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Calvisi SL, Olarte D, Meloni M, Bianchi S. Sonographic diagnosis of radiographically undetectable bennet fracture. J Ultrasound 2024:10.1007/s40477-024-00901-z. [PMID: 38691324 DOI: 10.1007/s40477-024-00901-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 03/29/2024] [Indexed: 05/03/2024] Open
Abstract
Intra-articular fractures of the base of the first metacarpal (Bennet fractures) are prone to dislocation and require surgical reduction and fixation to prevent secondary degenerative joint disease and chronic dysfunction. Therefore, a prompt diagnosis is necessary, mostly achieved by conventional roentgenograms. We report the case of a 62-year-old man in whom a Bennet fracture was highly suspected on ultrasound (US) examination realized after a fall. Standard radiographs, obtained after US to confirm the diagnosis, were interpreted as normal. A computed tomography was then performed showing a typical Bennet fracture. This case report demonstrates that a careful assessment of bones must be an integral part of any routine musculo-skeletal US examination, particularly in post-traumatic patients. US can detect bone fractures where radiograph is not discriminating.
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Affiliation(s)
- Stefania Laura Calvisi
- Casa di Cura Beato Palazzolo, Bergamo, Italy.
- CIM SA, Cabinet Imagerie Médicale, Géneva, Switzerland.
| | - Diana Olarte
- CIM SA, Cabinet Imagerie Médicale, Géneva, Switzerland
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Marco Meloni
- Ospedale Moriggia Pelascini, Gravedona e Uniti, Italy
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2
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Popat A, Harikrishnan S, Seby N, Sen U, Patel SK, Mittal L, Patel M, Vundi C, Patel Y, Babita, Kumar A, Nakrani AA, Patel M, Yadav S. Utilization of Point-of-Care Ultrasound as an Imaging Modality in the Emergency Department: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e52371. [PMID: 38694948 PMCID: PMC11062642 DOI: 10.7759/cureus.52371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 05/04/2024] Open
Abstract
Point-of-care ultrasound (POCUS) is an imaging modality that has become a fundamental part of clinical care provided in the emergency department (ED). The applications of this tool in the ED have ranged from resuscitation, diagnosis, and therapeutic to procedure guidance. This review aims to summarize the evidence on the use of POCUS for diagnosis and procedure guidance. To achieve this, CrossRef, PubMed, Cochrane Library, Web of Science, and Google Scholar databases were extensively searched for studies published between January 2000 and November 2023. Additionally, the risk of bias assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies 2 (for studies on the diagnostic role of POCUS) and Cochrane Risk of Bias tool (for studies on the use of POCUS for procedure guidance). Furthermore, diagnostic accuracy outcomes were pooled using STATA 16 software (StatCorp., College Station, TX, USA), while outcomes related to procedure guidance were pooled using the Review Manager software. The study included 81 articles (74 evaluating the diagnostic application of POCUS and seven evaluating the use of POCUS in guiding clinical procedures). In our findings sensitivities and specificities for various conditions were as follows: appendicitis, 65% and 89%; hydronephrosis, 82% and 74%; small bowel obstruction, 93% and 82%; cholecystitis, 75% and 96%; retinal detachment, 94% and 91%; abscess, 95% and 85%; foreign bodies, 67% and 97%; clavicle fractures, 93% and 94%; distal forearm fractures, 97% and 94%; metacarpal fractures, 94% and 92%; skull fractures, 91% and 97%; and pleural effusion, 91% and 97%. A subgroup analysis of data from 11 studies also showed that the two-point POCUS has a sensitivity and specificity of 89% and 96%, while the three-point POCUS is 87% sensitive and 92% specific in the diagnosis of deep vein thrombosis. In addition, the analyses showed that ultrasound guidance significantly increases the overall success rate of peripheral venous access (p = 0.02) and significantly reduces the number of skin punctures (p = 0.01) compared to conventional methods. In conclusion, POCUS can be used in the ED to diagnose a wide range of clinical conditions accurately. Furthermore, it can be used to guide peripheral venous access and central venous catheter insertion.
