ACR Appropriateness Criteria Acute Trauma to the Ankle

Mosher, Timothy J.; Kransdorf, Mark J.; Adler, Ronald S.; Appel, Marc; Beaman, Francesca D.; Bernard, Stephanie A.; Bruno, Michael A.; Dempsey, Molly; Fries, Ian Blair; Khoury, Viviane; Khurana, Bharti; Roberts, Catherine C.; Tuite, Michael J.; Ward, Robert James; Zoga, Adam C.; Weissman, Barbara N.

doi:10.1016/j.jacr.2014.11.015

Cited by 25 publications

(10 citation statements)

References 61 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…1). At full text level 22 primary articles, 35 review articles 6, and 14 guidelines [68][69][70][71][72][73][74][75][76][77][78][79][80][81] were included. Articles assigned NHMRC level of evidence 11 by two authors independently (see page 15 of this reference for further details https://www.nhmrc.gov.au/_files_nhmrc/file/ guidelines/developers/nhmrc_levels_grades_evidence_120423.…”

Section: Search Resultsmentioning

confidence: 99%

Review article: Best practice management of common ankle and foot injuries in the emergency department (part 2 of the musculoskeletal injuries rapid review series)

Strudwick

McPhee

Bell

et al. 2017

Emerg Medicine Australasia

View full text Add to dashboard Cite

Ankle and foot injuries are the most common musculoskeletal injuries presenting to Australian EDs and are associated with a large societal and economic impact. The quality of ED care provided to patients with ankle and foot fractures or soft tissue injuries is critical to ensure the best possible outcomes for the patient. This rapid review investigated best practice for the assessment and management of common ankle and foot injuries in the ED. Databases including PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites, were searched in 2017. Primary studies, systematic reviews and guidelines were considered for inclusion. English language articles published in the last 12 years that addressed the acute assessment, management or prognosis in the ED were included. Data extraction of included articles was conducted, followed by quality appraisal to rate the level of evidence where possible. The search revealed 1242 articles, of which 71 were included in the review (n = 22 primary articles, n = 35 systematic reviews and n = 14 guidelines). This rapid review provides clinicians managing fractures and soft tissue injuries of the ankle and foot in the ED a summary of the best available evidence to enhance the quality of care for optimal patient outcomes. Following a thorough history and physical examination, including the application of the Ottawa ankle rules, ED clinicians should not only provide a diagnosis, but rate the severity of soft tissue injuries, or stability of fractures and dislocations, which are the pivotal decision points in guiding ED treatment, specialist referral and the follow-up plan.

show abstract

Section: Search Resultsmentioning

confidence: 99%

Review article: Best practice management of common ankle and foot injuries in the emergency department (part 2 of the musculoskeletal injuries rapid review series)

Strudwick

McPhee

Bell

et al. 2017

Emerg Medicine Australasia

View full text Add to dashboard Cite

show abstract

“…Evaluation of extremity trauma is among the most common imaging tasks in any emergency department [1]. While digital radiography remains the primary means of fracture diagnosis due to cost-efficiency, low radiation dose, and ubiquitous availability, computed tomography (CT) can provide advantages over x-ray imaging in detection of subtle fractures or visualization of fracture displacement and assist pre-surgical planning [2][3][4]. Furthermore, cone-beam CT (CBCT) can contribute to trauma assessment by ruling out fractures that were suspected in previous radiography [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Twin robotic x-ray system in small bone and joint trauma: impact of cone-beam computed tomography on treatment decisions

