Sonography Assisted Fracture Reduction (SAFeR) in children with displaced forearm fractures

Displaced forearm fractures are common in children and require closed reduction in the emergency department. The procedure is commonly performed "blindly" without real time imaging guidance. This may lead to multiple reduction attempts and malalignment. Although fluoroscopy can provide real-time assessment, it is not readily available in many departments and involves radiation exposure. Ultrasonography is an alternative real-time imaging modality. The purpose of this study was to determine whether the use of real-time bedside sonography during closed reduction of distal and middle third forearm fractures decreases the number of reduction attempts and the number of patients requiring surgery due to malalignment.

Methods: During 2015, a bedside ultrasound protocol was implemented to guide forearm fracture reductions at Rambam Health Care Campus (RHCC). We performed a retrospective cohort study and compared the results of "blind" reductions without any imaging guidance to Sonography Assisted Fracture Reduction (SAFeR). The need for reduction was determined according to published criteria.

Results: From 2014 to 2016, 458 patients required reduction in the ED. Of these 289 were performed without real-time imaging (group 1) and 169 were performed using SAFeR (group 2). Re-reduction was required in 28 patients (10%) in group 1 vs. 1 patient (0.6%) in group 2. Surgery was required in 14 patients (5%) and 2 patients (1%) respectively.

Conclusion: The current study shows that SAFeR may be used to guide forearm fracture reduction in children and may reduce the number of re-reductions compared to the blind technique.