Ultrasound Matches X-rays for Dog Rib Fracture Diagnosis—But Takes Longer

Comparison of Radiography and Ultrasound for Diagnosis of Rib Fractures in Canine Cadavers

Cole Harding, Søren R. Boysen, Cameron G. Knight, Sally L. Sukut, Madison Hillstead, Ashley Finch, Julie Menard

Background:
Rib fractures are common in canine blunt thoracic trauma and their identification is clinically important to detect associated thoracic injuries. Although radiography is commonly used, it has limitations, and ultrasound (specifically point-of-care ultrasound, POCUS) has shown superior sensitivity in human studies. This study aimed to compare the diagnostic accuracy of POCUS and digital radiography for detecting rib fractures in canine cadavers, using necropsy findings as the reference standard.

Methods:
Nine canine cadavers underwent randomized surgical creation of rib fractures or served as controls. Expert and novice sonographers performed POCUS examinations, while expert and novice radiologists reviewed thoracic radiographs. Rib fracture detection was compared against necropsy-confirmed fractures. Time taken to complete ultrasound scanning and radiograph interpretation was recorded. Fractures were classified as complete fractures (CF) or greenstick fractures (GSF).

Results:
Ultrasound and radiography showed comparable sensitivity and specificity for detecting rib fractures: 83% and 99.74% for ultrasound, 82% and 99.22% for radiography, respectively. Expert POCUS had particularly high sensitivity for complete fractures but lower for greenstick fractures. Time to diagnosis was significantly shorter for radiograph interpretation (3–10 minutes) than for ultrasound scanning (26–65 minutes), with experts faster than novices in both modalities. Ultrasound was more sensitive for detecting subtle, non-displaced (greenstick) fractures, especially on the external rib cortex.

Limitations:
The study was conducted on thawed cadavers, which may not fully replicate imaging conditions in live animals. Only large-breed dogs were studied. Surgically created fractures may not entirely represent naturally occurring trauma patterns. The results may not fully translate to clinical settings where patient movement and pain are factors.

Conclusions:
POCUS is as sensitive and specific as radiography for detecting rib fractures in dogs, though it requires more time to perform. It offers a radiation-free, bedside diagnostic alternative, particularly useful when radiography is impractical or unavailable. Experience significantly improves ultrasound efficiency and fracture detection. Further research in live, traumatized dogs is warranted to validate these findings in clinical practice.

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