Prognostic value of an immediate lateral standing X-ray with a TLSO in patients with a thoracolumbar burst fracture

Díez-Ulloa, Máximo-Alberto; Gallego-Goyanes, A.

doi:10.1016/j.recote.2015.03.001

Cited by 2 publications

(2 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The actual verification of this old hypothesis makes it meaningful not only to label X-ray images accordingly but also to be aware of the patients’ position while the X-ray image is taken within therapeutic decision-making processes ( Figure 1 ), as it is common when interpreting X-rays of the chest or spine ( Figure 2 ) [ 24 , 26 , 27 , 28 , 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

Self-Reduction in Proximal Humerus Fractures through Upright Patient Positioning: Is It up to Gravity?

Razaeian

Krettek²,

Hawi

2022

Diagnostics

View full text Add to dashboard Cite

Background: The self-reduction in proximal humerus fractures (PHFs) remains a poorly explored myth, and it was rarely investigated in the past. One of the oldest hypotheses suggests that gravity and the weight of the affected arm alone are driving forces, which facilitate a self-reducing potential in PHFs. However, thus far, clear radiographic evidence for this theory is missing in the literature. This study aimed to investigate the immediate effect of upright patient positioning on self-reducing of PHFs. Methods: Between November 2019 and November 2020, seven consecutively bedridden but mentally competent patients were admitted to our emergency department with an acute proximal humerus fracture. Within routinely attempts of closed reductions under the control of an image converter (C-arm), immobile patients were mobilized into an upright sitting position on a stretcher while the affected arm was immobilized in a sling. Fluoroscopic controls were performed before and after upright positioning. Changes in the head-shaft angle (HSA), as well as the medial hinge index (MHI), were determined on plain true anteroposterior (AP) fluoroscopic images. Results: In all cases, upright patient positioning had an immediate self-reducing effect. This effect could be seen in five out of seven cases for both HSA and MHI. Changes in HSA and MHI averaged 21.2° and 0.25, respectively. Mean deviation from an ideal, anatomic HSA of 135° decreased through upright positioning from 25.5° to 13.8°. Mean deviation from an ideal, anatomic MHI of 1 decreased through upright positioning from 0.28 to 0.19. Conclusions: Upright patient positioning might contribute immediately to the self-reduction in PHF through the force of gravity. This underlines the importance of being aware of patients’ position when interpreting X-ray images within treatment decision-making processes.

show abstract

Section: Discussionmentioning

confidence: 99%

Self-Reduction in Proximal Humerus Fractures through Upright Patient Positioning: Is It up to Gravity?

Razaeian

Krettek²,

Hawi

2022

Diagnostics

View full text Add to dashboard Cite

show abstract

“…When a TL fracture appears to be stable/non-operative or indeterminate on CT, it is often interrogated for stability with an upright radiograph with or without the use of a thoracic-lumbar-sacral orthosis (TLSO) brace [ 5 , 9 , 16 ]. This practice gained support after Mehta et al [ 17 ] showed an average increase in anterior vertebral compression of 12% and lateral Cobb angle of 7° between supine and weight-bearing radiographs, which led to a change from non-operative to operative management in 7/28 (25%) of patients.…”

Section: Introductionmentioning

confidence: 99%

Utility of upright radiographs in traumatic thoracolumbar fracture management

Laurita

Brant

Degener-O'Brien

et al. 2022

BMC Musculoskelet Disord

View full text Add to dashboard Cite

Background It is common practice to use a combination approach of computed tomography (CT) scan followed by upright radiographs when assessing traumatic thoracolumbar (TL) vertebral fractures. The purpose of this study was to determine the clinical utility of upright spine radiographs in the setting of traumatic TL fracture management. Our null hypothesis is that upright TL radiographs rarely change management of acute vertebral fractures. Methods A retrospective study was performed on patients with an initial plan of non-operative management for a TL fracture between January 2014 and June 2020 at a single Level 1 trauma center. Patients were followed from time of initial consult to either conversion to surgery (operative) or last available outpatient follow up imaging (non-operative). Lateral kyphotic angle of the fractured vertebra and anterior vertebral body height% loss on initial CT, first upright radiograph, and endpoint upright radiograph imaging were measured. Measurements were compared between and within operative and non-operative groups using t-tests and Mann-Whitney U tests when appropriate. P-values ≤ 0.05 were considered statistically significant. Results The study included 70 patients with an average age of 54 years and 37 (52.9%) were women. Six (8.6%) of 70 patients had a change from non-operative to operative management based on upright radiographs. The mean (standard deviation) change in degrees of kyphosis from CT scan to first X-ray was 4.6 (7.0) in the non-operative group and 11.5 (8.1) in the operative group (P = 0.03). Delta degrees of kyphosis from CT scan to endpoint X-ray was 6.4 (9.0) and 16.2 (6.2) in the non-operative and operative groups, respectively (P = 0.01). In the operative group, mean degrees of kyphosis increased from 1.6 (7.6) in initial CT to 13.1 (8.9) in first X-ray (P = 0.02). First X-ray mean anterior body height% loss was 37.5 (17.6) and 53.2 (16.1) in the non-operative and operative groups, respectively (P = 0.04). Conclusions Upright radiographs are useful in guiding traumatic vertebral fracture management decisions. Larger studies are needed to determine the degree of change in kyphosis between CT and first standing radiograph that is suggestive of operative management. Trial registration number and date of registration Not applicable.

show abstract

Prognostic value of an immediate lateral standing X-ray with a TLSO in patients with a thoracolumbar burst fracture

Cited by 2 publications

References 12 publications

Self-Reduction in Proximal Humerus Fractures through Upright Patient Positioning: Is It up to Gravity?

Self-Reduction in Proximal Humerus Fractures through Upright Patient Positioning: Is It up to Gravity?

Utility of upright radiographs in traumatic thoracolumbar fracture management

Contact Info

Product

Resources

About