Trends in Musculoskeletal Imaging in Trauma Patients

Vallier, Heather A.; Ahmadinia, Kasra; Forde, Frank A.; Ekstein, Charles; Nash, Clyde L.; Tornetta, Paul

doi:10.1097/bot.0000000000000076

Cited by 8 publications

(10 citation statements)

References 46 publications

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“…Computed tomography employs ionizing radiation for image acquisition, and the radiation doses imparted to patients are higher from CT than from radiographs. 59 When clinically indicated, CT should be utilized, but principles of radiation safety must be followed. The organs of pediatric patients are exquisitely sensitive to radiation, and a child’s longer life expectancy yields a lengthier period of time during which he or she could potentially develop a radiation-induced cancer.…”

Section: Physeal Imagingmentioning

confidence: 99%

Imaging of Physeal Injury

2014

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Context:As the intensity of youth participation in athletic activities continues to rise, the number of overuse injuries has also increased. A subset of overuse injuries involves the physis, which is extremely susceptible to injury. This paper aims to review the utility of the various imaging modalities in the diagnosis and management of physeal injuries in the skeletally immature population.Evidence Acquisition:A search for the keywords pediatric, physis, growth plate, x-ray, computed tomography, magnetic resonance imaging, and overuse injury was performed using the PubMed database. No limits were set for the years of publication. Articles were reviewed for relevance with an emphasis on the imaging of growth plate injuries.Study Design:Retrospective literature review.Level of Evidence:Level 4.Results:Three major imaging modalities (radiographs, computed tomography, and magnetic resonance imaging) complement each other in the evaluation of pediatric patients with overuse injuries. However, magnetic resonance imaging is the only modality that offers direct visualization of the physis, and it also offers the best soft tissue contrast for evaluating the other periarticular structures for concomitant injury.Conclusion:Imaging has an important role in the diagnosis of physeal injuries, and the information it provides has a tremendous impact on the subsequent management of these patients.

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Section: Physeal Imagingmentioning

confidence: 99%

Imaging of Physeal Injury

2014

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“…A delicate balance exists between image quality and radiation exposure in the evaluation of orthopaedic trauma patients. [1][2][3][4][5][6][7] The ability to characterize unique fracture patterns and musculoskeletal anatomy has significantly im-proved with advances in computed tomography (CT) techniques. 1,[8][9][10][11][12][13][14][15] However, the collective radiation burden sustained by the population has also increased substantially.…”

Section: Introductionmentioning

confidence: 99%

“…1,[8][9][10][11][12][13][14][15] However, the collective radiation burden sustained by the population has also increased substantially. 3,7,[16][17][18][19] Distal femur fractures make up 3% to 6% of all femoral fractures and present a considerable challenge in surgical planning. 20 Up to 38% of distal femur fractures are associated with coronal plane fractures of the femoral condyles (Hoffa fractures) and require specific fixation techniques to obtain acceptable outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…Since the first clinical scan in 1971, the use and availability of CT imaging has increased drastically. [1][2][3]7,16 The estimated number of annual CT scans performed in the United States grew from 3 million in 1980 3 to 85.3 million in 2011, the largest reported amount to date. 22,23 During the 1990s and early 2000s, CT scan volume increased at a rate of greater than 10% per year, significantly outpacing the United States population growth rate of less than 1% annually.…”

Section: Introductionmentioning

confidence: 99%

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Radiation Dose Reduction of Computed Tomography in Complex Distal Femur Fractures: A Cadaver Study to Develop a Low Dose Scanning Protocol

