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

Mustafa Avci, Nalan Kozaci, Gul Tulubas, Gulsum Caliskan, Aysegul Yuksel, Adeviye Karaca, Fatih Doganay, Ibrahim Etli, Mustafa Avci, Nalan Kozaci, Gul Tulubas, Gulsum Caliskan, Aysegul Yuksel, Adeviye Karaca, Fatih Doganay, Ibrahim Etli

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.

Keywords: POCUS; bone ultrasonography; diagnosis of fracture with ultrasonography; fracture characteristics; long-bone; point-of-care ultrasonography; trauma ultrasonography.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study flow diagram. SE: sensitivity; SP: specificity; PPV: positive predictive value; NPV: negative predictive value.
Figure 2
Figure 2
Radiological images of ankle joint in a 33-year-old male patient. (A) Tibial linear fracture with extension into the joint space and fibular linear fracture. (B) Tibial linear fracture with stepping-off and angulation, and fibular linear fracture. (C) Tibial fragmented fracture with stepping-off and angulation. (D) Fibular linear fracture. (E) Tibial linear fracture with extension into the joint space, and fibular linear fracture. (F) Tibial fragmented fracture, and fibular linear fracture. (Note: The clinical orthopedics and traumatologist thought that computed tomography is required for determining the characteristic of fractures and treatment decision of fractured bones.).

References

    1. Avci M., Kozaci N., Beydilli İ., Yılmaz F., Eden A.O., Turhan S. The comparison of bedside point-of-care ultrasound and computed tomography in elbow injuries. Am. J. Emerg. Med. 2016;34:2186–2190. doi: 10.1016/j.ajem.2016.08.054.
    1. Cross K.P. Bedside Ultrasound for Pediatric Long Bone Fractures. Clin. Pediatr. Emerg. Med. 2011;12:27–36. doi: 10.1016/j.cpem.2010.12.002.
    1. Barata I., Spencer R., Suppiah A., Raio C., Ward M.F., Sama A. Emergency Ultrasound in the Determination of Pediatric Long-Bone Fractures. Pediatr. Emerg. Care. 2012;28:1154–1157. doi: 10.1097/PEC.0b013e3182716fb7.
    1. Kozaci N., Ay M.O., Akcimen M., Turhan G., Sasmaz I., Turhan S., Celik A. Evaluation of the effectiveness of bedside point-of-care ultrasound in the diagnosis and management of distal radius fractures. Am. J. Emerg. Med. 2015;33:67–71. doi: 10.1016/j.ajem.2014.10.022.
    1. Kozaci N., Ay M.O., Akcimen M., Sasmaz I., Turhan G., Boz A. The effectiveness of bedside point-of-care ultrasonography in the diagnosis and management of metacarpal fractures. Am. J. Emerg. Med. 2015;33:1468–1472. doi: 10.1016/j.ajem.2015.06.052.
    1. Uz I., Yürüktümen A., Boydak B., Bayraktaroğlu S., Ozçete E., Cevrim O., Ersel M., Kıyan S. Impact of the practice of “Extended Focused Assessment with Sonography for Trauma” (e-FAST) on clinical decision in the emergency department. Ulus. Travma Acil Cerrahi Derg. 2013;19:327–332. doi: 10.5505/tjtes.2013.23326.
    1. Kozaci N., Ay M.O., Avci M., Beydilli I., Turhan S., Donertas E., Ararat E. The comparison of radiography and point-of-care ultrasonography in the diagnosis and management of metatarsal fractures. Injury. 2017;48:542–547. doi: 10.1016/j.injury.2016.12.018.
    1. Kozaci N., Ay M.O., Avci M., Turhan S., Donertas E., Celik A., Ararat E., Akgun E. The comparison of point-of-care ultrasonography and radiography in the diagnosis of tibia and fibula fractures. Injury. 2017;48:1628–1635. doi: 10.1016/j.injury.2017.04.010.
    1. Avci M., Kozaci N., Yuksel S., Etli I., Yilmaz Y. Comparison of radiography and computed tomography in emergency department evaluation of ankle trauma. Ann. Med. Res. 2019;26:867–872. doi: 10.5455/annalsmedres.2019.01.050.
    1. Weinberg E.R., Tunik M.G., Tsung J.W. Accuracy of clinician-performed point-of-care ultrasound for the diagnosis of fractures in children and young adults. Injury. 2010;41:862–868. doi: 10.1016/j.injury.2010.04.020.
    1. Menkes J.S. In: Initial Evaluation and Management of Orthopedic Injuries. InTintinalli’s Emergency Medicine: A Comprehensive Study Guide. 8th ed. Tintinalli J.E., Stapczynski J.S., Ma O.J., Yealy D.M., Meckler G.D., Cline D.M., editors. McGraw-Hill; New York, NY, USA: 2016. pp. s1777–s1791. Section 22, Chapter 267.
    1. Meena S., Sharma P., Sambharia A.K., Dawar A. Fractures of Distal Radius: An Overview. J. Fam. Med. Prim. Care. 2014;3:325–332. doi: 10.4103/2249-4863.148101.
    1. Haller P.R. Compartment Syndrome. In: Tintinalli J.E., Stapczynski J.S., Ma O.J., Yealy D.M., Meckler G.D., Cline D.M., editors. Tintinalli’s Emergency Medicine, A Comprehensive Study Guide. 8th ed. McGraw-Hill; New York, NY, USA: 2016. pp. s1883–s1886. Section 22, Chapter 278.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir