Comparison of Ultrasonography and Radiography in Detection of Thoracic Bone Fractures; a Systematic Review and Meta-Analysis.

INTRODUCTION: The potential benefit of ultrasonography for detection of thoracic bone fractures has been proven in various surveys but no comprehensive conclusion has been drawn yet; therefore, the present study aimed to conduct a thorough meta-analytic systematic review on this subject. METHODS: Two reviewers independently carried out a comprehensive systematic search in Medline, EMBASE, ISI Web of Knowledge, Scopus, Cochrane Library, and ProQuest databases. Data were summarized as true positive, false positive, true negative and false negative and were analyzed via STATA 11.0 software using a mixed-effects binary regression model. Sources of heterogeneity were further assessed through subgroup analysis. RESULTS: Data on 1667 patients (807 subjects with and 860 cases without thoracic fractures), whose age ranged from 0 to 92 years, were extracted from 17 surveys. Pooled sensitivity and specificity of ultrasonography in detection of thoracic bone fractures were 0.97 (95% CI: 0.90-0.99; I2= 88.88, p<0.001) and 0.94 (95% CI: 0.86-0.97; I2= 71.97, p<0.001), respectively. The same measures for chest radiography were found to be 0.77 (95% CI: 0.56-0.90; I2= 97.76, p<0.001) and 1.0 (95% CI: 0.91-1.00; I2= 97.24, p<0.001), respectively. The sensitivity of ultrasonography was higher in detection of rib fractures, compared to fractures of sternum or clavicle (97% vs. 91%). Moreover, the sensitivity was found to be higher when the procedure was carried out by a radiologist in comparison to an emergency medicine specialist (96% vs. 90%). CONCLUSION: Base on the findings of the present meta-analysis, screening performance characteristic of ultrasonography in detection of thoracic bone fractures was found to be higher than radiography. However, these characteristics were more prominent in detection of rib fractures and in cases where was performed by a radiologist.

Short-term currative effect of horizontal osteotomy across injured vertebral forⅤdegree old fracture-disloca-tions of thoracolumbar spine / 局解手术学杂志

Objective To discuss the short-term currative effect of horizontal osteotomy across injured vertebral forⅤdegree old frac-ture-dislocations of thoracolumbar spine.Methods The data of 4 patients who received horizontal osteotomy across injured vertebral internal fixation in our hospital from April 2010 to October 2012 were retrospectively analyzed,of which 1 case with T8-9 fracture dislocation,2 cases with T10-11 fracture dislocation,1 case with T11-12 fracture dislocation.The Franke1 classification of all patients were grade A.Results All 4 cases were achieved completely fracture reduction and followed-up for 2-14 months(an average of 7.4 months),who could get sitting posi-tion with the support of brace 1 week after operation.The postoperative follow-up indicated that all 4 cases got fusion,but there was no improve-ment for Franke1 classification.Conclusion The method of horizontal osteotomy across injured vertebral forⅤdegree old fracture-dislocations of thoracolumbar spine has good short-term clinical effect,with the advantages of shorter operation time,less bleeding and good reduction effect.

Pathologic sternal involvement is a potential risk factor for severe sagittal plane deformity in multiple myeloma with concomitant thoracic fractures.

BACKGROUND CONTEXT: Skeletal involvement is observed in almost 80% of patients presenting with symptomatic multiple myeloma (MM). The vertebral column is the most frequently affected site by myeloma-induced osteoporosis, osteolysis, and compression fractures. Multiple pathologic compression fractures can lead to significant spinal deformity, which is often considered for complex reconstruction because of the poor quality of life for the affected patients. PURPOSE: This study aimed to compare the clinical and radiological outcomes of two groups of MM patients; the first group had thoracic spine fractures and a concomitant pathologic sternal fracture (SF), and the second group had thoracic fractures but no sternal fracture (NSF). STUDY DESIGN: This was a cross-sectional study. PATIENT SAMPLE: The sample comprised 98 consecutive patients (n=98) with symptomatic MM and concomitant pathologic thoracic spine fractures over a 3-year period at a national tertiary referral center for the management of MM with spinal involvement. OUTCOME MEASURES: Clinical outcome measures used included European Quality of Life-5 Dimensions (EQ-5D), Oswestry Disability Index (ODI), and visual analogue scale (VAS) pain score. METHODS: All consecutive patients with MM were enrolled. The cohort was split into two patient groups: patients with SFs (SF group) and patients without sternal fractures (NSF group). Clinical, serologic, and pathologic variables, radiological findings, treatment strategies, and outcome measures were collected. RESULTS: The SF group was younger (58±13 years vs. 66±11 years [p=.008]) when compared with the NSF group. The SF group presented with a greater thoracic kyphosis (73°±18° vs. 53°±17.5° [p=.005]), similar VAS pain scores (50.6±22.1 vs. 54.4±22.5 [p>.05]), but poorer EQ-5D (0.24±0.13 vs. 0.48±0.23 [p<.001]) score and ODI (60.6±10.3 vs. 48.2±17.8 [p=.013]) when compared with the NSF group. CONCLUSIONS: Pathologic SF in an MM patient with thoracic compression fractures is a potential risk factor for the development of a severe thoracic kyphotic deformity and sagittal malalignment. This has been demonstrated in this study to be associated with a very poor health-related quality of life. A greater awareness of sternal myeloma disease is needed at presentation (the time of the primary survey) so that SFs can be potentially avoided, thereby preventing progression to a severe kyphotic deformity.

Percutaneous pedicle screw fixation for thoracolumbar fractures.

The application of percutaneous techniques for the management of thoracolumbar fractures is gaining popularity. Short-segment or long-segment percutaneous pedicle screw fixation can be used to treat a wide variety of thoracolumbar fractures in patients who are neurologically normal. This approach provides internal fixation, allowing the fracture to heal and sparing the motion segments above and below the fracture, as the instrumentation can be removed later.