Background: Traditionally, X-rays have remained the standard modality for bone fracture diagnosis. However, other diagnostic modalities most notably ultrasound have emerged as a simple, radiation-safe, effective imaging tool to diagnose bone fractures. Despite the advantages, there is a prevalent scarcity of literature recognizing its significance in bone trauma management. This review investigates the effectiveness of ultrasound in the diagnosis of various bone fractures when compared to conventional radiography such as X-rays. Methodology: Electronic databases such as PubMed/Medline, SCOPUS, and Web of Science (WOS) were reviewed for observational studies and review articles from the years 2017–2022 utilizing MESH terminology in a broad term search strategy. The search returned a total of 248 articles. After removal of duplicates, abstract, and full-text screening this systematic review ultimately utilized data from 31 articles. All searches were performed and analyzed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) methodology and were conducted during August 2022. In accordance with the guidelines for assessing the quality of included systematic reviews, we used the AMSTAR 2020, Supplemental Digital Content 2, http://links.lww.com/MS9/A241 (A Measurement Tool to Assess Systematic Reviews) tool to evaluate the methodological quality of the included studies. A data extraction form based on the Cochrane Consumers and Communication Review group’s extraction template for quality assessment and evidence synthesis was used for data extraction. The information extracted included details such as author information, database, journal details, type of study, etc. Studies included will be classified into long bones, short bones, pneumatic bones, irregular bones, ankle and knee, stress fractures, hip fractures, POCUS, and others. All included studies considered bias and ethical criteria and provided valuable evidence to answer the research question. Results: The search returned a total of 248 articles, with 192 articles remaining after the removal of duplicates. Primary screening of the title and abstract articles from the database search and additional sources identified 68 relevant articles for full-text screening. This systematic review ultimately used data from 33 articles of the remaining articles we included all of them because they had more than 70% certainty, using the STROBE tool for observational articles, narrative reviews with the ENTREQ guide, and systematic reviews and meta-analyses with the PRISMA guide; however, two articles were excluded at the eligibility stage because of risk of bias. Conclusion: This systematic review provides insightful evidence on safety and effectiveness of ultrasound in diagnosing fractures when compared to the conventional imaging modalities such as X-rays. This shall promote further large-scale, multi-centre research that can eventually guide clinic practice in diagnosing and managing various bone fractures.

Introduction In Latin America, ethnic disparities rooted in the colonial legacy have persisted. There is limited scientific evidence critically analyzing the temporal changes in ethnic inequalities in reproductive, maternal, neonatal, and child health (RMNCH), and the potential impact of policies on the progress of reducing these gaps for Indigenous peoples. After the 2000 crisis, Ecuador had the region’s largest ethnic disparities in intervention coverage and social determinants due to structural racism. Inclusion policies improved starting in 2008. The main study aim was to analyze the coverage and ethnic inequalities of six RMNCH health interventions, the evolution of social determinants, and the potential impact of policies and strategies over 14 years. Methods using a mixed method design, we analyze three nationally representative surveys (2004, 2012, and 2018) to compare the evolution of social determinants; and the coverage and inequalities of six RMNCH health interventions, stratified by ethnicity (women and child Indigenous, Afro-Ecuadorians, and reference group); and we estimated absolute inequality measures and adjusted coverage ratios using Poisson regression models. Through a literature review and temporal graphs, we analyzed plans, policies, and strategies in health, education, and ethnic inclusion during the same period to estimate their potential impact. Results By 2018, the population self-identifying as Indigenous had doubled the percentage of people in the 4th and 5th wealth quintiles (from 10% to 20%) and increased secondary education attainment from 25% to 45% compared to 2004, though these changes were less evident in rural areas. Between 2004 and 2018, prenatal care coverage, institutional delivery care, and births attended by professionals increased from 27% to 75% among the Indigenous population. Although the coverage ratios show that ethnic gaps persist, inequalities progressively reduced during this period. These reductions coincided with efforts of social participation and organization that led to the constitutional recognition of pluractionality, combined with increased social investment in education and health in rural areas, and the development and implementation of policies and strategies that promoted intercultural practices in health. However, there is a noted lack of monitoring processes and impact assessment of these strategies. Conclusions The reduction of ethnic inequalities in RMNCH in Ecuador could be explained by inclusive policies and programs implemented in recent years, social organization and participation, and the involvement of actors and leaders in the implementation of these. Temporal studies based on routine surveys allow for the observation of changes and analysis of the potential impact of policies and strategies. Ecuador exemplifies actions that may have contributed to the reduction of inequalities, which could serve as a reference for other countries seeking to improve the health of Indigenous peoples. These observations also provide a pre-pandemic image, offering insights prior to the potential effects of COVID-19 and five years before assessing the outcomes of the 2030 Agenda for Sustainable Development.