• Logo
  • SBMUJournals

Screening Characteristics of Ultrasonography in Detection of Ankle Fractures

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



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.


Ankle fractures; radiography; ultrasonography; sensitivity and specificity


English E. Fractures and Soft Tissue Injuries of the Feet

and Ankle. Canadian Family Physician. 1985;31:585.

McBirnie J. The epidemiology of tibial fractures. Journal

of Bone & Joint Surgery, British Volume. 1995;77(3):417–

Court-Brown C, Rimmer S, Prakash U, McQueen M.

The epidemiology of open long bone fractures. Injury.


Court-Brown CM, Caesar B. Epidemiology of adult fractures:

a review. Injury. 2006;37(8):691–7.

Haapamaki VV, KiuruMJ, Koskinen SK. Ankle and foot injuries:

analysis of MDCT findings. American Journal of

Roentgenology. 2004;183(3):615–22.

Marder RA. Current methods for the evaluation of ankle

ligament injuries. The Journal of Bone & Joint Surgery.


Esmailian M, Zargarbashi EH, Masoumi B, Karami M.

Accuracy of ultrasonography in confirmation of adequate

reduction of distal radius fractures. Emergency.

;1(1):pp. 7–10.

Barata I, Spencer R, Suppiah A, Raio C, Ward MF,

Sama A. Emergency ultrasound in the detection of pediatric

long-bone fractures. Pediatric emergency care.


Ekinci S, Polat O, Günalp M, Demirkan A, Koca A. The

accuracy of ultrasound evaluation in foot and ankle

trauma. The American journal of emergency medicine.


Esmailian M, Haj Zargarbashi E, Masoumi B, Karami M.

Accuracy of Ultrasonography in Confirmation of Adequate

Reduction of Distal Radius Fractures. Emergency.


Bianchi S, Luong DH. Stress fractures of the ankle malleoli

diagnosed by ultrasound: a report of 6 cases. Skeletal

radiology. 2014;43(6):813–8.

DaCruzD, Taylor R, Savage B, Bodiwala G.Ultrasound assessment

of the suspected scaphoid fracture. Archives of

emergency medicine. 1988;5(2):97–100.

Weinberg ER, TunikMG, Tsung JW. Accuracy of clinicianperformed

point-of-care ultrasound for the diagnosis

of fractures in children and young adults. Injury.


Heiner JD, Proffitt AM, McArthur TJ. The ability of emergency

nurses to detect simulated long bone fractures

with portable ultrasound. International emergency nursing.


usetti C, Poletti PA, Pradel PH, Garavaglia G, Platon A,

Della Santa DR, et al. Diagnosis of occult scaphoid fracture

with high-spatial-resolution sonography: a prospective

blind study. Journal of Trauma and Acute Care

Surgery. 2005;59(3):677–81.

Hauger O, Bonnefoy O, Moinard M, Bersani D, Diard F.

Occult fractures of the waist of the scaphoid: early diagnosis

by high-spatial-resolution sonography. American

journal of Roentgenology. 2002;178(5):1239–45.

Canagasabey MD, Callaghan MJ, Carley S. The sonographic

Ottawa foot and ankle rules study (the SOFAR

study). Emergency Medicine Journal. 2011;28(10):838–

Trinh E, McMillan D, Gough J, Brewer K. Emergency

department use of ultrasonography to detect lateral

ankle fractures. Annals of Emergency Medicine.


Atilla OD, Yesilaras M, Kilic TY, Tur FC, Reisoglu A, Sever

M, et al. The accuracy of bedside ultrasonography as a

diagnostic tool for fractures in the ankle and foot. Academic

EmergencyMedicine. 2014;21(9):1058–61.

Yousefifard M, Baikpour M, Ghelichkhani P, Asady H,

Darafarin A, Amini EsfahaniMR, et al. Comparison ofUltrasonography

and Radiography inDetection of Thoracic

Bone Fractures; a Systematic Review and Meta-Analysis.


Sabzghabaei A, Shojaee M, Arhami Dolatabadi A,

Manouchehrifar M, Asadi M. Ultrasound-Guided Reduction

of Distal Radius Fractures. Emergency. 2014;4.

DOI: https://doi.org/10.22037/emergency.v4i4.10314


  • There are currently no refbacks.