Ultrasound Secondary Signs for the Diagnosis of Pediatric Distal Forearm Fractures: A Diagnostic Study.

OBJECTIVE: To evaluate the diagnostic accuracy of ultrasound secondary signs of fractures in pediatric patients aged 5-15 y presenting to the emergency department with a clinically non-deformed distal forearm injury. METHODS: This diagnostic study was conducted in South East Queensland, Australia. Emergency clinicians performed point-of-care ultrasound on eligible patients and recorded secondary signs of fractures (pronator quadratus hematoma [PQH] sign, periosteal hematoma, visible angulation) or physeal fractures (fracture-to-physis distance [FPD], physis alteration). The reference standard was the final fracture diagnosis determined by expert panel. The primary outcome was the diagnostic accuracy of secondary signs for cortical breach and physeal fractures. Diagnostic statistics were reported for each relevant secondary sign. RESULTS: A total of 135 participants were enrolled. The expert panel diagnosed 48 "no" fracture, 52 "buckle" fracture and 35 "other" fracture. All "other" fractures were cortical breach fractures and included 15 Salter-Harris II fractures. The PQH sign demonstrated high sensitivity and moderate specificity to diagnose cortical breach fractures (91%, 95% Confidence Interval [CI] 78%-97% and 82%, 73%-88%). Poor sensitivity but high specificity was observed for the visible angulation and periosteal hematoma secondary signs. FPD <1cm showed perfect sensitivity and moderate specificity (100%, 80%-100% and 85%, 78%-90%) for diagnosis of Salter-Harris II fracture. Conversely, physis alteration showed poor sensitivity but excellent specificity (40%, 20%-64% and 99%, 95%-100%) for the diagnosis of Salter-Harris II fractures. CONCLUSION: Ultrasound secondary signs showed good diagnostic accuracy for both cortical breach fractures and Salter-Harris II fractures. Future research should consider optimal use of secondary signs to improve diagnostic accuracy.

A meta-analysis on the diagnostic utility of ultrasound in pediatric distal forearm fractures.

Pediatric distal forearm fractures, comprising 30% of musculoskeletal injuries in children, are conventionally diagnosed using radiography. Ultrasound has emerged as a safer diagnostic tool, eliminating ionizing radiation, enabling bedside examinations with real-time imaging, and proving effective in non-hospital settings. The objective of this study is to evaluate the diagnostic efficacy of ultrasound for detecting distal forearm fractures in the pediatric population. A systematic review and meta-analysis were conducted through a comprehensive literature search in PubMed, Scopus, Web of Science, and Embase databases until October 1, 2023, following established guidelines. Eligible studies, reporting diagnostic accuracy measures of ultrasound in pediatric patients with distal forearm fractures, were included. Relevant data elements were extracted, and data analysis was performed. The analysis included 14 studies with 1377 patients, revealing pooled sensitivity and specificity of 94.5 (95% CI 92.7-95.9) and 93.5 (95% CI 89.6-96.0), respectively. Considering pre-test probabilities of 25%, 50%, and 75% for pediatric distal forearm fractures, positive post-test probabilities were 83%, 44%, and 98%, while negative post-test probabilities were 2%, 6%, and 15%, respectively. The bivariate model indicated significantly higher diagnostic accuracy in the subgroup with trained ultrasound performers vs. untrained performers (p = 0.03). Furthermore, diagnostic accuracy was significantly higher in the subgroup examining radius fractures vs. ulna fractures (p < 0.001), while no significant differences were observed between 4-view and 6-view ultrasound subgroups or between radiologist ultrasound interpreters and non-radiologist interpreters. This study highlighted ultrasound's reliability in detecting pediatric distal forearm fractures, emphasizing the crucial role of expertise in precisely confirming fractures through ultrasound examinations.

Ultrasonography or Radiography for Suspected Pediatric Distal Forearm Fractures.

