BackgroundUltrasound (US) is a good first-line alternative for the diagnosis of bone fractures in adults as well as children. Our study shows that, compared to X-ray, in a resource-constrained environment, on-site US has a high sensitivity (98%) and specificity (96%) in the diagnosis of bone fractures.PurposeTo compare the accuracy of on-the-spot US with conventional radiography in the screening for bone fractures during the Paris–Dakar rally raid.Material and MethodsEighty-three patients (81 men, 2 women) with clinically suspected bone fractures were included in 2013 and 2014. They underwent X-ray and US on the spot, blindly interpreted by two musculoskeletal radiologists. Using X-ray as gold standard, we calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for US, for each anatomic location. The accuracy of US and radiography were also assessed, as were the number of fragments and their degree of displacement (Student’s t-test).ResultsCompared with X-ray, sensitivity, specificity, PPV, and NPV of on-site US were, respectively, for the presence (or absence) of fractures: 98%, 98%, 100%, and 95%. The accuracy of US was 99%. Only one radial styloid process fracture was misdiagnosed with US. There was no significant difference between US and X-ray (P > 0.93) concerning the number of fragments and their degree of displacement.ConclusionBedside musculoskeletal ultrasound performed by trained musculoskeletal radiologists is a useful method in determining and assessing bone fractures in a resource constrained environment.

Posttraumatic carpal and carpometacarpal dislocations represent a heterogeneous group of disorders resulting from high-energy wrist trauma. Perilunate injury is the most common and best-known manifestation of carpal dislocation, typically occurring after hyperextension trauma. Other forms are very rare and have different causative mechanisms. Carpometacarpal (CMC) dislocations are also uncommon and may affect isolated or multiple CMC joints. These lesions are prone to wrist instability if not treated promptly. The aim of this article is to provide a systematic radiologic approach to the evaluation of wrist injury and to present two acute cases of rare CMC dislocations.

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