{"id":35822,"date":"2026-09-05T15:01:57","date_gmt":"2026-09-05T15:01:57","guid":{"rendered":"https:\/\/suresultmed.com\/?p=35822"},"modified":"2026-09-05T15:01:57","modified_gmt":"2026-09-05T15:01:57","slug":"rib-fracture-ultrasound-pocus","status":"publish","type":"post","link":"https:\/\/suresultmed.com\/it\/rib-fracture-ultrasound-pocus\/","title":{"rendered":"Rib Fracture Ultrasound: the 6-Minute D3Ultra Chest Wall Walkthrough"},"content":{"rendered":"<div class=\"sr-rf-2026\" data-suresult-article-root data-sr-author-voice=\"fernando-mariz-md jailyn-avila-md\">\n<style>body.postid-35822 .wd-page-title.post-title-large-image{background:#fff!important;color:#1b2426!important;min-height:0!important;height:auto!important;padding:44px 0 6px!important}\nbody.postid-35822 .wd-page-title.post-title-large-image .wd-page-title-bg{display:none!important}\nbody.postid-35822 .wd-page-title.post-title-large-image .wd-post-meta,body.postid-35822 .wd-page-title .meta-post-categories,body.postid-35822 .entry-meta{display:none!important}\nbody.postid-35822 .wd-page-title .wd-post-cat{display:none!important}\nbody.postid-35822 .post-featured-image{display:none!important}\nbody.postid-35822 .wd-page-title .container{max-width:1080px!important;width:min(calc(100% - 28px),1080px)!important;padding-inline:0!important;margin-inline:auto!important;align-items:flex-start!important;text-align:left!important}\nbody.postid-35822 .wd-page-title.post-title-large-image .entry-title{color:#1b2426!important;font-family:\"Helvetica Neue\",Arial,system-ui,-apple-system,sans-serif!important;font-weight:800!important;letter-spacing:-.022em!important;line-height:1.04!important;font-size:clamp(34px,5.2vw,60px)!important;text-transform:none!important;max-width:24ch;text-wrap:balance;margin-inline:0}\nbody.postid-35822 .wd-page-title.post-title-large-image .entry-title:before{content:\"Suresult \u00b7 Scan Library \u00b7 September 2026\";display:block;font-family:ui-monospace,\"SF Mono\",\"Cascadia Mono\",Menlo,Consolas,monospace;font-size:12px;font-weight:500;letter-spacing:.18em;text-transform:uppercase;color:#b9791f;margin:0 0 24px}\nbody.postid-35822 .sidebar-container,body.postid-35822 .wd-sidebar,body.postid-35822 .widget-area{display:none!important}\nbody.postid-35822 .wd-content-layout.content-layout-wrapper{display:block!important;width:min(calc(100% - 28px),1240px)!important;max-width:1240px!important;margin-inline:auto!important}\nbody.postid-35822 .wd-content-area.site-content,body.postid-35822 .wd-entry-content{max-width:1120px!important;margin-inline:auto!important;width:100%!important}\n.sr-rf-2026{--ink:#1b2426;--ink-soft:#586669;--ink-faint:#8a9698;--rule:#d7dedc;--rule-soft:#e6ebe9;--panel:#fafbfa;--flat:#2f7d78;--flat-soft:#e2efed;--sub:#c98a2b;--sub-soft:#f3e6cf;--sub-line:#b9791f;--mono:ui-monospace,\"SF Mono\",\"Cascadia Mono\",Menlo,Consolas,monospace;--serif:Charter,\"Iowan Old Style\",\"Palatino Linotype\",Georgia,serif;--sans:\"Helvetica Neue\",Arial,system-ui,-apple-system,sans-serif;color:var(--ink);font-family:var(--serif);font-size:19px;line-height:1.68;max-width:1080px;margin:0 auto;padding:0 0 70px;-webkit-font-smoothing:antialiased}\n.sr-rf-2026 *{box-sizing:border-box}\n.sr-rf-2026 figure{margin:0}\n.sr-rf-2026 ::selection{background:var(--sub-soft);color:#1b2426}\n.sr-rf-2026 p{margin:0 0 20px;max-width:70ch}\n.sr-rf-2026 a{color:var(--flat)!important;font-weight:600;text-decoration:underline;text-underline-offset:3px;text-decoration-thickness:1px}\n.sr-rf-2026 a:hover{text-decoration-thickness:2px}\n.sr-rf-2026 strong{font-weight:700;color:var(--ink)}\n.sr-rf-2026 h2{font-family:var(--sans);font-weight:800;letter-spacing:-.018em;font-size:clamp(25px,3.4vw,34px);line-height:1.1;margin:52px 0 16px;color:var(--ink);text-wrap:balance}\n.sr-rf-2026 h3{font-family:var(--sans);font-weight:700;letter-spacing:-.01em;font-size:19px;line-height:1.25;margin:30px 0 10px;color:var(--ink)}\n.sr-rf-2026 section[id]{scroll-margin-top:110px}\n.sr-rf-2026 a:focus-visible,.sr-rf-2026 summary:focus-visible,.sr-rf-2026 button:focus-visible{outline:2px solid var(--sub-line);outline-offset:3px;border-radius:2px}\n.sr-rf-2026 ::-webkit-scrollbar{height:10px;width:10px}\n.sr-rf-2026 ::-webkit-scrollbar-track{background:var(--rule-soft)}\n.sr-rf-2026 ::-webkit-scrollbar-thumb{background:#b9c4c2;border-radius:6px;border:2px solid var(--rule-soft)}\n.sr-rf-2026 ::-webkit-scrollbar-thumb:hover{background:var(--ink-faint)}\n.sr-rf-krow{font-family:var(--mono);font-size:11px;letter-spacing:.16em;text-transform:uppercase;color:var(--sub-line);font-weight:600;display:flex;align-items:center;gap:10px;margin:52px 0 -6px}\n.sr-rf-krow:before{content:\"\";width:26px;height:2px;background:var(--sub);flex:0 0 auto}\n.sr-rf-krow+h2{margin-top:10px}\n.sr-mast{border-bottom:1px solid var(--ink);padding:2px 0 26px;margin:0 0 8px}\n.sr-rf-2026 p.sr-deck{font-family:var(--serif);font-size:clamp(19px,2.2vw,23px);line-height:1.5;color:var(--ink-soft);max-width:44ch;margin:0 0 24px}\n.sr-byline{display:flex;flex-wrap:wrap;gap:8px 22px;align-items:center;font-family:var(--mono);font-size:12.5px;letter-spacing:.02em;color:var(--ink-soft)}\n.sr-byline b{color:var(--ink);font-weight:600}\n.sr-byline br,.sr-byline>p:empty,.sr-author-panel br,.sr-author-panel>p:empty,.sr-author-grid br,.sr-author-grid>p:empty,.sr-author-card br,.sr-author-card>p:empty,.sr-author-card__head br,.sr-author-card__id br,.sr-author-meta br,.sr-rf-band__key br,.sr-rf-signs br,.sr-rf-sign br,.sr-rf-ev br,.sr-rf-ev__row br,.sr-rf-traps br,.sr-rf-trap br,.sr-rf-rt br,.sr-rf-figrow br,.sr-light-toc__head br,.sr-light-toc__links br{display:none}\n.sr-byline__author{display:inline-flex;align-items:center;gap:9px}\n.sr-byline__author img{width:30px;height:30px;border-radius:999px;object-fit:cover;border:1px solid var(--rule);background:#fff;flex:0 0 auto}\n.sr-byline__label{display:block;width:100%;font-size:10.5px;letter-spacing:.14em;text-transform:uppercase;color:#637274}\n.sr-verified-badge{color:var(--flat);border:1px solid var(--flat);border-radius:2px;padding:2px 8px;text-transform:uppercase;letter-spacing:.1em;font-size:10.5px;font-weight:600}\n.sr-rf-stage{margin:26px 0 0}\n.sr-rf-player{position:relative;aspect-ratio:16\/9;background:#04060a;border:1px solid var(--rule);border-radius:4px;overflow:hidden;display:block;width:100%;padding:0;cursor:pointer;transition:box-shadow .45s cubic-bezier(.2,.8,.25,1),transform .45s cubic-bezier(.2,.8,.25,1)}\n.sr-rf-player img{width:100%;height:100%;object-fit:cover;display:block;filter:saturate(.9) contrast(1.02);transition:filter .5s cubic-bezier(.2,.8,.25,1),transform .8s cubic-bezier(.2,.8,.25,1)}\n.sr-rf-player:hover{transform:translateY(-2px);box-shadow:0 18px 40px -18px rgba(27,36,38,.55)}\n.sr-rf-player:hover img{filter:saturate(1.04) contrast(1.05);transform:scale(1.012)}\n.sr-rf-player iframe{position:absolute;inset:0;width:100%;height:100%;border:0}\n.sr-rf-play{position:absolute;inset:0;display:flex;align-items:center;justify-content:center;pointer-events:none}\n.sr-rf-play svg{width:82px;height:82px;filter:drop-shadow(0 6px 20px rgba(0,0,0,.55));transition:transform .45s cubic-bezier(.2,.8,.25,1)}\n.sr-rf-player:hover .sr-rf-play svg{transform:scale(1.075)}\n.sr-rf-play circle{transition:fill .45s ease}\n.sr-rf-player:hover .sr-rf-play circle{fill:rgba(201,138,43,.94)}\n.sr-rf-badge{position:absolute;left:0;bottom:0;display:flex;gap:0;font-family:var(--mono);font-size:11px;letter-spacing:.1em;text-transform:uppercase;pointer-events:none}\n.sr-rf-badge span{background:rgba(4,6,10,.82);color:#e8eeec;padding:7px 12px;border-top:1px solid rgba(255,255,255,.14);border-right:1px solid rgba(255,255,255,.14);font-variant-numeric:tabular-nums}\n.sr-rf-2026 figcaption.sr-rf-cap{font-family:var(--mono);font-size:11.5px;line-height:1.7;color:var(--ink-soft);margin:12px 0 0;max-width:84ch}\n.sr-rf-cap b{color:var(--ink-soft);font-weight:600}\n#quick-answer{background:var(--panel);border:1px solid var(--rule);border-left:3px solid var(--sub);border-radius:0 4px 4px 0;padding:26px 28px 12px;margin:34px 0 10px}\n#quick-answer h2{font-family:var(--mono);font-weight:600;font-size:12px;letter-spacing:.18em;text-transform:uppercase;color:var(--sub-line);margin:0 0 16px}\n#quick-answer p{font-size:20px;line-height:1.6;max-width:75ch}\n#quick-answer p strong{background:linear-gradient(transparent 64%,var(--sub-soft) 64%)}\n.sr-rf-2026 p.sr-answer-note{font-family:var(--mono);font-size:12px;line-height:1.7;color:var(--ink-soft);border-top:1px solid var(--rule);padding-top:14px;margin-top:4px;max-width:84ch}\n.sr-rf-band{background:var(--ink);color:#eef2f1;border-radius:4px;padding:38px 34px 30px;margin:34px 0 0}\n.sr-rf-band__eye{font-family:var(--mono);font-size:11px;letter-spacing:.2em;text-transform:uppercase;color:var(--sub);margin:0 0 12px;font-weight:600}\n.sr-rf-band h2{color:#fff;margin:0 0 10px;font-size:clamp(24px,3.2vw,32px)}\n.sr-rf-2026 p.sr-rf-band__sub{color:#a9b8b6;font-size:17px;line-height:1.55;max-width:62ch;margin:0 0 26px}\n.sr-rf-signs{display:grid;grid-template-columns:repeat(2,1fr);gap:0;border-top:1px solid rgba(255,255,255,.14);border-bottom:1px solid rgba(255,255,255,.14)}\n.sr-rf-signs br,.sr-rf-signs>p:empty,.sr-rf-sign br,.sr-rf-sign>p:empty{display:none}\n.sr-rf-2026 .sr-rf-sign{display:block;padding:24px 26px 22px;text-decoration:none!important;color:inherit!important;font-weight:400!important;border-left:1px solid rgba(255,255,255,.1);transition:background .25s ease}\n.sr-rf-2026 .sr-rf-sign:first-child{border-left:0}\n.sr-rf-2026 .sr-rf-sign:hover{background:rgba(255,255,255,.05)}\n.sr-rf-sign__n{display:block;font-family:var(--mono);font-size:26px;font-weight:700;color:var(--sub);line-height:1;letter-spacing:-.02em;font-variant-numeric:tabular-nums}\n.sr-rf-sign__h{display:block;font-family:var(--sans);font-size:18px;font-weight:700;color:#fff;line-height:1.24;letter-spacing:-.012em;margin:12px 0 10px}\n.sr-rf-sign__q{display:block;font-family:var(--serif);font-size:14.5px;line-height:1.55;color:#a9b8b6;margin:0 0 10px}\n.sr-rf-sign__l{display:block;font-family:var(--sans);font-size:14.5px;line-height:1.55;color:#dfe8e6;margin:0 0 12px}\n.sr-rf-sign__t{display:block;font-family:var(--mono);font-size:11.5px;color:var(--sub);font-variant-numeric:tabular-nums;letter-spacing:.04em}\n.sr-rf-2026 .sr-rf-sign:hover .sr-rf-sign__t{color:#f0d9ac}\n.sr-rf-ev{display:block;margin:26px 0 0;padding:22px 0 0;border-top:1px solid rgba(255,255,255,.14)}\n.sr-rf-ev br,.sr-rf-ev>p:empty{display:none}\n.sr-rf-2026 p.sr-rf-ev__h{font-family:var(--mono);font-size:10.5px;letter-spacing:.16em;text-transform:uppercase;color:#8b9b99;margin:0 0 16px;max-width:none}\n.sr-rf-ev__row{display:grid;grid-template-columns:190px minmax(0,1fr) 62px 132px;align-items:center;gap:14px;margin:0 0 9px}\n.sr-rf-ev__k{font-family:var(--sans);font-size:13.5px;color:#dfe8e6;font-weight:600;line-height:1.3}\n.sr-rf-ev__bar{display:block;height:9px;background:rgba(255,255,255,.09);border-radius:1px;overflow:hidden}\n.sr-rf-ev__bar i{display:block;height:100%;background:#3f9d96;border-radius:1px}\n.sr-rf-ev__row:first-child .sr-rf-ev__bar i{background:#f0d9ac}\n.sr-rf-ev__v{font-family:var(--mono);font-size:14px;color:#fff;font-weight:700;font-variant-numeric:tabular-nums;text-align:right}\n.sr-rf-ev__d{font-family:var(--mono);font-size:10.5px;color:#8b9b99;letter-spacing:.03em}\n.sr-rf-traps{display:grid;grid-template-columns:repeat(4,1fr);gap:14px;margin:26px 0 0;padding:22px 0 0;border-top:1px solid rgba(255,255,255,.14)}\n.sr-rf-traps br,.sr-rf-traps>p:empty,.sr-rf-trap br{display:none}\n.sr-rf-trap{display:block}\n.sr-rf-trap b{display:block;font-family:var(--sans);font-size:13.5px;color:#fff;font-weight:700;line-height:1.3;margin:0 0 5px}\n.sr-rf-trap em{display:block;font-style:normal;font-family:var(--mono);font-size:10.5px;line-height:1.65;color:#9aa9a7}\n.sr-rf-rt{display:flex;width:100%;margin:24px 0 0;gap:3px}\n.sr-rf-rt