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© 2007 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 26:1143-1148 • 0278-4297

Prospective Use of Ultrasound Imaging to Detect Bony Hand Injuries in Adults

Vivek S. Tayal, MD, Jill Antoniazzi, MD, Manoj Pariyadath, MD and H. James Norton, PhD

Departments of Emergency Medicine (V.S.T., J.A., M.P.) and Biostatistics (H.J.N.), Carolinas Medical Center, Charlotte, North Carolina USA. Dr Antoniazzi is currently with McNeil Hospital, Chicago, Illinois USA; Dr Pariyadath is currently with the Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina USA.

Address correspondence to Vivek S. Tayal, MD, Department of Emergency Medicine, Carolinas Medical Center, Box 32861, Charlotte, NC 28232 USA. E-mail: vtayal{at}carolinas.org

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, 1 spiral nondisplaced mid-third metacarpal fracture, and 1 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.

Key Words: bone • fracture • hand • injury • ultrasound

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Copyright © 2007 by the American Institute of Ultrasound in Medicine.