title: Accuracy of ultrasonography for determining successful realignment of pediatric forearm fractures.
abstract: OBJECTIVE
  The primary objective of this study is to assess the accuracy of point-of-care ultrasonography compared with blinded orthopedic assessment of fluoroscopy in determining successful realignment of pediatric forearm fractures. The secondary objective is to determine the rate of agreement of ultrasonography and fluoroscopy in real-time by the treating physician.
  
  
  METHODS
  A cross-sectional study was conducted in children younger than 18 years and presenting to an academic emergency department with forearm fractures requiring realignment of a single bone. Physicians performed closed reductions with ultrasonographic assessment of realignment until the best possible reduction was achieved. Fluoroscopy was then immediately performed and images were saved. A positive test result was defined as an inadequately reduced fracture on fluoroscopy by a blinded pediatric orthopedic surgeon (reference standard) and on ultrasonography (index test) and fluoroscopy in real-time by the treating physician.
  
  
  RESULTS
  One hundred patients were enrolled (median age 12.1 years; 74% male patients); the radius was involved in 98%, with 27% involving the growth plate. The sensitivity, specificity, positive predictive value, and negative predictive value were 50% (95% confidence interval [CI] 15.4% to 84.6%), 89.1% (95% CI 82.8% to 95.5%), 28.6% (95% CI 4.9% to 52.2%), and 95.3% (95% CI 90.9% to 99.8%), respectively. The treating physicians' agreement rate of the real-time images was 98%.
  
  
  CONCLUSIONS
  Point-of-care ultrasonography can help emergency physicians determine when pediatric forearm fractures have been adequately realigned, but inadequate reductions should be confirmed by other imaging modalities.
authors.affiliation: Division of Pediatric Emergency Medicine, Montreal Children's Hospital-McGill University Health Center, Montreal, Quebec, Canada; Faculty of Medicine, McGill University, Montreal, Quebec, Canada. Electronic address: sasha.dubrovsky@mcgill.ca.
authors.forename: Alexander Sasha
authors.initials: AS
authors.lastname: Dubrovsky
authors.affiliation: Division of Pediatric Emergency Medicine, Hospital for Sick Children and Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Anna
authors.initials: A
authors.lastname: Kempinska
authors.affiliation: Division of Pediatric Emergency Medicine, Montreal Children's Hospital-McGill University Health Center, Montreal, Quebec, Canada; Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Centre for Medical Education and Arnold and Blema Steinberg Simulation Centre, McGill University, Montreal, Quebec, Canada.
authors.forename: Ilana
authors.initials: I
authors.lastname: Bank
authors.affiliation: Clinical Research Centre, Montreal Children's Hospital-McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: Elise
authors.initials: E
authors.lastname: Mok
mesh_terms: D000293:Adolescent; D002648:Child; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D005592:Fracture Fixation / Q000379:methods*; D006801:Humans; D008297:Male; D019095:Point-of-Care Systems; D011884:Radius / Q000000981:diagnostic imaging / Q000601:surgery; D011885:Radius Fractures / Q000000981:diagnostic imaging* / Q000601:surgery / Q000628:therapy; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018084:Ultrasonography, Interventional