Keywords:
Emergency, Musculoskeletal bone, Plain radiographic studies, Audit and standards, Decision analysis, Patterns of Care
Authors:
C.-T. Cheng, D. Varma, D. Smit; VIC/AU
DOI:
10.1594/ranzcr2016/R-0011
Results
A total number of 394 patients were included in this study,
with 404 instances of ankle imaging.
The mean age was 38.5 years,
and approximately half (47.5%) of the patients were female.
In this study,
the overall prevalence of ankle fractures was 23.8%.
There was a reasonable compliance with the OAR with imaging,
with 87.6% of ankle imaging being compliant with the OAR indications.
25.9% of cases that had a positive score for the OAR had a positive or suspicious radiography for an ankle fracture (detailed in Table 1).
The sensitivity of the OAR in this study was found to be 0.96 (95% CI 0.89-0.99),
with a specificity of 0.15 (95% CI 0.11-0.19).
The positive likelihood ratio was 1.12 (95% CI 1.05-1.19) and the negative likelihood ratio was 0.29 (95% CI 0.11-0.77).
In addition to ankles,
there were 154 instances of a different associated joint imaged which included the knee,
leg,
calcaneum,
foot and toes.
Of these,
20.1% found additional positive or suspicious fractures in areas other than the ankle.
Furthermore,
in 8 instances,
imaging of the ankle revealed positive or suspicious fractures in the foot.
There were also 16 instances where further imaging such as computed tomography or magnetic resonance imaging was conducted.
Of these,
only 1 case revealed a subchondral undisplaced fracture through the anterior aspect of the distal tibial physeal scar on MRI that was interpreted as subchondral sclerosis on the plain film.