What is the diagnostic accuracy of ultrasound versus x-ray for closed metatarsal fractures?

Abstract

Compared to X-ray, ultrasound (US) has a positive likelihood ratio (LR+) of 15 and a negative LR (LR-) of 0.04 for foot and ankle fractures, making US a reasonable diagnostic option (SOR: B, metaanalysis of prospective cohort studies). US performed by clinicians with more experience may increase specificity up to 99% (SOR: C, single cohort study). X-ray and point-of-care US perform similarly in the detection of fifth metatarsal fractures, fracture angulation, and step-off (SOR: C, small diagnostic cohort study).