Tibial Fracture Fixation Team Logo.jpg

Buckle (Torus) Fracture of Pediatric Female Left Distal Radius

This module allows traditional bone setters, pre-hospital providers, clinical officers, nurses, nurse practitioners, and medical officers to become confident and competent in performing point-of-care ultrasound diagnostic imaging to rule out the presence of a pediatric distal forearm fracture and distinguish between buckle (torus) fractures and cortical break fractures to make appropriate referrals as part of the management of closed pediatric (< 16 years of age) distal forearm fractures in regions without access to X-ray imaging and orthopedic specialist coverage.[1][2][3][4][5][6][7][8][9]

Please print off this training logbook before simulation skills training, complete this training logbook during simulation skills training, and file and save a back-up copy of the completed and signed training logbook for your training records.

Training Logbook[edit | edit source]

Simulation Training on Healthy Adults
Forearm Labelled Features Saved Ultrasound Images with Labelled Features for 6-View Technique Ultrasound Scanning for Pediatric Distal Forearm Fractures Saved Videos and Images for Diagnosing Pronator Quadratus Hematoma Sign
Left

Epiphysis

Metaphysis

Diaphysis

View #1: Dorsal Radius

View #2: Dorsal Ulna

View #3: Lateral Ulna

View #4: Lateral Radius

View #5: Volar Radius

View #6: Volar Ulna

Video

Image

Right

Epiphysis

Metaphysis

Diaphysis

View #1: Dorsal Radius

View #2: Dorsal Ulna

View #3: Lateral Ulna

View #4: Lateral Radius

View #5: Volar Radius

View #6: Volar Ulna

Video

Image

Simulation Training on Unblinded Models
Bone Model # Labelled Features Saved Ultrasound Images with Labelled Features That Document Diagnosis Diagnosis Management Plan for Simulated Patient
1 + 2

Epiphysis

Physis

Metaphysis

Diaphysis

Buckle Fracture

Cortical Break Fracture

View #1: Dorsal Radius

View #2: Dorsal Ulna

View #3: Lateral Ulna

View #4: Lateral Radius

View #5: Volar Radius

View #6: Volar Ulna

No Fracture

Buckle Fracture

Other Fracture

Clinical Observation Only

Application of Bandage Wrap, Removable Forearm Splint, or Backslab Cast

Referral for X-Ray Imaging

Other:__________________________

3 + 4

Epiphysis

Physis

Metaphysis

Diaphysis

Buckle Fracture

Cortical Break Fracture

View #1: Dorsal Radius

View #2: Dorsal Ulna

View #3: Lateral Ulna

View #4: Lateral Radius

View #5: Volar Radius

View #6: Volar Ulna

No Fracture

Buckle Fracture

Other Fracture

Clinical Observation Only

Application of Bandage Wrap, Removable Forearm Splint, or Backslab Cast

Referral for X-Ray Imaging

Other:__________________________

5 + 6

Epiphysis

Physis

Metaphysis

Diaphysis

Buckle Fracture

Cortical Break Fracture

View #1: Dorsal Radius

View #2: Dorsal Ulna

View #3: Lateral Ulna

View #4: Lateral Radius

View #5: Volar Radius

View #6: Volar Ulna

No Fracture

Buckle Fracture

Other Fracture

Clinical Observation Only

Application of Bandage Wrap, Removable Forearm Splint, or Backslab Cast

Referral for X-Ray Imaging

Other:__________________________

Simulation Training on Blinded Models
Bone Model # Labelled Features Saved Ultrasound Images with Labelled Features That Document Diagnosis Diagnosis Management Plan for Simulated Patient
5 + 6

