Ultrasonography to Assess Suspected Bone Fractures: Beliefs and Usage in General Practice in Germany – A Cross-Sectional Survey

Abstract

Background: Over the last two decades, ultrasonography (US) has been shown to be an accurate tool for the diagnosis of suspected bone fractures; however, the conditions for integrating this usage of US into general practice need to be specified. In this study, we surveyed German general practitioners (GPs) to assess their knowledge, attitudes, and utilization of US for the diagnosis of suspected fractures. Methods: Notification of the study, a self-designed questionnaire, and a reminder were sent by mail to 600 randomly selected GPs in Saxony and Saxony-Anhalt. Results: The response rate was 47.7% (n=286), and respondents did not differ from the population of all GPs in respect to sex and practice type. Of all GPs surveyed, 48.6% used an US device in their practice. On average, GPs diagnosed six patients with suspected fractures per month, yet only 39.3% knew about the possibility of ultrasonographic fracture diagnosis, and only 4.3% of GPs using US utilized it for this purpose. Among participants, 71.9% believed that US is inferior to conventional X-rays for the diagnosis of bony injuries. Users of US were better informed of and used this imaging modality more often for fracture diagnosis than non-users. Conclusion: The need to rule out possible fractures frequently arises in general practice, and US devices are broadly available. Further efforts are needed to improve the knowledge and attitudes of GPs regarding the accuracy of US for fracture diagnosis. Multicenter controlled trials could explore the usefulness and effectiveness of this seldom used diagnostic approach.