BACKGROUND: Data on whether ultrasonography for the initial diagnostic imaging of forearm fractures in children and adolescents is noninferior to radiography for subsequent physical function of the arm are limited. METHODS: In this open-label, multicenter, noninferiority, randomized trial in Australia, we recruited participants 5 to 15 years of age who presented to the emergency department with an isolated distal forearm injury, without a clinically visible deformity, in whom further evaluation with imaging was indicated. Participants were randomly assigned to initially undergo point-of-care ultrasonography or radiography, and were then followed for 8 weeks. The primary outcome was physical function of the affected arm at 4 weeks as assessed with the use of the validated Pediatric Upper Extremity Short Patient-Reported Outcomes Measurement Information System (PROMIS) score (range, 8 to 40, with higher scores indicating better function); the noninferiority margin was 5 points. RESULTS: A total of 270 participants were enrolled, with outcomes for 262 participants (97%) available at 4 weeks (with a window of ±3 days) as prespecified. PROMIS scores at 4 weeks in the ultrasonography group were noninferior to those in the radiography group (mean, 36.4 and 36.3 points, respectively; mean difference, 0.1 point; 95% confidence interval [CI], -1.3 to 1.4). Intention-to-treat analyses (in 266 participants with primary outcome data recorded at any time) produced similar results (mean difference, 0.1 point; 95% CI, -1.3 to 1.4). No clinically important fractures were missed, and there were no between-group differences in the occurrence of adverse events. CONCLUSIONS: In children and adolescents with a distal forearm injury, the use of ultrasonography as the initial diagnostic imaging method was noninferior to radiography with regard to the outcome of physical function of the arm at 4 weeks. (Funded by the Emergency Medicine Foundation and others; BUCKLED Australian New Zealand Clinical Trials Registry number, ACTRN12620000637943).

The 3D-Printed Titanium Truss Cage for the Treatment of Concurrent Complex Malunion, Synostosis and Large Bone Defect Following Forearm Injuries: A Case Report.

A 28-year-old man sustained a complex forearm injury from high-energy trauma, causing ulnar nerve injury, a bone defect, forearm malunion and synostosis. A 3D-printed titanium truss cage was used to solve these problems. This patient achieved union of the bone defect, was pain-free and had no recurrent synostosis 2 years after reconstructive surgery. The advantages of the 3D-printed titanium truss cage included anatomical fit, immediate mobilisation and low morbidity of the donor side of the bone graft. This study reported a promising result from using 3D-printed titanium truss cages to manage complex forearm bony problems. Level of Evidence: Level V (Therapeutic).

Prescribing braces after forearm fractures does not decrease refracture rate.

Refracture is one of the most common complications of pediatric forearm fractures. One way to decrease this risk is to extend immobilization with a brace after the cast has been removed to allow for a range of motion exercises. The purpose of this study was to examine whether prescribing a brace after casting was discontinued decreased the risk of refracture. A retrospective, cohort study was performed at one level I trauma center. Girls under 10 years and boys under 12 years who sustained a forearm fracture from January 2013 to December 2018 were included. Patients with open fractures, fractures that required operative intervention, fractures involving the physis, fracture-dislocations, floating elbows, fractures in children with endocrine abnormalities, and fractures in patients lost to follow-up were excluded. The primary endpoint was a refracture within 6 months of the original injury that extended through the original fracture site. In total 2093 patients met the inclusion criteria. There were 19 refractures (0.9%). There was no statistically significant difference in the refracture rate between the braced (11/1091) and unbraced (8/1002) cohorts (Fisher exact value 0.65 at P < 0.05). The most common fracture type that went on to refracture was greenstick fractures. This large, retrospective study aimed to examine whether prescribing a brace had any significant effect on the refracture rate. Bracing after the cast is removed may help ease family anxiety and extend the period of immobilization while allowing for hygiene and range of motion, but it does not significantly decrease the rate of refracture.

A Narrative Review of the Uses of Ultrasound in the Evaluation, Analgesia, and Treatment of Distal Forearm Fractures.

