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La Certeza de la Ecografía a Pie de Cama como Herramienta Diagnóstica para las Fracturas en las Torceduras de Tobillo y Pie
Author(s) -
Atilla Ozge Duman,
Yesilaras Murat,
Kilic Turgay Yilmaz,
Tur Feriyde Caliskan,
Reisoglu Ali,
Sever Mustafa,
Aksay Ersin
Publication year - 2014
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.12467
Subject(s) - medicine , ankle , radiography , orthopedic surgery , foot (prosody) , emergency department , gold standard (test) , foot and ankle surgery , confidence interval , prospective cohort study , physical examination , medial malleolus , radiology , surgery , linguistics , philosophy , psychiatry
Objectives Ultrasonography ( US ) has been shown to be helpful in diagnosing fractures in the emergency department ( ED ) setting. The aim of this study was to determine the diagnostic accuracy of US for fractures in patients presenting to the ED with foot and/or ankle sprain and positive Ottawa foot and ankle rules. Methods This was a prospective study of consecutive patients aged 18 years and over were admitted to the ED with acute foot and/or ankle sprain and positive Ottawa foot and ankle rules. After the patients by were examined by bedside US , anteroposterior and lateral ankle radiographs were obtained, as well as anteroposterior and oblique foot radiographs. The films were evaluated by an orthopedic surgeon who was blinded to the US examination results. The orthopedic surgeon's evaluation was considered the criterion standard for diagnosing a fracture. Results A total of 246 patients were included in the study. In 76 (30.9%) of the patients, a total of 79 fractures were detected by radiography. Ten false‐negative and nine false‐positive results were obtained by US examination. Only one patient, whose US showed a fracture but whose radiographs were normal, had a fracture detected by computed tomography ( CT ). The sensitivity and specificity of US scanning in detecting fractures were 87.3% (95% confidence interval [ CI ] = 77.5% to 93.4%) and 96.4% (95% CI = 93.1% to 98.2%), respectively. Conclusions Ultrasound had good sensitivity and specificity for diagnosing fifth metatarsal, lateral, and medial malleolus fractures in the patients with foot and/or ankle sprain. However, sensitivity and specificity of US for navicular fractures were low.