Fellow, Pediatric Emergency Medicine Oregon Health & Science University Portland, Oregon, United States
Background: There is a growing body of literature to support the use of ultrasound in management of long bone fractures in adult patients with forearm fractures. Children’s bones differ from adult bones in two important ways: 1) the presence of an open physis consisting of non-ossified bone which is not visible on standard radiograph and appears as a radiolucency; 2) the morphology of fractures in pediatric long bones including buckle fractures which can be missed on radiographs. Ultrasound may be a readily accessible tool to distinguish between fractured and intact bones in pediatric patients in an emergency setting and provide information relevant to the management of these injuries. Objective: To document and describe ultrasonographic images of pediatric long bones (radius, ulna, tibia, fibula) including identification of bone and physis. To document and describe ultrasonographic images of different fracture morphologies in pediatric long bones: Salter-Harris I-V, buckle, greenstick, spiral/toddler’s fracture, displaced vs nondisplaced fractures. Design/Methods: An IRB approved prospective convenience sample of patients aged 0-18 years in an urban level 1 pediatric trauma center with extremity injury or pain are currently being enrolled. Ultrasound images of injured and matched uninjured extremity are obtained by pediatric emergency medicine physicians using high frequency linear array transducers. Sonogram of injured and uninjured extremities are compared. Sonogram of injured extremity is additionally compared to radiograph as gold standard. We will qualitatively describe appearance of bone, periosteal lift, soft tissue changes, hematoma formation in fracture and nonfractured states. Measurements by calipers on US machine and compared to measurements on radiograph of displacement, angulation, shortening; t-test will be used. Pearson correlation coefficient will used to measure the strength of relationship. Currently enrolling patients with expected completion of enrollment by January 2024, data analysis and manuscript production to be completed by April 2024.
