Ulnar bone fracture diagnostic study of choice: Difference between revisions

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VisualWikitext

Latest revision as of 07:07, 30 December 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammadmain Rezazadehsaatlou[2] ;

Overview

Not all suspected fractures require imaging. Some fractures are minor and are treated similarly to soft-tissue injuries. Radiographic parameters should be used to check the normal anatomy and to detect anatomical anomalies and fractures. X-rays to determine the location and extent of the break. Occasionally, another scan, such as an MRI, might be used to get more-detailed images.

Diagnostic Study of Choice

Study of choice

X-ray

X-ray is the gold standard test for the diagnosis of Ulnar bone fracture. But, occasionally, another imaging modalities such as CT scan and/or MRI, might be used to get more detailed images and information regarding the involved bone and near organs.

At least two radiographic projections ( anteroposterior [AP] and lateral) of the forearm should be obtained but the Posteroanterior, lateral, and oblique views can be used together to describe the fracture. These two view show the fracture, the extent of displacement, and the extent of injury. It should be noted that finding any foreign bodies in open fractures and gunshot injuries is an important fact in these type of injuries. Meanwhile, a tuberosity view may help ascertain the rotational displacement of the fracture. This would help in planning how much supination or pronation is needed to achieve accurate anatomic reduction^[1]^[2].

Additional views such as oblique view may be done when:

The evaluation suggests fracture and 2 projections are negative.
They are routine for certain joints (eg, a mortise view for evaluating an ankle, an oblique view for evaluating a foot).
Certain abnormalities are suspected.

Different types of information can be found using X-rays in fracture:


Posteroanterior view	Radial inclination Radial length Ulnar variance
Lateral view	Carpal malalignment Tear drop angle Antero-posterior distance Volar or dorsal tilt
Oblique view	Pronated oblique view

MRI or CT can be used if

A fracture is not visible on plain x-rays but is strongly suspected clinically (common with scaphoid fractures and impacted femoral neck [subcapital] hip fractures).
More detail is needed to guide treatment (eg, for scapular fractures, pelvic fractures, or intraarticular fractures).

For example, if findings after a fall suggest hip fracture but x-rays are normal, MRI should be done to check for an occult hip fracture.

Other tests may be done to check for related injuries:

Arteriography or CT angiography to check for suspected arterial injuries
Electromyography and/or nerve conduction studies (rarely done immediately; more typically done when nerve symptoms persist weeks to months after the injury)

Computed tomography

Computed tomography (CT) is an useful modality in distal radius/ulnar pathologies and fractures. Radiography still is a primary imaging modality in forearm trauma, but in patients with complex fracture patterns, which the extent of the injury and the condition of the dislocated fragments is not clear in radiography evaluation, the CT scan evaluation is a recommended complementary examination. Consequently it can be concluded that the CT scan can help to identify the subsequent propagation of the fracture.

Other modalities

Magnetic resonance imaging (MRI)

Magnetic resonance imaging (MRI) is a limited modality in radioulnar injuries. MRI is not indicated in uncomplicated forearm fractures.

ultrasonography

ultrasonography imaging can be considered for the fractures diagnosis in patients with acute trauma. The main advantages of sonography comparing to other conventional imaging are the absence of radiation exposure and availability of this modality.Angiography or vascular Doppler ultrasonography are another useful tools to determine the level of vascular injury caused during the trauma in specific selected cases who the vascular injury is suspected^[3].

The comparison of various diagnostic studies for Ulnar fracture (with/without radius fracture)

Test	Sensitivity	Specificity
X - Ray	91.5%	87.6%
Test 2	...%	...%

Ulntrasonograhoy	91%	94%

References

↑ Guss MS, Kaye D, Rettig M (September 2016). "Bennett Fractures A Review of Management". Bull Hosp Jt Dis (2013). 74 (3): 197–202. PMID 27620542.
↑ Hopkins CM, Calandruccio JH, Mauck BM (January 2017). "Controversies in Fractures of the Proximal Ulna". Orthop. Clin. North Am. 48 (1): 71–80. doi:10.1016/j.ocl.2016.08.011. PMID 27886684.
↑ Schmid GL, Lippmann S, Unverzagt S, Hofmann C, Deutsch T, Frese T (November 2017). "The Investigation of Suspected Fracture-a Comparison of Ultrasound With Conventional Imaging". Dtsch Arztebl Int. 114 (45): 757–764. doi:10.3238/arztebl.2017.0757. PMID 29202925.