br,.sr-rf-rt>p:empty{display:none}\n.sr-rf-rt__seg{display:block;min-width:0;padding:9px 0 0;border-top:3px solid rgba(255,255,255,.28)}\n.sr-rf-rt__seg--teach{border-top-color:var(--sub)}\n.sr-rf-rt__seg--live{border-top-color:#3f9d96}\n.sr-rf-2026 p.sr-rf-ev__note{font-family:var(--mono);font-size:11px;line-height:1.7;color:#9aa9a7;margin:14px 0 0;max-width:80ch}\n.sr-rf-rt__seg b{display:block;font-family:var(--mono);font-size:11px;color:#e8eeec;font-weight:600;font-variant-numeric:tabular-nums;letter-spacing:.03em}\n.sr-rf-rt__seg em{display:block;font-style:normal;font-family:var(--mono);font-size:10px;line-height:1.5;color:#8b9b99;letter-spacing:.02em;margin-top:3px}\n.sr-rf-rt__seg--close em{display:none}\n.sr-rf-2026 p.sr-rf-band__key{display:flex;flex-wrap:wrap;gap:8px 24px;font-family:var(--mono);font-size:11px;letter-spacing:.06em;color:#9aa9a7;margin:20px 0 0;max-width:none}\n.sr-rf-band__key span{display:inline-flex;align-items:center;gap:8px}\n.sr-rf-band__key i{width:14px;height:9px;border-radius:1px;display:inline-block}\n.sr-rf-2026 p.sr-rf-band__note{font-family:var(--mono);font-size:11px;line-height:1.75;color:#9aa9a7;margin:16px 0 0;max-width:80ch}\n.sr-rf-fig{margin:26px 0 30px;border:1px solid var(--rule);border-radius:4px;overflow:hidden;background:#04060a}\n.sr-rf-fig img{display:block;width:100%;height:auto}\n.sr-rf-2026 figcaption.sr-rf-figcap{font-family:var(--mono);font-size:11.5px;line-height:1.7;color:var(--ink-soft);background:#fff;border-top:1px solid var(--rule);padding:14px 18px;margin:0;max-width:none}\n.sr-rf-2026 figcaption.sr-rf-figcap b{color:var(--ink);font-weight:600}\n.sr-table-wrap{overflow-x:auto;margin:22px 0 8px;border:1px solid var(--rule);border-radius:4px}\n.sr-rf-km{border-collapse:collapse;width:100%;min-width:720px;table-layout:fixed;font-family:var(--sans);font-size:14px}\n.sr-rf-km th{font-family:var(--mono);font-size:10.5px;letter-spacing:.13em;text-transform:uppercase;color:#637274;text-align:left;font-weight:600;padding:13px 16px;border-bottom:1px solid var(--rule);background:var(--panel);white-space:nowrap}\n.sr-rf-km th:last-child{white-space:normal}\n.sr-rf-km td{padding:15px 16px;border-bottom:1px solid var(--rule-soft);vertical-align:top;line-height:1.5;color:var(--ink-soft)}\n.sr-rf-km tr:last-child td{border-bottom:0}\n.sr-rf-km tr:hover td{background:#fcfdfc}\n.sr-rf-2026 .sr-rf-t a{font-family:var(--mono);font-size:13px;font-variant-numeric:tabular-nums;color:var(--flat)!important;text-decoration:none;border-bottom:1px solid var(--flat-soft);padding-bottom:1px}\n.sr-rf-2026 .sr-rf-t a:hover{border-bottom-color:var(--flat)}\n.sr-rf-km td b{display:block;font-weight:700;color:var(--ink);font-size:14.5px;margin:0 0 5px}\n.sr-rf-screen{display:block}\n.sr-rf-set{font-family:var(--mono);font-size:11.5px;line-height:1.75;color:var(--ink-soft);letter-spacing:.01em}\n.sr-rf-flag{display:inline-block;font-family:var(--mono);font-size:9.5px;letter-spacing:.11em;text-transform:uppercase;color:var(--sub-line);border:1px solid var(--sub-soft);background:#fdf8ef;border-radius:2px;padding:2px 6px;margin:0 0 6px;font-weight:600}\n.sr-rf-2026 p.sr-table-note{font-family:var(--mono);font-size:11.5px;line-height:1.7;color:var(--ink-soft);margin:10px 0 0;max-width:84ch}\n.sr-rf-tx{border:1px solid var(--rule);border-radius:4px;margin:22px 0 0;background:#fff}\n.sr-rf-tx>summary{font-family:var(--mono);font-size:12px;letter-spacing:.14em;text-transform:uppercase;color:var(--ink-soft);font-weight:600;padding:16px 22px;cursor:pointer;list-style:none;display:flex;align-items:center;justify-content:space-between;gap:14px;background:var(--panel);border-radius:4px}\n.sr-rf-tx[open]>summary{border-bottom:1px solid var(--rule);border-radius:4px 4px 0 0}\n.sr-rf-tx>summary::-webkit-details-marker{display:none}\n.sr-rf-tx>summary:after{content:\"Collapse\";font-size:10.5px;letter-spacing:.1em;color:#637274;font-weight:400}\n.sr-rf-tx:not([open])>summary:after{content:\"Read the transcript\"}\n.sr-rf-txbody{padding:26px 30px 8px}\n.sr-rf-txsec{border-top:1px solid var(--rule-soft);padding-top:20px;margin-top:26px}\n.sr-rf-txsec:first-of-type{border-top:0;padding-top:0;margin-top:0}\n.sr-rf-txwin{font-family:var(--mono)!important;font-size:10.5px!important;letter-spacing:.15em;text-transform:uppercase;color:var(--sub-line);font-weight:600!important;margin:0 0 12px!important}\n@media (min-width:1000px){.sr-rf-txnote span{max-width:74ch;margin-left:188px}.sr-rf-txsec{display:grid;grid-template-columns:158px minmax(0,1fr);gap:0 30px;align-items:start}.sr-rf-txsec br,.sr-rf-txsec>p:empty{display:none}.sr-rf-txwin{margin:5px 0 0!important;text-align:right}.sr-rf-txcol{max-width:74ch}}\n.sr-rf-2026 p.sr-rf-txp{font-size:17.5px;line-height:1.72;color:var(--ink-soft);max-width:74ch;margin:0 0 18px}\n.sr-rf-2026 a.sr-rf-txt{font-family:var(--mono);font-size:11.5px;font-variant-numeric:tabular-nums;color:#2a706c!important;text-decoration:none;background:var(--flat-soft);border-radius:2px;padding:2px 6px;margin-right:10px;letter-spacing:.02em;white-space:nowrap;font-weight:600}\n.sr-rf-2026 a.sr-rf-txt:hover{background:#215c58;color:#fff!important}\n.sr-rf-2026 p.sr-rf-txnote{font-family:var(--mono);font-size:11.5px;line-height:1.7;color:var(--ink-soft);margin:0 0 24px;padding:0 0 20px;border-bottom:1px solid var(--rule-soft);max-width:none}\n.sr-rf-txnote span{display:block;max-width:84ch}\n.sr-rf-dev{border:1px solid var(--rule);border-radius:4px;overflow:hidden;margin:22px 0 0}\n.sr-rf-dev__grid{display:grid;grid-template-columns:1fr 1fr}\n.sr-rf-dev__grid br,.sr-rf-dev__grid>p:empty{display:none}\n.sr-rf-dev__col{padding:26px 28px}\n.sr-rf-dev__col+.sr-rf-dev__col{border-left:1px solid var(--rule);background:var(--panel)}\n.sr-rf-2026 p.sr-rf-dev__h{font-family:var(--mono);font-size:10.5px;letter-spacing:.14em;text-transform:uppercase;color:#637274;font-weight:600;margin:0 0 16px}\n.sr-rf-2026 p.sr-rf-dev__name{font-family:var(--sans);font-weight:800;font-size:21px;letter-spacing:-.015em;color:var(--ink);margin:0 0 4px}\n.sr-rf-2026 p.sr-rf-dev__price{font-family:var(--mono);font-size:12.5px;color:var(--sub-line);margin:0 0 18px;letter-spacing:.03em}\n.sr-rf-spec{list-style:none;margin:0;padding:0;font-family:var(--mono);font-size:12px;line-height:1.6;color:var(--ink-soft)}\n.sr-rf-spec li{display:grid;grid-template-columns:96px 1fr;gap:14px;padding:8px 0;border-top:1px solid var(--rule-soft)}\n.sr-rf-spec li:first-child{border-top:0}\n.sr-rf-spec b{color:#637274;font-weight:600;font-size:10.5px;letter-spacing:.09em;text-transform:uppercase;padding-top:1px}\n.sr-rf-spec span{font-variant-numeric:tabular-nums}\n.sr-rf-dev__links{display:flex;flex-wrap:wrap;gap:10px 14px;padding:18px 28px;border-top:1px solid var(--rule);background:#fff;font-family:var(--mono);font-size:12px}\n.sr-rf-dev__links br,.sr-rf-dev__links>p:empty{display:none}\n.sr-rf-2026 .sr-rf-dev__links a{text-decoration:none;border:1px solid var(--rule);border-radius:3px;padding:9px 14px;color:var(--flat)!important;letter-spacing:.03em;transition:border-color .2s ease,background .2s ease}\n.sr-rf-2026 .sr-rf-dev__links a:hover{border-color:var(--flat);background:#eef6f4;color:#2a706c!important}\n.sr-rf-rels{display:grid;grid-template-columns:repeat(3,1fr);gap:22px;margin:22px 0 0}\n.sr-rf-rels br,.sr-rf-rels>p:empty{display:none}\n.sr-rf-2026 .sr-rf-rel{display:block;text-decoration:none!important;color:inherit!important;border:1px solid var(--rule);border-radius:4px;overflow:hidden;font-weight:400!important;transition:border-color .25s ease,transform .25s cubic-bezier(.2,.8,.25,1),box-shadow .25s ease}\n.sr-rf-2026 .sr-rf-rel:hover{border-color:var(--ink-faint);transform:translateY(-2px);box-shadow:0 12px 26px -16px rgba(27,36,38,.5)}\n.sr-rf-rel__img{display:block;position:relative;aspect-ratio:16\/9;background:#04060a}\n.sr-rf-rel__img img{width:100%;height:100%;object-fit:cover;display:block}\n.sr-rf-rel__len{position:absolute;right:8px;bottom:8px;font-family:var(--mono);font-size:10.5px;background:rgba(4,6,10,.86);color:#e8eeec;padding:3px 7px;border-radius:2px;font-variant-numeric:tabular-nums}\n.sr-rf-rel__b{display:block;padding:16px 18px 18px}\n.sr-rf-rel__t{display:block;font-family:var(--sans);font-weight:700;font-size:15.5px;line-height:1.3;color:var(--ink);margin:0 0 7px;letter-spacing:-.01em}\n.sr-rf-rel__d{display:block;font-size:14.5px;line-height:1.55;color:var(--ink-soft);margin:0 0 12px}\n.sr-rf-rel__cta{display:block;font-family:var(--mono);font-size:11px;letter-spacing:.1em;text-transform:uppercase;color:var(--flat);font-weight:600}\n.sr-rf-2026 p.sr-rf-hublink{font-family:var(--mono);font-size:12px;color:var(--ink-soft);margin:18px 0 0;max-width:84ch}\n.sr-rf-q{border-bottom:1px solid var(--rule-soft);padding:0}\n.sr-rf-q:first-of-type{border-top:1px solid var(--rule-soft)}\n.sr-rf-q>summary{font-family:var(--sans);font-weight:700;font-size:17px;color:var(--ink);padding:18px 34px 18px 0;cursor:pointer;list-style:none;position:relative;line-height:1.35}\n.sr-rf-q>summary::-webkit-details-marker{display:none}\n.sr-rf-q>summary:after{content:\"\";position:absolute;right:8px;top:50%;width:9px;height:9px;border-right:1.5px solid var(--ink-faint);border-bottom:1.5px solid var(--ink-faint);transform:translateY(-70%) rotate(45deg);transition:transform .25s ease}\n.sr-rf-q[open]>summary:after{transform:translateY(-30%) rotate(225deg)}\n.sr-rf-q p{margin:0 0 12px;color:var(--ink-soft);font-size:17px;max-width:75ch}\n.sr-rf-cite{display:block;font-family:var(--mono);font-size:11px;color:var(--ink-soft);line-height:1.7;padding:0 0 20px;max-width:80ch}\n.sr-rf-src{list-style:none;margin:22px 0 0;padding:0;font-family:var(--mono);font-size:12px;line-height:1.7}\n.sr-rf-src li{padding:14px 0;border-top:1px solid var(--rule-soft)}\n.sr-rf-src li span{display:block;color:var(--ink-soft);margin-top:4px;max-width:88ch}\n.sr-final-cta{background:var(--ink);color:#eef2f1;border-radius:4px;padding:38px 34px 34px;margin:52px 0 0;display:grid;grid-template-columns:minmax(0,1fr) 300px;gap:34px;align-items:center}\n.sr-final-cta br,.sr-final-cta>p:empty{display:none}\n.sr-final-cta h2{color:#fff!important;margin:0 0 12px!important;font-size:clamp(22px,3vw,29px)!important}\n.sr-rf-2026 .sr-final-cta p{color:#a9b8b6;font-size:16.5px;line-height:1.6;margin:0;max-width:56ch}\n.sr-chat-link{display:block}\n.sr-crisp-consult-btn{position:relative;display:inline-flex;align-items:center;justify-content:center;gap:9px;width:100%;min-height:48px;border:0;border-radius:4px;background:linear-gradient(135deg,#39e889 0%,#22c55e 52%,#00c853 100%);color:#fff;font-family:var(--mono);font-size:12px;font-weight:700;letter-spacing:.04em;line-height:1.1;padding:13px 16px;box-shadow:0 8px 18px rgba(34,197,94,.24);animation:srBlBreath 2.65s ease-in-out infinite;cursor:pointer}\n.sr-crisp-consult-btn:before{content:\"\";width:8px;height:8px;border-radius:999px;background:#ecfff3;box-shadow:0 0 0 0 rgba(236,255,243,.78),0 0 9px rgba(236,255,243,.86);animation:srBlDotPulse 1.8s ease-out infinite}\n@keyframes srBlBreath{0%,100%{transform:translateY(0);box-shadow:0 8px 18px rgba(34,197,94,.24),0 0 0 0 rgba(34,197,94,.2)}50%{transform:translateY(-1px);box-shadow:0 12px 24px rgba(34,197,94,.34),0 0 0 7px rgba(34,197,94,.08)}}\n@keyframes srBlDotPulse{0%{box-shadow:0 0 0 0 rgba(236,255,243,.76),0 0 9px rgba(236,255,243,.85)}70%{box-shadow:0 0 0 8px rgba(236,255,243,0),0 0 12px rgba(236,255,243,.65)}100%{box-shadow:0 0 0 0 rgba(236,255,243,0),0 0 9px rgba(236,255,243,.85)}}\n.sr-author-panel{margin:20px 0 0}\n.sr-rf-2026 p.sr-byline__label{margin:0;max-width:none}\n.sr-author-grid{display:grid;grid-template-columns:1fr 1fr;gap:0 30px;margin:10px 0 14px}\n.sr-author-card{border-top:1px solid var(--rule);padding:13px 0 4px;min-width:0}\n.sr-author-card__head{display:flex;align-items:center;gap:11px}\n.sr-author-card__head img{width:42px;height:42px;border-radius:999px;object-fit:cover;border:1px solid var(--rule);background:#fff;flex:0 0 