Abstract
Background
An ankle sprain is a common injury, and patients are usually examined with plain radiographs
to rule out a fracture despite the fact that only a small minority actually have one.
Purpose
To investigate if ultrasound (US)-guided triage can decrease the need for radiographic
imaging in patients with ankle trauma.
Hypothesis
Orthopedic surgeons can use point-of-care US with limited training to triage ankle
trauma that requires standard radiographs.
Methods
Seven junior orthopedic surgeons underwent a 30-minute standardized training session
using a basic US musculoskeletal examination designed to exclude ankle fractures.
One-hundred twenty-two patients with ankle trauma were included at the emergency department
and underwent clinical investigation, including examination according to the Ottawa
ankle rules as well as US and standard ankle radiographs. In this study group, radiographs
identified 23 significant fractures. Ultrasound-guided triage could not exclude a
fracture in 37 patients. All of the 23 fractures seen on radiographs were among the
37 patients where US could not rule out a fracture. Ottawa ankle rules managed to
exclude the need for radiographs in 28 of the 122 patients, whereas 85 who underwent
the US-guided triage could have avoided a radiograph. Avulsion fractures at the tip
of the fibula were not considered significant.
Conclusion
This study demonstrates that with limited standardized training a junior, an orthopedic
surgeon is able to use US-guided triage during the primary examination at the emergency
department to exclude at least significant ankle fractures. This practice could decrease
the need for radiographic imaging, avoiding a mandatory radiographic investigation
in many patients with ankle trauma. It would also make it possible to treat many patients
with ankle trauma more rapidly and to reduce costs and radiation exposure.
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Article Info
Publication History
Published online: October 23, 2013
Accepted:
September 5,
2013
Received in revised form:
September 1,
2013
Received:
July 8,
2013
Footnotes
☆An M-Turbo Sonosite Ultrasound system and a linear 15-MHz probe was provided by a Secma/Sonosite representative for a 1-year loan free was charge for the purpose of this study. No other cooperation or exchange has taken place with this or any other company.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
