The history of clinical musculoskeletal radiology

Developing a core outcome set for acetabular fractures: a systematic review protocol

BACKGROUND

Clinical trials investigating acetabular fractures are heterogeneous in their investigated outcomes and their corresponding measurements. Standardization may facilitate comparability and pooling of research results, which would lead to an increase in knowledge about the optimal treatment of acetabular fractures, resulting in long-term evidence-based treatment decisions and improvements in patient care. The aim of this systematic review is to identify the reported outcomes and their measurements from studies on treatments for acetabular fractures to develop a core outcome set which contains the most relevant outcome measures to be included in future studies.

METHODS

Studies published in English and German including patients aged 16 years and older, with a surgically treated acetabular fracture, will be included. Studies with nonsurgical treatment, pathologic fractures, polytraumatized patients, and patients younger than 16 years of age will be excluded because other outcomes may be of interest in these cases. Any prospective and retrospective study will be included. Systematic reviews will be excluded, but their included studies will be screened for eligibility. The literature will be searched on MEDLINE, CENTRAL, Web of Science, ClinicalTrials.gov, and WHO ICTRP. Risk of selective reporting of outcomes will be assessed using the Outcome Reporting Bias in Trials classification system. Heterogeneously defined outcomes that measure the same outcome will be grouped and subsequently categorized into outcome domains using the taxonomy of the Core Outcome Measures in Effectiveness Trials Initiative.

DISCUSSION

It is expected that a high number of studies will be included, and many outcomes will be identified using different definitions and measurement instruments. A limitation of this systematic review is that only previously investigated outcomes will be detected, thus disregarding potentially relevant outcomes.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022357644.

Musculoskeletal involvement of COVID-19: review of imaging

The global pandemic of coronavirus disease 2019 (COVID-19) has revealed a surprising number of extra-pulmonary manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. While myalgia is a common clinical feature of COVID-19, other musculoskeletal manifestations of COVID-19 were infrequently described early during the pandemic. There have been emerging reports, however, of an array of neuromuscular and rheumatologic complications related to COVID-19 infection and disease course including myositis, neuropathy, arthropathy, and soft tissue abnormalities. Multimodality imaging supports diagnosis and evaluation of musculoskeletal disorders in COVID-19 patients. This article aims to provide a first comprehensive summary of musculoskeletal manifestations of COVID-19 with review of imaging.

Utility of musculoskeletal ultrasound in a Department of Defense rheumatology practice: a four-year retrospective experience

OBJECTIVE

To analyze the utility of musculoskeletal ultrasound (MSUS) in a rheumatology department and characterize relevant clinical trends.

METHODS

Electronic medical records of all patients (n = 503) requiring MSUS in our department from January 2007 to December 2011 were reviewed. Rheumatologists performed MSUS using MyLab 25 or MyLab 70 systems. Clinical data were collected, including age, sex, symptoms, joint(s) examined, MSUS findings, procedures, further radiologic studies, and additional specialty consults. Results were tabulated from 717 total MSUS encounters and each was categorized as a completed encounter or an incomplete encounter. All magnetic resonance imaging (MRI) reports that followed MSUS were examined for concurrence. Cumulative numbers of MSUS examinations and MRIs were totaled. The Medicare global national average cost for MRIs and potential savings were calculated.

RESULTS

A total of 789 joint sites were examined by MSUS. There were 84 US-guided procedures. Overall, 158 specialty consults were generated. After MSUS, 55 additional radiologic studies were ordered. There were 613 (85.5%) primary completed MSUS encounters and 104 cases (14.5%) requiring further imaging studies or an orthopedic consultation. There was an increased use of MSUS and a concurrent decreased use of MRI in our department over 4 consecutive years. We calculated the total potential savings from our rheumatology service to the Department of Defense as approximately $27,937.80 to $38,047.20 over 4 years.

CONCLUSION

MSUS has a positive impact in a rheumatology practice. MSUS augments the clinical examination, influences diagnosis and management, decreases reliance on other imaging modalities, and reduces health care costs.

Magnetic resonance imaging of the long bones of the upper extremity

The long bones of the upper extremity are often overlooked in favor of addressing their intervening joints. However, there are a wide variety of pathologic processes that can involve these anatomic segments. To better understand the complex anatomy of the upper extremity, this article is divided into sections describing the osseous, muscular, and neurovascular anatomy of the arm and forearm using a compartmental approach. The discussion touches on a few common normal variants and their potential functional consequences. The upper extremity joints of the shoulder, elbow, and wrist are addressed separately.

Communication and documentation of preliminary and final radiology reports

The "wet-read" consultation has been defined as a rapid response to a clinical question posed by a physician to a radiologist. These preliminary interpretations are often not well documented, have poor fidelity, and are subject to modifications and revisions. Moreover, preliminary interpretations may be subject to reinterpretation through a variety of scenarios. Recent technological advances in radiology have further hindered the ability to harmonize differences between preliminary and final interpretations and communicate these differences to treating physicians. High-fidelity simulation may represent a risk management strategy aimed at bridging the gap between radiology and communication technology.