Detection Rate Of Fractures Research Articles

Dual-energy CT in diagnosing sacral fractures: assessment of diagnostic accuracy and intra- and inter-rater reliabilities.

Evaluating sacral fractures is crucial in fragility fractures of the pelvis. Dual-energy CT (DECT) is considered useful for diagnosing unclear fractures on single-energy CT (SECT). This study aims to investigate the effectiveness of DECT in diagnosing sacral fractures. Thirty cases with suspected sacral fractures underwent SECT, DECT, and MRI. The exams were evaluated by two groups: three inexperienced surgeons (Group I) and three experienced surgeons (Group E). Diagnoses were made initially using SECT (pre-DECT) and then reassessed including DECT (post-DECT). This process was repeated twice. Presence of fractures was determined based on MRI. Sensitivity, specificity, inter-rater and intra-rater reliability, and diagnostic accuracy were calculated. Diagnostic accuracy was statistically compared between two groups. Sensitivity was 0.73 in pre-DECT and 0.9 in post-DECT, while specificity was 0.83 in pre-DECT and 0.91 in post-DECT. Sensitivity significantly improved with the addition of DECT (McNemar test: p < 0.001). Intra-rater reliability (Fleiss' kappa coefficient) was 0.44 in pre-DECT and 0.76 in post-DECT. Inter-rater reliability (Cohen's kappa coefficient) was 0.6 in pre-DECT and 0.81 in post-DECT. Diagnostic accuracy was significantly lower in group I than group E in pre-DECT (P = 0.019, 0.048), but there was no significant difference between two groups in post-DECT. Combined use of DECT with SECT improved the detection rate of sacral fractures and enhanced intra-rater and inter-rater reliability. High diagnostic accuracy was achieved regardless of the observer's experience. These results indicate that DECT is a useful imaging modality for diagnosing sacral fractures.

High Detection Rate of Posterolateral Tibial Plateau Fractures and Poor Functional Outcomes in Type IIIB Impaction Fractures After Anterior Cruciate Ligament Rupture and Reconstruction.

The incidence of anterior cruciate ligament (ACL) ruptures has been increasing annually. However, clinical surgeons have overlooked the impaction fractures of the posterolateral tibial plateau and lateral femoral condyle in patients with ACL ruptures. The purpose of the present study was to report the detection rate of the posterolateral tibial plateau impaction fractures in patients with ACL ruptures, and to evaluate the functional outcomes of patients following ACL reconstruction (ACLR) without treatment of the tibial fractures at a 2-year postoperative follow-up. Four hundred eighty-eight patients treated for ACL ruptures between January 2016 and June 2020 were retrospectively reviewed, and the posterolateral tibial plateau impaction fractures were classified based on MRI assessment. The detection rate of the posterolateral tibial plateau impaction fractures was calculated, and the functional outcomes (SF-12 Mental Component Summaries, SF-12 Physical Component Summaries, Tegner, Lysholm, IKDC, and KOOS) were evaluated at a 2-year postoperative follow-up. The detection rate of posterolateral tibial plateau impaction fractures was 41.6% among ACL ruptures. Of these, 285 cases (58.4%) had no fractures, 98 cases (20.1%) had type I impaction fractures, 41 cases (8.4%) had type IIA impaction fractures, 15 cases (3.1%) had type IIB impaction fractures, 22 cases (4.5%) had type IIIA impaction fractures, and 27 cases (5.5%) had type IIIB impaction fractures. Patients with type IIIA or IIIB impaction fractures showed an increased detection rate of contact mechanism compared to the other subgroups. Significant differences in Tegner (postoperation) and KOOS (QOL) were found between no fracture and type IIIB impaction fractures in patients following ACLR. The detection rate of posterolateral tibial plateau impaction fractures in patients with ACL ruptures was high. Patients with type IIIB impaction fractures following ACLR had poor functional outcomes.

