LAUSR

A 10-year-old male sustained an injury during a soccer game when he was hit by the ball and experienced hyper-flexion of his right hand. He was visibly distressed and immediately complained of wrist pain. He came off the field and had ice placed on the area. A few hours after the game, he was still reporting significant pain so asked a friend and emergency physician for advice, who suggested that, given we were in the COVID-19 pandemic, he could conduct an ultrasound on his wrist using his smartphone at home (Fig. 1a). Using a Butterfly iQ device (Butterfly Network, Guilford, CT, USA) connected to an iPhone X (Apple Corporation, Cupertino, CA, USA), the ultrasound detected a cortical bulge on the dorsal aspect of the distal right radius (Fig. 1b). A torus fracture was approximately 2 cm proximal to the radiocarpal joint. Reassured that no urgent in-hospital management was required, the limb was splinted and confirmatory radiographs were performed subsequently at a less busy time to optimise physical distancing (Fig. 1c). A full recovery was made. In several countries, the COVID-19 pandemic resulted in a significant decline in presentations to emergency departments with non-COVID related presentations in both adults and children leading to concern that patients with severe conditions were failing to seek timely care and in some cases presenting late with more severe conditions. The use of point-of-care ultrasound (POCUS) for the diagnosis of paediatric fractures is well described and validated but still rarely used in the prehospital setting. In this case, we have shown how POCUS was used during the pandemic to diagnose and appropriately risk stratify a limb injury in a child, highlighting the potential benefit of personal, affordable handheld POCUS devices during biosafety situations where isolation is required. This may have practical implications in developing countries during the COVID-19 pandemic.