Point-Of-Care Ultrasound Pronator Quadratus Haematoma Sign Visualised in Adult Distal Radius Fractures: A Case Series

Subtle fractures of the distal forearm in adults are not always readily apparent on radiography. Point-of-care ultrasound (POCUS) offers a potentially valuable adjunct to conventional radiography in fracture diagnosis. The main advantage of POCUS over radiography is its ability to delineate soft tissue structures, which can provide additional diagnostic information.

Two adult patients who presented with isolated distal forearm injuries. They were chosen based on a high clinical suspicion for fracture but equivocal radiography findings. The pronator quadratus haematoma (PQH) sign was detected with sonography in both patients, with increased echogenicity and thickening of the muscle, caused by bleeding and swelling within the pronator quadratus muscle compartment, indicative of a distal radial fracture.

This case series illustrates how the sonographic PQH sign can be used as an adjunct to radiography for the diagnosis of adult distal radius fractures. However, prospective studies with more extensive cohorts are essential to validate the reliability of the PQH sign and to refine its use in clinical practice.