J Korean Soc Radiol.  2012 Dec;67(6):473-481. 10.3348/jksr.2012.67.6.473.

Diagnostic Value of Multidetector Computed Tomography in Radial Head or Neck Fractures

• Cho HH
• Hwang JY
• Lee SW
• Shin SJ

• KMID: 2097984
• DOI: http://doi.org/10.3348/jksr.2012.67.6.473

Abstract

PURPOSE
To evaluate the diagnostic value of multidetector computed tomography (MDCT) in radial head or neck fracture, and to evaluate factors that affect MDCT image quality.
MATERIALS AND METHODS
Sixty-six radial fractures in 65 patients, who underwent both radiography and MDCT, were included. Detection of fracture and classification of types were recorded for each modality. Patients were divided into the good (A) and poor (B) image quality groups, and recorded the factors, such as arm positioning, flexion angle, and cancellous bone density.
RESULTS
The detection rate of fracture showed no significant difference between the two modalities. However, classification of the fracture type was significantly accurate by MDCT (p < 0.0001). Eight cases were only detected on MDCT and three cases were only detected on radiography. Fracture type was discordant in 11 cases. MDCT scanning with raising arm (p < 0.0001), with lesser flexion angle (p = 0.004), and higher cancellous bone density (p = 0.010) showed better image quality.
CONCLUSION
Radiography is a good primary tool for detecting radial head or neck fracture. However, MDCT can be an additional tool for classifying the fracture type and cases with negative radiographic findings. Arm positioning, flexion angle, and cancellous bone density affect MDCT image quality.

MeSH Terms

Arm
Bone Density
Head
Humans
Multidetector Computed Tomography
Neck
Radius

Figure

• 

  Fig. 1 Type III radial fracture in 38-year-old man. On lateral (A) and external oblique (B) views, fracture with 2.5 mm displacement is noted (arrow), diagnosed as Type II fracture. On sagittal (C) and axial (D) planes of multidetector computed tomography, another fracture line (arrowhead) is seen with displacement, diagnosed as Type III fracture. Articular depression is better depicted on sagittal plane (C) than axial plane (D).

• 

  Fig. 2 Type III radial fracture in 28-year-old man (Group A). The fracture lines are clearly noted on axial (A), sagittal (B), coronal (C) planes and volume rendering technique image (D). In this case, patient positioned with raising his arm, flexion angle of elbow joint was 30° and cancellous bone density of radius was measured about 360 Hounsfield unit.

• 

  Fig. 3 Type I radial fracture in 56-year-old woman (Group B). The fracture lines are not seen on axial (A), sagittal (B) and coronal (C) planes. Volume rendering technique image (D) is non-diagnostic due to disturbance artifacts. In this case, patient was positioned with lowering her arm, with flexion angle about 70° and cancellous bone density was lower than 200 HU. Fracture line at the radial head was detected on anterior posterior view of radiography (E).

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