Goal-directed Ultrasonography for Detecting Traumatic X-ray Missed Fibula Fracture in the Emergency Department

We present the case of a 45-year-old man who presented to the emergency department (ED) for ankle trauma sustained during a football match. Physical examination and X-ray of his ankle were negative for bone fractures. He was discharged from the ED, but returned 3 weeks later with a painful and swelling leg. Compressive ultrasonography of his right lower limb was negative for venous thrombosis, but ultrasound evaluation of the leg clearly showed a fibula fracture. Although the diagnosis of fractures usually relies on X-ray, the literature contains many reports of goal-directed ultrasound diagnosis of long bone fracture in military settings and remote locations. The usefulness of a noninva-sive examination like bedside ultrasonography and goal-directed evaluation of patients in the ED are discussed, with reference to the literature.