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Abstract
BACKGROUND Clinical examination after trauma, especially in young children, often proves difficult. As a result, the majority of images show unremarkable findings in the imaging workup of trauma by radiography. Sonography represents an imaging technique without the use of X-rays. As the quality of ultrasound equipment has increased over the past 20 years, numerous studies have demonstrated that fractures in children and adolescents can be detected with very high sensitivity and specificity by sonography. METHOD This paper reviews the results obtained so far in the literature. Based on these findings, the importance of sonographic fracture diagnosis in childhood and adolescence for the most important locations is demonstrated. RESULTS When examining with a high-frequency linear transducer, sensitivities and specificities of more than 90 % can be achieved for the detection of fractures. Dislocations are also reliably detected. In contrast to X-ray examination, sonography allows the diagnosis of cartilage and soft-tissue injuries. Sonography reveals callus formation earlier than radiographs. The examination causes less pain than X-ray examination. If sonographic clarification is limited purely to fracture detection or exclusion, less time is required compared to X-ray diagnosis. The procedure can be learned quickly. If the documentation follows a defined standard examination procedure, the results can also be reproduced by non-examiners. CONCLUSION So far, sonography has only been an additive procedure in fracture diagnosis. However, there are now initial recommendations for sonographic fracture diagnosis alone, such as in skull, clavicle and non-displaced distal forearm fractures. KEY POINTS · Sonography can be used to detect or rule out fractures very sensitively.. · Sonographic examination causes less pain than X-ray examination.. · Sonography is usually an additive procedure in fracture diagnosis.. · In the meantime, sonography alone may be sufficient for diagnosing individual fractures.. ZITIERWEISE · Moritz JD. Sonografische Frakturdiagnostik im Kindes- und Jugendalter. Fortschr Röntgenstr 2023; 195: 790 - 796.
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Affiliation(s)
- Jörg Detlev Moritz
- Radiology and Neuroradiology, Pediatric Radiology, UK-SH, Campus Kiel, Germany
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Fan Y, Liu Q, Yu X, Zhang J, Wang W, Liu C. Ultrasound, a new adjuvant method for treating acute Monteggia fracture in children. J Orthop Surg Res 2023; 18:595. [PMID: 37568239 PMCID: PMC10422793 DOI: 10.1186/s13018-023-04075-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
PURPOSE This study aims to evaluate the feasibility of using ultrasound-guided Kirschner wire or elastic intramedullary nail for fixation in the treatment of acute Monteggia fracture in children. METHODS A retrospective analysis was conducted on 31 cases of acute Monteggia fracture in children treated with ultrasound-guided Kirschner wire or elastic intramedullary nail fixation between April 2020 and December 2022, including 14 cases of Kirschner wire fixation and 17 cases of elastic intramedullary nail fixation. During the operation, soft tissue compression and nerve and vascular injuries were explored, fracture reduction was performed under ultrasound guidance, and operation time was recorded. After the operation, X-ray examination was conducted to assess the quality of fracture reduction. At the last follow-up, the flexion, extension, pronation, and supination angles of both affected and unaffected elbow joints were measured, and the Mayo score was used to evaluate elbow joint function. RESULTS The average duration of surgery was 50.16 ± 19.21 min (ranging from 20 to 100 min). Based on the evaluation criteria for assessing reduction quality, 28 cases were deemed excellent, while 3 cases were considered good. After immobilization with long-arm cast for 4-6 weeks postoperatively, elbow and forearm rotation exercises were performed. Kirschner wires were removed after an average of 6.64 ± 0.93 weeks (ranging from 6 to 9 weeks) postoperatively, and elastic intramedullary nails were removed after an average of 5.12 ± 1.54 months (ranging from 4 to 10 months) postoperatively. The average follow-up time was 19.13 ± 11.22 months (ranging from 4 to 36 months). During the final follow-up, the affected limb's range of motion in flexion, extension, pronation, and supination was (141.16 ± 4.24)°, (4.61 ± 2.81)°, (84.52 ± 3.74)°, and (84.23 ± 3.69)°, respectively. There was no notable variance when compared to the healthy limb, which had a range of motion of (141.81 ± 2.99)°, (4.81 ± 2.50)°, (85.61 ± 3.12)°, and (85.03 ± 2.73)° (P > 0.05). The Mayo Elbow Performance index classified 29 cases as excellent and 2 cases as good. CONCLUSION Ultrasound-guided Kirschner wire or elastic intramedullary nail fixation can be used for the treatment of acute Monteggia fracture in children, which can explore the surrounding nerves, blood vessels, and soft tissue compression, reduce the difficulty of reduction, and cause minimal trauma. It can greatly reduce the risk of radiation exposure and complications such as vascular and nerve injury during the operation.
