Using bedside ultrasound to diagnose forearm fractures in children

Grant ID: EMPJ-222R31-2019-SNELLING

Project Summary

This is a multicentre, open-labelled diagnostic randomised controlled trial to comparing the use of portable ultrasound and x-ray imaging to diagnose a buckle fracture in children. The trial will determine if there are differences in functional outcomes, patient and care-giver preferences, and health system benefits.

Children frequently present to the emergency department with forearm injuries and often have an x-ray to assess if there is a fracture. Due to the soft and plastic nature of the bones in young children, injuries can cause their bones to bend, known as a buckle fracture. Bedside ultrasound is a test that emergency practitioners can use to rapidly diagnose a fracture at the time of examination, without exposing children to ionising radiation. Ultrasound in this setting is well tolerated, only requiring light touch and gentle manipulation of the forearm and has similar accuracy when compared with x-rays for diagnosing children’s forearm fractures.

This is the first trial of its kind to assess whether an x-ray is unnecessary when there is either a buckle fracture or no fracture seen on a portable ultrasound machine. This is important as they can be treated at the time of review without any further delay, which will avoid these children being exposed to ionising radiation. Children will be randomised to receive either an ultrasound or x-ray for their forearm injury. Both groups will be followed up to see whether there are any differences in their recovery and to determine any complications. We will also determine the time and cost implications of this new approach, which could enable families to go home earlier and could be more cost-effective, with less x-rays being ordered.



- Snelling, P.J., Jones, P., Moore, M., Gimpel, P., Rogers, R., Liew, K., Ware, R.S., Keijzers, G., 2022. Describing the learning curve of novices for the diagnosis of paediatric distal forearm fractures using point-of-care ultrasound. Australasian Journal of Ultrasound in Medicine: 25(2): 66-73. doi: 10.1002/ajum.12291. PMID: 35722050; PMCID: PMC9201201.

- Snelling, P.J., Keijzers, G., Byrnes, J., Bade, D., George, S., Moore, M., Jones, P., Davison, M., Roan, R. and Ware, R.S., 2021. 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, 22(1), pp.1-12.

- Snelling, P.J., Keijzers, G. and Ware, R.S., 2021. Point‐of‐Care Ultrasound Pronator Quadratus Hematoma Sign for Detection of Clinically Non‐Angulated Pediatric Distal Forearm Fractures: A Prospective Cohort Study. Journal of Ultrasound in Medicine.

- Snelling, P. J., 2020. Getting started in paediatric emergency medicine point‐of‐care ultrasound: Five fundamental applications. Australasian Journal of Ultrasound in Medicine, 23(1), 5-9.


Amount Awarded


Grant Scheme


Principal Investigator:
Dr Peter Snelling

Co Investigators:
Prof Robert Ware
Prof Gerben Keijzers
A/Prof Joshua Byrnes
Mr Mark Moore
Dr Michelle Davison
Dr Corey Cassidy
Dr David Bade
Dr Randipsingh (Randy) Bindra

Associate Investigators:
Dr Stuart Watkins
Dr David Herd
Ms Peta Gimpel
Ms Rosemary Rogers
Dr Robert Roan
Dr Shane George
Dr Christopher Carty
Dr Ruaraidh McRitchie


Collaborating Institutions

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