auto}\n.sr-author-card__id{display:flex;flex-direction:column;min-width:0}\n.sr-rf-2026 .sr-author-card__id b{font-family:var(--sans);font-size:15px;font-weight:700;color:var(--ink);letter-spacing:-.006em;line-height:1.2}\n.sr-author-card__role{font-family:var(--mono);font-size:10.5px;letter-spacing:.05em;color:#637274;line-height:1.4;margin-top:3px}\n.sr-rf-2026 .sr-author-card details{margin:9px 0 0}\n.sr-rf-2026 .sr-author-card summary{font-family:var(--mono);font-size:10.5px;letter-spacing:.13em;text-transform:uppercase;color:var(--flat);font-weight:600;cursor:pointer;list-style:none;display:inline-flex;align-items:center;gap:8px;padding:2px 0}\n.sr-rf-2026 .sr-author-card summary::-webkit-details-marker{display:none}\n.sr-rf-2026 .sr-author-card summary:after{content:\"+\";font-family:var(--sans);font-size:13px;line-height:1;color:var(--ink-faint);font-weight:400}\n.sr-rf-2026 .sr-author-card details[open] summary:after{content:\"\u00813\"}\n.sr-rf-2026 .sr-author-card details p{margin:10px 0 0;color:var(--ink-soft);font-size:15px;line-height:1.6;max-width:62ch}\n.sr-rf-2026 p.sr-author-card__links{font-family:var(--mono);font-size:11px;letter-spacing:.03em;margin:10px 0 2px;color:var(--ink-faint);max-width:none}\n.sr-author-meta{display:flex;flex-wrap:wrap;gap:8px 20px;align-items:center;font-family:var(--mono);font-size:12.5px;letter-spacing:.02em;color:var(--ink-soft)}\n.sr-rf-2026 p.sr-author-meta{margin:0;max-width:none}\n.sr-author-meta b{color:var(--ink);font-weight:600}\n.sr-light-toc{display:none;position:fixed;top:140px;left:calc(50% + 640px);width:300px;z-index:20;background:#fff;border:1px solid #d7dedc;border-radius:4px;padding:18px 18px 16px;max-height:calc(100vh - 190px);overflow:auto;font-family:ui-monospace,\"SF Mono\",\"Cascadia Mono\",Menlo,Consolas,monospace}\n.sr-light-toc__head{display:flex;align-items:baseline;justify-content:space-between;gap:10px;margin:0 0 10px}\n.sr-rf-2026 .sr-light-toc__title{font-size:11px;letter-spacing:.18em;text-transform:uppercase;color:#b9791f;margin:0;font-weight:600}\n.sr-rf-2026 .sr-light-toc__progress{font-size:10px;color:#637274;letter-spacing:.06em;font-variant-numeric:tabular-nums}\n.sr-light-toc__links{display:flex;flex-direction:column;counter-reset:toc}\n.sr-rf-2026 .sr-light-toc__links a{counter-increment:toc;display:flex;align-items:baseline;gap:10px;font-size:12px;line-height:1.35;color:#586669!important;text-decoration:none;font-weight:400;padding:6px 8px 6px 10px;border-left:2px solid #e6ebe9}\n.sr-rf-2026 .sr-light-toc__links a:before{content:counter(toc,decimal-leading-zero);font-size:9.5px;color:#637274;letter-spacing:.06em;min-width:18px;flex:0 0 auto}\n.sr-rf-2026 .sr-light-toc__links a:hover{color:#1b2426!important;border-left-color:#c98a2b}\n.sr-rf-2026 .sr-light-toc__links a.sr-toc-active{color:#1b2426!important;border-left-color:#c98a2b;font-weight:600}\n.sr-rf-2026 p.sr-light-toc__note{font-family:Charter,\"Iowan Old Style\",Georgia,serif;font-size:13.5px;line-height:1.5;color:#586669;margin:14px 0 10px;max-width:none}\n@media (min-width:1420px) and (max-width:1919px){body.postid-35822 .wd-content-area.site-content,body.postid-35822 .wd-entry-content{max-width:1180px!important}.sr-rf-2026{max-width:1180px}.sr-light-toc{display:block;left:auto;right:4px;width:114px;padding:12px 7px}.sr-rf-2026 .sr-light-toc__links a{font-size:9.5px;padding:5px 3px}.sr-rf-2026 p.sr-light-toc__note{font-size:11px}.sr-light-toc .sr-crisp-consult-btn{font-size:9px;padding:10px 3px}.sr-rf-2026 .sr-light-toc__progress{font-size:9px}}\n@media (min-width:1920px){.sr-light-toc{display:block}body.postid-35822 .wd-content-area.site-content,body.postid-35822 .wd-entry-content{max-width:1200px!important}.sr-rf-2026{max-width:1200px}}\n@media (max-width:900px){.sr-author-grid{grid-template-columns:1fr;gap:0}.sr-rf-dev__grid{grid-template-columns:1fr}.sr-rf-dev__col+.sr-rf-dev__col{border-left:0;border-top:1px solid var(--rule)}.sr-rf-rels{grid-template-columns:1fr 1fr}.sr-final-cta{grid-template-columns:1fr;gap:24px}.sr-rf-traps{grid-template-columns:1fr 1fr;gap:18px}.sr-rf-ev__row{grid-template-columns:150px minmax(0,1fr) 56px;gap:10px}.sr-rf-ev__d{display:none}}\n@media (max-width:640px){.sr-rf-2026{font-size:18px;padding:0 0 60px}.sr-byline__author{width:100%;align-items:center;flex-wrap:wrap;gap:6px 10px}.sr-byline b{white-space:nowrap}.sr-byline{gap:12px 18px}.sr-rf-badge__x{display:none}.sr-rf-signs{grid-template-columns:1fr}.sr-rf-2026 .sr-rf-sign{border-left:0;padding:20px 18px}.sr-rf-2026 .sr-rf-sign+.sr-rf-sign{border-top:1px solid rgba(255,255,255,.1)}.sr-rf-traps{grid-template-columns:1fr;gap:14px}.sr-rf-ev__row{grid-template-columns:1fr;gap:4px;margin:0 0 14px}.sr-rf-ev__v{text-align:left}.sr-rf-rt__seg em{display:none}.sr-rf-band{padding:28px 20px 24px}.sr-rf-rels{grid-template-columns:1fr}.sr-rf-txbody{padding:20px 18px 4px}.sr-rf-dev__col{padding:22px 20px}.sr-rf-dev__links{padding:16px 20px}.sr-rf-dev__links a{flex:1 1 auto;text-align:center}#quick-answer{padding:22px 20px 8px}#quick-answer p{font-size:18.5px}.sr-final-cta{padding:28px 20px 26px}.sr-rf-spec li{grid-template-columns:1fr;gap:2px}.sr-rf-sign__h{font-size:16px}.sr-rf-play svg{width:62px;height:62px}}\n@media (prefers-reduced-motion:reduce){.sr-rf-2026 *,.sr-light-toc *{animation-duration:.001ms!important;animation-iteration-count:1!important;transition-duration:.001ms!important}}<\/style>\n<div class=\"sr-mast\">\n<p class=\"sr-deck\">A lower-rib survey run end to end on a linear probe &mdash; short axis to find the rib, long axis to follow its cortex, and the costochondral junction where the picture changes &mdash; with every moment timestamped, the settings read off the device screen, and the whole recording transcribed.<\/p>\n<div class=\"sr-author-panel\" data-suresult-author-panel aria-label=\"Article authors\">\n<p class=\"sr-byline__label\">Written and clinically reviewed by<\/p>\n<div class=\"sr-author-grid\">\n<article class=\"sr-author-card\" data-sr-author=\"fernando-mariz-md\">\n<div class=\"sr-author-card__head\"><img src=\"https:\/\/suresultmed.com\/wp-content\/uploads\/fernando-mariz-md-author-avatar.png\" alt=\"Fernando Mariz, MD\" width=\"42\" height=\"42\" loading=\"lazy\" decoding=\"async\"><span class=\"sr-author-card__id\"><b>Fernando Mariz, MD<\/b><span class=\"sr-author-card__role\">Gynecology, pelvic surgery, sonography<\/span><\/span><\/div>\n<details data-sr-author-bio>\n<summary>About Dr. Mariz<\/summary>\n<p>I am Dr. Fernando Mariz, a gynecology and pelvic surgery physician practicing in New York City. Before my medical career, I served in the U.S. Marine Corps, where I developed the discipline, focus, and steadiness that continue to shape the way I care for patients today. At Maiden Lane Medical, my work covers women&rsquo;s health, preventive care, sonography, pelvic pain, abnormal uterine bleeding, and minimally invasive gynecologic procedures.<\/p>\n<p class=\"sr-author-card__links\"><a href=\"https:\/\/maidenlanemedical.com\/profile\/fernando-mariz-md\/\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Maiden Lane Medical profile<\/a> &middot; <a href=\"https:\/\/weillcornell.org\/fernando-marizmd-9639\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Weill Cornell Medicine<\/a><\/p>\n<\/details>\n<\/article>\n<article class=\"sr-author-card\" data-sr-author=\"jailyn-avila-md\">\n<div class=\"sr-author-card__head\"><img src=\"https:\/\/suresultmed.com\/wp-content\/uploads\/jailyn-avila-md-author-avatar.png\" alt=\"Jailyn Avila, MD\" width=\"42\" height=\"42\" loading=\"lazy\" decoding=\"async\"><span class=\"sr-author-card__id\"><b>Jailyn Avila, MD<\/b><span class=\"sr-author-card__role\">Emergency medicine, POCUS education<\/span><\/span><\/div>\n<details data-sr-author-bio>\n<summary>About Dr. Avila<\/summary>\n<p>I am Dr. Jailyn Avila, an emergency medicine physician, educator, and digital health innovator based in Southern California. My clinical work is rooted in emergency care, while my teaching focuses on point-of-care ultrasound, residency education, and practical training for physicians. Through my roles with Emergent Medical Associates, UHS SoCal MEC Emergency Medicine Residency, Core Ultrasound, and FemInEM, I work at the intersection of patient care, medical education, and accessible digital learning.<\/p>\n<p class=\"sr-author-card__links\"><a href=\"https:\/\/jailynavila.com\/\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Personal site<\/a> &middot; <a href=\"https:\/\/feminem.org\/about\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">FemInEM<\/a><\/p>\n<\/details>\n<\/article>\n<\/div>\n<p class=\"sr-author-meta\"><span class=\"sr-verified-badge\">Verified authors<\/span><span>Updated <b>September 5, 2026<\/b><\/span><\/p>\n<\/div>\n<\/div>\n<figure class=\"sr-rf-stage\">\n<button class=\"sr-rf-player\" id=\"sr-rf-player\" type=\"button\" aria-label=\"Play the 6-minute rib fracture walkthrough\"><br \/>\n<img src=\"https:\/\/suresultmed.com\/wp-content\/uploads\/rib-short-axis-cortex-shadow-poster.jpg\" alt=\"Short-axis rib view on a Suresult D3Ultra: rib cross-sections with posterior acoustic shadowing and the pleural line running between them, 40 mm depth, H10.0 MHz\" width=\"1300\" height=\"947\" fetchpriority=\"high\" decoding=\"async\"><br \/>\n<span class=\"sr-rf-play\"><svg viewBox=\"0 0 84 84\" aria-hidden=\"true\" focusable=\"false\"><circle cx=\"42\" cy=\"42\" r=\"40\" fill=\"rgba(10,14,18,.62)\" stroke=\"rgba(255,255,255,.9)\" stroke-width=\"1.6\"\/><path d=\"M34.5 28.2 L58 42 L34.5 55.8 Z\" fill=\"#fff\"\/><\/svg><\/span><br \/>\n<span class=\"sr-rf-badge\"><span>6:42<\/span><span class=\"sr-rf-badge__k\">10 key moments<\/span><span class=\"sr-rf-badge__x\">Transcript below<\/span><\/span><br \/>\n<\/button><figcaption class=\"sr-rf-cap\"><b>Recorded on a D3Ultra and posted to the Suresult channel, 12 October 2025.<\/b> The poster above and the frozen frame further down are two different moments of the same live scan; the walkthrough runs 6:42, and the transcript covers it to 6:09.<\/figcaption><\/figure>\n<section id=\"quick-answer\">\n<h2>Quick answer<\/h2>\n<p><strong>A rib fracture shows on ultrasound as a break in the bright line of the rib cortex, and often as a fine raised stripe of lifted periosteum with a hematoma beneath it.<\/strong> You find both with a high-frequency linear probe placed at the point of maximum tenderness: across the rib to locate it, then along the rib to follow the cortex. It is a better first test than a chest film, and the recording puts the numbers on screen at 0:56 &mdash; ultrasonography found 58 of 59 rib fractures where the oblique rib view found 27 and the PA chest radiograph 24, in less than half the examination time. European guidance says the same thing in guideline form: when radiography is negative and clinical suspicion of an acute fracture is high, scan. What this walkthrough demonstrates is the normal, and that is precisely its value &mdash; the presenting clinician follows an intact cortex along a lower rib all the way to the costochondral junction. I would start anyone new to this exam exactly there, because you cannot recognise a step-off until you know precisely what an unbroken rail looks like at 10 MHz. Start at 4:31 for the scanning, at 0:46 for the evidence.<\/p>\n<p class=\"sr-answer-note\">Looking for a device rather than the exam? The <a href=\"https:\/\/suresultmed.com\/specialty\/handheld-ultrasound-for-emergency-medicine\/\">emergency medicine hub<\/a> covers the models used for trauma and chest work, and the <a href=\"https:\/\/suresultmed.com\/shop\/handheld-ultrasounds\/d3ultra-multipurpose-handheld-ultrasound\/\">D3Ultra product page<\/a> carries the full specification and current price.<\/p>\n<\/section>\n<section id=\"two-signs\">\n<div class=\"sr-rf-band\">\n<p class=\"sr-rf-band__eye\">Two signs<\/p>\n<h2>What ends the search, and what fools it<\/h2>\n<p class=\"sr-rf-band__sub\">The rib cortex is a bright rail with clean shadow underneath. Two findings break that pattern for real; four normal structures break it for no reason at all. Click either sign to jump the video to the moment it is taught.