INVESTIGATION OF THE RADIOLOGICAL TECHNIQUES TO DETECT OSTEOLYTIC LESIONS, FRACTURES, AND OSTEOPOROSIS IN MULTIPLE MYELOMA PATIENTS

Aim: Multiple myeloma is a malignancy of clonal plasmacytes. Osteolytic lesions represent a criterion for symptomatic myeloma and are associated with bone loss, pathological fractures, and osteoporosis. Skeletal surveys with other sophisticated techniques and dual-energy x-ray absorptiometry (DEXA) are used to screen lytic lesions, and bone mineral loss, respectively. Here, we aimed to investigate the rates of detection regarding osteolytic lesions and bone mineral loss by several imaging techniques.&#x0D; Materials and Methods: The study was carried out in Adnan Menderes University Hospital/Turkey, between the years 2004- 2020. Three-hundred and ten symptomatic myeloma patients were screened retrospectively. The results of radiological techniques were recorded. The detection rate of osteolytic lesions, fractures, and plasmacytomas by imaging techniques, as well as bone mineral loss with DEXA was recorded. Also, associations with gender, myeloma type, lytic lesions, and osteoporosis were investigated.&#x0D; Results: Skeletal survey and PET-CT detected lytic lesions in 71.3% and 81.2% of patients, respectively. PET-CT had a sensitivity of 96.1% and specificity of 90.6% to detect lytic lesions. MRI was only used for patients with suspicious fractures and detected them for all patients who underwent MRI. The osteoporosis rate was 83.1% for 113 patients who underwent DEXA. Any association between lytic lesions and gender/myeloma type was not detected. &#x0D; Conclusion: Our study demonstrated that osteolytic lesions are not correlated with gender or myeloma type. PET-CT is a sensitive and specific method for detecting osteolytic lesions. Although DEXA is sensitive, its specificity is limited to detect osteoporosis in patients with lytic lesions.

MRI-Based Classification for Tibial Spine Fracture: Detection Efficacy, Classification Accuracy, and Reliability

Recently, a new MRI-based classification for evaluating tibial spine fractures (TSFs) was developed to aid in treating these injuries. Our objective was to assess the detection efficacy, classification accuracy, and reliability of this classification in detecting and grading TSFs, as well as its impact on treatment strategy, compared to the Meyers and McKeever (MM) classification. A retrospective study included 68 patients with arthroscopically confirmed TSFs. All patients had plain radiography and conventional MRI of the affected knee before arthroscopy. Three experienced radiologists independently reviewed all plain radiographs and MRI data and graded each patient according to MM and MRI-based classifications. The detection efficacy, classification accuracy, and inter-rater agreement of both classifications were evaluated and compared, using arthroscopic findings as the gold standard. The final analysis included 68 affected knees. Compared to the MM classification, the MRI-based classification produced 22.0% upgrade of TSFs and 11.8% downgrade of TSFs. According to the reviewers, the fracture classification accuracy of the MRI-based classification (91.2-95.6%) was significantly higher than that of the MM classification (73.5-76.5%, p=0.002-0.01). The fracture detection rate of MRI-based classification (94.1-98.5%) was non-significantly higher than that of the MM classification (83.8-89.7%, p=0.07-0.4). The soft tissue injury detection accuracy for MRI-based classification was 91.2-94.1%. The inter-rater reliability for grading TSFs was substantial for both the MM classification (κ=0.69) and MRI-based classification (κ=0.79). MRI-based classification demonstrates greater accuracy and reliability compared to MM classification for detecting and grading TSFs and associated soft tissue injuries.

Artificial intelligence versus radiologist in the accuracy of fracture detection based on computed tomography images: a multi-dimensional, multi-region analysis.