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Affiliation(s)
- Apurva Popat
- Internal Medicine, Marshfield Clinic Health System, Marshfield, USA
| | | | - Niran Seby
- Internal Medicine, Tbilisi State Medical University, Tbilisi, GEO
| | - Udvas Sen
- Internal Medicine, Agartala Government Medical College, Agartala, IND
| | - Sagar K Patel
- Internal Medicine, Gujarat Adani Institute of Medical Sciences, Bhuj, IND
| | - Lakshay Mittal
- Internal Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Mitkumar Patel
- Internal Medicine, Mahatma Gandhi Mission (MGM) Medical College, Navi Mumbai, IND
| | - Charitha Vundi
- Internal Medicine, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, IND
| | - Yashasvi Patel
- Internal Medicine, Geetanjali Medical College and Hospital, Udaipur, IND
| | - Babita
- Internal Medicine, Uzhhorod National University, Uzhhorod, UKR
| | - Ashish Kumar
- General Practice, Gujarat Medical Education and Research Society (GMERS) Medical College and Hospital, Ahmedabad, IND
| | - Akash A Nakrani
- Internal Medicine, Gujarat Adani Institute of Medical Sciences, Surat, IND
| | - Mahir Patel
- Medical School, Byramjee Jeejeebhoy Medical College, Ahmedabad, IND
| | - Sweta Yadav
- Internal Medicine, Gujarat Medical Education and Research Society (GMERS) Medical College and Hospital, Ahmedabad, IND
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3
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Thom C, Han D, Vandersteenhoven P, Ottenhoff J, Kongkatong M. POINT-OF-CARE ULTRASOUND FOR GUIDANCE OF CLOSED REDUCTION OF FIFTH METACARPAL NECK (BOXER'S) FRACTURE. J Emerg Med 2023; 64:321-327. [PMID: 37019497 DOI: 10.1016/j.jemermed.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/23/2022] [Accepted: 01/06/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Ultrasound has been used previously in fracture identification, analgesia delivery, and fracture reduction for patients in the emergency department. It has not been previously described as a tool for the guidance of closed fracture reduction in fifth metacarpal neck fractures ("boxer's fractures"). CASE REPORT A 28-year-old man presented with hand pain and swelling after punching a wall. Point-of-care ultrasound revealed a significantly angulated fifth metacarpal fracture, which was confirmed with a subsequent hand x-ray study. After an ultrasound-guided ulnar nerve block, closed reduction was performed. Ultrasound was used to assess reduction and ensure improvement in bony angulation during the closed reduction attempts. Post-reduction x-ray study confirmed improved angulation and adequate alignment. Why Should an Emergency Physician Be Aware of This? Point-of-care ultrasound has previously had efficacy in fracture diagnosis and anesthesia delivery for fifth metacarpal fractures. Ultrasound can also be used at the bedside to assist in the determination of adequate fracture reduction when performing closed reduction of a boxer's fracture.
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Affiliation(s)
- Christopher Thom
- Department of Emergency Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - David Han
- Department of Emergency Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Peter Vandersteenhoven
- Department of Emergency Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Jakob Ottenhoff
- Department of Emergency Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Matthew Kongkatong
- Department of Emergency Medicine, University of Virginia Health System, Charlottesville, Virginia
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Mohamed MB, Paulsingh CN, Ahmed TH, Mohammed Z, Singh T, Elhaj MS, Mohamed N, Khan S. A Systematic Review and Meta-Analysis of the Efficacy of Buddy Taping Versus Reduction and Casting for Non-operative Management of Closed Fifth Metacarpal Neck Fractures. Cureus 2022; 14:e28437. [PMID: 36176848 PMCID: PMC9512295 DOI: 10.7759/cureus.28437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/26/2022] [Indexed: 11/26/2022] Open
Abstract
A closed fifth metacarpal neck fracture is a frequently encountered upper limb fracture that occurs when the bone breaks right below the little finger's knuckle. At the moment, there is no agreement on the best way to treat these fractures. This research seeks to look at the efficacy of buddy taping versus reduction and casting for non-operative management of uncomplicated closed fifth metacarpal neck fractures. A systematic review of PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), PubMed Central (PMC), and the Cochrane Library databases was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to find relevant studies about buddy taping versus reduction and casting for non-operative management. Disabilities of the arm, shoulder, and hand (DASH) score; satisfaction score; visual analog scale (VAS); range of motion (ROM); strength; and other outcomes were reported in this study. We used Review Manager 5.4 (The Cochrane Collaboration, London, UK) for the meta-analysis. Seven trials with a total of 454 patients were considered in the review and four in the quantitative analysis. All the included studies were randomized controlled trials (RCTs). Our study concluded that buddy taping was effective for improving pain, range of motion, and strength. The DASH score and satisfaction score didn't show any significant difference. Thus, we recommend the use of buddy taping rather than plaster and immobilization for the management of uncomplicated closed fifth metacarpal neck fractures.
