Screening Characteristics of Ultrasonography in Detection of Ankle Fractures

Introduction: Ankle fracture is one of the most common joint fractures. X-ray and physical examination are its<br />main methods of diagnosis. Recently, ultrasonography (US) is considered as a simple and non-invasive method<br />of fracture diagnosis. This study evaluated the diagnostic accuracy of US in detection of ankle fracture in comparison<br />to plain radiography. Methods: In this diagnostic accuracy study, which was done in emergency departments<br />of Imam Hossein and Shohadaye Tajrish hospitals, Tehran, Iran, during 2014, 141 patients with suspected<br />diagnosis of distal leg or ankle fracture were examined by US and radiography (gold standard), independently.<br />Screening performance characteristics of US in detection of distal leg fractures were calculated using SPSS version<br />21. Results: 141 patients with the mean age of 34§11.52 years (range: 15–50) were evaluated (75.9% male).<br />Radiography confirmed ankle fracture in 102 (72.3%) patients. There was a significant correlation between the<br />results of US and radiography [Agreement: 95%; kappa: 0.88 (95% CI: 0.80–0.97); P Ç 0.001]. The screening performance<br />characteristics of US in detection ankle fracture were as follows: sensitivity 98.9% (95% CI: 93.5% -<br />99.9%), specificity 86.4% (95% CI: 71.9%–94.3%), PPV 94.1% (95% CI: 87.1%–97.6%), NPV 97.4% (95% CI: 84.9%–<br />99.8%), PLR 16 (95% CI: 7.3–34.8), and NLR 0.02 (95% CI: 0.003 – 0.182). The area under the ROC curve of US<br />in this regard was 95.8 (95% CI: 91.9§99.7). Conclusion: According to the results of this study, we can use US<br />as an accurate and non-invasive method with high sensitivity and specificity in diagnosis ofmalleolus fractures.<br />However, the inherent limitations of US such as operator dependency should be considered in this regard