Occult Intertrochanteric Fracture Mimicking the Fracture of Greater Trochanter / 대한고관절학회지

PURPOSE: Occult intertrochanteric fractures are misdiagnosed as isolated greater trochanteric fractures in some cases. We investigated the utility of three-dimensional computed tomography (3D-CT) and magnetic resonance imaging (MRI) in the diagnosis and outcome management of occult intertrochanteric fractures. MATERIALS AND METHODS: This study involved 23 cases of greater trochanteric fractures as diagnosed using plain radiographs from January 2004 to July 2013. Until January 2008, 9 cases were examined with 3D-CT only, while 14 cases were screened with both 3D-CT and MRI scans. We analyzed diagnostic accuracy and treatment results following 3D-CT and MRI scanning. RESULTS: Nine cases that underwent 3D-CT only were diagnosed with isolated greater trochanteric fractures without occult intertrochanteric fractures. Of these, a patient with displacement received surgical treatment. Of the 14 patients screened using both CT and MRI, 13 were diagnosed with occult intertrochanteric fractures. Of these, 11 were treated with surgical intervention and 2 with conservative management. CONCLUSION: Three-dimensional CT has very low diagnostic accuracy in diagnosing occult intertrochanteric fractures. For this reason, MRI is recommended to confirm a suspected occult intertrochanteric fracture and to determine the most appropriate mode of treatment.

Analysing the value of postprocessing technique with multi-slice helical CT in detection of the occult facture / 实用医学杂志

Objective To investigate the value of postprocessing technique of multi-slice helical CT for the occult fracture located in complicated structure. Methods One hundred-thirteen patients with acute trauma but negative on plain X-ray film were reviewed retrospectively. All of the patients underwent MSCT ,and original data were reformed with reconstruction. Results Of one hundred-thirteen injuried patients , fractures were demonstrated with MSCT imaging in forty-eight cases. Conclusion The combination use of axial image of MSCT , reconstruction and post-processing is of high value in definite detection of occult fracture , and play an important role in selecting therapy project and evaluating prognosis.

Research on applied analysis on 64 row spiral CT post-processing technique in the occult fracture of rib / 中国医学装备

Objective:To explore the clinical application value of multi-slice spiral CT in the diagnosis.Methods: Twenty nine patients with clinically suspected rib fractures and X-ray showed no 64 row helical CT scanning in patients with chest trauma fractures after reconstruction, multiplanar reconstruction and VR imaging.Results: Twenty nine patients with occult fracture of rib on the MPR, VR imaging were rib image good, 28 cases were single, multiple rib fractures in 1 cases, the total of 4 cases with rib fracture, incomplete fracture in 25 cases.Conclusion: The 64 row helical CT for occult rib fracture detection rates, diagnostic accordance rate was superior to X-ray plain film, various post-processing techniques applied to timely, accurate, intuitive display rib fracture location, shape, extent of chest trauma, occult rib fracture first choice inspection method.

Bone & Soft Tissue Injuries Diagnosed by Magnetic Resonance Imaging in Thoracolumbar Fractures

PURPOSE: To assess diagnostic efficacy of the MRI in thoracolumbar fractures, especially in changes of bone and soft tissue which cannot be documented by other diagnostic tools. MATERIALS AND METHODS: Among 85 patients managed for thoracolumbar fractures between January 1997 and June 2003, MRI was performed in 30 patients to get more informations. Plain X-ray, CT and MRI of these cases were reviewed retrospectively by two orthopaedic spine surgeons and one radiologist to investigate the informations which only MRI could afford. RESULTS: 14 (46.7%) among 30 patients had occult fractures of vertebrae other than main fracture which had not been diagnosed as fractured. Besides 6 patients who showed distraction of posterior structure on plain X-ray, injury of posterior ligament complex was confirmed by MRI in 12(40%) patients. Additionally, MRI visualized other soft tissue injuries such as intramuscular and subcutaneous hematoma, changes of the spinal cord and intervertebral disc. In 16 among 30 patients, informations achieved from MRI were the most important factors in deciding treatment modality. CONCLUSION: MRI seems to be efficient in visualizing not only soft tissue injury such as ligament but also occult fractures of additional vertebra in thoracolumbar fractures, therefore MRI seems to be an important diagnostic tool in decision of treatment modalities, especially in cases of uncertain stability.

Value of MR Imaging in Diagnosing Occult Fracture and Associated with Other Injuries of the Knee / 实用放射学杂志

Objective To appraise the value of MR imaging in detecting occult fracture and associated with other injuries of knee. Methods 68 cases with acute knee trauma were underwent radiography and MR imaging examination.Results All 68 cases had negative radiographic results. 83 occult fractures in 68 cases were found by MRI, and 75 occult fractures were located in the lower part of femur and upper part of tibia. Fracture patterns were line shape,arborization. By MR imaging, ligament injuries were showed in 32 cases, menisci injuries were demonstrated in 22 cases, and hydrarthrosis were manifested in 60 cases.Conclusion When knee joint injured patients with obvious clinical symptoms and negative radiographic results, the MRI is the best choice for further examination. It is sensitive in detecting occult fractures and associated with other injuries of knee joint.

An Occult Fracture in a Ankylosing Spondylitis Patient

A61-year-old head-injured patient exhibited acute onset of paraplegia during hospital in-care. Review of radiographs showed an occult linear transverse fracture line between the T11 and T12 vertebrae. An MRI scan performed after paraplegia showed compression of the spinal cord by a bony fragment. This case report presents a rare but devastating complication of an occult fracture at the T-L junction in patient with ankylosing spondylitis which was considered less significant due to more severe head injury. Thorough clinical and roentgenographic examination of the entire vertebral column is recommended in patients with ankylosing spondylitis who have sustained injury. Even if minor spinal trauma occurs in such clinical setting, the condition should be managed as a spinal fracture with potentially serious neurologic complications.

Atlantoaxial Occult Fracture:Multi-slice Spiral CT Diagnosis / 实用放射学杂志

Objective To discuss the diagnostic value of multi-slice spiral CT 2D and 3D reconstruction for atlantoaxial occult fracture.Methods Multi-slice spiral CT scans were performed in 38 patients who were suspected of fracture but were not detected with radiography,and the images were post-processed with Vitrea workstation(including MPR,MIP,VR and SSD).The images were observed by two experienced radiologists.Results Of 38 cases,28 cases were detected having small fractures with spiral CT reconstruction.Conclusion Multi-slice spiral CT 2D and 3D reconstructions are of important value in diagnosing atlantoaxial occult fracture.