Painful swelling and deformity of upper arm after a traffic accident

This lady suffered from painful swelling and deformity on her left upper arm after a traffic accident.
Physical examination indicated a humeral shaft fracture without associated neuromuscular injury on distal extremity.

This video is taken using Vscan, a pocket-sized ultrasound.
We use linear part of the transducer and started the scan from transverse approach.
For any tubular structures, the best way to start ultrasound scan is the transverse approach. To confirm the pathology, we have to scan the lesion from both long axis and short axis views of the target structure.
For trauma evaluation, EFAST is our first priority to exclude life threatening conditions.
For long bone fracture, especially for the shaft part, ultrasound is useful to detect cortical surface disruption on long axis approach, a.k.a. fracture.
Note the angulation of the fractured and separated bones marked in the white lines.

X-ray is still the first choice for stable extremity injury evaluation. 
But for austere environment or out-of-hospital situations, using ultrasound for long bone fracture evaluation can be one component of the trauma ultrasound protocol. For occult long bone fracture, ultrasound scanning with high resolution linear transduce can be useful, too.

The other old lady fell from motorcycle and had painful wrist.
X-ray indicated distal radial fracture.

Now, we can see the fracture, right ??


Take Home Message
1. Linear transducer from short axis to long axis evaluation 
2. Fracture = disruption of smooth hyperechoic cortical surface 
3. Useful for long bone fracture in austere situations.


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