Diagnostic Accuracy of Bone Scan Compared to Computed Tomography of Thorax Fractures of Chest Trauma Patients

PURPOSE: Thorax computed tomography (CT) is the diagnostic test for chest trauma patients in the emergency department. Thorax CT has high diagnostic accuracy for rib, sternum fractures. However, rib, sternum fractures are often missed by thorax CT. In this study, the accuracy of thorax CT as a diagnostic test of rib, sternum fractures was examined by comparing the diagnosis of rib, sternum fractures by bone scan. METHODS: A total of 112 patients who had visited the emergency department due to chest trauma and who had undergone both thorax CT and bone scan from January 1, 2010, to June, 30, 2013 were examined. We examined the patients'characteristics, vital signs and cause of trauma through a retrospective analysis of medical records, and thorax CT and bone scan were read by a radiologist and a nuclear medicine specialist. RESULTS: Among 112 patients, 62 patients (55.3%) were male, 50 patients (44.7%) were female, and mean age was 56. There were 59 patients who had no fracture on thorax CT and were regarded as contusion. In 59 patients, 28 patients (47.5%) were diagnosis rib, sternum fractures detected by bone scan. Sex (p=0.188), age (p=0.624), and cause of trauma (p=0.389) were not significant predictors for rib, sternum fractures. However, combined fracture (p=0.043) showed significant correlation. In this study, the sensitivity, specificity, positive predictive value, and negative predictive value of thorax CT in diagnosis of rib, sternum fractures were 64.5%, 93.9%, 96.2%, and 52.5%. CONCLUSION: Thorax CT has low sensitivity (64.5%) and low negative predictive value (52.5%) in detection of rib, sternum fractures. Although thorax CT shows no thorax fracture, when patients have persistent pain or they need accurate diagnosis, we may recommend bone scan for detection of rib, sternum fractures and accurate diagnosis.

Spontaneous Femoral Artery Pseudoaneurysm Rupture in Systemic Lupus Erythematosus Patient

Femoral artery pseudoaneurysm, a very uncommon disease, is usually reported trauma, iatrogenic vascular intervention, and nail fixation in the treatment of fracture. The femoral artery is a major vessel for blood supply to the lower extremities. If the femoral artery is injured, the patient will experience cardiovascular collapse and hypovolemic shock due to massive hemorrhage. We report on the case of a 49-year-old male patient who had been diagnosed with systemic lupus erythematosus (SLE), who was admitted to our hospital with progressive swelling of the right thigh without any trauma history. A computed tomographic scan with arterial enhancement showed a large pseudoaneurysm of the right femoral artery, which was then treated successfully with great saphenous vein graft surgery.

Influence of Type of Screw on the Bacterial Adherence and Infection / 대한정형외과학회잡지

The purpose of the study was to evaluate the effect of commonly used orthopaedic material, stainless steel (SS) screw (2.7xlOmm, Synthes) and titanium (Ti) screw (2.7x10mm, Synthes), on bacterial adherence and infection. The bacteria used for this study was Staphylococcus epidermidis for its ability of adherence. For in vitro assay, screws of each material were placed into test tube containing 107 colony forming unit (CFU) of S. epidermidis in trypticase soy broth for 18 hours. Following incubation, each screws were treated either with trypsin or with an ultrasonic cleaner. For in vivo assay, we inoculated 5x107 CFU of S. epidermidis into the proximal tibial metaphysis of the rabbits, and then inserted Ti screw on the right side and SS screw on the left side. The amount of in vitro adherence of S. epidermidis was greater for SS screw than for Ti screw. Especially following trypsin treatment, SS groups yielded significantly higher bacterial counts than Ti group, respectively (1.4x105 CFU vs 2.8x104 CFU, p<0.05). We found a significantly higher bacterial count after use of SS screw than after Ti screw in rabbits in vivo assay also. Trypsin treatment for identifying biofilm embedded bacteria from implanted metal may be useful in the diagnosis of infection. Ti screw appears to have biocompatibility to inhibit bacterial adherence compared with SS screw in the rabbit tibial model.