title: The utility of bedside ultrasonography in identifying fractures and guiding fracture reduction in children.
abstract: OBJECTIVE
  To compare bedside ultrasonography (BUS) to radiography for identifying long bone fractures, the need for reduction, and the adequacy of reduction.
  
  
  METHODS
  Children aged 2 to 17 years presenting to a pediatric emergency department with long bone injuries were prospectively enrolled. Bedside ultrasonography was performed before ordering initial radiographs. If a fracture was identified, measurements of angulation and displacement were made based on BUS images. Radiographs were used to guide management. Patients who had a fracture identified on radiograph underwent standard care. Later, agreement between BUS and radiography for fracture identification, the need for reduction, and the adequacy of reduction were determined.
  
  
  RESULTS
  Thirty-three patients were enrolled, the mean age was 9.1 years (+/-3.1 years). Sixty six bones were studied; 56 (84.8%) involved the upper extremity. Fractures were identified in 59.1% of all bones; 13 (33.3%) required reduction.The agreement between BUS and radiography for fracture identification was 95.5%, for the need for reduction 92.3%, and for the adequacy of reduction 92.3%. The sensitivity and specificity of BUS for fracture identification, need for reduction and reduction adequacy was 0.97 (95% confidence interval [CI], 0.85-1.00), 0.93 (95% CI, 0.74-0.99), and 1.00 (95% CI 0.79-1.00), and 0.85 (95% CI, 0.61-0.96), 1.00 (95% CI, 0.59-1.00) and 0.80 (95% CI, 0.30-0.99), respectively.
  
  
  CONCLUSIONS
  These data suggest that BUS evaluation of upper extremity injuries not involving joints maybe comparable to radiography for identifying fractures, the need for reduction, and the adequacy of reduction in children. If further investigations which include a larger number of lower extremity, growth plate, and joint injuries support our findings, BUS may gain a more prominent role in managing children with all long bone injuries.
authors.affiliation: Albert Einstein College of Medicine, Lewis M. Fraad Departmentof Pediatrics, Emergency Medicine, Jacobi Medical Center, Bronx, NY 10461, USA.
authors.forename: Darshan D
authors.initials: DD
authors.lastname: Patel
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Blumberg
authors.forename: Ellen F
authors.initials: EF
authors.lastname: Crain
mesh_terms: D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005596:Fractures, Closed / Q000000981:diagnostic imaging* / Q000628:therapy; D006132:Growth Plate / Q000000981:diagnostic imaging; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging* / Q000628:therapy; D007223:Infant; D008297:Male; D019095:Point-of-Care Systems; D011446:Prospective Studies; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging* / Q000628:therapy; D000072042:Salter-Harris Fractures; D016037:Single-Blind Method; D013978:Tibial Fractures / Q000000981:diagnostic imaging* / Q000628:therapy; D014458:Ulna Fractures / Q000000981:diagnostic imaging* / Q000628:therapy; D014463:Ultrasonography