Diagnosis Of Long Bone Fractures Research Articles

Comparing Ultrasonography With Plain Radiography in the Diagnosis of Long Bone Fractures

Objective: This study was designed to compare sonography to skeletal radiography, in the diagnosis of long bone fractures. Materials and Methods: This was a cross-sectional and analytical study including 188 patients of varied ages that had 251 suspected long bone fractures. It was conducted over a 9-month period, in the emergency department of a teaching hospital, within the Swat district of Pakistan. After assessing the clinical symptoms of the fracture by an emergency orthopedic physician, sonography was followed by a radiograph performed for these referred patients. Results: Sonography shows a diagnostic accuracy of 91.23% for detecting long bone fractures, with a sensitivity and specificity of 100% and 76.84%, respectively. The positive predictive value and negative predictive value were 87.64% and 100%, respectively. Sonography was able to detect small fractures (up to 0.23 mm) that are often missed on the patient’s radiograph. Conclusion: Sonography may be useful as an initial screening imaging technique for the diagnosis of long bone fractures. The potential exists to reduce the need for unnecessary skeletal radiographs, which could reduce treatment time, cost, and ionizing radiation hazards.

Accuracy of point of care ultrasound in the diagnosis of long bone fractures in the emergency department

Introduction: Long bone fractures account for a significant portion of injuries in the emergency department (ED). This study aimed to determine the accuracy of point of care ultrasound (POCUS) compared to x-ray in the diagnosis of long bone fractures in the ED.
 Method: This cross-sectional study assessed 147 patients presenting to the ED of Patan Academy of Health Sciences (PAHS), with suspected long bone fractures, from Oct 2021 through Jun 2022. In all patients, POCUS examination was done by emergency fellows and then standard plain x-ray was performed. Data were analyzed by SPSS 28.0 to determine sensitivity and specificity.
 Result: A total of 147 patients were included in the study. Compared with x-ray, sensitivity, specificity, PPV and NPV of POCUS in determining fractures was found to be 86%, 98.96%, 97.72% and 93.2%, respectively. Based on bone injured, the highest sensitivity and specificity were obtained with forearm fractures, which was equal to 97.22% and 100%, respectively. Based on age categorization, the highest sensitivity (100%) and specificity (100%) were obtained in pediatric age group i.e. up to 16 years.
 Conclusion: This study demonstrated that POCUS has high sensitivity and specificity in the diagnosis of long bone fractures, compared to x-ray.

85 Parent and youth experiences of emergency department care for suspected long bone fractures in children

Abstract Background Long bone fractures are a frequent reason for visits to the pediatric emergency department (ED) where patients obtain the definitive care they require. Youth are rarely involved in quality assessment and improvement initiatives. Objectives To describe parent and youth experiences of their ED care for suspected long bone fractures. Design/Methods This prospective survey study of parents/youth consulting a tertiary care pediatric ED used surveys co-constructed by ED clinicians and parent partners. English/French speaking patients aged 10 to 18 years old with suspected long-bone fracture at triage – and their parents – were eligible to complete the survey during their ED stay. Electronic surveys were developed for parents and youth and pre-tested with 12 youth and 14 parents. Descriptive data was generated using SPSS v.25 (IBM Inc.). Results Three hundred surveys were distributed to eligible participants from March 2018 to June 2019 and 249 surveys were completed (148 parents, 101 youth). At least one member from 189 families completed a survey. Parents and youth participants had median ages of 44 and 12 years old, respectively. Most patients (98%) had a radiograph as part of their work-up, usually in the ED (76%); Twenty-seven percent were referred with radiographs. Most families (61%) received a diagnosis of long-bone fracture and were referred to orthopaedics for outpatient follow-up. Families’ median length of stay was 4h08min (range 43 min-14h30min). Parents (88mm) and youth (81mm) reported high median satisfaction with their overall ED care on 100 mm visual analog scales. Most parents (81%) and youth (75%) reported receiving just enough information from ED staff, though only half (50%) of the parents received information on how to care for their child at home. More than 90% of parents believed that the ED team treated their child’s pain. Eighty-one percent of youth reported that pain was treated sufficiently although 63% believed it had been treated quickly. Most parents (56%) and youth (72%) reported their ED stay was longer than anticipated; parents’ perceptions did not correlate with ED length of stay on logistic regression (p=0.014), while youth’s did (p=0.009). Few parents (33%) or youth (32%) reported receiving regular information on ED wait times. Conclusion Parent and youth perspectives of their ED care are complementary, and both should be considered in patient-oriented quality improvement initiatives.

