Diagnosis of acute fractures of the extremities: comparison of low-field MRI and conventional radiography

Remplik, Philipp; Stäbler, Axel; Merl, T.; Roemer, Frank W.; Bohndorf, Klaus

doi:10.1007/s00330-003-2066-6

Cited by 13 publications

(3 citation statements)

References 25 publications

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“…Following abstract review, 89 articles were progressed to full-text review. A total of 23 articles were included for qualitative synthesis, of which 10 articles yielded data suitable for meta-analysis [12][13][14][15][16][17][18][19][20][21]. These 10 articles examined an aggregate of 3902 sets of radiographs, producing a total of 4709 radiograph interpretation episodes for metaanalysis (see Fig.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

“…This included soft tissue injury, fractures, dislocations, osteomyelitis and osteoporosis. The other nine articles defined positive and negative finding as the presence or absence of a bony fracture [12,13,[15][16][17][18][19][20][21]. However, two of these nine articles went further and required radiograph interpreters to correctly classify any fracture identified for their findings to be regarded as a 'true' positive.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

“…However, weaknesses were noted due to lack of prospective size calculation and establishing an unbiased endpoint. The extent to which these factors influence results is uncertain; however, sample sizes in a number of studies appear underpowered [ 12 , 19 , 20 ].…”

Section: Limitationsmentioning

confidence: 99%

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Reporting errors in plain radiographs for lower limb trauma—a systematic review and meta-analysis

York

Franklin²,

Reynolds³

et al. 2021

Skeletal Radiol

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Introduction Plain radiographs are a globally ubiquitous means of investigation for injuries to the musculoskeletal system. Despite this, initial interpretation remains a challenge and inaccuracies give rise to adverse sequelae for patients and healthcare providers alike. This study sought to address the limited, existing meta-analytic research on the initial reporting of radiographs for skeletal trauma, with specific regard to diagnostic accuracy of the most commonly injured region of the appendicular skeleton, the lower limb. Method A prospectively registered, systematic review and meta-analysis was performed using published research from the major clinical-science databases. Studies identified as appropriate for inclusion underwent methodological quality and risk of bias analysis. Meta-analysis was then performed to establish summary rates for specificity and sensitivity of diagnostic accuracy, including covariates by anatomical site, using HSROC and bivariate models. Results A total of 3887 articles were screened, with 10 identified as suitable for analysis based on the eligibility criteria. Sensitivity and specificity across the studies were 93.5% and 89.7% respectively. Compared with other anatomical subdivisions, interpretation of ankle radiographs yielded the highest sensitivity and specificity, with values of 98.1% and 94.6% respectively, and a diagnostic odds ratio of 929.97. Conclusion Interpretation of lower limb skeletal radiographs operates at a reasonably high degree of sensitivity and specificity. However, one in twenty true positives is missed on initial radiographic interpretation and safety netting systems need to be established to address this. Virtual fracture clinic reviews and teleradiology services in conjunction with novel technology will likely be crucial in these circumstances.

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Section: Study Selection and Characteristicsmentioning

confidence: 99%

Section: Study Selection and Characteristicsmentioning

confidence: 99%

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Reporting errors in plain radiographs for lower limb trauma—a systematic review and meta-analysis

York

Franklin²,

Reynolds³

et al. 2021

Skeletal Radiol

View full text Add to dashboard Cite

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Wrist and Hand

Chatha¹

2012

Imaging Musculoskeletal Trauma

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Acute knee trauma: role of ultrasound

et al. 2006

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The purpose of this study was to determine the diagnostic accuracy of high spatial resolution ultrasonography (US) in the detection of lipohemarthrosis of the knee and to evaluate this sign as criteria of intra-articular fracture. Forty-eight patients with clinical suspicion of knee fracture were prospectively examined by conventional radiography, sonography examination and computed tomography (CT) within 48 h after trauma in order to depict direct (fracture line) and indirect (lipohemarthrosis) signs of intra-articular fracture. Lipohemarthrosis was defined as a multi-layered collection in the subquadricipital recess. CT was considered as the gold standard for both direct and indirect fracture criteria. CT imaging showed direct signs of intra-articular fracture in 31 patients (65%). Among these patients, 30 (97%) had a lipohemarthrosis. Conventional radiographs showed intra-articular fracture in 26 patients (54%). Among these, 18 (69%) had a lipohemarthrosis. Sonographic examinations could not depict any direct sign of intra-articular fracture but showed a lipohemarthrosis in 29 (93%) of patients with proven fracture via CT. This allowed the depiction of four out of five occult knee fractures. The sensitivity, specificity, positive predictive value, negative predictive value of sonography for the diagnosis of lipohemarthrosis was 97, 100, 100 and 94%, respectively, compared with 55, 100, 100 and 55% with conventional radiographs. Using lipohemarthrosis as criterion of fracture, the sensitivity, specificity, positive predictive value and negative predictive value of sonography for early detection of intra-articular knee fractures was 94, 94, 97 and 89%, respectively, compared with 84, 88, 93 and 75% with conventional radiographs. We concluded that, by showing lipohemarthrosis in the subquadricipital recess, high-resolution sonography is a reliable and accurate technique for the evaluation of intra-articular knee fractures.

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Diagnosis of acute fractures of the extremities: comparison of low-field MRI and conventional radiography

Cited by 13 publications

References 25 publications

Reporting errors in plain radiographs for lower limb trauma—a systematic review and meta-analysis

Reporting errors in plain radiographs for lower limb trauma—a systematic review and meta-analysis

Wrist and Hand

Acute knee trauma: role of ultrasound

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