Elbow
Michael-Alexander Malahias; Philip-Panagiotis Manolopoulos; Vikram Kadu; Omid Shahpari; Dimitrios Fagkrezos; Maria-Kyriaki Kaseta
Abstract
Background: Some of the Mason type I fractures cannot be detected on early radiographic images. These occultfractures are considered as a diagnostic challenge for physicians. Our aim was to determine the value of bedsideultrasonography for the detection of Mason I radial head fractures that are non-visible ...
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Background: Some of the Mason type I fractures cannot be detected on early radiographic images. These occultfractures are considered as a diagnostic challenge for physicians. Our aim was to determine the value of bedsideultrasonography for the detection of Mason I radial head fractures that are non-visible in early X-ray’s.Methods: A prospective blind single-center diagnostic study was conducted (from June 2012 till May 2013) concerning23 patients who were clinically suspicious of having a radial head fracture. These patients were evaluated with abedside high frequency ultrasound in the Emergency Room (E.R.). The two sonographic criteria that were consideredto be diagnostic for fracture were: a. effusion besides the radial head-neck and b. cortical discontinuity of the radialhead or neck. All patients also underwent a Computed Tomography (CT) as the gold standard imaging modality fordiagnosis of occult radial head fractures.Results: Fifteen out of 23 patients were diagnosed with radial head fracture using both ultrasound and CT. On the otherhand, there were three patients with negative ultrasound and positive CT, in addition two patients were found positive inthe ultrasonographic exam, while this result was not confirmed by the CT scan. In comparison with CT, ultrasound examappeared to have 83.3% sensitivity, 60% specificity, 88.2% positive prognostic value and 50% negative prognosticvalue (when at least one diagnostic sonographic criterion was positive). The accuracy of the sonographic study for thediagnosis of the aforementioned fractures was 78.2%. Effusion in contact with the radial neck was the most sensitivesonographic sign (14/15 of the true positive radial head ultrasounds).Conclusion: Bedside ultrasound in the E.R. was proven to be a sensitive tool for early (day-1) diagnosis of the occultradial head fractures. It could be used as an adjacent imaging modality in patients suspicious for radial head fracture,when the initial X-rays are negative.Level of evidence: II
Hand
Silke A. Spit; Stéphanie J.E. Becker; Michiel G.J.S. Hageman; David Ring
Abstract
Background:It is possible that some hamate hook fractures are not diagnosed or treated, thereby affecting the study of their natural history. Study of the prevalence of incidental hamate hook fractures, nonunions, and other abnormalities on computed tomography (CT) ordered for another reason could ...
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Background:It is possible that some hamate hook fractures are not diagnosed or treated, thereby affecting the study of their natural history. Study of the prevalence of incidental hamate hook fractures, nonunions, and other abnormalities on computed tomography (CT) ordered for another reason could document a subset of undiagnosed and untreated hamate hook fractures which might change our understanding about the natural history.Methods: Reports of 2489 hand, wrist, and forearm CT scans for hamate hook abnormalities were searched. We excluded 19 patients with anticipated hamate fractures and 1 patient that had a hamate hook excision. Twenty-eight patients had an unanticipated hamate hook abnormality.Results: There was a significant difference in the prevalence of incidental hamate hook abnormalities by sex but not by age. Among the 28 unexpected hamate hook abnormalities, there were 16 fractures of the base (12 acute, 1 nonunion, and 3 of uncertain age), 5 acute oblique fractures, and 7 tip abnormalities/ossicles. The patient with an incidental nonunion had a CT scan for wrist pain and was diagnosed with gout.All fractures involved a direct blow to the hand (distal radius or scaphoid fracture, or crush injury). The 7 patients with a hamate tip abnormality had a CT scan for a distal radius or metacarpal fracture, crush injury or wrist pain. Five acute fractures were treated operatively with excision and the other 23 fractures were treated nonoperatively.Conclusion: Hamate fractures can be diagnosed incidental to other hand and wrist problems on CT.
Shoulder
Frans Mulder; Jos Mellema; David Ring
Abstract
Background: Previous anatomic and radiological studies have described the relationship of the clavicle to major neurovascular structures in healthy subjects. We were curious about this relationship in patients with a clavicle fracture and if it is different from non-fractured clavicles. ...
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Background: Previous anatomic and radiological studies have described the relationship of the clavicle to major neurovascular structures in healthy subjects. We were curious about this relationship in patients with a clavicle fracture and if it is different from non-fractured clavicles. Methods: We retrospectively identified all patients with a clavicle fracture between July 2001 and October 2013 in two level 1 trauma centers. Patients aged 18 years or greater with an acute unilateral clavicle fracture and a chest CT scan in the supine position displaying both clavicles and the complete fracture were included. Seventy patients were available for study. The distance was measured from the fracture site and from the closest clavicular cortex to the closest major artery, major vein, and inner surface of the thoracic cavity. CT data was evaluated in OsiriX DICOM viewer software with the use of three-dimensional Multiplanar Reconstruction. Results: Compared to the fractured side, the clavicle was significantly closer to the artery and vein on the non-fractured side (PP=0.0025 respectively). There was a significant difference in the median distance of the fracture site to the artery, vein, and inner surface of thoracic cavity between the different types of fractures (P<0.001). A post-hoc comparison showed significant differences in all distances between fracture types, except for the distance of proximal third compared to middle third fractures to the closest artery (P=0.41). There was no significant difference in distance when the arm is up overhead compared to down by the side of the body in computed tomography (CT) scans. Conclusions: A fracture of the clavicle changes the relationship of the clavicle to major vital structures. The minimum distance of the clavicle to the closest artery and vein is significantly less on the non-fractured side, compared to the fractured side.
Trauma
Ydo V. Kleinlugtenbelt; Vanessa A.B. Scholtes; Jay Toor; Christian Amaechi; Mario Maas; Mohit Bhandari; Rudolf W. Poolman; Peter Kloen
Abstract
Background: The purpose of this study was to determine whether Multi-Detector Computed Tomography (MDCT) in addition to plain radiographs influences radiologists’ and orthopedic surgeons’ diagnosis and treatment plans for delayed unions and non-unions. Methods: A retrospective ...
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Background: The purpose of this study was to determine whether Multi-Detector Computed Tomography (MDCT) in addition to plain radiographs influences radiologists’ and orthopedic surgeons’ diagnosis and treatment plans for delayed unions and non-unions. Methods: A retrospective database of 32 non-unions was reviewed by 20 observers. On a scale of 1 to 5, observers rated on X-Ray and a subsequent Multi Detector Helical Computer Tomography (MDCT) scan was performed to determine the following categories: "healed", "bridging callus present", "persistent fracture line" or "surgery advised". Interobserver reliability in each category was calculated using the Interclass Correlation Coefficient (ICC). The influence of the MDCT scan on the raters’ observations was determined in each case by subtracting the two scores of both time points. Results: All four categories show fair interobserver reliability when using plain radiographs. MDCT showed no improvement, the reliability was poor for the categories "bridging callus present" and "persistent fracture line", and fair for "healed" and "surgery advised". In none of the cases, MDCT led to a change of management from nonoperative to operative treatment or vice versa. For 18 out of 32 cases, the treatment plans did not alter. In seven cases MDCT led to operative treatment while on X-ray the treatment plan was undecided. Conclusion: In this study, the interobserver reliability of MDCT scan is not greater than conventional radiographs for determining non-union. However, a MDCT scan did lead to a more invasive approach in equivocal cases. Therefore a MDCT is only recommended for making treatment strategies in those cases.