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Hendrix N, Hendrix W, Maresch B, van Amersfoort J, Oosterveld-Bonsma T, Kolderman S, Vestering M, Zielinski S, Rutten K, Dammeier J, Ong LLS, van Ginneken B, Rutten M. Artificial intelligence for automated detection and measurements of carpal instability signs on conventional radiographs. Eur Radiol 2024:10.1007/s00330-024-10744-1. [PMID: 38634877 DOI: 10.1007/s00330-024-10744-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/26/2024] [Accepted: 03/21/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES To develop and validate an artificial intelligence (AI) system for measuring and detecting signs of carpal instability on conventional radiographs. MATERIALS AND METHODS Two case-control datasets of hand and wrist radiographs were retrospectively acquired at three hospitals (hospitals A, B, and C). Dataset 1 (2178 radiographs from 1993 patients, hospitals A and B, 2018-2019) was used for developing an AI system for measuring scapholunate (SL) joint distances, SL and capitolunate (CL) angles, and carpal arc interruptions. Dataset 2 (481 radiographs from 217 patients, hospital C, 2017-2021) was used for testing, and with a subsample (174 radiographs from 87 patients), an observer study was conducted to compare its performance to five clinicians. Evaluation metrics included mean absolute error (MAE), sensitivity, and specificity. RESULTS Dataset 2 included 258 SL distances, 189 SL angles, 191 CL angles, and 217 carpal arc labels obtained from 217 patients (mean age, 51 years ± 23 [standard deviation]; 133 women). The MAE in measuring SL distances, SL angles, and CL angles was respectively 0.65 mm (95%CI: 0.59, 0.72), 7.9 degrees (95%CI: 7.0, 8.9), and 5.9 degrees (95%CI: 5.2, 6.6). The sensitivity and specificity for detecting arc interruptions were 83% (95%CI: 74, 91) and 64% (95%CI: 56, 71). The measurements were largely comparable to those of the clinicians, while arc interruption detections were more accurate than those of most clinicians. CONCLUSION This study demonstrates that a newly developed automated AI system accurately measures and detects signs of carpal instability on conventional radiographs. CLINICAL RELEVANCE STATEMENT This system has the potential to improve detections of carpal arc interruptions and could be a promising tool for supporting clinicians in detecting carpal instability.
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Affiliation(s)
- Nils Hendrix
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
- Jheronimus Academy of Data Science, Sint Janssingel 92, 5211 DA, 's-Hertogenbosch, The Netherlands.
| | - Ward Hendrix
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Department of Radiology, Jeroen Bosch Ziekenhuis, Henri Dunantstraat 1, 5223 GZ, 's-Hertogenbosch, The Netherlands
| | - Bas Maresch
- Department of Radiology, Ziekenhuis Gelderse Vallei, Willy Brandtlaan 10, 6717 RP, Ede, The Netherlands
| | - Job van Amersfoort
- Department of Surgery, Ziekenhuis Gelderse Vallei, Willy Brandtlaan 10, 6717 RP, Ede, The Netherlands
| | - Tineke Oosterveld-Bonsma
- Department of Radiology, Ziekenhuis Gelderse Vallei, Willy Brandtlaan 10, 6717 RP, Ede, The Netherlands
| | - Stephanie Kolderman
- Department of Radiology, Ziekenhuis Gelderse Vallei, Willy Brandtlaan 10, 6717 RP, Ede, The Netherlands
| | - Myrthe Vestering
- Department of Radiology, Ziekenhuis Gelderse Vallei, Willy Brandtlaan 10, 6717 RP, Ede, The Netherlands
| | - Stephanie Zielinski
- Department of Surgery, Ziekenhuis Gelderse Vallei, Willy Brandtlaan 10, 6717 RP, Ede, The Netherlands
| | - Karlijn Rutten
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Jan Dammeier
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Lee-Ling Sharon Ong
- Jheronimus Academy of Data Science, Sint Janssingel 92, 5211 DA, 's-Hertogenbosch, The Netherlands
- Cognitive Science and Artificial Intelligence Department, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, The Netherlands
| | - Bram van Ginneken
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Matthieu Rutten
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Department of Radiology, Jeroen Bosch Ziekenhuis, Henri Dunantstraat 1, 5223 GZ, 's-Hertogenbosch, The Netherlands
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Keller G, Rachunek K, Springer F, Kraus M. Evaluation of a newly designed deep learning-based algorithm for automated assessment of scapholunate distance in wrist radiography as a surrogate parameter for scapholunate ligament rupture and the correlation with arthroscopy. LA RADIOLOGIA MEDICA 2023; 128:1535-1541. [PMID: 37726593 PMCID: PMC10700195 DOI: 10.1007/s11547-023-01720-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE Not diagnosed or mistreated scapholunate ligament (SL) tears represent a frequent cause of degenerative wrist arthritis. A newly developed deep learning (DL)-based automated assessment of the SL distance on radiographs may support clinicians in initial image interpretation. MATERIALS AND METHODS A pre-trained DL algorithm was specifically fine-tuned on static and dynamic dorsopalmar wrist radiography (training data set n = 201) for the automated assessment of the SL distance. Afterwards the DL algorithm was evaluated (evaluation data set n = 364 patients with n = 1604 radiographs) and correlated with results of an experienced human reader and with arthroscopic findings. RESULTS The evaluation data set comprised arthroscopically diagnosed SL insufficiency according to Geissler's stages 0-4 (56.5%, 2.5%, 5.5%, 7.5%, 28.0%). Diagnostic accuracy of the DL algorithm on dorsopalmar radiography regarding SL integrity was close to that of the human reader (e.g. differentiation of Geissler's stages ≤ 2 versus > 2 with a sensitivity of 74% and a specificity of 78% compared to 77% and 80%) with a correlation coefficient of 0.81 (P < 0.01). CONCLUSION A DL algorithm like this might become a valuable tool supporting clinicians' initial decision making on radiography regarding SL integrity and consequential triage for further patient management.
