What is the role of bedside ultrasonography in the evaluation of rib fractures?

Updated: Jun 13, 2017
  • Author: Sarah L Melendez, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Answer

Bedside ultrasonography by emergency physicians has been described and provides rapid diagnosis with no radiation exposure. [33]

Advantages include diagnosis of fracture in unossified bone in children, and diagnosis of other rib fractures that may be missed on plain radiographs. Small preliminary studies suggest that ultrasonography may be more sensitive than chest radiography in detecting rib fractures when physicians who perform the examination are comfortable using the technique. [34, 35, 36, 37]

Ultrasound also detects costal cartilage fractures and costochondral junction fractures better than radiography. Healing fractures with callous formation and sternal fractures may also be sonographically detected.

The technique includes first clinically identifying the site of maximal tenderness, then using a high-frequency 7-MHz to 12-MHz linear transducer. The transducer is placed perpendicular to the long axis of the rib to identify the posterior surface of the rib by its distinct acoustic shadowing and then rotated 90 degrees to detect any discontinuity of cortical alignment, seen as a break in the hyperechoic rib margin. [33]

Other reported but less common sonographic signs suggestive of fracture include the following: a linear acoustic edge shadow posterior to the fracture, a reverberation artifact posterior to the fracture, and the presence of a hypoechoic hematoma. Once a rib fracture is diagnosed, ultrasonography can then be conveniently and reliably used to exclude the likely complications of pneumothorax and hemothorax. [33]

A limitation is that retroscapular ribs and the infraclavicular portion of the first rib are technically inaccessible by sonography. However, these are uncommon sites for rib fractures. [33]


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