About dynamic msk imaging modalities in the study of post-traumatic 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.
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.
About Mri and Ultrasound study of palmar fibromatosis of the hand.
This fibrosing hand disorder often leads to progressive and debilitating flexion contractures of the fingers. The diagnosis is made clinically but defining how much a fibrous nodule infiltrates a tendon is a keyelement in the diagnosis and treatment strategy, especially because recurrence after surgery is common.
For this reason I always perform both Mri and ultrasound examinations in my daily practice. Always.
Sagittal (left) and Axial (right) T2w Mri scans (0.3 Tesla); red arrows indicate the fibrous nodule and flexor tendons.
The video below demonstrates the nodule traction on the underlying flexor tendons, resulting in flexion contractures of the digits (Dupuytren contractures).
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.
It’s not easy to evaluate the hand anatomy after a major trauma; I wanto to share with you a post-surgical study of dyaphiseal fracture of a finger, suspected for an associated annular pulley injury. It is evident the degeneration picture of both flexors and extensor tendons near the site of fracture. The dynamic Mri with flexion-extension active movements, well depict the real extent of the degnerative changes, without associated annular pulley injuries. I find very useful the correlation between Ultrasound and Mri dynamic study, so I suggest to always perform both imagine modalities.
Sagittal ultrasound scan; it is evident the proximal phalanx fracture.
Sagittal T1w and Coronal Ge-Stir Mri scans after surgical reduction of 4th finger fracture