Extremities fractures are a leading cause of death and disability, especially in the elderly. Avulsion fracture are also the most commonly missed diagnosis, and delayed diagnosis leads to higher litigation rates. Therefore, this study evaluates the diagnostic efficiency of the artificial intelligence (AI) model before and after optimization based on computed tomography (CT) images and then compares it with that of radiologists, especially for avulsion fractures. The digital X-ray photography [digital radiography (DR)] and CT images of adult limb trauma in our hospital from 2017 to 2020 were retrospectively collected, with or without 1 or more fractures of the shoulder, elbow, wrist, hand, hip, knee, ankle, and foot. Labeling of the fracture referred to the visualization of the fracture on the corresponding CT images. After training the pre-optimized AI model, the diagnostic performance of the pre-optimized AI, optimized AI model, and the initial radiological reports were evaluated. For the lesion level, the detection rate of avulsion and non-avulsion fractures was analyzed, whereas for the case level, the accuracy, sensitivity, and specificity were compared among them. The total datasets (1,035 cases) were divided into a training set (n=675), a validation set (n=169), and a test set (n=191) in a balanced joint distribution. At the lesion level, the detection rates of avulsion fracture (57.89% vs. 35.09%, P=0.004) and non-avulsion fracture (85.64% vs. 71.29%, P<0.001) by the optimized AI were significantly higher than that by pre-optimized AI. The average precision (AP) of the optimized AI model for all lesions was higher than that of pre-optimized AI model (0.582 vs. 0.425). The detection rate of avulsion fracture by the optimized AI model was significantly higher than that by radiologists (57.89% vs. 29.82%, P=0.002). For the non-avulsion fracture, there was no significant difference of detection rate between the optimized AI model and radiologists (P=0.853). At the case level, the accuracy (86.40% vs. 71.93%, P<0.001) and sensitivity (87.29% vs. 73.48%, P<0.001) of the optimized AI were significantly higher than those of the pre-optimized AI model. There was no statistical difference in accuracy, sensitivity, and specificity between the optimized AI model and the radiologists (P>0.05). The optimized AI model improves the diagnostic efficacy in detecting extremity fractures on radiographs, and the optimized AI model is significantly better than radiologists in detecting avulsion fractures, which may be helpful in the clinical practice of orthopedic emergency.

Evaluating AI rib fracture detections using follow-up CT scans

PurposeThis study compares the results of Artificial Intelligence (AI) diagnosis of rib fractures using initial CT and follow-up CT as the final diagnostic criteria, and studies AI-assisted diagnosis in improving the detection rate of rib fractures. MethodsA retrospective study was conducted on 113 patients who underwent initial and follow-up CT scans due to trauma. The initial and follow-up CT were used as diagnostic criteria, respectively. All images were transmitted to the AI software (V2.1.0, Huiying Medical Technology Co., Beijing, China) for rib fracture detection. The radiologist group (Group 1), AI group (Group 2), and Radiologist with AI group (Group 3) reviewed CT images at an interval of one month, recorded and compared the differences in the sensitivity and specificity for diagnosing rib fractures. Results589 and 712 rib fractures were diagnosed by the initial and follow-up CT, respectively. The initial CT diagnosis failed to detect 127 rib fractures, resulting in a missed rate of 17.84%. In addition, four normal ribs were mistakenly identified as being fractured. The follow-up CT was regarded as the diagnostic standard for rib fractures. The sensitivity and specificity were 82.16% and 99.80% for Group 1, 79.35% and 84.90% for Group 2, and 91.57% and 99.70% for Group 3. The sensitivity of Group 3 was higher than that of Group 1 and Group 2 (p < 0.05). The specificity was lower for Group 2 compared with Group 1 and Group 3 (p < 0.05). ConclusionAI-assisted diagnosis improved the detection rate of rib fractures, the follow-up CT should be used for the diagnosis standard of rib fractures, and AI misdiagnoses can be greatly reduced when a radiologist reviews the diagnosis.

Preoperative Mixed-Reality Visualization of Complex Tibial Plateau Fractures and Its Benefit Compared to CT and 3D Printing.

Various studies have shown the benefit of three-dimensional (3D) computed tomography (CT) reconstruction and especially 3D printing in the treatment of tibial plateau fractures (TPFs). This study aimed to investigate whether mixed-reality visualization (MRV) using mixed-reality glasses can provide a benefit for CT and/or 3D printing in planning treatment strategies for complex TPFs. Three complex TPFs were selected for the study and processed for 3D imaging. Subsequently, the fractures were presented to specialists in trauma surgery using CT (including 3D CT reconstruction), MRV (hardware: Microsoft HoloLens 2; software: mediCAD MIXED REALITY) and 3D prints. A standardized questionnaire on fracture morphology and treatment strategy was completed after each imaging session. 23 surgeons from 7 hospitals were interviewed. A total of 69.6% (n = 16) of those had treated at least 50 TPFs. A change in fracture classification according to Schatzker was recorded in 7.1% of the cases and in 78.6% an adjustment of the ten-segment classification was observed after MRV. In addition, the intended patient positioning changed in 16.1% of the cases, the surgical approach in 33.9% and osteosynthesis in 39.3%. A total of 82.1% of the participants rated MRV as beneficial compared to CT regarding fracture morphology and treatment planning. An additional benefit of 3D printing was reported in 57.1% of the cases (five-point Likert scale). Preoperative MRV of complex TPFs leads to improved fracture understanding, better treatment strategies and a higher detection rate of fractures in posterior segments, and it thus has the potential to improve patient care and outcomes.

