Diagnostic value of ultrasound for fracture of the distal radius and ulna: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

 WANG Ling ¹ , WANG Mengshu ² , ZHOU Qi ³

1. Department of Ultrasound, People’s Hospital of Gansu Province, Lanzhou, 730000, P.R.China;
2. The First Hospital of Lanzhou University, Lanzhou, 730000, P.R.China;
3. School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, P.R.China;

Corresponding author：

WANG Ling, Email: gssrmyywl2016@163.com

Keywords：

Ultrasound; Fracture of the distal radius and ulna; X-ray; Meta-analysis; Diagnostic test

DOI：

10.7507/1672-2531.201611013

Video：

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Objective To systematically review the value of ultrasound in the diagnosis of fracture of the distal radius and ulna for providing evidence for clinical diagnosis. MethodsWe searched PubMed, EMbase, The Cochrane Library (Issue 7, 2016), CNKI, CBM and WanFang Data databases for studies about ultrasound in the diagnosis of fracture of the distal radius and ulna from inception to August 1^st, 2016. Two reviewers independently screened literatures according to inclusion and exclusion criteria, extracted data, and assessed the risk of bias of included studies by using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) tool, and then meta-analysis was performed by using Meta-Disc 1.4 software. ResultsA total of 16 articles involving 1 182 patients and 631 fractures were included. The results of heterogeneity test revealed that there was statistical heterogeneity among the results of studies, thus, random effects model was used for meta-analysis. The results of meta-analysis showed that the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnosis odds ratio for ultrasound diagnosis fracture of the distal radius and ulna were 0.95 (95%CI 0.94 to 0.97), 0.92 (95%CI 0.89 to 0.94), 9.98 (95%CI 5.20 to 19.15), 0.07 (95%CI 0.04 to 0.13), 187.94 (95%CI 65.67 to 537.84), respectively. The area under the SROC curve was 0.976 4. ConclusionUltrasound is a useful non-invasive method as a routine examination for fracture of the distal radius and ulna. Due to the limited quality and quantity of included studies, the above conclusion is needed to be validated by more high-quality studies.

Citation： WANGLing, WANGMengshu, ZHOUQi. Diagnostic value of ultrasound for fracture of the distal radius and ulna: a systematic review. Chinese Journal of Evidence-Based Medicine, 2017, 17(2): 213-220. doi: 10.7507/1672-2531.201611013 Copy

