Cone-beam computed tomography compared to X-ray in diagnosis of radial fractures
Abstract
Background: The purpose of this study was to determine whether radiological measurements of radial fracture position made in cone beam computed tomography (CBCT) projection images are comparable to those made on traditional radiographs and could potentially substitute them.
Methods: One hundred patients with fractures of the distal radius referred for radiographs were recruited for an additional CBCT scan which was performed immediately afterwards between January and December 2021 were analyzed retrospectively.
Results: Using plain radiographs compared to CBCT wrist fracture was confirmed in 98 cases and CBCT in 100 cases. Median effective dose of CBCT was as low as 1,41mSv comparated with 0,19mSv for standard radiography. According to fracture localization, conventional radiography diagnosed 54% intra-articular fractures, 5,9% extra-articular, 60% multi-fragmented, 13,9% dislocated, 74,3% distal and scaphoid fractures 6.9% and CBCT imaging method diagnosed
64,4% intraarticular fractures, 6,9% extraarticular, 68,3% multifragmented, 19,8% dislocated, 76,2% distal and scaphoid fractures 13,9%. The inter-rater correlation was higher in the CBCT compared to radiography ( p=0,01; p=0,00; p=0,00; p=0,013;p=0,032; p=0,037).
Conclusion: The cone beam imaging method is of great importance as a supplementary method to conventional radiography, which still remains the primary method in diagnosing wrist fractures.
Keywords
References
Nelson L . How to classify distal radial fractures-a report. ERADIUS International Distal radius Fracture Study Group, IFSSH Bone & Joint Committeee,2006.
Hove LM. Epidemiology of scaphoid fractures in Bergen, Norway, Scand. J.Plast. Reconstr. Surg. Hand. Surg. 1999; 33: 423-426.
Garala K, Taub NA, Dias JJ. The epidemiology of fractures of the scaphoid: Impact of age, gender, deprivation and seasonality. J. Bone Joint. 2016;98: 654-659.
Hackney LA, Dodds SD. Assessment od scaphoid fracure healing. Curr.Rev. Musculoskelet Med. 2011; (4):16-21.
Bhat A, Kumar B, Acharya A . Radiographic imaging of the wrist. Indian Journal of Plastic Surgery. 2011; 44(2):186-196.
Ricci M, Boldini M, Bonfante E. Cone beam computed tomography comparated to X-ray in diagnosis of extremities bone fractures : a study of 198 cases.Eur J Radiol Open. 2019; 6:119-121.
Kunz A.S,Schmalzl J, Huflage H, Luetkens K, Patzer T, Kuhl F, Gruschwitz P, Petritsch B, Schmitt R, Bley T, Grunz J. Twin Robotic Gantry -Free Cone Beam CT in Acute Elbow Trauma. Radiology vol.306,No,3 ,2022.
Grunz JP , Gietzen CH, Grunz K. Imaging of Carpal Instabilities. Fortschr Röntgenstr 2021; 193: 139–150.
Omsland TK, Ahmed LA, Gronskag A, Achei B, Emaus N, Langhammer A. More forearm fractures among urban than rural women. J Bone Miner Res.2011; 26 (4): 850-6.
Grunz JP, Jordan MC, Schmitt R, Luetkens KS, Huflage H, Meffert RH, Bley TA, Kunz AS. Gantry-Free Hight Resolution Cone Beam CT: Efficacy for Distal Radius and Scaphoid Fracture Detection and Characterization. Academic Radiology 2022;30 (7): 1358-1366.
Borel C, Larbi A, Delclauxs S ., et al. Diagnostic value of cone beam computed tomography (CBCT) in occult scaphoid and wrist fractures. Eur J Radiol. 2017; 97: 59-64.
Gilley E, Puri SK, Hearns KA, Weiland AJ, Carlson MG. The inportance of computed tomography in determining in scaphoid fractures. J Wrist Surg. 2018;7: 38-42.
Malle WH, Doornberg JN, Poolman RW, Kloen P, Maas M, de vet HCW. Computed tomography versus magnetic resonance imaging versus bone scintigraphy for clinically suspected scaphoid fractures in patients with negative plain radiographs .Cochrane Database of Systematic Reviews 2012, Issue 8.
Carpenter CR, et al. Adult scaphoid fracure. Acad. Emerg. Med.2024;21: 101-121.
Neubauer J, Benndorf M, Ehritt-Braun C, Reising K, Yilmaz T,et al. Comparation of the diagnostic accuracy of cone beam computed tomography and radiography for scaphoid fractures. Scientific Reports 2018; 8:3906.
Vouri JP, Aro HT. Lisfranc joint injuries: trauma mechanisms and associated injuries. J Trauma
; 35(1): 40-45.
Jenkins PJ, Slade K, Huntley JS, Robinson CM. A comparative analysis of the accuracy,
diagnostic uncertainty and cost of imaging modalities in suspected scaphoid fractures. J Injuri
; 39(7): 768-774.
DOI: 10.5457/ams.v55i1.874
