Multidetector computed tomography (MDCT) is a highly valuable imaging tool for the diagnosis of occult fractures. Thus, the performance of tomosynthesis in detecting radiographically occult fractures is considered as comparable to CT. Tomosynthesis has the ability to demonstrate cortical, as well as moderately displaced trabecular fractures. ĭigital radiography known as tomosynthesis has been shown to be superior to conventional radiographs in the detection of occult fracture of the scaphoid. In metaphyseal areas, delayed signs of fracture include a band of sclerosis perpendicular to the trabeculae, while diaphyseal fractures may present as periosteal thickening. Particular attention should be paid when analysing the subchondral plate, which may be disrupted or deformed. Although the classical presentation consists of a radiolucent line and cortical disruption, the radiographic signs will depend upon the time elapsed between the first clinical symptoms and the time of radiographic examination, the location of the fracture within the bone, and the ratio of cortical to cancellous bone. A fall on an outstretched hand suggests scaphoid fracture. The mechanism of trauma may also be helpful to locate the potential fracture. In wrist trauma, for instance, the interpreter should pay close attention to the scaphoid and triquetrum, which are the two most commonly injured carpal bones. Moreover, one should be aware of the commonly encountered lesions and their locations. The general rule is to perform two orthogonal views, but more specific views should be added if there is any suspicion of fracture. Trabecular angulation, impaction lines, and sclerotic bands also suggest fracture in osseous structures with a significant proportion of cancellous bone such as proximal femur. Osseous lines should be checked for integrity (e.g., acetabular rim in the hip). However, the radiographic technique (positioning in particular) must be optimal for this evaluation to be valid. Fat pads should be carefully examined for convexity, which implies joint effusion (e.g., in the hip and elbow joints). Awareness of normal anatomic features is crucial for the interpreter to be able to detect subtle signs of fracture. Correct diagnosis primarily relies on the reader's experience. The detection of subtle signs of fracture requires a high standard for the acquisition technique and a thorough and systematic interpretation of radiographic images. Radiography is the first step for detection of fractures. Our aim is to raise the awareness of both clinicians and radiologists to this common problem by illustrating various cases of radiographically occult and subtle fractures. Pediatric and microtrabecular fractures-known as bone bruises and contusions-are outside the scope of this paper. The term “stress fracture” is more general and encompasses both of the latter two entities. Occult and subtle fractures may be divided into: (1) fractures associated with high energy trauma (2) fatigue fracture secondary to repetitive and unusual stress being applied to bone with normal elastic resistance and (3) insufficiency fracture resulting from normal or minimal stress on a bone with decreased elastic resistance. It will also prevent inherent complications such as nonunion, malunion, premature osteoarthritis, and avascular osteonecrosis (as in scaphoid fracture). Early detection, on the other hand, enables more effective treatment, a shorter hospitalization period if necessary, and decreased medical costs in the long run. The burden entailed in missing these fractures includes prolonged pain with a loss of function, and disability. In both cases, a negative radiographic diagnosis with prominent clinical suspicion of osseous injury will prompt advanced imaging examination such as computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and nuclear medicine to confirm or exclude the clinically suspected diagnosis. While occult fractures present no radiographic findings, radiographically subtle fractures are easily overlooked on initial radiographs. Failure to recognize the subtle signs of osseous injury is one of the reasons behind this major diagnostic challenge. Indeed, fractures represent up to 80% of the missed diagnoses in the emergency department. Radiographically occult and subtle fractures are a common diagnostic challenge in daily practice.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |