Ulnar fracture imaging findings
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Ulnar fracture imaging findings On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammadmain Rezazadehsaatlou[2] ;
Overview
Radiographic imaging is important in diagnosis, classification, treatment and follow-up assessment of ulnar fractures. The configuration of midshaft fractures of the ulnar fracture varies depending on the mechanism of injury and the degree of violence involved. Low-energy fractures tend to be transverse or short oblique involvements, but high-energy injuries are commonly comminuted or segmented with extensive soft-tissue injuries. Computed tomography (CT) is useful in distal radius fractures and ulnar joint pathologies[1][1].
X-Ray evaluation
The orthopedic surgeon should consider to have at least two radiographic projections (ie, anteroposterior [AP] and lateral) of the forearm. These show the fracture, the extent of displacement, and the extent of comminution. The orthopedic surgeon should pay serious attention toward finding any foreign bodies in open fractures and gunshot injuries. Also imperative is to include the elbow and wrist joint in the radiographs of ulnar fractures to ensure that the distal radioulnar joint injuries are not missed[2][3][4].
A tuberosity view is helpfull ascertain the rotational displacement of the fracture. Also, it would be helpful for the orthopedic surgeon in planning how much supination or pronation is needed to achieve accurate anatomic reduction. The ulna is laid flat on the cassette with its subcutaneous border in contact with the cassette; the x-ray tube is tilted toward the olecranon by 20°. This radiograph is then compared with a standard set of diagrams that show the prominence of the radial tuberosity in various degrees of pronation and supination in order to determine the scope of the rotational deformity[5][6][7].
CT Scan Evaluation
Its been reported that the articular fractures of the distal radius were statistically more likely to occur at the intervals between the ligament attachments than at the ligament attachments. The most common fracture sites were the center of the sigmoid notch, between the short and long radiolunate ligaments, and the central and ulnar aspects of the scaphoid fossa dorsally. These results suggest that CT may be used to identify the subsequent propagation of the fracture and the likely site of the impaction of the carpus on the distal radius articular surface[8][9][10].
MRI
Magnetic resonance imaging (MRI) is a powerful diagnostic tool to assess the abnormalities of the bone, ligaments and soft tissues associated with the ulnar fractures but it is known as a limited utility in radioulnar injuries and is not indicated in uncomplicated forearm fractures but it[4][10][11].
References
- ↑ 1.0 1.1 Canton G, Hoxhaj B, Fattori R, Murena L (October 2018). "Annular ligament reconstruction in chronic Monteggia fracture-dislocations in the adult population: indications and surgical technique". Musculoskelet Surg. 102 (Suppl 1): 93–102. doi:10.1007/s12306-018-0564-6. PMID 30343474.
- ↑ Ayalon O, Marcano A, Paksima N, Egol K (January 2016). "Concomitant Ulnar Styloid Fracture and Distal Radius Fracture Portend Poorer Outcome". Am J. Orthop. 45 (1): 34–7. PMID 26761916.
- ↑ Bae DS (June 2016). "Successful Strategies for Managing Monteggia Injuries". J Pediatr Orthop. 36 Suppl 1: S67–70. doi:10.1097/BPO.0000000000000765. PMID 27100040.
- ↑ 4.0 4.1 Turan S, Çankaya D, Yılmaz S, Karakuş D, Dündar A, Özdemir G (August 2016). "Effect of ulnar styloid fracture on outcomes after conservative treatment of distal radius fracture". Eklem Hastalik Cerrahisi. 27 (2): 87–93. PMID 27499320.
- ↑ Lüninghake FJ, Yarar S, Rueger J, Schädel-Höpfner M (April 2014). "[Carpometacarpal fractures and fracture dislocations of rays 2-5]". Unfallchirurg (in German). 117 (4): 299–306. doi:10.1007/s00113-013-2509-8. PMID 24700082.
- ↑ Yang H, Wang B, Wang J, Li R, Zhao S, Bu W (September 2013). "[Clinical research of ulnar styloid fracture complicated with wrist dorsal branch of ulnar nerve injury]". Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi (in Chinese). 27 (9): 1028–31. PMID 24279007.
- ↑ Chen HW, Wang ZY, Wu X, Tang B, Zhu W, Zhou G, Liu F, Qiu B (June 2017). "Evaluation of a combined posterior lateral and anteromedial approach in the treatment of terrible triad of the elbow: A retrospective study". Medicine (Baltimore). 96 (22): e6819. doi:10.1097/MD.0000000000006819. PMC 5459697. PMID 28562532.
- ↑ Yoon RS, Tyagi V, Cantlon MB, Riesgo AM, Liporace FA (October 2016). "Complex coronoid and proximal ulna fractures are we getting better at fixing these?". Injury. 47 (10): 2053–2059. doi:10.1016/j.injury.2016.07.060. PMID 27527379.
- ↑ Mueller S, Kahrs LA, Gaa J, Ortmaier T, Clausen JD, Krettek C (July 2017). "Patient specific pointer tool for corrective osteotomy: Quality of symmetry based planning and case study of ulnar reconstruction surgery". Injury. 48 (7): 1325–1330. doi:10.1016/j.injury.2017.05.012. PMID 28549780.
- ↑ 10.0 10.1 Broekhuis D, Bessems JH, Colaris JW (December 2016). "Avulsion fracture of the supinator crest as an indication for a sustained posterolateral (sub)luxation of the elbow. A case report, anatomical evaluation and review of the literature". Orthop Traumatol Surg Res. 102 (8): 1113–1116. doi:10.1016/j.otsr.2016.09.016. PMID 27825706.
- ↑ Amit B, Ashish D, Vinit V, Raj S, Shivani B, Narender M, Rohit S, Paritosh G, Navdeep G (2013). "Missed ulnar nerve injury and closed forearm fracture in a child". Chin. J. Traumatol. 16 (4): 246–8. PMID 23910681.