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Ultrasound: Bone
From WikEM
Contents
Background
- U/S can be used to find fractures with high specificity and sensitivity
- U/S is an added option for post-reduction if fluoro is not available
Sensitivity and Specificity
- Fifth metatarsal fracture - SN 0.971 and SP 1.00[1]
- Long bone fracture - SN 0.929 and SP 0.833 (vs PE which is 0.786 and 0.90)[2]
- Rib fracture - SN 0.90 and SP 1.00 (vs CXR with is 0.15 and 1.00)[3]
- Pediatric Long Bone: SN 0.953 and 0.855[4]
- Ultrasound detected 100.0% of diaphyseal fractures and 93.1% of end-of-bone or near-joint fractures
Images
Normal
Longitudinal view of long bone
Longitudinal view
Transverse view of long bone
Transverse view
Abnormal
- Generic fracture.png
Fracture
- Intertroch fracture.png
Intertrochanteric Fracture
- Metacarpal fracture.png
Metacarpal Fracture
Instructions
- Use linear probe (high frequency probe)
- Place probe in longitudinal plane with bone over site of deformity or maximal pain
- Fan and slide side to side to optimize
- Slide distal to proximal to find tranverse and oblique fractures
- Turn probe 90° to assess for longitudinal and oblique fractures
Findings
- Positive Findings
- Discontinuity in the cortex of the bone
- Hypoechoic fluid collection over the cortex can suggest a hematoma and suggests a fracture could be present
- Negative Findings
- Continuous cortex
Pearls and Pitfalls
- As you enter the joint, there can be discontinuity in the bones but not sharp or abruptly
- A similar discontinuity can be seen over growth plates, but again are not abrupt
- A water bath may aid in searching for fractures in the hands and feet
See Also
External Links
References
- ↑ Ha AS, et al. The accuracy of bedside ultrasonography as a diagnostic tool for the fifth metatarsal fractures. The American journal of emergency medicine (Impact Factor: 1.54). 11/2013; DOI: 10.1016/j.ajem.2013.11.00
- ↑ Marshburn, TH, et al. Goal-Directed Ultrasound in the Detection of Long-Bone Fractures. Journal of Trauma-Injury Infection & Critical Care. 2004; 57(2):329-332. doi:10.1097/01.TA.0000088005.35520.CB
- ↑ Griffith, JF, et al. Sonography compared with radiography in revealing acute rib fracture. American Journal of Roentgenology. 1999;173: 1603-1609.
- ↑ Barata I1 et al. Emergency ultrasound in the detection of pediatric long-bone fractures. Pediatr Emerg Care. 2012 Nov;28(11):1154-7. doi: 10.1097/PEC.0b013e3182716fb7.
