A comparative study on the use of ultra-low dose computed tomography scans with conventional computed tomography scans for the evaluation of proximal tibia intra-articular fractures.

Purpose: A rise in the need of preoperative CT assessment of proximal tibial intra-articular fractures has given rise to an increased load of radiation exposure. This comparative study aims at assessing the efficacy of low dose CT scan by collating images of tibial plateau fractures produced by low dose CT scan with that of conventional dose CT scan. Furthermore, the study aims at computing the comprehensive reduction in the effective dosage of radiation when low dose CT scan is employed for assessing these fractures. Methods: The study comprise of 23 cases of proximal tibial intra-articular fractures (confirmed by initial radiographs). Low-dose CT scan of the injured limb was preceded by conventional dose CT scan for generating images that were assessed and reported independently by five (single blinded) radiologists (using Schatzker's CT based classification). Quantification of fracture was done to compare them statistically. Results: A sensitivity of 93.94 % and positive predictive value of 93.92 % was observed on comparing images from low dose and conventional dose CT scan. An effective reduction of 89.81 % in overall dosage of radiation exposure was observed. Conclusion: Near equal quality images were generated by low dose CT scan as compared to conventional dose CT scan, thereby demonstrating its non-inferiority with an effective reduction of 89.81 % in overall dosage of radiation exposure.

Intraosseous schwannoma of the humerus: a rarity yet warrants consideration.

Intraosseous schwannoma is extremely rare that it is not often considered among differential diagnosis for an osteolytic lesion, especially in long bones of the extremities. Amounting to less than 0.2% of all primary bone tumours and less than 200 cases reported so far, with only 3 cases involving the humerus, we hereby report the fourth case. In addition to its rarity, this was the only case of an intraosseous schwannoma involving the humerus bone which presented with a pathological fracture in a 45-year-old woman after sustaining a trivial trauma. Radiological examination revealed a geographic type of osteolytic lesion in distal shaft region of the left humerus. Only a histopathological examination helped in revealing and confirming the diagnosis of an intraosseous schwannoma. Treatment of the tumour with complete excision with bone graft reconstruction and osteosynthesis yields good results with very low risk of recurrence.