Ultrasound-assisted triage of ankle trauma can decrease the need for radiographic imaging.

Area of Science:

• Emergency Medicine
• Radiology
• Orthopedic Surgery

Background:

• Ankle sprains are common, but most patients undergo radiography to rule out fractures, exposing them to unnecessary radiation.
• Plain radiographs are often overutilized in evaluating ankle trauma, despite low fracture rates.

Purpose of the Study:

• To determine if ultrasound (US)-guided triage can reduce the need for radiographic imaging in patients with ankle trauma.
• To assess the feasibility of point-of-care US for orthopedic surgeons in triaging ankle injuries.

Main Methods:

• Seven junior orthopedic surgeons received 30 minutes of standardized training on a basic US examination for ankle fractures.
• 122 patients with ankle trauma were evaluated using clinical examination (Ottawa ankle rules), US, and radiography.
• The study compared the diagnostic accuracy of US triage against radiographic findings for significant fractures.

Main Results:

• Ultrasound-guided triage could have potentially avoided radiographs in 85 out of 122 patients.
• All 23 significant fractures identified by radiography were correctly flagged by US as unable to exclude.
• Ottawa ankle rules alone excluded the need for radiographs in only 28 patients.

Conclusions:

• Limited US training enables junior orthopedic surgeons to effectively triage ankle trauma in the ED.
• US-guided triage significantly decreases the need for radiographic imaging, reducing costs and radiation exposure.
• This method allows for faster treatment initiation for patients with ankle trauma.