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Affiliation(s)
- YongFei Fan
- Department of Orthopaedic Surgery, Fuyang People’s Hospital Affiliated to Anhui Medical University, Anhui Spinal Deformity and Clinical Medical Research Center, Fuyang People’s Hospital, Fuyang, 236000 Anhui People’s Republic of China
| | - QiXin Liu
- Department of Orthopaedic Surgery, Fuyang People’s Hospital Affiliated to Anhui Medical University, Anhui Spinal Deformity and Clinical Medical Research Center, Fuyang People’s Hospital, Fuyang, 236000 Anhui People’s Republic of China
| | - XueDi Yu
- Department of Ultrasound, Fuyang People’s Hospital Affiliated to Anhui Medical University, Fuyang People’s Hospital, Fuyang, 236000 Anhui People’s Republic of China
| | - JianQiang Zhang
- Department of Orthopaedic Surgery, Fuyang People’s Hospital Affiliated to Anhui Medical University, Anhui Spinal Deformity and Clinical Medical Research Center, Fuyang People’s Hospital, Fuyang, 236000 Anhui People’s Republic of China
| | - Wei Wang
- Department of Orthopaedic Surgery, Fuyang People’s Hospital Affiliated to Anhui Medical University, Anhui Spinal Deformity and Clinical Medical Research Center, Fuyang People’s Hospital, Fuyang, 236000 Anhui People’s Republic of China
| | - ChaoYu Liu
- Department of Orthopaedic Surgery, Fuyang People’s Hospital Affiliated to Anhui Medical University, Anhui Spinal Deformity and Clinical Medical Research Center, Fuyang People’s Hospital, Fuyang, 236000 Anhui People’s Republic of China
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Jia S, Wang J, Yu B, Xu C, Li K. Ultrasound assistance in treatment with elastic stable intramedullary nail fixation in radial and ulnar fractures in children. INTERNATIONAL ORTHOPAEDICS 2023; 47:773-779. [PMID: 36629850 DOI: 10.1007/s00264-022-05683-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE Radial and ulnar fractures are one of the most common fractures in children. When closed reduction of fractures fails, elastic stable intramedullary nail (ESIN) fixation can mostly be used under the guidance of fluoroscopy. In this study, we evaluated the effect of ultrasound (US) as assistance for radial and ulnar fracture reduction and the insertion of ESINs. METHODS There were 56 patients with midshaft radial and ulnar fractures included in our hospital from March 2019 to August 2021. After applying the inclusion and exclusion criteria and according to the treatment method, they were divided into the US group (patients treated with US assistance) and the conventional group (C-group, patients treated with fluoroscopy guidance). All patients' clinical data were collected. Operation time, fluoroscopy times, radiation dose, and post-operative complications were analyzed. The elbow function was evaluated using the Mayo Elbow Performance Index. RESULTS There were 26 patients in the US group and 30 in the C-group. The average operation time was 44.5±19.4 min in the US group and 65.1±16.2 min in the C-group. There were significant differences regarding the surgery time, fluoroscopy time, and radiation dose between the groups (all p = 0.001). The average follow-up time was 13.5±3.1 months. No significant difference was found regarding radial nerve injury, extensor pollicis longus rupture, non-union or delayed union, ulnar nerve injury, or acute compartment syndrome. There was no difference in elbow function at the final follow-up. CONCLUSION US guidance can be adopted for the treatment of displaced radial and ulnar fracture reduction and the insertion of ESINs. It can significantly decrease fluoroscopy times, radiation doses, and duration of surgery.
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Affiliation(s)
- Song Jia
- Pediatric Surgery, The Second Affiliated Hospital of Shandong First Medical University, Changcheng Road 619#, Taian City, Shandong Province, China
| | - Jing Wang
- Ultrasound Department, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, China
| | - Baohua Yu
- Pediatric Orthopedics, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Cheng Xu
- Pediatric Surgery, The Second Affiliated Hospital of Shandong First Medical University, Changcheng Road 619#, Taian City, Shandong Province, China
| | - Kuang Li
- Pediatric Surgery, The Second Affiliated Hospital of Shandong First Medical University, Changcheng Road 619#, Taian City, Shandong Province, China.
