Accuracy of bedside ultrasonography for the diagnosis of finger fractures

Aksay, Ersin; Kılıç, Turgay Yılmaz; Yeşilaras, Murat; Tür, Feriyde Çalışkan; Sever, Mustafa; Kalenderer, Önder

doi:10.1016/j.ajem.2016.01.010

Cited by 14 publications

(14 citation statements)

References 8 publications

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“…These varied considerably in sample size, from 15 to 260 subjects, and consisted of participants recruited consecutively upon presentation to the Emergency Department, with the exception of Dallaudière et al, who conducted their research in a prehospital setting [27], and two papers which recruited participants from specialist units, namely hand surgery [12] and rheumatology [22]. The largest bulk of evidence was produced by research conducted in Turkey [13, 19, 26, 28–33] and other Middle-Eastern countries such as Iran [34, 35] and Israel [24], with the remaining 14 studies spread across continental Europe and the Americas.…”

Section: Resultsmentioning

confidence: 99%

“…Fracture sites varied widely across the included studies, with one paper not reporting outcomes relating to specific fracture types [21]. Fractures of the hand were the most commonly investigated site of injury, with six studies focussed on metacarpal and/or phalangeal fractures [29, 30, 32, 33, 35, 36], and three dealing with fractures of the scaphoid [12, 20, 23]. Other specific injury sites included fractures of the foot and ankle [13, 28, 31, 37, 38], including metatarsal stress fractures [22] and Hill-Sachs injuries [18, 39].…”

Section: Resultsmentioning

confidence: 99%

“…All included studies enrolled patients consecutively, with most using a convenience sampling design – that is, patients meeting the inclusion criteria were recruited within the specified time period if a researcher or sonographer was present at the time of patient presentation to hospital [19–21, 25, 28, 30–33, 36–38, 41]. Despite randomising patient selection in order to minimize researcher influence, this method of sampling may introduce some degree of selection bias if certain characteristics are overrepresented in patients presenting to hospital between specific working hours.…”

Section: Resultsmentioning

confidence: 99%

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The effectiveness of ultrasound in the detection of fractures in adults with suspected upper or lower limb injury: a systematic review and subgroup meta-analysis

et al. 2019

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BackgroundThe aim of the present review is to assess the effectiveness of ultrasound (US) in the detection of upper and lower limb bone fractures in adults compared to a diagnostic gold standard available in secondary and tertiary care centres (e.g. radiography, CT scan or MRI).MethodsThe review followed PRISMA guidelines and used a database-specific search strategy with Medline, EMBASE and The Cochrane Library plus secondary sources (see supplementary material for completed PRISMA checklist). Diagnostic performance of ultrasound was assessed with a qualitative synthesis and a meta-analysis of two data subgroups.ResultsTwenty-six studies were included (n = 2360; fracture prevalence =5.3 % to 75.0%); data were organised into anatomical subgroups, two of which were subjected to meta-analysis. Sensitivity and specificity ranged from 42.11 − 100% and 65.0 − 100%, with the highest diagnostic accuracy in fractures of the foot and ankle. The pooled sensitivity and specificity of US was 0.93 and 0.92 for upper limb fractures (I2 = 54.7 % ; 66.3%), and 0.83 and 0.93 for lower limb fractures (I2 = 90.1 % ; 83.5%).ConclusionUltrasonography demonstrates good diagnostic accuracy in the detection of upper and lower limb bone fractures in adults, especially in fractures of the foot and ankle. This is supported by pooled analysis of upper and lower limb fracture subgroups. Further research in larger populations is necessary to validate and strengthen the quality of the available evidence prior to recommending US as a first-line imaging modality for prehospital use.Trial registrationThe protocol is registered with the PROSPERO International register of systematic reviews: ID = CRD42017053640.Electronic supplementary materialThe online version of this article (10.1186/s12873-019-0226-5) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The effectiveness of ultrasound in the detection of fractures in adults with suspected upper or lower limb injury: a systematic review and subgroup meta-analysis

et al. 2019

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“…A US examination is not applicable to patients with open fractures and severe soft tissue injury and those with external fixation, such as a plaster cast or splint. (4) Ultrasound‐guided fracture reduction is more dependent on the surgeon's hand skill and experience …”