Thousand shades of gray – The role of imaging display in diagnosis of occult scaphoid fractures – A pilot study

IntroductionMost hospitals and clinics utilize commercial grade displays for viewing wrist radiographs. There is no evidence regarding the role of the imaging display used to evaluate the radiographs. The aim of this study was to compare the rates of scaphoid fracture diagnosis by commercial grade and medical grade displays. MethodsWrist radiographs of patients that had clinical signs of scaphoid fracture without findings on plain radiography (suspected scaphoid fractures) were retrospectively collected from ER department and interpreted for radiographic signs of fracture by four orthopedics seniors commercial grade and medical grade displays. The difference in fracture diagnosis rates were studied. Inter- and intra-observer variability were also studied. ResultsStudy population comprised of 175 high quality wrist radiographs were interpreted. Mean 48.25 (27%) scaphoid fractures were observed on commercial grade display compared to 66 (38.2%) on medical grade display (p = 0.076). The total inter-observer agreement could be defined as a moderate agreement (κ = 0.527, Accuracy = 0.77). Total agreement between all observers were observed in 86 (49.1%) cases compared to 89 (50.9%) cases when reviewing X-rays on commercial and medical displays, respectively. DiscussionThe scaphoid fracture detection rate on medical grade display was not statistically higher compared to non-medical grade displays, but we did find a tendency toward medical grade display. We found that in a substantial number of cases, our observers recognize signs of fracture that were initially evaluated as "suspected fracture" by the ER physicians. As a pilot study, we found evidence that support the need for a prospective study designed to compare the observations to a gold standard modality, such as MRI. We believe utilizing medical grade displays can increase the rate of diagnosis in cases of clinically suspected scaphoid fractures and better manage the clinical scenario of a suspected scaphoid fracture.

Bumps and Bruises in the Trauma Bay: A Level One Trauma Center's Analysis of Dedicated Skeletal X-Ray Imaging.

The Ottawa Ankle Rule and Canadian C-Spine Rule were created to guide the utility of radiographic studies. There are no guidelines to guide X-rays within trauma. Our objective was to evaluate which findings have the highest yield for determining fractures on skeletal x-ray. A retrospective study was performed on 5050 patients at a level one trauma center from January 2018 through October 2019. 2382 patients received X-Rays. Our analysis focused on five categories: limb deformity/obvious open fracture, abrasions, hematoma/contusion/sprain, laceration, and skin tear. Standard demographic and outcome variables were collected. While the cost burden on an overwhelmed system, time in the trauma bay prior to disposition and radiation exposure has not been fully evaluated, our evidence shows that X-Rays ordered for soft tissue defects are less sensitive at identifying fracture (0.0-6.9% fracture detection rate, P = 0.00) than when ordered for limb deformity or obvious fracture.

Diagnostic value and limitations of CT in detecting rib fractures and analysis of missed rib fractures: a study based on early CT and follow-up CT as the reference standard

To evaluate the value and limitations of computed tomography (CT) diagnosis of rib fractures, and to discuss the characteristics of missed rib fractures. One hundred and sixty chest trauma patients who underwent both early CT (within 48 h) and follow-up CT (14 days later) were enrolled. For early CT examinations, the diagnosis of rib fractures was divided into routine assessment and verification assessment. The detection rates of rib fractures in both patterns were calculated, and the characteristics of missed rib fractures were analysed, based on the imaging results of the twice CT examinations as the reference standard. A total of 584 fracture sites were confirmed. The overall detection rate of rib fractures in the routine assessment method was 72.4%. In the verification assessment, the detection rates of rib fractures of four observation strategies (axial images, multiplanar reconstruction [MPR], axial images+volume reconstruction [VR] and MPR+VR) were 76.2%, 79.1%, 78.6%, 80.8%, respectively. The incidence of occult fractures was 19.2% (112/584). In both assessment methods, the detection rates of rib fractures at the costochondral junction were the lowest (60%, 65%, respectively); the detection rates ranged from 63.6% to 74.7% for non-displaced rib fractures, but 100% for displaced rib fractures. Most (78.9%) missed rib fractures were accompanied by visible fractures on the same or adjacent first to second rib. Most missed rib fractures are occult on early CT, which is attributable to the limitations of the CT technique. The number of displaced rib fractures on early CT is a more stable and reliable clinical indicator.