Epiphysis

Physis

Metaphysis

Diaphysis

Buckle Fracture

Cortical Break Fracture

View #1: Dorsal Radius

View #2: Dorsal Ulna

View #3: Lateral Ulna

View #4: Lateral Radius

View #5: Volar Radius

View #6: Volar Ulna

No Fracture

Buckle Fracture

Other Fracture

Clinical Observation Only

Application of Bandage Wrap, Removable Forearm Splint, or Backslab Cast

Referral for X-Ray Imaging

Other:__________________________

7 + 8

Epiphysis

Physis

Metaphysis

Diaphysis

Buckle Fracture

Cortical Break Fracture

View #1: Dorsal Radius

View #2: Dorsal Ulna

View #3: Lateral Ulna

View #4: Lateral Radius

View #5: Volar Radius

View #6: Volar Ulna

No Fracture

Buckle Fracture

Other Fracture

Clinical Observation Only

Application of Bandage Wrap, Removable Forearm Splint, or Backslab Cast

Referral for X-Ray Imaging

Other:__________________________

9 + 10

Epiphysis

Physis

Metaphysis

Diaphysis

Buckle Fracture

Cortical Break Fracture

View #1: Dorsal Radius

View #2: Dorsal Ulna

View #3: Lateral Ulna

View #4: Lateral Radius

View #5: Volar Radius

View #6: Volar Ulna

No Fracture

Buckle Fracture

Other Fracture

Clinical Observation Only

Application of Bandage Wrap, Removable Forearm Splint, or Backslab Cast

Referral for X-Ray Imaging

Other:__________________________

Learner's Nameː

Learner's Signature:

Assistant's Nameː

Assistant's Signature:

Date of Trainingː

Acknowledgements[edit | edit source]

This work is funded by a grant from the Intuitive Foundation. Any research, findings, conclusions, or recommendations expressed in this work are those of the author(s), and not of the Intuitive Foundation.

References[edit | edit source]

  1. Onyemaechi NO, Itanyi IU, Ossai PO, Ezeanolue EE. Can traditional bonesetters become trained technicians? Feasibility study among a cohort of Nigerian traditional bonesetters. Hum Resour Health. 2020 Mar 20;18(1):24. doi: 10.1186/s12960-020-00468-w. PMID: 32197617; PMCID: PMC7085192.
  2. Heiner JD, McArthur TJ. The ultrasound identification of simulated long bone fractures by prehospital providers. Wilderness Environ Med. 2010 Jun;21(2):137-40. doi: 10.1016/j.wem.2009.12.028. Epub 2009 Dec 22. PMID: 20591377.
  3. Heiner JD, Baker BL, McArthur TJ. The ultrasound detection of simulated long bone fractures by U.S. Army Special Forces Medics. J Spec Oper Med. 2010 Spring;10(2):7-10. PMID: 20936597.
  4. Heiner JD, Proffitt AM, McArthur TJ. The ability of emergency nurses to detect simulated long bone fractures with portable ultrasound. Int Emerg Nurs. 2011 Jul;19(3):120-4. doi: 10.1016/j.ienj.2010.08.004. Epub 2010 Sep 25. PMID: 21665155.
  5. Snelling PJ, Jones P, Keijzers G, Bade D, Herd DW, Ware RS. Nurse practitioner administered point-of-care ultrasound compared with X-ray for children with clinically non-angulated distal forearm fractures in the ED: a diagnostic study. Emerg Med J. 2021 Feb;38(2):139-145. doi: 10.1136/emermed-2020-209689. Epub 2020 Sep 8. PMID: 32900856.
  6. Snelling PJ, Jones P, Moore M, Gimpel P, Rogers R, Liew K, Ware RS, Keijzers G. Describing the learning curve of novices for the diagnosis of paediatric distal forearm fractures using point-of-care ultrasound. Australas J Ultrasound Med. 2022 Mar 7;25(2):66-73. doi: 10.1002/ajum.12291. PMID: 35722050; PMCID: PMC9201201.
  7. Heiner JD, McArthur TJ. A simulation model for the ultrasound diagnosis of long-bone fractures. Simul Healthc. 2009 Winter;4(4):228-31. doi: 10.1097/SIH.0b013e3181b1a8d0. PMID: 19915442.
  8. Snelling PJ, Keijzers G, Byrnes J, Bade D, George S, Moore M, Jones P, Davison M, Roan R, Ware RS. Bedside Ultrasound Conducted in Kids with distal upper Limb fractures in the Emergency Department (BUCKLED): a protocol for an open-label non-inferiority diagnostic randomised controlled trial. Trials. 2021 Apr 14;22(1):282. doi: 10.1186/s13063-021-05239-z. PMID: 33853650; PMCID: PMC8048294.
  9. Snelling PJ. A low-cost ultrasound model for simulation of paediatric distal forearm fractures. Australas J Ultrasound Med. 2018 Feb 25;21(2):70-74. doi: 10.1002/ajum.12083. PMID: 34760505; PMCID: PMC8409885.

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