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Affiliation(s)
- Gabriel Keller
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
- Department of Diagnostic Radiology, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.
| | - Katarzyna Rachunek
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center Tübingen, Eberhard Karls University of Tübingen, 72076, Tübingen, Germany
| | - Fabian Springer
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
- Department of Diagnostic Radiology, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Mathias Kraus
- Institute of Information Systems, FAU Erlangen-Nuremberg, Nuremberg, Germany
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Kuru CA, Sezer R, Çetin C, Haberal B, Yakut Y, Kuru İ. Use of Generalizability Theory Evaluating Comparative Reliability of the Scapholunate Interval Measurement With X-ray, CT, and US. Acad Radiol 2023; 30:2290-2298. [PMID: 36604227 DOI: 10.1016/j.acra.2022.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/03/2022] [Accepted: 11/20/2022] [Indexed: 01/05/2023]
Abstract
RATIONALE AND OBJECTIVES There is no universally accepted standard technique for measuring the scapholunate interval and no specific sources of measurement error have been identified. We aimed to establish a set of normal radiological criteria for the scapholunate interval that could be used in comparative studies of wrist pathology to determine interobserver reliability and to identify potential errors that might influence measurements. MATERIALS AND METHODS A total of 60 healthy volunteers participated in the study. Scapholunate interval was measured by three independent observers using X-ray, CT, and US in four positions, including neutral, fist, radial and ulnar deviation. Inter-observer reliability was tested using intraclass correlation coefficient. Generalizability theory was applied to evaluate specific sources of measurement error related to participant, observer, imaging modality and measurement position. RESULTS In neutral position, the scapholunate interval measured by X-ray, CT, and US was 3.1 mm, 3.5 mm and 3.5 mm respectively. The interval remained constant during fist and radial deviation but decreased during ulnar deviation. Correlation coefficients ranged from 0.874 to 0.907 for X-ray, 0.773-0.881 for CT and 0.964-0.979 for US. In the generalizability study, the participant x modality x position interaction accounted for the largest proportion of total variance (29%). CONCLUSION X-ray, CT, and US are reliable modalities for measuring the scapholunate interval, with US having the highest reliability. Participant and position factors may independently contribute to measurement error. Therefore, standardized measurement positions are recommended to obtain reliable measurement results.
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Affiliation(s)
- Cigdem Ayhan Kuru
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Altindag, Ankara, Turkey (C.A.K.); Department of Radiology, Faculty of Medicine, Baskent University, Ankara, Turkey (R.S.); Department of Orthopedics and Traumatology, Faculty of Medicine, Baskent University, Ankara, Turkey (C.C., B.H., I.K.); Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hasan Kalyoncu University, Ankara, Turkey (Y.Y.)
| | - Rahime Sezer
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Altindag, Ankara, Turkey (C.A.K.); Department of Radiology, Faculty of Medicine, Baskent University, Ankara, Turkey (R.S.); Department of Orthopedics and Traumatology, Faculty of Medicine, Baskent University, Ankara, Turkey (C.C., B.H., I.K.); Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hasan Kalyoncu University, Ankara, Turkey (Y.Y.).
| | - Can Çetin
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Altindag, Ankara, Turkey (C.A.K.); Department of Radiology, Faculty of Medicine, Baskent University, Ankara, Turkey (R.S.); Department of Orthopedics and Traumatology, Faculty of Medicine, Baskent University, Ankara, Turkey (C.C., B.H., I.K.); Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hasan Kalyoncu University, Ankara, Turkey (Y.Y.)
| | - Bahtiyar Haberal
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Altindag, Ankara, Turkey (C.A.K.); Department of Radiology, Faculty of Medicine, Baskent University, Ankara, Turkey (R.S.); Department of Orthopedics and Traumatology, Faculty of Medicine, Baskent University, Ankara, Turkey (C.C., B.H., I.K.); Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hasan Kalyoncu University, Ankara, Turkey (Y.Y.)
| | - Yavuz Yakut
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Altindag, Ankara, Turkey (C.A.K.); Department of Radiology, Faculty of Medicine, Baskent University, Ankara, Turkey (R.S.); Department of Orthopedics and Traumatology, Faculty of Medicine, Baskent University, Ankara, Turkey (C.C., B.H., I.K.); Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hasan Kalyoncu University, Ankara, Turkey (Y.Y.)
| | - İlhami Kuru
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Altindag, Ankara, Turkey (C.A.K.); Department of Radiology, Faculty of Medicine, Baskent University, Ankara, Turkey (R.S.); Department of Orthopedics and Traumatology, Faculty of Medicine, Baskent University, Ankara, Turkey (C.C., B.H., I.K.); Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hasan Kalyoncu University, Ankara, Turkey (Y.Y.)
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Orkut S, Gillet R, Granero J, Hossu G, Douis N, Athlani L, Blum A, Gondim Teixeira PA. Assessment of Scapholunate Instability on 4D CT Scans in Patients with Inconclusive Conventional Images. Radiology 2023; 308:e230193. [PMID: 37698480 DOI: 10.1148/radiol.230193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Background Initial imaging work-up using radiography and CT arthrography sometimes can be insufficient to identify a scapholunate (SL) instability (SLI) in patients suspected of having SL ligament tears. Purpose To determine the diagnostic performance of four-dimensional (4D) CT in the identification of SLI and apply the findings to patients suspected of having SLI and with inconclusive findings on radiographs and CT arthrograms. Materials and Methods This prospective single-center study enrolled participants suspected of having SLI (recent trauma, dorsal pain, positive Watson test results, decreased grip strength) between March 2015 and March 2020. Participants with wrist fractures, substantial joint stiffness, or history of wrist surgery were excluded. Each participant underwent radiography, CT arthrography, and 4D CT on the same day. Participants were divided into three groups: those with no SLI, those with SLI, and those with inconclusive results. SL gap and radioscaphoid and lunocapitate angle were measured using semiautomatic quantitative analysis of 4D CT images by two independent readers. Receiver operating characteristic curves were used to evaluate the diagnostic performance of 4D CT. Thresholds were determined with the Youden index and were applied to the inconclusive group. Results Of the 150 included participants (mean age, 41 years ± 14 [SD]; 102 male, 48 female), there were 63 with no SLI, 48 with SLI, and 39 with inconclusive results. The maximum value and range of SL gap measurements on 4D CT scans showed high sensitivity (83% [40 of 48] and 90% [43 of 48], respectively) and high specificity (95% [59 of 62] and 81% [50 of 62], respectively) in the identification of SLI. At least one of these parameters was abnormal on 4D CT scans in 17 of 39 (44%) participants in the inconclusive group, and 10 of 17 (59%) participants had confirmed SLI. In the 22 participants in the inconclusive group with no indication of SLI at 4D CT, follow-up showed no evidence of SLI in 10 (45%) and enabled confirmation of SLI via arthroscopy in three (14%). Conclusion Scapholunate gap measurements on kinematic 4D CT scans enabled correct identification of SLI in 59% of participants with inconclusive results on conventional images. ClinicalTrials.gov registration no. NCT02401568 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Demehri and Ibad in this issue.
