Radiologic clinics of North America
-
Scintigraphic techniques play an important role in the diagnosis and evaluation of a wide variety of musculoskeletal injuries. They provide physiologic and pathophysiologic information but do not provide the exquisite resolution of computed tomography or magnetic resonance imaging. Thus, scintigraphy studies should be ordered only when they would be expected to provide data that will establish a diagnosis or help in planning therapy.
-
The radiologic evaluation of upper extremity trauma relies primarily on standard as well as optional radiographic projections. Certain injuries are more fully evaluated with fluoroscopy, arthrography, ultrasound, computed tomography, or magnetic resonance imaging. The imaging approach to upper extremity trauma is presented, with emphasis on subtle or commonly overlooked lesions. The indications for evaluation by fluoroscopy, arthrography, and advanced imaging modalities are discussed.
-
Magnetic resonance (MR) imaging has been applied toward the assessment of a wide spectrum of injuries to the musculoskeletal system. This use of MR imaging has been enthusiastically accepted by orthopedic surgeons, and the assessment of musculoskeletal trauma has emerged as one of the most commonly utilized applications of this diagnostic method. ⋯ Emphasis is placed on the most commonly encountered conditions, namely, those that are accidental, exercise-, and sports-related. Technical considerations as they pertain to the design and interpretation of trauma-related musculoskeletal MR imaging are addressed.
-
Imaging of patients with pelvic trauma begins with a logical approach to plain radiographs. These films reveal the probable mechanism of injury and suggest a rationale for emergent reduction. Radiographs, along with the clinical impression, suggest the likelihood of associated soft tissue injury, possibly requiring further specific radiographic studies. ⋯ When multiple ribs are fractured in two places, the radiologist should suggest the possibility of flail chest. Sternal fractures and multiple rib fractures, including the first three ribs, may herald life-threatening vascular or cardiac damage. To summarize, the radiologist contributes most to the care of the trauma patient by recognizing roentgen patterns of injury, knowing which are commonly accompanied by damage to critical soft tissues, and performing the indicated radiographic studies efficiently.