Trauma is one of the leading causes of morbidity in childhood, with approximately one in four injuries resulting in a fracture [1]. Unlike adults, children have growth plates located at the ends of their long bones. Fractures involving the growth plate (physeal fractures) are clinically significant because they may lead to partial or complete interruption of bone growth, angular deformities, or limb length discrepancies [2,3].

X-ray (XR) is the initial imaging modality for evaluating fractures in the emergency department. XR generally provides adequate diagnostic and therapeutic guidance. Furthermore, XR is convenient, widely available, relatively easy to interpret, and cost-effective. As a standard for fracture diagnosis, images of the affected extremity are taken in two planes, and oblique radiographs can be added as needed [4,5]. However, especially in younger children, bone ossification is inadequate, so fractures may not be detected on XR [5]. Additionally, XR imaging is inadequate for visualizing soft tissue problems. In cases where XR imaging is inadequate, computed tomography (CT) and magnetic resonance imaging (MRI) are used to better assess fracture fragments and joint spaces. However, these methods have several disadvantages, including being time-consuming, prolonging emergency department stays, being costly, and not always readily available. Since XR and CT involve ionizing radiation, the potential effects of radiation exposure should be carefully considered, particularly during childhood and adolescence. Therefore, the benefit–risk ratio should be carefully evaluated, and the indications for X-ray and CT imaging should be thoroughly considered [[6], [7], [8]].

Ultrasonography (US) has been used for the evaluation of trauma patients presenting to the emergency department since the 1980s. US can visualize soft tissue injuries and reduce the risk of missed diagnoses in pediatric incomplete fractures. Closed reductions can also be performed under US guidance. In addition, vascular structures and early callus formation can be visualized. US enables visualization of the growth plate in pediatric patients and allows comparison with the unaffected side. It is cost-effective and provides real-time assessment. Most importantly, it does not involve ionizing radiation, making it safe for repeated use during follow-up examinations. Numerous studies have demonstrated the utility of US in the evaluation of acute trauma in pediatric patients [2,5,8].

Studies have demonstrated the utility and accuracy of point-of-care ultrasonography (POCUS) in the diagnosis and reduction of fractures in emergency departments [8,9]. However, no studies have specifically evaluated the use of ultrasonography in assessing physeal fractures or in applying the Salter-Harris classification in cases of extremity trauma.

The aim of this study was to compare the accuracy of POCUS with XR in diagnosing fractures and in applying the Salter-Harris (SH) classification among patients who presented to the emergency department with trauma and suspected physeal fractures.