Ultrasound for Diagnosing Costochondral Joint Separation

This study investigates the diagnostic effectiveness of ultrasound (USG) in identifying costochondral joint separation in patients presenting with blunt thoracic trauma. The study aims to assess USG's sensitivity, specificity, and accuracy compared to computed tomography (CT), which is considered the gold standard.

Costochondral separation, a condition where the connection between the rib and its cartilage is disrupted, is often challenging to diagnose with traditional imaging techniques. Ultrasound offers a non-invasive, portable, and radiation-free alternative, potentially allowing for rapid diagnosis and improved patient outcomes.

Participants will undergo both USG and CT imaging as part of the diagnostic protocol. The primary outcome measure will be the diagnostic accuracy of USG in detecting costochondral joint separation. Secondary outcomes include time to diagnosis, patient comfort, and correlation of ultrasound findings with clinical presentations.

The study will be conducted prospectively at Ondokuz Mayıs University Faculty of Medicine from March 2025 to March 2027, involving a sample size of 51 patients based on power analysis. Data collected will include demographic information, trauma specifics, imaging findings, and clinical outcomes.

The results are expected to contribute significantly to the field of thoracic trauma care by demonstrating the utility of ultrasound in settings where quick and accurate diagnosis is critical.

• Ultrasound (USG) (Device): The intervention involves the use of a portable ultrasound (USG) device to assess costochondral joint separation in patients with blunt thoracic trauma. The ultrasound examination will focus on detecting disruptions in the connection between the ribs and cartilage, providing a non-invasive, radiation-free diagnostic method. A 12-MHz linear transducer will be used to scan the rib area for fractures or separations. The findings will be compared to those of computed tomography (CT), considered the gold standard. This intervention is designed to evaluate the accuracy, sensitivity, and specificity of ultrasound as a diagnostic tool in this context.

Primary outcomes

• Number of Participants with Accurate Ultrasound Diagnosis Compared to CT [Within the first 24 hours of patient admission.]: The diagnostic accuracy (sensitivity, specificity, and overall accuracy) of ultrasound (USG) in detecting costochondral joint separation, using computed tomography (CT) as the reference standard.

Sex: All, ages: 18 Years to 80 Years

Inclusion Criteria:

* Patients aged 18 to 80 years
* Patients with blunt thoracic trauma
* Patients suspected of having costochondral joint separation
* Patients who provide consent for ultrasound and CT imaging

Exclusion Criteria:

* Patients under 18 or over 80 years of age
* Patients with penetrating thoracic trauma
* Patients with subcutaneous emphysema that prevents ultrasound evaluation
* Patients allergic to ultrasound gel
* Pregnant patients (as CT imaging is contraindicated)
* Patients unable to undergo CT imaging
* Patients who refuse to participate in the study
* Obese patients (body mass index >30), as ultrasound evaluation may be challenging

• Results publication: Stengel D, Leisterer J, Ferrada P, Ekkernkamp A, Mutze S, Hoenning A. Point-of-care ultrasonography for diagnosing thoracoabdominal injuries in patients with blunt trauma. Cochrane Database Syst Rev. 2018 Dec 12;12(12):CD012669. doi: 10.1002/14651858.CD012669.pub2. PMID 30548249
• Results publication: Wilkerson RG, Stone MB. Sensitivity of bedside ultrasound and supine anteroposterior chest radiographs for the identification of pneumothorax after blunt trauma. Acad Emerg Med. 2010 Jan;17(1):11-7. doi: 10.1111/j.1553-2712.2009.00628.x. PMID 20078434