1.	王刚. 手法复位夹板外固定联合中医益气活血汤对老年肢体骨折患者骨痂 X 线评分及血清 ALP 水平的影响. 中国老年学杂志, 2014, 34(14): 4029-4031.
2.	董瑞萍. 中药熏洗配合功能锻炼治疗四肢骨折后期功能障碍 50 例的体会. 贵阳中医学院学报, 2012, 34(3): 92.
3.	徐建高. 前臂外固定器治疗前臂远端骨折. 河南外科学杂志, 2005, 11(1): 53-54.
4.	王亦璁. 骨与关节损伤. 第4版, 2007, 北京: 人民卫生出版社.
5.	Byrd GD, Rozental TD. Wrist fractures. Available at: http://bestpractice.bmj.com/best-practice/monograph/392.html.
6.	徐林, 蔡锦方. 桡骨远端关节内骨折的研究进展. 中国矫形外科杂志, 2004, 12(18): 1416-1417.
7.	罗为民. 双微型钢板内固定治疗尺骨远端骨折 11 例体会. 江西医药, 2014, 49(8): 699.
8.	Ackermann O, Liedgens P, Eckert K, et al. Ultrasound diagnosis of juvenile forearm fractures. J Med Ultrason, 2010, 37(3): 123-127.
9.	Mizuta T, Benson WM, Foster BK, et al. Statistical analysis of the incidence of physical injuries. J Pediatr Orthop, 1987, 7(7): 518-523.
10.	Cuenca J, Martínez AA, Herrera A, et al. The incidence of distal forearm fractures in Zaragoza (Spain). Chirurgie De La Main, 2003, 22(4): 211-215.
11.	Kaukonen JP, Porras M, Karaharju E, et al. Anatomical results after distal forearm fractures. Ann Chir Gynaecol, 1988, 77(1): 21-26.
12.	Aitali L, Andreassi MG, Foffa I, et al. Cumulative patient effective dose and acute radiation-induced chromosomal DNA damage in children with congenital heart disease. Heart, 2010, 96(4): 269-274.
13.	Brenner DJ, Doll R, Goodhead DT, et al. Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. PNAS, 2003, 100(24): 13761-13766.
14.	Linet MS, Kim KP, Rajaraman P, et al. Children's exposure to diagnostic medical radiation and cancer risk: epidemiologic and dosimetric considerations. Pediatr Radiol, 2009, 39(1): 4-26.
15.	Miller RW. Special susceptibility of the child to certain radiation-induced cancers. Environ Health Perspect, 1995, 103 (Suppl 6): 41-44.
16.	Linet MS, Slovis TL, Miller DL, et al. Cancer risks associated with external radiation from diagnostic imaging procedures. CA Cancer J Clin, 2012, 62(2): 75-100.
17.	王天仪, 王爱民, 陈晓宁, 等. 超声在骨折诊断中的应用研究进展. 中国医药, 2012, 7(2): 255-256.
18.	Demers G, Migliore S, Bennett DR, et al. Ultrasound evaluation of cranial and long bone fractures in a cadaver model. Mil Med, 2012, 177(7): 836-839.
19.	Heiner JD, Proffitt AM, Mcarthur TJ. The ability of emergency nurses to detect simulated long bone fractures with portable ultrasound. Int Emerg Nurs, 2011, 19(3): 120-124.
20.	Marshburn TH, Legome E, Sargsyan A, et al. Goal-directed ultrasound in the detection of long-bone fractures. J Trauma, 2004, 57(2): 329-332.
21.	Noble VE, Legome E, Marshburn T. Long bone ultrasound: makingthe diagnosis in remote locations. J Trauma, 2003, 54(54): 800.
22.	Ackermann O, Eckert K, Pellengahr CS. Ultrasound diagnosis of forearme fractures in the growing age, no more x-ray. Ultraschall Med, 2013, doi: 10.1055/s-0033-1354901.
23.	Chaar-Alvarez FM, Warkentine F, Cross K, et al. Bedside ultrasound diagnosis of nonangulated distal forearm fractures in the pediatric emergency department. Pediatr Emerg Care, 2011, 27(11): 1027-1032.
24.	Abi KS, Haddadzebouni S, Roukoz S, et al. Ultrasound as an adjunct to radiography in minor musculoskeletal pediatric trauma. J Med Liban, 2011, 59(2): 70-74.
25.	Cho KH, Lee SM, Lee YH, et al. Ultrasound Diagnosis of Either an Occult or Missed Fracture of an Extremity in Pediatric-Aged Children. J Korean Rad Soc, 2010, 11(1): 84-94.
26.	O'Malley P, Tayal VS. Use of emergency musculoskeletal sonography in diagnosis of an open fracture of the hand. J Ultrasound Med, 2007, 26(5): 679-682.
27.	Eckert K, Ackermann O. Sonographic fracture diagnosis in children. Der Unfallchirurg, 2014, 117(4): 355-368.
28.	Ekşioğlu F, Altinok D, Uslu MM, et al. Ultrasonographic findings in pediatric fractures. Turk J Pediatr, 2003, 45(2): 136-140.
29.	Rathfelder FJ, Paar O. Possibilities for using sonography as a diagnostic procedure in fractures during the growth period. Der Unfallchirurg, 1995, 98(12): 645-649.
30.	Sinha TP, Bhoi S, Kumar S, et al. Diagnostic accuracy of bedside emergency ultrasound screening for fractures in pediatric trauma patients. J Emerg Trauma Shock, 2011, 4(4): 443-445.
31.	Bavil AS, Nemati NM. musculoskeletal ultrasound in pediatric trauma. Iran J Radiol, 2008, 30(3): 150-160.
32.	Cross KP. Bedside ultrasound for pediatric long bone fractures. Clin Pediatr Emerg Med, 2011, 12(1): 27-36.
33.	Joshi N, Lira A, Mehta N, et al. Diagnostic Accuracy of History, Physical Examination, and Bedside Ultrasound for Diagnosis of Extremity Fractures in the Emergency Department: A Systematic Review. Acad Emerg Med, 2013, 20(1): 1-15.
