ACR Appropriateness Criteria ® Stress (Fatigue/Insufficiency) Fracture, Including Sacrum, Excluding Other Vertebrae

Bencardino, Jenny T.; Stone, Taylor; Roberts, Catherine C.; Appel, Marc; Baccei, Steven J.; Cassidy, R. Carter; Chang, Eric Y.; Fox, Michael G.; Greenspan, Bennett S.; Gyftopoulos, Soterios; Hochman, Mary G.; Jacobson, Jon A.; Mintz, Douglas N.; Mlady, Gary; Newman, Joel S.; Rosenberg, Zehava Sadka; Shah, Nidhi; Small, Kirstin M.; Weissman, Barbara N.

doi:10.1016/j.jacr.2017.02.035

Cited by 58 publications

(42 citation statements)

References 83 publications

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“…For severe cases of trauma, please refer to the ACR Appropriateness Criteria Ò topic on "Blunt Chest Trauma" [7] and the ACR Appropriateness Criteria Ò topic on "Major Blunt Trauma," which will be made available on the ACR website when completed. For suspected stress fractures, please refer to the ACR Appropriateness Criteria Ò topic on "Stress (Fatigue/Insufficiency) Fracture, Including Sacrum, Excluding Other Vertebrae" [8].…”

Section: Discussion Of Procedures By Variant Variant 1: Suspected Ribmentioning

confidence: 99%

ACR Appropriateness Criteria® Rib Fractures

Imaging¹,

Henry

Donnelly

et al. 2019

Journal of the American College of Radiology

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Rib fractures are the most common thoracic injury after minor blunt trauma. Although rib fractures can produce significant morbidity, the diagnosis of injuries to underlying organs is arguably more important as these complications are likely to have the most significant clinical impact. Isolated rib fractures have a relatively low morbidity and mortality and treatment is generally conservative. As such, evaluation with standard chest radiographs is usually sufficient for the diagnosis of rib fractures, and further imaging is generally not appropriate as there is little data that undiagnosed isolated rib fractures after minor blunt trauma affect management or outcomes. Cardiopulmonary resuscitation frequently results in anterior rib fractures and chest radiographs are usually appropriate (and sufficient) as the initial imaging modality in these patients. In patients with suspected pathologic fractures, chest CT or Tc-99m bone scans are usually appropriate and complementary modalities to chest radiography based on the clinical scenario.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.Disclaimer: The ACR Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified medical condition(s). These criteria are intended to guide radiologists, radiation oncologists, and referring physicians in making decisions regarding radiologic imaging and treatment. Generally, the complexity and severity of a patient's clinical condition should dictate the selection of appropriate imaging procedures or treatments. Only those examinations generally used for evaluation of the patient's condition are ranked. Other imaging studies necessary to evaluate other co-existent diseases or other medical consequences of this condition are not considered in this document. The availability of equipment or personnel may influence the selection of appropriate imaging procedures or treatments. Imaging techniques classified as investigational by the FDA have not been considered in developing these criteria; however, study of new equipment and applications should be encouraged. The ultimate decision regarding the appropriateness of any specific radiologic examination or treatment must be made by the referring physician and radiologist in light of all the circumstances presented in a...

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Section: Discussion Of Procedures By Variant Variant 1: Suspected Ribmentioning

confidence: 99%

ACR Appropriateness Criteria® Rib Fractures

Imaging¹,

Henry

Donnelly

et al. 2019

Journal of the American College of Radiology

View full text Add to dashboard Cite

show abstract

“…Since stress fractures to the bone are a continuum of mechanical failure ranging from simple bone marrow oedema to small micro-cracks with minor cortical disruption or complete fracture with or without fragments displacement, the most suitable diagnostic procedure is usually location-specific and patient-dependent. Evidence indicates that magnetic resonance imaging (MRI) has the highest combined sensitivity and specificity in the diagnostics of rib stress fractures, outperforming plain radiography, computed tomography (CT), positron emission tomography CT (PET-CT) and bone scintigraphy by delineating rib injury up to 14 days earlier when compared to other diagnostic modalities [ 8 ]. However, in patients with CIEDs implanted in either subclavicular region, MRI faces significant interpretation-related disadvantages in readings for rib fractures due to artefacts produced by the metallic housing of the pulse generator, regardless of the implanted system’s MRI-compatibility status.…”

Section: Discussionmentioning

confidence: 99%

Pacemaker-generated stress fracture of the second rib: a case report

Kšela

Racman

Zbacnik

et al. 2020

J Cardiothorac Surg

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Background Pocket-related complications following the implantation of cardiovascular implantable electronic devices primarily include pocket hematoma, infection, skin erosion or decubitus, device migration, and Twiddler's syndrome, with other pathologies such as nerve impairment or bone lesions being extremely rarely encountered. We report a case of a 20-year old asthenic, non-athlete female patient presenting with a device-generated fracture of the second rib several months after sub-muscular permanent pacemaker implantation due to repeated bilateral pre-pectoral pocket infections. Case presentation A 20-year old female patient was readmitted to our institution 9 months following sub-pectoral implantation of a permanent pacemaker, complaining of severe pocket-related pain, which arose spontaneously in the absence of direct trauma, intense physical activity or vigorous coughing, and was associated with normal day-to-day activity. To rule out a pacemaker re-infection, a native computed tomography and a positron emission tomography—computed tomography of the thorax were performed. Both modalities excluded an infection but showed a healing fracture and a focus of enhanced metabolic activity in the anterolateral part of the right second rib, indicating a non-traumatic or stress fracture of the bone. Consequently, a complete extraction of the pulse generator and both leads was performed and the smallest available single-chamber pulse generator with a single atrial electrode was implanted in the sub-fascial, pre-muscular pocket in the now recovered and uninfected left subclavicular region, alleviating patient’s severe pain symptoms and significantly enhancing her quality of life. Conclusions In the absence of direct trauma, intense physical activity or vigorous coughing, we assume that in this asthenic girl a normal day-to-day motion of the right shoulder has persistently forced the sub-muscularly placed pulse generator toward thoracic wall, putting increased repetitive pressure force on the underlying bones, finally causing a fatigue stress fracture of the second rib. In asthenic phenotype patients with small thorax and short subclavicular distance, a sub-muscular pacemaker implantation can potentially cause unique and unexpected pocket-related adverse events necessitating advanced diagnostics and timely treatment.

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“…Since stress fractures to the bone are a continuum of mechanical failure ranging from simple bone marrow oedema to small micro-cracks with minor cortical disruption or complete fracture with or without fragments displacement, the most suitable diagnostic procedure is usually location-speci c and patientdependent. Evidence indicates that magnetic resonance imaging (MRI) has the highest combined sensitivity and speci city in the diagnostics of rib stress fractures, outperforming plain radiography, computed tomography (CT), positron emission tomography CT (PET-CT) and bone scintigraphy by delineating rib injury up to 14 days earlier when compared to other diagnostic modalities (8). However, in patients with CIEDs implanted in either subclavicular region, MRI faces signi cant interpretation-related disadvantages in readings for rib fractures due to artefacts produced by the metallic housing of the pulse generator, regardless of the implanted system's MRI-compatibility status.…”

Section: Discussionmentioning

confidence: 99%

Pacemaker-generated stress fracture of the second rib: a case report

Kšela

Racman

Zbacnik

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Pocket-related complications following the implantation of cardiovascular implantable electronic devices primarily include pocket hematoma, infection, skin erosion or decubitus, device migration, and Twiddler's syndrome, with other pathologies such as nerve impairment or bone lesions being extremely rarely encountered. We report a case of a 20-year old asthenic, non-athlete female patient presenting with a device-generated fracture of the second rib several months after sub-muscular permanent pacemaker implantation due to repeated bilateral pre-pectoral pocket infections.Case presentation: A 20-year old female patient was readmitted to our institution 9 months following sub-pectoral implantation of a permanent pacemaker, complaining of severe pocket-related pain, which arose spontaneously in the absence of direct trauma, intense physical activity or vigorous coughing, and was associated with normal day-to-day activity. To rule out a pacemaker re-infection, a native computed tomography and a positron emission tomography - computed tomography of the thorax were performed. Both modalities excluded an infection but showed a healing fracture and a focus of enhanced metabolic activity in the anterolateral part of the right second rib, indicating a non-traumatic or stress fracture of the bone. Consequently, a complete extraction of the pulse generator and both leads was performed and the smallest available single-chamber pulse generator with a single atrial electrode was implanted in the sub-fascial, pre-muscular pocket in the now recovered and uninfected left subclavicular region, alleviating patient’s severe pain symptoms and significantly enhancing her quality of life.Conclusions: In the absence of direct trauma, intense physical activity or vigorous coughing, we assume that in this asthenic girl a normal day-to-day motion of the right shoulder has persistently forced the sub-muscularly placed pulse generator toward thoracic wall, putting increased repetitive pressure force on the underlying bones, finally causing a fatigue stress fracture of the second rib. In asthenic phenotype patients with small thorax and short subclavicular distance, a sub-muscular pacemaker implantation can potentially cause unique and unexpected pocket-related adverse events necessitating advanced diagnostics and timely treatment.

show abstract

ACR Appropriateness Criteria ® Stress (Fatigue/Insufficiency) Fracture, Including Sacrum, Excluding Other Vertebrae

Cited by 58 publications

References 83 publications

ACR Appropriateness Criteria® Rib Fractures

ACR Appropriateness Criteria® Rib Fractures

Pacemaker-generated stress fracture of the second rib: a case report

Pacemaker-generated stress fracture of the second rib: a case report

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