The Use of Ultrasound to Exclude Extremity Fractures in Adults

Sonographic diagnosis of radiographically undetectable bennet fracture

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.

Comparison of ultrasonography and conventional radiography in the diagnosis of extremity fractures in the emergency department

Objective: The purpose of the study is to compare the diagnostic accuracy (sensitivity and specificity) of ultrasonography (USG) with that of conventional radiography (CR), the standard imaging modality used to diagnose acute extremities fractures. Materials and Methods: The prospective investigation examined 245 patients with clinical symptoms of an extremity fracture. Radiography (anteroposterior and lateral radiographs for each patient, oblique if necessary) and USG were performed on all participants and compared with all the results. Results: CR verified 98.5% of 132 patients who were determined to have extremities fractures with USG. CR, on the other hand, confirmed 99.1% of 112 patients who were reported to have no extremities fractures by USG. The sensitivity (detection of fractures based on USG of patients with fractures detected based on the CR imaging) was 99.2% (95%CI=95.8-99.9); selectivity (no fracture was detected based on USG of patients with no fracture detected based on the CR imaging) was 98.2% (95%CI=93.8-99.7); the positive predictability was 98.48% (95%CI=94.2-99.6), whereas the negative predictability value was 99.1%(95%CI=94-99.8). Conclusion: USG and CR showed similar diagnostic performances in the diagnosis of extremity fractures. USG can be considered an alternative to CR in the examination of extremity fractures with comparable diagnostic performance.