34.	Saul T, Ng L, Lewiss RE. Point-of-care ultrasound in the diagnosis of upper extremity fracture-dislocation, a pictorial essay. Med Ultrason, 2013, 15(15): 230-236.
35.	Simanovsky N, Lamdan R, Hiller N, et al. Sonographic detection of radiographically occult fractures in pediatric ankle and wrist injuries. J Pediatr Orthop B, 2009, 29(2): 142-145.
36.	于德江, 江朝光, 李众利, 等. 超声在汶川地震骨折诊断中的应用. 中华医学超声杂志(电子版), 2008, 5(5): 782-788.
37.	Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med, 2011, 155(8): 529-536.
38.	Beltrame V, Stramare R, Rebellato N, et al. Sonographic evaluation of bone fractures: a reliable alternative in clinical practice? Clin Imaging, 2012, 36(3): 203-208.
39.	Chen L, Kim Y, Moore CL. Diagnosis and guided reduction of forearm fractures in children using bedside ultrasound. Pediatr Emerg Care, 2007, 23(8): 528-531.
40.	Herren C, Sobottke R, Ringe MJ, et al. Ultrasound-guided diagnosis of fractures of the distal forearm in children. Orthop Traumatol Surg Res, 2015, 101(4): 501-505.
41.	Hübner U, Schlicht W, Outzen S, et al. Ultrasound in the diagnosis of fractures in children. Joint Bone J, 2000, 82(8): 1170-1173.
42.	Javadzadeh HR, Davoudi A, Davoudi F, et al. Diagnostic value of "bedside ultrasonography" and the "water bath technique" in distal forearm, wrist, and hand bone fractures. Emerg Radiol, 2014, 21(1): 1-4.
43.	Kozaci N, Ay MO, Akcimen M, et al. Evaluation of the effectiveness of bedside point-of-care ultrasound in the diagnosis and management of distal radius fractures. Am J Emerg Med, 2015, 33(1): 67-71.
44.	Moritz JD, Berthold LD, Soenksen SF, et al. Ultrasound in diagnosis of fractures in children: unnecessary harassment or useful addition to X-ray? Ultraschall Med, 2008, 29(3): 267-274.
45.	Musa S, Wilson P. Ultrasonography and radiography: a comparison. Emerg Nurse, 2015, 23(2): 34-37.
46.	Patel DD, Blumberg SM, Crain EF. The utility of bedside ultrasonography in identifying fractures and guiding fracture reduction in children. Pediatr Emerg Care, 2009, 25(4): 221-225.
47.	Waterbrook AL, Adhikari S, Stolz U, et al. The accuracy of point-of-care ultrasound to diagnose long bone fractures in the ED. Am J Emerg Med, 2013, 31(9): 1352-1356.
48.	Weinberg ER, Tunik MG, Tsung JW. Accuracy of clinician-performed point-of-care ultrasound for the diagnosis of fractures in children and young adults. Injury, 2010, 41(8): 862-868.
49.	Williamson D, Watura R, Cobby M. Ultrasound imaging of forearm fractures in children: a viable alternative? J Accid Emerg Med, 2000, 17(1): 22-24.
50.	张敬东, 杨琰, 吴道珠. B 超诊断并引导儿童前臂骨折闭合复位. 实用骨科杂志, 2014, 20(4): 347-349.
51.	王古衡, 谢仁国, 汤锦波. 上肢骨折发生率和发生特点的临床资料分析. 中华手外科杂志, 2012, 28(2): 95-98.
52.	Katzer C, Wasem J, Eckert K, et al. Ultrasound in the Diagnostics of Metaphyseal Forearm Fractures in Children: A Systematic Review and Cost Calculation. Pediatr Emerg Care, 2015, 32(6): 401-407.
53.	Eckert K, Ackermann O, Schweiger B, et al. Ultrasound as a viable alternative to standard X-rays for the diagnosis of distal forearm fractures in children. Z Orthop Unfall, 2012, 150(4): 409-414.
54.	Annelie S, Walenkamp MMJ, Abdelali B, et al. A clinical decision rule for the use of plain radiography in children after acute wrist injury: development and external validation of the Amsterdam pediatric wrist rules. Pediatr Radiol, 2016, 46(1): 50-60.
55.	Slovis TL. Children, computed tomography radiation dose, and the As Low As Reasonably Achievable (ALARA) concept. Pediatrics, 2003, 112(4): 971-972.
56.	Chern TC, Jou IM, Lai KA, et al. Sonography for monitoring closed reduction of displaced extra-articular distal radial fractures. J Bone Joint Surg Am, 2002, 84-A(2): 194-203.
57.	Dubrovsky AS, Kempinska A, Bank I, et al. Accuracy of ultrasonography for determining successful realignment of pediatric forearm fractures. Ann Emerg Med, 2015, 65(3): 260-265.
58.	Kodama N, Takemura Y, Ueba H, et al. Ultrasound-assisted closed reduction of distal radius fractures. J Hand Surg Am, 2014, 39(7): 1287-1294.
59.	Rezashah SH, Ebrahimi M, Ahmadik K, et al. Diagnostic accuracy of portable ultrasonography in confirmation of adequate reduction of distal radius fracture. Emerg (Tehran), 2013, 1(1): 7-10.
60.	Durston W, Swartzentruber R. Ultrasound guided reduction of pediatric forearm fractures in the ED. Am J Emerg Med, 2000, 18(1): 72-77.

