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FRACTURES

Visualising fractures on US is usually easy. Depending on the location of the fracture and the amount of penetration required, use with the linear (superficial bones eg radius, tibia) or the curvilinear/abdominal transducer (deep bones eg femur). Place the transducer longitudinal to the bone with the probe marker cranial. Start proximal to the fracture line, fan, rotate and rock the transducer until the cortex is bright white and horizontal on the screen. Then translate the transducer distally until a break in the cortex is seen: this is the fracture line. 

Curvilinear transducer for an occult hip fracture in a patient with an altered conscious state (labelling by clinican sonographer - excuse the spelling!)

Linear transducer, distal radius fracture

US check post attempted reduction, still displaced

Further manipulation leading to a perfect reduction. Post reduction XR performed in radiology

I use US mostly when reducing fractures: it allows me to visualise the exact fracture location and to determine the adequacy of reduction, sometimes obviating the need for a portable XR. 

PITFALLS

The main pitfall is mistaking the joint line as a fracture. You could get the patient to flex/extend the joint to determine the location to avoid this mistake. Also, the cortex curves inferiorly at the joint line, whereas at a fracture line there is a sharp horizontal break to the cortex. 

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