Multiplanar computed tomography: a multidimensional tool for evaluation and treatment of acetabular fractures

Fractures of the acetabulum present a formidable diagnostic and therapeutic challenge. Improved management has decreased the mortality associated with these injuries. Prolonged survival of the severely injured has raised the associated morbidity. To improve diagnosis and treatment in these patients, computed tomography with multiplanar reconstructions has been utilized in the pre- and post-operative period in 30 patients. This refinement provides a precise, accurate, and reproducible method of establishing the diagnostic data base. Consequently it is possible to better define the pathoanatomy, make decisions as to the best technique for intervention, and facilitate execution of these techniques by improved preoperative planning and postintervention assessment. It is concluded that computed tomography with multiplanar reconstructions optimizes the ability to manage these injuries.     

三维CT重建在髋臼及胫骨平台骨折中的应用

目的：探讨三维CT重建髋臼骨折及胫骨平台骨折的临床应用价值。方法；收集髋臼骨折6例。胫骨平台骨折4例，所有患者均接受X线片，CT平扫和三维CT重建检查，评估骨折分离，移位的程度，对骨折进行分型，选择合理的治疗方案。结果：根据三维CT重建，较X线片更为直观地反映骨折的空间分离，移位情况，术前得以准确地评价骨折，明确分型，指导手术，结论：三维CT重建能多方位，立体地显示关节内骨折的形态，帮助术者正确合理地选择手术入路及内固定方法，取得好的疗效。     

The role of computed tomography in the assessment and treatment of acetabular fractures

The assessment of acetabular fractures by conventional radiology is difficult whilst essential to the planning of orthopaedic treatment. This report details the results of computed tomography (CT) in a study of acetabular fractures in 30 patients. Computed tomography was always superior to conventional radiology, particularly in the evaluation of lesions of the posterior acetabular margin. The standard classification of the fractures did not require modification but was reinforced by the three-dimensional visualisation of the lesions. The particular contribution of CT was in the assessment of associated lesions often not apparent on conventional views of the pelvis: these comprised sacroiliac lesions in 60% of cases, intra-articular loose bodies in 33% of cases and pelvic haematomas in 17% of cases. As a result of CT, treatment was changed in one third of cases. In addition to its role in indicating the need for surgical or orthopaedic treatment, CT sometimes permitted a better choice of surgical technique, especially in respect of sacroiliac lesions causing as yet unexplained sciatica.     

Computed tomography in the management of acetabular fractures

Twenty-four patients who sustained major hip trauma received computed tomography (CT) scans as well as conventional radiographs. A comparison of plain films with the CT scans showed that CT aided the diagnosis in 23 patients (96%): that CT altered the diagnosis in 14 patients (58%) and that the CT findings altered the management in eight patients (33%). It is our conclusion that CT scanning plays an essential role in the work-up and management of patients with major hip trauma.     

Three-dimensional computed tomography analysis of non-osteoarthritic adult acetabular dysplasia

OBJECTIVE: Little data exists on the original morphology of acetabular dysplasia obtained from patients without radiographic advanced osteoarthritic changes. The aim of this study was to investigate the distribution and degree of acetabular dysplasia in a large number of patients showing no advanced degenerative changes using three-dimensional computed tomography (3DCT). MATERIALS AND METHODS: Eighty-four dysplastic hips in 55 consecutive patients were studied. All 84 hips were in pre- or early osteoarthritis without radiographic evidence of joint space narrowing, formation of osteophytes or cysts, or deformity of femoral heads. The mean age at the time of CT scan was 35 years (range 15-64 years). 3D images were reconstructed and analyzed using recent computer imaging software (INTAGE Realia and Volume Player). Deficiency types and degrees of acetabular dysplasia were precisely evaluated using these computer software. RESULTS: The average Harris hip score at CT scans was 82 points. Twenty-two hips (26%) were classified as anterior deficiency, 17 hips (20%) as posterior deficiency, and 45 hips (54%) as lateral deficiency. No significant difference was found in the Harris hip score among these groups. The analysis of various measurements indicated wide variations. There was a significant correlation between the Harris hip score and the acetabular coverage (p < 0.001). CONCLUSION: Our results indicated wide variety of deficiency type and degree of acetabular dysplasia. Hips with greater acetabular coverage tended to have a higher Harris hip score.     