1. 王刚. 手法复位夹板外固定联合中医益气活血汤对老年肢体骨折患者骨痂 X 线评分及血清 ALP 水平的影响. 中国老年学杂志, 2014, 34(14): 4029-4031.
2. 董瑞萍. 中药熏洗配合功能锻炼治疗四肢骨折后期功能障碍 50 例的体会. 贵阳中医学院学报, 2012, 34(3): 92.
3. 徐建高. 前臂外固定器治疗前臂远端骨折. 河南外科学杂志, 2005, 11(1): 53-54.
4. 王亦璁. 骨与关节损伤. 第4版, 2007, 北京: 人民卫生出版社.
5. Byrd GD, Rozental TD. Wrist fractures. Available at: http://bestpractice.bmj.com/best-practice/monograph/392.html.
6. 徐林, 蔡锦方. 桡骨远端关节内骨折的研究进展. 中国矫形外科杂志, 2004, 12(18): 1416-1417.
7. 罗为民. 双微型钢板内固定治疗尺骨远端骨折 11 例体会. 江西医药, 2014, 49(8): 699.
8. Ackermann O, Liedgens P, Eckert K, et al. Ultrasound diagnosis of juvenile forearm fractures. J Med Ultrason, 2010, 37(3): 123-127.
9. Mizuta T, Benson WM, Foster BK, et al. Statistical analysis of the incidence of physical injuries. J Pediatr Orthop, 1987, 7(7): 518-523.
10. Cuenca J, Martínez AA, Herrera A, et al. The incidence of distal forearm fractures in Zaragoza (Spain). Chirurgie De La Main, 2003, 22(4): 211-215.
11. Kaukonen JP, Porras M, Karaharju E, et al. Anatomical results after distal forearm fractures. Ann Chir Gynaecol, 1988, 77(1): 21-26.
12. Aitali L, Andreassi MG, Foffa I, et al. Cumulative patient effective dose and acute radiation-induced chromosomal DNA damage in children with congenital heart disease. Heart, 2010, 96(4): 269-274.
13. Brenner DJ, Doll R, Goodhead DT, et al. Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. PNAS, 2003, 100(24): 13761-13766.
14. Linet MS, Kim KP, Rajaraman P, et al. Children's exposure to diagnostic medical radiation and cancer risk: epidemiologic and dosimetric considerations. Pediatr Radiol, 2009, 39(1): 4-26.
15. Miller RW. Special susceptibility of the child to certain radiation-induced cancers. Environ Health Perspect, 1995, 103 (Suppl 6): 41-44.
16. Linet MS, Slovis TL, Miller DL, et al. Cancer risks associated with external radiation from diagnostic imaging procedures. CA Cancer J Clin, 2012, 62(2): 75-100.
17. 王天仪, 王爱民, 陈晓宁, 等. 超声在骨折诊断中的应用研究进展. 中国医药, 2012, 7(2): 255-256.
18. Demers G, Migliore S, Bennett DR, et al. Ultrasound evaluation of cranial and long bone fractures in a cadaver model. Mil Med, 2012, 177(7): 836-839.
19. Heiner JD, Proffitt AM, Mcarthur TJ. The ability of emergency nurses to detect simulated long bone fractures with portable ultrasound. Int Emerg Nurs, 2011, 19(3): 120-124.
20. Marshburn TH, Legome E, Sargsyan A, et al. Goal-directed ultrasound in the detection of long-bone fractures. J Trauma, 2004, 57(2): 329-332.
21. Noble VE, Legome E, Marshburn T. Long bone ultrasound: makingthe diagnosis in remote locations. J Trauma, 2003, 54(54): 800.
22. Ackermann O, Eckert K, Pellengahr CS. Ultrasound diagnosis of forearme fractures in the growing age, no more x-ray. Ultraschall Med, 2013, doi: 10.1055/s-0033-1354901.
23. Chaar-Alvarez FM, Warkentine F, Cross K, et al. Bedside ultrasound diagnosis of nonangulated distal forearm fractures in the pediatric emergency department. Pediatr Emerg Care, 2011, 27(11): 1027-1032.
