Lei Chen1, Yunie Kim, Christopher L Moore. 1. Section of Emergency Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06504, USA. Lei.chen@yale.edu
Abstract
BACKGROUND: Forearm fractures are common injuries in children. Displaced and angulated fractures usually require reduction. Ultrasound diagnosis and guided reduction offer several potential advantages: (1) the procedure does not involve ionizing radiation; (2) compared with fluoroscopy units, the newer ultrasound units are more portable; and (3) repeated studies can be obtained easily and quickly. OBJECTIVE: The primary objective was to investigate the accuracy of emergency department (ED) physician-performed ultrasound in the diagnosis and guided reduction of forearm fractures in children. METHODS: Children suspected of having forearm fractures were enrolled prospectively in an urban pediatric ED from June 2004 to November 2004. A bedside ultrasound of the forearm bones was performed by a pediatric emergency medicine physician. Ultrasound findings were compared with radiograph findings. Reductions were performed under ultrasound guidance. Postreduction radiographs were performed. Any need for further reduction was recorded. RESULTS: During the study period, 68 patients were enrolled. Radiographs revealed forearm fractures in 48 patients. Twenty-nine subjects had fractures of the radius alone; 17 had fractures of both the radius and the ulna, and 2 had fractures of the ulna alone. Ultrasound revealed the correct type and location of the fracture in 46 patients. The sensitivity for the detection of forearm fractures was 97% (95% confidence interval [CI], 89%-100%) using ultrasound. The specificity was 100% (95% CI, 83%-100%). Twenty-six subjects underwent reduction of their fractures in the ED. Two subjects required rereduction after the initial reduction. The initial success rate of ultrasound-guided reduction was 92% (95% CI, 75%-99%). CONCLUSIONS: Bedside ultrasound performed by pediatric emergency medicine physicians is a reliable and convenient method of diagnosing forearm fractures in children. It is also useful in guiding the reduction of these fractures.
BACKGROUND: Forearm fractures are common injuries in children. Displaced and angulated fractures usually require reduction. Ultrasound diagnosis and guided reduction offer several potential advantages: (1) the procedure does not involve ionizing radiation; (2) compared with fluoroscopy units, the newer ultrasound units are more portable; and (3) repeated studies can be obtained easily and quickly. OBJECTIVE: The primary objective was to investigate the accuracy of emergency department (ED) physician-performed ultrasound in the diagnosis and guided reduction of forearm fractures in children. METHODS:Children suspected of having forearm fractures were enrolled prospectively in an urban pediatric ED from June 2004 to November 2004. A bedside ultrasound of the forearm bones was performed by a pediatric emergency medicine physician. Ultrasound findings were compared with radiograph findings. Reductions were performed under ultrasound guidance. Postreduction radiographs were performed. Any need for further reduction was recorded. RESULTS: During the study period, 68 patients were enrolled. Radiographs revealed forearm fractures in 48 patients. Twenty-nine subjects had fractures of the radius alone; 17 had fractures of both the radius and the ulna, and 2 had fractures of the ulna alone. Ultrasound revealed the correct type and location of the fracture in 46 patients. The sensitivity for the detection of forearm fractures was 97% (95% confidence interval [CI], 89%-100%) using ultrasound. The specificity was 100% (95% CI, 83%-100%). Twenty-six subjects underwent reduction of their fractures in the ED. Two subjects required rereduction after the initial reduction. The initial success rate of ultrasound-guided reduction was 92% (95% CI, 75%-99%). CONCLUSIONS: Bedside ultrasound performed by pediatric emergency medicine physicians is a reliable and convenient method of diagnosing forearm fractures in children. It is also useful in guiding the reduction of these fractures.
Authors: Alan J R Macfarlane; Brian D Sites; Vincent R Sites; Ali M Naraghi; Vincent W S Chan; Mandeep Singh; John G Antonakakis; Richard Brull Journal: HSS J Date: 2010-08-17
Authors: Jennifer R Marin; Alyssa M Abo; Alexander C Arroyo; Stephanie J Doniger; Jason W Fischer; Rachel Rempell; Brandi Gary; James F Holmes; David O Kessler; Samuel H F Lam; Marla C Levine; Jason A Levy; Alice Murray; Lorraine Ng; Vicki E Noble; Daniela Ramirez-Schrempp; David C Riley; Turandot Saul; Vaishali Shah; Adam B Sivitz; Ee Tein Tay; David Teng; Lindsey Chaudoin; James W Tsung; Rebecca L Vieira; Yaffa M Vitberg; Resa E Lewiss Journal: Crit Ultrasound J Date: 2016-11-03
Authors: Klaus Dresing; Ralf Kraus; Francisco Fernandez; Peter Schmittenbecher; Kaya Dresing; Peter Strohm; Christopher Spering Journal: Unfallchirurg Date: 2021-12-16 Impact factor: 1.000
Authors: Duncan Smith-Rohrberg Maru; Ryan Schwarz; Andrews Jason; Sanjay Basu; Aditya Sharma; Christopher Moore Journal: Global Health Date: 2010-10-14 Impact factor: 4.185
Authors: Azzam S Al-Kadi; Lawrence M Gillman; Chad G Ball; Nova L Panebianco; Andrew W Kirkpatrick Journal: Eur J Trauma Emerg Surg Date: 2009-07-15 Impact factor: 3.693