• Vivek S Tayal, Jill Antoniazzi, Manoj Pariyadath, and H James Norton.
• Department of Emergency Medicine, Carolinas Medical Center, Box 32861, Charlotte, NC 28232, USA. vtayal@carolinas.org
• J Ultrasound Med. 2007 Sep 1;26(9):1143-8.

ObjectiveWe hypothesized that high-resolution linear ultrasound imaging performed by emergency sonologists would be accurate in the diagnosis of bony injuries of the hand.MethodsThis 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.ResultsA 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.ConclusionsUltrasound imaging performed by emergency sonologists showed excellent sensitivity and specificity in the diagnosis of hand fractures.

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