Lin Bin, Yuan Danqin, Chen Weiting, Liu Ying, Ji Xiaozhen
Department of Orthopedics, Taizhou Integrated Chinese and Western Medicine Hospital, China.
Department of Critical Care Medicine, Taizhou Integrated Chinese and Western Medicine Hospital, China.
J Int Med Res. 2025 Jun;53(6):3000605251351273. doi: 10.1177/03000605251351273. Epub 2025 Jun 25.
ObjectiveUltrasound provides real-time, high-resolution imaging and is increasingly recognized as a valuable diagnostic tool for clavicle fractures. Compared with traditional imaging modalities, ultrasound offers advantages such as point-of-care accessibility, absence of radiation exposure, and rapid diagnosis capability, making it particularly useful in emergency settings. However, the diagnostic performance of ultrasound across different clinical studies remains inconsistent. Therefore, this study aimed to systematically assess the diagnostic accuracy of ultrasound for clavicle fractures through a meta-analysis of existing studies.MethodsA systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A comprehensive search of PubMed, Scopus, Embase, Cochrane Library, and Web of Science was performed until 25 February 2025. Studies reporting the sensitivity, specificity, and overall diagnostic performance of ultrasound for clavicle fractures were included. Data extraction and statistical analysis were performed using Stata version 18.0.ResultsA meta-analysis of seven eligible studies showed a pooled sensitivity of 92% (95% confidence interval: 87%-95%) and pooled specificity of 95% (95% confidence interval: 91%-98%), indicating relatively high diagnostic accuracy. Sensitivity showed low-to-moderate heterogeneity, whereas specificity demonstrated significant heterogeneity. Fagan plot and likelihood ratio analysis supported the clinical utility of ultrasound for both confirming and excluding clavicle fractures. The likelihood ratio scattergram indicated that ultrasound shows good performance in ruling in clavicle fractures but only moderately good performance in ruling them out.ConclusionCurrent evidence indicates that ultrasound is a promising, noninvasive diagnostic modality for clavicle fractures, especially in emergency settings. Its diagnostic accuracy, coupled with its safety profile, makes it a potentially valuable tool. Nevertheless, standardization of scanning protocols and further validation in diverse populations are needed. Future studies are warranted to standardize scanning protocols, evaluate operator-dependent factors, and validate findings across broader clinical settings. PROSPERO CRD: 42025643069.
目的
超声可提供实时、高分辨率成像，越来越被视为锁骨骨折的一种有价值的诊断工具。与传统成像方式相比，超声具有诸如床旁可及性、无辐射暴露以及快速诊断能力等优势，使其在急诊环境中特别有用。然而，不同临床研究中超声的诊断性能仍不一致。因此，本研究旨在通过对现有研究进行荟萃分析，系统评估超声对锁骨骨折的诊断准确性。
方法
按照系统评价和荟萃分析的首选报告项目指南进行系统评价和荟萃分析。对PubMed、Scopus、Embase、Cochrane图书馆和Web of Science进行全面检索，直至2025年2月25日。纳入报告超声对锁骨骨折的敏感性、特异性和总体诊断性能的研究。使用Stata 18.0进行数据提取和统计分析。
结果
对七项符合条件的研究进行的荟萃分析显示，合并敏感性为92%（95%置信区间：87%-95%），合并特异性为95%（95%置信区间：91%-98%），表明诊断准确性相对较高。敏感性显示出低至中度的异质性，而特异性表现出显著的异质性。Fagan图和似然比分析支持超声在确认和排除锁骨骨折方面的临床实用性。似然比散点图表明，超声在诊断锁骨骨折方面表现良好，但在排除骨折方面仅表现中等。
结论
目前的证据表明，超声是一种有前景的、用于锁骨骨折的无创诊断方法，尤其是在急诊环境中。其诊断准确性及其安全性使其成为一种潜在有价值的工具。然而，需要扫描方案的标准化以及在不同人群中的进一步验证。未来的研究有必要标准化扫描方案，评估操作者相关因素，并在更广泛的临床环境中验证结果。PROSPERO注册号：42025643069。