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5
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张 来, 吕 亚, 卢 承, 王 孝, 郭 绍, 张 海. [Treatment of the fifth metacarpal neck fracture with elastic intramedullary nail under the guidance of high frequency ultrasound]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:154-159. [PMID: 33624466 PMCID: PMC8171670 DOI: 10.7507/1002-1892.202008079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/06/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To analyze the feasibility and effectiveness of elastic intramedullary nail fixation for the fifth metacarpal neck fracture under the guidance of high frequency ultrasound. METHODS The clinical data of 30 patients with the fifth metacarpal neck fractures who were treated with elastic intramedullary nails fixation under the guidance of high frequency ultrasound and met the selection criteria between May 2013 and September 2017 were retrospectively analysed. There were 24 males and 6 females, the age ranged from 18 to 58 years, with an average of 31.4 years. The head-shaft angle of the fifth metacarpal was (55.6±11.3)°. The time from injury to operation was 12 hours to 8 days, with an average of 2.4 days. The operation time, number of intraoperative fluoroscopy, fracture reduction, complications, and fracture healing time were recorded. The head-shaft angle of the fifth metacarpal on the affected side after fracture healing were measured and compared with the healthy side. At last follow-up, the active range of motion of the fifth metacarpophalangeal joint of both sides were measured, and the function was evaluated by using the total active movement (TAM) evaluation standard of the Hand Surgery Association of Chinese Medical Association. RESULTS The operation time was 22-40 minutes, with an average of 32.4 minutes; the intraoperative fluoroscopy was performed once; ultrasound images and X-ray fluoroscopy showed that the fracture was well reduced and no adjustment was required. The incisions healed well after operation, without tendon adhesion or local numbness. All 30 patients were followed up 8-16 months, with an average of 11.7 months. The fracture healing time was 4-8 weeks, with an average of 5.6 weeks. The head-shaft angle of the fifth metacarpal was (13.2±1.4)°, which was significantly improved when compared with preoperative value ( t=-20.02, P=0.00); and there was no significant difference ( t=1.94, P=0.06) when compared with the healthy side [(12.6±1.0)°]. At last follow-up, the active range of motion of the fifth metacarpophalangeal joint on the affected side was (89.4±2.4)°, showing no significant difference ( t=-1.58, P=0.13) when compared with the healthy side [(90.3±2.0)°]. According to the TAM evaluation standard of the Hand Surgery Association of Chinese Medical Association, all patients were considered to be excellent. CONCLUSION The effectiveness of elastic intramedullary nail fixation for the fifth metacarpal neck fracture under the guidance of high frequency ultrasound is definite. It can dynamically observe the fracture reduction from different angles, reduce ionizing radiation and postoperative complications.
