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Diagnosis and management of fractures with point-of-care ultrasound

Diagnosis and management of fractures with point-of-care ultrasound. Why use ultrasound?. More accurate. More sensitive than physical exam (93% versus 83%) Marshburn, et al. J Trauma 2004

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Diagnosis and management of fractures with point-of-care ultrasound

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  1. Diagnosis and management of fractures with point-of-care ultrasound

  2. Why use ultrasound?

  3. More accurate • More sensitive than physical exam (93% versus 83%) Marshburn, et al. J Trauma 2004 • 100% specific even in the hands of non-physicians and overall accuracy 94% Dulchalvsky, et al. J Trauma 2002 • Ultrasound superior than xray in detecting rib fractures Griffith, et al. AJR 1999

  4. Time-saving • No studies looking at time to diagnosis • Can diagnose rib fractures before CT Kleckner, Del Rios, Lewiss. Ann Emerg Med 2008 • Can diagnose femoral neck fractures before MRI Meade, Del Rios. Manuscript in progress

  5. Portable • At the bedside • Easily repeated • Less manipulation of extremity

  6. Decrease radiation • Can guide fracture reduction successfully Chen, et al. Pediatric Emerg Care, 2007 and Durston, et al Am J Emerg Med 2000

  7. Technique

  8. Probe selection • High frequency linear probe in most cases • May need low frequency probe depending on body habitus

  9. Views • Longitudinal • scan along entire bone from proximal to distal articulation • note depth of soft tissue and cortex • Transverse • turn 90 degrees at site of disruption • note presence of hematoma and depth of soft tissue

  10. Normal anatomy • Bone is a bright reflector • Normal cortex is smooth and uninterrupted

  11. Focused questions • Is there an interruption in the bony cortex? • Can a degree of angulation or displacement be assessed?

  12. Other questions • Is there a hematoma at the site of the fracture? • Think procedural guidance • Is there significant disruption of the surrounding soft tissues?

  13. Pathology

  14. Water bath technique • Water is an excellent acoustic window Blaivas, et al. Am J Emerg Med 2004 • Clean, no need for direct contact of probe with structure of interest

  15. Pitfalls • Bone is too superficial or site TTP • Use standoff pad or water bath • Can’t find a break • Use your physical exam to guide position of probe • Strange anatomy • Look at the contralateral side

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