Emergency department point-of-care ultrasound in forearm fracture management
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Shaye Seefried et al., in their paper Paediatric forearm fractures manipulated in the emergency department: incidence and risk factors for re-manipulation under general anaesthesia,[[1]] show a high rate of reduction failure in forearm fractures in children in the Starship Hospital Emergency Department (ED). They suggest that the use of fluoroscopy in the ED would obviate the associated financial and opportunity costs of reduction failure.
A cheaper and more available real-time imaging modality is point-of-care ultrasound (POCUS). Many studies over the last 5 years show the accuracy of POCUS-assisted fracture reduction in the ED.[[2–5]] Every ED has an ultrasound machine: many emergency physicians have been using POCUS to assist in fracture assessment and management for more than a decade. By adopting POCUS as the modality of choice in fracture reduction, the additional costs of specialised radiation equipment, its storage, safety and maintenance can be circumvented in what are already cluttered EDs.
POCUS-assisted fracture reduction has also been shown to reduce ED length of stay.[[6]]
In addition to reducing the need for re-manipulation, the use of POCUS presents an opportunity for orthopaedic trainees to add this skill to their therapeutic repertoire.
Summary
Abstract
Aim
Method
Results
Conclusion
Author Information
Acknowledgements
Correspondence
Correspondence Email
Competing Interests
1) Seefried S, Chin-Goh K, Sahakian V, et al. Paediatric forearm fractures manipulated in the emergency department: incidence and risk factors for re-manipulation under general anaesthesia. N Z Med J. 2022;135(1560):60-66.
2) Auten JD, Naheedy JH, Hurst ND, et al. Comparison of pediatric post-reduction fluoroscopic- ultrasound forearm fracture images. Am J Emerg Med. 2019;37(5):832-38. doi: 10.1016/j.ajem.2018.07.050.
3) Scheier E, Balla U. Ultrasound-Guided Distal Forearm Fracture Reduction by Pediatric Emergency Physicians: A Single Center Retrospective Study. Pediatr Emerg Care. 2022;38(2):e756-e760. doi: 10.1097/PEC.0000000000002464.
4) Ottenhoff J, Kongkatong M, Hewitt M, et al. A Narrative Review of the Uses of Ultrasound in the Evaluation, Analgesia, and Treatment of Distal Forearm Fractures. J Emerg Med. 2022 Dec;63(6):755-765. doi: 10.1016/j.jemermed.2022.09.012.
5) Wood D, Reddy M, Postma I, et al. Ultrasound in forearm fractures: a pragmatic study assessing the utility of Point of Care Ultrasound (PoCUS) in identifying and managing distal radius fractures. Emerg Radiol. 2021;28(6):1107-1112. doi: 10.1007/s10140-021-01957-8.
6) Gillon J, Gorn M, Wilkinson M. Comparison of ultrasound -guided versus fluoroscopy-guided reduction of forearm fractures in children. Emerg Radiol. 2021;28:303-07.
For the PDF of this article,
contact nzmj@nzma.org.nz
Emergency department point-of-care ultrasound in forearm fracture management
View Article PDF
Shaye Seefried et al., in their paper Paediatric forearm fractures manipulated in the emergency department: incidence and risk factors for re-manipulation under general anaesthesia,[[1]] show a high rate of reduction failure in forearm fractures in children in the Starship Hospital Emergency Department (ED). They suggest that the use of fluoroscopy in the ED would obviate the associated financial and opportunity costs of reduction failure.
A cheaper and more available real-time imaging modality is point-of-care ultrasound (POCUS). Many studies over the last 5 years show the accuracy of POCUS-assisted fracture reduction in the ED.[[2–5]] Every ED has an ultrasound machine: many emergency physicians have been using POCUS to assist in fracture assessment and management for more than a decade. By adopting POCUS as the modality of choice in fracture reduction, the additional costs of specialised radiation equipment, its storage, safety and maintenance can be circumvented in what are already cluttered EDs.
POCUS-assisted fracture reduction has also been shown to reduce ED length of stay.[[6]]
In addition to reducing the need for re-manipulation, the use of POCUS presents an opportunity for orthopaedic trainees to add this skill to their therapeutic repertoire.
Summary
Abstract
Aim
Method
Results
Conclusion
Author Information
Acknowledgements
Correspondence
Correspondence Email
Competing Interests
1) Seefried S, Chin-Goh K, Sahakian V, et al. Paediatric forearm fractures manipulated in the emergency department: incidence and risk factors for re-manipulation under general anaesthesia. N Z Med J. 2022;135(1560):60-66.
