Diagnose & Describe Distal Radial Fractures with
Bedside Ultrasound.
M Azam Majeed, Asif Naveed, D Yeo
Background:
Radiography is the usual diagnostic tool for examining
fractures. However, exposure to radiation is of particular
concern when you need it more than once. Bedside
ultrasound (BSUS) is a noninvasive tool to effectively
identify and define fractures in the ED setting.
When there are mass casualties or on a very busy day at
the Emergency Department (ED), non-life-threatening
skeletal injuries are often kept waiting for hours for
treatment because radiographic examination is delayed.
Bedside ultrasound is a quick, noninvasive, alternative for
identifying bone fractures in the ED setting.
Objectives:
This study compares the diagnostic utility of bedside
ultrasound done by emergency physicians (EP)] vs
radiography for diagnosing and defining radial fractures in
the ED.
Settings:
In the ED of University hospital Birmingham in England.
Inclusion:
Patients with distal radius fractures with the age of >16yrs.
Exclusion:
Patients with wounds around the fracture site and age
<16yrs.
Method:
We have 10 cases presenting to the ED with distal radius
fractures. They had their routine X rays and then
ultrasound of the wrist.
2 independent ED consultants were asked to measure the
angles in AP and lateral view of the wrist x rays. 2 other
ED consultants were then shown ultrasound pictures to
measure the angles. They were blinded to X rays results.
Then a correlation was measured.
Results:
All fractures were picked up by the x rays (100%). The
difference between the X rays and ultrasound guided
fracture angle measurement is only 1 degree.
Discussion:
Radiography is the established diagnostic tool for diagnosing
and defining fractures. However, they do cause radiation
exposure. BSUS is a noninvasive screening tool to efficiently
diagnose fractures in the ED.
The present study intended to examine the role of BUS as a
viable tool to diagnose and define fracture in the ED. We were
able to diagnose fractures with 100% accuracy.
The mean difference between X rays and ultrasound guided
fracture angle measurement was only 1 degree.
The results make a strong case to use BSUS in diagnosing and
defining fractures of distal radius.