Intracranial Injury Among Children with Abuse-Related Long Bone Fractures.

BackgroundIntracranial injury (ICI) from abusive head trauma is the leading cause of death among young abused children but is difficult to detect. Long bone fracture (LBF) may lead to the recognition of abuse in young abused children.ObjectivesThis study is the first to report the incidence and features of ICI in children with abuse and LBFs.MethodsThis is a retrospective study of children younger than 3 years with the diagnosis of LBF in the National Trauma Data Bank from 2009 to 2014. LBF, abuse, and clinical features were identified using International Classification of Diseases, Ninth Revision codes. Abuse-related LBF with and without ICI were compared to identify risk factors for ICI.ResultsThere were 4345 encounters for abuse-related LBF in kids ages < 3 years; 970 (22%) had ICI. Infants < 1 year of age were more likely to have ICI compared with older children (odds ratio [OR] 1.79, 95% confidence interval [CI] 1.38–2.33). After adjusting for age, fracture of the ulna, radius, tibia, or fibula were associated with greater odds of ICI (OR 3.35, 95% CI 2.81–4.00). Abuse-related LBF with additional findings of skull fracture, rib fracture, or head/neck bruising had an increased odds of ICI (OR 8.27, 95% CI 6.85–9.98; OR 2.67, 95% CI 2.28–3.14; OR 2.41, 95% CI 1.99–2.92, respectively).ConclusionsICI occurred in nearly 1 in 4 children under 3 years old with abuse-related LBF. Abuse-related LBF with skull fracture, rib fracture, head/neck bruising, or patient age < 1 year should prompt consideration for ICI with head imaging.

Analgesia Use in Children with Acute Long Bone Fractures in the Pediatric Emergency Department.

Practice variation exists in pain management of children with long bone fractures (LBFs). The objectives of this study were to describe current pain management in children with LBFs and the factors associated with the undertreatment of pain. We retrospectively studied children (aged 0-18years) with a diagnosis of LBF in a pediatric emergency department (PED) from November 2015 through August 2016. Demographic characteristics and quality measures were noted. We determined the impact of PED crowding using the National Emergency Department Overcrowding Scale. A total of 905 patients (63% male, 48% African American) were enrolled. Median age was 6years (interquartile range [IQR] 7years), 72% had upper extremity injuries, falls were the most common mechanism (74%), and the majority were discharged (77%). Median time to pain score was 6min (IQR 14min). Seventy-two percent received analgesia with a median time to order of 63min and medication receipt of 87min. Ibuprofen was the analgesia prescribed most commonly. There were no identified factors associated with oligoanalgesia. Nonuse of narcotics was associated with African-American race, public insurance, single fractures, and arrival via private vehicle. Ambulance arrivals, lower extremity fractures, and disaster mode were associated with receiving analgesia within 60min. In our study, 28% of children with LBFs did not receive pain medications, especially during normal PED volumes. Additional studies are required to explore triage as a venue for analgesia delivery for LBFs.

Comparison of Point-of-Care Ultrasonography and Radiography in the Diagnosis of Long-Bone Fractures.

Background and objectives: In this study, the accuracy of point-of-care ultrasonography (POCUS) was compared to radiography (XR) in the diagnosis of fractures, the determination of characteristics of the fractures, and treatment selection of fractures in patients admitted to the emergency department (ED) due to trauma and suspected long bone (LB) fractures. Materials and Methods: The patients were included in the study, who were admitted to ED due to trauma, and had physical examination findings suggesting the presence of fractures in LB (humerus, radius, ulna, femur, tibia, and fibula). The patients were evaluated by two emergency physicians (EP) in ED. The first EP examined LBs with POCUS and the second EP examined them with XR. LBs were evaluated on the anterior, posterior, medial, and lateral surfaces and from the proximal joint to the distal one (shoulder, elbow, wrist, hip, knee, and ankle joint) in both longitudinal and transverse axes with POCUS. Results: A total of 205 patients with suspected LB fractures were included in the study. LB fractures were determined in 99 patients with XR and in 105 patients with POCUS. The sensitivity, specificity, positive predictive value, negative predictive value of POCUS in determining the fractures were 99%, 93%, 93%, and 99%, respectively, compared to XR. Compared to XR, POCUS was able to determine 100% of fissure type fractures (kappa (κ) value: 0.765), 83% of linear fractures (κ: 0.848), 92% of fragmented fractures(κ: 0.756), 67% of spiral fractures (κ:0.798), 75% of avulsion type fractures (κ: 0.855), and 100% of full separation type fractures (κ: 0.855). Conclusions: This study has demonstrated that POCUS has a high sensitivity in diagnosing LB fractures. POCUS has a high sensitivity in identifying fracture characteristics. POCUS can be used as an alternative imaging method to XR in the diagnosis of LB fractures and in the determination of fracture characteristics.