Template:WH Template:WS

[pmid27620542-1] Guss MS, Kaye D, Rettig M (September 2016). "Bennett Fractures A Review of Management". Bull Hosp Jt Dis (2013). 74 (3): 197–202. PMID 27620542.

[pmid27886684-2] Hopkins CM, Calandruccio JH, Mauck BM (January 2017). "Controversies in Fractures of the Proximal Ulna". Orthop. Clin. North Am. 48 (1): 71–80. doi:10.1016/j.ocl.2016.08.011. PMID 27886684.

[pmid29202925-3] Schmid GL, Lippmann S, Unverzagt S, Hofmann C, Deutsch T, Frese T (November 2017). "The Investigation of Suspected Fracture-a Comparison of Ultrasound With Conventional Imaging". Dtsch Arztebl Int. 114 (45): 757–764. doi:10.3238/arztebl.2017.0757. PMID 29202925.

[1]

[2]

[3]

@@ Line 3: / Line 3: @@
 {{CMG}}; {{AE}}[[User:DrMars|Mohammadmain Rezazadehsaatlou[2]]] ;
 == Overview ==
-Radiographic parameters should be used to check the normal anatomy and to detect anatomical anomalies and fractures.
+Not all suspected fractures require imaging. Some fractures are minor and are treated similarly to soft-tissue injuries. Radiographic parameters should be used to check the normal anatomy and to detect anatomical anomalies and fractures. X-rays to determine the location and extent of the break. Occasionally, another scan, such as an MRI, might be used to get more-detailed images.
 == Diagnostic Study of Choice ==
 === Study of choice ===
-X-rays to determine the location and extent of the break. Occasionally, another scan, such as an MRI, might be used to get more-detailed images.
-X-ray is the gold standard test for the diagnosis of Ulnar bone fracture. But, occasionally, another imaging modalities such as CT scan and/or MRI, might be used to get more detailed images and information regarding the involved bone and near organs.
+=== X-ray ===
+X-ray is the gold standard test for the diagnosis of Ulnar bone fracture. But, occasionally, another imaging modalities such as CT scan and/or MRI, might be used to get more detailed images and information regarding the involved bone and near organs.
-==== The comparison of various diagnostic studies for [disease name] ====
+At least two radiographic projections ( anteroposterior [AP] and lateral) of the forearm should be obtained but the Posteroanterior, lateral, and oblique views can be used together to describe the fracture. These two view show the fracture, the extent of displacement, and the extent of injury. It should be noted that finding any foreign bodies in open fractures and gunshot injuries is an important fact in these type of injuries. Meanwhile, a tuberosity view may help ascertain the rotational displacement of the fracture. This would help in planning how much supination or pronation is needed to achieve accurate anatomic reduction<ref name="pmid27620542">{{cite journal |vauthors=Guss MS, Kaye D, Rettig M |title=Bennett Fractures A Review of Management |journal=Bull Hosp Jt Dis (2013) |volume=74 |issue=3 |pages=197–202 |date=September 2016 |pmid=27620542 |doi= |url=}}</ref><ref name="pmid27886684">{{cite journal |vauthors=Hopkins CM, Calandruccio JH, Mauck BM |title=Controversies in Fractures of the Proximal Ulna |journal=Orthop. Clin. North Am. |volume=48 |issue=1 |pages=71–80 |date=January 2017 |pmid=27886684 |doi=10.1016/j.ocl.2016.08.011 |url=}}</ref>.
-{|
+Additional views such as oblique view may be done when:
+*  The evaluation suggests fracture and 2 projections are negative.
+*  They are routine for certain joints (eg, a mortise view for evaluating an ankle, an oblique view for evaluating a foot).
+*  Certain abnormalities are suspected.
+Different types of information can be found using X-rays in fracture:
+{| class="wikitable"
+|+
+!'''Posteroanterior view'''
+!
+* '''Radial inclination'''
+* '''Radial length'''
+* '''Ulnar variance'''
+|-
+|'''Lateral view'''
+|
+* '''Carpal malalignment'''
+* '''Tear drop angle'''
+* '''Antero-posterior distance'''
+* '''Volar or dorsal tilt'''
+|-
+|'''Oblique view'''
+|'''Pronated oblique view'''
+|}
+== '''MRI''' or '''CT''' can be used if ==
+*  A fracture is not visible on plain x-rays but is strongly suspected clinically (common with scaphoid fractures and impacted femoral neck [subcapital] hip fractures).