BACKGROUND: Distal forearm fractures are a commonly encountered injury in the emergency department (ED), accounting for 500,000 to 1.5 million visits and 17% of ED fractures. The evaluation and management of these fractures frequently employs x-ray studies, conscious sedation, closed reduction, and splinting. Point-of-care ultrasound (POCUS) can offer significant benefit in the diagnosis and management of these common injuries. OBJECTIVE OF THE REVIEW: To review the clinical utility of POCUS in the diagnosis of distal forearm fractures, as well as to demonstrate the performance of ultrasound-guided analgesia delivery and ultrasound-guided reduction technique. DISCUSSION: The initial evaluation of forearm injuries frequently includes x-ray studies. However, multiple studies have shown ultrasound to be sensitive and specific for distal radius fractures, with the added value of detecting soft tissue injuries missed by conventional radiography. POCUS may also facilitate analgesia through the use of ultrasound-guided hematoma blocks, which removes the need for conscious sedation prior to manipulation. Finally, POCUS can be used after manipulation to assess cortical realignment of the bone fragments and spare the patient multiple reduction attempts and repeat radiographs. CONCLUSION: Distal forearm fractures are common, and the emergency physician should be adept with the evaluation and management of these injuries. POCUS can be a reliable modality in the detection of these fractures and can be used to facilitate analgesia and augment success of reduction attempts. These techniques may decrease length of stay, improve patient pain, and decrease reduction attempts.

Paediatric forearm fractures: assessment and initial management.

The forearm is the most common site of fracture in children. At the time of initial assessment, a thorough examination and neurovascular assessment of the limb is necessary. X-rays allow evaluation of the fracture location and type, in addition to the degree of displacement. With the help of intranasal opiates, manipulation of fracture fragments can be performed in the emergency department. Immobilisation in plaster is the gold standard treatment for paediatric forearm fractures where the degree of displacement is within acceptable parameters. Manipulation and casting should be followed by orthogonal radiographs and a repeated neurovascular assessment of the limb. Oral analgesia and safety netting information should be provided on discharge and the child should be reviewed in fracture clinic within a week of the injury. This article reviews the British Orthopaedic Association Standards for Trauma and Orthopaedics for the early management of paediatric forearm fractures that do not require operative management.

Flexible Nailing of Pediatric Both Bone Forearm Fracture.

SUMMARY: This is the case of a 12-year-old boy presented with a displaced radial and ulnar shaft fracture. Historically, these fractures were managed conservatively with closed reduction and cast immobilization; however, there has been an increasing trend toward operative fixation. Malalignment is an indication for operative fixation of pediatric both bone forearm fractures. Flexible nailing was performed in this case because of the small incisions, minimal tissue disruption, shorter operative time, and ease of implant removal. Five years postoperatively, the patient's fracture was healed. Patient presented with an excellent clinical outcome including full range of motion and no pain. He had full strength of his arm and no deficits.

Cast revision is effective for critical three-point index values in paediatric forearm fractures: a prospective study.

Three-point index (TPI) has been reported to be effective in predicting the displacement of forearm fractures. The aim of this prospective study was to investigate the clinical efficacy of recasting critical but acceptable casts according to three-point index (0.6 < TPI < 0.8) before a redisplacement occurs in childhood forearm fractures. A TPI of 0.6-0.8 was determined in 68 patients, and these were separated as group 1 ( n = 34) applied with prophylactic recasting and group 2 ( n = 34) where treatment was continued with same cast. The remaining 28 patients had TPI < 0.6 and were assigned as group 3. Groups were compared in respect of age, initial displacement, cast type, location of fracture, initial and late three-point index values and inter- and intraobserver reliabilities of TPI measurements. Significantly less displacement was seen in group 1 than in group 2 ( P = 0.004). It was found that a 0.1 increase of index value in the initial and late TPIs increases the probability of redisplacement by 5.06 and 7.78 times, respectively. Late TPI, measured 1 week after casting, had better predictive value than the initial TPI with a sensitivity of 77.8%, specificity of 92.3%, positive predictive value of 70% and negative predictive value of 94.7%. Patients in the grey zone will be able to safely complete the cast treatment with prophylactic recasting without surgical intervention. TPI should be remeasured at the end of first week, as its predictive value becomes more accurate after swelling subsides.

