Use of Ultrasound for Diagnosis of Clavicle Fractures in the Emergency Department

Background: Plain radiography is the method for diagnosing the fracture of the clavicle. The use of US to diagnose clavicle fracture has several advantages when compared to radiography. It could prevent the patient from radiation exposure, especially in vulnerable populations. It may also expedite the diagnosis and decrease the length of stay in the ED. In this study we aimed to discuss the diagnostic success of ultrasonography versus x-ray. Materials and Method: All patients admitted to the emergency department with a shoulder trauma were investigated for their eligibility to be included in the study. A standardized ultrasonography performed by the same investigator to vizualise clavicle from sternal junction through acromial junction. After ultrasonography, plain radiography was performed. Results: The mean age was 45.53 (min = 18; max = 86; SD = 18.791) years and 72.7% were male. Among all patients, 42 clavicula fractures were detected via graphy and 26 (62%) were seen in males and 57 patients with no clavicle fractures. The sensitivity of US to radiographically detected fracture was 92.86% (95%CI, 80.52% to 98.5%), and the specificity was 98.25% (95%CI = 90.61% to 99.96%). The PPV was 97.5% (84.8% to 99.63%) and the NPV was 94.92% (95% CI = 86.23% to 98.23%). Conclusions: Ultrasonography is a good alternative for diagnosing clavicle fracture. Future studies should examine the use of ultrasonography as a method for diagnosing of clavicle fracture by emergency physicians with only basic ultrasonographic training.

Trauma, Clavicle fracture, Ultrasonography

[1] Control CfD, Prevention. National Hospital Ambulatory Medical Care Survey: 2010 Emergency Department Summary Tables. Centers for Disease Control and Prevention. 2016.

[2] Herteleer M, Winckelmans T, Hoekstra H, et al. Epidemiology of clavicle fractures in a level 1 trauma center in Belgium. Eur J Trauma Emerg Surg. 2018;44:717-726.

[3] Wiesel B, Nagda S, Mehta S, et al. Management of midshaft clavicle fractures in adults. J Am Acad Orthop Surg. 2018;26:e468-e476.

[4] Anderson K. Evaluation and treatment of distal clavicle fractures. Clin Sports Med. 2003;22:319-326, vii.

[5] Dogan S, Kalafat UM, Yüksel B, et al. Use of radiography and ultrasonography for nasal fracture identification in children under 18 years of age presenting to the ED. Am J Emerg Med. 2017;35:465-468.

[6] Park YH, Jung RB, Lee YG, et al. Does the use of bedside ultrasonogra-phy reduce emergency department length of stay for patients with renal colic?: a pilot study. Clin Exp Emerg Med. 2016;3:197-203.

[7] McNeil CR, McManus J, Mehta S. The accuracy of portable ultrasonog-raphy to diagnose fractures in an austere environment. Prehosp Emerg Care. 2009;13:50-52.

[8] Marshburn TH, Legome E, Sargsyan A, et al. Goal-directed ultrasound in the detection of long-bone fractures. J Trauma. 2004;57:329-332.

[9] Cross KP, Warkentine FH, Kim IK, et al. Bedside ultrasound diagnosis of clavicle fractures in the pediatric emergency department. Acad Emerg Med. 2010;17:687-693.

[10] Chien M, Bulloch B, Garcia-Filion P, et al. Bedside ultrasound in the diagnosis of pediatric clavicle fractures. Pediatr Emerg Care. 2011;27:1038-1041.

[11] Patten RM, Mack LA, Wang KY, et al. Non-displaced fractures of the greater tuberosity of the humerus: sonographic detection. Radiology. 1992;182:201-204.

[12] Weinberg ER, Tunik MG, Tsung JW. Accuracy of clinician-performed point-of-care ultrasound for the diagnosis of fractures in children and young adults. Injury. 2010;41:862-868.

[13] Chen L, Kim Y, Moore CL. Diagnosis and guided reduction of forearm fractures in children using bedside ultrasound. Pediatr Emerg Care. 2007;23:528-531.

[14] Moritz J, Berthold L, Soenksen S. Ultrasound in diagnosis of fractures in children: unnecessary harassment or useful addition to X-ray? Ultraschall Med. 2008;29:267-274.

[15] Ekþioðlu F, Altýnok D, Uslu MM. Ultrasonographic findings in pediatric fractures. Turk J Pediatr. 2003;45:136-140.

[16] Sferopoulos N. Fracture separation of the medial clavicular epiphysis: ultrasonography findings. Arch Orthop Trauma Surg. 2003;123:367-369.

[17] Katz R, Landman J, Dulitzky F, et al. Fracture of the clavicle in the newborn. An ultrasound diagnosis. J Ultrasound Med. 1988;7:21-23.

[18] Blab E, Geissler W, Rokitansky A. Sonographic management of infantile clavicular fractures. Pediatr Surg Int. 1999;15:251-254.