<\/p>\n<div class=\"sr-rf-signs\"><a class=\"sr-rf-sign\" href=\"#t=296\" data-sr-seek=\"296\"><span class=\"sr-rf-sign__n\">1<\/span><span class=\"sr-rf-sign__h\">A break in the cortical line<\/span><span class=\"sr-rf-sign__q\">The rib cortex reflects almost everything that reaches it, so it draws as a bright unbroken line with nothing but shadow beneath.<\/span><span class=\"sr-rf-sign__l\">Follow that line along the rib. A fracture is a step or an interruption in it \u2014 the brightness jumps across the break instead of running through.<\/span><span class=\"sr-rf-sign__t\">Taught at 4:56<\/span><\/a><a class=\"sr-rf-sign\" href=\"#t=337\" data-sr-seek=\"337\"><span class=\"sr-rf-sign__n\">2<\/span><span class=\"sr-rf-sign__h\">A lifted periosteum<\/span><span class=\"sr-rf-sign__q\">The second sign sits above the bone, not in it, and it is the one that is missed when the cortex looks passable.<\/span><span class=\"sr-rf-sign__l\">Bleeding under the periosteum lifts it off the cortex, so a hypoechoic collection separates a fine raised bright stripe from the bone below it.<\/span><span class=\"sr-rf-sign__t\">Taught at 5:37<\/span><\/a><\/div>\n<div class=\"sr-rf-ev\">\n<p class=\"sr-rf-ev__h\">Fractures detected, of 59 confirmed in 61 patients with minor blunt chest trauma<\/p>\n<p><span class=\"sr-rf-ev__row\"><span class=\"sr-rf-ev__k\">Ultrasonography<\/span><span class=\"sr-rf-ev__bar\"><i style=\"width:100.0%\"><\/i><\/span><span class=\"sr-rf-ev__v\">98.3%<\/span><span class=\"sr-rf-ev__d\">58 of 59 fractures<\/span><\/span><span class=\"sr-rf-ev__row\"><span class=\"sr-rf-ev__k\">Oblique rib view<\/span><span class=\"sr-rf-ev__bar\"><i style=\"width:46.6%\"><\/i><\/span><span class=\"sr-rf-ev__v\">45.8%<\/span><span class=\"sr-rf-ev__d\">27 of 59<\/span><\/span><span class=\"sr-rf-ev__row\"><span class=\"sr-rf-ev__k\">PA chest radiography<\/span><span class=\"sr-rf-ev__bar\"><i style=\"width:41.4%\"><\/i><\/span><span class=\"sr-rf-ev__v\">40.7%<\/span><span class=\"sr-rf-ev__d\">24 of 59<\/span><\/span><\/p>\n<p class=\"sr-rf-ev__note\">The study the recording displays at 0:56: Pishbin et al., <i>Chinese Journal of Traumatology<\/i> 2017. Mean examination time was 12 minutes for ultrasonography against 27 for radiography. Full citation under Sources.<\/p>\n<\/div>\n<div class=\"sr-rf-traps\"><span class=\"sr-rf-trap\"><b>Costochondral junction<\/b><em>A slight angulation or a narrow gap without callus is a normal variant here.<\/em><\/span><span class=\"sr-rf-trap\"><b>Tendon and ligament insertions<\/b><em>Attachment zones are physiological cortical discontinuities.<\/em><\/span><span class=\"sr-rf-trap\"><b>Nutrient vessel channels<\/b><em>Vessels penetrating the cortex read as a break in it.<\/em><\/span><span class=\"sr-rf-trap\"><b>Unfused ossification centres<\/b><em>In children, accessory centres and growth plates look like fragments.<\/em><\/span><\/div>\n<div class=\"sr-rf-rt\"><span class=\"sr-rf-rt__seg sr-rf-rt__seg--teach\" style=\"width:67.4%\"><b>0:00<\/b><em>The argument, the evidence and the cautions<\/em><\/span><span class=\"sr-rf-rt__seg sr-rf-rt__seg--live\" style=\"width:24.4%\"><b>4:31<\/b><em>The rib scanned on camera<\/em><\/span><span class=\"sr-rf-rt__seg sr-rf-rt__seg--close\" style=\"width:8.2%\"><b>6:09<\/b><em>Close<\/em><\/span><\/div>\n<p class=\"sr-rf-band__key\"><span><i style=\"background:#c98a2b\"><\/i>the argument, the evidence and the cautions<\/span><span><i style=\"background:#3f9d96\"><\/i>the rib scanned on camera<\/span><span><i style=\"background:rgba(255,255,255,.28)\"><\/i>close<\/span><\/p>\n<p class=\"sr-rf-band__note\">No fracture is scanned on camera in this recording. The rib followed from 4:56 is intact, and the labelled picture of a fractured rib that appears at 5:41 is a reference image rather than a live acquisition &mdash; which is worth knowing before you watch, and does not cost the walkthrough anything, because the skill it teaches is recognising the normal rail. The presenting clinician also names osteophytes, erosions and pseudo-erosions among the look-alikes at 1:49; those stay in the transcript as his own words. The four listed above are the ones carried by the sources at the foot of this page.<\/p>\n<\/div>\n<\/section>\n<section id=\"key-moments\">\n<p class=\"sr-rf-krow\">Timestamped<\/p>\n<h2>Key moments, with the settings<\/h2>\n<p>The third column is the part normally missing from a scan video: the depth, transmit frequency and gain showing on the device at that moment. What is striking on this recording is that they never change. One depth, one frequency, one gain carry the entire survey &mdash; and that frequency is the ceiling of what this probe&#8217;s linear array offers.<\/p>\n<div class=\"sr-table-wrap\">\n<table class=\"sr-rf-km\">\n<colgroup>\n<col style=\"width:82px\">\n<col>\n<col style=\"width:268px\"><\/colgroup>\n<thead>\n<tr>\n<th>Time<\/th>\n<th>What is on screen<\/th>\n<th>Transducer, depth, frequency, gain<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td class=\"sr-rf-t\"><a href=\"#t=0\" data-sr-seek=\"0\">0:00<\/a><\/td>\n<td><b>Why a rib fracture is an ultrasound problem<\/b><span class=\"sr-rf-flag\">teaching<\/span><span class=\"sr-rf-screen\">Presenting clinician to camera<\/span><\/td>\n<td class=\"sr-rf-set\"><\/td>\n<\/tr>\n<tr>\n<td class=\"sr-rf-t\"><a href=\"#t=46\" data-sr-seek=\"46\">0:46<\/a><\/td>\n<td><b>The comparison study and the EFSUMB bone recommendation, on screen<\/b><span class=\"sr-rf-flag\">teaching<\/span><span class=\"sr-rf-screen\">The cited paper, then the recommendation list<\/span><\/td>\n<td class=\"sr-rf-set\"><\/td>\n<\/tr>\n<tr>\n<td class=\"sr-rf-t\"><a href=\"#t=89\" data-sr-seek=\"89\">1:29<\/a><\/td>\n<td><b>Where ultrasound falls short: a narrow slice, and bone you cannot reach<\/b><span class=\"sr-rf-flag\">teaching<\/span><span class=\"sr-rf-screen\">Presenting clinician to camera<\/span><\/td>\n<td class=\"sr-rf-set\"><\/td>\n<\/tr>\n<tr>\n<td class=\"sr-rf-t\"><a href=\"#t=128\" data-sr-seek=\"128\">2:08<\/a><\/td>\n<td><b>The look-alikes, and why you scan the other side<\/b><span class=\"sr-rf-flag\">teaching<\/span><span class=\"sr-rf-screen\">Presenting clinician to camera<\/span><\/td>\n<td class=\"sr-rf-set\"><\/td>\n<\/tr>\n<tr>\n<td class=\"sr-rf-t\"><a href=\"#t=156\" data-sr-seek=\"156\">2:36<\/a><\/td>\n<td><b>Three reasons you are scanning: unknown site, localised pain, or following healing<\/b><span class=\"sr-rf-flag\">teaching<\/span><span class=\"sr-rf-screen\">Live scan of the lower ribs begins under the narration<\/span><\/td>\n<td class=\"sr-rf-set\">Linear \u00b7 D 40 mm \u00b7 F H10.0 MHz \u00b7 GN 105 dB<\/td>\n<\/tr>\n<tr>\n<td class=\"sr-rf-t\"><a href=\"#t=182\" data-sr-seek=\"182\">3:02<\/a><\/td>\n<td><b>Scan plane: longitudinal along the rib, perpendicular to the fracture line<\/b><span class=\"sr-rf-flag\">teaching<\/span><span class=\"sr-rf-screen\">Probe tracking along the lower ribs<\/span><\/td>\n<td class=\"sr-rf-set\">Linear \u00b7 D 40 mm \u00b7 F H10.0 MHz \u00b7 DR 80<\/td>\n<\/tr>\n<tr>\n<td class=\"sr-rf-t\"><a href=\"#t=237\" data-sr-seek=\"237\">3:57<\/a><\/td>\n<td><b>Cartilage against cortex, and positioning a patient who cannot move<\/b><span class=\"sr-rf-flag\">teaching<\/span><span class=\"sr-rf-screen\">Probe tracking along the lower ribs<\/span><\/td>\n<td class=\"sr-rf-set\">Linear \u00b7 D 40 mm \u00b7 F H10.0 MHz \u00b7 DR 80<\/td>\n<\/tr>\n<tr>\n<td class=\"sr-rf-t\"><a href=\"#t=271\" data-sr-seek=\"271\">4:31<\/a><\/td>\n<td><b>Short axis first: the rib, its shadow, and the pleura between<\/b><span class=\"sr-rf-screen\">Short-axis view of the rib on the device screen<\/span><\/td>\n<td class=\"sr-rf-set\">Linear \u00b7 D 40 mm \u00b7 F H10.0 MHz \u00b7 ENH 0 \u00b7 Compound OFF<\/td>\n<\/tr>\n<tr>\n<td class=\"sr-rf-t\"><a href=\"#t=296\" data-sr-seek=\"296\">4:56<\/a><\/td>\n<td><b>Rotate to long axis and track the cortex to the costochondral junction<\/b><span class=\"sr-rf-screen\">A continuous bright cortical line followed along the rib<\/span><\/td>\n<td class=\"sr-rf-set\">Linear \u00b7 D 40 mm \u00b7 F H10.0 MHz \u00b7 GN 105 dB \u00b7 MI 0.9<\/td>\n<\/tr>\n<tr>\n<td class=\"sr-rf-t\"><a href=\"#t=337\" data-sr-seek=\"337\">5:37<\/a><\/td>\n<td><b>Above the cortex: hematoma and fluid lifting the periosteum<\/b><span class=\"sr-rf-screen\">Live scan, then a labelled reference image of a fractured rib<\/span><\/td>\n<td class=\"sr-rf-set\">Linear \u00b7 D 40 mm then 60 mm \u00b7 F H10.0 MHz \u00b7 DR 80<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<p class=\"sr-table-note\">Settings transcribed from the device interface visible in the recording. Depth is the D value on screen; frequency is the F value, harmonic. The first four rows are argued against slides and reference images, so no device panel is on screen for them. Depth steps from 40 mm to 60 mm inside the final row.<\/p>\n<\/section>\n<section id=\"what-it-shows\">\n<p class=\"sr-rf-krow\">Reading the images<\/p>\n<h2>What this scan shows<\/h2>\n<p>The rib cortex is the whole exam. Bone reflects almost all the sound that reaches it, so at 10 MHz the surface of the rib draws as a bright continuous line about a centimetre down, with nothing but acoustic shadow beneath. You are not imaging the inside of the bone and never will be. You are reading its surface, and a fracture is a break in that surface.<\/p>\n<figure class=\"sr-rf-fig\">\n<img src=\"https:\/\/suresultmed.com\/wp-content\/uploads\/rib-cortex-long-axis-costochondral.jpg\" alt=\"Long-axis rib scan on a Suresult D3Ultra: the bright cortical line runs across the field with layered soft tissue above it as the probe approaches the costochondral junction, 40 mm depth, H10.0 MHz\" width=\"1300\" height=\"947\" loading=\"lazy\" decoding=\"async\"><figcaption class=\"sr-rf-figcap\"><b>The cortex in long axis, frozen at 5:30.<\/b> The rail the presenting clinician is following: a bright, continuous cortical line with layered soft tissue above it and clean shadow below. This is the normal that a step-off has to be measured against. Linear array &middot; D 40 mm &middot; F H10.0 MHz &middot; GN 105 dB &middot; DR 80 &middot; Compound OFF.<\/figcaption><\/figure>\n<p>Find the rib in short axis first. Across the rib you get a rounded bright cap with a dark shadow falling away beneath it, and between two of those caps sits the pleural line, deeper and sliding with the breath. That is the orientation check, and it is worth repeating every so often: a bright line that is not casting a shadow is pleura, not cortex. Then rotate ninety degrees. In long axis the cortex becomes a rail you can follow, and following it is the exam &mdash; along one rib, down an intercostal space, along the next.<\/p>\n<p>Two findings end the search. The first is a step or an interruption in that bright rail. The second sits above it: blood under the periosteum lifts a fine bright stripe off the bone with a dark collection between the two, and it is the sign that survives when the cortex itself looks passable. Expect the picture to change at the costochondral junction, where cartilage stops reflecting the way bone does and the sound passes into the rib instead. That transition is normal, and taking it for a break is the commonest way I see this exam go wrong.<\/p>\n<\/section>\n<section id=\"transcript\">\n<p class=\"sr-rf-krow\">Verbatim<\/p>\n<h2>Full transcript<\/h2>\n<details class=\"sr-rf-tx\" id=\"sr-rf-transcript\" data-sr-transcript=\"1\" open>\n<summary>Transcript &mdash; 6:42, 36 passages<\/summary>\n<div class=\"sr-rf-txbody\">\n<p class=\"sr-rf-txnote\"><span>Transcribed from the recording and edited for readability; square brackets mark an editorial clarification, and every timestamp jumps the video.<\/span><\/p>\n<section class=\"sr-rf-txsec\">\n<h3 class=\"sr-rf-txwin\">Why ultrasound, and not only radiography<\/h3>\n<div class=\"sr-rf-txcol\">\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=0\" data-sr-seek=\"0\">0:00<\/a>Today we&#8217;re going to use a Suresult D3Ultra to look for rib fractures.<\/p>\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=7\" data-sr-seek=\"7\">0:07<\/a>Now, a lot of people, a lot of doctors, when they think of a fracture, they think radiographs, they think X-rays. And even myself, I was trained that way. But in fact, ultrasound is actually much better.<\/p>\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=21\" data-sr-seek=\"21\">0:21<\/a>But wait \u2014 ultrasound, that&#8217;s soft tissue. But the cortex glows brightly, so you can see a discontinuity in the cortex. And soft tissue: you can see a hematoma underneath the periosteum. The periosteum gets lifted by, basically, fluid from the injury.<\/p>\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=38\" data-sr-seek=\"38\">0:38<\/a>So it is very, very sensitive. It&#8217;s very easy to pick up a fracture with ultrasound compared to a radiograph.<\/p>\n<\/div>\n<\/section>\n<section class=\"sr-rf-txsec\">\n<h3 class=\"sr-rf-txwin\">The evidence put on screen<\/h3>\n<div class=\"sr-rf-txcol\">\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=46\" data-sr-seek=\"46\">0:46<\/a>In fact, in one study specific to rib fractures \u2014 it was back in 2017 \u2014 they found that ultrasound had a sensitivity, caught 98 % of the fractures, whereas the oblique rib view and the PA chest radiographs detected 46 % and 41 % of rib fractures respectively.<\/p>\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=67\" data-sr-seek=\"67\">1:07<\/a>So that&#8217;s very, very impressive.<\/p>\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=69\" data-sr-seek=\"69\">1:09<\/a>And in fact, there&#8217;s a consensus statement that says, if you have a patient and they&#8217;ve had radiographs, but you&#8217;re like, \u201cI still have a clinical suspicion that they have a fracture\u201d \u2014 they say, well, get an ultrasound and satisfy your clinical suspicion. Because in general, ultrasound has a much higher sensitivity.<\/p>\n<\/div>\n<\/section>\n<section class=\"sr-rf-txsec\">\n<h3 class=\"sr-rf-txwin\">Where ultrasound falls short<\/h3>\n<div class=\"sr-rf-txcol\">\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=88\" data-sr-seek=\"88\">1:28<\/a>Now, the downsides of ultrasound: you have to screen through \u2014 you&#8217;re taking a very narrow slice. So you have to really screen through the bones and look all around the bones.<\/p>\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=99\" data-sr-seek=\"99\">1:39<\/a>And there&#8217;s some places you just can&#8217;t get the unit, so you can&#8217;t screen the whole body, every bone, completely \u2014 because you just can&#8217;t manipulate the ultrasound unit around every bone.<\/p>\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=109\" data-sr-seek=\"109\">1:49<\/a>The other caution is you have to make sure you&#8217;re not mistaking something like an osteophyte, or an erosion, or what&#8217;s called a pseudo-erosion, for a fracture.<\/p>\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=119\" data-sr-seek=\"119\">1:59<\/a>There&#8217;s often a little depression where a ligament attaches, and you don&#8217;t want to mistake that as a discontinuity of the cortex.<\/p>\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=127\" data-sr-seek=\"127\">2:07<\/a>And of course, children look really strange no matter what type of imaging you&#8217;re using. So you don&#8217;t want to mistake normal anatomy in a child for a fracture.<\/p>\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=136\" data-sr-seek=\"136\">2:16<\/a>And remember, you have both sides of the person, so scan both sides if you want to see a normal \u2014 and use your split screen.<\/p>\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=143\" data-sr-seek=\"143\">2:23<\/a>[This is] specific to rib fractures. If you wanted to, for example, check the lungs for pneumothorax or hemothorax, you have the right tool in your hands already. Just take 60 seconds and you can check for those as well.<\/p>\n<\/div>\n<\/section>\n<section class=\"sr-rf-txsec\">\n<h3 class=\"sr-rf-txwin\">Why you are scanning at all<\/h3>\n<div class=\"sr-rf-txcol\">\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=156\" data-sr-seek=\"156\">2:36<\/a>Okay. So you may have no idea where the injury is. You may have to screen through every single rib. Or you may have a clinical indication of sort of where the injury might be.<\/p>\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=167\" data-sr-seek=\"167\">2:47<\/a>And you may know exactly where the injury is, because you&#8217;re just following the injury and you&#8217;re monitoring healing.<\/p>\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=172\" data-sr-seek=\"172\">2:52<\/a>In fact, it is recommended to follow fractures with ultrasound imaging, because you can see the callus and you can basically watch it heal, if you deem that useful.<\/p>\n<\/div>\n<\/section>\n<section class=\"sr-rf-txsec\">\n<h3 class=\"sr-rf-txwin\">Scan plane and technique<\/h3>\n<div class=\"sr-rf-txcol\">\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=182\" data-sr-seek=\"182\">3:02<\/a>Now, for the fracture, we want an image sort of perpendicular to the fracture line. Now of course, we don&#8217;t know where the fracture is \u2014 if there is a fracture \u2014 but ideally we&#8217;ll see that discontinuity as it sort of jumps across that line.<\/p>\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=194\" data-sr-seek=\"194\">3:14<\/a>So for ribs, we know where the fracture is going to be. The fracture is going to be sort of up and down. So we&#8217;re going to go longitudinal along the rib.<\/p>\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=202\" data-sr-seek=\"202\">3:22<\/a>Now, how I&#8217;m going to do that is: I can palpate, and I can sort of feel and follow one rib \u2014 or basically follow the intercostal space, because that&#8217;s easier to follow. And then I can just basically have the transducer sort of follow just on top.<\/p>\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=213\" data-sr-seek=\"213\">3:33<\/a>And I can just follow along the rib, go down one intercostal space, follow along the rib.<\/p>\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=218\" data-sr-seek=\"218\">3:38<\/a>If you get lost, you can of course figure out where you are by taking a coronal view, or a view sort of transverse to the rib. And you can look at the ribs \u2014 because you don&#8217;t want to be looking at the pleura of the lungs and think you&#8217;re looking at the ribs.<\/p>\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=230\" data-sr-seek=\"230\">3:50<\/a>So this is a good idea: every once in a while, turn it 90 degrees and make sure you&#8217;re taking a picture of what you want.<\/p>\n<\/div>\n<\/section>\n<section class=\"sr-rf-txsec\">\n<h3 class=\"sr-rf-txwin\">Cartilage, and a patient who cannot move<\/h3>\n<div class=\"sr-rf-txcol\">\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=237\" data-sr-seek=\"237\">3:57<\/a>When you switch to cartilage, cartilage doesn&#8217;t look like normal bone and cortex. You can&#8217;t see through cortex, and you can see through cartilage. So it&#8217;s a striking change when you start to hit cartilage.<\/p>\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=248\" data-sr-seek=\"248\">4:08<\/a>In terms of patient positioning: if someone has a rib fracture, breathing probably isn&#8217;t very easy for them, moving around probably isn&#8217;t very easy for them. So take an image in whatever position they&#8217;re in \u2014 if they&#8217;re lying on their side, if they&#8217;re sitting, if they&#8217;re standing.<\/p>\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=264\" data-sr-seek=\"264\">4:24<\/a>Nice thing about ultrasound is you can sort of work around whatever body position they&#8217;re in, if you have a handheld ultrasound.<\/p>\n<\/div>\n<\/section>\n<section class=\"sr-rf-txsec\">\n<h3 class=\"sr-rf-txwin\">The rib, scanned on camera<\/h3>\n<div class=\"sr-rf-txcol\">\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=271\" data-sr-seek=\"271\">4:31<\/a>And let&#8217;s just get into it. I&#8217;ll turn it on here.<\/p>\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=275\" data-sr-seek=\"275\">4:35<\/a>And I&#8217;ll find the rib. And let&#8217;s take a short axis view.<\/p>\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=284\" data-sr-seek=\"284\">4:44<\/a>We can see where that rib is, right? It stands up in between the ribs. We have the pleura. So you don&#8217;t want to be in the pleura \u2014 you want to be the ribs, which are more superficial. But I can rotate this.<\/p>\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=296\" data-sr-seek=\"296\">4:56<\/a>So what I&#8217;m looking for is this cortex, and I want to make sure that it&#8217;s continuous. And I can follow it, and follow it, and follow it, and follow it \u2014 there it is again \u2014 and follow it, and follow it, and follow it.<\/p>\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=318\" data-sr-seek=\"318\">5:18<\/a>And then at a certain point, you&#8217;re going to hit the costochondral junction. Just double-check where you are, what&#8217;s going on.<\/p>\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=325\" data-sr-seek=\"325\">5:25<\/a>And you can see I go from not being able to see through the cortex, and then all of a sudden now I can see through the rib, right? So now I&#8217;m at cartilage instead of bone.<\/p>\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=337\" data-sr-seek=\"337\">5:37<\/a>Now remember, it isn&#8217;t just the fact that the cortex is continuous. You can also look above the cortex, right? And you&#8217;ll have basically a hematoma and fluid basically lifting up the periosteum, if there is a fracture. So keep an eye out for that as well.<\/p>\n<\/div>\n<\/section>\n<section class=\"sr-rf-txsec\">\n<h3 class=\"sr-rf-txwin\">Close<\/h3>\n<div class=\"sr-rf-txcol\">\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=355\" data-sr-seek=\"355\">5:55<\/a>Now if you want, you can go into a quick lung exam, but I have another video for that \u2014 or you can go to my website, [where] I think I have an hour-long video of trauma ultrasound that will explain how to do a trauma lung exam.<\/p>\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=368\" data-sr-seek=\"368\">6:08<\/a>But that&#8217;s it for the ribs.<\/p>\n<p class=\"sr-rf-txp\"><a class=\"sr-rf-txt\" href=\"#t=369\" data-sr-seek=\"369\">6:09<\/a>[Sponsor segment omitted, 6:09\u20136:42]<\/p>\n<\/div>\n<\/section>\n<\/div>\n<\/details>\n<\/section>\n<section id=\"device\" class=\"sr-choice\">\n<p class=\"sr-rf-krow\">Hardware<\/p>\n<h2>Device and settings<\/h2>\n<p>One probe, one setting, the whole survey. The left column is the published specification; the right column is what the device interface actually showed while this exam was being run, and the right column is the one I would work from if you are reproducing it. Chest-wall work wants the linear array at the top of its frequency range, because the cortex sits a centimetre down and resolution beats penetration there. If the same probe is going to look for an effusion at the base afterwards, that is a convex-array job and these are the wrong numbers to copy.