Comparison of ultrasonography and conventional radiography in the diagnosis of extremity fractures

Comparison of Ultrasonography and Conventional Radiography in The Diagnosis of Extremity Fractures Introduction: Limb injuries are among the common reasons admitted to the emergency room. Due to these traumas, bone fractures and soft tissue disorders may occur. Direct X-ray detection is the first traditionally used imaging method, but a few studies have been reported to use of ultrasonography in the diagnosis of fractures. In this study, evaluating the effectiveness of USG in the diagnosis of patients admitted to the emergency department with suspicion of limb fracture was aimed. Material and Method: Between the dates of 05.05.2019 and 30.11.2019, 245 patients aged 4 years and over who admitted to our hospital's Emergency Medicine Clinic with limb trauma were included in the study. Longitudinal and transverse plane ultrasonographic imaging was performed on the symptom areas of all patients by a single emergency medical assistant who was trained in ultrasonography. Later, anterior-posterior, lateral and if necessary oblique extremity radiographs were taken to the patients. Radiographs were interpreted by other emergency medical assistants who did not have any information about USG findings. Direct radiography, interpreted by the emergency medical assistant responsible for the patient, was accepted as the gold standard diagnostic tool. The data, obtained within the scope of the research, were analyzed in SPSS (Statistical Package for Social Sciences) 23 program. Results: A total of 245 patients, aged between 4 and 91 years, 143 (58.4%) males and 102 (41.6%) females with an average age of 30.76 ± 23.16 were included in the study. The patients were classified according to age groups, 146 (59.6%) were in the adult group (18 years old and above), while 99 (40.4%) were in the pediatric group (4-18 years old). It was determined that the applications were made most frequently in May, between 16:00 and 23:59. The most common cause of trauma mechanism in patients was falling (52.7%). Sensitivity of USG in determining limb fractures is 99.24%, selectivity 98.25%, positive predictability value 98.48% and negative predictability value was found as 99.12%. Humerus distal fractures (34.2%) were most common in children, while radial distal fractures (36.5%) were most common in adults in the upper extremity. Distal fibula fractures (50%) were most common in children in the lower extremity, while phalanx fractures (29.5%) were most common in adults. According to the results of USG, 14 fractures (12.5%), which were not prolonged into the joint space, were found to be extended according to the X-Ray imaging results, and this difference was statistically significant (p <, 001). USG imaging took 2 minutes for the patient with the shortest duration and 5 minutes for the patient with the longest duration. X-Ray imaging time was 5 minutes in the patient with the shortest duration and 60 minutes in the patient with the longest duration. Conclusion: In this study we performed USG's sensitivity and selectivity in diagnosis of fractures in patients admitted to the emergency room due to extremity trauma, was found to be higher than compared with conventional radiography. We consider that ultrasonography can be used as an effective diagnostic tool in the diagnosis of fractures in emergency departments, as well as preventing unnecessary radiation exposure in children and pregnant women with radiation sensitive tissues and this process will save time. Keywords: Emergency room, limb, limb trauma, limb fractures, ultrasonography