The effectiveness of bedside point-of-care ultrasonography in the diagnosis and management of metacarpal fractures

• Published in: The American journal of emergency medicine 2015-10, Vol.33 (10), p.1468-1472
• Main Authors: Kozaci, Nalan, MD, Ay, Mehmet Oguzhan, MD, Akcimen, Mehmet, MD, Sasmaz, Ikbal, MD, Turhan, Gokcen, MD, Boz, Ali, MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Bones; Child; Child, Preschool; Edema; Emergency; Emergency medical care; Emergency Service, Hospital; Female; Fractures; Fractures, Bone - diagnostic imaging; Fractures, Bone - therapy; Humans; Injuries; Male; Metacarpal Bones - diagnostic imaging; Metacarpal Bones - injuries; Middle Aged; Physicians; Point-of-Care Systems; Prospective Studies; Radiography; Sensitivity and Specificity; Ultrasonography; Young Adult
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2015.06.052

Abstract Objective We aimed to compare the effectiveness of point-of-care ultrasonography (POCUS) with direct radiography (DR) in the diagnosis and management of the patients with metacarpal fractures (MFs). Methods Patients between ages 5 and 55 years admitted to the emergency department with suspected MFs were included to the study. Emergency physicians (EPs) participating in the study were divided into 2 groups (POCUS, DR). Patients were evaluated by one of the EPs from each group. The EP performing the POCUS examination was blinded to the radiograph results. Results A total of 66 patients with MFs were included to the study. Fracture was determined in 36 (55%) patients with DR and in 37 (56%) patients with POCUS. When compared with radiography, the sensitivity of fracture detection with POCUS was 92%; specificity, 87%; positive predictive value, 89%; and negative predictive value, 90% (95% confidence interval, 80%-98%). Sensitivity of detecting localization of the fracture with POCUS was 92%; specificity, 87%; positive predictive value, 89%; and negative predictive value, 89% (95% confidence interval, 80%-98%). Of the patients with fracture, 69% have angulation and 24% have step-off determined with POCUS. Specificity of POCUS in the decision for treatment choice was 100%, and sensitivity was 99%. Conclusion We found that POCUS could be applied easily with success by EPs in diagnosing MFs, determining the type of the fracture and required treatment methods correctly. Point-of-care US can be used to rule out a suspected MF, thereby avoiding the time and expense of radiography.