Ability of Bedside Ultrasonography for the Diagnosis of Long Bone Fractures in Multiple Trauma Patients

The aim of the study is valuable but not perfect and I would like to add a one important point about diagnosis of long bone fractures in extremity injuries. In this article, the authors stated that bedside ultrasound is not a reliable tool for diagnosis of fractures in adults, and it cannot be a good replacement for radiography

Comparing diagnostic accuracy of bedside ultrasound and radiography for bone fracture screening in multiple trauma patients at the ED

IntroductionLong bone fractures are currently diagnosed using radiography, but radiography has some disadvantages (radiation and being time consuming). The present study compared the diagnostic accuracy of bedside ultrasound and radiography in multiple trauma patients at the emergency department (ED). MethodThe study assessed 80 injured patients with multiple trauma from February 2011 to July 2012. The patients were older than 18 years and triaged to the cardiopulmonary resuscitation ward of the ED. Bedside ultrasound and radiography were conducted for them. The findings were separately and blindly assessed by 2 radiologists. Sensitivity, specificity, the positive and negative predictive value, and κ coefficient were measured to assess the accuracy and validity of ultrasound as compared with radiography. ResultsThe sensitivity of ultrasound for diagnosis of limb bone fractures was not high enough and ranged between 55% and 75% depending on the fracture site. The specificity of this diagnostic method had an acceptable range of 62% to 84%. Ultrasound negative prediction value was higher than other indices under study and ranged between 73% and 83%, but its positive prediction value varied between 33.3% and 71%. The κ coefficient for diagnosis of long bone fractures of upper limb (κ = 0.58) and upper limb joints (κ = 0.47) and long bones of lower limb (κ = 0.52) was within the medium range. However, the value for diagnosing fractures of lower limb joints (κ = 0.47) was relatively low. ConclusionBedside ultrasound is not a reliable method for diagnosing fractures of upper and lower limb bones compared with radiography.

The Ultrasound Detection Of Simulated Long Bone Fractures By U. S. Army Special Forces Medics

U.S. Army Special Forces Medics (18Ds) operate in austere environments where decisions regarding patient management may be limited by available resources. Portable ultrasound may allow for the detection of fractures in environments where other imaging modalities such as radiography are not readily available or practical.We used a simulation training model for the ultrasound diagnosis of long bone fractures to study the ability of 18Ds to detect the presence or absence of a fracture using a portable ultrasound.The fracture simulation model is composed of a bare turkey leg bone that is mechanically fractured and housed in a shallow plastic container within an opaque gelatin base solution. Five fracture patterns were created: transverse, segmental, oblique, comminuted, and no fracture. After a brief orientation session, twenty 18Ds evaluated the models in a blinded fashion with a SonoSite M-Turbo portable ultrasound device for the presence or absence of a fracture.18Ds demonstrated 100% sensitivity (95% CI: 94.2% to 100%) in fracture detection and an overall specificity of 90% (95% CI: 66.8-98.2%) due to two false positive assessments of the no fracture model.Using a portable ultrasound device, 18Ds were able to correctly detect the presence or absence of a simulated long bone fracture with a high degree of sensitivity and specificity. Future studies are needed to investigate the clinical impact of this diagnostic ability.

Goal-directed Ultrasonography for Detecting Traumatic X-ray Missed Fibula Fracture in the Emergency Department

We present the case of a 45-year-old man who presented to the emergency department (ED) for ankle trauma sustained during a football match. Physical examination and X-ray of his ankle were negative for bone fractures. He was discharged from the ED, but returned 3 weeks later with a painful and swelling leg. Compressive ultrasonography of his right lower limb was negative for venous thrombosis, but ultrasound evaluation of the leg clearly showed a fibula fracture. Although the diagnosis of fractures usually relies on X-ray, the literature contains many reports of goal-directed ultrasound diagnosis of long bone fracture in military settings and remote locations. The usefulness of a noninva-sive examination like bedside ultrasonography and goal-directed evaluation of patients in the ED are discussed, with reference to the literature.