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Affiliation(s)
- 来福 张
- 河南中医药大学(郑州 450046)Henan University of Chinese Medicine, Zhengzhou Henan, 450046, P.R.China
| | - 亚庆 吕
- 河南中医药大学(郑州 450046)Henan University of Chinese Medicine, Zhengzhou Henan, 450046, P.R.China
| | - 承印 卢
- 河南中医药大学(郑州 450046)Henan University of Chinese Medicine, Zhengzhou Henan, 450046, P.R.China
| | - 孝辉 王
- 河南中医药大学(郑州 450046)Henan University of Chinese Medicine, Zhengzhou Henan, 450046, P.R.China
| | - 绍勇 郭
- 河南中医药大学(郑州 450046)Henan University of Chinese Medicine, Zhengzhou Henan, 450046, P.R.China
| | - 海龙 张
- 河南中医药大学(郑州 450046)Henan University of Chinese Medicine, Zhengzhou Henan, 450046, P.R.China
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6
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Hussain MH, Ghaffar A, Choudry Q, Iqbal Z, Khan MN. Management of Fifth Metacarpal Neck Fracture (Boxer's Fracture): A Literature Review. Cureus 2020; 12:e9442. [PMID: 32864266 PMCID: PMC7451089 DOI: 10.7759/cureus.9442] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Boxer’s fracture is the fifth metacarpal neck fracture resulting from direct trauma to the clenched fist. Worldwide, this type of fracture is the most typical presentation to emergency departments. The management of fifth metacarpal fractures varies from one setting to another. Conservative management is the preferred option for closed, non-angulated, non-malrotated fractures while open fractures, significant angulation, rotational deformity, and intra-articular extension are recognised indications for surgical intervention. The scope of this article covers the results of a literature review examining the management strategies for such fractures.
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Affiliation(s)
| | - Ali Ghaffar
- Orthopaedics and Trauma, East Lancashire NHS Hospitals, Blackburn, GBR
| | - Qaisar Choudry
- Orthopaedics and Trauma, East Lancashire NHS Hospitals, Blackburn, GBR
| | - Zafar Iqbal
- Emergency Medicine, California Institute of Behavioural Neurosciences and Psychology, Fairfield, USA.,Emergency Department, The Kidney Center, Karachi, PAK
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7
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Bhavsar MB, Moll J, Barker JH. Bone Fracture Sensing Using Ultrasound Pitch-Catch Measurements: A Proof-of-Principle Study. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:855-860. [PMID: 31806498 DOI: 10.1016/j.ultrasmedbio.2019.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/07/2019] [Accepted: 11/12/2019] [Indexed: 06/10/2023]
Abstract
The most common imaging method used to diagnose and monitor bone fractures and healing is multiple radiographic images performed by highly trained professionals with expensive equipment that can expose patients to high levels of ionizing radiation. Here we introduce and illustrate proof-of-concept of a potential alternative method for measuring bone fractures: ultrasound pitch-catch measurement technique. Measurements are performed with two piezoelectric transducers, housed in standard orthopedic screws and fixed on either side of simulated fractures, with and without an orthopedic plate, in ex vivo pig limb bones. Using this measurement method, we were able to detect significant differences between uncut and 2-, 5- and 10-mm-deep bone cuts using a two-sided t-test with an α level of 5%.
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Affiliation(s)
- Mit B Bhavsar
- Experimental Orthopedics and Trauma Surgery, Frankfurt Initiative for Regenerative Medicine, J. W. Goethe University, Frankfurt, Germany.
