Use of Point-of-Care Ultrasound to Identify Occult Fractures of the Tibia in the Pediatric Emergency Department: A Case Series

J Emerg Med. 2022 Apr;62(4):559-565. doi: 10.1016/j.jemermed.2021.11.025. Epub 2022 Jan 20.


Background: Although point-of-care ultrasound (POCUS) has been shown to be useful in the identification of both pediatric and adult long-bone fractures in the emergency setting, radiography remains the standard of care. Emergency physicians are often faced with the dilemma of how to evaluate and treat the child with lower leg injury and physical examination concerning for fracture but no readily identifiable fracture line on radiography.

Case reports: We present four cases in which POCUS was used to diagnose a radiographically occult fracture of the proximal tibia in young children. This is the first case series of occult fracture of the tibia diagnosed with POCUS. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: POCUS can demonstrate evidence of fracture even after unremarkable radiography is obtained, and POCUS findings consistent with fracture might allow for more effective guidance on discharge.

Keywords: POCUS; case series; occult fracture; sonography; tibia.

Publication types

  • Case Reports

MeSH terms

  • Child
  • Child, Preschool
  • Emergency Service, Hospital
  • Fractures, Bone*
  • Fractures, Closed* / diagnostic imaging
  • Humans
  • Point-of-Care Systems
  • Prospective Studies
  • Tibia / diagnostic imaging
  • Tibia / injuries
  • Ultrasonography