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Affiliation(s)
- Sinan Orkut
- From the Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France (S.O., R.G., A.B., P.A.G.T.); Université de Lorraine, Inserm, IADI, Nancy, France (R.G., G.H., N.D., P.A.G.T.); and Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU de Nancy, Nancy, France (J.G., L.A.)
| | - Romain Gillet
- From the Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France (S.O., R.G., A.B., P.A.G.T.); Université de Lorraine, Inserm, IADI, Nancy, France (R.G., G.H., N.D., P.A.G.T.); and Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU de Nancy, Nancy, France (J.G., L.A.)
| | - Jonathan Granero
- From the Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France (S.O., R.G., A.B., P.A.G.T.); Université de Lorraine, Inserm, IADI, Nancy, France (R.G., G.H., N.D., P.A.G.T.); and Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU de Nancy, Nancy, France (J.G., L.A.)
| | - Gabriela Hossu
- From the Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France (S.O., R.G., A.B., P.A.G.T.); Université de Lorraine, Inserm, IADI, Nancy, France (R.G., G.H., N.D., P.A.G.T.); and Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU de Nancy, Nancy, France (J.G., L.A.)
| | - Nicolas Douis
- From the Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France (S.O., R.G., A.B., P.A.G.T.); Université de Lorraine, Inserm, IADI, Nancy, France (R.G., G.H., N.D., P.A.G.T.); and Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU de Nancy, Nancy, France (J.G., L.A.)
| | - Lionel Athlani
- From the Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France (S.O., R.G., A.B., P.A.G.T.); Université de Lorraine, Inserm, IADI, Nancy, France (R.G., G.H., N.D., P.A.G.T.); and Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU de Nancy, Nancy, France (J.G., L.A.)
| | - Alain Blum
- From the Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France (S.O., R.G., A.B., P.A.G.T.); Université de Lorraine, Inserm, IADI, Nancy, France (R.G., G.H., N.D., P.A.G.T.); and Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU de Nancy, Nancy, France (J.G., L.A.)
| | - Pedro Augusto Gondim Teixeira
- From the Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France (S.O., R.G., A.B., P.A.G.T.); Université de Lorraine, Inserm, IADI, Nancy, France (R.G., G.H., N.D., P.A.G.T.); and Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU de Nancy, Nancy, France (J.G., L.A.)
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Bakker D, Kraan GA, Colaris JW, Mathijssen N, Ring D, Crijns TJ. Is Midcarpal Arthroscopy for Suspected Scapholunate Pathology Associated With Greater Interobserver Agreement and More Frequent Offer of Surgery? J Hand Surg Am 2022; 47:962-969. [PMID: 36031464 DOI: 10.1016/j.jhsa.2022.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 05/24/2022] [Accepted: 07/06/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE This study compared the interobserver agreement of arthroscopic classification of suspected scapholunate interosseous ligament (SLIL) pathology with and without midcarpal arthroscopy to help inform diagnostic strategies. It also measured the association of midcarpal arthroscopy with recommendations for reconstructive surgery. The association of midcarpal arthroscopy with the type of surgery recommended was also studied. METHODS Fourteen consecutive videos of diagnostic radiocarpal and midcarpal wrist arthroscopy for suspected SLIL pathology were selected. An international survey-based experiment was conducted among upper extremity surgeons of the Science of Variation Group. Participants were randomized to view either radiocarpal arthroscopic videos or radiocarpal and midcarpal videos. Surgeons rated SLIL pathology according to the Geissler classification and recommended surgical or nonsurgical treatment. If surgical treatment was recommended, they indicated the type of procedure. RESULTS The interobserver agreement for the Geissler classification was slight/fair for observers who reviewed midcarpal and radiocarpal videos and for those who viewed radiocarpal videos only. Viewing midcarpal videos was associated with higher pathology grades, the recommendation for reconstructive surgery, and a preference for tenodesis over scapholunate ligament repair. CONCLUSIONS Diagnostic wrist arthroscopy for a wrist with normal radiological alignment has poor interobserver agreement. CLINICAL RELEVANCE The pursuit of a pathology that accounts for wrist symptoms in a nonspecific interview and examination and normal radiographs is understandable; however, the low reliability of the scapholunate pathology of diagnostic arthroscopy might be associated with more potential harm than benefit.
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Affiliation(s)
- Daniel Bakker
- Department of Surgery and Perioperative Care, Dell Medical School-The University of Texas at Austin, Austin, TX
| | - Gerald A Kraan
- Reinier Haga, Orthopaedic Center, Zoetermeer, The Netherlands
| | - Joost W Colaris
- Erasmus Medical Center, Department of Orthopaedic Surgery, Rotterdam, The Netherlands
| | - Nina Mathijssen
- Reinier Haga, Orthopaedic Center, Zoetermeer, The Netherlands
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School-The University of Texas at Austin, Austin, TX.
| | - Tom J Crijns
- Department of Surgery and Perioperative Care, Dell Medical School-The University of Texas at Austin, Austin, TX
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Puig de la Bellacasa I, Salva-Coll G, Esplugas M, Quintas S, Lluch A, Garcia-Elias M. Bilateral Ulnar Deviation Supination Stress Test to Assess Dynamic Scapholunate Instability. J Hand Surg Am 2022; 47:639-644. [PMID: 35534323 DOI: 10.1016/j.jhsa.2022.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 01/22/2022] [Accepted: 02/23/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE We describe a new radiologic test to assess the integrity of the scapholunate ligament in dynamic scapholunate dysfunction. METHODS A bilateral forearm-holding device was designed to perform a comparative radiographic assessment of the scapholunate joint gap during resisted isometric contraction of the extensor carpi ulnaris muscle with full supination of the forearm. The concept is based on the known scaphoid pronation effect of this muscle. Clinical data from 12 patients were collected retrospectively and used to analyze the patients' symptomatic and asymptomatic (contralateral) wrists with a newly developed test called the Bilateral Ulnar Deviation Supination (BUDS) test. A wrist arthroscopy was performed in all cases as a reference standard for the radiologic test. RESULTS The test was positive in 7 patients, with a mean scapholunate joint gap of 4.8 mm. The mean differences in the scapholunate joint gaps between both wrists were 2.6 mm in BUDS-positive patients and 0.2 mm in BUDS-negative patients. A Geissler stage III or IV scapholunate ligament rupture was confirmed in all BUDS-positive patients; by contrast, BUDS-negative patients exhibited either no lesion or a Geissler stage I injury. CONCLUSIONS The BUDS test is a new radiologic test based on proven biomechanical effects that is able to accurately assess dynamic scapholunate dysfunctions. The analysis carried out found a correlation between radiographic and arthroscopic findings. Further research is needed to confirm the validity and reliability of the test. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
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Affiliation(s)
| | - Guillem Salva-Coll
- Hospital Universitari Son Espases, Mallorca, Spain; Instituto Balear de Cirugía de Mano, Mallorca, Spain
| | | | - Saioa Quintas
- Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - Alex Lluch
- Hospital Vall d'Hebron, Barcelona, Spain; Institut Kaplan, Barcelona, Spain
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Rachunek K, Springer F, Barczak M, Kolbenschlag J, Daigeler A, Medved F. An algorithmic diagnostic approach to scapholunate ligament injuries based on comparison of X-ray examinations and arthroscopy in 414 patients. J Plast Reconstr Aesthet Surg 2022; 75:3293-3303. [PMID: 35725956 DOI: 10.1016/j.bjps.2022.04.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/15/2022] [Accepted: 04/12/2022] [Indexed: 12/21/2022]
Abstract
Conventional X-ray imaging is usually the first diagnostic assessment after clinical examination in case of suspected scapholunate interosseous ligament (SLIL) injury. Nevertheless, there is no consensus on the norms of the scapholunate distance (SLD) or carpal angles. Therefore, we aimed to determine the utility of static and dynamic radiographs in the diagnostic of an SLIL injury in comparison with the reference standard arthroscopy. We retrospectively analyzed the preoperative X-ray series and surgical records of arthroscopies of 414 patients. Radiological assessment included conventional static X-rays in the posteroanterior (PA) projection, clenched fist views in ulnar and radial deviations, in which the SLD at the midportion of the scapholunate (SL) joint was measured. The scapholunate angle (SLA) and radiolunate angle (RLA) were measured on lateral wrist radiographs. Receiver operating characteristic (ROC) curves were created to determine possible cut-off points of the radiological indices for the diagnosis of SLIL injury. Further, a logistic regression with the parameters having the highest area under the curve (AUC) was calculated. We found that SLD in ulnar inclination (AUC= 0.774), SLD in PA projection (AUC = 0.748), and SLA (AUC = 0.737) had the highest diagnostic value. The AUC of the combination of these three parameters was 0.822 for all patients with any SLIL lesion and 0.850 for patients with SLIL lesions of 3-4 Geissler grade. Further investigation of SLIL pathology would be appropriate in the case of SLD in ulnar inclination of 2.7 mm, SLD in PA projection of 1.9 mm and SLA of 63°.
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Affiliation(s)
- K Rachunek
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany.
| | - F Springer
- Department of Diagnostic and Interventional Radiology, University Hospital, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
| | - M Barczak
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
| | - J Kolbenschlag
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
| | - A Daigeler
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
| | - F Medved
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
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Lee GE, Forster GL, Freilich AM, DeGeorge BR. Magnetic Resonance Arthrography of the Wrist: The Impact on Operative Management of Wrist Injuries. J Wrist Surg 2022; 11:120-126. [PMID: 35478944 PMCID: PMC9038300 DOI: 10.1055/s-0041-1735305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
Background There is no consensus on the utility of arthrography in the evaluation of wrist injuries. This study evaluates ordering trends of different types of magnetic resonance imaging (MRI) of the wrist and compares rates of surgery following these imaging modalities. Methods A national claims-based database was used to identify patients who underwent MRI within 90 days of a first-instance diagnosis of wrist injury from 2010 to 2018. The utilization of MRI without intravenous (IV) contrast, MRI with IV contrast, and MRI with arthrogram was investigated. The instances of operative procedures of the wrist within 1 year of MRI study were recorded. Patient demographics, comorbidities, type of operative procedure, and ordering physician specialty were obtained. Logistic regression analysis was used to evaluate the utilization of MRI and subsequent 1-year operative intervention rates as well as association of patient-related factors. Results Magnetic resonance arthrography use was associated with higher rates of subsequent operative treatment. Surgeons were more likely to order an arthrogram at the time of MRI. Younger patients were more likely to undergo MRI-based advanced imaging. Conclusion Surgeons may perceive MRA of the wrist to play an important role in operative decision-making following wrist injury. Level of Evidence This is a Level III, retrospective cohort study.
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Affiliation(s)
- Glenn E. Lee
- Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Grace L. Forster
- University of Virginia School of Medicine, Charlottesville, Virginia
| | - Aaron M. Freilich
- Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Brent R. DeGeorge
- Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
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9
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Facet Inclinations and Interfacet Angle of the Distal Radius on Posteroanterior Radiographs: Clinical Associations With 3 Carpal Pathologies. J Hand Surg Am 2021; 48:410.e1-410.e9. [PMID: 34973882 DOI: 10.1016/j.jhsa.2021.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 09/04/2021] [Accepted: 11/05/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The radiographic interfacet angle (IFA), scaphoid facet inclination (SFI), and lunate facet inclination (LFI) of the distal radius were measured in patients with 3 distinct wrist pathologies to determine whether there is an association between these radiographic measurements and these conditions. METHODS Posteroanterior wrist radiographs were compiled from patients with 3 types of common wrist pathologies (scaphoid waist fracture [n = 54], scapholunate [SL] dissociation [n = 23], and dorsal ganglion [n = 51]). The patients were all Caucasians aged 20 to 45 years who met strict radiographic criteria. The IFA, SFI, and LFI values of these patients were compared with those obtained from 400 normal wrist radiographs of subjects who met the same selection criteria. RESULTS In men with a scaphoid waist fracture, the IFA and SFI were significantly greater than in normal men, whereas the LFI was significantly lower. In the SL dissociation group, for all patients and for subgroups stratified according to sex, the IFA and SFI were significantly lower than in the normal matched groups. In the dorsal ganglion group, differences were found in the IFA and SFI for women, but not for men. CONCLUSIONS The facet orientations of the distal radius in patients with scaphoid fracture, SL dissociation, and dorsal ganglion differed from those in the normal population. The IFA alone is most likely to be associated with all 3 pathologies. The SFI and LFI are less likely to be associated with patients with carpal pathologies. CLINICAL RELEVANCE Patients with a greater IFA may be susceptible to scaphoid fractures when they fall on an overstretched hand. Patients with a smaller IFA may be susceptible to SL dissociation when they fall on an overstretched hand.
