6/27/23, 11:48 PM BUCKLED Pathway Feedback Search Clinical Topics Home Studies BUCKLED BUCKLED Disease Distal radius fracture Trial question Is ultrasonography noninferior to radiography as initial diagnostic imaging method in children and adolescents with distal forearm injury? Study design Multi-center Open label RCT Population Characteristics of study participants 47.0% female N = 270 53.0% male 270 patients (126 female, 144 male) Inclusion criteria: participants 5-15 years of age who presented to the emergency department with an isolated distal forearm injury, without a clinically visible deformity, in whom further evaluation with imaging was indicated Key exclusion criteria: injury sustained for > 48 hours at time of emergency department presentation; known metabolic bone disease; suspicion of non-accidental injury; congenital bone malformation; compound fracture Interventions N=135 ultrasonography (point-of-care ultrasonography performed by emergency department healthcare practitioner) N=135 radiography (biplanar imaging performed by a radiographer and later reported by a radiologist) P i t https://web.pathway.md/studies/recOF7dwUXGrLcXTF 1/2 6/27/23, 11:48 PM BUCKLED Pathway Primary outcome Pediatric Upper Extremity Short Patient-Reported Outcomes Measurement Information System score at 4 weeks 36.4 36.4 36.3 27.3 18.2 Difference not exceeding nonferiority margin 9.1 0.0 Ultrasonography Radiography Difference not exceeding nonferiority margin in PROMIS System score at 4 weeks (36.4 vs. 36.3; MD 0.1, 95% CI -1.3 to 1.4) Secondary outcomes No significant difference in PROMIS System score at 1 week (28.4 vs. 27.7; MD 0.7, 95% CI -1.4 to 2.8) No significant difference in PROMIS System score at 8 weeks (39.2 vs. 39.1; MD 0.1, 95% CI -0.5 to 0.7) No significant difference in participant-reported satisfaction at week 4 (1.57 vs. 1.72; MD -0.15, 95% CI -0.36 to 0.06) Safety outcomes No significant difference in adverse events or unplanned returns to the emergency department. Conclusion In participants 5-15 years of age who presented to the emergency department with an isolated distal forearm injury, without a clinically visible deformity, in whom further evaluation with imaging was indicated, ultrasonography was noninferior to radiography with respect to PROMIS System score at 4 weeks. Reference Peter J Snelling, Philip Jones, David Bade et al. Ultrasonography or Radiography for Suspected Pediatric Distal Forearm Fractures. N Engl J Med. 2023 Jun 1;388(22):2049-2057. Open reference URL https://web.pathway.md/studies/recOF7dwUXGrLcXTF 2/2