Şık Nihan, Öztürk Ali, Koşay Mustafa Can, Yılmaz Durgül, Duman Murat
Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey.
Department of Orthopedics and Traumatology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey.
Am J Emerg Med. 2021 Oct;48:243-248. doi: 10.1016/j.ajem.2021.05.021. Epub 2021 May 10.
The objective of the present study was to the determine the accuracy of point-of-care ultrasound (POCUS) in assessing closed reduction (CR) of pediatric forearm fractures in a pediatric emergency setting.
After determination of the need for CR using X-ray images by an orthopedic consultant, POCUS examinations were performed just before and after the reduction attempt. The transducer was positioned longitudinally over the dorsal, volar, and lateral surfaces of the radius and ulna to view the fracture site. The presence of angulation, displacement, or bayonetting of the fracture fragments was recorded. The adequacy of realignment according to the POCUS and the orthopedic consultant's final determination were recorded.
Sixty-two patients were enrolled in the study and 96 bones were evaluated. The sensitivity and specificity of POCUS for adequacy of CR were 95.8% [95% confidence interval (CI): 88.3-99.1)] and 95.8% (95% CI: 78.8-99.8), the positive predictive value was 98.5% (95% CI: 91.0-99.7), and the negative predictive value was 88.4% (95% CI: 71.6-95.8). The corresponding positive and negative likelihood ratios were 23 (3.37-156.77) and 0.04 (0.01-0.12). There was high agreement between POCUS and X-ray images for predicting adequacy of CR [κ: 0.892 (±0.053)]. There was also a significant correlation between POCUS and X-ray measurements of angulation and displacement performed before and after CR, respectively (p < 0.001).
Our study has reported the successful use of POCUS for the management of pediatric forearm fractures in a pediatric emergency department. Point-of-care ultrasound can minimize radiation exposure and appears to be an alternative and accurate tool for reduction attempts.
本研究的目的是确定在儿科急诊环境中，即时超声（POCUS）评估小儿前臂骨折闭合复位（CR）的准确性。
在骨科顾问通过X线影像确定需要进行CR后，在复位尝试前后立即进行POCUS检查。将探头纵向放置在桡骨和尺骨的背侧、掌侧及外侧表面，以观察骨折部位。记录骨折碎片的成角、移位或刺刀状畸形情况。记录根据POCUS判断的复位充分性以及骨科顾问的最终判定结果。
62例患者纳入本研究，共评估96根骨骼。POCUS判断CR充分性的敏感性和特异性分别为95.8%[95%置信区间（CI）：88.3 - 99.1]和95.8%（95%CI：78.8 - 99.8），阳性预测值为98.5%（95%CI：91.0 - 99.7），阴性预测值为88.4%（95%CI：71.6 - 95.8）。相应的阳性和阴性似然比分别为23（3.37 - 156.77）和0.04（0.01 - 0.12）。在预测CR充分性方面，POCUS与X线影像之间具有高度一致性[κ：0.892（±0.053）]。在CR前后分别进行的POCUS与X线测量的成角和移位之间也存在显著相关性（p < 0.001）。
我们的研究报告了POCUS在儿科急诊科成功用于小儿前臂骨折管理。即时超声可将辐射暴露降至最低，似乎是复位尝试的一种准确替代工具。