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10
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Dietrich TJ, Toms AP, Cerezal L, Omoumi P, Boutin RD, Fritz J, Schmitt R, Shahabpour M, Becce F, Cotten A, Blum A, Zanetti M, Llopis E, Bień M, Lalam RK, Afonso PD, Mascarenhas VV, Sutter R, Teh J, Pracoń G, de Jonge MC, Drapé JL, Mespreuve M, Bazzocchi A, Bierry G, Dalili D, Garcia-Elias M, Atzei A, Bain GI, Mathoulin CL, Del Piñal F, Van Overstraeten L, Szabo RM, Camus EJ, Luchetti R, Chojnowski AJ, Grünert JG, Czarnecki P, Corella F, Nagy L, Yamamoto M, Golubev IO, van Schoonhoven J, Goehtz F, Klich M, Sudoł-Szopińska I. Interdisciplinary consensus statements on imaging of scapholunate joint instability. Eur Radiol 2021; 31:9446-9458. [PMID: 34100996 PMCID: PMC8589813 DOI: 10.1007/s00330-021-08073-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/12/2021] [Accepted: 05/12/2021] [Indexed: 11/29/2022]
Abstract
Objectives The purpose of this agreement was to establish evidence-based consensus statements on imaging of scapholunate joint (SLJ) instability by an expert group using the Delphi technique. Methods Nineteen hand surgeons developed a preliminary list of questions on SLJ instability. Radiologists created statements based on the literature and the authors’ clinical experience. Questions and statements were revised during three iterative Delphi rounds. Delphi panellists consisted of twenty-seven musculoskeletal radiologists. The panellists scored their degree of agreement to each statement on an eleven-item numeric scale. Scores of ‘0’, ‘5’ and ‘10’ reflected complete disagreement, indeterminate agreement and complete agreement, respectively. Group consensus was defined as a score of ‘8’ or higher for 80% or more of the panellists. Results Ten of fifteen statements achieved group consensus in the second Delphi round. The remaining five statements achieved group consensus in the third Delphi round. It was agreed that dorsopalmar and lateral radiographs should be acquired as routine imaging work-up in patients with suspected SLJ instability. Radiographic stress views and dynamic fluoroscopy allow accurate diagnosis of dynamic SLJ instability. MR arthrography and CT arthrography are accurate for detecting scapholunate interosseous ligament tears and articular cartilage defects. Ultrasonography and MRI can delineate most extrinsic carpal ligaments, although validated scientific evidence on accurate differentiation between partially or completely torn or incompetent ligaments is not available. Conclusions Delphi-based agreements suggest that standardized radiographs, radiographic stress views, dynamic fluoroscopy, MR arthrography and CT arthrography are the most useful and accurate imaging techniques for the work-up of SLJ instability. Key Points • Dorsopalmar and lateral wrist radiographs remain the basic imaging modality for routine imaging work-up in patients with suspected scapholunate joint instability. • Radiographic stress views and dynamic fluoroscopy of the wrist allow accurate diagnosis of dynamic scapholunate joint instability. • Wrist MR arthrography and CT arthrography are accurate for determination of scapholunate interosseous ligament tears and cartilage defects.
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Affiliation(s)
- Tobias Johannes Dietrich
- Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, CH 9007, St. Gallen, Switzerland. .,Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland.
| | - Andoni Paul Toms
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - Luis Cerezal
- Radiology Department, DMC-Diagnóstico Médico Cantabria, Castilla 6-Bajo, 39002, Santander, Spain
| | - Patrick Omoumi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Robert Downey Boutin
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, MC-5105, Stanford, CA, 94305, USA
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, NYU Langone Health, 660 First Avenue, New York, NY, 10016, USA
| | - Rainer Schmitt
- Klinikum der Ludwig-Maximilians-Universität München, Klinik und Poliklinik für Radiologie, Marchioninistraße 15, D-81377, München, Germany
| | - Maryam Shahabpour
- Department of Radiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Anne Cotten
- Service de Radiologie et Imagerie Musculosquelettique, CCIAL, CHU de Lille, 59800, Lille, France
| | - Alain Blum
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, UDL, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, France
| | - Marco Zanetti
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland.,Department of Musculoskeletal Radiology, Clinic Hirslanden Zurich, Witellikerstrasse 40, 8008, Zurich, Switzerland
| | - Eva Llopis
- Hospital de la Ribera, IMSKE, Valencia, Paseo Ciudadela 13, 46003, Valencia, Spain
| | - Maciej Bień
- Gamma Medical Center, Broniewskiego 3, 01-785, Warsaw, Poland
| | - Radhesh Krishna Lalam
- Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - P Diana Afonso
- Musculoskeletal Imaging Unit, Imaging Center, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Av. Lusiada 100, 1500-650, Lisbon, Portugal.,Hospital Particular da Madeira, HPA, Funchal, Madeira, Portugal
| | - Vasco V Mascarenhas
- Musculoskeletal Imaging Unit, Imaging Center, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Av. Lusiada 100, 1500-650, Lisbon, Portugal.,AIRC, Advanced Imaging Research Consortium, Lisbon, Portugal
| | - Reto Sutter
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland.,Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
| | - James Teh
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Grzegorz Pracoń
- Gamma Medical Center, Broniewskiego 3, 01-785, Warsaw, Poland.,Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartańska 1, 02-637, Warsaw, Poland
| | - Milko C de Jonge
- Department of Radiology, St. Antonius Hospital Utrecht, Utrecht, The Netherlands
| | - Jean-Luc Drapé
- Service de Radiologie B, Groupe Hospitalier Cochin, AP-HP Centre, Université de Paris, 75014, Paris, France
| | - Marc Mespreuve
- Department of Medical Imaging, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, 40136, Bologna, Italy
| | - Guillaume Bierry
- MSK Imaging, University Hospital, 1 Avenue Molière, 67098, Strasbourg Cedex, France
| | - Danoob Dalili
- Epsom & St Helier University Hospitals NHS Trust Radiology Department, Dorking Road, Epsom, London, KT18 7EG, UK
| | - Marc Garcia-Elias
- Hand and Upper Extremity Surgery, Creu Blanca, P° Reina Elisenda 57, 08022, Barcelona, Spain
| | - Andrea Atzei
- Pro-Mano, Treviso, Italy and Ospedale Koelliker, Corso G. Ferraris 247, 10134, Torino, Italy
| | - Gregory Ian Bain
- Department of Orthopaedic Surgery, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | | | - Francisco Del Piñal
- Instituto de Cirugía Plástica y de la Mano, Serrano 58 1B, 28001, Madrid, Spain
| | - Luc Van Overstraeten
- Hand and Foot Surgery Unit (HFSU) SPRL, Rue Pierre Caille 9, 7500, Tournai, Belgium.,Department of Orthopaedics and Traumatology, Erasme University Hospital, Route de Lennik, 808, Brussels, Belgium
| | - Robert M Szabo
- Department of Orthopaedic Surgery, University of California Davis, Health System, 4800 Y Street, Sacramento, CA, 95817, USA
| | - Emmanuel J Camus
- Hand Surgery Unit, Clinique de Lille Sud, 96 Rue Gustave Delory, Lesquin, France
| | | | - Adrian Julian Chojnowski
- Orthopaedics and Trauma Department, Hand and Upper Limb Surgery, Norfolk and Norwich University NHS Trust Hospital, Colney Lane, Norwich, NR4 7UY, UK
| | - Jörg G Grünert
- Department of Hand, Plastic and Reconstructive Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Piotr Czarnecki
- Traumatology, Orthopaedics and Hand Surgery Department, Poznan University of Medical Sciences, ul. 28 Czerwca 1956r. nr 135/147, 61-545, Poznań, Poland
| | - Fernando Corella
- Orthopedic and Trauma Department, Hospital Universitario Infanta Leonor, C/ Gran Vía del Este N° 80, 28031, Madrid, Spain.,Hand Surgery Unit, Hospital Universitario Quirónsalud Madrid, Madrid, Spain.,Surgery Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Ladislav Nagy
