Rawan Nahas, PGY-5
Article: Kozaci N, et al. The effectiveness of bedside point-of-care ultrasonography in the diagnosis and management of metacarpal fractures. American Journal of Emergency Medicine. 33 (2015): 1468-1472.
Background
Metacarpal fractures (MFs) constitute about 40% of all hand fractures. Direct radiography (DR) is generally used in the determination of fracture types and methods of treatment. The use of point-of-care ultrasonography (POCUS) is increasing in evaluation of orthopedic injuries, as it is easy to learn and apply.
The Study
Type: Prospective planned study
Population: Patients who were admitted to the Emergency Department with low energy, simple extremity traumas, and a considered MF as a result of physical examination.
Clinical Setting: Emergency Department in Antalya Education and Research Hospital.
Exclusion Criteria:
Patients with diagnosed metacarpal injuries with a direct radiography before coming to the emergency department
Open fractures
Neurovascular injury
Fracture along with dislocation
Other system injuries
Unstable vital signs
Life-threatening injuries
Patients who did not consent
Inclusion Criteria: All other patients between the ages of 5-55 years between June-September 2014.
Aim of the study: To compare the effectiveness of POCUS with direct radiography in diagnosis and management of the patients with MFs.
Methods:
Emergency physicians (EPs) participating in the study were divided into 2 equal groups before starting the study. The first group was the POCUS group, and the second was the radiography group.
The physician from the POCUS group evaluated metacarpal bones of the patient using a linear probe.
A physician in the radiography group who was unaware of the POCUS results evaluated PA and lateral plain radiographs of the patient.
After determining fracture, localization of the fracture, fracture type, step-off, and angulation were measured.
The data obtained by physicians from both groups were pooled; and sensitivity, specificity, positive predictive value, and negative predictive values of POCUS were measured.
Treatment option were elastic bandage, splinting , splinting following reduction or surgery.
Results:
A total of 66 patients with considered MF were included in the study.
Fractures were detected in 36 (55%) patients by DR and 37 (56%) patients by POCUS.
Compared with DRs:
Specificity and sensitivity for step-off detection was 100%.
Take home message:
POCUS has high sensitivity and specificity in the determination and management of MF, and could be easily applied by EPs after musculoskeletal POCUS training with success in diagnosing MFs and determining the correct fracture type and required treatment methods. It can also rule out MF thereby avoiding the time and expense of radiography.