24. Abi KS, Haddadzebouni S, Roukoz S, et al. Ultrasound as an adjunct to radiography in minor musculoskeletal pediatric trauma. J Med Liban, 2011, 59(2): 70-74.
25. Cho KH, Lee SM, Lee YH, et al. Ultrasound Diagnosis of Either an Occult or Missed Fracture of an Extremity in Pediatric-Aged Children. J Korean Rad Soc, 2010, 11(1): 84-94.
26. O'Malley P, Tayal VS. Use of emergency musculoskeletal sonography in diagnosis of an open fracture of the hand. J Ultrasound Med, 2007, 26(5): 679-682.
27. Eckert K, Ackermann O. Sonographic fracture diagnosis in children. Der Unfallchirurg, 2014, 117(4): 355-368.
28. Ekşioğlu F, Altinok D, Uslu MM, et al. Ultrasonographic findings in pediatric fractures. Turk J Pediatr, 2003, 45(2): 136-140.
29. Rathfelder FJ, Paar O. Possibilities for using sonography as a diagnostic procedure in fractures during the growth period. Der Unfallchirurg, 1995, 98(12): 645-649.
30. Sinha TP, Bhoi S, Kumar S, et al. Diagnostic accuracy of bedside emergency ultrasound screening for fractures in pediatric trauma patients. J Emerg Trauma Shock, 2011, 4(4): 443-445.
31. Bavil AS, Nemati NM. musculoskeletal ultrasound in pediatric trauma. Iran J Radiol, 2008, 30(3): 150-160.
32. Cross KP. Bedside ultrasound for pediatric long bone fractures. Clin Pediatr Emerg Med, 2011, 12(1): 27-36.
33. Joshi N, Lira A, Mehta N, et al. Diagnostic Accuracy of History, Physical Examination, and Bedside Ultrasound for Diagnosis of Extremity Fractures in the Emergency Department: A Systematic Review. Acad Emerg Med, 2013, 20(1): 1-15.
34. Saul T, Ng L, Lewiss RE. Point-of-care ultrasound in the diagnosis of upper extremity fracture-dislocation, a pictorial essay. Med Ultrason, 2013, 15(15): 230-236.
35. Simanovsky N, Lamdan R, Hiller N, et al. Sonographic detection of radiographically occult fractures in pediatric ankle and wrist injuries. J Pediatr Orthop B, 2009, 29(2): 142-145.
36. 于德江, 江朝光, 李众利, 等. 超声在汶川地震骨折诊断中的应用. 中华医学超声杂志(电子版), 2008, 5(5): 782-788.
37. Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med, 2011, 155(8): 529-536.
38. Beltrame V, Stramare R, Rebellato N, et al. Sonographic evaluation of bone fractures: a reliable alternative in clinical practice? Clin Imaging, 2012, 36(3): 203-208.
39. Chen L, Kim Y, Moore CL. Diagnosis and guided reduction of forearm fractures in children using bedside ultrasound. Pediatr Emerg Care, 2007, 23(8): 528-531.
40. Herren C, Sobottke R, Ringe MJ, et al. Ultrasound-guided diagnosis of fractures of the distal forearm in children. Orthop Traumatol Surg Res, 2015, 101(4): 501-505.
41. Hübner U, Schlicht W, Outzen S, et al. Ultrasound in the diagnosis of fractures in children. Joint Bone J, 2000, 82(8): 1170-1173.
42. Javadzadeh HR, Davoudi A, Davoudi F, et al. Diagnostic value of "bedside ultrasonography" and the "water bath technique" in distal forearm, wrist, and hand bone fractures. Emerg Radiol, 2014, 21(1): 1-4.
43. Kozaci N, Ay MO, Akcimen M, et al. Evaluation of the effectiveness of bedside point-of-care ultrasound in the diagnosis and management of distal radius fractures. Am J Emerg Med, 2015, 33(1): 67-71.