An attention‐based cascade R‐CNN model for sternum fracture detection in X‐ray images

Fracture is one of the most common and unexpected traumas. If not treated in time, it may cause serious consequences such as joint stiffness, traumatic arthritis, and nerve injury. Using computer vision technology to detect fractures can reduce the workload and misdiagnosis of fractures and also improve the fracture detection speed. However, there are still some problems in sternum fracture detection, such as the low detection rate of small and occult fractures. In this work, the authors have constructed a dataset with 1227 labelled X-ray images for sternum fracture detection. The authors designed a fully automatic fracture detection model based on a deep convolution neural network (CNN). The authors used cascade R-CNN, attention mechanism, and atrous convolution to optimise the detection of small fractures in a large X-ray image with big local variations. The authors compared the detection results of YOLOv5 model, cascade R-CNN and other state-of-the-art models. The authors found that the convolution neural network based on cascade and attention mechanism models has a better detection effect and arrives at an mAP of 0.71, which is much better than using the YOLOv5 model (mAP = 0.44) and cascade R-CNN (mAP = 0.55).

Comparison of Plain Radiography with Spiral Computed Tomography and 3D Reformation in Tibial Plateau Fractures: A Cross-sectional Study

Introduction: Tibial plateau fractures may result in major disabilities if not diagnosed at the right time. Plain radiography is the first and foremost imaging modality of choice to evaluate trauma followed by Computed Tomography (CT). Aim: To evaluate tibial plateau fractures on CT and compare them with 3D reformations and plain radiography, and classify the fractures using Schatzker’s classification. Materials and Methods: The prospective cross-sectional study was conducted at a tertiary care centre in Bengaluru, Karnataka, India, between November 2016 to June 2018. The study sample comprised of 53 patients who presented with fracture of the tibial plateau. Demographic details and brief clinical history of the subjects were recorded. All patients underwent conventional radiography as well as CT of the knee, including three-Dimensional (3D) reconstruction. The region of interest was assessed for the presence, displacement, depression, extent and comminution of the fracture. Data was analysed using R version 4.0.3. Chi-square test was used to see the association between different variables. Cohen’s Kappa was employed to determine the agreement of plain radiograph and CT findings. Results: The mean age of patients was 44.01±13.23 years. The extent of the fracture line and communition of fracture were visible on all sections of CT for all samples, but 3D CT did not reveal the extent of the fracture line in 9.43% of the sample (p=0.003) and communition was visible only in 15.09% of the sample. On comparing the plain radiograph and CT findings for tibial plateau fractures, a close to perfect agreement in diagnosing the displacement of fracture (Cohen’s Kappa, 0.9618, p&lt;0.001), followed by a fair agreement in diagnosing fracture communition (Cohen’s Kappa, 0.3748; p=0.0015) were noted. The positive predictive value of tibial plateau fracture detection rate by plain radiography and CT findings were 88.7% and 98.1%, respectively. These fractures assessed as per Schatzker’s classification revealed majority of the patients had bicondylar plateau with diaphyseal discontinuity 19 (35.85%) followed by bicondylar plateau 14 (26.42%). Conclusion: In this study, CT was observed to be an excellent modality for the evaluation of tibial plateau fractures including depression, displacement, comminution and extent of fractures when compared to plain radiography.

The Necessity of CT Hip Scans in the Investigation of Occult Hip Fractures and Their Effect on Patient Management

The diagnostic challenge of negative plain radiography in the context of a previously ambulatory patient is increasing with the rise in geriatric trauma. These patients are often diagnosed with small undisplaced fractures of the pelvis and femur which may not alter management. This study aims to assess the frequency at which computed tomography (CT) hip scans altered patient management and whether two X-ray projections of the hip affected fracture detection rate. All CT hip scans performed over a three-year period were identified retrospectively. Only CT hips pertaining to the identification of occult fractures were included in the study. A total of 447 (63.6%) CT hips were performed to exclude an occult fracture, which was only detected in 108 (24.1%) of the scans requested. The majority were subcapital (n = 58, 53.7%) or intertrochanteric (n = 39, 36.1%). There was no significant difference between fracture detection rates when comparing one and two views of the pelvis. 82.4% (n = 89) of occult hip fractures were managed operatively. CT imaging led to a change in patient management in 20% of cases. The frequency at which CT scan detects and alters management in occult hip fractures confirms the justification for its use. Increasing the number of X-ray projection views does not decrease the reliance on CT. Pelvic ring fractures are common in nonambulatory patients following trauma, and if confirmed on initial imaging, subsequent imaging to exclude a concurrent occult hip is unnecessary. The focus of further research should be towards the development of investigation algorithms which decrease the reliance on CT and defining the optimal surgical criteria for occult hip fractures.

