Scaphoid fracture: evaluation with flexion-extension tomography

Assessment of healing of a scaphoid fracture, which may be associated with delayed fusion and nonunion, is a challenging task for the radiologist. Thirty cases of clinically suspected nonunion scaphoid waist fractures with inconclusive plain radiographs were prospectively studied by means of stationary tomography and lateral flexion-extension tomography. The angle between the two scaphoid fragments as seen in extension was measured and compared with the angle as seen in flexion. A difference of 10 degrees or greater between flexion and extension was considered significant. This was noted in 14 of 15 cases of nonunion. Fifteen cases without angle differences were accurately diagnosed as stable. One false-negative case was noted, which on review was attributed to a limited extension view. Flexion-extension tomography is a highly valuable diagnostic modality in evaluating the stability and healing of scaphoid fracture and is superior to conventional (stationary) tomography.     

腕舟状骨骨折不愈合的手术治疗

探讨腕舟状骨骨折不愈合因素及预防、治疗方法。对23例腕舟状骨骨折行切开复位植骨AO螺钉内固定术,12～24周后骨折全部愈合,腕关节功能恢复良好。     

应力性骨折的影像学诊断

目的研究不同部位应力性骨折的影像学特点并分析其生物力学基础。方法搜集20例应力性骨折患者的X线、CT、MRI、发射型计算机体层显像(ECT)资料，分析其影像学表现及其与骨骼生物力学薄弱区的相关性。结果20例中，胫骨14例、跖骨2例、肋骨1例、股骨颈并双侧肋骨多发性骨折1例、股骨下段1例、腓骨1例。2例早期应力性骨折X线上表现为较具特征性的“灰色骨皮质征”；修复期骨痂呈球形或不规则形生长，骨膜反应明显，2例可见“双皮质征”；骨折局部愈合，典型表现为“扣征”。CT扫描能清晰显示骨质改变和软组织水肿；MRI上骨痂生长表现为T1WI低信号，T2WI稍高信号；骨髓水肿范围较平片及CT所见大，T1WI呈低信号，T2WI呈高信号；骨折线呈长T1、短T2信号；ECT表现为骨折处放射性浓聚。应力性骨折发生部位具有一定特征性，好发于骨骼生物力学上的薄弱区。结论应力性骨折的发生部位及影像学表现均具有一定的特征性，X线平片仍是诊断应力性骨折的首选方法，CT与MRI对于鉴别诊断具有较高价值，ECT对显示病变敏感性较高，但无特异性。     

PACS: current status and cost-effectiveness

European Radiology -     

交锁髓内针治疗粉碎性下肢长骨干骨折不愈合23例

目的：探讨交锁髓内针治疗粉碎性下肢长骨干骨折不愈合的临床疗效,方法：采用交锁髓内针和植骨治疗粉碎性下肢长骨干骨折不愈合共23例,其中男15例,女8例,平均年龄37．5岁,致伤原因分别为交通伤,高处坠落伤,术后早期不负重功能锻炼,结果：23例随访时间平均11个月,所有闰例均骨性愈合,膝关节功能较术前有明显改善,无髓内针断裂,锁钉断裂等发生,结论：交锁髓内针是目前治疗粉碎性下肢长骨干骨折不愈合的有效方法之一,固定牢固,术后可早期功能锻炼,膝关节功能恢复较好。     

Scaphoid fracture detection in a military population: a standardized approach for medical referral

OBJECTIVE: The objective was to test, refine, and implement an algorithm for early detection and referral of clinical scaphoid fractures by U.S. Army medical personnel. Our goal was to reduce complications resulting from delayed diagnosis and to improve outcomes affecting soldier health and unit readiness. METHODS: Data on scaphoid fractures treated in the orthopedic department at Tripler Army Medical Center were collected from January 1, 2001, through December 31, 2003. Demographic variables included gender, age, and military rank. RESULTS: The incidence of scaphoid fractures in our population was 43 cases per 100,000 personnel per year. An algorithm to guide nonorthopedic providers was developed after review of the medical literature. CONCLUSION: We present an algorithm-based approach to soldiers presenting with post-traumatic wrist pain. The algorithm was fashioned with the aim of reducing complications and poor outcomes associated with delayed diagnosis of scaphoid fractures, affecting soldier health and unit readiness. A prospective study of the algorithm is underway.     

