Pediatric Distal Forearm Fractures/Self-Assessment Framework

Medical knowledge page data
Part of	Pediatric Distal Forearm Fractures
Parent	Pediatric Distal Forearm Fractures

This module allows traditional bone setters, pre-hospital providers, clinical officers, nurses, nurse practitioners, and medical officers to become confident and competent in performing point-of-care ultrasound diagnostic imaging to rule out the presence of a pediatric distal forearm fracture and distinguish between buckle (torus) fractures and cortical break fractures to make appropriate referrals as part of the management of closed pediatric (< 16 years of age) distal forearm fractures in regions without access to X-ray imaging and orthopedic specialist coverage.^[1]^[2]^[3]^[4]^[5]^[6]^[7]^[8]^[9]

Self-Assessment Framework[edit | edit source]

Please print off this self-assessment framework before the simulation skills training, review it after the simulation skills training, and file and save a back-up copy of the completed and signed self-assessment framework and your ultrasound images for your training records.

Review all the acquired images to determine if they meet all the quality standards outlined in the checklist below.

Quality Assurance Checklist Standards for Ultrasound Image Acquisition and Interpretation
#	Proper Technique for Image Acquisition and Interpretation	Ultrasound Image Meets Standard	Ultrasound Image Does Not Meet Standard
1	Probe (black) is properly oriented with the probe marker (blue) facing distally.	When the probe is properly oriented with the probe marker facing distally, the epiphysis (E), physis (P), metaphysis (M), and diaphysis (D) are oriented in a left-to-right direction.	Ultrasound scan of buckle fracture of forearm (shown by arrow). When the probe is not properly oriented (i.e., the probe marker is facing proximally), the epiphysis (E), physis (P), metaphysis (M), and diaphysis (D) are oriented in a right-to-left direction.
2	Probe is properly positioned perpendicular to the bone.	When the probe is properly positioned perpendicular to the bone, the image is clear with distinct margins of the bone cortex including the epiphysis (E), metaphysis (M), and diaphysis (D).	When the probe is not properly positioned perpendicular to the bone, the image is unclear or without distinct margins of the bone cortex.
3	Probe is properly aligned with the bone	When the probe is properly aligned to the bone, the full length of the epiphysis, metaphysis or diaphysis will be in view in the image.	Lateral view of buckle fracture of radius (shown by arrow). When the probe is not properly aligned to the bone (i.e., is rotated) the epiphysis (E*) will not be fully in view.
4	Probe is set to the proper depth of 4 cm when evaluating the pronator quadratus muscle.	When the probe is set to the proper depth of 4 cm, the entire pronator quadratus muscle is visualized to identify a hematoma.	When the probe is not set to the proper depth of 4 cm, the entire pronator quadratus muscle is not visualized.
5	All features are properly labelled.	In this lateral radius view of a 12-year-old healthy male patient, the epiphysis (E), physis (P), metaphysis (M), and diaphysis (D) are properly labelled.	In this dorsal radius view of a 12-year-old healthy male patient, the diaphysis (D), epiphysis (E), and metaphysis (M) are labelled incorrectly. Click here to also see an image with no labelled features.

Any image that does not meet the standard for all the quality assurance checklist items must be re-acquired in accordance with the techniques described below.

Self-Assessment of Image Acquisition and Interpretation for Ultrasound Diagnosis of Pediatric Distal Forearm Fractures

Ultrasound Scanning Site	Please check off each ultrasound view that meets all 5 quality assurance checklist standards
Left Forearm of Healthy Adult	View #1: Dorsal Radius View #2: Dorsal Ulna View #3: Lateral Ulna View #4: Lateral Radius View #5: Volar Radius View #6: Volar Ulna View of Pronator Quadratus
Right Forearm of Healthy Adult	View #1: Dorsal Radius View #2: Dorsal Ulna View #3: Lateral Ulna View #4: Lateral Radius View #5: Volar Radius View #6: Volar Ulna View of Pronator Quadratus
Models #1 + #2	View #1: Dorsal Radius View #2: Dorsal Ulna View #3: Lateral Ulna View #4: Lateral Radius View #5: Volar Radius View #6: Volar Ulna
Models #3 + #4	View #1: Dorsal Radius View #2: Dorsal Ulna View #3: Lateral Ulna View #4: Lateral Radius View #5: Volar Radius View #6: Volar Ulna
Models #5 + #6 (Unblinded Training)	View #1: Dorsal Radius View #2: Dorsal Ulna View #3: Lateral Ulna View #4: Lateral Radius View #5: Volar Radius View #6: Volar Ulna
Models #5 + #6 (Blinded Training)	View #1: Dorsal Radius View #2: Dorsal Ulna View #3: Lateral Ulna View #4: Lateral Radius View #5: Volar Radius View #6: Volar Ulna
Models #7 + #8	View #1: Dorsal Radius View #2: Dorsal Ulna View #3: Lateral Ulna View #4: Lateral Radius View #5: Volar Radius View #6: Volar Ulna
Models #9 + #10	View #1: Dorsal Radius View #2: Dorsal Ulna View #3: Lateral Ulna View #4: Lateral Radius View #5: Volar Radius View #6: Volar Ulna

