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

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.

Evaluation of the effectiveness of bedside point-of-care ultrasound in the diagnosis and management of distal radius fractures.

OBJECTIVE: The aim of the study was to compare the effectiveness of point-of-care ultrasound (POCUS) with direct radiography in diagnosis and management of the patients with distal radius fractures (DRFs). METHODS: In this study, patients between ages 5 and 55 years admitted to the emergency department with low energy upper extremity trauma with suspected DRF were evaluated with POCUS and direct radiography by emergency physicians (EPs) trained in either musculoskeletal (MSK) imaging or x-ray interpretation of DRF. The EP performing the POCUS examination was blinded to the x-ray results. RESULTS: A total of 83 patients with DRF were included in the study. There were 18 (22%) females, and 65 (78%) males enrolled in the study. Mean age was 13 ± 14 years for males, and 15 ± 13 years for females. Compared with direct radiography, POCUS yielded 98% sensitivity, 96% specificity, 98% positive predictive value, 96% negative predictive value, and 98% accuracy of the test in detecting fractures. POCUS yielded 96% sensitivity, 93% specificity value in detecting linear fractures; 78% sensitivity, 98% specificity in detecting torus-type fractures, and 100% specificity and sensitivity for detecting fissure fractures. Specificity of POCUS in the decision for reduction was 100% and sensitivity was 98%; specificity was 100% for splint application. CONCLUSION: In our study, it was shown that POCUS could be applied easily by EPs trained in MSK POCUS imaging with success in diagnosing DRF and determining the correct fracture type and required treatment methods.