Clinical impact of MRI in acute wrist fractures

Mack, Martin G.; Keim, S.; Balzer, J. O.; Schwarz, W.; Hochmuth, K.; Windolf, Joachim; Vogl, Thomas J.

doi:10.1007/s00330-002-1600-2

Cited by 35 publications

(21 citation statements)

References 24 publications

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“…5). MRI is well established for evaluation of tendon abnormalities and subtle bone marrow changes [2]. MRI is a static technique, however, and not optimal for evaluation of the dynamic component of ECU tendon instability.…”

Section: Discussionmentioning

confidence: 99%

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Ultrasound Imaging of Normal Displacement of the Extensor Carpi Ulnaris Tendon Within the Ulnar Groove in 12 Forearm–Wrist Positions

Lee

Ablove

Singh

et al. 2009

American Journal of Roentgenology

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OBJECTIVE Instability of the extensor carpi ulnaris (ECU) tendon can be a difficult clinical diagnosis because of normal changes in tendon position during wrist motion. Our goal was to determine the normal variation of ECU tendon displacement in 12 forearm–wrist positions. SUBJECTS AND METHODS Ultrasound imaging of the ECU tendons of 40 symptom-free wrists of healthy volunteers (13 women, seven men; mean age, 22.3 years; range, 20–25 years) was performed. Each ECU tendon was examined in 12 positions: four wrist positions (ulnar deviation, radial deviation, flexion, and extension) in each of three forearm positions (pronation, supination, and neutral). RESULTS ECU tendon displacement in the right hand was not significantly different from that in the left, and displacement in men did not differ significantly from that in women. There was a small but significant difference between displacement in the dominant and that in the nondominant hand (p < 0.02). Mean ECU tendon displacement was greatest in the supinated forearm position (p < 0.001) followed by the neutral position (p < 0.001) and was least in the pronated position (p < 0.001). Both ulnar deviation (p < 0.001) and flexion (p < 0.002) were associated with greater ECU tendon displacement than were radial deviation (p < 0.001) and extension (p < 0.002). Maximum percentage displacement volar to the ulnar border of the groove was 50% in flexed supination and ulnar deviation. The maximum displaced distance volar to the ulnar border of the groove was 5 mm. CONCLUSION Sonographic evaluation of the ECU tendon is simple and practical. Knowledge of normal ECU displacement relative to the ulnar groove may help in evaluation of ulnar-sided wrist pain.

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Section: Discussionmentioning

confidence: 99%

“…MRI is effective in the detection of subtle bone marrow changes and soft-tissue abnormalities in addition to pathologic changes in the ECU tendon [2]. However, musculoskeletal ultrasound may be a cost-effective alternative to MRI in evaluation of the ECU tendon.…”

mentioning

confidence: 99%

Ultrasound Imaging of Normal Displacement of the Extensor Carpi Ulnaris Tendon Within the Ulnar Groove in 12 Forearm–Wrist Positions

Lee

Ablove

Singh

et al. 2009

American Journal of Roentgenology

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“…9,52,53 Early MRI for clinical scaphoid fracture Mack et al followed 56 acutely injured wrists with MRI (1.5T) performed on average 6.6 days after initial normal radiographs. 54 A scaphoid fracture was deemed present if a cortical fracture line and/or a trabecular fracture line was present, displayed by decreased signal intensity on T1 images. The presence of an increased signal intensity around the fracture line on T2 images, representing surrounding oedema is usually seen.…”

Section: Mrimentioning

confidence: 99%

Review of imaging of scaphoid fractures

Smith

Bain

Turner

et al. 2010

ANZ Journal of Surgery

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Scaphoid fractures are the most common fractures of the carpus, accounting for 79% of all carpal fractures. Early diagnosis of scaphoid fractures is imperative owing to potential complications following the fracture, including non-union, avascular necrosis, carpal instability and osteoarthritis. Plain radiography remains the initial imaging modality to assess scaphoid fractures. Magnetic resonance imaging (MRI) is excellent in the detection of clinically suspected, but initially radiographically negative, scaphoid fractures. Cost-effectiveness analysis studies have demonstrated MRI is effective in this setting. Gadolinium enhanced MRI has been shown to be superior to unenhanced MRI in the detection of avascular necrosis. Computerized tomography scan is the preferred modality to assess the intricacies of scaphoid fracture, including fracture location and deformity, as well as union status. This review paper explores the recent advances in imaging of the scaphoid, with reference also to avascular necrosis and non-union following a scaphoid fracture.

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“…This case highlights some of the problems encountered with traditional x-ray views, and the need to consider oblique views as either standard procedure or as an adjunct where clinical suspicion remains high even in the presence of normal x-rays. This point remains valid even given the increasing use and availability of other forms of radiological investigation [6-9]. …”

Section: Discussionmentioning

confidence: 98%

Lessons to be learned from a missed case of Hamate fracture: a case report

Borse

Hahnel

Faraj

2010

Journal of Orthopaedic Surgery and Research

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IntroductionWe report the case of a missed fracture through the body of the hamate bone, only detected on a later, mistakenly taken 30° oblique x-ray view. This case highlights some of the problems encountered with traditional x-ray views, and the need to consider oblique views as either standard procedure or as an adjunct where clinical suspicion remains high even in the presence of normal x-rays.Case presentationA healthy 26-year-old Caucasian male fell whilst jogging, suffering a low velocity injury to his right hand. Initial accident and emergency examination and x-rays failed to demonstrate a fracture. At clinic, anteroposterior and carpal tunnel radiographs showed no fracture, however a mistakenly taken oblique x-ray revealed a displaced hamate body fracture.ConclusionThe authors believe that where a hamate fracture is suspected, an oblique x-ray view should be considered as part of the initial diagnostic investigations. Furthermore an oblique x-ray view is of particular use when clinical suspicion for hamate fracture remains high in the light of otherwise normal x-rays.

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Clinical impact of MRI in acute wrist fractures

Abstract: The purpose of this study was to evaluate the clinical impact of MRI in the early diagnosis of wrist trauma. High-resolution MR imaging was performed on a 1.5-T unit (Symphony Quantum, Siemens, Erlangen, Germany) using coronal and axial

Cited by 35 publications

References 24 publications

Ultrasound Imaging of Normal Displacement of the Extensor Carpi Ulnaris Tendon Within the Ulnar Groove in 12 Forearm–Wrist Positions

Ultrasound Imaging of Normal Displacement of the Extensor Carpi Ulnaris Tendon Within the Ulnar Groove in 12 Forearm–Wrist Positions

Review of imaging of scaphoid fractures

Lessons to be learned from a missed case of Hamate fracture: a case report

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