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A systematic review and meta-analysis on the diagnostic utility of ultrasound for clavicle fractures

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Abstract

Background

Ultrasound’s real-time, high-resolution imaging, and accessibility at the point of care make it a valuable tool for diagnosing clavicle fractures, with growing evidence supporting its diagnostic accuracy compared to other imaging modalities.

Objective

To assess the diagnostic utility of ultrasound in detecting clavicle fractures.

Methods

A systematic review and meta-analysis were conducted by performing a comprehensive literature search in PubMed, Scopus, Web of Science, and Embase databases up to March 10, 2023, following established guidelines. Eligible studies that reported outcomes of interest were included, relevant data elements were extracted, and data analysis was performed using STATA software version 17.0.

Results

Meta-analysis of seven included studies showed high-pooled sensitivity (0.94) and specificity (0.98) values for ultrasonography in diagnosing clavicle fractures, with low to moderate heterogeneity for sensitivity and high heterogeneity for specificity. Meta-regression and subgroup analyses revealed that pediatric studies had higher sensitivity but significantly lower specificity (P=0.01) compared to mixed or adult studies. Additional subgroup analysis in the pediatric group indicated decreased heterogeneity for specificity. Fagan plot analysis demonstrated favorable post-test probabilities for both positive and negative results across varying pre-test probabilities. Additionally, the likelihood ratio scatter matrix showed moderate to high test performance for both exclusion and confirmation purposes.

Conclusion

The current literature supports ultrasound as a reliable imaging modality for detecting clavicle fractures. It offers accurate diagnosis without exposing patients, especially children, to radiation.

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References

  1. Nicholson JA, Tsang STJ, MacGillivray TJ, Perks F, Simpson AHRW. What is the role of ultrasound in fracture management?: diagnosis and therapeutic potential for fractures, delayed unions, and fracture-related infection. Bone Joint Res. 2019;8(7):304–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Ackermann O, Simanowski J, Eckert K. Fracture ultrasound of the extremities. Ultraschall Med. 2020;41(1):12–28.

    Article  PubMed  Google Scholar 

  3. Du MJ, Lin YH, Chen WT, Zhao H. Advances in the application of ultrasound for fracture diagnosis and treatment. Eur Rev Med Pharmacol Sci. 2022;26(21):7949–54.

    PubMed  Google Scholar 

  4. Chiu YH, Shyu SG. Utilization of diagnostic ultrasound in the detection of hip fracture. Med Ultrason. 2021;23(2):240–1.

    PubMed  Google Scholar 

  5. Litrenta J, Masrouha K, Wasterlain A, Castaneda P. Ultrasound evaluation of pediatric orthopaedic patients. J Am Acad Orthop Surg. 2020;28(16):e696–705.

    Article  PubMed  Google Scholar 

  6. Morgan C, Bennett-Brown K, Stebbings A, Li L, Dattani R. Clavicle fractures. Br J Hosp Med (Lond). 2020;81(7):1–7.

    Article  PubMed  Google Scholar 

  7. Kani KK. Clavicle fractures: review and update for radiologists. Curr Probl Diagn Radiol. 2020;49(3):199–204.

    Article  PubMed  Google Scholar 

  8. Hatch RL, Clugston JR, Taffe J. Clavicle fractures [Internet]. May 16, 2023. [cited Jun 23, 2023]. https://www.uptodate.com/contents/clavicle-fractures. Accessed June 20, 2023.

  9. Serpico M, Tomberg S. The emergency medicine management of clavicle fractures. Am J Emerg Med. 2021;49:315–25.

    Article  PubMed  Google Scholar 

  10. Ramponi DR, Jo CM. Clavicle fractures. Adv Emerg Nurs J. 2021;43(2):123–7.

    Article  PubMed  Google Scholar 

  11. Kozaci N, Avcı M, Ararat E, et al. Comparison of ultrasonography and computed tomography in the determination of traumatic thoracic injuries. Am J Emerg Med. 2019;37(5):864–8.

    Article  PubMed  Google Scholar 

  12. Liu J, Zhang L, Qiu RX. Ultrasound instead of x-ray to diagnose neonatal fractures: a feasibility study based on a case series. Front Pediatr. 2022;10:847776.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Weinberg ER, Tunik MG, Tsung JW. Accuracy of clinician-performed point-of-care ultrasound for the diagnosis of fractures in children and young adults. Injury. 2010;41(8):862–8.

