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Review of supplemental views and stress radiography in musculoskeletal trauma: lower extremity

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Abstract

The standard radiographic series is not always sufficient to diagnose and characterize subtle musculoskeletal injuries. Missed or delayed diagnoses can negatively affect patient acute morbidity and long-term outcomes. Similarly, management based on erroneous diagnoses may lead to unnecessary treatment and restrictions. Body-part- or joint-specific supplemental radiographic views and stress radiography offer an alternative for further evaluation of subtle injuries in specific clinical situations and may obviate the need for the added cost and potential ionizing radiation exposure of further cross-sectional imaging. Familiarity with these complementary exams allows radiologists to play an important role in patient care, as their utilization can improve diagnostic accuracy, clarify subtle or uncertain findings, and direct timely patient management. This review highlights important supplemental views and stress radiographic examinations useful in the evaluation of emergent lower extremity musculoskeletal trauma.

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References

  1. Khurana B, Sheehan SE, Sodickson AD, Weaver MJ (2014) Pelvic ring fractures: what the orthopedic surgeon wants to know. Radiographics 34:1317–1333

    Article  PubMed  Google Scholar 

  2. Campbell SE (2005) Radiography of the hip: lines, signs, and patterns of disease. Semin Roentgenol 40:290–319

    Article  PubMed  Google Scholar 

  3. Brandser EA, El-Khoury GY, Marsh JL (1995) Acetabular fractures: a systemic approach to classification. Emerg Radiol 2:18–28

    Article  Google Scholar 

  4. Durkee NJ, Jacobson J, Jamadar D, Karunakar MA, Morag Y, Hayes C (2006) Classification of common acetabular fractures: radiographic and CT appearances. Am J Roentgenol 187:915–925

    Article  Google Scholar 

  5. Garras DN, Carothers JT, Olson SA (2008) Single-leg-stance (flamingo) radiographs to assess pelvic instability: how much motion is normal? J Bone Joint Surg Am 90:2114–2118

    Article  PubMed  Google Scholar 

  6. James EW, Williams BT, LaPrade RF (2014) Stress radiography for the diagnosis of knee ligament injuries: a systematic review. Clin Orthop Relat Res 472:2644–2657

    Article  PubMed Central  PubMed  Google Scholar 

  7. Lafferty PM, Min W, Tejwani NC (2009) Stress radiographics in orthopaedic surgery. J Am Acad Orthop Surg 17:528–539

    PubMed  Google Scholar 

  8. Schulz MS, Steenlage ES, Russe K, Strobel MJ (2007) Distribution of posterior tibial displacement in knees with posterior cruciate ligament tears. J Bone Joint Surg Am 89:332–338

    Article  PubMed  Google Scholar 

  9. Sawant M, Narasimha MA, Ireland J (2004) Valgus knee injuries: evaluation and documentation using a simple technique of stress radiography. Knee 11:25–28

    Article  PubMed  Google Scholar 

  10. DiGiovanni BF, Partal G, Baumhauer JF (2004) Acute ankle injury and chronic lateral instability in the athlete. Clin Sports Med 23:1–19

    Article  PubMed  Google Scholar 

  11. Mansour R, Jibri Z, Kamath S, Mukherjee K, Ostlere S (2011) Persistent ankle pain following a sprain: a review of imaging. Emerg Radiol 18:211–225

    Article  PubMed  Google Scholar 

  12. Beynnon BD, Webb G, Huber BM, Pappas CN, Renström P, Haugh LD (2005) Radiographic measurement of anterior talar translation in the ankle: determination of the most reliable method. Clin Biomech 20:301–306

    Article  Google Scholar 

  13. Dowling LB, Giakoumis M, Ryan JD (2014) Narrowing the normal range for lateral ankle ligament stability with stress radiography. J Foot Ankle Surg 53:269–273

    Article  PubMed  Google Scholar 

  14. Rijke A, Jones B, Vierhout P (1986) Stress examination of traumatized lateral ligaments of the ankle. Clin Orthop Relat Res 9:143–151

    Google Scholar 

  15. Van den Bekerom MJ, Mutsaerts EL, Niek van Dijk C (2009) Evaluation of the integrity of the deltoid ligament in supination external rotation ankle fractures: a systematic review of the literature. Arch Orthop Trauma Surg 129:227–235

    Article  PubMed  Google Scholar 

  16. Michelson JD, Varner KE, Checcone M (2001) Diagnosing deltoid injury in ankle fracture: the gravity stress view. Clin Orthop Relat Res 387:178–182

    Article  PubMed  Google Scholar 

  17. Donovan A, Schweitzer ME (2012) Imaging musculoskeletal trauma interpretation and reporting. Wiley-Blackwell, Chichester

    Book  Google Scholar 

  18. Kaplan JD, Karlin JM, Scurran BL, Daly N (1991) Lisfranc’s fracture-dislocation: a review of the literature and case reports. J Am Podiatr Med Assoc 81:531–539

    Article  CAS  PubMed  Google Scholar 

  19. Potter HG, Deland JT, Gusmer PB, Carson E, Warren RF (1998) Magnetic resonance imaging of the Lisfranc ligament of the foot. Foot Ankle Int 19:438–446

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Michael V. Friedman.

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Friedman, M.V., Chris, S., Baker, J.C. et al. Review of supplemental views and stress radiography in musculoskeletal trauma: lower extremity. Emerg Radiol 22, 589–594 (2015). https://doi.org/10.1007/s10140-015-1315-8

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  • DOI: https://doi.org/10.1007/s10140-015-1315-8

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