A study of portable ultrasound in detecting the presence of minor fractures in patients showed that 85% of patients with a fracture confirmed by X-ray had injuries detected through ultrasonography.

You'd still want a radiographer to rule out fractures but emergency clinicians could rule in fractures using ultrasound images, they conclude.

Ultrasound is a high pitched sound wave generated at a frequency of more than 20,000Hz in air, though the frequency changes depending on the density of the objects through which it passes.

Over a 12 month period, 97 patients with suspected minor fractures who turned up to Cirencester Hospital’s minor injury unit volunteered to participate in the study, which is reported in this month’s issue of Emergency Nurse journal.

Following clinical assessments of suspected limb fractures where the skin was not broken (closed fractures), patients were referred to X-ray, as usual, but also for ultrasound imaging of their injured area. Images from both were then compared.

Results showed that 60 patients (62%) had fractures confirmed by normal routine X-ray assessment. Analysis showed that 51 of these patients (85%) had injuries detected through ultrasonography. The ultrasound picked up on 87% of the 24 patients with arm fractures.

Ultrasound is easy to perform at the bedside and patients who took part in the study said it is more convenient, less painful and distressing than radiography. Ultrasound also allows the comparison of right and left limbs without concern about multiple exposure to irradiation. From a staff point of view, ultrasonography training is minimal, and its use also has the potential to save money for emergency care settings.

Authors Salam Musa and Paul Wilson said, ‘The study suggests that ultrasonography is a reliable way to detect fractures of the distal radius or ulna and it is reasonable to conclude that portable ultrasound devices will play an increasingly significant role in the assessment of patients with suspected minor or even subtle fractures in emergency care settings.’

Musa S., Wilson P., 'Ultrasonography and radiography: a comparison', Emergency Nurse, 23, 2, 34-37. DOI:10.7748/en.23.2.34.e1416