All images must meet all the quality assurance standards checklist in order to pass this skills training module.

Learner's Nameː

Learner's Signature:

Assistant's Nameː

Assistant's Signature:

Date of Trainingː

Training Module Certificate of Completion[edit | edit source]

Once all the ultrasound images have been reviewed and confirmed they all meet standards in the quality assurance checklist, then:

Get certificate

Click the button above.
Type in your name, download and print out a certificate of completion for this training module.
Photograph your certificate on your cellphone as a backup and file the printed certificate in your training records.

Acknowledgements[edit | edit source]

This work is funded by a grant from the Intuitive Foundation. Any research, findings, conclusions, or recommendations expressed in this work are those of the author(s), and not of the Intuitive Foundation.

References[edit | edit source]

↑ Onyemaechi NO, Itanyi IU, Ossai PO, Ezeanolue EE. Can traditional bonesetters become trained technicians? Feasibility study among a cohort of Nigerian traditional bonesetters. Hum Resour Health. 2020 Mar 20;18(1):24. doi: 10.1186/s12960-020-00468-w. PMID: 32197617; PMCID: PMC7085192.
↑ Heiner JD, McArthur TJ. The ultrasound identification of simulated long bone fractures by prehospital providers. Wilderness Environ Med. 2010 Jun;21(2):137-40. doi: 10.1016/j.wem.2009.12.028. Epub 2009 Dec 22. PMID: 20591377.
↑ Heiner JD, Baker BL, McArthur TJ. The ultrasound detection of simulated long bone fractures by U.S. Army Special Forces Medics. J Spec Oper Med. 2010 Spring;10(2):7-10. PMID: 20936597.
↑ Heiner JD, Proffitt AM, McArthur TJ. The ability of emergency nurses to detect simulated long bone fractures with portable ultrasound. Int Emerg Nurs. 2011 Jul;19(3):120-4. doi: 10.1016/j.ienj.2010.08.004. Epub 2010 Sep 25. PMID: 21665155.
↑ Snelling PJ, Jones P, Keijzers G, Bade D, Herd DW, Ware RS. Nurse practitioner administered point-of-care ultrasound compared with X-ray for children with clinically non-angulated distal forearm fractures in the ED: a diagnostic study. Emerg Med J. 2021 Feb;38(2):139-145. doi: 10.1136/emermed-2020-209689. Epub 2020 Sep 8. PMID: 32900856.
↑ Snelling PJ, Jones P, Moore M, Gimpel P, Rogers R, Liew K, Ware RS, Keijzers G. Describing the learning curve of novices for the diagnosis of paediatric distal forearm fractures using point-of-care ultrasound. Australas J Ultrasound Med. 2022 Mar 7;25(2):66-73. doi: 10.1002/ajum.12291. PMID: 35722050; PMCID: PMC9201201.
↑ Heiner JD, McArthur TJ. A simulation model for the ultrasound diagnosis of long-bone fractures. Simul Healthc. 2009 Winter;4(4):228-31. doi: 10.1097/SIH.0b013e3181b1a8d0. PMID: 19915442.
↑ Snelling PJ, Keijzers G, Byrnes J, Bade D, George S, Moore M, Jones P, Davison M, Roan R, Ware RS. Bedside Ultrasound Conducted in Kids with distal upper Limb fractures in the Emergency Department (BUCKLED): a protocol for an open-label non-inferiority diagnostic randomised controlled trial. Trials. 2021 Apr 14;22(1):282. doi: 10.1186/s13063-021-05239-z. PMID: 33853650; PMCID: PMC8048294.
↑ Snelling PJ. A low-cost ultrasound model for simulation of paediatric distal forearm fractures. Australas J Ultrasound Med. 2018 Feb 25;21(2):70-74. doi: 10.1002/ajum.12083. PMID: 34760505; PMCID: PMC8409885.

