Dynamic MSK Imaging of Metacarpal Fracture

About dynamic msk imaging modalities in the study of post-traumatic metacarpal fracture

4th metacarpal fracture

Acute 4th metacarpal spiroid fracture of a professional football goalkeeper; first diagnosis was made directly on pitch with an ultrasound examination. Plain radiographs and Mri exam were performed just one hour after trauma.

One month after surgical fixation the fracture is studied with dynamic US, Mri and Cone-Beam CT imaging. The US and MR dynamic evaluations, show a regular tendon sliding over the fixation devices.

No metal-induced artifacts were seen, allowing a perfect visualization of the implanted devices.

CBCT Reconstruction

Cone-Beam CT Sagittal (left) and Coronal (right) reconstructions.

The study was completed with dynamic Mri (0.3 Tesla) and Cone-Beam CT scans, performed with active flexion-extension of carpal-metacarpal joint structures.

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Ulnar Nerve Synovial Impingement

about dynamic ultrasound findings of ulnar nerve synovial impingement

This is the case of a patient suffering for a post-traumatic olecranon bursitis with ulnar nerve entrapment symptoms, one month after an elbow contusion.

A standard plain radiograph was made immediatly after trauma, showing a small bony fragment of the olecranon cortical surface.

Elbow

Olecranon Bursitis

Sagittal T2w (left) and Axial T2w (right) Mri scans (0.3 Tesla).

The Mri exam shows a gross olecranon bursitis, but the inflammatory process involving the ulnar nerve is better appreciated with the dynamic ultrasound examination.

My suggestion is always tha same… Mri and Ultrasound exams complement each other succesfully, so use both togheter in your daily practice.

Calcaneofibular Ligament Injury

There is usually a predictable kinematic pattern of injury involving the anterior talofibular ligament followed by the calcaneofibular ligament; don’t forget that finding a complete rupture of the calcaneofibular ligament means that also the anterior talofibular ligament must be injured.

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Coronal (left) and Axial (right) T2 weighted Mri scans (0.3 Tesla) demonstrate a complete rupture of the calcaneofibular ligament.

The ultrasound imaging needs an accurate dynamic evaluation to demonstrate the injured ligament.

In this young professional football player both the anterior talofibular and calcaneofibular ligaments are completely torn.

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Coronal (left) and Axial (right) T2 weighted Mri scans of the same patient: a complete rupture of the ATFL is evident.

The ultrasound dynamic investigation well defines the high degree injury of the ligament.