Finger fractures imaging: accuracy of cone-beam computed tomography and multislice computed tomography

Objective  

To compare the diagnostic accuracy and radiation exposure of cone beam computed tomography (CBCT) and multislice computed tomography (MSCT) in the evaluation of finger fractures.     

Multidetector computed tomography in acute joint fractures

Conventional radiography plays an essential diagnostic role in the primary evaluation of acute joint trauma. In complex fractures, however, computed tomography (CT) is an imaging modality often used second to radiography. As a result of technical breakthroughs in the field, multidetector CT (MDCT) allows faster imaging and better temporal, spatial, and contrast resolution compared with conventional single-slice spiral CT. MDCT with multiplanar reformation is helpful in disclosing fracture patterns, particularly in complex joint fractures, where they reveal occult fractures and show the exact number of fracture components and their degree of displacement.     

Multidetector computed tomography diagnosis of adult elbow fractures

Purpose: To assess acute phase multidetector computed tomography (MDCT) findings in elbow traumas.

Material and Methods: Fifty-six patients (32 M, 24 F, age 16 to 88 years, mean 44 years) underwent MDCT of the elbow due to an acute trauma during a time period of 34 months.

Results: A total of 65 fractures and 3 main fracture types were established: 16 (25%) ulnar coronoid process fractures, 13 (20%) radial head fractures, and 12 (18%) humeral supracondylar fractures. Three main injury mechanisms were falling (38 (68%) patients), falling from high places (6 (11%) patients), and traffic accidents (5 (9%) patients). In 6 (11%) patients, MDCT revealed 13 occult fractures in the elbow joint compared to primary radiography. In four (7%) patients a displaced fracture fragment was detected in primary radiography, but the origin of the fragment was unclear. In all four cases, MDCT revealed the origin of the fragment.

Conclusion: Radiography remains the primary imaging modality in elbow trauma, but in complex fracture patterns, where the extent of the fractures and the position or origin of dislocated fragments is not clear by radiography, the MDCT is a recommended complementary examination.     

X-ray computed tomography in fractures of the acetabulum

Radiographic assessment of these fractures remains difficult. Conventional techniques according to Letournel show the lesions but not to the best advantage, for instance the "congruency" of femoral head with acetabulum. 54 CT scan were performed (1982-1984) every time a doubt was persisting. Incarcerations of fragments, impactions of the acetabulum, sacro-iliac joint disjunctions, congruency and lesions of femoral head are much better seen with scanner. In planing the surgical therapy (or orthopedic), CT scan add a great deal to the information and dramatically improves the results.     

Under-reporting of osteoporotic vertebral fractures on computed tomography

Purpose

Osteoporotic vertebral fractures are frequently asymptomatic. They are often not diagnosed clinically or radiologically. Despite this, prevalent osteoporotic vertebral fractures predict future osteoporotic fractures and are associated with increased mortality and morbidity. Appropriate management of osteoporosis can reduce future fracture risk. Fractures on lateral chest radiographs taken for other conditions are frequently overlooked by radiologists. Our aim was to assess the value of computed tomography (CT) in the diagnosis of vertebral fracture and identify the frequency with which significant fractures are missed.

Materials and methods

The thoracic CT scans of 100 consecutive male and 100 consecutive female patients over 55 years were reviewed. CT images were acquired on General Electric Lightspeed multi-detector (MD) CT scanners (16 or 32 row) using 1.25 mm slice thickness. Midline sagittal images were reconstructed from the 3D volume images. The presence of moderate (25–40% height loss) or severe (>40% height loss) vertebral fractures between T1 and L1 was determined using an established semi-quantitative method and confirmed by morphological measurement. Results were compared with the formal CT report.

