應用即時照護超音波於攣縮手指骨折

Application of Point-of-Care Ultrasound (PoCUS) in Finger Fractures with Flexion Contracture

即時照護超音波（point-of-care ultrasound, PoCUS）已廣泛應用在急重症、內科及骨科等多個領域，顯示其診斷骨折、軟組織病變與導引程序的實用性。然而，針對手部小骨骨折之診斷，其臨床應用仍屬探索階段，尤其在伴隨肢體攣縮、無法配合影像擺位之高齡臥床病人中，往往難以施行傳統放射線檢查，PoCUS潛能更值得關注與探討。一位77歲長期臥床男性，病史包括心房顫動、高血壓、腦中風與血管性失智症，四肢攣縮、無法言語溝通。住院期間因肺炎接受治療並安排物理治療，照顧者於執行左手指伸展時，聽到「喀」聲，懷疑骨折。因肢體攣縮，X光影像品質不佳，無法明確診斷。隨後施行床邊PoCUS，發現左手第4指近端指骨骨皮質中斷，診斷為非位移性骨折，經骨科建議以保守治療處置並追蹤。本案例顯示，PoCUS可作為特殊病人族群中評估手部小骨骨折的替代工具。其快速、無輻射、可於床邊進行之特性，尤適用於無法接受傳統影像學檢查的病人。未來仍需更多研究，以驗證PoCUS於此應用之敏感度與特異度，進一步確立其在臨床診斷流程中的角色。

Point-of-care ultrasound (PoCUS) has been widely applied across multiple specialties including emergency, internal medicine, and orthopedics, demonstrating its utility in diagnosing fractures, soft tissue lesions, and guiding procedures. However, its clinical application in diagnosing small hand bone fractures remains in the exploratory stage. This is especially true in elderly bedridden patients with limb contractures who are unable to cooperate with conventional imaging positioning. In such cases, traditional radiographic examinations are often difficult to perform, highlighting the potential role of PoCUS in this context. We report the case of a 77-year-old bedridden male with a medical history of atrial fibrillation, hypertension, stroke, and vascular dementia. The patient had severe limb contractures and was nonverbal. During hospitalization for pneumonia, he was undergoing physical therapy when caregivers noted a“cracking”sound while extending his left fingers, raising suspicion of a fracture. Due to limb contractures, radiographs were suboptimal and inconclusive. A bedside PoCUS was subsequently performed, revealing cortical disruption of the proximal phalanx of the left fourth finger, indicating a nondisplaced fracture. Conservative management was recommended by the orthopedic team, with follow-up arranged. This case illustrates the potential of PoCUS as an alternative diagnostic tool for small hand bone fractures in special patient populations. Its rapid, radiation-free, and bedside nature makes it particularly suitable for patients unable to undergo conventional imaging. Further research is needed to validate the sensitivity and specificity of PoCUS in this application and to define its role in clinical diagnostic algorithms.