Emergency Medicine Thu 09 July 2020 Waterbath evaluation technique for ultrasound of distal hand and foot injuries in emergency department..
Keywords :  FracturePocusTraumaWaterbathEmergency 
Researcher : Shrimal prawal
Research Guide : Bhoi sanjeev
Institution Name : All india institute of medical sciences new delhi


Background: Hands and feet are the most functional organs of human body. Therefore, appropriate management of their fractures is an important aspect of emergency medicine practice. Diagnosis relies on clinical examination and radiographs which are often inconclusive. Sonography using a gel mound is a standard technique for evaluation of soft tissue structures. However, complex curved structures often yield suboptimal contact. The solution may lie in an age old waterbath technique in which the extremity is immersed in a waterbath which acts as a media for the ultrasound waves. Aims: To compare the diagnostic utility of waterbath ultrasound technique to x-ray in diagnosis of fractures of small bones of hand and foot. Settings & Design: prospective cross sectional(diagnostic) study. Materials & Methods: A 12 inch plastic toybox filled with water would be used as the waterbath. The affected extremity is immersed in the water such that the superior surface is just below the water edge. scanning is performed by linear probe placed 1 cm away from the injury site. Extremity will be examined from plantar, dorsal, medial and lateral sides along long and short axis. After it, the patient would be taken for radiographs. Statistical Methods: All the data was collected in predesigned proforma and entered into Microsoft excel spread sheet in computer. We expressed the test data as frequencies for nominal variables and as mean ± SD or median with range for continuous variables. The data was analysed using spss software and the sensitivity, specificity, Positive likelihood ratio, Negative likelihood ratio, Positive predictive value, Negative predictive value and accuracy was calculated for the xray, ultrasound, long axis and short axis separately.Result: A total of 100 patients were recruited in the study- 50 cases of suspected hand fractures, and 50 cases of suspected foot fractures. 1 patient was dropped out because disposition was unclear.73.73% (n=73) were males and 26.26%(n=26) were females. The test characteristics of waterbath technique were as follows: sensitivity – 96.82%(95% CI 89.16-99.62), specificity – 94.44%(95% CI 81.34 – 99.32), PLR – 17.41(95% CI 4.53-67.10), NLR -0.03(95%CI 0.01 – 0.13), PPV – 96.82%(95%CI- 89.96-99.17), NPV – 94.44%(95% CI – 81.26-98.52), Accuracy – 95.95%(95% CI – 90.07-98.90). Conclusions: In comparison with the xrays, waterbath ultrasound technique has excellent performance characteristics in terms of sensitivity, specificity, PLR, NLR, and accuracy. The performance was better in hand as compared to the foot which can be explained by the complex anatomy of the foot and difficulty in maneuvering the probe around it. Both of the missed fractures in the study were in the foot region, one of which was due to incorrect alignment of the USG probe with the fracture line(5th metatarsal fracture), and the other one was due to difficulty in maneuvering the probe around hindfoot region(talus fracture). Both of the false positive cases in the waterbath technique were due to proximity with the joint space.

DOI: 1594293364   Year of publication: 2019

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