Emergency Radiology

, Volume 21, Issue 1, pp 1–4 | Cite as

Diagnostic value of “bedside ultrasonography” and the “water bath technique” in distal forearm, wrist, and hand bone fractures

  • Hamid Reza Javadzadeh
  • Amir Davoudi
  • Farnoush Davoudi
  • Mohammad Reza Ghane
  • Hojatolla Khajepoor
  • Hasan Goodarzi
  • Mehrdad Faraji
  • Sadrollah Mahmoudi
  • Somayeh Sadat Shariat
  • Kazem Emami Meybodi
Original Article
First Online:
Received:
Accepted:

Abstract

Bedside ultrasonography (BUS) has been widely used in many emergency evaluations, but the technique was not thoroughly evaluated for use in adult fractures. The water bath technique (WBT) is a modality which overcomes some important limitations of using BUS in extremity fractures. The study aims to evaluate and compare diagnostic values of BUS and WBT. The sensitivity, specificity, positive and negative predictive values (PPV and NPV), positive and negative likelihood ratios (LR+ and LR−), and accuracy of BUS and WBT were calculated and compared by the McNemar chi-square test. BUS had the highest sensitivity, specificity, PPV, and LR+ in the distal forearm. The highest NPV and LR− of BUS were seen in phalangeal and wrist injuries, respectively. The WBT examination had the highest sensitivity in phalangeal injuries and the highest specificity, PPV, and LR+ in the distal forearm. The highest NPV and LR− of the WBT examination were seen in phalangeal and wrist injuries, respectively. The McNemar χ 2 values for the comparison of BUS and WBT indicate that the two techniques provide statistically different results. The ultrasound revealed excellent diagnostic values which make it a favorable alternative in evaluating upper extremity fractures in adults. The WBT provides even better results.

Keywords

Ultrasonography Diagnostic test Bone fractures 
This is a preview of subscription content, log in to check access.

