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Comparison of diagnostic accuracy of point-of-care ultrasonography and X-ray of bony injuries of the knee

  • Original Article
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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

We aimed to compare the accuracy of point-of-care ultrasonography (POCUS) and X-ray (XR) in the diagnosis of knee bone fractures and fracture characteristics in cases of injuries to the knee.

Methods

The study was conducted in the emergency department (ED) of a tertiary hospital between March 2017 and March 2019. It included patients who presented to the ED with isolated knee injuries, were suspected to have a bony lesion based on clinical examinations, and were ultimately referred for XR. Five emergency physicians (EPs) who had at least three years of ED experience participated in the study. Before the study, these EPs received training on knee examination and radiographic investigation of the knee joint. They were also trained on how to assess the knee joint using POCUS. The knee bones, patella, femur, tibia, and fibula were evaluated. A POCUS examination of the knee bones was carried out according to the eight-step Kozaci Protocol.

Results

This study included 92 patients with knee trauma. The mean age of the patients was 34 ± 16 years (6–55 years). Using POCUS and XR, fractures were detected in 40 (43%) and 32 patients (35%), respectively. Relative to XR, for detecting fractures, POCUS showed sensitivity, specificity, positive predictive value, and negative predictive value of 97%, 85%, 78%, 98%, respectively, and the kappa value was 0.774. POCUS examination revealed hematoma and edema in the soft tissue in 34 (37%) patients and hemarthrosis in 33 patients (36%).

Conclusion

XR is the first and most widely used imaging modality to identify fractures of the knee bone trauma. However, POCUS examination can successfully diagnose bony lesions of the knee in patients with stable vital signs and without life-threatening injuries. It can also easily diagnose hematoma and hemarthrosis. Therefore, POCUS can be used as a diagnostic tool in emergency situations where XR is not available.

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Funding

The authors did not receive support from any organization for the submitted work.

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, Alanya Education and Research Hospital, Alanya Alaaddin Keykubat University, Antalya, Turkey

    Nalan Kozaci

  2. Department of Emergency Medicine, Antalya Education and Research Hospital, University of Health Sciences, Varlık Mh, Kazım Karabekir Caddesi, Muratpaşa, 07100, Antalya, Turkey

    Mustafa Avci & Adeviye Karaca

  3. Department of Radiology, Kahta State Hospital, Adiyaman, Turkey

    Serkan Yuksel

  4. Department of Emergency Medicine, Gaziantep 25 December State Hospital, Gaziantep, Turkey

    Eda Donertas

  5. Department of Emergency Medicine, Bilecik State Hospital, Bilecik, Turkey

    Gizem Gonullu

  6. Department of Orthopedics and Traumatology, Antalya Education and Research Hospital, University of Health Sciences, Antalya, Turkey

    Ibrahim Etli

Authors
  1. Nalan Kozaci
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  2. Mustafa Avci
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  3. Serkan Yuksel
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  4. Eda Donertas
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  5. Adeviye Karaca
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  6. Gizem Gonullu
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  7. Ibrahim Etli
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by NK, MA, SY, ED, AK, GG and IE. The first draft of the manuscript was written by NK and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mustafa Avci.

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Authorship

All authors whose names appear on the submission. (1) made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work; (2) drafted the work or revised it critically for important intellectual content; (3) approved the version to be published; and (4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was initiated in the ED of a tertiary hospital following hospital ethics committee (institutional review board) approval.

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Kozaci, N., Avci, M., Yuksel, S. et al. Comparison of diagnostic accuracy of point-of-care ultrasonography and X-ray of bony injuries of the knee. Eur J Trauma Emerg Surg 48, 3221–3227 (2022). https://doi.org/10.1007/s00068-022-01883-5

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  • DOI: https://doi.org/10.1007/s00068-022-01883-5

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