Top

Published in:

01-10-2017 | Musculoskeletal

Systematic evaluation of concomitant extensor tendon sheath injury in patients with distal intra-articular radial fractures in MDCT using the floating fat sign

Published in: European Radiology | Issue 10/2017

Abstract

Objectives

We aimed to evaluate the involvement of extensor tendon sheaths in a large MDCT study group of patients with distal intra-articular radial fractures using the floating fat sign.

Methods

603 MDCT scans of patients with acute intra-articular distal radial fractures (Frykman III-VIII) acquired between January 2005 and October 2011 were analysed in consensus by two radiologists. The extensor tendon sheath involvement was assessed for each extensor tendon compartment and visually graded from 0 to 2 based on the amount of fat-fluid levels.

Results

Extensor tendon sheath involvement with fat-fluid levels was observed in 71.0% of the distal radial fractures, mainly in the second or third compartment. The frequency and degree of tendon sheath involvement was not related to the fracture severity. There was no statistically significant difference in the frequency of tendon effusion between the CT scans acquired before or after closed reduction.

Conclusion

Traumatic rupture of the extensor tendon sheaths with concomitant fatty effusion is a common finding in patients with distal intra-articular radial fractures.

Key points

• Fat effusions in tendon sheaths are frequent in distal intra-articular radial fractures.

• Fat effusions in tendon sheaths are caused by traumatic bone marrow spilling.

• Effusions typically involve the second and third compartment simultaneously.

Kennedy SA, Hanel DP (2013) Complex distal radius fractures. Orthopedic Clin North Am 44:81–92CrossRef

Frank J, Pralle H, Lehnert M, Marzi I (2010) Concomitant injuries of distal radius fractures. Unfallchirurg 113(10):796–803CrossRefPubMed

Katz MA, Beredjiklian PK, Bozentka DJ, Steinberg DR (2001) Computed tomography scanning of intra-articular distal radius fractures: does it influence treatment? J Hand Surg [Am] 26:415–421CrossRef

Schneppendahl J, Windolf J, Kaufmann RA (2012) Distal radius fractures: current concepts. J Hand Surg [Am] 37:1718–1725CrossRef

Spence LD, Savenor A, Nwachuku I, Tilsley J, Eustace S (1997) MRI of fractures of the distal radius: comparison with conventional radiographs. Skeletal Radiol 27:244–249CrossRef

Chang CH, Tsai YS, Sun JS, Hou SM (2000) Ipsilateral distal radius and scaphoid fractures. J Formos Med Assoc 99:733–737PubMed

Iwamoto A, Morris RP, Andersen C, Patterson RM, Viegas SF (2006) An anatomic and biomechanic study of the wrist extensor retinaculum septa and tendon compartments. J Hand Surg [Am] 31:896–903CrossRef

Helal B, Chen SC, Iwegbu G (1982) Rupture of the extensor pollicis longus tendon in undisplaced Colles' type of fracture. Hand 14:41–47CrossRefPubMed

Owers KL, Lee J, Khan N, Healy J, Eckersley R (2007) Ultrasound changes in the extensor pollicis longus tendon following fractures of the distal radius--a preliminary report. J Hand Surg Eur 32(4):467–471CrossRef

10.

Ansede G, Healy J, Lee J (2009) Extensor pollicis longus tendon rupture following avulsion fracture of the third metacarpal. Skeletal Radiol 38:81–84CrossRefPubMed

11.

Strandell G (1955) Post-traumatic rupture of the extensor pollicis longus tendon--pathogenesis and treatment; survey based on 208 cases, including 14 personal cases. Acta Chir Scand 109(2):81–96PubMed

12.

Le Corroller T, Parratte S, Zink J-V, Argenson J-N, Champsaur P (2010) Floating fat in the wrist joint and in the tendon sheaths. Skeletal Radiol 39:931–933CrossRefPubMed

13.

McConnell M, Cohen H, Scuderi M (2013) Non-displaced distal radius fracture with fat-fluid levels in the adjacent extensor tendon sheaths on MRI. Skeletal Radiol 42:1761–1765CrossRefPubMed

14.

Ali S, Huebner S, Groshek F, Schaffer A (2014) The floating fat sign of trauma. Can Assoc Radiol J 65:106–112CrossRefPubMed

15.

Mandziak DG, Watts AC, Bain GI (2011) Ligament contribution to patterns of articular fractures of the distal radius. J Hand Surg [Am] 36:1621–1625CrossRef

16.

Tanabe K, Nakajima T, Sogo E, Denno K, Horiki M, Nakagawa R (2011) Intra-articular fractures of the distal radius evaluated by computed tomography. J Hand Surg [Am] 36:1798–1803CrossRef

17.

Cvitanic OA, Henzie GM, Adham M (2007) Communicating foramen between the tendon sheaths of the extensor carpi radialis brevis and extensor pollicis longus muscles: imaging of cadavers and patients. AJR Am J Roentgenol 189:1190–1197CrossRefPubMed

18.

Kural C, Sungur I, Kaya I, Ugras A, Ertürk A, Cetinus E (2010) Evaluation of the reliability of classification systems used for distal radius fractures. Orthopedics 33:801PubMed

19.

Küçük L, Kumbaracı M, Günay H, Karapınar L, Ozdemir O (2013) Reliability and reproducibility of classifications for distal radius fractures. Acta Orthop Traumatol Turc 47:153–157CrossRefPubMed

20.

Jacob D, Cohen M, Bianchi S (2007) Ultrasound imaging of non-traumatic lesions of wrist and hand tendons. Eur Radiol 17:2237–2247CrossRefPubMed

21.

Lee JC, Healy JC (2005) Normal sonographic anatomy of the wrist and hand. Radiographics 25:1577–1590CrossRefPubMed

Title: Systematic evaluation of concomitant extensor tendon sheath injury in patients with distal intra-articular radial fractures in MDCT using the floating fat sign
Publication date: 01-10-2017
Published in: European Radiology / Issue 10/2017
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-017-4787-y

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Systematic evaluation of concomitant extensor tendon sheath injury in patients with distal intra-articular radial fractures in MDCT using the floating fat sign

Abstract

Objectives

Methods

Results

Conclusion

Key points

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Key points

Please log in to get access to this content

Other articles of this Issue 10/2017

Follow-up assessment of coiled intracranial aneurysms using zTE MRA as compared with TOF MRA: a preliminary image quality study

FLAIR* to visualize veins in white matter lesions: A new tool for the diagnosis of multiple sclerosis?

Myocardial segmentation based on coronary anatomy using coronary computed tomography angiography: Development and validation in a pig model

Diagnostic accuracy of magnetic resonance imaging techniques for treatment response evaluation in patients with high-grade glioma, a systematic review and meta-analysis

Patient dose in interventional radiology: a multicentre study of the most frequent procedures in France

Bacterial contamination of ultrasound probes in different radiological institutions before and after specific hygiene training: do we have a general hygienical problem?