Notes

Acknowledgments

This study was conducted under the accreditation and supervision of the Trauma Research Center of Baghiyatallah University of Medical Sciences. We would like to acknowledge the contribution of the Departments of Emergency Medicine and Radiology of Baghiyatallah Hospital in recruiting, evaluating, and managing the study subjects.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Moore CL, Copel JA (2011) Point-of-care ultrasonography. N Engl J Med 364:749–757PubMedCrossRefGoogle Scholar
  2. 2.
    Joshi N, Lira A, Mehta N, Paladino L, Sinert R (2013) Diagnostic accuracy of history, physical examination, and bedside ultrasound for diagnosis of extremity fractures in the emergency department: a systematic review. Acad Emerg Med 20(1):1–15PubMedCrossRefGoogle Scholar
  3. 3.
    Marshburn TH, Legome E, Sargsyan A (2004) Goal-directed ultrasound in the detection of long-bone fractures. J Trauma 57:329–332PubMedCrossRefGoogle Scholar
  4. 4.
    Nichol G, Stiell IG, Wells GA, Juergensen LS, Laupacis A (1999) An economic analysis of the Ottawa knee rule. Ann Emerg Med 34:438–447PubMedCrossRefGoogle Scholar
  5. 5.
    Tayal VS, Antoniazzi J, Pariyadath M, Norton HJ (2007) Prospective use of ultrasound imaging to detect bony hand injuries in adults. J Ultrasound Med 26:1143–1148PubMedGoogle Scholar
  6. 6.
    Cheung KS, Wong HT, Leung LP, Tsang TC, Leung GK (2012) Diagnostic accuracy of Focused Abdominal Sonography for Trauma in blunt abdominal trauma patients in a trauma centre of Hong Kong. Chin J Traumatol 15(5):273–278PubMedGoogle Scholar
  7. 7.
    Kakaei F, Zarrintan S, Rikhtegar R, Yaghoubi AR (2013) Iranian 2012 earthquake: the importance of Focused Assessment with Sonography for Trauma (FAST) in assessing a huge mass of injured people. Emerg Radiol 20:307–308PubMedCrossRefGoogle Scholar
  8. 8.
    Legome E, Pancu D (2004) Future applications for emergency ultrasound. Emerg Med Clin North Am 22(3):817–827PubMedCrossRefGoogle Scholar
  9. 9.
    Summers SM, Scruggs W, Menchine MD (2010) A prospective evaluation of emergency department bedside ultrasonography for the detection of acute cholecystitis. Ann Emerg Med 56:114–122PubMedCrossRefGoogle Scholar
  10. 10.
    Alrajhi K, Woo MY, Vaillancourt C (2012) Test characteristics of ultrasonography for the detection of pneumothorax: a systematic review and meta-analysis. Chest 141(3):703–708PubMedCrossRefGoogle Scholar
  11. 11.
    Stein JC, Wang R, Adler N (2010) Emergency physician ultrasonography for evaluating patients at risk for ectopic pregnancy: a meta-analysis. Ann Emerg Med 56:674–683PubMedCrossRefGoogle Scholar
  12. 12.
    Engin G, Yekeler E, Güloğlu R, Acunaş B, Acunaş G (2000) US versus conventional radiography in the diagnosis of sternal fractures. Acta Radiol 41(3):296–299PubMedCrossRefGoogle Scholar
  13. 13.
    Javadrashid R, Khatoonabad M, Shams N, Esmaeili F, Jabbari Khamnei H (2011) Comparison of ultrasonography with computed tomography in the diagnosis of nasal bone fractures. Dentomaxillofac Radiol 40(8):486–491PubMedCrossRefGoogle Scholar
  14. 14.
    Thiede O, Kromer JH, Rudack C, Stoll W, Osada N, Schmal F (2005) Comparison of ultrasonography and conventional radiography in the diagnosis of nasal fractures. Arch Otolaryngol Head Neck Surg 131(5):434–439PubMedCrossRefGoogle Scholar
  15. 15.
    Patel DD, Blumberg SM, Crain EF (2009) The utility of bedside ultrasonography in identifying fractures and guiding fracture reduction in children. Pediatr Emerg Care 25:221–225PubMedCrossRefGoogle Scholar
  16. 16.
    Sinha TP, Bhoi S, Kumar S (2011) Diagnostic accuracy of bedside emergency ultrasound screening for fractures in pediatric trauma patients. J EmergTrauma Shock 4:443–445Google Scholar
  17. 17.
    Williamson D, Watura R, Cobby M (2000) Ultrasound imaging of forearm fractures in children: a viable alternative? J Accid Emerg Med 17(1):22PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Cross KP, Warkentine FH, Kim IK, Gracely E, Paul RI (2010) Bedside ultrasound diagnosis of clavicle fractures in the pediatric emergency department. Acad Emerg Med 17(7):687–693PubMedCrossRefGoogle Scholar
  19. 19.
    Gaddis GM, Greenwald P, Huckson S (2007) Toward improved implementation of evidence-based clinical algorithms: clinical practice guidelines, clinical decision rules, and clinical pathways. Acad Emerg Med 14:1015–1022PubMedGoogle Scholar
  20. 20.
    Heiner JD, Baker BL, McArthur TJ (2010) The ultrasound detection of simulated long bone fractures by U.S. Army Special Forces Medics. J Spec Oper Med 10(2):7–10PubMedGoogle Scholar
  21. 21.
    McManus JG, Morton MJ, Crystal CS, McArthur TJ, Helphenstine JS, Masneri DA et al (2008) Use of ultrasound to assess acute fracture reduction in emergency care settings. Am J Disaster Med 3(4):241–247PubMedGoogle Scholar
  22. 22.
    McNeil CR, McManus J, Mehta S (2009) The accuracy of portable ultrasonography to diagnose fractures in an austere environment. Prehosp Emerg Care 13:50–52PubMedCrossRefGoogle Scholar
  23. 23.
    Moritz JD, Berthold LD, Soenksen SF, Alzen GF (2008) Ultrasound in diagnosis of fractures in children: unnecessary harassment or useful addition to X-ray? Ultraschall Med 29(3):267–274PubMedCrossRefGoogle Scholar
  24. 24.
    Baldry J (2010) Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 3. Can ultrasound diagnose scaphoid fractures? Emerg Med J 27(11):876–877PubMedCrossRefGoogle Scholar
  25. 25.
    Moore CL, Molina AA, Lin H (2006) Ultrasonography in community emergency departments in the United States: access to ultrasonography performed by consultants and status of emergency physician-performed ultrasonography. Ann Emerg Med 47:147–153PubMedCrossRefGoogle Scholar
  26. 26.
    Andercon BC (2013) Evaluation of the adult with acute wrist pain. In: Fields KB (ed) UpToDate. UpToDate, WalthamGoogle Scholar
  27. 27.
    Munk B, Bolvig L, Krøner K, Christiansen T, Borris L, Boe S (2000) Ultrasound for diagnosis of scaphoid fractures. J Hand Surg (Br) 25(4):369–371CrossRefGoogle Scholar

Copyright information

© Am Soc Emergency Radiol 2013

Authors and Affiliations

  • Hamid Reza Javadzadeh
    • 1
  • Amir Davoudi
    • 1
  • Farnoush Davoudi
    • 2
  • Mohammad Reza Ghane
    • 1
  • Hojatolla Khajepoor
    • 3
  • Hasan Goodarzi
    • 1
  • Mehrdad Faraji
    • 1
  • Sadrollah Mahmoudi
    • 1
  • Somayeh Sadat Shariat
    • 4
  • Kazem Emami Meybodi
    • 5
  1. 1.Trauma Research Center, Emergency Medicine Department, Baghiyatallah HospitalBaghiyatallah University of Medical SciencesTehranIran
  2. 2.Community and Preventive Medicine DepartmentTehran University of Medical SciencesTehranIran
  3. 3.Radiology DepartmentBaghiyatallah University of Medical SciencesTehranIran
  4. 4.Internal Medicine DepartmentBaghiyatallah University of Medical SciencesTehranIran
  5. 5.Orthopedic DepartmentBaghiyatallah University of Medical SciencesTehranIran

Personalised recommendations