What is the role of imaging studies in the workup of foot fractures?

Updated: Sep 23, 2018
  • Author: Robert Silbergleit, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Answer

Bone scanning, CT scanning, MRI, and ultrasonography may help diagnose certain foot fractures that are occult on plain film radiography. [19, 20] Although recent anecdotal reports and small diagnostic trials suggest that ultrasonography may someday have a role in routine assessment of acute foot fractures, [21, 22] second-line imaging studies generally do not need to be performed while the patient is in the ED and are usually ordered only after consultation with a foot surgeon.

Bedside ultrasonography in addition to Ottawa Foot and Ankle Rules (OFAR) in acutely injured patients was found to reduce the number of ordered x-rays and length of stay in ED in patients 18 years and older. The sensitivity of US in detecting foot and ankle fractures was 100%, and the specificity of OFAR increased from 50% to 100% with the addition of US. The negative predictive value and positive predictive value were both 100%. [23]


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