INVESTIGATION OF THE QUALIFICATION OF RADIOLOGICAL TECHNIQUES TO DETECT OSTEOLYTIC LESIONS, FRACTURES, AND OSTEOPOROSIS IN MULTIPLE MYELOMA PATIENTS

Multiple myeloma(MM) is a malignancy of clonal plasma cells. Osteolytic lesions represent a criterion for symptomatic myeloma and are associated with bone loss, pathological fractures, and osteoporosis. Skeletal surveys with other sophisticated techniques and dual-energy x-ray absorptiometry (DEXA) are used to screen lytic lesions, and bone mineral loss, respectively. Here, we aimed to investigate the detection rate of osteolytic lesions and bone mineral loss by several imaging techniques in MM. Three-hundred and ten symptomatic MM patients were screened retrospectively. The results of radiological techniques were recorded. The detection rate of osteolytic lesions, fractures, and plasmacytomas by imaging techniques, as well as bone mineral loss with DEXA was recorded. Also, associations with gender, MM type, lytic lesions, and osteoporosis were investigated. Skeletal survey and PET-CT detected lytic lesions in 71.3% and 81.2% of patients, respectively. PET-CT had a sensitivity of 96.1% and specificity of 90.6% to detect lytic lesions. MRI was only used for patients with suspicious fractures and detected them for all patients who underwent MRI. The osteoporosis rate was 83% for 113 patients who underwent DEXA. Any association between lytic lesions and gender or MM type was not detected. Our study demonstrated that osteolytic lesions are not correlated with gender or MM type. PET-CT is a sensitive and specific method for detecting osteolytic lesions. Although DEXA is sensitive, its specificity is limited to detect osteoporosis in patients with lytic lesions.

Radiographic and clinical characterization of coracoid fractures: a retrospective cohort analysis

Coracoid fracture is a rare injury. The aim of this study is to present the demographics, clinical and radiologic characteristics, and outcomes of coracoid fracture in a cohort of 32 patients. We queried our institutional electronic medical record database (years 2012-2020) to identify patients with coracoid fractures using specific International Classification of Disease-10 codes. Demographic data, injury details including mechanism of injury and associated injuries, imaging performed, and treatment outcomes were obtained from retrospective chart review. A radiologist reviewed all available imaging studies (radiographs/CT/MRI) and classified the fractures according to Ogawa and Eyres classifications. Missed diagnoses were determined by comparing initial imaging reports with the follow-up imaging obtained in the office. Thirty-two patients with coracoid fractures were identified during the study period. Sixteen fractures (50%) occurred in the setting of low-energy trauma. Twelve fractures were missed on initial radiographs, and diagnosis with three-view radiographs (AP, scapular-Y and axillary) was 88% compared to 33% (p < 0.03) with two views (AP, scapular-Y). The majority of fractures were non-displaced (94%), and 56% were Ogawa Type-II fractures. Associated injuries were seen in 81% of patients. Most fractures (94%) were treated without surgery with excellent outcomes. Coracoid fractures continue to be a rare injury. In contrast to previous studies, in this case series of 32 patients, half of the fractures were associated with low-energy trauma, which correlated with higher percentage of non-displaced fractures and Ogawa Type-II fractures. Addition of the axillary view in the trauma radiographic series significantly improved the initial fracture detection rate. Retrospective study.