<\/p>\n<div class=\"sr-rf-dev\">\n<div class=\"sr-rf-dev__grid\">\n<div class=\"sr-rf-dev__col\" data-sr-spec-table=\"1\">\n<p class=\"sr-rf-dev__h\">Published specification<\/p>\n<p class=\"sr-rf-dev__name\">Suresult D3Ultra<\/p>\n<p class=\"sr-rf-dev__price\">Convex &middot; linear &middot; phased in one head &mdash; {{SRX_PRICE:28571}}<\/p>\n<ul class=\"sr-rf-spec\">\n<li><b>Convex<\/b><span>3.2 \/ 5.0 MHz &middot; 90&ndash;300 mm &middot; 45&deg;<\/span><\/li>\n<li><b>Linear<\/b><span>7.5 \/ 10 MHz &middot; 20 \/ 40 \/ 60 \/ 100 mm &middot; 40 mm<\/span><\/li>\n<li><b>Phased<\/b><span>3.2 \/ 5.0 MHz &middot; 90&ndash;300 mm &middot; 60&deg;<\/span><\/li>\n<li><b>Modes<\/b><span>B, M, Color Doppler, Power Doppler, PW Doppler<\/span><\/li>\n<li><b>Array<\/b><span>192 elements &middot; 64 channels &middot; 256 grey levels<\/span><\/li>\n<li><b>Gain \/ DR<\/b><span>30&ndash;105 dB &middot; 40&ndash;110<\/span><\/li>\n<li><b>Body<\/b><span>156 &times; 65 &times; 20 mm &middot; 263 g &middot; 2 h scanning<\/span><\/li>\n<li><b>Platform<\/b><span>iOS, Android, Windows &middot; dual-band Wi-Fi<\/span><\/li>\n<\/ul>\n<\/div>\n<div class=\"sr-rf-dev__col\">\n<p class=\"sr-rf-dev__h\">Read off the screen in this recording<\/p>\n<ul class=\"sr-rf-spec\">\n<li><b>Array<\/b><span>Linear &middot; unchanged for the whole survey<\/span><\/li>\n<li><b>Depth<\/b><span>D 40 mm &middot; the shallowest step but one, and it steps to 60 mm at 5:58<\/span><\/li>\n<li><b>Frequency<\/b><span>F H10.0 MHz, harmonic &middot; the top of the linear range<\/span><\/li>\n<li><b>Gain<\/b><span>GN 105 dB &middot; the top of the published range<\/span><\/li>\n<li><b>Dynamic range<\/b><span>DR 80<\/span><\/li>\n<li><b>Processing<\/b><span>ENH 0 &middot; Compound OFF<\/span><\/li>\n<li><b>Output<\/b><span>MI 0.9 &middot; TIS 0.2<\/span><\/li>\n<li><b>Mode<\/b><span>B throughout &middot; no M-mode or Doppler is used on this exam<\/span><\/li>\n<\/ul>\n<\/div>\n<\/div>\n<div class=\"sr-rf-dev__links\"><a href=\"https:\/\/suresultmed.com\/shop\/handheld-ultrasounds\/d3ultra-multipurpose-handheld-ultrasound\/\">D3Ultra specification and price &rarr;<\/a><a href=\"https:\/\/suresultmed.com\/specialty\/handheld-ultrasound-for-emergency-medicine\/\">Emergency medicine hub &rarr;<\/a><a href=\"https:\/\/suresultmed.com\/suresult-video-library\/\">Scan Library &rarr;<\/a><\/div>\n<\/div>\n<\/section>\n<section id=\"related\">\n<p class=\"sr-rf-krow\">Same probe, other windows<\/p>\n<h2>Related scans<\/h2>\n<div class=\"sr-rf-rels\"><a class=\"sr-rf-rel\" href=\"https:\/\/suresultmed.com\/efast-exam-handheld-ultrasound\/\"><span class=\"sr-rf-rel__img\"><img decoding=\"async\" src=\"https:\/\/suresultmed.com\/wp-content\/uploads\/efast-exam-right-upper-quadrant-poster.jpg\" alt=\"Right upper quadrant scan on a handheld probe: liver and right kidney with the hepatorenal recess between them\" width=\"640\" height=\"360\" loading=\"lazy\"><span class=\"sr-rf-rel__len\">14:09<\/span><\/span><span class=\"sr-rf-rel__b\"><span class=\"sr-rf-rel__t\">eFAST trauma exam on the same probe<\/span><span class=\"sr-rf-rel__d\">Where a chest-wall survey sits inside a full trauma study \u2014 pericardium, both upper quadrants and the pelvis, scanned in one pass.<\/span><span class=\"sr-rf-rel__cta\">Read the walkthrough &rarr;<\/span><\/span><\/a><a class=\"sr-rf-rel\" href=\"https:\/\/suresultmed.com\/suresult-video-library\/\"><span class=\"sr-rf-rel__img\"><img decoding=\"async\" src=\"https:\/\/suresultmed.com\/wp-content\/uploads\/lung-ultrasound-pleural-line-m-mode-poster.jpg\" alt=\"Lung ultrasound frame on a handheld probe: bright pleural line in B-mode with an M-mode strip below it\" width=\"640\" height=\"360\" loading=\"lazy\"><span class=\"sr-rf-rel__len\">9:28<\/span><\/span><span class=\"sr-rf-rel__b\"><span class=\"sr-rf-rel__t\">Lung exam: A-lines, B-lines and the BLUE protocol<\/span><span class=\"sr-rf-rel__d\">The 60-second pleural check the presenting clinician recommends adding at 2:23, taught properly: sliding, A-lines, B-lines and the curtain sign.<\/span><span class=\"sr-rf-rel__cta\">Watch in the Library &rarr;<\/span><\/span><\/a><a class=\"sr-rf-rel\" href=\"https:\/\/suresultmed.com\/suresult-video-library\/\"><span class=\"sr-rf-rel__img\"><img decoding=\"async\" src=\"https:\/\/suresultmed.com\/wp-content\/uploads\/efast-related-dvt-three-point.jpg\" alt=\"Three-point compression DVT scan frame on a handheld linear probe showing a vein under compression\" width=\"640\" height=\"360\" loading=\"lazy\"><span class=\"sr-rf-rel__len\">1:23<\/span><\/span><span class=\"sr-rf-rel__b\"><span class=\"sr-rf-rel__t\">DVT: the three-point compression scan<\/span><span class=\"sr-rf-rel__d\">The other quick linear-probe study worth knowing: common femoral, femoral and popliteal veins, compressed in sequence.<\/span><span class=\"sr-rf-rel__cta\">Watch in the Library &rarr;<\/span><\/span><\/a><\/div>\n<p class=\"sr-rf-hublink\">All the clinical clips, filterable by anatomy and probe, are in the <a href=\"https:\/\/suresultmed.com\/suresult-video-library\/\">Scan Library<\/a>.<\/p>\n<\/section>\n<section id=\"faq\">\n<p class=\"sr-rf-krow\">Asked on this search<\/p>\n<h2>Rib fracture questions<\/h2>\n<div class=\"sr-faq sr-rf-faq\">\n<details class=\"sr-rf-q\" open>\n<summary>Can you see a rib fracture on ultrasound?<\/summary>\n<p>Yes. The rib cortex reflects almost all the sound that reaches it, so it draws as a bright continuous line with acoustic shadow beneath; a fracture appears as a sharp discontinuity or step-off in that line. A second sign sits above the bone: bleeding lifts the periosteum away from the cortex, leaving a fine raised bright stripe with a hypoechoic collection under it. Both are found with a high-frequency linear probe placed at the point of maximum tenderness, first across the rib to locate it and then along the rib to follow the cortex. The second sign is the one I would not skip: it stays visible when the cortex itself still looks intact.<\/p>\n<p><span class=\"sr-rf-cite\">Source: <a href=\"https:\/\/www.acep.org\/sonoguide\/basic\/msk\" rel=\"nofollow noopener\" target=\"_blank\">ACEP Sonoguide \u2014 Musculoskeletal Ultrasound<\/a>. Accessed September 5, 2026.<\/span><\/details>\n<details class=\"sr-rf-q\">\n<summary>Is ultrasound more sensitive than an X-ray for rib fractures?<\/summary>\n<p>In a cross-sectional study of 61 patients with minor blunt chest trauma, ultrasonography detected 58 of the 59 rib fractures found (98.3 %), while the oblique rib view detected 27 (45.8 %) and PA chest radiography 24 (40.7 %). The ultrasound examinations also took less time, averaging 12 minutes against 27 for radiography. European guidance reflects this: EFSUMB recommends ultrasound in accessible bone areas when radiography is negative but clinical suspicion of an acute fracture is high.<\/p>\n<p><span class=\"sr-rf-cite\">Source: <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC5555243\/\" rel=\"nofollow noopener\" target=\"_blank\">Pishbin E, Ahmadi K, Foogardi M, Salehi M, Seilanian Toosi F, Rahimi-Movaghar V. Comparison of ultrasonography and radiography in diagnosis of rib fractures. Chinese Journal of Traumatology 2017;20(4):226\u2013228<\/a>. Accessed September 5, 2026.<\/span><\/details>\n<details class=\"sr-rf-q\">\n<summary>What can be mistaken for a fractured rib on ultrasound?<\/summary>\n<p>Several normal structures produce a discontinuity in the cortical line. At the costochondral junction a slight angulation or a narrow gap without callus is a normal variant. Tendon and ligament attachment zones, and nutrient vessels penetrating the cortex, are physiological breaks in the bone surface. In children, growth plates and accessory ossification centres read as fragments. Correlating the finding with the point of tenderness and comparing the same rib on the other side resolves most of them.<\/p>\n<p><span class=\"sr-rf-cite\">Source: <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC12781705\/\" rel=\"nofollow noopener\" target=\"_blank\">Abu-Zidan FM, Alao DO, Cevik AA. Point-of-care ultrasound (POCUS) diagnosis of rib fractures. World Journal of Emergency Surgery 2025;21(1):1<\/a>. Accessed September 5, 2026.<\/span><\/details>\n<details class=\"sr-rf-q\">\n<summary>How do you scan a rib for a fracture?<\/summary>\n<p>Place a linear probe perpendicular to the rib for a transverse view at the site of highest tenderness, then rotate 90 degrees and trace along the length of the rib, watching the cortical line for a break and the tissue above it for a hematoma. Following the intercostal space is easier than following the rib itself, and that is the habit I would build first. Turning back to the transverse view periodically confirms you are still on rib rather than on pleura, and the patient can stay in whatever position they can tolerate.<\/p>\n<p><span class=\"sr-rf-cite\">Source: <a href=\"https:\/\/www.acep.org\/sportsmedicine\/newsroom\/newsroom-articles\/jul2025\/cracking-the-case-rib-fractures\" rel=\"nofollow noopener\" target=\"_blank\">Duong HA. Cracking the Case: Rib Fractures. ACEP Sports Medicine Section, 18 July 2025<\/a>. Accessed September 5, 2026.<\/span><\/details>\n<\/div>\n<\/section>\n<section id=\"sources\">\n<p class=\"sr-rf-krow\">Provenance<\/p>\n<h2>Sources<\/h2>\n<ul class=\"sr-rf-src\">\n<li><a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC5555243\/\" rel=\"nofollow noopener\" target=\"_blank\">Pishbin E, Ahmadi K, Foogardi M, Salehi M, Seilanian Toosi F, Rahimi-Movaghar V. Comparison of ultrasonography and radiography in diagnosis of rib fractures. Chinese Journal of Traumatology 2017;20(4):226\u2013228<\/a><span>Cross-sectional study of 61 patients with minor blunt chest trauma. Ultrasonography detected 58 (98.3 %) of the rib fractures, the oblique rib view 27 (45.8 %) and PA chest radiography 24 (40.7 %); mean examination time was 12 \u00b1 3 minutes against 27 \u00b1 6. This is the paper displayed on screen at 0:56. Accessed September 5, 2026.<\/span><\/li>\n<li><a href=\"https:\/\/doi.org\/10.1055\/a-1562-1455\" rel=\"nofollow noopener\" target=\"_blank\">Fodor D, Rodriguez-Garcia SC, Cantisani V, et al. The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound \u2014 Part I: Extraarticular Pathologies. Ultraschall in der Medizin 2022;43(1):34\u201357<\/a><span>Bone recommendation 2: in accessible bone areas, when radiography is negative but clinical suspicion of acute fracture is high, US should be used (LoE 1, SoR strong; strong consensus, 95 %). This is the recommendation list shown on screen at 1:12. Accessed September 5, 2026.<\/span><\/li>\n<li><a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC12781705\/\" rel=\"nofollow noopener\" target=\"_blank\">Abu-Zidan FM, Alao DO, Cevik AA. Point-of-care ultrasound (POCUS) diagnosis of rib fractures. World Journal of Emergency Surgery 2025;21(1):1<\/a><span>Describes the step-off and the cortical interruption with acoustic shadowing, and the normal costochondral variants that resemble them; recommends correlating with the point of tenderness and comparing the contralateral side. Accessed September 5, 2026.<\/span><\/li>\n<li><a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC9748005\/\" rel=\"nofollow noopener\" target=\"_blank\">Cocco G, Ricci V, Villani M, et al. Ultrasound imaging of bone fractures. Insights into Imaging 2022;13(1):189<\/a><span>Lists the physiological bone discontinuities that mimic fractures: nutrient vessels penetrating the cortex, growth plates, accessory ossification centres, and tendon and ligament attachment zones. Accessed September 5, 2026.<\/span><\/li>\n<li><a href=\"https:\/\/www.acep.org\/sonoguide\/basic\/msk\" rel=\"nofollow noopener\" target=\"_blank\">ACEP Sonoguide \u2014 Musculoskeletal Ultrasound<\/a><span>Bone cortex appears as bright hyperechoic lines with no echoes deep to the densely calcified surface; a fracture appears as a sharp discontinuity in that bright line. Accessed September 5, 2026.<\/span><\/li>\n<li><a href=\"https:\/\/www.acep.org\/sportsmedicine\/newsroom\/newsroom-articles\/jul2025\/cracking-the-case-rib-fractures\" rel=\"nofollow noopener\" target=\"_blank\">Duong HA. Cracking the Case: Rib Fractures. ACEP Sports Medicine Section, 18 July 2025<\/a><span>Technique reference: a linear probe perpendicular to the rib for a transverse view at the site of highest tenderness, tracing the rib&#8217;s length, with a longitudinal view for confirmation; notes that the examination is operator dependent. Accessed September 5, 2026.