Section: Discussionmentioning

confidence: 99%

Value of Ultrasound‐Guided Closed Reduction and Minimally Invasive Fixation in the Treatment of Metacarpal Fractures

Shen

Wang

2019

J of Ultrasound Medicine

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ObjectivesTo investigate the value of ultrasound‐guided closed reduction and minimally invasive fixation in the treatment of metacarpal fractures.MethodsTwenty‐four patients with acute metacarpal fractures were randomly divided into experimental and control groups, with 12 patients in each group. Ultrasound‐guided closed reduction and fixation were performed in the experimental group, whereas C‐arm fluoroscopy‐assisted fixation was performed in the control group. Patients in both groups were followed to compare the treatment efficacy.ResultsThe success rates of ultrasound‐guided closed reduction of fractures were 75.00% (9 of 12) in the experimental group and 83.33% (10 of 12) in the control group, and the difference was not statistically significant (χ2 = 0.253; P = .615) between the groups. The mean numbers of C‐arm fluoroscopy‐assisted procedures ± SD were 1.50 ± 0.67 times in the experimental group and 2.50 ± 0.80 in the control group, and the difference was statistically significant (t = –3.317; P = .003). The mean healing times of fractures were 5.47 ± 0.67 weeks in the experimental group and 5.73 ± 0.81 weeks in the control group; the excellence rates of total active motion were 83.33% (10 of 12) in the experimental group and 91.67% (11 of 12) in the control group; the mean grip strength values were 31.78 ± 3.13 kg in the experimental group and 33.43 ± 3.30 kg in the control group. There were no significant differences in those 3 parameters between the groups (P > .05 in each comparison).ConclusionsUltrasound‐guided closed reduction and minimally invasive fixation is an effective treatment of metacarpal fractures and can reduce exposure to x‐ray radiation.

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“…We performed no statistical tests because there were only 6 conflicting results—too few to test statistically. Some studies have indicated that it is particularly difficult to identify a fracture in the hand and in the metatarsals 4 - 7 , whereas other studies evaluating specific bones have shown good results 8 - 10 . Age did not seem to have an impact on whether a patient with a suspected fracture had a fracture or not 11 .…”

Section: Discussionmentioning

confidence: 99%

The Use of Ultrasound to Exclude Extremity Fractures in Adults

Døssing

Mechlenburg

Hansen

et al. 2017

JBJS OA

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Background:The purpose of the present study was to investigate whether ultrasonography can be used as a diagnostic tool to exclude extremity fractures in adults.Methods:This prospective comparative study involved 91 patients (age, ≥18 years) who had been referred by general practitioners for a conventional radiographic examination of a suspected extremity fracture. No additional clinical examination was performed. Ultrasound examination was consistently carried out prior to conventional radiographic examination, which was regarded as the gold standard. At the end of the study, the positive scans were confirmed by a specialist who was highly skilled in ultrasonography.Results:The prevalence of fractures in the study population was 27%. Ultrasonography had a sensitivity of 92%, a specificity of 94%, a positive predictive value of 85%, a negative predictive value of 97%, a positive likelihood ratio of 15.33, and a negative likelihood ratio of 0.085. There seemed to be no association between the anomalous results and patient age or the specific anatomical region of the fracture.Conclusions:The present study indicates that ultrasonography, when performed and interpreted by experienced ultrasonographers, has high accuracy for the diagnosis of a suspected extremity fracture. No systematic differences were found between the results of radiography and ultrasonography, and ultrasonography showed a high sensitivity and specificity.Level of Evidence:Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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Accuracy of bedside ultrasonography for the diagnosis of finger fractures

Cited by 14 publications

References 8 publications

The effectiveness of ultrasound in the detection of fractures in adults with suspected upper or lower limb injury: a systematic review and subgroup meta-analysis

The effectiveness of ultrasound in the detection of fractures in adults with suspected upper or lower limb injury: a systematic review and subgroup meta-analysis

Value of Ultrasound‐Guided Closed Reduction and Minimally Invasive Fixation in the Treatment of Metacarpal Fractures

The Use of Ultrasound to Exclude Extremity Fractures in Adults

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