    Article  PubMed  Google Scholar 

  14. Halm BM, Chaudoin LT. Diagnosis of a posterior fracture dislocation of the medial clavicle in an adolescent with point-of-care ultrasound. Pediatr Emerg Care. 2017;33(7):519–21.

    Article  PubMed  Google Scholar 

  15. Moritz JD, Berthold LD, Soenksen SF, Alzen GF. Ultrasound in diagnosis of fractures in children: unnecessary harassment or useful addition to X-ray? Ultraschall Med. 2008;29(3):267–74.

    Article  CAS  PubMed  Google Scholar 

  16. Chien M, Bulloch B, Garcia-Filion P, Youssfi M, Shrader MW, Segal LS. Bedside ultrasound in the diagnosis of pediatric clavicle fractures. Pediatr Emerg Care. 2011;27(11):1038–41.

    Article  PubMed  Google Scholar 

  17. Karacabey S, Sanrı E. Use of ultrasound for diagnosis of clavicle fractures in the emergency department. Signa Vitae. 2021;17(1):139–42.

    Google Scholar 

  18. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155(8):529–36.

    Article  PubMed  Google Scholar 

  20. Arends LR, Hamza TH, van Houwelingen JC, Heijenbrok-Kal MH, Hunink MG, Stijnen T. Bivariate random effects meta-analysis of ROC curves. Med Decis Making. 2008;28(5):621–38.

    Article  CAS  PubMed  Google Scholar 

  21. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Deeks JJ, Macaskill P, Irwig L. The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol. 2005;58(9):882–93.

    Article  PubMed  Google Scholar 

  23. Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biom. 2000;56(2):455–63.

    Article  CAS  Google Scholar 

  24. Dwamena BA. MIDAS: a program for meta-analytical integration of diagnostic accuracy studies in Stata. Ann Arbor, Michigan: Division of Nuclear Medicine, Department of Radiology, University of Michigan Medical School; 2007.

    Google Scholar 

  25. Cross KP, Warkentine FH, Kim IK, Gracely E, Paul RI. Bedside ultrasound diagnosis of clavicle fractures in the pediatric emergency department. Acad Emerg Med. 2010;17(7):687–93.

    Article  PubMed  Google Scholar 

  26. Bachrach LK, Gordon CM, Section on endocrinology. Bone densitometry in children and adolescents. Pediatrics. 2016;138(4):e20162398.

    Article  PubMed  Google Scholar 

  27. Atanelov Z, Bentley TP. Greenstick fracture. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. 2022 Aug 1; 2022.

    Google Scholar 

  28. Subramanian S, Viswanathan VK. Bone age. In: StatPearls [Internet]. Treasure island (FL): StatPearls Publishing; 2023 Jan–. 2023 Jan 16; 2018.

    Google Scholar 

  29. Hryhorczuk AL, Restrepo R, Lee EY. Pediatric musculoskeletal ultrasound: practical imaging approach. AJR Am J Roentgenol. 2016;206(5):W62–72.

    Article  PubMed  Google Scholar 

  30. Shah RR, Kinder J, Peelman J, Moen TC, Sarwark J. Pediatric clavicle and acromioclavicular injuries. J Pediatr Orthop. 2010;30:S69–72.

    Article  Google Scholar 

  31. Markes AR, Garcia-Lopez E, Halvorson RT, Swarup I. Management of displaced midshaft clavicle fractures in pediatrics and adolescents: operative vs nonoperative treatment. Orthop Res Rev. 2022;14:373–81.

    PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We would like to acknowledge the use of ChatGPT, a language model developed by OpenAI based on the GPT-3.5 architecture, which was used to assist with language corrections during the editing process of this manuscript, resulting in improved readability and language quality. After using this tool, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication.

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Authors and Affiliations

  1. Department of Radiology, Keck School of Medicine, University of Southern California (USC), 1441 Eastlake Ave Ste 2315, Los Angeles, CA, 90089, USA

    Amir Hassankhani, Melika Amoukhteh, Payam Jannatdoust, Parya Valizadeh & Ali Gholamrezanezhad

  2. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Amir Hassankhani & Melika Amoukhteh

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  1. Amir Hassankhani
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  2. Melika Amoukhteh
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Correspondence to Amir Hassankhani.

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Hassankhani, A., Amoukhteh, M., Jannatdoust, P. et al. A systematic review and meta-analysis on the diagnostic utility of ultrasound for clavicle fractures. Skeletal Radiol 53, 307–318 (2024). https://doi.org/10.1007/s00256-023-04396-3

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  • DOI: https://doi.org/10.1007/s00256-023-04396-3

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