<\/span><\/li>\n<li><a href=\"https:\/\/suresultmed.com\/shop\/handheld-ultrasounds\/d3ultra-multipurpose-handheld-ultrasound\/\" rel=\"nofollow noopener\" target=\"_blank\">Suresult D3Ultra product page<\/a><span>Published specification for the device used in this recording. Accessed September 5, 2026.<\/span><\/li>\n<li><a href=\"https:\/\/www.youtube.com\/watch?v=mS-k33vIl9U\" rel=\"nofollow noopener\" target=\"_blank\">POCUS for Rib Fracture Detection \u2014 Suresult channel, 12 October 2025<\/a><span>The recording transcribed on this page. Accessed September 5, 2026.<\/span><\/li>\n<\/ul>\n<\/section>\n<div class=\"sr-final-cta\">\n<div>\n<h2>Which probe does your chest-wall work actually need?<\/h2>\n<p>A rib survey asks for the highest frequency you own and almost no depth. The lung and effusion work that usually follows it asks for the opposite. A three-in-one head covers both from one device; a dedicated pair covers both better, for more money. Tell us the setting and the case mix and you will get a direct recommendation in one conversation &mdash; one probe, two, or neither.<\/p>\n<\/div>\n<div class=\"sr-chat-link\">\n<button class=\"sr-crisp-consult-btn\" type=\"button\" data-sr-crisp-open onclick=\"window.$crisp=window.$crisp||[];window.$crisp.push(['do','chat:open']);\">ONLINE EXPERT CONSULT<\/button>\n<\/div>\n<\/div>\n<nav id=\"sr-rf-toc\" class=\"sr-light-toc sr-sticky-toc sr-article-toc\" data-suresult-toc data-sr-hide-on-wide-table aria-label=\"Rib walkthrough navigation\">\n<div class=\"sr-light-toc__head\">\n<div class=\"sr-light-toc__title\">On this page<\/div>\n<p><span class=\"sr-light-toc__progress\" id=\"sr-rf-progress\">0%<\/span><\/div>\n<div class=\"sr-light-toc__links\"><a href=\"#quick-answer\">Quick answer<\/a><a href=\"#two-signs\">Two signs<\/a><a href=\"#key-moments\">Key moments<\/a><a href=\"#what-it-shows\">What this scan shows<\/a><a href=\"#transcript\">Full transcript<\/a><a href=\"#device\">Device and settings<\/a><a href=\"#related\">Related scans<\/a><a href=\"#faq\">Rib fracture questions<\/a><a href=\"#sources\">Sources<\/a><\/div>\n<p class=\"sr-light-toc__note\">Not sure which probe your chest-wall work needs?<\/p>\n<p><button class=\"sr-crisp-consult-btn\" type=\"button\" data-sr-crisp-open onclick=\"window.$crisp=window.$crisp||[];window.$crisp.push(['do','chat:open']);\">ONLINE EXPERT CONSULT<\/button><br \/>\n<\/nav>\n<\/div>\n<p><script>(function(){\nvar AMP=String.fromCharCode(38);\nvar VID='mS-k33vIl9U';\nfunction embed(start){\nvar u='https:\/\/www.youtube-nocookie.com\/embed\/'+VID+'?rel=0'+AMP+'autoplay=1';\nif(start){u=u+AMP+'start='+start;}\nreturn u;\n}\nfunction mount(start){\nvar pl=document.getElementById('sr-rf-player');\nif(!pl){return null;}\nif(pl.classList.contains('is-live')){\nvar fr=pl.querySelector('iframe');\nif(fr){fr.src=embed(start);}\nreturn pl;\n}\nvar f=document.createElement('iframe');\nf.src=embed(start);\nf.title='Rib fracture ultrasound: the chest wall walkthrough';\nf.allow='accelerometer;autoplay;clipboard-write;encrypted-media;gyroscope;picture-in-picture';\nf.setAttribute('allowfullscreen','');\npl.innerHTML='';\npl.appendChild(f);\npl.classList.add('is-live');\nreturn pl;\n}\nvar p0=document.getElementById('sr-rf-player');\nif(p0){p0.addEventListener('click',function(){mount(0);});}\nvar tx=document.getElementById('sr-rf-transcript');\nif(tx){\nif(window.matchMedia('(max-width:768px)').matches){tx.removeAttribute('open');}\n}\ndocument.addEventListener('click',function(e){\nvar t0=e.target;\nif(!t0){return;}\nif(!t0.closest){return;}\nvar a=t0.closest('[data-sr-seek]');\nif(!a){return;}\ne.preventDefault();\nvar pl=mount(a.getAttribute('data-sr-seek'));\nif(pl){pl.scrollIntoView({behavior:'smooth',block:'start'});}\n});\nvar toc=document.getElementById('sr-rf-toc');\nif(toc){\nvar links=[].slice.call(toc.querySelectorAll('a[href^=\"#\"]'));\nvar secs=[];\nvar map={};\nlinks.forEach(function(a){\nvar id=a.getAttribute('href').slice(1);\nvar el=document.getElementById(id);\nif(el){secs.push(el);map[id]=a;}\n});\nwindow.__srBlSpy=function(){\nif(!links.length){return;}\nvar line=window.innerHeight*0.28;\nvar idx=0;\nfor(var i=0;i<secs.length;i++){\nif(secs[i].getBoundingClientRect().top<=line){idx=i;}\n}\nlinks.forEach(function(l){l.classList.remove('sr-toc-active');});\nlinks[idx].classList.add('sr-toc-active');\n};\nif(window.IntersectionObserver){\nvar io=new IntersectionObserver(function(){window.__srBlSpy();},{rootMargin:'-12% 0px -72% 0px'});\nsecs.forEach(function(s){io.observe(s);});\n}\nwindow.__srBlSpy();\n}\nvar pr=document.getElementById('sr-rf-progress');\nvar tick=false;\nfunction upd(){\ntick=false;\nif(window.__srBlSpy){window.__srBlSpy();}\nvar h=document.documentElement;\nvar m=h.scrollHeight-h.clientHeight;\nvar v=m>0?Math.round(h.scrollTop\/m*100):0;\nif(pr){pr.textContent=v+'%';}\n}\nwindow.addEventListener('scroll',function(){\nif(tick){return;}\ntick=true;\nrequestAnimationFrame(upd);\n},{passive:true});\nupd();\n})();<\/script><br \/>\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\/\/suresultmed.com\/rib-fracture-ultrasound-pocus\/#article\",\"headline\":\"Rib Fracture Ultrasound: the 6-Minute D3Ultra Chest Wall Walkthrough\",\"description\":\"A lower-rib survey on a linear probe: short axis to find the rib and its acoustic shadow, long axis to follow the cortical line to the costochondral junction, and the two signs of a fracture \u2014 a break in the cortex and a periosteum lifted by hematoma \u2014 with timestamped key moments, the full transcript, and the depth, gain and frequency read off the device interface.\",\"datePublished\":\"2026-09-05\",\"dateModified\":\"2026-09-05\",\"inLanguage\":\"en-US\",\"mainEntityOfPage\":{\"@type\":\"WebPage\",\"@id\":\"https:\/\/suresultmed.com\/rib-fracture-ultrasound-pocus\/\"},\"image\":\"https:\/\/suresultmed.com\/wp-content\/uploads\/rib-fracture-ultrasound-pocus-cover.jpg\",\"author\":[{\"@type\":\"Person\",\"@id\":\"https:\/\/suresultmed.com\/#fernando-mariz-md\",\"name\":\"Fernando Mariz, MD\",\"jobTitle\":\"Gynecology and pelvic surgery physician\",\"url\":\"https:\/\/suresultmed.com\/author\/dr-fernando-mariz-md\/\",\"knowsAbout\":[\"Gynecology\",\"Pelvic surgery\",\"Sonography\",\"Point-of-care ultrasound\"]},{\"@type\":\"Person\",\"@id\":\"https:\/\/suresultmed.com\/#jailyn-avila-md\",\"name\":\"Jailyn Avila, MD\",\"jobTitle\":\"Emergency medicine physician and POCUS educator\",\"knowsAbout\":[\"Emergency medicine\",\"Point-of-care ultrasound\",\"Residency education\"]}],\"publisher\":{\"@type\":\"Organization\",\"@id\":\"https:\/\/suresultmed.com\/#organization\",\"name\":\"Suresult\",\"url\":\"https:\/\/suresultmed.com\/\"},\"video\":{\"@id\":\"https:\/\/suresultmed.com\/rib-fracture-ultrasound-pocus\/#video\"},\"about\":{\"@type\":\"MedicalTest\",\"name\":\"Rib fracture ultrasound (chest wall POCUS)\"},\"keywords\":\"rib fracture ultrasound, rib ultrasound, ultrasound for rib fracture, chest wall ultrasound, costal cartilage fracture ultrasound, cortical step-off, POCUS\"},{\"@type\":\"VideoObject\",\"@id\":\"https:\/\/suresultmed.com\/rib-fracture-ultrasound-pocus\/#video\",\"name\":\"POCUS for rib fracture detection \u2014 a full chest wall walkthrough with transcript\",\"description\":\"A lower-rib survey on a linear probe at 10 MHz: locating the rib in short axis against its acoustic shadow and the pleural line beneath, rotating to long axis and tracking the cortex along the rib to the costochondral junction, and the two findings that indicate a fracture \u2014 an interruption or step in the cortical line, and a periosteum lifted off the bone by hematoma.\",\"thumbnailUrl\":[\"https:\/\/suresultmed.com\/wp-content\/uploads\/rib-short-axis-cortex-shadow-poster.jpg\"],\"uploadDate\":\"2025-10-12\",\"duration\":\"PT6M42S\",\"embedUrl\":\"https:\/\/www.youtube-nocookie.com\/embed\/mS-k33vIl9U\",\"isFamilyFriendly\":true,\"inLanguage\":\"en\",\"publisher\":{\"@type\":\"Organization\",\"@id\":\"https:\/\/suresultmed.com\/#organization\",\"name\":\"Suresult\",\"url\":\"https:\/\/suresultmed.com\/\"},\"mainEntityOfPage\":{\"@id\":\"https:\/\/suresultmed.com\/rib-fracture-ultrasound-pocus\/\"},\"transcript\":\"Today we're going to use a Suresult D3Ultra to look for rib fractures. Now, a lot of people, a lot of doctors, when they think of a fracture, they think radiographs, they think X-rays. And even myself, I was trained that way. But in fact, ultrasound is actually much better. But wait \u2014 ultrasound, that's soft tissue. But the cortex glows brightly, so you can see a discontinuity in the cortex. And soft tissue: you can see a hematoma underneath the periosteum. The periosteum gets lifted by, basically, fluid from the injury. So it is very, very sensitive. It's very easy to pick up a fracture with ultrasound compared to a radiograph. In fact, in one study specific to rib fractures \u2014 it was back in 2017 \u2014 they found that ultrasound had a sensitivity, caught 98 % of the fractures, whereas the oblique rib view and the PA chest radiographs detected 46 % and 41 % of rib fractures respectively. So that's very, very impressive. And in fact, there's a consensus statement that says, if you have a patient and they've had radiographs, but you're like, \u201cI still have a clinical suspicion that they have a fracture\u201d \u2014 they say, well, get an ultrasound and satisfy your clinical suspicion. Because in general, ultrasound has a much higher sensitivity. Now, the downsides of ultrasound: you have to screen through \u2014 you're taking a very narrow slice. So you have to really screen through the bones and look all around the bones. And there's some places you just can't get the unit, so you can't screen the whole body, every bone, completely \u2014 because you just can't manipulate the ultrasound unit around every bone. The other caution is you have to make sure you're not mistaking something like an osteophyte, or an erosion, or what's called a pseudo-erosion, for a fracture. There's often a little depression where a ligament attaches, and you don't want to mistake that as a discontinuity of the cortex. And of course, children look really strange no matter what type of imaging you're using. So you don't want to mistake normal anatomy in a child for a fracture. And remember, you have both sides of the person, so scan both sides if you want to see a normal \u2014 and use your split screen. [This is] specific to rib fractures. If you wanted to, for example, check the lungs for pneumothorax or hemothorax, you have the right tool in your hands already. Just take 60 seconds and you can check for those as well. Okay. So you may have no idea where the injury is. You may have to screen through every single rib. Or you may have a clinical indication of sort of where the injury might be. And you may know exactly where the injury is, because you're just following the injury and you're monitoring healing. In fact, it is recommended to follow fractures with ultrasound imaging, because you can see the callus and you can basically watch it heal, if you deem that useful. Now, for the fracture, we want an image sort of perpendicular to the fracture line. Now of course, we don't know where the fracture is \u2014 if there is a fracture \u2014 but ideally we'll see that discontinuity as it sort of jumps across that line. So for ribs, we know where the fracture is going to be. The fracture is going to be sort of up and down. So we're going to go longitudinal along the rib. Now, how I'm going to do that is: I can palpate, and I can sort of feel and follow one rib \u2014 or basically follow the intercostal space, because that's easier to follow. And then I can just basically have the transducer sort of follow just on top. And