44. Moritz JD, Berthold LD, Soenksen SF, et al. Ultrasound in diagnosis of fractures in children: unnecessary harassment or useful addition to X-ray? Ultraschall Med, 2008, 29(3): 267-274.
45. Musa S, Wilson P. Ultrasonography and radiography: a comparison. Emerg Nurse, 2015, 23(2): 34-37.
46. Patel DD, Blumberg SM, Crain EF. The utility of bedside ultrasonography in identifying fractures and guiding fracture reduction in children. Pediatr Emerg Care, 2009, 25(4): 221-225.
47. Waterbrook AL, Adhikari S, Stolz U, et al. The accuracy of point-of-care ultrasound to diagnose long bone fractures in the ED. Am J Emerg Med, 2013, 31(9): 1352-1356.
48. Weinberg ER, Tunik MG, Tsung JW. Accuracy of clinician-performed point-of-care ultrasound for the diagnosis of fractures in children and young adults. Injury, 2010, 41(8): 862-868.
49. Williamson D, Watura R, Cobby M. Ultrasound imaging of forearm fractures in children: a viable alternative? J Accid Emerg Med, 2000, 17(1): 22-24.
50. 张敬东, 杨琰, 吴道珠. B 超诊断并引导儿童前臂骨折闭合复位. 实用骨科杂志, 2014, 20(4): 347-349.
51. 王古衡, 谢仁国, 汤锦波. 上肢骨折发生率和发生特点的临床资料分析. 中华手外科杂志, 2012, 28(2): 95-98.
52. Katzer C, Wasem J, Eckert K, et al. Ultrasound in the Diagnostics of Metaphyseal Forearm Fractures in Children: A Systematic Review and Cost Calculation. Pediatr Emerg Care, 2015, 32(6): 401-407.
53. Eckert K, Ackermann O, Schweiger B, et al. Ultrasound as a viable alternative to standard X-rays for the diagnosis of distal forearm fractures in children. Z Orthop Unfall, 2012, 150(4): 409-414.
54. Annelie S, Walenkamp MMJ, Abdelali B, et al. A clinical decision rule for the use of plain radiography in children after acute wrist injury: development and external validation of the Amsterdam pediatric wrist rules. Pediatr Radiol, 2016, 46(1): 50-60.
55. Slovis TL. Children, computed tomography radiation dose, and the As Low As Reasonably Achievable (ALARA) concept. Pediatrics, 2003, 112(4): 971-972.
56. Chern TC, Jou IM, Lai KA, et al. Sonography for monitoring closed reduction of displaced extra-articular distal radial fractures. J Bone Joint Surg Am, 2002, 84-A(2): 194-203.
57. Dubrovsky AS, Kempinska A, Bank I, et al. Accuracy of ultrasonography for determining successful realignment of pediatric forearm fractures. Ann Emerg Med, 2015, 65(3): 260-265.
58. Kodama N, Takemura Y, Ueba H, et al. Ultrasound-assisted closed reduction of distal radius fractures. J Hand Surg Am, 2014, 39(7): 1287-1294.
59. Rezashah SH, Ebrahimi M, Ahmadik K, et al. Diagnostic accuracy of portable ultrasonography in confirmation of adequate reduction of distal radius fracture. Emerg (Tehran), 2013, 1(1): 7-10.
60. Durston W, Swartzentruber R. Ultrasound guided reduction of pediatric forearm fractures in the ED. Am J Emerg Med, 2000, 18(1): 72-77.

Chinese Journal of Evidence-Based Medicine

Diagnostic value of ultrasound for fracture of the distal radius and ulna: a systematic review

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