+*  More detail is needed to guide treatment (eg, for scapular fractures, pelvic fractures, or intraarticular fractures).
+For example, if findings after a fall suggest hip fracture but x-rays are normal, MRI should be done to check for an occult hip fracture.
+Other tests may be done to check for related injuries:
+*  Arteriography or CT angiography to check for suspected arterial injuries
+*  Electromyography and/or nerve conduction studies (rarely done immediately; more typically done when nerve symptoms persist weeks to months after the injury)
+=== Computed tomography ===
+Computed tomography (CT) is an useful modality in distal radius/ulnar pathologies and fractures. Radiography still is a primary imaging modality in forearm trauma, but in patients with complex fracture patterns, which the extent of the injury and the condition of the dislocated fragments is not clear in radiography evaluation, the CT scan evaluation is a recommended complementary examination. Consequently it can be concluded that the CT scan can help to identify the subsequent propagation of the fracture.
+=== Other modalities ===
+=== Magnetic resonance imaging (MRI) ===
+Magnetic resonance imaging (MRI) is a limited modality in radioulnar injuries. MRI is not indicated in uncomplicated forearm fractures.
+=== ultrasonography ===
+ultrasonography imaging can be considered for the fractures diagnosis in patients with acute trauma. The main advantages of sonography comparing to other conventional imaging are the absence of radiation exposure and availability of this modality.Angiography or vascular Doppler ultrasonography are another useful tools to determine the level of vascular injury caused during the trauma in specific selected cases who the vascular injury is suspected<ref name="pmid29202925">{{cite journal |vauthors=Schmid GL, Lippmann S, Unverzagt S, Hofmann C, Deutsch T, Frese T |title=The Investigation of Suspected Fracture-a Comparison of Ultrasound With Conventional Imaging |journal=Dtsch Arztebl Int |volume=114 |issue=45 |pages=757–764 |date=November 2017 |pmid=29202925 |doi=10.3238/arztebl.2017.0757 |url=}}</ref>.
+==== The comparison of various diagnostic studies for Ulnar fracture (with/without radius fracture) ====
+{| class="wikitable"
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
@@ Line 19: / Line 65: @@
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
 |-
-! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
+! style="background: #696969; color: #FFFFFF; text-align: center;" |X - Ray
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |91.5%
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |87.6%
 |-
 ! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
+|-
+!
+!
+!
+|-
+!Ulntrasonograhoy
+!91%
+!94%
+|-
+!
+!
+!
 |}
-<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small>
-===== Diagnostic results =====
-The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
-* [Finding 1]
-* [Finding 2]
-===== Sequence of Diagnostic Studies =====
-The [name of investigation] must be performed when:
-* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
-* A positive [test] is detected in the patient, to confirm the diagnosis.
-OR
-The various investigations must be performed in the following order:
-* [Initial investigation]
-* [2nd investigation]
-=== Name of Diagnostic Criteria ===
-'''It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.'''
-[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
-OR
-There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
-OR
-The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
-OR
-The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
-OR
-[Disease name] may be diagnosed at any time if one or more of the following criteria are met:
-* Criteria 1
-* Criteria 2
-* Criteria 3
-OR
-'''IF there are clear, established diagnostic criteria'''
-The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
-OR
-The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
-OR
-The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
-OR
-'''IF there are no established diagnostic criteria'''
-There are no established criteria for the diagnosis of [disease name].
 ==References==