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Screening Characteristics of Ultrasonography in Detection of Ankle Fractures

Majid Shojaee, Farhad Hakimzadeh, Parisa Mohammadi, Anita Sabzghabaei, Mohammad Manouchehrifar, Ali Arhami Dolatabadi

Abstract

Introduction: Ankle fracture is one of the most common joint fractures. X-ray and physical examination are its
main methods of diagnosis. Recently, ultrasonography (US) is considered as a simple and non-invasive method
of fracture diagnosis. This study evaluated the diagnostic accuracy of US in detection of ankle fracture in comparison
to plain radiography. Methods: In this diagnostic accuracy study, which was done in emergency departments
of Imam Hossein and Shohadaye Tajrish hospitals, Tehran, Iran, during 2014, 141 patients with suspected
diagnosis of distal leg or ankle fracture were examined by US and radiography (gold standard), independently.
Screening performance characteristics of US in detection of distal leg fractures were calculated using SPSS version
21. Results: 141 patients with the mean age of 34§11.52 years (range: 15–50) were evaluated (75.9% male).
Radiography confirmed ankle fracture in 102 (72.3%) patients. There was a significant correlation between the
results of US and radiography [Agreement: 95%; kappa: 0.88 (95% CI: 0.80–0.97); P Ç 0.001]. The screening performance
characteristics of US in detection ankle fracture were as follows: sensitivity 98.9% (95% CI: 93.5% -
99.9%), specificity 86.4% (95% CI: 71.9%–94.3%), PPV 94.1% (95% CI: 87.1%–97.6%), NPV 97.4% (95% CI: 84.9%–
99.8%), PLR 16 (95% CI: 7.3–34.8), and NLR 0.02 (95% CI: 0.003 – 0.182). The area under the ROC curve of US
in this regard was 95.8 (95% CI: 91.9§99.7). Conclusion: According to the results of this study, we can use US
as an accurate and non-invasive method with high sensitivity and specificity in diagnosis ofmalleolus fractures.
However, the inherent limitations of US such as operator dependency should be considered in this regard.

Keywords

Ankle fractures; radiography; ultrasonography; sensitivity and specificity

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DOI: http://dx.doi.org/10.22037/emergency.v4i4.10314

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