Distal Radius Fractures in Children

ABSTRACT Master thesis, programme in medicine Title Distal radius fractures in children: Can point-of-care ultrasonography decrease the need for radiographs? Author and year Christian Tingström, 2015. Institution Emergency Department, Sahlgrenska University Hospital, Drottning Silvias Barnsjukhus, Östra Sjukhuset, Gothenburg. City and country Gothenburg, Sweden. Background Pediatric fractures are very common and many of these involve the distal radius. Juvenile bones are different in structure compared to adults and display a different panorama of injuries and treatments. Radiographs are the gold standard, but recent studies have shown that ultrasonography can be used to diagnose skeletal injuries. Purpose We aimed to see if point-of-care ultrasonography performed by physicians unpracticed to ultrasonography was as good as radiographs in finding and differing between complete and incomplete distal radius fractures. The research question was to which extent ultrasonography could decrease the need of radiographs? Possible advantages (time, economy and radiation) in using fewer radiographs in favor of ultrasonography were discussed. Study design Comparative study. Methods The data was based on a population, three to sixteen years old, which attended children’s medical services within three days after trauma. Study physicians formed their opinion on if a fracture was present after ultrasonography examinations and radiographs respectively, the ultrasonography assessment was blinded to the radiographs. Cross tabulation with Cohen’s Kappa and One-sample T-test was used in IBM® SPSS Statistics to analyze inter-rater agreement. Results A total of sixty-nine patients were included in the study. The study physicians managed to correctly assess fifty-eight out of sixty-nine (84%) (95% CI, 75-93) cases compared with radiograph assessment. The study physicians managed to diagnose all fractures with an overestimation by two but classified five complete fractures as incomplete. Conclusion Point-of-care ultrasonography performed by physicians without former education on ultrasonography has a big potential in reducing the number of radiographs needed. However, further research is recommended to establish more accurate criteria when differing between incomplete and complete fractures. Key words Distal radius fractures, children, ultrasonography, point-of-care ultrasonography