| | - Jochen Moll
- Department of Physics, J. W. Goethe University, Frankfurt, Germany
| | - John H Barker
- Experimental Orthopedics and Trauma Surgery, Frankfurt Initiative for Regenerative Medicine, J. W. Goethe University, Frankfurt, Germany
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8
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Krastman P, Mathijssen NM, Bierma-Zeinstra SMA, Kraan G, Runhaar J. Diagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review update. BMC Musculoskelet Disord 2020; 21:12. [PMID: 31910838 PMCID: PMC6947988 DOI: 10.1186/s12891-019-2988-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/04/2019] [Indexed: 02/02/2023] Open
Abstract
Background The standard diagnostic work-up for hand and wrist fractures consists of history taking, physical examination and imaging if needed, but the supporting evidence for this work-up is limited. The purpose of this study was to systematically examine the diagnostic accuracy of tests for hand and wrist fractures. Methods A systematic search for relevant studies was performed. Methodological quality was assessed and sensitivity (Se), specificity (Sp), accuracy, positive predictive value (PPV) and negative predictive value (NPV) were extracted from the eligible studies. Results Of the 35 eligible studies, two described the diagnostic accuracy of history taking for hand and wrist fractures. Physical examination with or without radiological examination for diagnosing scaphoid fractures (five studies) showed Se, Sp, accuracy, PPV and NPV ranging from 15 to 100%, 13–98%, 55–73%, 14–73% and 75–100%, respectively. Physical examination with radiological examination for diagnosing other carpal bone fractures (one study) showed a Se of 100%, with the exception of the triquetrum (75%). Physical examination for diagnosing phalangeal and metacarpal fractures (one study) showed Se, Sp, accuracy, PPV and NPV ranging from 26 to 55%, 13–89%, 45–76%, 41–77% and 63–75%, respectively. Imaging modalities of scaphoid fractures showed predominantly low values for PPV and the highest values for Sp and NPV (24 studies). Magnetic Resonance Imaging (MRI), Computed Tomography (CT), Ultrasonography (US) and Bone Scintigraphy (BS) were comparable in diagnostic accuracy for diagnosing a scaphoid fracture, with an accuracy ranging from 85 to 100%, 79–100%, 49–100% and 86–97%, respectively. Imaging for metacarpal and finger fractures showed Se, Sp, accuracy, PPV and NPV ranging from 73 to 100%, 78–100%, 70–100%, 79–100% and 70–100%, respectively. Conclusions Only two studies were found on the diagnostic accuracy of history taking for hand and wrist fractures in the current review. Physical examination was of moderate use for diagnosing a scaphoid fracture and of limited use for diagnosing phalangeal, metacarpal and remaining carpal fractures. MRI, CT and BS were found to be moderately accurate for the definitive diagnosis of clinically suspected carpal fractures.
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Affiliation(s)
- Patrick Krastman
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Room NA1911 PO Box 2040, 3000, CA, Rotterdam, the Netherlands.
| | - Nina M Mathijssen
- Department of Orthopaedic Surgery, Reinier de Graaf Groep, Reinier de Graafweg 5-11, 2625, AD, Delft, the Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of Orthopaedics, Erasmus MC University Medical Center Rotterdam, Room NA1920 PO Box 2040, 3000, CA, Rotterdam, the Netherlands.,Department of General Practice, Erasmus MC University Medical Center Rotterdam, Room NA1920 PO Box 2040, 3000, CA, Rotterdam, the Netherlands
| | - Gerald Kraan
- Department of Orthopaedic Surgery, Reinier de Graaf Groep, Reinier de Graafweg 5-11, 2625, AD, Delft, the Netherlands
| | - Jos Runhaar
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Room NA1911 PO Box 2040, 3000, CA, Rotterdam, the Netherlands
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9
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Abstract
With the high cost and limited availability of gold standard imaging modalities, ultrasound has become an alternative in many musculoskeletal (MSK) injuries. Ultrasound has become increasingly portable and readily available in many acute care settings. Its ability to diagnose MSK injuries and help guide management has the potential to improve patient safety and flow. Ultrasound has been shown to diagnose fractures, dislocations, and tendon and ligament injuries. It helps guide fracture and dislocation reductions and aids in regional anesthesia for pain management. This article reviews the common MSK injuries that can be diagnosed with ultrasound with a focus on point-of-care ultrasound.
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Affiliation(s)
- Robert Simard
- Emergency Department, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue C7-53, Toronto, Ontario M4N 3M5, Canada; Emergency Department, North York General Hospital, Toronto, Ontario, Canada.
