Report by: Gabby May, Specialist Trainee in Emergency Medicine

Checked by: Alan Grayson, Specialist Trainee in Emergency Medicine

Institution: Stepping Hill Hospital, Stockport, UK and East Lancashire Hospitals

A short-cut review was carried out to establish whether ultrasound is an effective diagnostic tool in the assessment of paediatric wrist fractures. A total of 42 papers was found using the reported search, of which four represented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are shown in table 1. The clinical bottom line is that although promising, there is not enough evidence at present to advocate the use of ultrasound over x ray for diagnosis of paediatric forearm fractures.

Three-part question

[In a child with a clinically suspected fracture of the wrist] is [bedside ultrasound as accurate as plain radiography] in [confirming the diagnosis]?

Clinical scenario

A 4-year-old boy attends the emergency department (ED) complaining of a painful wrist following a fall. You …