The value of ultrasound for detecting hand fractures

Abstract

Backgrounds: Hand fractures are the second most common upper-extremity fractures. The standard X-ray has shortcomings, such as exposure to radiation. Ultrasound has been reported as an alternative method of detecting hand fractures. In this study, we used meta-analysis to assess the diagnostic value of ultrasound for hand fractures.Methods: Web of Science, PubMed, Embase, and Cochrane Library databases were searched for relative citations up to June 2019. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), area under the summary receiver operating characteristic curve (AUC), and summary receiver operating characteristic (SROC) curve were estimated.Results: Seven studies including 842 participants (845 examined hands) met our inclusion criteria. The pooled sensitivity, specificity, PLR, and NLR of ultrasound for detecting hand fractures were 91%, 96%, 20.66, and 0.09, respectively. The pooled DOR was 231.17, indicating a very powerful diagnostic ability of ultrasound. Meta-regression showed that there was no heterogeneity with respect to age, cut-off, the performer of the ultrasound, and the types of hand fractures.Conclusions: Our results showed that ultrasound had an excellent diagnostic value for hand fractures. In clinic, we proposed using ultrasound as a first-line and radiation-free modality in detecting hand fractures, including phalanx and metacarpal fractures.Abbreviations: 95% CI = 95% confidence interval, AUC = area under the summary receiver operating characteristic curve, DOR = diagnostic odds ratio, NLR = negative likelihood ratio, PLR = positive likelihood ratio, QUADAS-2 = Quality Assessment of Diagnostic Accuracy Studies tool-2, SROC = summary receiver operating characteristic.

The diagnostic accuracy of ultrasound in the detection of foot and ankle fractures: a systematic review and meta-analysis

“…Zhao et al demonstrated that ultrasound had an excellent diagnostic value for hand fractures, with a pooled sensitivity of 0.91 and specificity of 0.96. Moreover, ultrasound was recommended as a first-line and radiation-free modality in detecting hand fractures [12]. Lee et al reported that ultrasound sensitivity varied from 0.88 to 0.99 and specificity varied from 0.82 to 0.94 in elbow fracture in pediatric patients with trauma [9].…”

“…In the recent years, ultrasound has emerged as a possible alternative for the diagnosis of bone fractures in the ED, which has been reported to have a high accuracy in pediatric elbow, distal radius, metacarpal, phalanx, ankle and metatarsal fractures [9][10][11][12]. One of the main advantages of ultrasound is the lack of ionizing radiation.…”

Fracture sonography – Literature review and current recommendations

“…Subcapital metacarpal-5 fractures [15,16] In subcapital MHK 5 fractures, the surgical indication depends on the dislocation of the metacarpal head. As an alternative to strictly lateral radiography, which is often compromised by superimposition of the other metacarpals, sonographic determination of axial dislocation can be performed in a volar plane, or in a side-to-side comparison in the case of uncertainty.…”

Snowed In: A Case Report on the Utilization of Ultrasound in the Diagnosis of Fractures

“…In contrast, ultrasonography is now an alternative method for diagnosing bone fractures [ 1 ]. Since the 1980s, ultrasound has been utilized in the emergency department setting to assess chest wall trauma but has expanded to assess pediatric and pregnancy-related traumas via the focused assessment with sonography in trauma (FAST) examination [ 2 ]. Ultrasonography has also been endorsed by the World Health Organization as an alternative method for diagnosing fractures in remote settings [ 3 ].…”