This month CanadiEM is featuring an article from the Canadian Journal of Emergency Medicine (CJEM) that looks at the use of point-of-care ultrasound (POCUS) in assessing long bone fractures (LBFs).1 The diagnosis and assessment of LBFs post-reduction is traditionally accomplished through plain radiographs taken at perpendicular angles to each other. However, some studies have suggested PoCUS may be used as a viable alternative.
To address this question, Chartier et al. performed a systematic review and meta-analysis of the literature. Based on inclusion and exclusion criteria, a total of 30 articles were included in the systematic review.Across 30 articles, they found that POCUS had a sensitivity and specificity for the diagnosis of long bone fractures of 64.7-100% and 79.2-100% respectively. By contrast, the sensitivity and specificity of POCUS in assessing post-reduction alignment was found to be 94-100% and 56-100% respectively. In addition to the systematic review, two meta-analyses were performed for two subpopulations of patients: pediatric forearm and adult ankle fractures. The pooled sensitivity and specificity for diagnosing pediatric forearm fracture by POCUS was found to be 93.1% and 89.5% respectively. For adult ankle fractures, the pooled sensitivity and specificity was 89.5% and 94.2% respectively.
Overall, this study shows that POCUS has good accuracy for the diagnosis and reduction alignment of LBFs in all cases and could be used as a reasonable alternative in certain settings.