Le bilan d’imagerie dans les traumatismes récents du rachis

Standing MRI for surgical planning of equine fracture repair

OBJECTIVE

To report the feasibility of standing MRI (sMRI) and document the value of sMRI in surgical planning for surgical repair of limb fractures in the horse.

STUDY DESIGN

Retrospective case series.

ANIMALS

Thirty-one horses with preoperative sMRI.

METHODS

Medical records were reviewed for fracture type, application of a polyester cast, sMRI sequences performed, technical variables, and image quality. Fracture geometry and concomitant lesions were compared between sMRI and radiography. The relative value of sMRI with regard to surgical planning was classified as minor (sMRI did not provide additional findings), intermediate (additional lesions found or slight modification to surgical plan), or major (sMRI led to significant alternations in surgical plan).

RESULTS

Standing MRI provided good studies in all horses. Standing MRI was classified as having major relevance in 12 of 31 horses, intermediate relevance in 14 of 31 horses, and minor relevance in 5 of 31 horses.

CONCLUSION

Preoperative sMRI produced good studies in all horses and influenced the surgical planning in the majority of fractures in this study. Application of a polyester cast seemed to improve comfort without appreciable loss of image quality.

CLINICAL SIGNIFICANCE

Standing MRI can be considered as an adjunct to plan the repair of equine fractures, and a polyester cast does not impair image quality.

[Imaging of acute spinal injury]

The mechanism location and type of injury varies according to patient age and severity of trauma. The imaging work-up with radiographs, CT and MRI must be adapted to each individual case. In the setting of minor trauma, standard radiographs are obtained when clinically indicated. In all other cases of high energy trauma, spinal trauma with neurological deficit or incomplete or difficult standard radiographic evaluation, CT will be indicated for osseous injuries while MRI will provide optimal evaluation of soft tissues. Dislocations require immediate treatment. The imaging work-up should by no means delay management. Significant sprains are rare. Several diagnostic pitfalls occur at both extremities of life.