Sound Bite 5 - Distal Radius Fracture (Paeds, 1 of 2)

Author: Dr Nick Mani

8yr old child presents to the Emergency Department with an injury to the left wrist after a fall. The wrist is swollen and tender, but there is no deformity or angulation.

You elect to perform Point-of-Care Ultrasound (POCUS) of the right normal wrist and compare it to the left injured side (Snelling, P.J. et al. 2021 ): -

Normalogy- Right Distal Radius Dorsal Long Axis View

(Click the right arrow for annotation. Purple- Soft tissue, Green- Distal radial cortex)

Pathology- Left Distal Radius Dorsal Long Axis View Buckle Fracture (Same Patient)

(Click the right arrow for annotation. Purple- Soft tissue, Green- Distal radial cortex, Orange- Distal radius cortex buckling)

Due to the department guideline, you still send the child for an XR which confirms the diagnosis of buckle fracture that could be managed with a splint: -

References: -

Snelling, Peter J et al. “Bedside Ultrasound Conducted in Kids with distal upper Limb fractures in the Emergency Department (BUCKLED): a protocol for an open-label non-inferiority diagnostic randomised controlled trial.” Trials vol. 22,1 282. 14 Apr. 2021

Snelling, Peter J et al. “Nurse practitioner administered point-of-care ultrasound compared with X-ray for children with clinically non-angulated distal forearm fractures in the ED: a diagnostic study.” Emergency medicine journal : EMJ vol. 38,2 (2021): 139-145

Perry, Daniel C et al. “Immobilisation of torus fractures of the wrist in children (FORCE): a randomised controlled equivalence trial in the UK.” Lancet (London, England) vol. 400,10345 (2022): 39-47