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The Validity and Reliability of Pocket-sized Ultrasound to Diagnose Distal-Radius Fracture and Quality of Closed-Reduction
Brian C Lau, MD; Aaron Robertson, BS; Daria Motamedi, MD; Nicolas Lee, MD
University of California San Francsico Medical Center, San Francisco, CA
Background: Closed reduction of a distal radius fracture is a common procedure, however, particularly with trainees or non-orthopedist, requires repeated radiographs or the use of fluoroscopy to obtain a satisfactory reduction. Repeated radiographs are costly and time intensive and fluoroscopy is not widely available. Additionally, in nontraditional medical settings such as the developing world, disaster areas, or in combat zones radiographs and fluoroscopy are not widely available. A portable pocket-sized handheld ultrasound may be a safe, effective, and efficient method to identify suspected distal radius fractures and assist with adequate fracture reductions. The purpose of this study is to evaluate distal radius diagnosis and assessment of closed reduction with a portable handheld ultrasound.
Methods: Twenty-three distal radius fracture patients (average age 52.5; 13 female) and 20 healthy control patients (average age 53.3; 10 female) were enrolled. Distal radius fractures had standard 3-view radiographs and 3-view handheld ultrasound (Mobisante Inc) exam of the wrist before and after reduction. Control patients had a one-time 3-view radiographs and 3-view handheld ultrasound exam performed. Radiographs were used as the gold standard and were reviewed by a blinded board-certified orthopedic hand-fellowship trained surgeon and board-certified and musculoskeletal-fellowship trained radiologist for no fracture, fracture without- satisfactory reduction, and fracture with-satisfactory reduction.
Results: The sensitivity of distal radius diagnosis on ultrasound was 100%; specificity was 85%; positive predictive value was 93.9%; negative predictive value was 100%. The accuracy was 95.5%. The sensitivity of identifying an unsatisfactory reduction was 86.5%; specificity was 79.3%, the positive predictive value was 84.2%, the negative predictive value was 82.1%. The inter-rater reliability had an overall percent agreement of 95.5% for distinguishing fracture or no fracture and a 92.6% overall percent agreement for identifying a satisfactory reduction.
Conclusion: Pocket-sized portable handheld ultrasounds demonstrate excellent accuracy in diagnosing distal radius fractures and assessing quality of closed reduction.
Clinical Relevance: Handheld ultrasounds may assist in efficient and cost-effective closed reduction of distal radius fractures and may be an alternative to radiographs in environments without access to radiographs including developing countries, disaster zones, or with emergency personnel.
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