Preliminary Diagnosis: Fractures

I. What imaging technique is first-line for this diagnosis?

Plain radiography.

II. Describe the advantages and disadvantages of this technique for diagnosing fractures.

Advantages

  • Diagnostic of fractures when radiologically evident step-off disruption of the cortex (cortices) is noted.

  • Quick imaging procedure.

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  • Requires minimal patient cooperation.

  • Low cost procedure.

  • Readily available.

Disadvantages

  • Difficult to evaluate for occult fracture or marrow trabecular fractures (microfractures).

  • Exposure to ionizing radiation.

III. What are the contraindications for the first-line imaging technique?

Contraindicated in pregnant women, especially during the first two trimesters. In an acute setting, the procedure may be considered if treatment of the fracture is an emergency.

IV. What alternative imaging techniques are available?

  • CT scan without IV contrast.

  • MR scan without IV contrast.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing fractures.

CT scan without IV contrast
Advantages

  • More sensitive than radiographs in the detection of fractures.

  • Can easily identify the quality and complexity of fractures, including displacement, fragmentation, and angulation.

Disadvantages

  • Exposure to large amounts of ionizing radiation.

  • More expensive than plain radiography.

MR scan without IV contrast
Advantages

  • Sensitive for very subtle non-displaced fractures (occult fractures, some stress-type fractures).

  • Can also identify fractures in markedly osteopenic or osteoporotic patients.

Disadvantages

  • Time consuming.

  • Requires significant patient cooperation to limit motion artifact.

  • Expensive.

  • Claustrophobic patients may require sedation.

VI. What are the contraindications for the alternative imaging techniques?

CT scan without IV contrast

Contraindicated in pregnant women, especially during the first two trimesters. In an acute setting, the procedure may be considered if treatment of the fracture is an emergency.

MR scan without IV contrast

Contraindicated in patients with non-MR compatible metallic hardware or foreign bodies.

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