The Feasibility Of point-of-Care UltraSound conducted by physiotherapists for the diagnosis of ankle syndesmosis injuries in the acute care setting: A diagnostic study (FOCUS)

Patients that have sustained an acute ankle injury (within seven days of their presentation) and meet the eligibility criteria will be recruited to the study. Consenting participants will be assigned to point of care ultrasound (POCUS) group based on the availability of a POCUS trained Emergency Physiotherapy Practitioner (EPP) and sonographer. A POCUS training EPP will be available on 92% of rostered shifts between the hours 0800 to 1800, therefore we expect no difficulties recruiting to the POCUS intervention. The EPP POCUS assessment and sonography ultrasound will happen within 4 hours of their presentation to the emergency department. All participants in the POCUS group will receive both POCUS by the EPP and a focused radiology ultrasound by a musculoskeletal sonographer. The EPP POCUS scan will be performed on a GE Venue (or equivalent ultrasound machine) and the sonographers will perform the same scan on their standard machine (Philips Epic Elite). Patient’s are enrolled when they present to ED and provide written consent. Baseline measurements include the EPP POCUS scan, and the sonography ultrasound scan with the formal radiologist report based on this scan . The radiology report will be the reference standard, which the EPP POCUS scan is being compared to. Patients that have an anterior inferior tibiofibular ligament (AITFL) injury on radiology ultrasound will be referred for Magnetic Resonance Imaging (MRI) and will be referred to orthopaedic fracture clinic for follow up. The MRI will be completed as an outpatient scan at the Wynnum or Cleveland Queensland xray clinics. These scans will take 15 minutes to 1 hour. The MRI scan will be performed by a radiographer and reported by a radiologist. This scan will be recommended to be performed within 1 week of leaving the emergency department. The patients will be seen at the fracture clinic within 2 weeks of their emergency department presentation. Patients that do not have an AITFL injury on radiology ultrasound will be seen in a physiotherapy soft tissue clinic at two weeks. Adherence to the interventions will be monitored by the principal investigator or research assistant via their electronic medical record, which displays their appointments and scans they have attended. Patients that have not attended their MRI scan, fracture clinic appointment or soft tissue clinic will receive a call from the principal investigator or research assistant to determine the reason. If patients have not attended their fracture clinic or physiotherapy soft tissue clinic appointments they will be offered another appointment as per the hospital fail to attend policy. Patient's will be discharged from the service if they fail to attend two appointments.