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland.,Division for Hand Surgery and Surgery of Peripheral Nerves, Balgrist University Hospital, University of Zurich, Forchstrasse, 340, 8008, Zurich, Switzerland
| | - Michiro Yamamoto
- Department of Hand Surgery, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan
| | - Igor O Golubev
- Hand and Microsurgery Division, National Medical Research Centre of Traumatology and Orthopaedic named after N.N. Priorov, Moscow, Russia
| | - Jörg van Schoonhoven
- Clinic for Hand Surgery, Rhön Medical Center, Campus Bad Neustadt, Von Guttenberg-Straße 11, 97616, Bad Neustadt/Saale, Germany
| | - Florian Goehtz
- Clinic for Hand Surgery, Rhön Medical Center, Campus Bad Neustadt, Von Guttenberg-Straße 11, 97616, Bad Neustadt/Saale, Germany
| | - Maciej Klich
- Department of Traumatology and Orthopaedics, Postgraduate Medical Center, A. Gruca Teaching Hospital, Otwock, Poland
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartańska 1, 02-637, Warsaw, Poland
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11
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Dornberger JE, Rademacher G, Stengel D, Hönning A, Dipl-Phys GS, Eisenschenk A, Mutze S, Goelz L. What Is the Diagnostic Accuracy of Flat-panel Cone-beam CT Arthrography for Diagnosis of Scapholunate Ligament Tears? Clin Orthop Relat Res 2021; 479:151-160. [PMID: 32701771 PMCID: PMC7899599 DOI: 10.1097/corr.0000000000001425] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/01/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cone beam CT (CBCT) is a widely available technique with possible indications in carpal ligament injuries. The accuracy of CBCT arthrography in diagnosing traumatic tears of the scapholunate ligament has not been reported. QUESTIONS/PURPOSES (1) What is the diagnostic accuracy of CBCT and how does it relate to the accuracy of multislice CT arthrography and conventional arthrography in diagnosing scapholunate ligament tears? (2) What is the estimated magnitude of skin radiation doses of each method? METHODS This secondary analysis of a previous prospective study included 71 men and women with suspected scapholunate ligament tears and indications for arthroscopy. Preoperative imaging was conventional arthrography and either MSCT arthrography for the first half of patients to be included (n = 36) or flat-panel CBCT arthrography for the remaining patients (n = 35). Index tests identified therapy-relevant SLL tears with dorsal or complete SLL ruptures, and these tears were compared with relevant SLL tears which were determined through arthroscopy as Geissler Stadium III and IV by probing the instable SL joint with a microhook or arthroscope. These injuries were treated by open ligament repair and Kirschner wire fixation. Accuracy values and 95% confidence intervals were calculated. Additional estimates of the radiation skin doses of each CBCT exam and two MSCT protocols were subsequently calculated using dose area products, dose length products, and CT dose indices. RESULTS The diagnostic accuracy was high for all imaging methods. 95% CIs were broadly overlapping and therefore did not indicate differences between the diagnostic groups: Sensitivity of CBCT arthrography was 100% (95% CI 77 to 100), specificity was 95% (95% CI 76 to 99.9), positive predictive value was 93% (95% CI 68 to 99.8), and negative predictive value was 100% (95% CI 83 to 100). For MSCT arthrography, the sensitivity was 92% (95% CI 64 to 99.8), specificity was 96% (95% CI 78 to 99.9), positive predictive value was 92% (95% CI 64 to 99.8), and negative predictive value was 96% (95% CI 78 to 99.9). For conventional arthrography, the sensitivity was comparably high: 96% (95% CI 81 to 99.9). Specificity was (81% [95% CI 67 to 92]); the positive predictive value was 77% (95% CI 59 to 89) and negative predictive value was 97% (95% CI 86 to 99.9). Estimated mean (range) radiation skin doses were reported in a descriptive fashion and were 12.9 mSv (4.5 to 24.9) for conventional arthrography, and 3.2 mSv (2.0 to 4.8) for CBCT arthrography. Estimated radiation skin doses were 0.2 mSv and 12 mSv for MSCT arthrography, depending on the protocol. CONCLUSION Flat-panel CBCT arthrography can be recommended as an accurate technique to diagnose scapholunate ligament injuries after wrist trauma. Estimated skin doses are low for CBCT arthrography and adapted MSCT arthrography protocols. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Jenny E Dornberger
- J. E. Dornberger, Burn Centre with Plastic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- J. E. Dornberger, A. Eisenschenk, Department of Hand, Replantation and Microsurgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- G. Rademacher, G. Schüler, S. Mutze, L. Goelz, Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Germany
- D. Stengel, BG Kliniken-Klinikverbund der Gesetzlichen Unfallversicherung gGmbH, Berlin, Germany
- D. Stengel, A. Hönning, Center for Clinical Research, BG Klinikum Unfallkrankenhaus Berlin, Germany
- D. Stengel, Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- A. Eisenschenk, Department of Hand Surgery and Microsurgery, University Medicine Greifswald, Greifswald, Germany
- S. Mutze, L. Goelz, Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Grit Rademacher
- J. E. Dornberger, Burn Centre with Plastic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- J. E. Dornberger, A. Eisenschenk, Department of Hand, Replantation and Microsurgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- G. Rademacher, G. Schüler, S. Mutze, L. Goelz, Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Germany
- D. Stengel, BG Kliniken-Klinikverbund der Gesetzlichen Unfallversicherung gGmbH, Berlin, Germany
- D. Stengel, A. Hönning, Center for Clinical Research, BG Klinikum Unfallkrankenhaus Berlin, Germany
- D. Stengel, Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- A. Eisenschenk, Department of Hand Surgery and Microsurgery, University Medicine Greifswald, Greifswald, Germany
- S. Mutze, L. Goelz, Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Dirk Stengel
- J. E. Dornberger, Burn Centre with Plastic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- J. E. Dornberger, A. Eisenschenk, Department of Hand, Replantation and Microsurgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- G. Rademacher, G. Schüler, S. Mutze, L. Goelz, Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Germany
- D. Stengel, BG Kliniken-Klinikverbund der Gesetzlichen Unfallversicherung gGmbH, Berlin, Germany
- D. Stengel, A. Hönning, Center for Clinical Research, BG Klinikum Unfallkrankenhaus Berlin, Germany
- D. Stengel, Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- A. Eisenschenk, Department of Hand Surgery and Microsurgery, University Medicine Greifswald, Greifswald, Germany
- S. Mutze, L. Goelz, Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Alexander Hönning
- J. E. Dornberger, Burn Centre with Plastic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- J. E. Dornberger, A. Eisenschenk, Department of Hand, Replantation and Microsurgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- G. Rademacher, G. Schüler, S. Mutze, L. Goelz, Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Germany
- D. Stengel, BG Kliniken-Klinikverbund der Gesetzlichen Unfallversicherung gGmbH, Berlin, Germany
- D. Stengel, A. Hönning, Center for Clinical Research, BG Klinikum Unfallkrankenhaus Berlin, Germany
- D. Stengel, Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- A. Eisenschenk, Department of Hand Surgery and Microsurgery, University Medicine Greifswald, Greifswald, Germany
- S. Mutze, L. Goelz, Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Gabriele Schüler Dipl-Phys
- J. E. Dornberger, Burn Centre with Plastic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- J. E. Dornberger, A. Eisenschenk, Department of Hand, Replantation and Microsurgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- G. Rademacher, G. Schüler, S. Mutze, L. Goelz, Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Germany