2) Auten JD, Naheedy JH, Hurst ND, et al. Comparison of pediatric post-reduction fluoroscopic- ultrasound forearm fracture images. Am J Emerg Med. 2019;37(5):832-38. doi: 10.1016/j.ajem.2018.07.050.
3) Scheier E, Balla U. Ultrasound-Guided Distal Forearm Fracture Reduction by Pediatric Emergency Physicians: A Single Center Retrospective Study. Pediatr Emerg Care. 2022;38(2):e756-e760. doi: 10.1097/PEC.0000000000002464.
4) Ottenhoff J, Kongkatong M, Hewitt M, et al. A Narrative Review of the Uses of Ultrasound in the Evaluation, Analgesia, and Treatment of Distal Forearm Fractures. J Emerg Med. 2022 Dec;63(6):755-765. doi: 10.1016/j.jemermed.2022.09.012.
5) Wood D, Reddy M, Postma I, et al. Ultrasound in forearm fractures: a pragmatic study assessing the utility of Point of Care Ultrasound (PoCUS) in identifying and managing distal radius fractures. Emerg Radiol. 2021;28(6):1107-1112. doi: 10.1007/s10140-021-01957-8.
6) Gillon J, Gorn M, Wilkinson M. Comparison of ultrasound -guided versus fluoroscopy-guided reduction of forearm fractures in children. Emerg Radiol. 2021;28:303-07.
For the PDF of this article,
contact nzmj@nzma.org.nz
Emergency department point-of-care ultrasound in forearm fracture management
View Article PDF
Shaye Seefried et al., in their paper Paediatric forearm fractures manipulated in the emergency department: incidence and risk factors for re-manipulation under general anaesthesia,[[1]] show a high rate of reduction failure in forearm fractures in children in the Starship Hospital Emergency Department (ED). They suggest that the use of fluoroscopy in the ED would obviate the associated financial and opportunity costs of reduction failure.
A cheaper and more available real-time imaging modality is point-of-care ultrasound (POCUS). Many studies over the last 5 years show the accuracy of POCUS-assisted fracture reduction in the ED.[[2–5]] Every ED has an ultrasound machine: many emergency physicians have been using POCUS to assist in fracture assessment and management for more than a decade. By adopting POCUS as the modality of choice in fracture reduction, the additional costs of specialised radiation equipment, its storage, safety and maintenance can be circumvented in what are already cluttered EDs.
POCUS-assisted fracture reduction has also been shown to reduce ED length of stay.[[6]]
In addition to reducing the need for re-manipulation, the use of POCUS presents an opportunity for orthopaedic trainees to add this skill to their therapeutic repertoire.
Summary
Abstract
Aim
Method
Results
Conclusion
Author Information
Acknowledgements
Correspondence
Correspondence Email
Competing Interests
1) Seefried S, Chin-Goh K, Sahakian V, et al. Paediatric forearm fractures manipulated in the emergency department: incidence and risk factors for re-manipulation under general anaesthesia. N Z Med J. 2022;135(1560):60-66.
2) Auten JD, Naheedy JH, Hurst ND, et al. Comparison of pediatric post-reduction fluoroscopic- ultrasound forearm fracture images. Am J Emerg Med. 2019;37(5):832-38. doi: 10.1016/j.ajem.2018.07.050.
3) Scheier E, Balla U. Ultrasound-Guided Distal Forearm Fracture Reduction by Pediatric Emergency Physicians: A Single Center Retrospective Study. Pediatr Emerg Care. 2022;38(2):e756-e760. doi: 10.1097/PEC.0000000000002464.
4) Ottenhoff J, Kongkatong M, Hewitt M, et al. A Narrative Review of the Uses of Ultrasound in the Evaluation, Analgesia, and Treatment of Distal Forearm Fractures. J Emerg Med. 2022 Dec;63(6):755-765. doi: 10.1016/j.jemermed.2022.09.012.
5) Wood D, Reddy M, Postma I, et al. Ultrasound in forearm fractures: a pragmatic study assessing the utility of Point of Care Ultrasound (PoCUS) in identifying and managing distal radius fractures. Emerg Radiol. 2021;28(6):1107-1112. doi: 10.1007/s10140-021-01957-8.
6) Gillon J, Gorn M, Wilkinson M. Comparison of ultrasound -guided versus fluoroscopy-guided reduction of forearm fractures in children. Emerg Radiol. 2021;28:303-07.
Contact diana@nzma.org.nz
for the PDF of this article
Emergency department point-of-care ultrasound in forearm fracture management
Shaye Seefried et al., in their paper Paediatric forearm fractures manipulated in the emergency department: incidence and risk factors for re-manipulation under general anaesthesia, show a high rate of reduction failure in forearm fractures in children in the Starship Hospital Emergency Department (ED).
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