Computed tomography with low-dose radiation versus standard-dose radiation for diagnosing fractures: systematic review and meta-analysis

Computed tomography (CT) accounts for 13% of all radiological examinations in the United States and 40-70% of the radiation that patients receive. Even with the advent of magnetic resonance imaging (MRI), CT continues to be the gold standard for diagnosing bone fractures. There is uncertainty as to whether CT with a low radiation dose has a fracture detection rate similar to that of standard-dose CT. To determine the detection rate of low-dose radiation CT and standard-dose radiation CT for fractures, in patients with suspected fractures. Systematic review of comparative studies on diagnostic accuracy within the evidence-based health program at a federal university in São Paulo (SP), Brazil. We searched the electronic databases Cochrane Library, MEDLINE, EMBASE and LILACS up to June 29, 2020, for studies evaluating the detection rates of low-dose CT and standard-dose CT for diagnosing bone fractures. The Research Triangle Institute (RTI) item bank tool was used for methodological quality evaluation. The fracture detection rate according to the number of bones evaluated, using CT with low-dose radiation was 20.3%, while with standard-dose radiation it was 19.2%, and the difference between the methods was not significant. The fracture detection rate according to the number of patients, using CT with low-dose radiation was 56.0%, while with standard-dose radiation it was 58.7%, and this difference between the methods was not significant, either. CT with low-dose radiation presented detection rates similar to those of CT with standard-dose radiation, regardless of the bones evaluated. CRD42019148491 at the PROSPERO database.

Application of X-ray image measurement in the early diagnosis of sports injury of ankle ligament.

Objectives:To study the value of X-ray analysis method of ankle fracture based on injury mechanism to improve the imaging diagnosis level of ankle fracture.Methods:This study was conducted from January 2016 to December 2019. It included 105 cases of fractures caused by sprained ankle joints. Their age was between 21-81 years with an average of 49.5 years, The traditional X-ray analysis method (Group-A) and the injury mechanism-based ankle fracture X-ray analysis method (Group-B) were used to analyze X-ray image data. Group-B also performed Weber classification and Lauge-Hansen classification on cases. Installment.Results:Of the 105 patients with ankle fractures, 97 patients in Group-B were able to make Lauge-Hansen classification. Of these 97 ankle fractures, 137 were found in Group-A, and 158 were found in Group-B. The wrong diagnosis of fracture in Group-A was 18%, and the wrong diagnosis of fracture in Group-B was 0.5%. There was a statistically significant difference between the two groups (P <0.05).Conclusion:The X-ray analysis method of ankle fractures based on injury mechanism can effectively improve the detection rate of hidden ankle fractures and high fibular fractures, and reduce the missed diagnosis, which is superior to the traditional X-ray analysis methods. At the same time, Weber classification, Lauge-Hansen classification and staging can be made for most cases, which is conducive to guiding clinical treatment.

Dual-energy CT in the diagnosis of occult acute scaphoid injury: a direct comparison with MRI

ObjectivesScaphoid injuries occult on plain radiography often require further imaging for definitive diagnosis. We investigate the utility of dual-energy computed tomography (DECT) for the detection of acute bone marrow oedema and fracture of scaphoid compared to MRI.Materials and methodsTwenty patients who presented acutely (without prior injury) to the emergency department with clinically suspected occult scaphoid fracture and had MRI of the wrist were prospectively recruited to have DECT (GE Revolution CT). Material decomposition images of the water-calcium base pair were generated and assessed in conjunction with the monochromatic images to permit correlation of marrow signal changes with any cortical disruption for fracture confirmation. The assessment was performed by two musculoskeletal radiologists blinded from MRI results. The statistical difference of MRI and reviewers’ detection of acute bone oedema (1 = present, 0 = absent) was performed using the Friedman test (SPSS v.16).ResultsMRI showed acute scaphoid fracture and/or bone marrow oedema in 14/20 patients of which 6 also had cortical disruption. On DECT, reviewer A identified oedema in 13 and cortical disruption in 10 patients while reviewer B identified oedema in 10 and cortical disruption in seven of the 14 MRI positive patients. No statistically significant difference in oedema detection on MRI and reviewers of DECT (p value 0.61) but DECT was more sensitive at detecting cortical disruption.ConclusionDECT has the capability to detect acute scaphoid oedema in addition to cortical fractures. However, compared to MRI, DECT has lower contrast resolution and less sensitive in the detection of mild oedema.Key Points• Dual-energy CT is able to detect acute traumatic scaphoid marrow oedema.• Dual-energy CT has greater detection rate of scaphoid fractures than MRI.• Dual-energy CT is an alternative to MRI for occult scaphoid injury.

