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Ability of Ultrasonography in Detection of Different Extremity Bone Fractures; a Case Series Study

Farzad Bozorgi, Massoud Shayesteh Azar, Seyed Hossein Montazer, Aroona Chabra, Seyed Farshad Heidari, Alireza Khalilian
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Abstract

Introduction: Despite radiography being the gold standard in evaluation of orthopedic injuries, using bedside
ultrasonography has several potential supremacies such as avoiding exposure to ionizing radiation, availability
in pre-hospital settings, being extensively accessible, and ability to be used on the bedside. The aim of the
present study is to evaluate the diagnostic accuracy of ultrasonography in detection of extremity bone fractures.
Methods: This study is a case series study, which was prospectively conducted on multiple blunt trauma patients,
who were 18 years old or older, had stable hemodynamic, Glasgow coma scale 15, and signs or symptoms
of a possible extremity bone fracture. After initial assessment, ultrasonography of suspected bones was performed
by a trained emergency medicine resident and prevalence of true positive and false negative findings
were calculated compared to plain radiology. Results: 108 patients with the mean age of 44.6 § 20.4 years were
studied (67.6% male). Analysis was done on 158 sites of fracture, which were confirmed with plain radiography.
91 (57.6%) cases were suspected to have upper extremity fracture(s) and 67 (42.4%) to have lower ones.
The most frequent site of injuries were forearm (36.7%) in upper limbs and leg (27.8%) in lower limbs. Prevalence
of true positive and false negative cases for fractures detected by ultrasonography were 59 (64.8%) and 32
(35.52%) for upper and 49 (73.1%) and 18 (26.9%) for lower extremities, respectively. In addition, prevalence of
true positive and false negative detected cases for intra-articular fractures were 24 (48%) and 26 (52%), respectively.
Conclusion: The present study shows the moderate sensitivity (68.3%) of ultrasonography in detection
of different extremity bone fractures. Ultrasonography showed the best sensitivity in detection of femur (100%)
and humerus (76.2%) fractures, respectively. It had low sensitivity in detection of in intra-articular fractures.

Keywords

Ultrasonography; radiography; fractures, bone; diagnosis; emergency service, hospital

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DOI: http://dx.doi.org/10.22037/emergency.v5i1.12821

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