Ultrasound better effective to Plain Radiography for the Detection of Long-bone Fractures

Ultrasound better effective to  Plain Radiography for the Detection of Long-bone Fractures

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Till now we are of the opinion that Ultrsound is not that helpful for detecting fracture but a study conducted although on animal model for detection of fracture by Residents in Emergency of hospital revealed that USG is rather better detect fracture of a long bone than X-ray.

                    Ultrasound (US) is a frequently used imaging modality in the emergency department (ED). It has advantages of being a rapid, cost-effective, noninvasive technique that does not use ionizing radiation. US has many applications in the ED setting, including intra-abdominal, cardiopulmonary, various soft-tissue applications and as a procedural adjunct (e.g., vascular access, incision, and drainage). In spite of literature describing US as a diagnostic modality used for the assessment of bony injuries for over two decades, point-of-care US is still variably employed in the evaluation of extremity trauma.

                       Extremity trauma is a common complaint in the ED, and long-bone fractures account for 3.5%–3.9% of ED visits nationwide annually. Long-bone fractures can have significant complications including neurovascular compromise, potentially causing significant morbidity or mortality. Current industry practice for patients presenting to the ED with extremity trauma is assessment by plain radiography (X-ray), which has disadvantages of wait time, reliance on departmental resources and other staff, patient exposure to ionizing radiation, increased patient discomfort, and cost. Conversely, ED physicians can use US to rapidly assess extremity trauma to mitigate these drawbacks.

              Studies have shown that US is a reliable imaging modality in the evaluation of bony injuries. Prospective studies have demonstrated US as high as 100% sensitive and 94% specific in the diagnosis of long-bone fractures, while a prospective urban ED study found a diagnostic accuracy of 94% and no false positives.

              This was an IRB-approved, randomized prospective study. Study participants included 40 EM residents at a single site. Fractures were mechanically induced in five chicken legs, and five legs were left unfractured. Chicken legs were imaged by both modalities. Participants were given 2 min to view each of the images. Participants were randomized to either US or X-ray interpretation first and randomized to viewing order within each arm.

           EM residents were better able to identify fractures using US compared to X-ray, especially as level of US and ED experience increased. These results encourage the use of US for the assessment of isolated extremity injury, particularly when the injury is diaphyseal.