title: Musculoskeletal injuries in a resource-constrained environment: comparing diagnostic accuracy of on-the-spot ultrasonography and conventional radiography for bone fracture screening during the Paris-Dakar rally raid.
abstract: BACKGROUND
  Ultrasound (US) is a good first-line alternative for the diagnosis of bone fractures in adults as well as children. Our study shows that, compared to X-ray, in a resource-constrained environment, on-site US has a high sensitivity (98%) and specificity (96%) in the diagnosis of bone fractures.
  
  
  OBJECTIVE
  To compare the accuracy of on-the-spot US with conventional radiography in the screening for bone fractures during the Paris-Dakar rally raid.
  
  
  METHODS
  Eighty-three patients (81 men, 2 women) with clinically suspected bone fractures were included in 2013 and 2014. They underwent X-ray and US on the spot, blindly interpreted by two musculoskeletal radiologists. Using X-ray as gold standard, we calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for US, for each anatomic location. The accuracy of US and radiography were also assessed, as were the number of fragments and their degree of displacement (Student's t-test).
  
  
  RESULTS
  Compared with X-ray, sensitivity, specificity, PPV, and NPV of on-site US were, respectively, for the presence (or absence) of fractures: 98%, 98%, 100%, and 95%. The accuracy of US was 99%. Only one radial styloid process fracture was misdiagnosed with US. There was no significant difference between US and X-ray (P > 0.93) concerning the number of fragments and their degree of displacement.
  
  
  CONCLUSIONS
  Bedside musculoskeletal ultrasound performed by trained musculoskeletal radiologists is a useful method in determining and assessing bone fractures in a resource constrained environment.
authors.affiliation: Hôpital Pellegrin, Service de Radiologie, Bordeaux, France ; Centre d'imagerie Ostéo-Articulaire, Clinique du sport de Bordeaux-Mérignac, Mérignac, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Dallaudière
authors.affiliation: Cliniques Universitaires Saint Luc, Service de Radiologie, Université Catholique de Louvain, Woluwe-Saint-Lambert, Belgium.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Larbi
authors.affiliation: Cliniques Universitaires Saint Luc, Service de Radiologie, Université Catholique de Louvain, Woluwe-Saint-Lambert, Belgium.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Lefere
authors.affiliation: Biostatistic Department, Unité de recherche Clinique, Paris Nord, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Perozziello
authors.affiliation: Hôpital Pellegrin, Service de Radiologie, Bordeaux, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Hauger
authors.affiliation: Paris Mutuaide Assistance, Bry-sur-Marne, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Pommerie
authors.affiliation: Clinique St-Jean de Dieu, Paris, France.
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Fraboulet
authors.affiliation: Service de Radiologie, CHU Dijon, Dijon, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Jacob
keywords: Ultrasound; X-ray; accuracy; bone; fracture