El acortamiento del radio como factor limitante para la reducción cerrada en fracturas de antebrazo pediátrico / Radius shortening as a limiting factor for closed reduction in pediatric forearm fractures

IntroducciónLas fracturas diafisarias de antebrazo (FDA) en pacientes esqueléticamente inmaduros son lesiones comunes que representan el 30% de las fracturas de la extremidad superior en este grupo etario. Existen casos con lesiones inestables o reducciones inaceptables, en los cuales está indicada la resolución quirúrgica mediante la reducción y estabilización con clavos endomedulares elásticos (CEE) por vía percutánea. Una de las ventajas que ofrece este sistema es evitar un abordaje del foco de fractura, pudiendo realizar la reducción de forma cerrada en la gran mayoría de estas. Sin embargo, no siempre es posible lograr una aceptable reducción cerrada y entonces es necesaria la apertura del foco de fractura. El objetivo de este estudio fue determinar si existen factores preoperatorios para predecir la dificultad de efectuar una reducción cerrada en estos pacientes.MétodosSe realizó un estudio retrospectivo de pacientes esqueléticamente inmaduros con FDA agudas, tratados con CEE por el mismo cirujano pediátrico. La variable de resultado primaria se definió como la necesidad de llevar a cabo una reducción abierta; considerado como un abordaje quirúrgico directo en el sitio de fractura. Se analizaron las características demográficas de los pacientes incluidos y las radiográficas de la fractura.ResultadosEncontramos que la mediana del porcentaje del acortamiento del radio preoperatorio en los grupos de reducción cerrada y reducción abierta fue del 1 y 5%, respectivamente; resultando en una diferencia estadísticamente significativa (p = 0,04).ConclusiónEl acortamiento del radio en las radiografías preoperatorias permite predecir un aumento del riesgo de requerir una reducción abierta de la fractura (39% de asociación); por lo cual, esta variable debe ser considerada por el traumatólogo general como un factor pronóstico para definir la derivación de estos pacientes.(AU)

IntroductionDiaphyseal forearm fractures in skeletally immature patients are common injuries that account for 30% of upper extremity fractures in this age group. There are cases with unstable injuries or unacceptable reductions, in which surgical resolution by reduction and stabilisation with percutaneous elastic endomedullary nailing is indicated. One of the advantages of this system is that it avoids an approach to the fracture site, allowing closed reduction in the vast majority of fractures. However, it is not always possible to achieve an acceptable closed reduction and opening of the fracture site is necessary. The aim of this study was to determine whether there are preoperative factors to predict the difficulty of performing closed reduction in these patients.MethodsA retrospective study of skeletally immature patients with acute diaphyseal forearm fractures treated with elastic endomedullary nailing by the same paediatric surgeon was performed. The primary outcome variable was defined as the need for open reduction; considered as a direct surgical approach to the fracture site. Demographic characteristics of the included patients and radiographic characteristics of the fracture were analysed.ResultsWe found that the median percentage of preoperative radial shortening in the closed reduction and open reduction groups was 1 and 5%, respectively; resulting in a statistically significant difference (p = 0.04).ConclusionRadial shortening on preoperative radiographs predicts an increased risk of requiring an open reduction of the fracture (39% association); thus we understand that this variable should be considered by the general traumatologist as a prognostic factor in defining the referral of these patients.(AU)

Radius shortening as a limiting factor for closed reduction in pediatric forearm fractures / El acortamiento del radio como factor limitante para la reducción cerrada en fracturas de antebrazo pediátrico