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Dresing K, Kraus R, Fernandez F, Schmittenbecher P, Dresing K, Strohm P, Spering C. [Imaging after trauma in clinics and practice for children and adolescents : Part 1 of the results of a nationwide online survey of the Pediatric Traumatology Section of the German Trauma Society]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:34-41. [PMID: 34918189 PMCID: PMC9842554 DOI: 10.1007/s00113-021-01115-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND The indication for radiography should strictly follow the ALARA (as low as reasonably achievable) principle in pediatric and adolescent trauma patients. The effect of radiation on the growing sensitive tissue of these patients should not be disregarded. QUESTION The Pediatric Traumatology Section (SKT) of the German Trauma Society (DGU) wanted to clarify how the principle is followed in trauma care. METHODS An online survey was open for 10 weeks. Target groups were trauma surgeons, pediatric surgeons, general surgeons, and orthopedic surgeons. RESULTS From Nov. 15, 2019, to Feb. 29, 2020, 788 physicians participated: branch office 20.56%, MVZ 4.31%, hospital 75.13%; resident 16.62%, senior 38.07%, chief 22.59%. By specialist qualification, the distribution was: 38.34% surgery, 33.16% trauma surgery, 36.66% special trauma surgery, 70.34% orthopedics and trauma surgery, 18.78% pediatric surgery. Frequency of contact with fractures in the above age group was reported as 37% < 10/month, 27% < 20/M, 36% > 20/M. About 52% always request radiographs in 2 planes after acute trauma. X-ray of the opposite side for unclear findings was rejected by 70%. 23% use sonography regularly in fracture diagnosis. In polytrauma children and adolescents, whole-body CT is never used in 18%, rarely in 50%, and standard in 14%. DISCUSSION The analysis shows that there is no uniform radiological management of children and adolescents with fractures among the respondents. CONCLUSION Comparing the results of the survey with the consensus findings of the SKT recently published in this journal, persuasion is still needed to change the use of radiography in primary diagnosis.
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Affiliation(s)
- Klaus Dresing
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Deutschland.
| | - Ralf Kraus
- Klinik für Unfallchirurgie und Orthopädie, Klinikum Bad Hersfeld, Bad Hersfeld, Deutschland
| | - Francisco Fernandez
- Kindertraumatologie, Klinikum Stuttgart Olgahospital, Stuttgart, Deutschland
| | | | - Kaya Dresing
- Darmstädter Kinderkliniken Prinzessin Margaret, Darmstadt, Deutschland
| | - Peter Strohm
- Klinik für Orthopädie und Unfallchirurgie, Klinikum Bamberg, Bamberg, Deutschland
| | - Christopher Spering
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Deutschland
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Kotlarsky P, Feldman O, Shavit I, Eidelman M. The use of real-time sonography-assisted fracture reduction in children with displaced forearm fractures. J Pediatr Orthop B 2022; 31:303-309. [PMID: 34074920 DOI: 10.1097/bpb.0000000000000886] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pediatric forearm and wrist fractures are common; furthermore, some are displaced and require manipulation and reduction. The procedure is commonly performed without real-time image guidance and evaluated radiographically after reduction and casting, leading to multiple reduction attempts and malalignment. Although fluoroscopy can provide real-time assessment of fracture alignment during the procedure, it is not readily available in many emergency departments (EDs) and involves radiation exposure. Ultrasonography is an alternative real-time imaging modality that is inexpensive and readily available. The purpose of this study was to determine whether the use of real-time bedside sonography during closed reduction of distal and middle third forearm fractures can decrease the number of reduction attempts and reduce the number of patients requiring surgery. We compared the results of a conventional blind manipulation, fracture reduction, and casting to fracture reduction under real-time ultrasonographic guidance, in patients treated in our ED between 2014 and 2016. Overall, 458 patients with distal or middle third fractures were included. Of these reductions, 289 were performed without real-time imaging (group 1) and 169 under real-time ultrasound guidance (group 2). In group 1, 10% of patients required re-reduction, and 5% of patients needed surgery. In group 2, only one patient (0.6%) required re-reduction and 1% of patients required surgery due to fracture instability. In conclusion, the current study shows that real-time ultrasound-guided forearm fracture reduction is an effective and inexpensive method for correction of displaced forearm and wrist fractures in children, which does not involve any radiation exposure.
