Prospective use of ultrasound imaging to detect bony hand injuries in adults.
OBJECTIVE
We hypothesized that high-resolution linear ultrasound imaging performed by emergency sonologists would be accurate in the diagnosis of bony injuries of the hand.


METHODS
This was a prospective observational study of adult patients with injuries of the hand at an urban emergency department with trained emergency sonologists. After informed consent, high-frequency linear ultrasound was used to evaluate the bony structures below the area of injury or tenderness of the hand. The presence of a fracture or dislocation was recorded. A standard radiograph was taken subsequently and read by a blinded radiologist. Standard descriptive statistics with confidence intervals were calculated.


RESULTS
A total of 78 patients were enrolled in the study. The incidence of deformity was 28%; swelling, 90%; and erythema, 20%. Thirty patients had a total of 31 fractures: 21 metacarpal and 10 phalangeal. Ultrasound imaging identified 28 of 31 fractures found on standard radiographs, except for 1 patient's fractures, which were confirmed at surgery. One dislocation was found on ultrasound imaging and confirmed by radiographs. Ultrasound imaging showed the following accuracy for fracture: sensitivity, 90%; specificity, 98%; likelihood ratio (LR)(+), 42.5; and LR(-), 0.1. In comparison, individual physical examination findings of deformity, swelling, and erythema had a maximal LR(+) of 5.15 and minimum LR(-) of 0.51. One metacarpal fracture at the base of the first metacarpal, 1 spiral nondisplaced mid-third metacarpal fracture, and 1 distal tuft phalangeal fracture were missed by ultrasound imaging. There was 1 false-positive ultrasound finding.


CONCLUSIONS
Ultrasound imaging performed by emergency sonologists showed excellent sensitivity and specificity in the diagnosis of hand fractures.
Tayal
Vivek S
VS
Department of Emergency Medicine, Carolinas Medical Center, Box 32861, Charlotte, NC 28232, USA. vtayal@carolinas.org
Antoniazzi
Jill
J
Pariyadath
Manoj
M
Norton
H James
HJ
D000328:Adult; D004636:Emergency Service, Hospital; D004890:Erythema / Q000000981:diagnostic imaging; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging; D006227:Hand Deformities, Acquired / Q000000981:diagnostic imaging; D006230:Hand Injuries / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography