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Castonguay T, Dover G. Infrared Thermography-A Novel Tool for Monitoring Fracture Healing: A Critically Appraised Topic With Evidence-Based Recommendations for Clinical Practice. J Sport Rehabil 2023; 32:834-839. [PMID: 37433522 DOI: 10.1123/jsr.2022-0390] [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: 11/17/2022] [Revised: 05/13/2023] [Accepted: 05/17/2023] [Indexed: 07/13/2023]
Abstract
CLINICAL SCENARIO Stress fractures are one of the most common injuries in athletes. Unfortunately, they are hard to diagnose, require multiple radiology exams and follow-up which leads to more exposure to radiation and an increase in cost. Stress fractures that are mismanaged can lead to serious complications and poorer outcomes for the athlete. During the rehabilitation process, it would be beneficial to be able to monitor the healing of fractures to know when it is safe to gradually allow a patient to a return to sport because the return to activity is not usually objective and based on pain level. CLINICAL QUESTION Can infrared thermography (IRT) be a useful tool to measure the pathophysiological state of the fracture healing? The aim of this critically appraised topic is to analyze the current evidence of IRT for measuring the temperature change in fractures to provide recommendations for medical practitioners. SUMMARY OF KEY FINDINGS For this critically appraised topic, we examined 3 articles that compared medical imaging and IRT over multiple time points during the follow-up. The 3 articles concluded that a 1 °C asymmetry in temperature followed by a return to normal (less than 0.3 °C) temperature during the healing process of fractures can be monitored using IRT. CLINICAL BOTTOM LINE Once the patient has been diagnosed with a fracture, IRT can safely be used to monitor the evolution of a fracture. When the thermogram progresses from a hot thermogram to a cold thermogram, the healing is considered good enough to return to sport. STRENGTH OF RECOMMENDATION Grade 2 evidence exists to support IRT being used by clinicians to monitor fracture healing. Due to the limited research and novelty of the technology, the current recommendations are for following the treatment of the fracture once the initial diagnosis is made.
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Affiliation(s)
- Tristan Castonguay
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC,Canada
| | - Geoff Dover
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC,Canada
- PERFORM Centre, Concordia University, CRIR-Centre de Réadaptation Constance-Lethbridge du CIUSSS COMLT, Montreal, QC,Canada
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Kawasaki R, Sakata A, Hosoda C, Harada S, Soeda T, Nishida Y, Matsumoto N, Tatsumi K, Nogami K, Yoshimura Y, Shima M. The use of infrared thermography for non-invasive detection of bleeding and musculoskeletal abnormalities in patients with hemophilia: an observational study. Thromb J 2023; 21:70. [PMID: 37381012 DOI: 10.1186/s12959-023-00511-5] [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: 04/06/2023] [Accepted: 06/05/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND In patients with hemophilia (PwH), bleeding often occurs in joints and muscles, and early detection of hemorrhage is important to prevent the onset and progression of mobility impairment. Complex-Image analysis such as ultrasonography, computed tomography, and magnetic resonance imaging are used to detect bleeding. On the other hand, no simple and rapid method to detect the active bleeding has been reported. Local inflammatory responses occur when blood leaks from damaged vessels, and the temperature at the site of active bleeding could be expected to increase in these circumstances, leading to an increase in surrounding skin temperature. Therefore, the purpose of this study was to investigate whether the measurement of skin temperature using infrared thermography (IRT) can be used as a diagnostic aid to detect active bleeding. METHODS Fifteen PwH (from 6 to 82 years old) complaining of discomfort such as pain were examined. Thermal images were obtained simultaneously at the affected sides and comparable unaffected sides. The average skin temperature of the affected side and of the unaffected side were measured. The temperature differences were calculated by subtracting the average skin temperature at the unaffected side from the affected side. RESULTS In eleven cases with active bleeding, the skin temperature at the affected side was more than 0.3 °C higher (0.3 °C to 1.4 °C) compared to the unaffected side. In two cases without active bleeding, there were no significant differences in skin temperature between the affected and unaffected sides. In two cases with previous rib or thumb bone fracture, the skin temperature at the affected side was 0.3 °C or 0.4 °C lower than that of the unaffected side, respectively. In two cases with active bleeding in which longitudinal evaluation was conducted, the difference in skin temperature decreased after hemostatic treatment. CONCLUSION The analysis of skin temperature deference using IRT was a useful supportive tool to readily assess musculoskeletal abnormalities and bleeding in PwH as well as to determine the success of the hemostatic treatment.
