Can Proximal Fibular Fractures Be Identified With Ultrasound By Novice Users In the Anatomy Lab

WANG David1, Sean HERRIN1, Brion BENNINGER1-9. Medical Anatomy Center1, Departments of Medical Anatomical Sciences2, Neuromuscular Medicine3, Family Practice4, Western University of Health Sciences, COMP–Northwest, Lebanon,... [ view full abstract ]

WANG David1, Sean HERRIN1, Brion BENNINGER1-9. Medical Anatomy Center1, Departments of Medical Anatomical Sciences2, Neuromuscular Medicine3, Family Practice4, Western University of Health Sciences, COMP–Northwest, Lebanon, OR. USA. Departments of Orthopaedics5, General Surgery6 and Sports Medicine7, Samaritan Health Services, Corvallis, OR. USA. Departments of Surgery8, Orthopaedics & Rehabilitation9, Oregon Health & Science University, Portland, OR. USA.

INTRODUCTION. Proximal fibular fractures occur most often in conjunction with other lower limb injuries, such as tibial trauma or twisting injuries causing Maisonneuve fractures, which are reported to be easily overlooked during initial physical examination (undiagnosed in over 11% of cases). Ultrasound has been found to identify fractures in long bones. The objective of this study was to investigate if medical students without any previous ultrasound experience could identify proximal fibular fractures with variable probes on embalmed cadavers. METHODS. Literature search was conducted to investigate ultrasound diagnosing of proximal fibular fractures on embalmed cadaveric specimens. Fukuda Denshi and eSoate ultrasound systems were used with a novel SonicEye finger probe (SFP) and an eSoate 18MHz classic linear probe (CL). 10 embalmed cadavers (n=20 sides) were imaged by 10 healthcare profession students (n=360 trials). These students had no previous teaching or experience with ultrasound (this was their first exposure). Students initially used the SFP on the first pass and the CL on the second pass. RESULTS. Literature search revealed no known studies. SFP demonstrated higher sensitivity and specificity vs. CL (SFP sensitivity: 56%, specificity: 76%, CL sensitivity: 35%, specificity: 68%). DISCUSSION. Students omitted fractures better than identifying them. The more favorable results of the SFP may have been due to control by placing their hand in a particular position allowing stable image acquisition. CL was prone to movement with slight body changes from users rendering it less stable acquiring images. Although the CL was expected to reveal better results, the SFP was favorable. The CL has a wider footplate for viewing compared to the SFP, which has a relatively narrower footplate. This may explain the better stability of image acquisition by the SFP. CONCLUSION. This study revealed true first time US users could identify proximal fibular fractures favoring SFP.