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10
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Sorensen B, Hunskaar S. Point-of-care ultrasound in primary care: a systematic review of generalist performed point-of-care ultrasound in unselected populations. Ultrasound J 2019; 11:31. [PMID: 31749019 PMCID: PMC6868077 DOI: 10.1186/s13089-019-0145-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/21/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Both the interest and actual extent of use of point-of-care ultrasound, PoCUS, among general practitioners or family physicians are increasing and training is also increasingly implemented in residency programs. However, the amount of research within the field is still rather limited compared to what is seen within other specialties in which it has become more established, such as in the specialty of emergency medicine. An assumption is made that what is relevant for emergency medicine physicians and their populations is also relevant to the general practitioner, as both groups are generalists working in unselected populations. This systematic review aims to examine the extent of use and to identify clinical studies on the use of PoCUS by either general practitioners or emergency physicians on indications that are relevant for the former, both in their daily practice and in out-of-hours services. METHODS Systematic searches were done in PubMed/MEDLINE using terms related to general practice, emergency medicine, and ultrasound. RESULTS On the extent of use, we identified 19 articles, as well as 26 meta-analyses and 168 primary studies on the clinical use of PoCUS. We found variable, but generally low, use among general practitioners, while it seems to be thoroughly established in emergency medicine in North America, and increasingly also in the rest of the world. In terms of clinical studies, most were on diagnostic accuracy, and most organ systems were studied; the heart, lungs/thorax, vessels, abdominal and pelvic organs, obstetric ultrasound, the eye, soft tissue, and the musculoskeletal system. The studies found in general either high sensitivity or high specificity for the particular test studied, and in some cases high total accuracy and superiority to other established diagnostic imaging modalities. PoCUS also showed faster time to diagnosis and change in management in some studies. CONCLUSION Our review shows that generalists can, given a certain level of pre-test probability, safely use PoCUS in a wide range of clinical settings to aid diagnosis and better the care of their patients.
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Affiliation(s)
- Bjarte Sorensen
- Hjelmeland General Practice Surgery, Prestagarden 13, 4130, Hjelmeland, Norway.
| | - Steinar Hunskaar
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre AS, Bergen, Norway
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11
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Zhao W, Wang G, Chen B, Xiao J, Sun X, Wu T, Ren H, Li X. The value of ultrasound for detecting hand fractures: A meta-analysis. Medicine (Baltimore) 2019; 98:e17823. [PMID: 31689869 PMCID: PMC6946312 DOI: 10.1097/md.0000000000017823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUNDS Hand fractures are the second most common upper-extremity fractures. The standard X-ray has shortcomings, such as exposure to radiation. Ultrasound has been reported as an alternative method of detecting hand fractures. In this study, we used meta-analysis to assess the diagnostic value of ultrasound for hand fractures. METHODS Web of Science, PubMed, Embase, and Cochrane Library databases were searched for relative citations up to June 2019. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), area under the summary receiver operating characteristic curve (AUC), and summary receiver operating characteristic (SROC) curve were estimated. RESULTS Seven studies including 842 participants (845 examined hands) met our inclusion criteria. The pooled sensitivity, specificity, PLR, and NLR of ultrasound for detecting hand fractures were 91%, 96%, 20.66, and 0.09, respectively. The pooled DOR was 231.17, indicating a very powerful diagnostic ability of ultrasound. Meta-regression showed that there was no heterogeneity with respect to age, cut-off, the performer of the ultrasound, and the types of hand fractures. CONCLUSIONS Our results showed that ultrasound had an excellent diagnostic value for hand fractures. In clinic, we proposed using ultrasound as a first-line and radiation-free modality in detecting hand fractures, including phalanx and metacarpal fractures.
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Affiliation(s)
| | | | - Binjuan Chen
- Ultrasonic Department, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | | | | | - Tingting Wu
- Ultrasonic Department, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
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12
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Evaluation of Diagnostic Value of Clinical Ultrasonography Compared to Radiography in the Diagnosis of Metacarpal Fractures in the Emergency. PAJOUHAN SCIENTIFIC JOURNAL 2019. [DOI: 10.52547/psj.17.4.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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13
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Baron A, Beirne G, Wald A. Paramedic point of care ultrasound at Australian mass gatherings. Australas J Ultrasound Med 2019; 22:56-60. [PMID: 34760538 PMCID: PMC8411800 DOI: 10.1002/ajum.12132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Point of care ultrasound (POCUS) is not traditionally performed by paramedics, and where it is used, is generally limited to resuscitative-type ultrasound examinations. We describe a select series of patient care cases collected between August 2017 and February 2018 which are the first known examples of expanded POCUS performed by a paramedic in this context. These point of care scans were performed for both high and lower acuity patient presentations and are felt to have contributed to improved decision-making in the treatment and onward referral of patients in the Australian festival and event medicine.
