Emergency physician accuracy using ultrasonography to diagnose lateral malleolar fracture

Am J Emerg Med. 2018 Mar;36(3):362-365. doi: 10.1016/j.ajem.2017.08.020. Epub 2017 Aug 7.


Objective: Many studies in the literature related to the investigation of the sensitivity and specificity of ultrasound examinations in lateral malleolar fractures is limited. The aim of this study is to investigate the sensitivity and specificity of ultrasound examinations performed by emergency physicians in fractures who are presented to the emergency department with blunt lateral malleolar trauma.

Method: Patients over 18years of age who were admitted to the ED with lateral malleolar tenderness were enrolled to this study with convenience sampling. Ultrasonographic examination was performed by emergency physicians. Following the ultrasound examination, a two-sided X-ray was performed. In the case of inconsistency between the US exam and the X-ray evaluated by the emergency physician, a CT was performed on the patients. The X-ray or CT imaging evaluation of an orthopedic surgeon was accepted as the gold standard.

Results: A hundred-twenty patients were included in the study. Fractures in the lateral malleolus were detected in 47 patients. The sensitivity of X-ray in the diagnosis of lateral malleolar fractures was 92.8%, (95% CI, 79.4-98.1) and the specificity was 100% (95% CI, 89.5-100), while the sensitivity of US exam was 100% (95% CI, 94.1-100), and the specificity was 93% (95% CI, 85-97.6). X-ray gave false negative results in 3 patients, whereas US gave false positive results in 5 patients.

Conclusion: In patients admitted to ED with lateral malleolus tenderness, the sensitivity of the ultrasound examination performed by emergency physicians regarding diagnosis of lateral malleolar fracture is higher than X-ray.

Keywords: Emergency department; Lateral malleolar fracture; Ultrasonography.

MeSH terms

  • Adult
  • Ankle / diagnostic imaging
  • Ankle Fractures / diagnostic imaging*
  • Emergency Service, Hospital* / standards
  • Emergency Service, Hospital* / statistics & numerical data
  • Female
  • Humans
  • Male
  • Prospective Studies
  • Radiography
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed
  • Ultrasonography* / standards