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Affiliation(s)
- Ryohei Kawasaki
- Medicinal Biology of Thrombosis and Hemostasis, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
- Product Research Department, Medical Affairs Division, Chugai Pharmaceutical Co., Ltd., Yokohama, Japan
- Advanced Medical Science of Thrombosis and Hemostasis, Nara Medical University, Kashihara, Japan
| | - Asuka Sakata
- Medicinal Biology of Thrombosis and Hemostasis, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Chihiro Hosoda
- Advanced Medical Science of Thrombosis and Hemostasis, Nara Medical University, Kashihara, Japan
| | - Suguru Harada
- Medicinal Biology of Thrombosis and Hemostasis, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
- Product Research Department, Medical Affairs Division, Chugai Pharmaceutical Co., Ltd., Yokohama, Japan
| | - Tetsuhiro Soeda
- Medicinal Biology of Thrombosis and Hemostasis, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
- Product Research Department, Medical Affairs Division, Chugai Pharmaceutical Co., Ltd., Yokohama, Japan
| | - Yukiko Nishida
- Medicinal Biology of Thrombosis and Hemostasis, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
- Project Planning and Coordination Department, Translational Research Division, Chugai Pharmaceutical Co., Ltd., Chuo-ku, Japan
| | - Naoki Matsumoto
- Medicinal Biology of Thrombosis and Hemostasis, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
- Product Research Department, Medical Affairs Division, Chugai Pharmaceutical Co., Ltd., Yokohama, Japan
| | - Kohei Tatsumi
- Medicinal Biology of Thrombosis and Hemostasis, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
- Advanced Medical Science of Thrombosis and Hemostasis, Nara Medical University, Kashihara, Japan
| | - Keiji Nogami
- Department of Pediatrics, Nara Medical University, Kashihara, Japan
| | - Yasushi Yoshimura
- Product Research Department, Medical Affairs Division, Chugai Pharmaceutical Co., Ltd., Yokohama, Japan
| | - Midori Shima
- Medicinal Biology of Thrombosis and Hemostasis, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan.
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Evaluating physiological progression of chronic tibial osteomyelitis using infrared thermography. RESEARCH ON BIOMEDICAL ENGINEERING 2022. [PMCID: PMC9244558 DOI: 10.1007/s42600-022-00228-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Purpose Medical infrared thermography (IRT) was used as a complementary means for the clinical evaluation of musculoskeletal trauma and progression of chronic tibial osteomyelitis. Methods Twenty-two adult patients with a medical diagnosis of chronic tibial osteomyelitis were followed up by IRT performed along with standard radiography. Thermal data of the affected limb were compared with those of the healthy contralateral limb based on the thermal profile of the lower limbs as per the medical thermography guideline (32 °C). Data were acquired in the following regions of the lower limb: proximal tibia, diaphysis, and distal tibia, using a FLIR infrared camera, and data were processed using MATLAB®. Results For patients with active infections, an increase in the average temperature of the affected limb above + 1.0 °C was observed when compared with the temperature of the contralateral. The wound region of the patients showed an increased temperature (32.3 °C) compared with the temperature of the contralateral (31.4 °C). In contrast, in latent infections, the thermal differences were small, generally below 0.3 °C, and thus were within the threshold of normality. In contrast, in areas diagnosed with reduced blood supply, the affected limb showed an average temperature up to − 5.7 °C below normal. Additionally, the initial temperature range (26.5 to 34.5 °C) decreased during the treatment to 29.8 to 34.1 °C, indicating a convergence toward normality. Conclusion IRT has significant potential as a complementary imaging modality in the follow-up of patients with bone lesions with a diagnosis of osteomyelitis as it does not use ionizing radiation, thus allowing repetitive use as desired. Thermal images show important physiological information related to vascularization necessary for bone repair, as well as provide a good indication of the boundary of the infected area, adjacent to the trauma, which is useful for positioning the radiography equipment. However, it should be noted that IRT cannot replace other medical imaging techniques, as it provides information about the skin and cannot directly evaluate the interior of the body.
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