Ultrasound Versus Landmarks for Great Toe Arthrocentesis

Area of Science:

• Orthopedic Surgery
• Medical Imaging
• Emergency Medicine

Background:

• Ultrasound (US) is recognized for superior joint aspiration in larger joints compared to traditional landmark (LM) techniques.
• Limited research exists on US efficacy for smaller joints, specifically toe joints.

Purpose of the Study:

• To determine if ultrasound (US) offers an advantage over landmark (LM) techniques for successful first-pass aspiration of first metatarsophalangeal joint (1st MTPJ) effusions.

Main Methods:

• A randomized, cross-over cadaveric trial involving 18 emergency medicine residents.
• Each resident performed 4 US-guided and 4 LM-guided aspirations of simulated 1st MTPJ effusions.
• Primary outcome was aspiration success; secondary outcome was time to successful aspiration.

Main Results:

• A total of 144 aspirations were performed (72 US, 72 LM).
• Success rates were 79.2% for US and 73.6% for LM (p=0.56), with no statistically significant difference.
• Successful US aspirations averaged 43.7 seconds, while LM averaged 34.0 seconds (p=0.07), also not statistically significant.

Conclusions:

• Ultrasound (US) guidance did not demonstrate superiority over landmark (LM) techniques for first-pass aspiration of 1st MTPJ effusions in this study.
• Neither success rate nor time to aspiration differed significantly between the two methods.