Chen Lei, Kim Yunie, Moore Christopher L
Section of Emergency Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06504, USA.
Pediatr Emerg Care. 2007 Aug;23(8):528-31. doi: 10.1097/PEC.0b013e318128f85d.
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.
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.
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.
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%).
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.
前臂骨折是儿童常见的损伤。移位和成角骨折通常需要复位。超声诊断和引导复位具有几个潜在优势：（1）该操作不涉及电离辐射；（2）与荧光透视设备相比，新型超声设备更便于携带；（3）可以轻松快速地进行重复检查。
主要目的是研究急诊科（ED）医生进行的超声检查在儿童前臂骨折诊断和引导复位中的准确性。
2004年6月至2004年11月，前瞻性纳入城市儿科急诊科疑似前臂骨折的儿童。由儿科急诊医学医生在前臂骨骼处进行床旁超声检查。将超声检查结果与X线片结果进行比较。在超声引导下进行复位。复位后进行X线片检查。记录是否需要进一步复位。
研究期间，共纳入68例患者。X线片显示48例患者存在前臂骨折。29例患者仅桡骨骨折；17例患者桡骨和尺骨均骨折，2例患者仅尺骨骨折。超声检查在46例患者中显示了正确的骨折类型和位置。超声检查检测前臂骨折的敏感性为97%（95%置信区间[CI]，89%-100%）。特异性为100%（95%CI，83%-100%）。26例患者在急诊科进行了骨折复位。2例患者在初次复位后需要再次复位。超声引导复位的初次成功率为92%（95%CI，75%-99%）。
儿科急诊医学医生进行的床旁超声检查是诊断儿童前臂骨折的可靠且便捷的方法。它在引导这些骨折的复位方面也很有用。
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