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Affiliation(s)
- Aidan Baron
- Paramedic Ultrasound Research GroupSydneyAustralia
- Emergency Cardiovascular and Critical Care Research GroupCentre for Health and Social Care ResearchKingston University and St George's University of LondonLondonUK
- Discipline of ParamedicineSchool of Biomedical SciencesFaculty of ScienceCharles Sturt UniversityAlburyNew South WalesAustralia
| | | | - Anthony Wald
- Paramedic Ultrasound Research GroupSydneyAustralia
- Monash Cardiovascular Research CentreMonashHeartMonash Medical CentreMelbourneVictoriaAustralia
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14
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Champagne N, Eadie L, Regan L, Wilson P. The effectiveness of ultrasound in the detection of fractures in adults with suspected upper or lower limb injury: a systematic review and subgroup meta-analysis. BMC Emerg Med 2019; 19:17. [PMID: 30691395 PMCID: PMC6350304 DOI: 10.1186/s12873-019-0226-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 01/10/2019] [Indexed: 01/20/2023] Open
Abstract
Background The aim of the present review is to assess the effectiveness of ultrasound (US) in the detection of upper and lower limb bone fractures in adults compared to a diagnostic gold standard available in secondary and tertiary care centres (e.g. radiography, CT scan or MRI). Methods The review followed PRISMA guidelines and used a database-specific search strategy with Medline, EMBASE and The Cochrane Library plus secondary sources (see supplementary material for completed PRISMA checklist). Diagnostic performance of ultrasound was assessed with a qualitative synthesis and a meta-analysis of two data subgroups. Results Twenty-six studies were included (n = 2360; fracture prevalence =5.3 % to 75.0%); data were organised into anatomical subgroups, two of which were subjected to meta-analysis. Sensitivity and specificity ranged from 42.11 − 100% and 65.0 − 100%, with the highest diagnostic accuracy in fractures of the foot and ankle. The pooled sensitivity and specificity of US was 0.93 and 0.92 for upper limb fractures (I2 = 54.7 % ; 66.3%), and 0.83 and 0.93 for lower limb fractures (I2 = 90.1 % ; 83.5%). Conclusion Ultrasonography demonstrates good diagnostic accuracy in the detection of upper and lower limb bone fractures in adults, especially in fractures of the foot and ankle. This is supported by pooled analysis of upper and lower limb fracture subgroups. Further research in larger populations is necessary to validate and strengthen the quality of the available evidence prior to recommending US as a first-line imaging modality for prehospital use. Trial registration The protocol is registered with the PROSPERO International register of systematic reviews: ID = CRD42017053640. Electronic supplementary material The online version of this article (10.1186/s12873-019-0226-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Leila Eadie
- Centre for Rural Health, University of Aberdeen, Inverness, Scotland, UK
| | - Luke Regan
- NHS Highland, Raigmore Hospital, Inverness, Scotland, UK
| | - Philip Wilson
- Centre for Rural Health, University of Aberdeen, Inverness, Scotland, UK
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Schmid GL, Lippmann S, Unverzagt S, Hofmann C, Deutsch T, Frese T. The Investigation of Suspected Fracture-a Comparison of Ultrasound With Conventional Imaging. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 114:757-764. [PMID: 29202925 DOI: 10.3238/arztebl.2017.0757] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 03/15/2017] [Accepted: 07/10/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Ultrasound imaging can be used to diagnose fractures in patients with acute trauma. Its main advantages over conventional imaging are the absence of radiation exposure and its greater availability. METHODS A systematic search in electronic databases (Medline, Embase, Cochrane CENTRAL) was supplemented by a manual search on the Internet and in the reference lists of pertinent publications. The QUADAS-2 instrument was used to assess the quality of the individual studies retrieved. In the metaanalysis, the sensitivity and specificity of the individual studies were pooled. RESULTS The available information on the diagnostic accuracy of ultrasound in the detection of fractures compared with that of conventional imaging (x-ray, CT, MRI) in patients with acute non-life-threatening trauma is summarized. The database search yielded 2153 hits, among which there were 48 studies that were suitable for inclusion in this review. The pooled sensitivity and specificity were 0.91 (95% confidence interval [0.90; 0.92]) and 0.94 [0.93; 0.95], although the analyzed studies were markedly heterogeneous (I²: sensitivity 74%, specificity 81%). The sensitivity of ultrasound was higher for the detection of fractures of the humerus, the forearm, the ankle, and the long bones in general, as well as fractures in children, and lower for fractures of the short bones of the hands and feet, and in adults. CONCLUSION Strong evidence supports the use of ultrasound imaging for certain indications in the detection of fractures.
