Third Metacarpal Fracture

about fracture ultrasound visualization

This is the case of a non-displaced third metacarpal fracture of a professional football player after a contusion at football match. The ultrasound dynamic exam shows a gross irregularity of the cortical bone surface, with perilesional soft-tissue swelling.

It’s very important to be familiar with the ultrasound appearance of fractures, because in a large number of cases the ultrasound exam allows to appreciate the early bone damages that can be as a result of overuse injuries often seen in athlete with stress fractures.

Several tudies showed that minor fractures which are not radiologically diagnosed, can be seen in the ultrasound examination, togheter with the surrounding soft tissue structures.

The x-ray evaluation still remains essential.

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Plain radiographs of the same patient.

My Mri and ultrasound devices are separated only by a wall, so I usually perform both imagine modalities to give a complete description of the pathologic findings.

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Coronal Ge-Stir (left) and T1w Mri scans (0.3 Tesla).

The 3D Sharc Mri acquisition allowed to better discriminate the real extent of the metacarpal fracture and its relationship with the articular plane.

 

Tibial Stress Fracture

Today a show you the case of a young football player  that came to my observation for a persistent pain on his postero-medial compartment of the leg; as you can see from the dynamic ultrasound examination, a gross irregularity of the cortical tibial surface was evident with intense periostal hypervascularity.

The tibia is the most common site of a stress fracture in the lower body, especially in young athletes. Don’t forget that sensibility of the ultrasound scan with bone-like structures is 100% but 0% specificity. The integration with other imaging modalities is always needed; Mri exam is essential.

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Sagittal Stir-3D Shark-T1w Mri scans 0.3 Tesla (from left to right)


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Axial Stir (left) and T2w (right) Mri scans (0.3 Tesla); intense periostal reaction is evident.

With plain radiograph positive findings may take months to appear; don’t be surprised if during the first few weeks after the onset of symptoms, x-rays of the damaged area may look normal; not in this case….

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Plain radiographs of the same patient: acute phase (left) and two months after (right).