Funded by the Emergency Medicine Foundation



This is a multicentre, open-labelled diagnostic randomised controlled trial to comparing the use of portable ultrasound and x-ray imaging to diagnose a buckle fracture in children. The trial will determine if there are differences in functional outcomes, patient and care-giver preferences, and health system benefits.

Children frequently present to the emergency department with forearm injuries and often have an x-ray to assess if there is a fracture. Due to the soft and plastic nature of the bones in young children, injuries can cause their bones to bend, known as a buckle fracture. Bedside ultrasound is a test that emergency practitioners can use to rapidly diagnose a fracture at the time of examination, without exposing children to ionising radiation. Ultrasound in this setting is well tolerated, only requiring light touch and gentle manipulation of the forearm and has similar accuracy when compared with x-rays for diagnosing children’s forearm fractures.

This is the first trial of its kind to assess whether an x-ray is unnecessary when there is either a buckle fracture or no fracture seen on a portable ultrasound machine. This is important as they can be treated at the time of review without any further delay, which will avoid these children being exposed to ionising radiation. Children will be randomised to receive either an ultrasound or x-ray for their forearm injury. Both groups will be followed up to see whether there are any differences in their recovery and to determine any complications. We will also determine the time and cost implications of this new approach, which could enable families to go home earlier and could be more cost-effective, with less x-rays being ordered.

Follow Twitter updates at:  @BUCKLED_RCT

Operation Ouch – Why should children be involved in research?

Presentations & Media


World Federation for Ultrasound in Medicine and Biology (WFUMB) 2019 Conference – Oration and Abstract

(Presentation can be accessed by ASUM members via their website)



Emergency Medicine Ultrasound Group Conference 2019.

The Future of POCUS: Paediatric Distal Forearm Buckle Fracture Research



Children’s Healthcare Australasia – Paediatric Emergency Medicine Special Interest Group Webinar September 2020.

More Information