![]() ![]() Ultrasound can be used in traumatic musculoskeletal injury to look for: 1 Be familiar with the ultrasound findings pathognomonic for a tibial plateau fracture.Understand the technique for performing an ultrasound evaluation of the knee in the setting of trauma.Is there a role for point-of-care ultrasound (POCUS) in this situation? Portable 2-view radiographs were obtained and interpreted as “no acute fracture.” On repeat examination, however, the patient continued to have pain and was now unable to bear weight on the affected extremity. She was tender to palpation over the proximal tibia. The emergency physician noted moderate swelling on exam with intact skin and distal pulses. She experienced no head strike or loss of consciousness, however she was unable to ambulate at the scene, and upon arrival to the ED, complained of left knee pain. X-rays of the hip and anteroposterior pelvis are normal.ĭiagnosis: suspected occult hip (neck of femur) fracture.A 70-year-old female with no past medical history was hit by a motor vehicle while crossing the street. She has a tender right hip and significant decreased range of motion (passive and active). There is no limb-shortening or external rotation. She has pain to the right hip and is non-weight-bearing. Case 3: Occult Hip FractureĪ 74-year-old female slips and falls. Therefore, the option of immobilization, crutches, strict non-weight-bearing, and close follow-up (ideally within a week) may be more reasonable, depending on your local resources and preferences. A younger patient with a similar assessment may be more likely to manage crutches. The patient should be kept non-weight-bearing until the diagnosis is clarified. In many older patients, this proposition is very risky, so the push would be for advanced imaging (a CT scan) as soon as can be reasonably arranged. More tests? Or “treat and more time?” The option for treat and more time means immobilization, crutches, and non-weight-bearing. Such fractures are at risk of displacing if the diagnosis is missed in the emergency department and the patient is allowed to weight-bear. Even in the face of normal X-rays, the high clinical suspicion should make one pause and consider occult fracture. On exam, the swollen knee, lateral joint line pain, and inability to bear weight are consistent with a likely tibial plateau injury. Valgus stress with immediate pain, rapid swelling (implying acute hemarthrosis), and non-weight-bearing suggest a lateral tibial plateau fracture, especially in older patients with osteoporosis. X-rays of the knee (four views) show effusion only.ĭiagnosis: suspected occult lateral tibial plateau fracture. On exam, the knee is swollen, there is tenderness along the lateral joint line, the ligaments are stable, and soft tissues are intact. 3,4 Case 2: Occult Lateral Tibial Plateau FractureĪ 78-year-old male presents with valgus stress to left knee, immediate pain, non-weight-bearing, and swelling within an hour. While there are suggestions in the literature that US may be an option for suspected scaphoid fractures, it is not considered sensitive enough to reliably alter ED management decisions. When to Use Point-of-Care Ultrasound for Skull FracturesĮxplore This Issue ACEP Now: Vol 39 – No 03 – March 2020.Tips for Emergency Physicians on Spotting Occult Knee Dislocation.Tips for Diagnosing Occult Fractures in the Emergency Department. ![]()
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