Ultrasound: Bone

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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

Abnormal

Instructions

  1. Use linear probe (high frequency probe)
  2. Place probe in longitudinal plane with bone over site of deformity or maximal pain
  3. Fan and slide side to side to optimize
  4. Slide distal to proximal to find tranverse and oblique fractures
  5. 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

  1. 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
  2. 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
  3. Griffith, JF, et al. Sonography compared with radiography in revealing acute rib fracture. American Journal of Roentgenology. 1999;173: 1603-1609.
  4. 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.