Comparison between computed tomography and magnetic resonance imaging in clinical diagnosis and treatment of tibial platform fractures.

BACKGROUNDTibial plateau fracture is one of the common fracture types. It occurs mainly in teenagers and is usually caused by a fall. After the occurrence of fracture, knee swelling, pain, limited activity, etc. greatly affect the patient’s exercise habits and lifestyle. X-ray, computed tomography (CT) and magnetic resonance imaging (MRI) were used in this examination. X-rays are relatively new and easy to operate. However, there are some errors in the observation of fracture collapse and fracture displacement. In recent years, CT and MRI have been actively used to diagnose various types of clinical fractures. They have more diagnostic power than X-ray film. However, some scholars believe that CT is also prone to errors in clinical application. The volume effect leads to missed diagnosis and misdiagnosis in some cases, while the multidirection scanning of MRI technology can effectively overcome the shortcomings of CT. To facilitate the selection of clinical examination regimens, this study further observed the diagnostic ability of these two regimens in the diagnosis of tibial plateau fractures.AIMTo explore the value of nuclear MRI and CT in the clinical diagnosis of tibial plateau fractures.METHODSA total of 120 patients with tibial plateau fractures admitted from September 2017 to August 2019 were included. All patients were examined by nuclear MRI and CT scanning. The results were sent to senior physicians in our hospital to complete the diagnosis.RESULTSNuclear magnetic resonance showed the same effects as CT in four aspects: fracture displacement, bone defect, fracture site and fracture comminution. There was no significant difference in the score data (P > 0.05). Nuclear magnetic resonance and CT tended to be consistent in the B3, C2 and C3 fracture diagnosis coincidence rate, combined injury detection rate and fracture detection rate. The diagnostic coincidence rate of type B1, B2 and C1 fractures and the accuracy rate of overall fracture classification indicated that the MRI technique was significantly better than that of CT (P > 0.05).CONCLUSIONMRI and CT have good diagnostic typing in the diagnosis of tibial plateau fractures, but MRI is more accurate and may be preferred.

An audit of the polytrauma fracture detection rate of clinicians evaluating lodox statscan bodygrams in two South African public sector trauma units

BackgroundIncreasing global demand for specialized radiological investigations has resulted in delayed or non-reporting of plain trauma radiographs by radiologists. This is particularly true in resource-limited environments, where referring clinicians rely largely on their own radiographic interpretation. A wide accuracy range has been documented for non-radiologist reporting of conventional trauma radiographs. The Lodox Statscan whole-body digital X-ray machine is a relatively new technology that poses unique interpretive challenges. The fracture detection rate of trauma clinicians utilizing this modality has not been determined. ObjectiveAn audit of the polytrauma fracture detection rate of clinicians evaluating Lodox Statscan bodygrams in two South African public-sector Trauma Units. MethodsA retrospective descriptive study of imaging data of Cape Town Level 1-equivalent public-sector Trauma Units during March-April 2015. Statscan bodygrams acquired for adult polytrauma triage were reviewed and correlated with follow-up imaging and patient records. Missed fractures were stratified by body part, mechanism of injury and ventilatory support. The fracture detection rate was determined with 95% confidence. The Generalised Fischer Exact Test assessed any association between the fracture site and failure of detection. Specialist orthopaedic review assessed the potential need for surgical management of missed fractures. Results227 patients (male = 193, 85%; mean age: 33 years) were included; 195 fractures were demonstrated on the whole-body triage projections. Lower limb fractures predominated (n = 66, 34%). The fracture detection rate was 89% (95% CI = 86–93%), with the site of fracture associated with failure of detection (p = 0.01). Twelve of 21 undetected fractures (57%) involved the elbow or shoulder girdle. All elbow fractures (n = 3, 100%), more than half the shoulder girdle fractures (9/13,69%) and 12% (15/123) of extremity fractures were undetected. One missed fracture (1/21,4.7%) unequivocally required surgical management, while a further 7 (7/21, 33.3%) could potentially have benefitted from surgery, depending on follow-up imaging findings. ConclusionThis is the first analysis of the accuracy of bodygram polytrauma fracture detection by clinicians. Particular review of the shoulder girdle, elbow and extremities for subtle fractures, in addition to standardized limb positioning, are recommended for improved diagnostic accuracy in this setting. These findings can inform clinician training courses in this domain.