IntroductionDiaphyseal forearm fractures in skeletally immature patients are common injuries that account for 30% of upper extremity fractures in this age group. There are cases with unstable injuries or unacceptable reductions, in which surgical resolution by reduction and stabilisation with percutaneous elastic endomedullary nailing is indicated. One of the advantages of this system is that it avoids an approach to the fracture site, allowing closed reduction in the vast majority of fractures. However, it is not always possible to achieve an acceptable closed reduction and opening of the fracture site is necessary. The aim of this study was to determine whether there are preoperative factors to predict the difficulty of performing closed reduction in these patients.MethodsA retrospective study of skeletally immature patients with acute diaphyseal forearm fractures treated with elastic endomedullary nailing by the same paediatric surgeon was performed. The primary outcome variable was defined as the need for open reduction; considered as a direct surgical approach to the fracture site. Demographic characteristics of the included patients and radiographic characteristics of the fracture were analysed.ResultsWe found that the median percentage of preoperative radial shortening in the closed reduction and open reduction groups was 1 and 5%, respectively; resulting in a statistically significant difference (p = 0.04).ConclusionRadial shortening on preoperative radiographs predicts an increased risk of requiring an open reduction of the fracture (39% association); thus we understand that this variable should be considered by the general traumatologist as a prognostic factor in defining the referral of these patients.(AU)

IntroducciónLas fracturas diafisarias de antebrazo (FDA) en pacientes esqueléticamente inmaduros son lesiones comunes que representan el 30% de las fracturas de la extremidad superior en este grupo etario. Existen casos con lesiones inestables o reducciones inaceptables, en los cuales está indicada la resolución quirúrgica mediante la reducción y estabilización con clavos endomedulares elásticos (CEE) por vía percutánea. Una de las ventajas que ofrece este sistema es evitar un abordaje del foco de fractura, pudiendo realizar la reducción de forma cerrada en la gran mayoría de estas. Sin embargo, no siempre es posible lograr una aceptable reducción cerrada y entonces es necesaria la apertura del foco de fractura. El objetivo de este estudio fue determinar si existen factores preoperatorios para predecir la dificultad de efectuar una reducción cerrada en estos pacientes.MétodosSe realizó un estudio retrospectivo de pacientes esqueléticamente inmaduros con FDA agudas, tratados con CEE por el mismo cirujano pediátrico. La variable de resultado primaria se definió como la necesidad de llevar a cabo una reducción abierta; considerado como un abordaje quirúrgico directo en el sitio de fractura. Se analizaron las características demográficas de los pacientes incluidos y las radiográficas de la fractura.ResultadosEncontramos que la mediana del porcentaje del acortamiento del radio preoperatorio en los grupos de reducción cerrada y reducción abierta fue del 1 y 5%, respectivamente; resultando en una diferencia estadísticamente significativa (p = 0,04).ConclusiónEl acortamiento del radio en las radiografías preoperatorias permite predecir un aumento del riesgo de requerir una reducción abierta de la fractura (39% de asociación); por lo cual, esta variable debe ser considerada por el traumatólogo general como un factor pronóstico para definir la derivación de estos pacientes.(AU)

[Transfixing wound of the forearm due to implantation of an unusual sharp object: a case report]. / Plaie transfixiante de l'avant-bras par implantation d'un objet tranchant inhabituel: à propos d'un cas.

Traumatic transfixed wounds of the limbs due to embedded foreign body are rare. Antebrachial segment involvement can lead to tissue damage, requiring specialized surgical treatment. Few studies have been reported, but surgical removal of the foreign body is indicated. We report the case of a 23-year-old patient, victim of physical violence, presenting with a transfixed wound due to the implantation of an atypical knife in the forearm. Clinical and radiographic tests showed significant muscle and neurovascular lesions. Surgical removal of the knife and lesion repair were performed. Surgical treatment of these traumas must be performed by an experienced surgical team to avoid the occurrence of iatrogenic lesions.

Treatment Choice of Complete Distal Forearm Fractures in 8 to 14 Years Old Children.

BACKGROUND: New surgical techniques have challenged traditional guidelines for nonsurgical treatment in pediatric and adolescent distal forearm fractures. This study was performed to compare outcomes and costs between closed reduction with percutaneous pinning (CRPP) and closed reduction with casting in the treatment of complete distal forearm fractures in children 8 to 14 years old. METHODS: A retrospective cohort study was performed of 175 displaced distal forearm fractures treated with 2 different methods in the emergency department of a children's trauma center. One hundred and fourteen children were managed using CRPP. The remaining 61 were treated with closed reduction and casting. All patients had initial follow-up radiographs. The quality of reduction and the residual angulation in both the coronal and sagittal planes were recorded. Outcomes included the angulation after reduction, residual angulation at final follow-up, radiation exposure, total immobilization time, days absent from school, total costs, and postoperative complications. RESULTS: The postreduction sagittal plane angulation was significantly lower in the CRPP group (P=0.037). While residual deformity between the groups at the 6-month final follow-up was not significantly different in either the sagittal or coronal planes (P=0.486, 0.726), patients in the nonoperative group received greater radiation than those in the operative group (P<0.001). Patients in the nonoperative group missed fewer classes and sustained lower costs (P<0.001, <0.001). The mean immobilization time in each group was not significantly different (31.4±4.4 vs. 32.8±5.9 d; P=0.227). CONCLUSIONS: Although the postreduction quality was a little better and radiation exposure was less in the CRPP group, there was no difference between the 2 groups in angulation, total immobilization time, or complication rates after 6 months. The cost and time absent from school of patients in the nonoperative group was significantly lower than in the operative group. There is no clear advantage to CRPP treatment on outcomes. Therefore, closed reduction and casting is recommended in complete distal forearm fractures of children 8 to 14 years old. LEVEL OF EVIDENCE: Level III-therapeutic study.

Ultrasound in forearm fractures: a pragmatic study assessing the utility of Point of Care Ultrasound (PoCUS) in identifying and managing distal radius fractures.

BACKGROUND: Point of Care Ultrasound (PoCUS) is a safe, non-invasive tool for identifying distal radius fractures and can potentially be utilised to assist clinicians to reduce displaced fractures. We aim to test whether PoCUS is accurate to identify distal radius fractures and to determine how PoCUS performs as a tool to confirm a successful fracture reduction. METHODS: A pragmatic prospective observational study was done in adult patients presenting with forearm injuries resulting in Colle's type distal radius fractures. Adults who presented to the emergency department (ED) with a suspected distal forearm fracture from August 2018 to July 2019 were conveniently sampled for inclusion into the study when a trained ED ultra-sonographer was available. PoCUS scans over the point of maximal tenderness were done using a high frequency linear transducer (7.5-10 mHz) prior to X-ray. Patients who required a manipulation of the fracture had a second ultrasound scan immediately after the procedure before the second X-ray was ordered. PoCUS scans were compared to X-rays for accuracy in both groups. RESULTS: Fractures were identified in 44 out of 47 included patients using both PoCUS and X-ray modalities. This showed a sensitivity of 100% (95% CI: 90-100%) and specificity of 100% (95% CI: 31-100%). Fracture manipulation was required in 35 out of 44 patients. The sensitivity and specificity of PoCUS in determining alignment accuracy when compared to X-ray were 100% (95% CI: 83-100%) and 64% (95% CI: 32-88%) respectively. The PPV and NPV were 86% (95% CI: 66-95%) and 100% (95% CI: 56-100%) respectively. Ten out of 44 (23%) patients with distal radius fractures ultimately required an Open Reduction and Internal Fixation (ORIF). CONCLUSION: Our study supports the use of PoCUS for identifying distal radius forearm fractures and may have some value in assisting clinicians to determine post reduction success. We still advocate using standard X-ray radiographs to confirm successful or adequate cortical alignment following a manipulation.

Intramedullary Steinmann pin nailing of the ulna: an option for the damage control orthopedics treatment of forearm fractures in open injuries in polytraumatized patients - A description of the technique and presentation of a case series.

INTRODUCTION: Forearm shaft fracture is common in young adult patients and associated with soft tissue and organ injuries. In open fractures in polytrauma patients, damage control orthopaedics (DCO) is well indicated. The aim of this study is to describe intramedullary Steinmann pin fixation of the ulna as a DCO procedure for the forearm and present a case series. DESCRIPTION OF THE TECHNIQUE: A 3.0 mm Steinmann pin is inserted retrograde in the ulna proximal fragment through the fracture site using the open wound as the approach. With direct visualization of the reduction, the pin is advanced into the distal fragment. The reduction of the longitudinal axis and shortening is thus achieved. PATIENTS AND METHODS: This method was used for all open fractures of forearm both-bone fractures in polytrauma patients undergoing DCO from 2014 to 2019. The alignment and length of the ulna were evaluated radiographically after pin fixation and before and after definitive fixation. Differences in the need for secondary procedures and infection rate between DCO and definitive fixation were also evaluated. RESULTS: There were 30 males (85.7%) with an average age of 32.9 ± 12.0 years and a mean ISS (Injury Severity Score) of 29.4 (range, 18.0-41.0). The most common associated injuries were thoracic trauma (62.8%) and head trauma (45.7%). In the radius and ulna, 51.4% and 60.0% of fractures, respectively, were multifragmentary (types B and C). Gustilo type IIIA represented 77.1% of the injuries. Pin fixation achieved good alignment and length in all cases. The mean time between DCO and definitive fixation was 12.0 days, and no secondary procedure was needed, nor any case developed either superficial or deep infection. The conversion from DCO to definitive fixation was considered easy in all cases. CONCLUSION: Intramedullary Steinmann pin fixation of the ulna is a viable option for DCO for forearm both-bone fractures in open fractures in polytrauma patients.

Manejo ecográfico de las fracturas de antebrazo distal en pacientes de edad pediátrica-revisión sistemática / Ultrasound management of distal forearm fractures in pediatric patients- systematic review

Objetivo: En este trabajo se pretende realizar una actualización sobre el papel de la ecografía en las fracturas de tercio distal de antebrazo en pacientes pediátricos, desde su diagnóstico, pasando por la asistencia en la reducción de la fractura, hasta el seguimiento ambulatorio. Material y métodos: Se incluyeron todos los estudios relacionados, estudios prospectivos, comparativos entre la ecografía y los métodos gold standard actuales (rayos x) en el diagnóstico, asistencia en la reducción y seguimiento de las fracturas de muñeca, en pacientes en edad pediátrica, publicados en los últimos 5 años, encontradas en las bases de datos de PUBMED, COCHRANE y EMBASE. Resultados: 14 estudios reunieron los criterios de inclusión con grados de evidencia II-III. Mostrando sensibilidades y especificidades >90% en el diagnóstico ecográfico, así como una tasa éxito en la reducción de la fractura comparable a los métodos habituales. Conclusión: La revisión presentada nos plantea la ecografía como alternativa real a la radiografía simple en la detección y como asistente en la reducción de las fracturas de antebrazo distal, así como su prometedor futuro en el seguimiento de esta patología.(AU)

Objective: Update the role of ultrasound in the distal third forearm fractures in pediatric patients, from the diagnosis, through assistance in reducing the fracture, to outpatient follow-up. Material and methods: All related studies, prospective, comparative studies between ultrasound and current gold standard methods (x-rays) in the diagnosis, assistance in the reduction and follow-up of wrist fractures, in pediatric patients, published in the last 5 years, found in PUBMED, COCHRANE and EMBASE databases, were included. Results: 14 studies reached the inclusion criteria with grades of evidence II-III. Showing sensitivities and specificities > 90% in fracture diagnosis by ultrasound, as well as a success reduction rate of the fracture comparable to the usual methods. Conclusion: The review presented shows us ultrasound as a real alternative to plain radiography in the detection and as a useful tool in the reduction of distal forearm fractures, as well as its promising future in the follow-up of this pathology.(AU)