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Ultrasound-guided pediatric forearm fracture reductions in a resource-limited ED
Bobby M Wellsh1, Jerzy M Kuzma2
1Emergency Medicine, Port Moresby General Hospital, Port Moresby, Papua New Guinea.
Insights
Ultrasound-guided closed reduction safely and effectively treats pediatric forearm fractures in resource-limited settings. This method improves fracture alignment, reduces repeat procedures, and shortens hospital stays for children.
Area of Science:
- Pediatric Orthopedics
- Medical Imaging
- Emergency Medicine
Background:
- Pediatric forearm fractures are common in resource-limited settings like Papua New Guinea.
- Current practice relies on radiographs for assessing closed reduction adequacy.
- This often results in 'blind' reductions with potential for suboptimal outcomes.
Purpose of the Study:
- To evaluate the safety and efficacy of ultrasound (US) in guiding closed reduction of pediatric forearm fractures.
- To assess US as a tool for improving reduction adequacy in low-resource environments.
- To compare US-guided reductions with traditional radiographic assessment.
Main Methods:
- Consecutive pediatric patients with closed forearm fractures requiring reduction were recruited.
- Ultrasound (US) was utilized to visualize and assist in fracture reductions.
- Outcomes measured included successful reduction rates, hospital length of stay, and adverse events.
Main Results:
- A high success rate of 94% (44/47) for US-guided reductions was achieved.
- The mean hospital stay for successful reductions was 8.77 hours.
- Only 6% of cases required repeat reduction, with minimal adverse events reported.
Conclusions:
- Ultrasound-guided closed reduction is a safe and effective technique for pediatric forearm fractures in low-resource settings.
- Real-time US visualization enhances clinical decision-making, reducing repeat procedures.
- This approach can lead to shorter hospital stays and improved patient outcomes.
Background:
Pediatric forearm fractures are a common presentation in emergency departments in Papua New Guinea. Often these children undergo "blind" closed reduction with reduction adequacy assessed by standard radiographs. This study aims to demonstrate the safety and efficacy of ultrasound (US) in guiding closed reduction of pediatric forearm fractures in a resource-limited setting.
Methods:
We recruited consecutive children with closed forearm fractures requiring reduction. A US scanner was used to visualize and aid fracture reductions. The outcome measures were the rate of successful reductions (ie, adequate alignment without the need for a second procedure or further surgical intervention), length of stay in hospital, and adverse events during each procedure and at follow-up after 6 weeks.
Results:
Of 47 children recruited, there were 44 (94%) successful reductions, whereas 3 (6%) required repeated reduction. The mean (SD) length of stay in hospital of the successful cases was 8.77 (3.66) hours. Two patients had tight plaster casts during early follow-up which were immediately addressed. Of the 44 successful cases, only 38 were retrieved for the final review. No further adverse events were observed in the latter.
Conclusions:
This small-scale study has demonstrated the safe and efficacious use of US-guided close reduction of pediatric forearm fractures in a low-resource setting. Using US, real-time visualization of reduction efforts can reassure the clinician in decision making, thus reducing the rate of repeated reductions and allowing shorter hospital stay.
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