about dynamic cone-beam ct imaging of TFCC wrist injury
It’s always difficult to combine clinical aspects and diagnostic imaging, approaching wrist joint pathology; in many circumstances the orthopaedic surgeon needs to directly visualize what’s happened during the joint motion, especially in a complex region such as the wrist.
I show you an example in which a complex tear of the triangular fibrocartilage complex (TFCC) is evident, togheter with a positive ulnar variance. TFCC is a complex of a fibrocartilaginous disk in association with several ligamentous structures, acting as a stabilizers of the distal radioulnar joint, and transmitting axial loading from carpus to the ulna.
Coronal T1w (left) and 3D SHARC (right) Mri scans (0.3 Tesla).
The dedicated Mri examination (0.3 Tesla), depicts the pathologic picture; the ulnar plus defines the reduction of the quadrilateral ulno-carpal space, and the consequent complex tear of the TFCC at its ulnar attachment; but what happens during the active movements? I usually perform also the dynamic evaluation, both with ultrasound and Mri exams. In this case the Cone-beam CT (CBCT) dynamic acquisitions give the answer.
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.
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.
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.