- D. Stengel, BG Kliniken-Klinikverbund der Gesetzlichen Unfallversicherung gGmbH, Berlin, Germany
- D. Stengel, A. Hönning, Center for Clinical Research, BG Klinikum Unfallkrankenhaus Berlin, Germany
- D. Stengel, Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- A. Eisenschenk, Department of Hand Surgery and Microsurgery, University Medicine Greifswald, Greifswald, Germany
- S. Mutze, L. Goelz, Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Andreas Eisenschenk
- J. E. Dornberger, Burn Centre with Plastic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- J. E. Dornberger, A. Eisenschenk, Department of Hand, Replantation and Microsurgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- G. Rademacher, G. Schüler, S. Mutze, L. Goelz, Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Germany
- D. Stengel, BG Kliniken-Klinikverbund der Gesetzlichen Unfallversicherung gGmbH, Berlin, Germany
- D. Stengel, A. Hönning, Center for Clinical Research, BG Klinikum Unfallkrankenhaus Berlin, Germany
- D. Stengel, Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- A. Eisenschenk, Department of Hand Surgery and Microsurgery, University Medicine Greifswald, Greifswald, Germany
- S. Mutze, L. Goelz, Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Sven Mutze
- J. E. Dornberger, Burn Centre with Plastic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- J. E. Dornberger, A. Eisenschenk, Department of Hand, Replantation and Microsurgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- G. Rademacher, G. Schüler, S. Mutze, L. Goelz, Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Germany
- D. Stengel, BG Kliniken-Klinikverbund der Gesetzlichen Unfallversicherung gGmbH, Berlin, Germany
- D. Stengel, A. Hönning, Center for Clinical Research, BG Klinikum Unfallkrankenhaus Berlin, Germany
- D. Stengel, Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- A. Eisenschenk, Department of Hand Surgery and Microsurgery, University Medicine Greifswald, Greifswald, Germany
- S. Mutze, L. Goelz, Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Leonie Goelz
- J. E. Dornberger, Burn Centre with Plastic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- J. E. Dornberger, A. Eisenschenk, Department of Hand, Replantation and Microsurgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- G. Rademacher, G. Schüler, S. Mutze, L. Goelz, Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Germany
- D. Stengel, BG Kliniken-Klinikverbund der Gesetzlichen Unfallversicherung gGmbH, Berlin, Germany
- D. Stengel, A. Hönning, Center for Clinical Research, BG Klinikum Unfallkrankenhaus Berlin, Germany
- D. Stengel, Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- A. Eisenschenk, Department of Hand Surgery and Microsurgery, University Medicine Greifswald, Greifswald, Germany
- S. Mutze, L. Goelz, Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
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Krastman P, Mathijssen NMC, Bierma-Zeinstra SMA, Kraan GA, Runhaar J. Diagnostic accuracy of history taking, physical examination and imaging for non-chronic finger, hand and wrist ligament and tendon injuries: a systematic review update. BMJ Open 2020; 10:e037810. [PMID: 33154046 PMCID: PMC7646346 DOI: 10.1136/bmjopen-2020-037810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The diagnostic work-up for ligament and tendon injuries of the finger, hand and wrist consists of history taking, physical examination and imaging if needed, but the supporting evidence is limited. The main purpose of this study was to systematically update the literature for studies on the diagnostic accuracy of tests for detecting non-chronic ligament and tendon injuries of the finger, hand and wrist. METHODS Medline, Embase, Cochrane Library, Web of Science, Google Scholar ProQuest and Cinahl were searched from 2000 up to 6 February 2019 for identifying studies. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 checklist, and sensitivity (Se), specificity (Sp), accuracy, positive predictive value (PPV) and negative predictive value (NPV) were extracted. RESULTS None of the studies involved history taking. Physical examination, for diagnosing lesions of the triangular fibrocartilage complex (TFCC), showed Se, Sp, accuracy, PPV and NPV ranging from 58% to 90%, 20% to 69%, 56% to 73%, 53% to 71% and 55% to 65%, respectively. Physical examination in hand and finger injuries the Se, Sp, accuracy, PPV and NPV ranged from 88% to 99%, 75% to 100%, 34% to 88%, 91% to 100% and 75% to 95%, respectively. The accuracy of MRI with high-resolution (3 T) techniques for TFCC and interosseous ligaments of the proximal carpal row ranged from 89% to 91% and 75% to 100%, respectively. The accuracy of MRI with low-resolution (1.5 T) techniques for TFCC and interosseous ligaments of the proximal carpal row ranged from 81% to 100% and 67% to 95%, respectively. CONCLUSIONS There is limited evidence on the diagnostic accuracy of history taking and physical examination for non-chronic finger, hand and wrist ligament and tendon injuries. Although some imaging modalities seemed to be acceptable for the diagnosis of ligament and tendon injuries in the wrist in patients presenting to secondary care, there is no evidence-based advise possible for the diagnosis of non-chronic finger, hand or wrist ligament and tendon injuries in primary care.
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Affiliation(s)
- Patrick Krastman
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Nina M C Mathijssen
- Department of Orthopaedic, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Orthopedics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Gerald A Kraan
- Department of Orthopaedic, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Jos Runhaar
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Appropriateness of the Use of Magnetic Resonance Imaging in the Diagnosis and Treatment of Wrist Soft Tissue Injury. Plast Reconstr Surg 2017; 141:410-419. [PMID: 29036028 DOI: 10.1097/prs.0000000000004023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND When diagnosing wrist soft tissue injury, the authors hypothesize that magnetic resonance imaging is used injudiciously and is associated with unnecessary cost. METHODS A retrospective review was conducted of patients aged 20 to 60 years who underwent magnetic resonance imaging for possible wrist soft tissue injury at a tertiary care center between 2009 and 2014. Treatment recommendation was classified as nonoperative, operative, or equivocal. If the magnetic resonance imaging-directed treatment recommendation differed from the pre-imaging recommendation, it was noted that the imaging influenced patient care (impact study). The cost estimate of an impact study was calculated by dividing the total studies performed by the number of studies that impacted the treatment recommendation and multiplying this value by the institutional wrist magnetic resonance imaging cost ($2246 in 2016). RESULTS One hundred forty patients were included. Magnetic resonance imaging affected treatment recommendation in 28 percent of patients. Independent predictors of impact on treatment recommendation were "question specific injury" (OR, 9.46; 95 percent CI, 3.18 to 28.16; p < 0.001) and "question scapholunate injury" (OR, 2.88; 95 percent CI, 1.21 to 6.88; p = 0.02). The only independent predictor of surgery was ordering physician (hand surgeon) (OR, 3.69; 95 percent CI, 1.34 to 10.13; p = 0.01). The cost of an impact study ordered by a non-hand surgeon versus a hand surgeon was $13,359 versus $6491, respectively. CONCLUSIONS The provider must carefully consider the pretest probability of ordering a study that will affect treatment recommendation. Injudicious screening with magnetic resonance imaging ($15,565) incurred a cost nearly seven times the cost of the one imaging scan ($2246) before impacting one treatment recommendation. In the current era of cost containment and bundled payment, diagnostic test probability must be appreciated to guide physician ordering practices.
