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Meta-Analysis
. 2017 Nov 10;114(45):757-764.
doi: 10.3238/arztebl.2017.0757.

The Investigation of Suspected Fracture-a Comparison of Ultrasound With Conventional Imaging

Gordian Lukas Schmid  1 , Stefan Lippmann, Susanne Unverzagt, Christiane Hofmann, Tobias Deutsch, Thomas Frese
Affiliations
Meta-Analysis

The Investigation of Suspected Fracture-a Comparison of Ultrasound With Conventional Imaging

Gordian Lukas Schmid et al. Dtsch Arztebl Int. .

Abstract

Background: Ultrasound imaging can be used to diagnose fractures in patients with acute trauma. Its main advantages over conventional imaging are the absence of radiation exposure and its greater availability.

Methods: A systematic search in electronic databases (Medline, Embase, Cochrane CENTRAL) was supplemented by a manual search on the Internet and in the reference lists of pertinent publications. The QUADAS-2 instrument was used to assess the quality of the individual studies retrieved. In the metaanalysis, the sensitivity and specificity of the individual studies were pooled.

Results: The available information on the diagnostic accuracy of ultrasound in the detection of fractures compared with that of conventional imaging (x-ray, CT, MRI) in patients with acute non-life-threatening trauma is summarized. The database search yielded 2153 hits, among which there were 48 studies that were suitable for inclusion in this review. The pooled sensitivity and specificity were 0.91 (95% confidence interval [0.90; 0.92]) and 0.94 [0.93; 0.95], although the analyzed studies were markedly heterogeneous (I²: sensitivity 74%, specificity 81%). The sensitivity of ultrasound was higher for the detection of fractures of the humerus, the forearm, the ankle, and the long bones in general, as well as fractures in children, and lower for fractures of the short bones of the hands and feet, and in adults.

Conclusion: Strong evidence supports the use of ultrasound imaging for certain indications in the detection of fractures.

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Figures

Figure 1
Figure 1
Search strategy and selection process of review
Figure 2
Figure 2
Sensitivity of ultrasound imaging versus reference standard in the diagnosis of fractures in the included studies Studies shaded in gray include examinations of children and adolescents only. 95% CI: 95% confidence interval; FN: Number of false negatives; Ref.: Reference; TP: Number of true positives
Figure 3
Figure 3
Specificity of ultrasound imaging versus reference standard in the diagnosis of fractures in the included studies Studies shaded in gray include examinations of children and adolescents only. 95% CI: 95% confidence interval; FP: Number of false positives; Ref.: Reference; TN: Number of true negatives
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