Document Type: Original Article

Authors

Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Objective: Ultrasonography (US) is not the method of choice for the diagnosis of calcaneal fractures. The aim of this study was to compare the diagnostic accuracy of US with plain radiography in the diagnosis of calcaneus fractures following blunt ankle and foot trauma. Methods: In this cross-sectional study, 214 patients (over 18 years) presenting to the emergency department (ED) with suspicion of traumatic calcaneus fracture following acute blunt trauma, were enrolled. Bedside ultrasonography was performed and interpreted by emergency physicians. After that, plain radiography was performed. Furthermore, all the patients were assessed by computed tomography (CT) scan as the gold standard. Results: Finally, 193 patients were enrolled with a mean age of 29.4±15.7 years (85.5% male). Fractures in the calcaneus were detected in 49 patients. The sensitivity and specificity of ultrasonography in the detection of calcaneal fractures were 83.6%, (confidence interval (CI), 69.7 –92.2) and 100% (95% CI, 96.7 –100), while the sensitivity and specificity of X-ray were 87.7% (95% CI, 74.5 –94.9) and 100% (95% CI, 96.7 –100). There was no false positive result for X-ray and US. Conclusion: Our findings suggest that bedside US with an acceptable sensitivity and specificity can be used as a promising alternative for the diagnosis of calcaneal fracture in ED.

Keywords

Main Subjects

 1. Eiff MP, Hatch RL. Fracture Management for Primary Care. 3rd ed. Philiadelphia: Elsevier Saunders; 2012.

2. Court-BrownCM, Heckman JD, McQueen MM, RicciWM, Tornetta P, McKee MD. Rockwood and Green’s Fractures in Adults. Philadelphia: Wolters Kluwer Health; 2015.

3. Sanders RW, Clare MP. Calcaneous fractures. In: Bucholz RW, Heckman JD, Court-Brown CM, Tornetta P, eds. Rockwood and Green’s Fractures in Adults. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2010. p. 2064.

4. Lukac D, Milenović N, Drapsin M, Kecojević V, Sekulić S, Klasnja A. Ultrasonographic diagnostics and evaluation of calcaneal fracture: case report. Srp Arh Celok Lek 2013; 141(7-8): 532-5. doi: 10.2298/sarh1308532l.

5. MitchellMJ, McKinley JC, RobinsonCM. The epidemiologyof calcaneal fractures. Foot (Edinb) 2009; 19(4): 197-200. doi: 10.1016/j.foot.2009.05.001.

6. Bianchi S, Luong DH. Stress fractures of the calcaneus diagnosed by sonography: report of 8 cases. J Ultrasound Med 2018; 37(2): 521-9. doi: 10.1002/jum.14276.

7. Augustin-Coley BM, Pigott DC, Gibson CB, Vander Noot RM, Gullett JP. Diagnosis of a radiographically occult calcaneus fracture with bedside sonography. J Ultrasound Med 2016; 35(6): 1363-6. doi: 10.7863/ultra.15.08054.

8. Atilla OD, Yesilaras M, Kilic TY, Tur FC, Reisoglu A, Sever M, et al. The accuracy of bedside ultrasonography as a diagnostic tool for fractures in the ankle and foot. Acad Emerg Med 2014; 21(9): 1058-61. doi: 10.1111/acem.12467.

9. Heydari F, Samsam Shariat S, Majidinejad S, Masoumi B. The use of ultrasonography for the confirmation of pulled elbow treatment. J Emerg Pract Trauma 2018; 4(1): 24-8. doi: 10.15171/jept.2017.24.

10. Hoffman DF, Adams E, Bianchi S. Ultrasonography of fractures in sports medicine. Br J Sports Med 2015; 49(3): 152-60. doi: 10.1136/bjsports-2014-094217.

11. Aygün M, Yaman HF, Bayındır A. The use of ultrasonography-guided peripheral intravenous access in emergency department patients with difficult venous access. Eurasian J Emerg Med 2010; 9: 9-16. doi: 10.4170/ jaem.2009.86580.

12. Evrin T, Katipoglu B, Szarpak L, Yılmaz A, Ünlüer EE. A new tool in the examination of lungs in the emergency department: lung ultrasound. Eurasian J Emerg Med 2017; 16(3): 137-40.

13. Heydari F, Masoumi B, Zamani M, Nasr-Esfahani M. Prospective evaluation of safe observation period after asymptomatic penetrating thoracic injury: 1 hour is enough. Adv J Emerg Med 2019; 3(4): e39. doi: 10.22114/ ajem.v0i0.148.

14. Golshani K, Ebrahim Zadeh M, Farajzadegan Z, Khorvash F. Diagnostic accuracy of optic nerve ultrasonography and ophthalmoscopy in prediction of elevated intracranial pressure. Emerg (Tehran) 2015; 3(2): 54-8.

15. Kozaci N, Ay MO, Avci M, Beydilli I, Turhan S, Donertas E, et al. The comparison of radiography and point-ofcare ultrasonography in the diagnosis and management of metatarsal fractures. Injury 2017; 48(2): 542-7. doi: 10.1016/j.injury.2016.12.018.

16. Haapamaki VV, Kiuru MJ, Koskinen SK. Ankle and foot injuries: analysis of MDCT findings. AJR Am J Roentgenol 2004; 183(3): 615-22. doi: 10.2214/ajr.183.3.1830615.

17. Arni D, Lambert V, Delmi M, Bianchi S. Insufficiency fracture of the calcaneum: Sonographic findings. J Clin Ultrasound 2009; 37(7): 424-7. doi: 10.1002/jcu.20577.

18. Ozturk P, Aksay E, Oray NC, Bayram B, Basci O, Tokgoz D. Emergency physician accuracy using ultrasonography to diagnose lateral malleolar fracture. Am J Emerg Med 2018; 36(3): 362-5. doi: 10.1016/j.ajem.2017.08.020.

19. Weinberg ER, Tunik MG, Tsung JW. Accuracy of clinicianperformed point-of-care ultrasound for the diagnosis of fractures in children and young adults. Injury 2010; 41(8): 862-8. doi: 10.1016/j.injury.2010.04.020