the physis. 28,29 For this reason, radiographic imaging is currently still required to further define distal forearm injuries. However, it may be possible to avoid radiographs in a select group of children with uncomplicated buckle fractures or no fracture detected on POCUS (Snelling PJ, 2020, unpublished data).…”