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.
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.
Two months after a peroneal fracture the x-rays show a regular healing but the patient feels pain: why?
I suggest you to always use both ultrasound and Mri imaging to better evaluate the correct healing of the fracture.
In this professional football player is also evident a gross perilesional edema involving the peroneal muscles togheter with the peroneal neurovascular bundle.
Axial T2w (left) and Stir (right) mri sequences of the same patient (0.3 Tesla).
Sagittal Stir (left) and T2w (right) Mri sequences (0.3 Tesla); the perilesional edema along the course of peroneal neurovascular bundle is evident.
The dynamic ultrasound exam allows to better appreciate all the structures involved in this pathological picture; just a little reminder: high sensibility but 0% specificity of the ultrasound imaging in the study of cortical bone.