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Point-of-Care Ultrasound Fracture–Physis Distance Association with Salter–Harris II Fractures of the Distal Radius in Children: The “POCUS 1-cm Rule”

  • Peter J. Snelling
    Correspondence
    Address correspondence to: Peter J. Snelling, Emergency Department, Gold Coast University Hospital, 1 Hospital Blvd, Southport, Queensland, 4215, Australia.
    Affiliations
    School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia

    Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia

    Sonography Innovation and Research (Sonar) Group, Queensland, Australia

    Child Health Research Centre, University of Queensland, South Brisbane, Queensland, Australia

    Queensland Children's Hospital, South Brisbane, Queensland, Australia
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  • Philip Jones
    Affiliations
    School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia

    Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia

    Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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  • Alan Gillespie
    Affiliations
    Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia
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  • David Bade
    Affiliations
    Queensland Children's Hospital, South Brisbane, Queensland, Australia
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  • Gerben Keijzers
    Affiliations
    School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia

    Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia

    Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
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  • Robert S. Ware
    Affiliations
    School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
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      Abstract

      Salter–Harris II fractures of the distal radius can result in serious complications. The aim of this study was to measure the fracture–physis distance using point-of-care ultrasound (POCUS) to determine whether a certain distance is associated with Salter–Harris II fractures, compared with other fracture types, in a cohort of children with X-ray–identified distal radius fractures. Participants were from a parent diagnostic study conducted in an Australian tertiary pediatric emergency department, which prospectively evaluated the diagnosis of pediatric distal forearm fractures using POCUS compared against X-ray. Nurse practitioners, who underwent 2 h of training, administered a six-view POCUS protocol in clinically non-angulated pediatric forearm injuries prior to X-ray. This was a secondary analysis of data from the parent study. The 122 participants with X-ray–identified distal radius fractures from the parent study had their POCUS images interpreted by two emergency physician sonologists, who measured the fracture–physis distance. The median and maximum fracture–physis distances for Salter–Harris II fractures (n = 19) were 8.00 and 9.85 mm, whereas minimum and median distances for incomplete fractures (n = 22) were 10.20 and 15.98 mm, and those for complete fractures (n = 9) were 10.85 and 12.85 mm. Buckle fracture (n = 72) distances ranged from 4.35 to 26.55 mm, with a median of 13.65 mm. In children diagnosed with a distal radius fracture on X-ray, a fracture–physis distance cutoff of 1 cm differentiated Salter–Harris II fractures from other cortical breach fracture types, but not buckle fractures. Although this exploratory study suggests the “POCUS 1-cm rule” could be used as a secondary sign to augment the diagnosis of Salter–Harris II distal radius fractures using POCUS, further research is required to validate this measurement prospectively.

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