O'Neill

Wisniewski

Adams

et al. 2019

Spartan Medical Research Journal

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CONTEXT CONTEXT Recent advances in diagnostic imaging have made computed tomography (CT) a widely used test in trauma patients. Consequently, the collective radiation burdened sustained by this patient population has increased substantially. The purpose of this cadaveric study was to determine if a significantly lowered CT radiation dose protocol would provide adequate imaging studies for the surgeon, using the distal femur as a model. METHODS METHODS Ten adult cadaveric knee specimens were used to create Orthopaedic Trauma Association (AO/OTA) 33-C3 distal femur fractures with associated coronal plane Hoffa fractures and varying intra-articular displacements. Using a single CT scanner, each cadaver was scanned at 5 separate protocols defined by sequentially lowered radiation doses, the highest of which was one-third the value of our institution's current protocol. These images were then evaluated by fellowship-trained orthopedic surgeons, an orthopedic trauma fellow, and residents. Observer reliability and confidence levels were calculated for measuring fracture displacement, assessing the quality of 3D reconstructions, and developing treatment plans. RESULTS RESULTS Across all reviewers and specimens, there was an average difference of 0.66 millimeters (mm) between the measured fracture gap and true fracture gap. The highest intraclass correlation coefficient (ICC) calculated for the inter-rater reliability of gap measurements was 0.983 at 75 mAs (95% CI: 0.955-0.996), followed by 0.973 (95% CI: 0.930-0.993) and 0.958 (95% CI: 0.896-0.988) at 15 mAs and 60 mAs, respectively. All 3D reconstructions obtained at 75 mAs and 45 mAs values (N = 8) were of acceptable imaging quality to all reviewers, while only 3 of 4 3D reconstructions obtained at 15 mAs were considered acceptable. There was no difference in treatment plans across all reviewers, regardless of radiation dose. CONCLUSIONS CONCLUSIONS In summary, our results indicate that CT scans of complex distal femur fractures at one-third the amount of radiation exposure may provide adequate imaging necessary to develop an appropriate treatment plan. At significantly lowered doses, the reviewers were able to accurately measure the amount of fracture displacement and identify the presence of each Hoffa fracture. Future studies are necessary to compare this protocol's diagnostic capacity and limitations in evaluating complex fractures with that of our institution's standard protocol in a clinical setting.

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“…16 However, advanced imaging with computed tomography (CT) scans in the setting of trauma have increased significantly, doubling between 2002 and 2008 alone, and provides superior spatial resolution and the ability to better evaluate the osseous morphology for preoperative planning. 17 While magnetic resonance imaging (MRI) is the modality of choice for evaluating soft tissue structures, it is less commonly used in these cases as it is more expensive and time-consuming. Despite being an ideal bone imaging study, CT scan has also been shown to reliably demonstrate soft tissue entrapment within fractures.…”

mentioning

confidence: 99%

Extensor Tendon Entrapment on Computed Tomography Imaging of Distal Radius Fractures

Nigh

Emerson

et al. 2019

Jnl Wrist Surg

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Objective To examine the association between distal radius fractures and tendon entrapment identified on computed tomography (CT) imaging. Patients and Methods After Institutional Review Board approval, we retrospectively reviewed distal radius fractures that underwent CT imaging from an electronic database between January 2006 to February 2018 at a single level 1 hospital trauma center. We categorized all distal radial fractures according to the AO-OTA (AO Foundation/Orthopaedic Trauma Association) classification. Distal upper extremity tendons were assessed for entrapment. Fisher's exact test was used for statistical analysis with significance at p < 0.05. Results A total of 183 distal radius fractures were identified in 179 patients. A total of 16 fractures (13 males and 3 females) were associated with tendon entrapment. Mechanism of injury included falls (n = 7), motor vehicle accidents (n = 6), dog bites (n = 2), and gunshot wound (n = 1). Entrapped tendons were limited to the extensor compartment and included the extensor pollicis longus (EPL; n = 11), extensor pollicis brevis (n = 1), extensor carpi ulnaris (n = 1), extensor carpi radialis longus (n = 1), and extensor digitorum communis (n = 2). The most commonly associated AO-OTA fracture pattern with tendon entrapment was complete articular radial fractures (2R3C; 69%), eight of which were simple articular with metaphyseal multifragmentary fractures (2R3C2). Of the distal radius fractures, 81% were associated with additional ulnar fractures of varying severity and displacement. Conclusion Approximately 8.7% of distal radius fractures were retrospectively identified to have tendon entrapment compared with a previously reported incidence of 1.3%. Wrist surgeons and radiologists should have higher suspicion for tendon entrapment and carefully review preoperative CT imaging for tendon entrapment in distal radius fractures especially if there is an intra-articular, multifragmentary injury pattern. Wrist surgeons and radiologists should also have increased suspicion for EPL tendon entrapments given its high incidence in association with distal radius fractures. Level of Evidence This is a Level III, retrospective cross-sectional study.

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Trends in Musculoskeletal Imaging in Trauma Patients

Cited by 8 publications

References 46 publications

Imaging of Physeal Injury

Imaging of Physeal Injury

Radiation Dose Reduction of Computed Tomography in Complex Distal Femur Fractures: A Cadaver Study to Develop a Low Dose Scanning Protocol

Extensor Tendon Entrapment on Computed Tomography Imaging of Distal Radius Fractures

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