I can just follow along the rib, go down one intercostal space, follow along the rib. If you get lost, you can of course figure out where you are by taking a coronal view, or a view sort of transverse to the rib. And you can look at the ribs \u2014 because you don't want to be looking at the pleura of the lungs and think you're looking at the ribs. So this is a good idea: every once in a while, turn it 90 degrees and make sure you're taking a picture of what you want. When you switch to cartilage, cartilage doesn't look like normal bone and cortex. You can't see through cortex, and you can see through cartilage. So it's a striking change when you start to hit cartilage. In terms of patient positioning: if someone has a rib fracture, breathing probably isn't very easy for them, moving around probably isn't very easy for them. So take an image in whatever position they're in \u2014 if they're lying on their side, if they're sitting, if they're standing. Nice thing about ultrasound is you can sort of work around whatever body position they're in, if you have a handheld ultrasound. And let's just get into it. I'll turn it on here. And I'll find the rib. And let's take a short axis view. We can see where that rib is, right? It stands up in between the ribs. We have the pleura. So you don't want to be in the pleura \u2014 you want to be the ribs, which are more superficial. But I can rotate this. So what I'm looking for is this cortex, and I want to make sure that it's continuous. And I can follow it, and follow it, and follow it, and follow it \u2014 there it is again \u2014 and follow it, and follow it, and follow it. And then at a certain point, you're going to hit the costochondral junction. Just double-check where you are, what's going on. And you can see I go from not being able to see through the cortex, and then all of a sudden now I can see through the rib, right? So now I'm at cartilage instead of bone. Now remember, it isn't just the fact that the cortex is continuous. You can also look above the cortex, right? And you'll have basically a hematoma and fluid basically lifting up the periosteum, if there is a fracture. So keep an eye out for that as well. Now if you want, you can go into a quick lung exam, but I have another video for that \u2014 or you can go to my website, [where] I think I have an hour-long video of trauma ultrasound that will explain how to do a trauma lung exam. But that's it for the ribs. [Sponsor segment omitted, 6:09\u20136:42]\",\"hasPart\":[{\"@type\":\"Clip\",\"@id\":\"https:\/\/suresultmed.com\/rib-fracture-ultrasound-pocus\/#clip-0\",\"name\":\"Why a rib fracture is an ultrasound problem\",\"startOffset\":0,\"endOffset\":46,\"url\":\"https:\/\/suresultmed.com\/rib-fracture-ultrasound-pocus\/#t=0\"},{\"@type\":\"Clip\",\"@id\":\"https:\/\/suresultmed.com\/rib-fracture-ultrasound-pocus\/#clip-46\",\"name\":\"The comparison study and the EFSUMB bone recommendation, on screen\",\"startOffset\":46,\"endOffset\":89,\"url\":\"https:\/\/suresultmed.com\/rib-fracture-ultrasound-pocus\/#t=46\"},{\"@type\":\"Clip\",\"@id\":\"https:\/\/suresultmed.com\/rib-fracture-ultrasound-pocus\/#clip-89\",\"name\":\"Where ultrasound falls short: a narrow slice, and bone you cannot reach\",\"startOffset\":89,\"endOffset\":128,\"url\":\"https:\/\/suresultmed.com\/rib-fracture-ultrasound-pocus\/#t=89\"},{\"@type\":\"Clip\",\"@id\":\"https:\/\/suresultmed.com\/rib-fracture-ultrasound-pocus\/#clip-128\",\"name\":\"The look-alikes, and why you scan the other side\",\"startOffset\":128,\"endOffset\":156,\"url\":\"https:\/\/suresultmed.com\/rib-fracture-ultrasound-pocus\/#t=128\"},{\"@type\":\"Clip\",\"@id\":\"https:\/\/suresultmed.com\/rib-fracture-ultrasound-pocus\/#clip-156\",\"name\":\"Three reasons you are scanning: unknown site, localised pain, or following healing\",\"startOffset\":156,\"endOffset\":182,\"url\":\"https:\/\/suresultmed.com\/rib-fracture-ultrasound-pocus\/#t=156\"},{\"@type\":\"Clip\",\"@id\":\"https:\/\/suresultmed.com\/rib-fracture-ultrasound-pocus\/#clip-182\",\"name\":\"Scan plane: longitudinal along the rib, perpendicular to the fracture line\",\"startOffset\":182,\"endOffset\":237,\"url\":\"https:\/\/suresultmed.com\/rib-fracture-ultrasound-pocus\/#t=182\"},{\"@type\":\"Clip\",\"@id\":\"https:\/\/suresultmed.com\/rib-fracture-ultrasound-pocus\/#clip-237\",\"name\":\"Cartilage against cortex, and positioning a patient who cannot move\",\"startOffset\":237,\"endOffset\":271,\"url\":\"https:\/\/suresultmed.com\/rib-fracture-ultrasound-pocus\/#t=237\"},{\"@type\":\"Clip\",\"@id\":\"https:\/\/suresultmed.com\/rib-fracture-ultrasound-pocus\/#clip-271\",\"name\":\"Short axis first: the rib, its shadow, and the pleura between\",\"startOffset\":271,\"endOffset\":296,\"url\":\"https:\/\/suresultmed.com\/rib-fracture-ultrasound-pocus\/#t=271\"},{\"@type\":\"Clip\",\"@id\":\"https:\/\/suresultmed.com\/rib-fracture-ultrasound-pocus\/#clip-296\",\"name\":\"Rotate to long axis and track the cortex to the costochondral junction\",\"startOffset\":296,\"endOffset\":337,\"url\":\"https:\/\/suresultmed.com\/rib-fracture-ultrasound-pocus\/#t=296\"},{\"@type\":\"Clip\",\"@id\":\"https:\/\/suresultmed.com\/rib-fracture-ultrasound-pocus\/#clip-337\",\"name\":\"Above the cortex: hematoma and fluid lifting the periosteum\",\"startOffset\":337,\"endOffset\":369,\"url\":\"https:\/\/suresultmed.com\/rib-fracture-ultrasound-pocus\/#t=337\"}]},{\"@type\":\"FAQPage\",\"@id\":\"https:\/\/suresultmed.com\/rib-fracture-ultrasound-pocus\/#faq\",\"mainEntity\":[{\"@type\":\"Question\",\"name\":\"Can you see a rib fracture on ultrasound?\",\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Yes. The rib cortex reflects almost all the sound that reaches it, so it draws as a bright continuous line with acoustic shadow beneath; a fracture appears as a sharp discontinuity or step-off in that line. A second sign sits above the bone: bleeding lifts the periosteum away from the cortex, leaving a fine raised bright stripe with a hypoechoic collection under it. Both are found with a high-frequency linear probe placed at the point of maximum tenderness, first across the rib to locate it and then along the rib to follow the cortex. The second sign is the one I would not skip: it stays visible when the cortex itself still looks intact.\"}},{\"@type\":\"Question\",\"name\":\"Is ultrasound more sensitive than an X-ray for rib fractures?\",\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"In a cross-sectional study of 61 patients with minor blunt chest trauma, ultrasonography detected 58 of the 59 rib fractures found (98.3 %), while the oblique rib view detected 27 (45.8 %) and PA chest radiography 24 (40.7 %). The ultrasound examinations also took less time, averaging 12 minutes against 27 for radiography. European guidance reflects this: EFSUMB recommends ultrasound in accessible bone areas when radiography is negative but clinical suspicion of an acute fracture is high.\"}},{\"@type\":\"Question\",\"name\":\"What can be mistaken for a fractured rib on ultrasound?\",\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Several normal structures produce a discontinuity in the cortical line. At the costochondral junction a slight angulation or a narrow gap without callus is a normal variant. Tendon and ligament attachment zones, and nutrient vessels penetrating the cortex, are physiological breaks in the bone surface. In children, growth plates and accessory ossification centres read as fragments. Correlating the finding with the point of tenderness and comparing the same rib on the other side resolves most of them.\"}},{\"@type\":\"Question\",\"name\":\"How do you scan a rib for a fracture?\",\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Place a linear probe perpendicular to the rib for a transverse view at the site of highest tenderness, then rotate 90 degrees and trace along the length of the rib, watching the cortical line for a break and the tissue above it for a hematoma. Following the intercostal space is easier than following the rib itself, and that is the habit I would build first. Turning back to the transverse view periodically confirms you are still on rib rather than on pleura, and the patient can stay in whatever position they can tolerate.\"}}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/suresultmed.com\/rib-fracture-ultrasound-pocus\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/suresultmed.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Scan Library\",\"item\":\"https:\/\/suresultmed.com\/suresult-video-library\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Rib fracture ultrasound: the chest wall walkthrough\",\"item\":\"https:\/\/suresultmed.com\/rib-fracture-ultrasound-pocus\/\"}]}]}<\/script><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A lower-rib survey run end to end on a linear probe &mdash; short axis to find the rib, long axis<\/p>","protected":false},"author":1,"featured_media":35827,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_seopress_titles_title":"Rib Fracture Ultrasound: 6-Minute Chest Wall Walkthrough","_seopress_titles_desc":"Follow the rib cortex in long axis to the costochondral junction \u2014 with timestamps, the settings read off the screen, and the full transcript.","_seopress_robots_index":"","_seopress_robots_follow":"","_seopress_robots_imageindex":"","_seopress_robots_snippet":"","_seopress_robots_primary_cat":"","_seopress_robots_breadcrumbs":"","_seopress_robots_freeze_modified_date":"","_seopress_robots_custom_modified_date":"","_seopress_robots_canonical":"","_seopress_social_fb_title":"","_seopress_social_fb_desc":"","_seopress_social_fb_img":"https:\/\/suresultmed.com\/wp-content\/uploads\/rib-fracture-ultrasound-pocus-cover.jpg","_seopress_social_fb_img_attachment_id":35827,"_seopress_social_fb_img_width":1600,"_seopress_social_fb_img_height":900,"_seopress_social_twitter_title":"","_seopress_social_twitter_desc":"","_seopress_social_twitter_img":"https:\/\/suresultmed.com\/wp-content\/uploads\/rib-fracture-ultrasound-pocus-cover.jpg","_seopress_social_twitter_img_attachment_id":35827,"_seopress_social_twitter_img_width":1600,"_seopress_social_twitter_img_height":900,"_seopress_redirections_value":"","_seopress_redirections_enabled":"","_seopress_redirections_enabled_regex":"","_seopress_redirections_logged_status":"","_seopress_redirections_param":"","_seopress_redirections_type":0,"_seopress_analysis_target_kw":"","_seopress_news_disabled":"","_seopress_video_disabled":"","_seopress_video":[],"_seopress_pro_schemas_manual":[],"_seopress_pro_rich_snippets_disable_all":"","_seopress_pro_rich_snippets_disable":[],"_seopress_pro_schemas":[],"footnotes":""},"categories":[457],"tags":[],"class_list":["post-35822","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-scan-library"],"acf":[],"_links":{"self":[{"href":"https:\/\/suresultmed.com\/it\/wp-json\/wp\/v2\/posts\/35822","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/suresultmed.com\/it\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/suresultmed.com\/it\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/suresultmed.com\/it\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/suresultmed.com\/it\/wp-json\/wp\/v2\/comments?post=35822"}],"version-history":[{"count":7,"href":"https:\/\/suresultmed.com\/it\/wp-json\/wp\/v2\/posts\/35822\/revisions"}],"predecessor-version":[{"id":35862,"href":"https:\/\/suresultmed.com\/it\/wp-json\/wp\/v2\/posts\/35822\/revisions\/35862"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/suresultmed.com\/it\/wp-json\/wp\/v2\/media\/35827"}],"wp:attachment":[{"href":"https:\/\/suresultmed.com\/it\/wp-json\/wp\/v2\/media?parent=35822"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/suresultmed.com\/it\/wp-json\/wp\/v2\/categories?post=35822"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/suresultmed.com\/it\/wp-json\/wp\/v2\/tags?post=35822"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}