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14
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Gondim Teixeira PA, Badr S, Hossu G, Lefebvre G, Abou Arab W, Blum A, Cotten A. Quantitative analysis of scapholunate diastasis using stress speckle-tracking sonography: a proof-of-concept and feasibility study. Eur Radiol 2017; 27:5344-5351. [DOI: 10.1007/s00330-017-4915-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 03/17/2017] [Accepted: 05/25/2017] [Indexed: 11/28/2022]
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15
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Cheriex KCAL, Sulkers GSI, Terra MP, Schep NWL, van Aard BJPL, Strackee SD. Scapholunate dissociation; diagnostics made easy. Eur J Radiol 2017. [PMID: 28624019 DOI: 10.1016/j.ejrad.2017.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Scapholunate dissociation (SLD) is a form of carpal instability, caused by rupture of the scapholunate ligament (SLL) the secondary stabiliser of the scapholunate (SL) compartment. SLD can cause osteoarthritis of the wrist. Recently a study was published that shows cineradiography to be an excellent radiological imaging technique for diagnosing SLD at a tertiary centre for hand and wrist surgery [1]. As the quality of these results can be influenced by the expertise of the operator and observer of the cineradiographic studies, the aim of this study was to determine if these results were reproducible at a secondary centre for hand and wrist surgery with less expertise in wrist cineradiography. All cineradiographic studies carried out during a 10-year period were obtained. All patients who underwent the gold standard procedure (arthroscopy/arthrotomy) after cineradiography were included, a total of 50 patients. The diagnostic accuracy of detecting SLD by both cineradiography and conventional radiography was calculated. Cineradiography had a high diagnostic accuracy, while the accuracy for conventional radiography was average. When all wrists with an SL distance ≥3mm were excluded (static SLD), diagnostic accuracy for conventional radiography dropped even lower, while accuracy for cineradiography remained high. These results are comparable with published accuracy rates and show that cineradiography has a high diagnostic value for detecting SLD and do not seem to be influenced by the operator or observer of the cineradiographic studies.
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Affiliation(s)
- K C A L Cheriex
- Department of Plastic, Reconstructive and Hand Surgery, Onze Lieve Vrouw Gasthuis Oost, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands.
| | - G S I Sulkers
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - M P Terra
- Department of Radiology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - N W L Schep
- Trauma Unit, Department of surgery, Maasstad Hospital, Maasstadweg 21, 3079 DZ Rotterdam, The Netherlands.
| | - B J P L van Aard
- Department of Plastic, Reconstructive and Hand Surgery, Onze Lieve Vrouw Gasthuis Oost, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands.
| | - S D Strackee
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Feehan L, Fraser T. Early controlled mobilization using dart-throwing motion with a twist for the conservative management of an intra-articular distal radius fracture and scapholunate ligament injury: A case report. J Hand Ther 2017; 29:191-8. [PMID: 27264904 DOI: 10.1016/j.jht.2016.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 02/22/2016] [Accepted: 02/25/2016] [Indexed: 02/03/2023]
Abstract
UNLABELLED This case describes an early controlled mobilization (ECM) approach that uses dart-throwing motion (DTM) with a twist orthoses as an alternative to immobilization for conservative management of a minimally displaced and intra-articular distal radius styloid fracture with an associated scapholunate ligament injury in a 47-year-old female health care administrator (JP). Pain-free active DTM began at day 10 (5 times/d) with a dynamic DTM with a twist orthosis worn during the day from weeks 3 to 6. At 6 weeks, JP had pain-free functional mobility and strength with minimal limitation in household and occupational activities, returning to her normal sporting activities by 3 months. ECM led to rapid return of normal functioning in the short term with no apparent impact on intermediate outcomes at 8 months. This case allows hand therapists to consider a similar ECM approach for the management of similar injuries in their patients. LEVEL OF EVIDENCE Level 5 and case report.
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Affiliation(s)
- Lynne Feehan
- Clinical Research, Rehabilitation Program, Fraser Health Authority, Surrey, British Columbia, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Trevor Fraser
- HealthOne Physiotherapy & Hand Clinic, Surrey, British Columbia, Canada
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17
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Werncke T, Sonnow L, Meyer BC, Lüpke M, Hinrichs J, Wacker FK, von Falck C. Ultra-high resolution C-Arm CT arthrography of the wrist: Radiation dose and image quality compared to conventional multidetector computed tomography. Eur J Radiol 2017; 89:191-199. [PMID: 28267538 DOI: 10.1016/j.ejrad.2017.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 01/16/2017] [Accepted: 02/05/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Objective of this phantom and cadaveric study was to compare the effective radiation dose (ED) and image quality (IQ) between C-arm computed tomography (CACT) using an ultra-high resolution 1×1 binning with a standard 16-slice CT (MDCT) arthrography of the wrist. METHODS ED was determined with thermoluminescence dosimetry using an anthropomorphic phantom and different patient positions. Imaging was conducted in 10 human cadaveric wrists after tri-compartmental injection of diluted iodinated contrast material and a wire phantom. IQ of MDCT was compared with CACT reconstructed with a soft (CACT1) and sharp (CACT2) kernel. High and low contrast resolution was determined. Three radiologists assessed IQ of wrist structures and occurrence of image artifacts using a 5-point Likert scale. RESULTS ED of MDCT was comparable to standard CACT (4.3μSv/3.7μSv). High contrast resolution was best for CACT2, decreased to CACT1 and MDCT. Low contrast resolution increased between CACT2 and MDCT (P<0.001). IQ was best for CACT2 (1.3±0.5), decreased to CACT1 (1.9±0.6) and MDCT (3.5±0.6). Non-compromising artifacts were only reported for CACT. CONCLUSIONS The results of this phantom and cadaveric study indicate that ultra-high resolution C-Arm CT arthrography of the wrist bears the potential to outperform MDCT arthrography in terms of image quality and workflow at the cost of mildly increasing image artifacts while radiation dose to the patient is comparably low for both, MDCT and C-Arm CT.
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Affiliation(s)
- Thomas Werncke
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - Lena Sonnow
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Bernhard C Meyer
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Matthias Lüpke
- University of Veterinary Medicine Hannover, Institute for General Radiology and Medical Physics, Bischofsholer Damm 15, 30173 Hannover, Germany
| | - Jan Hinrichs
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Frank K Wacker
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Christian von Falck
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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