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Affiliation(s)
| | - Oren Feldman
- Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel
| | - Itai Shavit
- Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel
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Scheier E, Balla U. Ultrasound-Guided Distal Forearm Fracture Reduction by Pediatric Emergency Physicians: A Single Center Retrospective Study. Pediatr Emerg Care 2022; 38:e756-e760. [PMID: 34140450 DOI: 10.1097/pec.0000000000002464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Fracture reduction under point-of-care ultrasound (POCUS) guidance facilitates measurement of residual angulation or displacement that may not be apparent on examination. Point-of-care ultrasound is without patient or staff exposure to ionizing radiation and enlists no additional staffing resources or patient transfer. METHODS We conducted a chart review of all children who underwent reduction of a distal forearm fracture in the pediatric emergency department over a 2-year period, from September 2018 to September 2020. We compared length of stay (LOS) with that for orthopedist-performed distal forearm reductions during the study period. We allowed a 6-week lag period to ensure no missed rereduction before analyzing the data. After reduction, children were instructed to follow up with an orthopedist within 1 week. Children with loss of reduction on orthopedic follow-up are referred back through our emergency department for operative reduction. RESULTS A total of 74 children with 75 distal forearm fractures were identified. Average LOS was 179 minutes for the pediatric emergency medicine physician reductions and 215 minutes for the orthopedist reductions (P < 0.001). Ninety-six percent of reductions were completed with POCUS assistance, and 61% had less than 5 degrees of angulation on postreduction radiography. Only 2.7% of children underwent rereduction. CONCLUSIONS Distal forearm fracture reductions by a pediatric emergency medicine physician under POCUS guidance have a high rate of excellent alignment, low rate of failed reduction, and significantly shorter LOS (P < 0.001) than reductions performed by orthopedists.
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Affiliation(s)
- Eric Scheier
- From the Pediatric Emergency Medicine, Kaplan Medical Center, Rehovot; and Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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Abstract
INTRODUCTION Pediatric orthopaedic patients have the potential for significant radiation exposure from the use of imaging studies, such as computed tomography and bone scintigraphy. With the potential for long-term treatment, such as is required for scoliosis or osteogenesis imperfecta, patients are at even greater risk of radiation-induced carcinogenesis. DISCUSSION Although an association between radiation and cancer risk is evident, causation is difficult to prove because comorbidities or genetic predispositions may play a role in the higher baseline rates of malignancy later in life. Efforts have been made over the years to reduce exposure using more modern imaging techniques and simple radiation reduction strategies. Educational efforts and clinical practice guidelines are decreasing the rate of computed tomography scan use in pediatrics. Although considerable work is being done on the development of radiation-free imaging modalities, imaging that uses ionizing radiation will, in the near term, be necessary in specific circumstances to provide optimal care to pediatric orthopaedic patients. CONCLUSION Knowledge of the ionizing radiation exposure associated with commonly used tests as well as radiation-reduction strategies is essential for the optimal and safe care of pediatric orthopaedic patients.
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Affiliation(s)
- Jeffrey R Sawyer
- Department of Orthopaedic Surgery, University of Tennessee/Campbell Clinic, Memphis, TN
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Şık N, Öztürk A, Koşay MC, Yılmaz D, Duman M. Accuracy of point-of-care ultrasound for determining the adequacy of pediatric forearm fracture reductions. Am J Emerg Med 2021; 48:243-248. [PMID: 33992985 DOI: 10.1016/j.ajem.2021.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/05/2021] [Accepted: 05/05/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The objective of the present study was to the determine the accuracy of point-of-care ultrasound (POCUS) in assessing closed reduction (CR) of pediatric forearm fractures in a pediatric emergency setting. METHODS After determination of the need for CR using X-ray images by an orthopedic consultant, POCUS examinations were performed just before and after the reduction attempt. The transducer was positioned longitudinally over the dorsal, volar, and lateral surfaces of the radius and ulna to view the fracture site. The presence of angulation, displacement, or bayonetting of the fracture fragments was recorded. The adequacy of realignment according to the POCUS and the orthopedic consultant's final determination were recorded. RESULTS Sixty-two patients were enrolled in the study and 96 bones were evaluated. The sensitivity and specificity of POCUS for adequacy of CR were 95.8% [95% confidence interval (CI): 88.3-99.1)] and 95.8% (95% CI: 78.8-99.8), the positive predictive value was 98.5% (95% CI: 91.0-99.7), and the negative predictive value was 88.4% (95% CI: 71.6-95.8). The corresponding positive and negative likelihood ratios were 23 (3.37-156.77) and 0.04 (0.01-0.12). There was high agreement between POCUS and X-ray images for predicting adequacy of CR [κ: 0.892 (±0.053)]. There was also a significant correlation between POCUS and X-ray measurements of angulation and displacement performed before and after CR, respectively (p < 0.001). CONCLUSION Our study has reported the successful use of POCUS for the management of pediatric forearm fractures in a pediatric emergency department. Point-of-care ultrasound can minimize radiation exposure and appears to be an alternative and accurate tool for reduction attempts.
