The comparison of radiography and point-of-care ultrasonography in the diagnosis and management of metatarsal fractures

Kozacı, Nalan; Ay, Mehmet Oğuzhan; Avcı, Mustafa; Beydilli, Inan; Turhan, Sadullah; Dönertaş, Eda; Ararat, Ertan

doi:10.1016/j.injury.2016.12.018

Cited by 24 publications

(32 citation statements)

References 18 publications

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“…In line with several previous studies [ 12 , 13 , 15 , 16 ], we also demonstrated the feasibility of surveillance US for the diagnosis and closed reduction of fractures in children. We have previously shown that US can improve the reduction of radial neck fractures in children [ 20 ].…”

Section: Discussionsupporting

confidence: 90%

“…It has the advantages of no radiation, dynamic monitoring, and easy learning and usage, as well as low cost and easy availability of equipment [ 11 – 14 ]. Recently, an increasing number of surgeons have also found US to be useful in the diagnosis of fractures, especially in young children, wherein the bone is not ossified and covered by cartilage, such as the forearm [ 13 ], radial head [ 12 ], femur [ 15 ], and metatarsal [ 16 ] fractures. It has also been found to be useful in the diagnosis of occult or missed fractures in children [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Surveillance ultrasonography for conservative treatment of femoral shaft fractures in young children

Gao

Wang

2020

J Orthop Surg Res

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Background The treatment for femoral shaft fracture (FSF) depends on the age of the patient. While the Pavlik harness is the first choice for patients under 6 months of age, spica casting is preferred for patients over 6 months and under preschool age. Minimally-invasive surgery using elastic stable intramedullary nails is also used in some cases. Skin traction is another treatment choice for some patients who are not candidates for the above methods. This study aimed to evaluate the feasibility of surveillance ultrasonography (US) for the conservative treatment of FSFs in young children. Materials and methods This retrospective study included 92 children who were diagnosed with FSF in our hospital from April 2017 to May 2019. After applying the inclusion and exclusion criteria, they were divided into US surveillance (A) and control (B) groups. All patients received conservative treatment by skin traction. For group A, US was used to assess the femur fractures and adjust its reduction on days 1, 3, 5, 7, 10, and 14 until the fracture stabilized. For group B, the fractures were checked by radiographs on days 1, 3, 5, 7, 10, and 14 until the callus appeared. The FSF angle was measured using anteroposterior and lateral radiographs. Results All patients were followed up for 18 months. The radiographic evaluation of both groups at the final follow-up showed a significant difference in the FSF angle. The radiograph times and accumulated radiation also showed significant differences between the two groups. However, there was no significant difference in the incidence of complications. Conclusions For FSF closed reduction, surveillance US is a better option compared to radiographs in children treated by skin traction. This approach can significantly decrease exposure to X-ray radiation and improve the reduction. Level of evidence III

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Surveillance ultrasonography for conservative treatment of femoral shaft fractures in young children

Gao

Wang

2020

J Orthop Surg Res

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“…POCUS has been demonstrated to be successful in determining the characteristics of bone fractures [1,4,5,8]. A study, investigating the metatarsal fractures, found the sensitivity of POCUS as 100% in determining the presence of angulation and 83% in determining the stepping-off distance of the fracture [7]. In a study comparing POCUS and CT in elbow injuries, sensitivity, specificity, PPV, and NPV of POCUS in determining the extension of the fracture to the joint space or involvement of the epiphyseal line were 100%, 97%, 92%, and 100%, respectively [1].…”

Section: Discussionmentioning

confidence: 99%

“…The point-of-care ultrasonography (POCUS) has recently been introduced to be utilized for evaluation of the musculoskeletal tissue. It has been demonstrated that US provides significant advantages especially in the pediatric population susceptible to radiation, at the pre-hospital settings, and in pregnant women, as well as reducing exposure to serial XR in the process of fracture reduction [7]. Furthermore, POCUS is not only used for imaging bone injuries but it is also utilized for visualizing ligaments, tendons, and soft tissues [5].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, POCUS is not only used for imaging bone injuries but it is also utilized for visualizing ligaments, tendons, and soft tissues [5]. Studies comparing POCUS to XR and CT have demonstrated that POCUS is highly sensitive in diagnosing fractures and identifying fracture characteristics [1,4,5,7,8]. In the decision-making process for the treatment of LB fractures, along with the determination of the fracture, it is important to identify the type of the fracture, its location, whether the fracture extends to the joint space, any presence of accompanying adjacent bone fractures, angulation, stepping-off, and soft tissue injuries.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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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.

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Fractures of the Foot

Gaulrapp¹

2021

Fracture Sonography

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The comparison of radiography and point-of-care ultrasonography in the diagnosis and management of metatarsal fractures

Cited by 24 publications

References 18 publications

Surveillance ultrasonography for conservative treatment of femoral shaft fractures in young children

Surveillance ultrasonography for conservative treatment of femoral shaft fractures in young children

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

Fractures of the Foot

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