Ultrasound in bone fracture diagnosis - a comparative meta-analysis and systematic review.

Abstract

This meta-analysis evaluates the diagnostic accuracy of ultrasound (US) for bone fractures over the past 47 years,comparing it to established imaging standards. We adhered to PRISMA 2020 guidelines to searchMedline, EMBASE, and the Cochrane Library using tailored search strategies. The primary outcome, US diagnostic performance,was analyzed across various subgroups including clinical relevance, patient age, and anatomical considerations. TheQUADAS-2 tool was employed to assess study quality and minimize bias. From 5,107 initially identified studies,75 met the inclusion criteria, encompassing 7,769 participants and 3,575 diagnosed fractures. The majority of studies wereprospective (79%) and compared US primarily with plain radiography (76%) and CT scans (19%). Of these, 61 studies wereamenable to systematic analysis, revealing US to have a sensitivity and specificity of 91% (95% CI: 90%-92%) and 91.3%(95% CI: 90.5%-92.1%), respectively. Likelihood ratios were favorable, with a positive value of 9.955 and a negative valueof 0.087, and an odds ratio of 132.67. The area under the curve stood at 0.9715, indicating high diagnostic accuracy despitesignificant heterogeneity (I²=81.3% for sensitivity, 89.3% for specificity). The evidence supports US as a highlyaccurate diagnostic tool for bone fractures, rivalling standard imaging methods like CT and radiography. Its notable diagnosticefficacy, combined with advantages in reducing pain, wait times, and radiation exposure, advocates for its broader application.Further validation in large-scale, randomized trials is essential to integrate US more fully into clinical guidelines for fracturemanagement.