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Affiliation(s)
- Nihan Şık
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Ali Öztürk
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Mustafa Can Koşay
- Department of Orthopedics and Traumatology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Durgül Yılmaz
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Murat Duman
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey.
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Gillon JT, Gorn M, Wilkinson M. Comparison of ultrasound-guided versus fluoroscopy-guided reduction of forearm fractures in children. Emerg Radiol 2020; 28:303-307. [PMID: 33030662 DOI: 10.1007/s10140-020-01862-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/01/2020] [Indexed: 11/26/2022]
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.
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Affiliation(s)
- Jason T Gillon
- Division of Pediatric Emergency Medicine, University of Texas at Austin Dell Medical School, Austin, TX, USA.
| | - Michael Gorn
- Division of Pediatric Emergency Medicine, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Matthew Wilkinson
- Division of Pediatric Emergency Medicine, University of Texas at Austin Dell Medical School, Austin, TX, USA
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Auten JD, Hurst ND, Kanegaye JT. Correspondence: Comparison of pediatric post-reduction fluoroscopic- and ultrasound forearm fracture images. Am J Emerg Med 2020; 38:395-396. [DOI: 10.1016/j.ajem.2019.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/04/2019] [Indexed: 10/26/2022] Open
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Abstract
With the high cost and limited availability of gold standard imaging modalities, ultrasound has become an alternative in many musculoskeletal (MSK) injuries. Ultrasound has become increasingly portable and readily available in many acute care settings. Its ability to diagnose MSK injuries and help guide management has the potential to improve patient safety and flow. Ultrasound has been shown to diagnose fractures, dislocations, and tendon and ligament injuries. It helps guide fracture and dislocation reductions and aids in regional anesthesia for pain management. This article reviews the common MSK injuries that can be diagnosed with ultrasound with a focus on point-of-care ultrasound.
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Affiliation(s)
- Robert Simard
- Emergency Department, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue C7-53, Toronto, Ontario M4N 3M5, Canada; Emergency Department, North York General Hospital, Toronto, Ontario, Canada.
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Sánchez-García A, Salmerón-González E, García-Vilariño E, Vanaclocha N, Valverde-Navarro A. Ultrasonography utilization in forearm fractures at the emergency department. Am J Emerg Med 2019; 37:2111. [PMID: 31186152 DOI: 10.1016/j.ajem.2019.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 06/04/2019] [Indexed: 11/16/2022] Open
Affiliation(s)
- Alberto Sánchez-García
- Plastic and Reconstructive Surgery Department, University and Polytechnic Hospital La Fe. Avenida Fernando Abril Martorell, 106, 46026 Valencia, Spain.
| | - Enrique Salmerón-González
- Plastic and Reconstructive Surgery Department, University and Polytechnic Hospital La Fe. Avenida Fernando Abril Martorell, 106, 46026 Valencia, Spain
| | - Elena García-Vilariño
- Plastic and Reconstructive Surgery Department, University and Polytechnic Hospital La Fe. Avenida Fernando Abril Martorell, 106, 46026 Valencia, Spain
| | - Nieves Vanaclocha
- Plastic and Reconstructive Surgery Department, University and Polytechnic Hospital La Fe. Avenida Fernando Abril Martorell, 106, 46026 Valencia, Spain
| | - Alfonso Valverde-Navarro
- Department of Human Anatomy and Embriology, University of Valencia, Valencia. Avenida Blasco Ibáñez, 13, 46010 Valencia, Spain
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