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

BACKGROUND: An ankle sprain is a common injury, and patients are usually examined with plain radiographs to rule out a fracture despite the fact that only a small minority actually have one. PURPOSE: To investigate if ultrasound (US)-guided triage can decrease the need for radiographic imaging in patients with ankle trauma. HYPOTHESIS: Orthopedic surgeons can use point-of-care US with limited training to triage ankle trauma that requires standard radiographs. METHODS: Seven junior orthopedic surgeons underwent a 30-minute standardized training session using a basic US musculoskeletal examination designed to exclude ankle fractures. One-hundred twenty-two patients with ankle trauma were included at the emergency department and underwent clinical investigation, including examination according to the Ottawa ankle rules as well as US and standard ankle radiographs. In this study group, radiographs identified 23 significant fractures. Ultrasound-guided triage could not exclude a fracture in 37 patients. All of the 23 fractures seen on radiographs were among the 37 patients where US could not rule out a fracture. Ottawa ankle rules managed to exclude the need for radiographs in 28 of the 122 patients, whereas 85 who underwent the US-guided triage could have avoided a radiograph. Avulsion fractures at the tip of the fibula were not considered significant. CONCLUSION: This study demonstrates that with limited standardized training a junior, an orthopedic surgeon is able to use US-guided triage during the primary examination at the emergency department to exclude at least significant ankle fractures. This practice could decrease the need for radiographic imaging, avoiding a mandatory radiographic investigation in many patients with ankle trauma. It would also make it possible to treat many patients with ankle trauma more rapidly and to reduce costs and radiation exposure.

Osteoporosis in adults with meningomyelocele: an unrecognized problem at rehabilitation clinics.

OBJECTIVES: To assess the prevalence of osteoporosis and osteopenia in adults with meningomyelocele and to explore whether neurologic level, ambulatory status, and other medical problems are associated with bone mineral density (BMD). DESIGN: A cross-sectional study, including a self-administered questionnaire and clinical assessment. SETTING: Outpatient referral clinic in Sweden. PARTICIPANTS: Twenty-one adults (mean age, 30 y) with meningomyelocele admitted to the Young Adult Teams in Göteborg and Boras, Sweden. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: BMD in the lumbar spine and hip and forearm measured with dual x-ray absorptiometry. RESULTS: Seven (33%) subjects had osteoporosis in at least 1 of the measured sites. Three patients had osteopenia and 2 had osteoporosis in the lumbar spine. Among the 15 subjects whose BMD of the hip region could be reliably measured, 7 (47%) had osteoporosis in the femoral neck or trochanteric region of the hip. Subjects with other medical problems commonly occurring in meningomyelocele had lower BMD in the femoral neck and trochanteric region of the hip than subjects without such factors. Ambulation alone showed only a tendency to be associated with BMD of the femoral neck, whereas the effect of other medical risk factors on BMD of the femoral neck was stronger among the nonambulators than the ambulators. CONCLUSIONS: Our results show that osteoporosis is a medical problem to be considered when treating and rehabilitating patients with meningomyelocele.