European Journal of Molecular & Clinical Medicine

Abstract

Aim: To evaluate the diagnostic accuracy of ultrasonography in detecting nasal bone
fractures compared with CT as the reference standard.
Methodology: A cross-sectional study was conducted in the Department of Radiology,
Maharshi Medical College & Hospital, Kumarhatti, Dist. Solan, Himachal Pradesh, pin code
173229 for the period of 1 year. The study group consisted of 100 patients with nasal bone
fracture who were investigated by physical examination. These patients were then examined
by conventional radiography and sonography. Physical examination was considered as the
gold standard for the diagnosis of nasal bone fracture. All patients were investigated
radiographically by a lateral and a Waters view X-ray at the beginning. The results were
evaluated by a radiologist. The reports were then recorded as either “positive” or “negative”
according to the existence of nasal bone fracture. Then, patients were examined by
sonography. Soft tissue edema and subperiosteal hematoma was also examined as a possible
predictor to differentiate an acute from a chronic fracture. The negative and positive
likelihood ratios (LR- and LR+), NPV and PPV were calculated and used for determining the
diagnostic accuracy. The LR-of ultrasonography was lower than radiography. The LR+of
sonography for the diagnosis of nasal bone fracture was 65.20 [9.28-390.10] which represents
a large and conclusive increase in the likelihood of the fracture in the presence of positive
findings. Furthermore, LR of sonography was 0.14 [0.10-0.21] which proposed a large to
moderate decrease in the likelihood of the fracture, in the presence of negative findings. LR+
of radiography was 6.20 [2.87-6.27] which showed a small increase of the likelihood of
fracture in positive results and the LR¯ of x-ray was 0.36 [0.21-0.42] which proposed a small
decrease in the likelihood of the fractures when the findings were negative.
Results: In this study, 100 patients who had nasal bone fracture in their physical examination
were investigated by sonography and radiography. Of these patients, 31 were women and 69
were men. The mean age of patients was 24.7 years. 37 (37%) patients were between 20-30
years and 28 (28%) were between 30-40 years, and 5 (5%) patients were < 20 years of age
group, while 7 (7%) were > 50 yearsand 23 patients were between 40-50 years of age group.
The youngest patient included in the study was a 12 year old male child and the oldest
patientwas a male of 60 years of age. Of the 100 patients, 78 had nasal bone fracture
(according to physical examination) and 22 patients were found normal but were investigated
due to legal issues. Out of the 78 clinically proven nasal bone fracture cases, conventional
radiography showed a fracture line in 65 cases.