Table 4.
Characteristics of the studies included in the narrative synthesis.
| Author | Year | Study type | Reports |
|---|---|---|---|
| Bencardino et al. 1 | 2017 | Narrative review | Trabecular stress fractures may go undetected by ultrasound because it cannot assess the subcortical bone. Despite being praised for being quick and inexpensive to execute, it has drawbacks to its operator dependence |
| Champagne et al. 3 | 2019 | Systematic review and meta-analysis | US presents a reasonable alternative to radiography in the diagnosis of scaphoid and metatarsal stress fractures, and Hill-Sachs lesions. Fractures at these anatomical sites are often radiographically occult at the time of injury, and a more accurate diagnostic test might facilitate the initial screening of patients. While other imaging modalities such as CT and MRI have been shown to accurately diagnose these injuries, these have significant limitations. Therefore, as US shows relatively high SN for these types of fracture across the included trials |
| Akimoto et al.[16] | 2020 | Prospective | Negative pocket-sized US findings of cortical discontinuity and joint fluid retention in the hip are useful for ruling out femoral proximal fractures and acute hip arthritis. pocket-sized US and XR have comparable diagnostic accuracies, and pocket-sized US could aid in the initial assessment of acute hip pain among the elderly in primary care settings. |
| Kwee et al. 14 | 2018 | Systematic review | The SN and SP of ultrasound in diagnosing radiographically occult scaphoid fracture ranged from 77.8 to 100% and from 71.4 to 100%, respectively, with pooled estimates of 85.6% (95% CI: 73.9%, 92.6%) and 83.3% % (95% CI: 72.0%, 90.6%), respectively. |
| Hwang et al. 19 | 2018 | Systematic review | The accuracy of US was significantly higher (P<0.001) than that of plain film (67.7%±4.7%). |
| Glorioso et al. 13 | 2022 | Cross-sectional | US enabled diagnosis of micro-injuries which were invisible to XR and allowed to detect possible damages to the sesamoid complex, providing a qualitative and quantitative evaluations of the post-traumatic alteration of the metacarpophalangeal joint of the first finger |
| Wu et al. 23 | 2021 | Systematic review and meta-analysis | The pooled SN, SP, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio for the diagnosis of foot and ankle fractures by US were 0.96 (95% CI, 0.90–0.99), 0.94 (95% CI, 0.88–0.97), 15.0 (95% CI, 7.9–28.6), 0.04 (95% CI, 0.02–0.11), and 367 (95% CI, 101–1338), respectively. |
| De Krom et al. 25 | 2022 | Systematic review and meta-analysis | The present study found SN and SP ranges of 0.20–0.90 and 0.38–0.97 for clinical features, MRI 0.57–0.85 and 0.81–1.00, ultrasonography 1.00 and 0.89–1.00, Malleolar Medial Fleck Sign 0.25 and 0.99, Ankle Mortise X-ray conventional 0.33–0.57 and 0.60–0.94, gravity stress radiography 0.71–1.00 and 0.72–0.88, and manual stress ankle radiography 0.65–1 .00 and 0.00–0.77. The largest AUC was found for ultrasound. |
| Su et al. 29 | 2018 | Prospective | All of the screening strategies, including the universal screening with dual-energy X-ray absorptiometry and the pre-screening with the Fracture Risk Assessment Tool or Quantitative Ultrasonography before dual-energy X-ray absorptiometry, were consistently more cost-effective than no screening for people aged 65 years old or over. |
| Nicholson et al. 10 | 2019 | Narrative review | Early studies have shown the potential of ultrasound as a valid alternative to XR to detect occult injuries in adults, and for rapid detection of long bone fractures in the resuscitation setting. |
| Schmid et al. 11 | 2020 | Cross-sectional | On average, General Practitioners diagnosed six patients with suspected fractures per month, yet only 39.3% knew about the possibility of ultrasonographic fracture diagnosis, and only 4.3% of General Practitioners using US applied it for this purpose. |
| Gottlieb et al. 30 | 2019 | Systematic review and meta-analysis | POCUS was also 97.9% (95% CI 10.5–100%) SN and 99.8% (95% CI 28.0–100%) SP for the diagnosis of associated fractures. |
| Lalande et al.[32] | 2017 | Cross-sectional | A majority (65%) of emergency physicians concluded that the POCUS technique to diagnose rib fracture was feasible (VAS score > 50). Median score for feasibility was 63. Median score was 31 (Interquartile range 5–57) for patients’ pain related to the POCUS |
| Schaper et al. 22 | 2021 | Systematic review and narrative synthesis | A clear outline of common stress fracture appearances using US were identified in a combined total of 119 participants. Each finding was ranked according to its popularity. Periosteal thickening (78/119) and cortical disruption/irregularity (83/119) were noted in all eight studies. Hypervascularity of the periosteum visualised by colour Doppler imaging (66/119) was reported in six of the eight studies. Soft-tissue hypervascularity (13/119), bony callus formation (5/119) and cortical break (22/119) were seen in three studies. |
AUC, area under the curve; CT, computed tomography; POCUS, point of care ultrasound; SN, sensitivity; SP, specificity; US, ultrasound; VAS, Visual Analogue Scale; XR, X-ray.