c A distal radius fracture – well proximal to the epiphysis.
So what to do next? We could put on a plaster backslab and get her back for Xray in the morning. But it is late the department is quiet – so why not go for a good position and maybe save her another round of pain etc…
Under a regional block (Bier’s c IV prilocaine) we do a gentle reduction. Use the US live imaging to ensure the cortex is aligned nicely. Once it is all lined up on the USS we put on a slab and send her home.
A nice reduction, Ortho team are happy – “follow up in a week for review.”
I wanted to put this case up as it is a new trick I have learned. The concept is not new – but it doesn’t really seem to have gotten a foothold in common ED practice here in Australia. Most of the big EDs have access to 24/7 radiology and fluoroscopy services. However, in the smaller rural towns we are often without either! I think this trick can really make a difference to the care of selected patients.
There is a bit of observational evidence out there:
As I often say when describing ultrasound techniques – there is little harm and a lot of potential gain to be seen. My thoughts are: as we get better at this with practice we will become more confident to use US in areas where we once would have waited for plain films or been forced to transfer long distances. It seems like a great trick to have in your remote doctor’s bag!
What do you think? Have you used US for long bone fracture diagnosis or to guide reduction?
I am a GP working in Broome, NW of Western Australia. I work as a hospital DMO (District Med Officer) doing Emergency, Anaesthestics, some Obstetrics and a lot of miscellaneous primary care. Also on the web as @broomedocs | + Casey Parker | Contact