Bilateral tarsometatarsal fracture-dislocations: a missed work-related injury.

Tarsometatarsal (Lisfranc) fracture-dislocation is an uncommon foot injury. Subtle injuries are more difficult to diagnose though they cause serious morbidity. Bilateral subtle tarsometatarsal injury has not been reported before. We report bilateral subtle tarsometatarsal dislocations that were caused by a work-related accident in a 25-year-old man. The injury was initially missed. Diagnosis was confirmed by computed tomography with curved reconstruction. Associated foot injuries are shown as a guide to the diagnosis.

Acute plain anterioposterior radiograph of the pelvis is not useful in detecting fractures of iliac wing and os sacrum: a prospective study of 73 patients using CT as gold standard.

Conflicting opinions exist to what extent interpreters of an acute anterioposterior (AP) radiograph of the pelvis underdiagnose pelvic injury. We have prospectively evaluated the usefulness of a plain AP radiograph of the pelvis in detecting injuries, using CT as the gold standard. Seventy-three haemodynamically stable blunt trauma patients, who had an AP radiograph of the pelvis and an abdominopelvic CT as part of their initial imaging evaluation, were included. There were 14 women and 59 men, with a mean age of 30 (3-61) years. Two senior radiologists, with special interest in CT examinations evaluating trauma, reviewed the radiographs and a month later the CT scans, blinded and independently. Usefulness index of the plain AP radiograph of the pelvis in detecting specific injuries was calculated using CT as the gold standard. A radiograph is regarded as useful if the usefulness index is 0.35 or more. The usefulness index for a plain AP radiograph of the pelvis for detecting a fracture of iliac wing and os sacrum was 0.25 and 0.01, respectively. An acute AP radiograph of the pelvis is not useful in detecting a fracture of iliac wing or os sacrum.

Usefulness of different imaging modalities in the assessment of scapular fractures caused by blunt trauma.

PURPOSE: To analyze the usefulness of chest and scapular trauma radiographs, axial computed tomography (CT), and two- and three-dimensional (2D and 3D) reconstruction CT in detecting fractures of the six anatomical regions of the scapula. MATERIAL AND METHODS: Forty-four patients, with a median age (range) of 34 (16-60) years, with scapular fractures caused by blunt trauma were prospectively collected between January 2003 and December 2005. Their chest and scapula radiographs, and axial, 2D, and 3D CTs were reviewed blindly and independently by two observers. Each modality was compared with a gold standard to determine its diagnostic usefulness. Our gold standard was consensus reached by all authors together examining all modalities at the same time. We also compared 3D CTs reconstructed from chest and scapula axial views. RESULTS: Axial and 3D reconstruction tomographic studies were the only useful modalities in assessing fractures in all six anatomical scapular regions. Three-dimensional CTs reconstructed from chest and scapula axial views were equally sensitive and specific. CONCLUSION: CT scanning with 3D reconstructions is the most useful imaging modality to detect and define the extent of scapular injury, and this can be done as part of a chest trauma computed tomography protocol.