Written by Chris Thom
Spoon Feed
This prospective study demonstrated a high accuracy of POCUS in identifying growth plate fractures in pediatric patients.
POCUS continues to succeed in extremity injury evaluation
In this prospective study, patients aged 0–18 years old with a suspected growth plate (physis) fracture were eligible for enrollment. Four emergency physicians with POCUS expertise enrolled patients. POCUS results were compared to x-ray interpretation, which served as the reference standard.
A total of 117 pediatric patients were included in the analysis. 85 patients had a fracture identified on x-ray; 49 of these were distal radius and/or ulna fractures. There were 10 humerus fractures, 6 femur fractures, and several alternate fracture locations (e.g. metacarpals, clavicle, tibia). POCUS demonstrated a sensitivity of 97% and specificity of 94% for the detection of any fracture. There were 15 fractures involving the growth plate, wherein POCUS had a sensitivity of 93% and specificity of 95%. For detection of fracture extension into the joint space, POCUS sensitivity was 62% and specificity was 100%.
How will this change my practice?
This study provides another excellent data point in the utility of POCUS for pediatric fracture evaluation. POCUS was highly accurate for the detection of fracture, including fractures that involve the growth plate. However, POCUS was not as accurate in the detection of fracture extension into the joint space. Given this, it is not surprising that POCUS was only able to correctly classify 60% of growth plate involving fractures (9/15) into the correct Salter-Harris classification. My own reading on this is that it is likely reasonable practice to forgo x-ray if one identifies an isolated buckle fracture on POCUS. However, if you are seeing a cortical breach fracture, then the x-ray may still help define the Salter Harris classification and subsequent treatment.
POCUS pro-tips and clips
You will want to use the high-frequency ultrasound transducer oriented in the long axis in order to visualize the bone cortex. This will appear as a highly echogenic line, which should be continuous and non-interrupted in the long axis. A fracture will appear as a cortical discontinuity, often associated with a degree of displacement. In pediatric cases, you’ll want to get comfortable with the sonographic appearance of the growth plate. This appears as a hypoechoic “gap” in the bone cortex just proximal to the joint space. There are telltale signs to differentiate a growth plate from a fracture, which include smooth adjacent bone contours and a lack of displacement. However, note that the growth plate does shrink in size with age. If in doubt, take advantage of symmetry by evaluating the contralateral limb for comparison.
Source
Diagnostic accuracy of point-of-care ultrasonography in physeal fractures. Am J Emerg Med. 2026 Feb;100:198-204. doi: 10.1016/j.ajem.2025.12.009. Epub 2025 Dec 15. PMID: 41418495.
