Ultrasonography in foot and ankle trauma

Introduction: Foot and ankle injuries represent a significant proportion of emergency department admissions. Standard imaging technique used in the diagnosis of these injuries is X-ray imaging. Very successful results with USG in the diagnosis of long bone fractures have been reported in the previous studies. The aim of this study was to evaluate the efficiency of USG in identifying fractures in patients admitted to the emergency department with foot and ankle injury. We suggest that using USG in the diagnosis of these fractures can prevent the unnecessary radiography in the emergency department. Material and Methods: A hundred and thirty six patients who were admitted to our Emergency Department between October 1st, 2015 and December 1st 2015, with foot and ankle trauma and had suspected fractures were included in the study. The patients were examined for fracture by USG (lateral malleol, medial malleol, calcaneus, talus, navicular, cuboid and metatars), in longitudinal and transverse plane by a single emergency physician. Then anteroposterior radiographs of ankle of the patients were obtained. These radiographs were interpreted by a single emergency medicine specialist. The researcher who interpreted the results of X-rays did not examine the patient and did not have access to ultrasound exam results. Foot and ankle radiographs reviewed by emergency physicians were considered to be the gold standard diagnostic tool. The characteristics of the cases such as age, gender, localization, and mechanism of injury were recorded in the study forms. Ultrasonography and direct radiography images were recorded digitally. Results: A total of 136 patients over 18 years of age were enrolled in the study. Eighty (58.8%) of our patients were male and 56 (41.2%) were female. The average age was 36 years. We found that the most common mechanisms of ankle injury were sprains (62.5%), falls (27.2%), impacts (7.3%), and compressions (2.9%), respectively. Fracture was detected in 62 of the 136 patients, depending on X-ray imaging results. Sixty of these fractures were visualized by ultrasound. Depending on these findings, we found that sensitivity of USG in the diagnosis of fractures was 96.7%, specificity was 100%, a positive predictive value was 100%, and negative predictive value was 97.3%, when compared to X-Ray imaging. The most common locations of fractures were metatars (53%), lateral malleol (16%), medial malleol (8%), bimalleol (5%), calcaneus (4%), naviculer (1.6%) according to X-Ray findings. In two cases that USG yielded false negative results, there were nondeplase fractures in the proximal of the fifth metatarsus. Conclusions: In this study; that we compared ultrasound with direct radiography in the diagnosis of fractures in patients admitted to our emergency department due to foot and ankle trauma; we found that the sensitivity of USG was 96.7%, the specificity (selectivity) was 100%, positive predictive value was 100%, and negative predictive value was 97.3%. In light of these findings and given the characteristics of USG such as being repeatable, not using ionizing radiation, transportable, and being safely available in pregnant women and children; we suggest that USG can be used safely and effectively in the diagnosis of foot and ankle fractures in the emergency services and unnecessary X-rays can be avoided.