Page data
Part of	Pediatric Distal Forearm Fractures
Keywords	orthopedic surgery, surgical training, pediatric distal forearm fracture, buckle fracture, torus fracture, greenstick fracture, complete fracture, non-displaced fracture, fracture care, fracture sonography, point-of-care ultrasound, portable ultrasound, handheld ultrasound, 3d printing, artificial bones, splinting
SDG	SDG03 Good health and well-being
Authors	Medical Makers
License	CC-BY-SA-4.0
Organizations	Medical Makers
Language	English (en)
Related	0 subpages, 6 pages link here
Impact	260 page views (more)
Created	August 15, 2022 by Medical Makers
Last modified	February 28, 2024 by Felipe Schenone
Cite as	Medical Makers (2022–2024). "Pediatric Distal Forearm Fractures/Self-Assessment Framework". Appropedia. Retrieved December 25, 2024.
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[1] Onyemaechi NO, Itanyi IU, Ossai PO, Ezeanolue EE. Can traditional bonesetters become trained technicians? Feasibility study among a cohort of Nigerian traditional bonesetters. Hum Resour Health. 2020 Mar 20;18(1):24. doi: 10.1186/s12960-020-00468-w. PMID: 32197617; PMCID: PMC7085192.

[2] Heiner JD, McArthur TJ. The ultrasound identification of simulated long bone fractures by prehospital providers. Wilderness Environ Med. 2010 Jun;21(2):137-40. doi: 10.1016/j.wem.2009.12.028. Epub 2009 Dec 22. PMID: 20591377.

[3] Heiner JD, Baker BL, McArthur TJ. The ultrasound detection of simulated long bone fractures by U.S. Army Special Forces Medics. J Spec Oper Med. 2010 Spring;10(2):7-10. PMID: 20936597.

[4] Heiner JD, Proffitt AM, McArthur TJ. The ability of emergency nurses to detect simulated long bone fractures with portable ultrasound. Int Emerg Nurs. 2011 Jul;19(3):120-4. doi: 10.1016/j.ienj.2010.08.004. Epub 2010 Sep 25. PMID: 21665155.

[5] Snelling PJ, Jones P, Keijzers G, Bade D, Herd DW, Ware RS. Nurse practitioner administered point-of-care ultrasound compared with X-ray for children with clinically non-angulated distal forearm fractures in the ED: a diagnostic study. Emerg Med J. 2021 Feb;38(2):139-145. doi: 10.1136/emermed-2020-209689. Epub 2020 Sep 8. PMID: 32900856.

[6] Snelling PJ, Jones P, Moore M, Gimpel P, Rogers R, Liew K, Ware RS, Keijzers G. Describing the learning curve of novices for the diagnosis of paediatric distal forearm fractures using point-of-care ultrasound. Australas J Ultrasound Med. 2022 Mar 7;25(2):66-73. doi: 10.1002/ajum.12291. PMID: 35722050; PMCID: PMC9201201.

[7] Heiner JD, McArthur TJ. A simulation model for the ultrasound diagnosis of long-bone fractures. Simul Healthc. 2009 Winter;4(4):228-31. doi: 10.1097/SIH.0b013e3181b1a8d0. PMID: 19915442.

[8] Snelling PJ, Keijzers G, Byrnes J, Bade D, George S, Moore M, Jones P, Davison M, Roan R, Ware RS. Bedside Ultrasound Conducted in Kids with distal upper Limb fractures in the Emergency Department (BUCKLED): a protocol for an open-label non-inferiority diagnostic randomised controlled trial. Trials. 2021 Apr 14;22(1):282. doi: 10.1186/s13063-021-05239-z. PMID: 33853650; PMCID: PMC8048294.

[9] Snelling PJ. A low-cost ultrasound model for simulation of paediatric distal forearm fractures. Australas J Ultrasound Med. 2018 Feb 25;21(2):70-74. doi: 10.1002/ajum.12083. PMID: 34760505; PMCID: PMC8409885.

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