![]() ![]() The authors speculate that this is due to easy detection of cortical deformity and real time correlation with bony tenderness on exam with ultrasound. In another study evaluating POCUS as compared to CT (the gold standard), for the diagnosis of elbow fractures not adequately visualized on x-ray, POCUS had a sensitivity of 97% and a specificity of 88%. reviewing the sensitivity and specificity for ultrasound diagnosis of upper extremity fractures completed by Emergency Medicine physicians compared to x-ray was 83-100% and 73-91% respectively. Identifying fractures of the elbow using POCUS includes visualizing cortical disruption, subperiosteal hematomas, posterior fat pad elevation or lipohemarthrosis. In particular, bedside ultrasound may be superior to x-ray for diagnosis of occult fractures such as nondisplaced fractures, buckle fractures, and Salter Harris I fractures. With the advent of ultrasound availability across Emergency Departments, there may be benefits for using POCUS as an adjunct in diagnosis or exclusion of fractures. However, radiographs are often negative for fracture in these injuries (50% for upper extremities and 85% for ankle injuries). DISCUSSIONĮxtremity injuries and concern for fractures are common reasons for patient visits to the Emergency Department. The patient was diagnosed with a left elbow dislocation with possible occult, proximal radial head avulsion fracture. CT imaging redemonstrated the bone fragment next to the lateral epicondyle suspicious of avulsion fracture, but without a clear source. Given the bone fragment which was seen on x-ray but no clear fracture, the patient then had a CT scan of her elbow to better characterize the injury. It also noted extensive soft tissue swelling with a punctate linear ossific process just proximal to the radial head which was thought to be a fracture fragment. The patient’s plain film report noted a posterior dislocation of the elbow.
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