Pediatric Distal Forearm Fractures/Ultrasound Diagnosis of Pediatric Distal Forearm Fractures

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]}

Skills Training Objectives[edit | edit source]

1. Identify the primary sonographic features of no fracture, a buckle (torus) fractures and a cortical break fracture of the pediatric distal forearm
2. Describe the secondary sonographic features of a cortical break fracture of the pediatric distal forearm
3. Perform the 6 view method for ultrasonographic diagnosis of pediatric distal forearm fractures
4. Practise conducting a bilateral ultrasound scan to diagnose a pronator quadratus hematoma

Materials and Equipment[edit | edit source]

#	Item
1	Any ultrasound device with a linear transducer (from 3.5 to 16 MHz and more) is suitable for fracture sonography. Nearly almost all commercially available portable ultrasound devices can be used.
2	Mobile device with ultrasound app installed
3	Ultrasound gel
4	3 Pediatric Forearm Simulators for unblinded training (White 3D Printed Pediatric Female Bone Models #1-6)
5	3 Pediatric Forearm Simulators for blinded training (Black 3D Printed Pediatric Female Bone Models #5-10)
6	Training Logbook
7	Self-Assessment Framework
7	Clipboard and pen

Basic Ultrasound Skills Training[edit | edit source]

Practice basic ultrasound skills on each other's arms:

1. Fanning the iQ
2. Sliding the iQ
3. Rotating the iQ
4. Proper Hand Positioning
5. Choosing the Right Preset
6. Adjusting the Overall Gain

6 View Technique for Ultrasound Scanning of Pediatric Distal Forearm Fractures[edit | edit source]

Ultrasound Scanning for Pronator Quadratus Hematoma Sign[edit | edit source]

Unblinded Training on Pediatric Female Forearm Simulators[edit | edit source]

1. Acquire, label, and save an image of the epiphysis, physis, metaphysis and diaphysis of the radius and ulna in each view.
2. Identify a buckle fracture which appears as an asymmetric outward or inward bending of the bone cortex in each view.
3. Identify a cortical break fracture which appears as a black zone in the bright, sharp white line of the bone cortex in each view.
4. Determine if no fracture, a buckle fracture, or a cortical break fracture is present in each view.
5. Select the appropriate treatment plan for each simulated patient.
6. Fill out the training logbook.
7. Review all the acquired images to determine if they meet all the standards outlined in the quality assurance checklist in the self-assessment framework.

Blinded Training on Pediatric Female Forearm Simulators[edit | edit source]

1. Acquire, label, and save an image of the epiphysis, physis, metaphysis and diaphysis of the radius and ulna in each view.
2. Identify a buckle fracture which appears as an asymmetric outward or inward bending of the bone cortex in each view.
3. Identify a cortical break fracture which appears as a black zone in the bright, sharp white line of the bone cortex in each view.
4. Determine if no fracture, a buckle fracture, or a cortical break fracture is present in each view.
5. Select the appropriate treatment plan for each simulated patient.
6. Fill out and sign the training logbook.
7. Review all the acquired images to determine if they meet all the standards outlined in the quality assurance checklist in the self-assessment framework.

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]