Emergency physicians performed Point-of-Care-Ultrasonography for detecting distal forearm fracture

Abstract

ObjectivesSeveral studies focusing diagnosis of forearm fracture using Point-of-Care-Ultrasonography (POCUS) had been carried out in children. There is a lack of evidence for the utility of sonographic (US) examination for detecting of distal forearm fracture in adults. We aim to determine the diagnostic sensitivity and specificity of POCUS examination for the fracture of the distal radius and ulna in adult patients presenting with blunt forearm trauma.Material and MethodsAdult patients presenting with acute distal forearm trauma and suspicion of fracture were enrolled into study. POCUS had been performed by blinded emergency physicians, than anteroposterior and lateral x-rays was obtained. If inconsistency between x-rays and POCUS has been occurred, computed tomography were ordered. Assessment of orthopedic surgeon was accepted as a gold standard diagnosis.ResultsNinety three POCUS were performed in 90 patients. Fifty nine radius and 19 ulna fracture had been diagnosed. POCUS detected all radius fracture, but missed 2 ulna fracture. There were 4 false positive results for both radius and ulna with POCUS. X-ray missed 4 radius, and 1 ulna fractures. Diagnostic sensitivity and specificity of POCUS for fracture of ulna were 89.5% (CI%95, 65.5–98.1) and 94.6 (CI%95, 86–98.2), for fracture of radius were 100% (CI%95, 92.4–100), and 88.2%. (CI%95, 71.6–96.1).ConclusionEmergency physician performed POCUS examination is very sensitive and specific the diagnosis of distal forearm fracture. Diagnostic sensitivity of POCUS for radius fracture is higher than x-ray.

The effectiveness of ultrasound in the detection of fractures in adults with suspected upper or lower limb injury: a systematic review and subgroup meta-analysis

“…The control modality was primarily radiography, although CT [12, 18–21] and MRI [22–24] were also employed. In two studies, the authors relied on CT scanning if plain radiography was equivocal [25] or if results were inconsistent between plain x-rays and point-of-care sonography [26].…”

“…These varied considerably in sample size, from 15 to 260 subjects, and consisted of participants recruited consecutively upon presentation to the Emergency Department, with the exception of Dallaudière et al, who conducted their research in a prehospital setting [27], and two papers which recruited participants from specialist units, namely hand surgery [12] and rheumatology [22]. The largest bulk of evidence was produced by research conducted in Turkey [13, 19, 26, 28–33] and other Middle-Eastern countries such as Iran [34, 35] and Israel [24], with the remaining 14 studies spread across continental Europe and the Americas.…”

“…Other specific injury sites included fractures of the foot and ankle [13, 28, 31, 37, 38], including metatarsal stress fractures [22] and Hill-Sachs injuries [18, 39]. The remaining eight studies focussed on a heterogeneous mixture of upper and lower limb fractures [27, 34] involving the radius and/or ulna [26, 40], humerus and/or femur [25, 41], hip [24] and patella [19].…”

“…Despite randomising patient selection in order to minimize researcher influence, this method of sampling may introduce some degree of selection bias if certain characteristics are overrepresented in patients presenting to hospital between specific working hours. Nine studies did not specify whether recruitment of patients was influenced by staffing [18, 24, 26, 27, 29, 34, 35, 39, 40], and four studies recruited all consecutive eligible patients [12, 13, 22, 23].…”

“…Standard radiography was employed as the reference standard for, and has a high sensitivity for diagnosing, fractures of the hand/arm [25, 26, 29, 30, 32, 33, 35, 36, 40], patella [19] and foot/ankle [13, 28, 31, 37, 38], with the exception of metatarsal stress fractures, which are usually radiologically occult at onset [22]. However, Banal et al avoided introducing bias into their investigation of this fracture type by utilising MRI, which is a highly sensitive modality for the diagnosis of stress fractures [22].…”