Hwang John S, Koury Kenneth L, Gorgy George, Sirkin Michael S, Reilly Mark C, Lelkes Valdis, Adams Mark R
Department of Orthopaedic Surgery, Rutgers, New Jersey Medical School, The State University of New Jersey, Newark, NJ.
J Orthop Trauma. 2017 Jun;31(6):334-338. doi: 10.1097/BOT.0000000000000786.
This study was to compare the use of computer tomography with plain radiographs for the evaluation of intra-articular extension of long bone fractures in the lower extremity after low-energy gunshot wounds.
Retrospective chart and radiographic review.
Level 1 Trauma Center.
PATIENTS/PARTICIPANTS: Data were collected from a single institution from 2000 to 2014. Inclusion criteria consisted of patients greater than 17 years of age, low-velocity gunshot injuries causing fracture of the femur or tibia, plain radiographs with adequate films, and computed tomography (CT) imaging of the fracture. This consisted of 133 patients with 140 fractures.
Intra-articular fracture extension was evaluated on initial plain radiographs and CTs.
Comparison of "gold standard" CT with all reviewers' evaluation of plain radiographs.
There were 140 total fractures; 108 were femoral fractures and 32 were tibial fractures. By comparing plain radiographs with the gold standard CT, the reviewers demonstrated correct diagnosis in 85% of intra-articular fractures and 96% of non-intra-articular fractures. In addition, the reviewers accurately diagnosed 70.8% of intra-articular extensions in the diaphysis and 70.5% in the metaphysis. The sensitivity and specificity for plain radiographs were 85.3% and 96.0%, respectively, for all locations. Metaphyseal and diaphyseal fractures demonstrated the poorest sensitivity at 80.7% and 82.1%, respectively.
Low-energy gunshot wounds with fractures in the diaphyseal of the distal femur and all metaphyseal fractures warrant CT evaluation to better examine for intra-articular fracture extension.
Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
本研究旨在比较计算机断层扫描与普通X线片在评估下肢低能量枪伤后长骨骨折关节内延伸情况的应用。
回顾性病历及影像学检查。
一级创伤中心。
患者/参与者：数据收集自2000年至2014年的单一机构。纳入标准包括年龄大于17岁、导致股骨或胫骨骨折的低速枪伤、有足够胶片的普通X线片以及骨折的计算机断层扫描（CT）影像。共133例患者，140处骨折。
在初始普通X线片和CT上评估关节内骨折延伸情况。
将“金标准”CT与所有审阅者对普通X线片的评估进行比较。
共有140处骨折；其中108处为股骨骨折，32处为胫骨骨折。通过将普通X线片与金标准CT进行比较，审阅者对关节内骨折的正确诊断率为85%，对非关节内骨折的正确诊断率为96%。此外，审阅者准确诊断出骨干关节内延伸的比例为70.8%，干骺端为70.5%。普通X线片在所有部位的敏感性和特异性分别为85.3%和96.0%。干骺端和骨干骨折的敏感性最差，分别为80.7%和82.1%。
股骨远端骨干及所有干骺端的低能量枪伤骨折需要进行CT评估，以更好地检查关节内骨折延伸情况。
诊断性三级。有关证据级别的完整描述，请参阅作者指南。
