Sivrikaya Semra, Aksay Ersin, Bayram Basak, Oray Nese Colak, Karakasli Ahmet, Altintas Emel
Dokuz Eylul University School of Medicine, Department of Emergency Medicine, Turkey.
Dokuz Eylul University School of Medicine, Department of Orthopedic Surgery, Turkey.
Turk J Emerg Med. 2016 May 19;16(3):98-101. doi: 10.1016/j.tjem.2016.04.002. eCollection 2016 Sep.
Several studies focusing diagnosis of forearm fracture using Point-of-Care-Ultrasonography (POCUS) had been carried out in children. There is a lack of evidence for the utility of sonographic (US) examination for detecting of distal forearm fracture in adults. We aim to determine the diagnostic sensitivity and specificity of POCUS examination for the fracture of the distal radius and ulna in adult patients presenting with blunt forearm trauma.
Adult patients presenting with acute distal forearm trauma and suspicion of fracture were enrolled into study. POCUS had been performed by blinded emergency physicians, than anteroposterior and lateral x-rays was obtained. If inconsistency between x-rays and POCUS has been occurred, computed tomography were ordered. Assessment of orthopedic surgeon was accepted as a gold standard diagnosis.
Ninety three POCUS were performed in 90 patients. Fifty nine radius and 19 ulna fracture had been diagnosed. POCUS detected all radius fracture, but missed 2 ulna fracture. There were 4 false positive results for both radius and ulna with POCUS. X-ray missed 4 radius, and 1 ulna fractures. Diagnostic sensitivity and specificity of POCUS for fracture of ulna were 89.5% (CI%95, 65.5-98.1) and 94.6 (CI%95, 86-98.2), for fracture of radius were 100% (CI%95, 92.4-100), and 88.2%. (CI%95, 71.6-96.1).
Emergency physician performed POCUS examination is very sensitive and specific the diagnosis of distal forearm fracture. Diagnostic sensitivity of POCUS for radius fracture is higher than x-ray.
已有多项针对儿童使用床旁超声（POCUS）诊断前臂骨折的研究。但关于超声（US）检查在成人前臂远端骨折检测中的效用，目前仍缺乏证据。我们旨在确定POCUS检查对因前臂钝性创伤就诊的成年患者桡骨和尺骨远端骨折的诊断敏感性和特异性。
纳入因急性前臂远端创伤且怀疑骨折的成年患者。由不知情的急诊医生进行POCUS检查，随后拍摄前后位和侧位X线片。若X线片与POCUS结果不一致，则进行计算机断层扫描。以骨科医生的评估作为金标准诊断。
对90例患者进行了93次POCUS检查。诊断出59例桡骨骨折和19例尺骨骨折。POCUS检测出了所有桡骨骨折，但漏诊了2例尺骨骨折。POCUS对桡骨和尺骨均有4例假阳性结果。X线片漏诊了4例桡骨骨折和1例尺骨骨折。POCUS对尺骨骨折的诊断敏感性和特异性分别为89.5%（95%CI，65.5 - 98.1）和94.6（95%CI，86 - 98.2），对桡骨骨折的诊断敏感性和特异性分别为100%（95%CI，92.4 - 100）和88.2%（95%CI，71.6 - 96.1）。
急诊医生进行的POCUS检查对前臂远端骨折的诊断具有很高的敏感性和特异性。POCUS对桡骨骨折诊断的敏感性高于X线片。
