Comparison of ultrasound-guided versus fluoroscopy-guided reduction of forearm fractures in children
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ORIGINAL ARTICLE
Comparison of ultrasound-guided versus fluoroscopy-guided reduction of forearm fractures in children Jason T. Gillon 1
&
Michael Gorn 1 & Matthew Wilkinson 1
Received: 2 September 2020 / Accepted: 1 October 2020 # American Society of Emergency Radiology 2020
Abstract Purpose Point-of-care ultrasound (POCUS) can be used to guide and assess reduction of pediatric forearm fractures. In this study, we sought to compare the success rate of ultrasound-guided fracture reduction with fluoroscopy-guided fracture reduction. We also sought to determine whether there are cost or time benefits to using ultrasound instead of fluoroscopy. Methods The electronic medical records of patients less than 18 years of age presenting to a pediatric emergency department with a forearm fracture between April 2016 and March 2019 were screened for inclusion in this study. A total of 27 ultrasound-guided reductions were identified during this time period and 81 fluoroscopy-guided reductions were randomly selected for comparison. Cost data was provided by the financial department. Reduction success, total length of stay, and costs were compared between the two groups, and multiple linear regression was used to determine the influence of any confounding predictor variables. Results There were no failed reductions in either group. Length of stay was shorter in the POCUS group (221 min) compared with the fluoroscopy group (254 min, p = 0.014), but this significance was lost in the regression model when adjusted for ketamine use. Provider costs ($430 v $442, p = 0.822) and total costs ($1219 v $1204, p = 0.851) were the same between the POCUS group and the fluoroscopy group, respectively. Conclusion POCUS appears to be an equally effective imaging modality to guide reduction of forearm fractures as compared to fluoroscopy. Keywords Ultrasound . POCUS . Forearm . Fracture . Children
Introduction Forearm fractures are the most common fracture in children, accounting for up to 50% of all fractures [1]. The majority of these fractures are fractures of the distal radius. The incidence of such fractures has been increasing in the pediatric population possibly due to an increase in sports participation [2]. Children with acute forearm fractures typically present to an emergency department (ED), where reduction is often required. Fracture reduction is commonly performed under fluoroscopy to assess reduction adequacy prior to splint or cast placement. Fluoroscopy, a source of ionizing radiation, has been associated with increased risk of neoplasm in children [3].
* Jason T. Gillon [email protected] 1
Division of Pediatric Emergency Medicine, University of Texas at Austin Dell Medical School, Austin, TX, USA
Point-of-care ultrasound (POCUS) has been increasingly utilized for the evaluation of musculoskeletal pathology in pediatrics. Identification and reduction of long bone fractures are both well described POCUS applications [4]. POCUS has excellent test characteristics to diagnose long bone fractures in children compared to the g
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