et al. 2020

View full text Add to dashboard Cite

Objectives Trauma evaluation of extremities can be challenging in conventional radiography. A multi-use x-ray system with cone-beam CT (CBCT) option facilitates ancillary 3-D imaging without repositioning. We assessed the clinical value of CBCT scans by analyzing the influence of additional findings on therapy. Methods Ninety-two patients underwent radiography and subsequent CBCT imaging with the twin robotic scanner (76 wrist/hand/finger and 16 ankle/foot/toe trauma scans). Reports by on-call radiologists before and after CBCT were compared regarding fracture detection, joint affliction, comminuted injuries, and diagnostic confidence. An orthopedic surgeon recommended therapy based on reported findings. Surgical reports (N = 52) and clinical follow-up (N = 85) were used as reference standard. Results CBCT detected more fractures (83/64 of 85), joint involvements (69/53 of 71), and multi-fragment situations (68/50 of 70) than radiography (all p < 0.001). Six fractures suspected in radiographs were ruled out by CBCT. Treatment changes based on additional information from CBCT were recommended in 29 patients (31.5%). While agreement between advised therapy before CBCT and actual treatment was moderate (κ = 0.41 [95% confidence interval 0.35–0.47]; p < 0.001), agreement after CBCT was almost perfect (κ = 0.88 [0.83–0.93]; p < 0.001). Diagnostic confidence increased considerably for CBCT studies (p < 0.001). Median effective dose for CBCT was 4.3 μSv [3.3–5.3 μSv] compared to 0.2 μSv [0.1–0.2 μSv] for radiography. Conclusions CBCT provides advantages for the evaluation of acute small bone and joint trauma by detecting and excluding extremity fractures and fracture-related findings more reliably than radiographs. Additional findings induced therapy change in one third of patients, suggesting substantial clinical impact. Key Points • With cone-beam CT, extremity fractures and fracture-related findings can be detected and ruled out more reliably than with conventional radiography. • Additional diagnostic information provided by cone-beam CT scans has substantial impact on therapy in small bone and joint trauma. • For distal extremity injury assessment, one-stop-shop imaging without repositioning is feasible with the twin robotic x-ray system.

show abstract

“…4 While MRI scans are considered a good alternative to radiographs, 5 frequently post-operative assessments of fracture healing need to be performed in the presence of metal hardware, 6 which produces significant artefacts on MRI and could prove challenging to interpret. In such cases, MDCT is regarded as an appropriate diagnostic modality in the assessment of fracture healing following initial assessment by plain radiograph (modality of choice), 7 where volume rendering mitigates the deleterious effects of streak artefacts 8 that are associated with the presence of metal hardware. 4,9 Recently, we designed, developed and tested the feasibility of a dedicated high-resolution three-dimensional (3D) extremity cone-beam CT (CBCT) scanner for musculoskeletal imaging that has the ability to obtain weightbearing scan acquisition.…”

Section: Introductionmentioning

confidence: 99%

Image quality of cone beam computed tomography for evaluation of extremity fractures in the presence of metal hardware: visual grading characteristics analysis

Osgood

Thawait

Hafezi-Nejad

et al. 2017

BJR

View full text Add to dashboard Cite

Objective: To evaluate image quality and interobserver reliability of a novel cone-beam CT (CBCT) scanner in comparison with plain radiography for assessment of fracture healing in the presence of metal hardware. Methods: In this prospective institutional review boardapproved Health Insurance Portability and Accountability Act of 1996-complaint study, written informed consent was obtained from 27 patients (10 females and 17 males; mean age 44 years, age range 21-83 years) with either upper or lower extremity fractures, and with metal hardware, who underwent CBCT scans and had a clinical radiograph of the affected part. Images were assessed by two independent observers for quality and interobserver reliability for seven visualization tasks. Visual grading characteristic (VGC) curve analysis determined the differences in image quality between CBCT and plain radiography.Interobserver agreement was calculated using Pearson's correlation coefficient. Results: VGC results displayed preference of CBCT images to plain radiographs in terms of visualizing (1) cortical and (2) trabecular bones; (3) fracture line; (4) callus formation; (5) bridging ossification; and (6) screw thread-bone interface and its inferiority to plain radiograph in the visualization of (7) large metallic side plate contour with strong interobserver correlation (p-value , 0.05), except for visualizing large metallic side plate contour. Conclusion: For evaluation of fracture healing in the presence of metal hardware, CBCT image quality is preferable to plain radiograph for all visualization tasks, except for large metallic side plate contours. Advances in knowledge: CBCT has the potential to be a good diagnostic alternative to plain radiographs in evaluation of fracture healing in the presence of metal hardware.

show abstract

ACR Appropriateness Criteria Acute Trauma to the Ankle

Cited by 25 publications

References 61 publications

Review article: Best practice management of common ankle and foot injuries in the emergency department (part 2 of the musculoskeletal injuries rapid review series)

Review article: Best practice management of common ankle and foot injuries in the emergency department (part 2 of the musculoskeletal injuries rapid review series)

Twin robotic x-ray system in small bone and joint trauma: impact of cone-beam computed tomography on treatment decisions

Image quality of cone beam computed tomography for evaluation of extremity fractures in the presence of metal hardware: visual grading characteristics analysis

Contact Info

Product

Resources

About