Orthopaedic Surgery Resident, McGovern Medical School at UTHealth Houston, Houston, TX.
Orthopaedic Trauma Service, McGovern Medical School at UTHealth Houston, Houston, TX.
Injury. 2021 Aug;52(8):2390-2394. doi: 10.1016/j.injury.2021.05.009. Epub 2021 May 15.
Preliminary results using a novel rapid-sequence MRI to diagnose ipsilateral femoral neck fractures in patients sustaining high-energy femoral shaft fractures have been favorable compared to radiographic and CT imaging alone. To evaluate and optimize this new institutional imaging protocol further, we reviewed our results one year after implementation.
Rapid-sequence MRI was added to the imaging evaluation of patients with high-energy femoral shaft fractures without femoral neck fractures identified on radiographs or CT imaging. Data was retrospectively reviewed from a consecutive series of patients who met inclusion criteria.
From September 2018 through September 2019, 114 patients sustained 121 high-energy femoral shaft fractures. The average patient age was 29.9 years, 73.7% (84/114) of patients were male, and 16.5% (20/121) were open fractures. Of patients indicated for a rapid-sequence MRI, 86% (92/107) underwent MR imaging. 5% (6/121) of patients had an ipsilateral femoral neck fracture identified on radiographs alone. Three additional femoral neck fractures were identified with CT imaging for an initial incidence of 7.4% (9/121). MRI identified 10 additional non-displaced femoral neck fractures, three complete and seven incomplete fractures, for an incidence of 15.7% (19/121). All identified femoral neck fractures were stabilized.
DISCUSSION/CONCLUSION: The addition of rapid-sequence MRI of the pelvis in patients with high-energy femoral shaft fractures reliably increases the diagnosis of ipsilateral femoral neck fractures not identified with standard imaging. There were no cases of missed/delayed femoral neck fractures in patients with a negative MRI. This new imaging protocol effectively and safely improves the diagnosis of this injury pattern.
与单独的放射影像学和 CT 成像相比，使用新型快速序列 MRI 诊断高能量股骨干骨折患者同侧股骨颈骨折的初步结果是有利的。为了进一步评估和优化这个新的机构成像方案，我们在实施一年后对我们的结果进行了回顾。
在没有放射影像学或 CT 影像学发现股骨颈骨折的情况下，快速序列 MRI 被添加到高能股骨干骨折患者的影像学评估中。对符合纳入标准的连续患者系列进行回顾性数据分析。
2018 年 9 月至 2019 年 9 月，114 例患者发生 121 例高能股骨干骨折。平均患者年龄为 29.9 岁，73.7%（84/114）的患者为男性，16.5%（20/121）为开放性骨折。在需要进行快速序列 MRI 的患者中，86%（92/107）接受了 MRI 检查。5%（6/121）的患者在放射影像学上单独发现同侧股骨颈骨折。另有 3 例股骨颈骨折通过 CT 影像学检查发现，初始发生率为 7.4%（9/121）。MRI 发现 10 例额外的无移位股骨颈骨折，其中 3 例完全骨折，7 例不完全骨折，发生率为 15.7%（19/121）。所有发现的股骨颈骨折均得到固定。
讨论/结论：在高能股骨干骨折患者中，骨盆快速序列 MRI 的添加可靠地增加了标准影像学检查未发现的同侧股骨颈骨折的诊断。在阴性 MRI 的患者中，没有漏诊/延迟诊断股骨颈骨折的病例。这种新的成像方案有效地、安全地改善了这种损伤模式的诊断。
