Prospective use of ultrasound Imaging to detect bony hand injuries in adults

Objective. We hypothesized that high-resolution linear ultrasound imaging performed by emergency sonologists would be accurate in the diagnosis of bony injuries of the hand. Methods. This was a prospective observational study of adult patients with injuries of the hand at an urban emergency department with trained emergency sonologists. After informed consent, high-frequency linear ultrasound was used to evaluate the bony structures below the area of injury or tenderness of the hand. The presence of a fracture or dislocation was recorded. A standard radiograph was taken subsequently and read by a blinded radiologist. Standard descriptive statistics with confidence intervals were calculated. Results. A total of 78 patients were enrolled in the study. The incidence of deformity was 28%; swelling, 90%,- and erythema, 20%. Thirty patients had a total of 31 fractures: 21 metacarpal and 10 phalangeal. Ultrasound imaging identified 28 of 31 fractures found on standard radiographs, except for 1 patient's fractures, which were confirmed at surgery. One dislocation was found on ultrasound imaging and confirmed by radiographs. Ultrasound imaging showed the following accuracy for fracture: sensitivity 90%,- specificity; 98%,- likelihood ratio (LR)(+), 42.5; and LR(-), 0.1. In comparison, individual physical examination findings of deformity, swelling, and erythema had a maximal LR(+) of 5.15 and minimum LR(-) of 0.51. One metacarpal fracture at the base of the first metacarpal, I spiral nondisplaced mid-third metacarpal fracture, and I distal tuft phalangeal fracture were missed by ultrasound imaging. There was 1 false-positive ultrasound finding. Conclusions. Ultrasound imaging performed by emergency sonologists showed excellent sensitivity and specificity in the diagnosis of hand fractures.