Ultrasound evaluation of cranial and long bone fractures in a cadaver model.
BACKGROUND
Ultrasound has been utilized in various settings for evaluation and treatment of skeletal injuries. Bone has different tissue acoustic impedance than soft tissue allowing visualization of the cortical disruption found in fractures.


OBJECTIVE
To determine emergency physicians' accuracy in diagnosing cranial and long bone fractures using ultrasound.


METHODS
This multi-center prospective double-blinded study used high-frequency linear ultrasound to detect induced fractures among eight test locations from eight cadaver models. After a standard orientation, blinded emergency physicians interpreted real-time sonographic images of test locations.


RESULTS
Proximal tibia combined sensitivity (SE)/specificity (SP) was 87.3/69.8% with a combined positive predictive value (PPV)/negative predictive value (NPV) of 84.6/74.3%. Distal radius combined SE/SP was 93.7/93.5% with a combined PPV/NPV of 93.4/90.8%. Frontal combined SE/SP was 84.1/88.9% with a PPV/NPV of 84.9/88.3%. Temporal-parietal combined SE/SP was 95.2/87.9% with a PPV/NPV of 94.8/88.2%. Time to decision varied from less than 10 seconds to 357 seconds. Mean time to decision was 43 to 63 seconds depending on fracture site.


CONCLUSIONS
Ultrasound by trained emergency medicine physicians can reliably identify fractures in the radius, tibia, frontal, and temporal bones in a very short amount of time, allowing for triage, treatment, and resource management.
Emergency Department, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 93245, USA.
Gerard
G
Demers
Salvatore
S
Migliore
Donald R
DR
Bennett
Michael D
MD
McCann
Colleen J
CJ
Kalynych
Kiva
K
Falgatter
Leslie
L
Simon
D002102:Cadaver; D002983:Clinical Competence; D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D005624:Frontal Bone / Q000000981:diagnostic imaging / Q000293:injuries*; D006801:Humans; D007396:Internship and Residency; D008505:Medical Staff, Hospital / Q000193:education; D010865:Pilot Projects; D011885:Radius Fractures / Q000000981:diagnostic imaging*; D012887:Skull Fractures / Q000000981:diagnostic imaging*; D013701:Temporal Bone / Q000000981:diagnostic imaging / Q000293:injuries*; D013978:Tibial Fractures / Q000000981:diagnostic imaging*; D013997:Time Factors; D014463:Ultrasonography