Jonathan D Auten1, John H Naheedy2, Nicole D Hurst3, Andrew T Pennock4, Kathryn A Hollenbach5, John T Kanegaye3. 1. Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, CA, United States; Rady Children's Hospital San Diego, San Diego, CA, United States. Electronic address: jonathan.d.auten.mil@mail.mil. 2. Rady Children's Hospital San Diego, San Diego, CA, United States; Department of Radiology, University of California San Diego School of Medicine, La Jolla, CA, United States. 3. Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, CA, United States; Rady Children's Hospital San Diego, San Diego, CA, United States. 4. Rady Children's Hospital San Diego, San Diego, CA, United States; Department of Orthopaedics, University of California San Diego School of Medicine, La Jolla, CA, United States. 5. Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, CA, United States; Rady Children's Hospital San Diego, San Diego, CA, United States; Skaggs School of Pharmacy, University of California San Diego, La Jolla, CA, United States.
Abstract
OBJECTIVE: Emergency department (ED) reduction of pediatric fractures occurs most commonly in the forearm and can be challenging if fluoroscopy is not available. We sought to assess the ability of point of-care ultrasonography (POCUS) to predict adequacy of reduction by fluoroscopy. METHODS: We prospectively enrolled ED patients 0-17 years of age with radial and/or ulnar fractures requiring reduction under fluoroscopic guidance. Post-reduction POCUS (probe dorsal, volar, and coronal) and fluoroscopic (AP and lateral) fracture images were recorded. Fracture angles were compared between blinded POCUS and fluoroscopic measurements and between POCUS measurements by a blinded emergency physician and a blinded radiologist, reporting mean differences and 95% confidence intervals. We calculated sensitivity, specificity, and likelihood ratios of POCUS in the prediction of fluoroscopically detected post-reduction malalignment, as interpreted by a blinded pediatric orthopaedist. RESULTS: The 58 patients were 7.9 ± 3.5 years of age and had 21 radial (36%), 1 ulnar (2%), and 36 radioulnar (62%) fractures. Fluoroscopy and POCUS angles were within a mean of 0.1°-3.2°, depending on the site and surface measured. Radiologist- and emergency physician-interpreted POCUS measurements were within a mean of 1° in all dimensions. POCUS identified inadequate reductions with 100% sensitivity and 92-93% specificity. CONCLUSIONS: Blinded emergency medicine and radiology interpretations of post-reduction POCUS fracture images agree closely. Post-reduction POCUS measurements are comparable to those obtained by fluoroscopy and accurately predict adequacy of reduction. POCUS can be used to guide pediatric fracture reduction when bedside fluoroscopy is not available in the ED. Published by Elsevier Inc.
OBJECTIVE: Emergency department (ED) reduction of pediatric fractures occurs most commonly in the forearm and can be challenging if fluoroscopy is not available. We sought to assess the ability of point of-care ultrasonography (POCUS) to predict adequacy of reduction by fluoroscopy. METHODS: We prospectively enrolled ED patients 0-17 years of age with radial and/or ulnar fractures requiring reduction under fluoroscopic guidance. Post-reduction POCUS (probe dorsal, volar, and coronal) and fluoroscopic (AP and lateral) fracture images were recorded. Fracture angles were compared between blinded POCUS and fluoroscopic measurements and between POCUS measurements by a blinded emergency physician and a blinded radiologist, reporting mean differences and 95% confidence intervals. We calculated sensitivity, specificity, and likelihood ratios of POCUS in the prediction of fluoroscopically detected post-reduction malalignment, as interpreted by a blinded pediatric orthopaedist. RESULTS: The 58 patients were 7.9 ± 3.5 years of age and had 21 radial (36%), 1 ulnar (2%), and 36 radioulnar (62%) fractures. Fluoroscopy and POCUS angles were within a mean of 0.1°-3.2°, depending on the site and surface measured. Radiologist- and emergency physician-interpreted POCUS measurements were within a mean of 1° in all dimensions. POCUS identified inadequate reductions with 100% sensitivity and 92-93% specificity. CONCLUSIONS: Blinded emergency medicine and radiology interpretations of post-reduction POCUS fracture images agree closely. Post-reduction POCUS measurements are comparable to those obtained by fluoroscopy and accurately predict adequacy of reduction. POCUS can be used to guide pediatric fracture reduction when bedside fluoroscopy is not available in the ED. Published by Elsevier Inc.
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