title: The effectiveness of bedside point-of-care ultrasonography in the diagnosis and management of metacarpal fractures.
abstract: OBJECTIVE
  We aimed to compare the effectiveness of point-of-care ultrasonography (POCUS) with direct radiography (DR) in the diagnosis and management of the patients with metacarpal fractures (MFs).
  
  
  METHODS
  Patients between ages 5 and 55 years admitted to the emergency department with suspected MFs were included to the study. Emergency physicians (EPs) participating in the study were divided into 2 groups (POCUS, DR). Patients were evaluated by one of the EPs from each group. The EP performing the POCUS examination was blinded to the radiograph results.
  
  
  RESULTS
  A total of 66 patients with MFs were included to the study. Fracture was determined in 36 (55%) patients with DR and in 37 (56%) patients with POCUS. When compared with radiography, the sensitivity of fracture detection with POCUS was 92%; specificity, 87%; positive predictive value, 89%; and negative predictive value, 90% (95% confidence interval, 80%-98%). Sensitivity of detecting localization of the fracture with POCUS was 92%; specificity, 87%; positive predictive value, 89%; and negative predictive value, 89% (95% confidence interval, 80%-98%). Of the patients with fracture, 69% have angulation and 24% have step-off determined with POCUS. Specificity of POCUS in the decision for treatment choice was 100%, and sensitivity was 99%.
  
  
  CONCLUSIONS
  We found that POCUS could be applied easily with success by EPs in diagnosing MFs, determining the type of the fracture and required treatment methods correctly. Point-of-care US can be used to rule out a suspected MF, thereby avoiding the time and expense of radiography.
authors.affiliation: Antalya Education and Research Hospital, Department of Emergency Medicine, Antalya, Turkey. Electronic address: nalankozaci@gmail.com.
authors.forename: Nalan
authors.initials: N
authors.lastname: Kozaci
authors.affiliation: Adana Numune Education and Research Hospital, Department of Emergency Medicine, Adana, Turkey.
authors.forename: Mehmet Oguzhan
authors.initials: MO
authors.lastname: Ay
authors.affiliation: Antalya Education and Research Hospital, Department of Emergency Medicine, Antalya, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Akcimen
authors.affiliation: Antalya Education and Research Hospital, Department of Emergency Medicine, Antalya, Turkey.
authors.forename: Ikbal
authors.initials: I
authors.lastname: Sasmaz
authors.affiliation: Antalya Education and Research Hospital, Department of Emergency Medicine, Antalya, Turkey.
authors.forename: Gokcen
authors.initials: G
authors.lastname: Turhan
authors.affiliation: Antalya Education and Research Hospital, Department of Emergency Medicine, Antalya, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Boz
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000628:therapy; D006801:Humans; D008297:Male; D050279:Metacarpal Bones / Q000000981:diagnostic imaging* / Q000293:injuries*; D008875:Middle Aged; D019095:Point-of-Care Systems; D011446:Prospective Studies; D011859:Radiography; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D055815:Young Adult