Detection of osteomyelitis at fracture nonunion sites: comparison of two scintigraphic methods

Forty-nine patients with 50 fracture nonunions 4-48 months after injury underwent technetium-99m methylene diphosphonate (99mTc-MDP) scintigraphy on day 1, combined 99mTc-MDP and indium-111 leukocyte (111In-WBC) scintigraphy on day 2, and gallium-67 (67Ga) scintigraphy on day 3. The results were compared to evaluate the relative abilities of these scintigraphic techniques to detect osteomyelitis. Nine patients had clinical evidence of infection at the time of imaging, and 40 patients (41 fractures) did not. Open-biopsy cultures were performed at all fracture sites and were positive at 21 (42%) of the 50 sites. Combined 99mTc-MDP/111In-WBC images were interpreted with the use of two criteria. A positive study by the first criterion required 111In-WBC localization in the region of the nonunion fracture. A positive study by the second criterion required 111In-WBC localization in bone at the fracture site. The first criterion yielded a sensitivity of 84%, specificity of 72%, and accuracy of 74%; the specificity improved to 97% with an accuracy of 88% when the second criterion was used. Ten (25%) of the 40 patients thought not to have osteomyelitis by clinical criteria at the time of imaging had true-positive 99mTc-MDP/111In-WBC studies by biopsy culture results. Gallium-67 studies were interpreted as nondiagnostic if localization of radioisotope at fracture sites was equal to that with 99mTc-MDP, positive if 67Ga localization was greater than that of 99mTc-MDP, and negative if it was less than that of 99mTc-MDP. Twenty-one 67Ga studies were interpreted as nondiagnostic; 11 (52%) of the 21 had culture-positive fracture sites. The accuracy of 67Ga/99mTc-MDP imaging was 39%. Combined 99mTc-MDP/111In-WBC imaging is useful in the detection of osteomyelitis at fracture nonunion sites and improves the specificity of 111In-WBC imaging by differentiating inflammation/infection in adjacent soft tissue from osteomyelitis at the fracture site. Gallium-67 with 99mTc-MDP imaging is not sufficiently reliable in this clinical setting to be useful as an indicator for osteomyelitis.     

Hepatic imaging: current status

The radiologist needs to be aware of the varied appearance of hepatic mass lesions and be prepared to recommend the most cost-effective imaging approach. In this article, the authors discuss their hepatic imaging experience, common pitfalls, and current recommendations.     

Digital angiography: current status

Digital angiography depends upon computer recording and manipulation of the radiographic image rather than the use of film. We use a small focal spot x-ray tube, a cesium iodide image intensifier and the image is recorded on a 512 X 512 matrix at 1.2 frames per second. Subtraction angiograms have been obtained in 250 patients and 86% of the results were graded as either good or excellent in head and neck examinations. There is however a small proportion of patients in whom results are unsatisfactory and in whom this fact can be attributed most often to cardiac failure. The advantages of digital intravenous and intra-arterial subtraction angiography have been evaluated and amount to improved patient safety, high system contrast and favourable cost effectiveness; these outweigh the limitations of the restricted field of view and the relatively low resolution of the image in comparison with conventional arteriography.     

MR colonography: current status

Magnetic resonance colonography (MRC) has gained access into clinical routine as a means for the assessment of the large bowel. There are widely accepted indications for MRC, especially in patients with incomplete conventional colonoscopy. Furthermore, virtual MRC is more and more propagated as a screening tool, with advantages especially inherent to the non-invasive character of this procedure and the lack of ionizing radiation exposition. Beyond a sufficiently high diagnostic accuracy, outstanding patient acceptance is a major advantage of MRC as a diagnostic modality. This review article describes indications, techniques and clinical outcome of current MRC approaches. Furthermore, the impact of fecal tagging concepts is discussed.     

A contribution to radiological diagnostics of xanthogranulomatous pyelonephritis (author's transl)]

Pyelonephritis xanthogranulomatosa is a peculiar manifestation of destructive interstitial nephritis which can be differentiated from other types of pyonephrosis exclusively by microscopic examination. Clinical symptomatology often points towards the existence of a renal tumor. The author analyses the clinical and radiological symptomatology of seven patients treated by him. The angiographic picture presented by pyelonephritis xanthogranulomatosa differs according to the character and extension of the inflammatory tissue lesion. The angiographic picture of the circumscribed and diffuse granular proliferative types resembles that of a poorly vascularised malignoma, whereas the destructive type resembles hydropyonephrosis.     

交锁髓内钉内固定术治疗尺骨骨折术后骨不连

目的评估交锁髓内钉内固定术治疗尺骨骨折术后骨不连的临床疗效。方法采用交锁髓内钉内固定术治疗11例尺骨骨折术后骨不连患者,其中4例萎缩型骨不连辅以自体髂骨植骨术。术后采用Meod标准评估骨折愈合情况及前臂功能。结果平均随访11．6个月（8～18个月）,11例骨折均愈合,前臂功能优7例,良3例,可1例。结论交锁髓内钉内固定术是治疗尺骨术后骨不连的可选择术式之一。