Results

Scans of 192 patients were analysed (95 female; 97 male); mean age 70.1 years. Thirty-eight (19.8%) patients had one or more moderate to severe vertebral fractures. Only 5 (13%) were correctly reported as having osteoporotic fractures in the official report. The sensitivity of axial CT images to vertebral fracture was 0.35.

Conclusion

Incidental osteoporotic vertebral fractures are under-reported on CT. The sensitivity of axial images in detecting these fractures is poor. Sagittal reformations are strongly recommended to improve the detection rate.     

Multidetector computed tomography of pediatric lateral condylar fractures

OBJECTIVE: The objective of this study was to compare lateral condylar fracture characterization using radiographs and multidetector computed tomography (MDCT) of the elbow and to evaluate outcomes in a group of children managed based on MDCT findings. METHODS: Unenhanced MDCT of the elbow with sagittal and coronal reformations was prospectively performed without sedation in 10 children between 1 and 16 years of age with lateral condylar fractures identified on frontal and lateral radiographs of the elbow. Two blinded readers reviewed all radiographs and MDCT images independently and in consensus. For the radiographs and MDCT images, readers graded the displacement of the lateral condyle fracture fragment and classified the fractures according to the Milch classification. Articular and epiphyseal cartilage integrity was assessed on MDCT. Patients were managed based on the consensus interpretation of the MDCT study. The frequency of interobserver agreement, discordant grading of fracture displacement and fracture classification between radiographs and MDCT images, and altered management based on the MDCT findings were determined. RESULTS: Individual readers agreed on fracture displacement in 9 patients (90%) on radiographs and in all 10 patients (100%) on MDCT. Individual readers agreed on fracture classification in 4 patients (40%) on radiographs and in 9 patients (90%) on MDCT. In 4 patients (40%), grading of fracture displacement differed between the consensus interpretation of the radiographs and MDCT images. In 6 patients (60%), fracture classification differed between the consensus interpretation of the radiographs and MDCT images. All 3 patients with fracture displacement greater than 5 mm and 1 patient with fracture displacement between 2 and 5 mm demonstrated disruption of the articular and epiphyseal cartilage on MDCT. Two patients (20%) with fracture displacement near the surgical threshold of 2 mm had altered management based on the MDCT findings. All patients progressed to complete fracture healing, with no delayed displacement or other complications. CONCLUSIONS: Multidetector computed tomography is a highly reproducible means of characterizing pediatric lateral condylar fractures and frequently demonstrates disruption of the epiphyseal and articular cartilage in patients with fracture displacement greater than 2 mm. The findings of MDCT may lead to altered treatment in patients with fracture displacement near the surgical threshold of 2 mm.     

Conventional radiology and computed tomography in facial fractures

The possibilities and limitations of conventional radiography and CT in detecting maxillo-facial fractures are shown both experimentally and in a clinical setting. In 36 patients examined by both methods after maxillo-facial trauma, CT and conventional radiography (including pluridirectional tomography) proved to be equal in detecting fractures of the orbital roof, the anterior wall of the frontal sinus, the nasal bone and the pterygoid process. CT is inferior to conventional radiography in fracture of the orbital floor, the frontal base of the skull, the hard plate and the zygomatic arch. CT is superior to conventional radiography in fractures of the medial and lateral wall of the orbit, the posterior wall of the frontal sinus, the posterior, medial and anterior wall of the maxillary sinus as well as the zygomatic bone.     

The acetabular sector angle of the adult hip determined by computed tomography

A new set of angles measured on standard axial CT images of the hip joint is defined. The angles provide information on the support of the femoral head from the anterior and the posterior part of the acetabulum. These angles have been measured in 82 adult hips, and correlated to a set of established parameters commonly measured at conventional roentgenography and on CT images of the hip joint. The defined angles may prove to be valuable in the total appreciation of hip joint function and stability.