SONO case series: point-of-care ultrasound for fracture diagnosis.

A 34-year-old man with no significant medical history presented to the ED with right lower extremity (RLE) pain after a motorcycle crash. The patient reported that he was travelling at approximately 8 km per hour when he hit a piece of trash on the roadway, skidded to one side, and fell to the ground with his motorcycle landing on top of his RLE. He attempted to ambulate on scene but was unable to bear weight due to severe pain in his RLE. He was helmeted during the crash and denied any other problems. On physical examination, he was well-appearing overall, with vital signs notable only for mild hypertension to 156/94 mm Hg, a pulse of 80 beats/min, a respiratory rate of 15 breaths/min, and an oxygen saturation of 99% on room air. Examination of his distal right leg was notable for swelling without obvious deformity nor other evidence of trauma. Passive and active range of motion of his right knee and ankle were limited by pain. His right foot was neurovascularly intact, with normal sensation and motor function and palpable distal pulses. The rest of the physical examination was unremarkable After a negative extended Focused Assessment with Sonography in Trauma, a point-of-care ultrasound (POCUS) of the right lower leg was performed as part of the initial evaluation, revealing a discontinuity of the cortical surface of the tibia consistent with an acute fracture. This diagnosis was subsequently confirmed on X-ray, which also demonstrated an ipsilateral proximal fibula fracture (figure 1). Figure 1 Photograph of the patient’s right lower extremity at time of arrival in the ED, lateral x-ray of the right ankle, and longitudinal ultrasound of the right tibia showing a cortical disruption. In 2016, the American College of Emergency Physicians specifically included MSK ultrasound, such as for …