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Affiliation(s)
- Gordian Lukas Schmid
- Department of General Practice and Family Medicine, Medical Faculty of the University of Leipzig; Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale); Institute for Medical Epidemiology, Biometrics and Computer Science, Martin-Luther-University Halle-Wittenberg, Halle (Saale); Library of Medicine, University of Leipzig
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16
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Døssing K, Mechlenburg I, Hansen LB, Søballe K, Østergaard H. The Use of Ultrasound to Exclude Extremity Fractures in Adults. JB JS Open Access 2017; 2:e0007. [PMID: 30229220 PMCID: PMC6133099 DOI: 10.2106/jbjs.oa.17.00007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: The purpose of the present study was to investigate whether ultrasonography can be used as a diagnostic tool to exclude extremity fractures in adults. Methods: This prospective comparative study involved 91 patients (age, ≥18 years) who had been referred by general practitioners for a conventional radiographic examination of a suspected extremity fracture. No additional clinical examination was performed. Ultrasound examination was consistently carried out prior to conventional radiographic examination, which was regarded as the gold standard. At the end of the study, the positive scans were confirmed by a specialist who was highly skilled in ultrasonography. Results: The prevalence of fractures in the study population was 27%. Ultrasonography had a sensitivity of 92%, a specificity of 94%, a positive predictive value of 85%, a negative predictive value of 97%, a positive likelihood ratio of 15.33, and a negative likelihood ratio of 0.085. There seemed to be no association between the anomalous results and patient age or the specific anatomical region of the fracture. Conclusions: The present study indicates that ultrasonography, when performed and interpreted by experienced ultrasonographers, has high accuracy for the diagnosis of a suspected extremity fracture. No systematic differences were found between the results of radiography and ultrasonography, and ultrasonography showed a high sensitivity and specificity. Level of Evidence: Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kaj Døssing
- Orthopaedic Department (K.D.) and Department of Physiotherapy and Occupational Therapy (H.Ø.), Viborg Regional Hospital, Denmark
| | - Inger Mechlenburg
- Orthopaedic Department (I.M. and K.S.), Centre of Research in Rehabilitation (I.M.), and Radiological Department (B.H.), Aarhus University Hospital, Denmark
| | - Lars Bolvig Hansen
- Orthopaedic Department (I.M. and K.S.), Centre of Research in Rehabilitation (I.M.), and Radiological Department (B.H.), Aarhus University Hospital, Denmark
| | - Kjeld Søballe
- Orthopaedic Department (I.M. and K.S.), Centre of Research in Rehabilitation (I.M.), and Radiological Department (B.H.), Aarhus University Hospital, Denmark
| | - Helle Østergaard
- Orthopaedic Department (K.D.) and Department of Physiotherapy and Occupational Therapy (H.Ø.), Viborg Regional Hospital, Denmark
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