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Table 2 Criteria for consideration of x-ray imaging after POCUS

From: 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

POCUS Primary sign

• Identification of a cortical breach fracture (apart from an isolated ulna styloid fracture or non-displaced, non-angulated ulna metaphyseal fracture)

POCUS Secondary signs:

• Buckle fracture < 1 cm from physis

• Pronator quadratus haematoma present (i.e. positive fat pad sign)

• Angulation greater than ~ 5 degrees (visually angulated)

• Physis widened or narrowed

• Periosteal haematoma

Clinical basis

• Clinical suspicion, despite normal POCUS findings e.g. ‘pain out of proportion’ as per clinician judgement