Nowell Jared, Murray Ryan S, Oetgen Matthew E, Martin Benjamin D
Department of Orthopaedic Surgery, Howard University Hospital, Washington, DC.
Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, DC.
J Pediatr Soc North Am. 2024 Feb 12;5(3):564. doi: 10.55275/JPOSNA-2023-564. eCollection 2023 Aug.
Fractures are typically evaluated and monitored using plain radiographs, but in the pediatric population the goal is always to reduce radiation exposure when possible. Dual-energy X-ray absorptiometry (DXA) is an imaging modality that uses less radiation. The evaluation of upper and lower extremity fractures in the pediatric population using DXA imaging has not yet been studied. Radiographs of 19 patients treated for forearm or tibia fractures were compared to images taken with a DXA machine. The angulation and translation of the fractures were measured twice each by two independent observers. Correlation of these values between plain radiographs and DXA scans along with intra- and inter-observer reliability was calculated. A total of 19 patients with a forearm or tibia fracture were enrolled in the study. Correlation with conventional radiographs for angulation was r=0.77, p<0.001, while for translation was r=0.76, p<0.001. The mean difference between the methods was 0.5 degrees (range of -6.7 to 7.7) for angulation and 4% (range of -28% to 37%) for translation. For plain radiographs the inter-rater reliability was 0.90 (95% confidence interval of 0.84-0.93) for angulation and 0.89 (0.68-0.95) for translation. The inter-rater reliability for DXA imaging was 0.77 (0.69-0.83) for angulation and 0.76 (0.41-0.88) for translation. Our study showed that DXA imaging correlates well with plain radiographs when measuring angulation and translation of forearm and tibia fractures in the pediatric population. This study is a proof of concept that DXA, a low-dose radiation alternative to plain radiographs, may be useful in the management of pediatric fractures. Level III.
•Decreasing radiation exposure in the pediatric population is an ongoing goal in pediatric orthopaedics.•Fracture follow-up imaging in the pediatric population currently is mainly restricted to plain radiographs.•A lower dose imaging modality might be an alternative to plain radiographs to monitor long bone fracture alignment.
骨折通常通过普通X线片进行评估和监测，但对于儿科人群，目标始终是尽可能减少辐射暴露。双能X线吸收法（DXA）是一种辐射剂量较低的成像方式。尚未对使用DXA成像评估儿科人群的上肢和下肢骨折进行研究。将19例接受前臂或胫骨骨折治疗的患者的X线片与用DXA机器拍摄的图像进行比较。两名独立观察者分别对骨折的成角和移位进行两次测量。计算普通X线片和DXA扫描之间这些值的相关性以及观察者内和观察者间的可靠性。共有19例前臂或胫骨骨折患者纳入本研究。成角与传统X线片的相关性为r = 0.77，p < 0.001，移位的相关性为r = 0.76，p < 0.00。两种方法之间的平均差异，成角为0.5度（范围为 - 6.7至7.7），移位为4%（范围为 - 28%至37%）。对于普通X线片，观察者间可靠性，成角为0.90（95%置信区间为0.84 - 0.93），移位为0.89（0.68 - 0.95）。DXA成像的观察者间可靠性，成角为0.77（0.69 - 0.83），移位为0.76（0.41 - 0.88）。我们的研究表明，在测量儿科人群前臂和胫骨骨折的成角和移位时，DXA成像与普通X线片具有良好的相关性。本研究是一个概念验证，即DXA作为普通X线片的低剂量辐射替代方法，可能在儿科骨折的管理中有用。三级。
•减少儿科人群的辐射暴露是儿科骨科的一个持续目标。•儿科人群骨折的随访成像目前主要限于普通X线片。•较低剂量的成像方式可能是监测长骨骨折对线的普通X线片的替代方法。
