Related Experiment Video
Updated: Nov 30, 2025
Author Spotlight: Assessing Surgical Frailty with Point-of-Care Ultrasound of Quadriceps Muscles
Published on: July 26, 2024
The Child With a Painful Arm: A POCUS Screening Protocol to Identify Fracture in Children With Upper Extremity Injury
Eric Scheier1, Yakir Shir1, Uri Balla1
1Department of Pediatric Emergency Medicine, Kaplan Medical Center, Rehovot, Israel.
Insights
Point-of-care ultrasound can help emergency physicians screen young children with arm injuries. This protocol aids in identifying fractures, improving diagnostic accuracy, and guiding treatment decisions for radial head subluxation.
Area of Science:
- Pediatric Emergency Medicine
- Musculoskeletal Ultrasound
- Diagnostic Imaging
Background:
- Young children frequently present with painful, immobile arms in the emergency department.
- Distinguishing injury types can be challenging in distressed children.
- Current practices involve radiography or empirical treatment for radial head subluxation.
Observation:
- A step-by-step point-of-care ultrasound screening protocol for the upper extremity was developed.
- This protocol aims to assess the probability of fracture before further intervention.
- Six children under 4 years old without clear trauma history or physical signs were evaluated.
Findings:
- The ultrasound protocol successfully identified fractures in some cases.
- In other cases, it lowered the probability of fracture, supporting safe radial head reduction.
- Focused radiography based on ultrasound findings can streamline imaging.
Implications:
- Point-of-care ultrasound can enhance diagnostic accuracy for pediatric arm injuries.
- It provides a safer approach to managing suspected radial head subluxation.
- This protocol can reduce unnecessary imaging and improve emergency care efficiency.
Background:
Young children present frequently to the emergency department with an immobile, painful arm. It is often difficult to discern a point of tenderness in a frightened, injured child. Common approaches included sending the child for x-ray studies of the extremity or empirically attempting reduction of radial head subluxation. We created a step-by-step point-of-care ultrasound screening protocol of the upper extremity to increase or decrease the probability of fracture before x-ray study or reduction.
Case Report:
We present the cases of 6 children younger than 4 years without a clear history of pulled elbow and without swelling or deformity on examination, for whom this protocol revealed fracture or lowered the probability of fracture, thereby increasing the safety of radial head reduction. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In most cases, identification of a single fracture on ultrasound allows for focused x-ray study on the area of fracture. Children with a normal ultrasound screen can undergo reduction of radial head subluxation safely.
