Comparison of Point-of-Care Ultrasonography and Radiography in the Diagnosis of Long-Bone Fractures

Abstract

Background and objectives: In this study, the accuracy of point-of-care ultrasonography (POCUS) was compared to radiography (XR) in the diagnosis of fractures, the determination of characteristics of the fractures, and treatment selection of fractures in patients admitted to the emergency department (ED) due to trauma and suspected long bone (LB) fractures. Materials and Methods: The patients were included in the study, who were admitted to ED due to trauma, and had physical examination findings suggesting the presence of fractures in LB (humerus, radius, ulna, femur, tibia, and fibula). The patients were evaluated by two emergency physicians (EP) in ED. The first EP examined LBs with POCUS and the second EP examined them with XR. LBs were evaluated on the anterior, posterior, medial, and lateral surfaces and from the proximal joint to the distal one (shoulder, elbow, wrist, hip, knee, and ankle joint) in both longitudinal and transverse axes with POCUS. Results: A total of 205 patients with suspected LB fractures were included in the study. LB fractures were determined in 99 patients with XR and in 105 patients with POCUS. The sensitivity, specificity, positive predictive value, negative predictive value of POCUS in determining the fractures were 99%, 93%, 93%, and 99%, respectively, compared to XR. Compared to XR, POCUS was able to determine 100% of fissure type fractures (kappa (κ) value: 0.765), 83% of linear fractures (κ: 0.848), 92% of fragmented fractures(κ: 0.756), 67% of spiral fractures (κ:0.798), 75% of avulsion type fractures (κ: 0.855), and 100% of full separation type fractures (κ: 0.855).Conclusions: This study has demonstrated that POCUS has a high sensitivity in diagnosing LB fractures. POCUS has a high sensitivity in identifying fracture characteristics. POCUS can be used as an alternative imaging method to XR in the diagnosis of LB fractures and in the determination of fracture characteristics.

Possible Role of Thoracic Ultrasound in the Diagnostic Pathway of Infant Abuse in the Pediatric Emergency Department

“…Other studies have reported that ultrasound is more sensitive than radiography to detect rib fractures 16–18 . Similar results were also found with the use of ultrasound in pediatric traumatic injuries, 19–22 although no cases of abuse were considered in those studies.…”

Comparison of X-Ray Imaging and Computed Tomography Scan in the Evaluation of Knee Trauma

“…In this study, the sensitivity of XR imaging in identifying two simultaneous bone fractures was reported as 56%, while the specificity was reported as 94%; the sensitivity in identifying trimalleolar fractures was reported as 17%, and the specificity was reported as 100% [5]. In another study investigating 205 patients with long bone traumas, nine patients had radius and ulna, and one patient had tibia and fibula; in addition to the long bone fracture, two patients had patella fractures, one patient had clavicula fractures, and one patient had calceneus fractures [12]. In a similar study investigating metatarsal fractures in 72 patients, multiple metatarsal fractures were detected in four patients [13].…”

“…There are studies comparing the imaging methods in the literature. Some of these studies are about comparing the imaging methods, which are: XR and magnetic resonance imaging (MRI) [1,10], XR imaging and ultrasonography (USG) [11,12,13,14,15,16], USG and CT scan [17], CT scan and MRI [18], USG and MRI [19], and some are about XR imaging and CT scans [3,5,8,9,20,21,22]. A small number of the studies comparing XR imaging and CT scanning examine the knee joint.…”

Bildgebung nach Unfall in Klinik und Praxis bei Kindern und Jugendlichen

“…Zahlreiche Arbeiten belegen den sinnvollen Einsatz der Sonographie in der Akuttraumatologie bei Kindern und Jugendlichen [ 2 , 27 , 32 , 51 ]. Sowohl lange Röhrenknochen, hier besonders der proximale Humerus und der Ellenbogen [ 10 , 22 , 44 ], speziell auch der Unterarm und distaler Radius [ 8 , 36 ] und Frakturen der Klavikula [ 27 ] eignen sich gut für den sonographischen Frakturnachweis. Auch in den USA wird in den letzten Jahren mehr und mehr in der Notfallbehandlung die Sonographie als „point-of-care ultrasonography“ (POCUS) eingesetzt [ 3 ].…”