Sonographic detection of occult fractures in the foot and ankle

Abstract

Purpose The purpose of this retrospective study was to determine whether high‐resolution sonography can aid in the diagnosis of radiographically occult fractures in the foot and ankle. Methods High‐resolution sonography with a 10‐MHz linear‐array transducer was performed in 268 patients with foot and ankle injuries whose initial plain x‐ray films were negative for fracture. Results Twenty‐four patients had occult fractures demonstrated by sonography. On sonography, the occult fractures appeared as a discontinuity of cortex echogenicity. The fractures were found at the calcaneus (n = 8), metatarsus (n = 6), talus (n = 3), navicular bone (n = 3), cuboid bone (n = 2), cuneiform bone (n = 1), and lateral malleolus (n = 1). Review of the patients' radiographs revealed tiny fractures at the sonographically identified locations in 2 patients. The first 5 patients underwent bone scans, which confirmed the presence of the fractures. The first 11 patients received follow‐up sonographic examination 6 weeks after diagnosis; in all 11, an echogenic line over the previous fracture site, presumably representing callus formation, was noted. Conclusions Sonography—a readily available, noninvasive imaging technique—can provide important information about soft tissue injuries and cortical discontinuities in the foot and ankle area. Using this procedure, occult fractures can be identified and delineated, and costly procedures such as MRI can be avoided. © 1999 John Wiley & Sons, Inc. J Clin Ultrasound 27:421–425, 1999.

Diagnosis and serial sonography of a proximal fifth metatarsal stress fracture

“…14 Since then, US has aided in diagnosing additional metatarsal stress fractures, 8,15,16 detection of other occult fractures in the foot and ankle, 17 stress fractures of the lower limb, 18 and prediction of fracture callus formation with the use of color Doppler US. 19 Furthermore, US has been recommended as a follow-up examination to negative radiography in the diagnostic workup of suspected stress fractures because it may circumvent the need for more costly tests such as MRI and skeletal scintigraphy.…”

“…19 Furthermore, US has been recommended as a follow-up examination to negative radiography in the diagnostic workup of suspected stress fractures because it may circumvent the need for more costly tests such as MRI and skeletal scintigraphy. 8,17 Currently, the following 5 US criteria are used to determine the presence of stress fractures: increased vascularity as demonstrated using color Doppler, periosteal elevation with a cortical break/loss of periosteal contiguity, periosteal reaction and early callus formation, hypoechoic area adjacent to the cortical break (corresponding to hematoma), and overlying soft tissue edema. 8,16,18 In this case, the following US criteria were initially noted: increased vascularity demonstrated with color Doppler, periosteal elevation, and cortical disruption.…”

Resuscitative Long-Bone Sonography for the Clinician: Usefulness and Pitfalls of Focused Clinical Ultrasound to Detect Long-Bone Fractures During Trauma Resuscitation

“…At least two longitudinal planes should be scanned, although an original description by Hü bner et al reported scanning in four longitudinal planes with transverse scans obtained as appropriate [23][24][25]. The cortex of the bone is seen as a homogenous, bright reflection of echoes with dorsal acoustic shadowing.…”

“…Wang et al [24] reported a series of foot fractures in which 9% of patients with radiographs interpreted as normal had fractures of the foot and ankle demonstrated by US. Marshburn et al [16] used a relatively low frequency 5-MHz non-linear transducer and a firstgeneration hand-carried US machine to examine suspected humerus and femur injuries.…”

Relevance of musculoskeletal sonography in the early diagnosis of metatarsal stress fractures

“…Bien que l'échographie ne soit pas actuellement considérée comme une méthode de choix dans le diagnostic des pathologies osseuses, les dernières années ont vu un certain nombre d'études utilisant l'échographie comme moyen diagnostique de fractures périphériques, montrant de bons, voire d'excellents résultats [4][5][6][7][8][9].…”