Abstract

Purpose:

Diagnosis of hand fractures is commonly performed in the emergency room or in the hand clinic with the aid of fluoroscopy. This results in frequent exposure of healthcare workers to radiation and requires expensive and bulky equipment for fluoroscopy. It also requires proper shielding of the patients and the healthcare workers, which can be cumbersome and time consuming and is often neglected.

With the intent to perform procedures using safer, faster and less expensive diagnostic methods, we decided to attempt diagnosing hand fractures with ultrasound guidance.

Materials and Methods:

Twenty residents involved with the diagnosis of hand fractures (Plastic Surgery, Orthopedic Surgery, Trauma and Emergency Medicine) were asked to perform an ultrasound exam using a 15 Mhz ultrasound probe on five previously prepared cadaver hands. The hands presented either a Benett's fracture, a Scaphoid fracture, a Boxers fracture, a proximal phalanx fracture or no fracture at all.

Results and conclusions:

The results of this study showed that the diagnostic accuracy of the ultrasound in the hands of residents without prior ultrasound experience varied with the location of the fracture. Over 90% of residents correctly diagnosed phalanx fractures and correctly identified the “decoy” lesion as not having a fracture. Over 80% identified the boxers fracture and the Benett's fracture.

In contrast, less than 50% of the residents were able to identify the scaphoid fracture correctly.

We conclude that ultrasound can be used as an alternative method for the diagnosis of hand fractures. The diagnostic accuracy varies in the hands of unexperienced physicians, suggesting that training and experience are needed, especially for the diagnosis of carpal fractures.