Abstract
Musculoskeletal disorders are a common presenting reason for emergency department patients. A wide range of musculoskeletal pathologies are commonly encountered by emergency physicians and related clinicians, and by radiologists, including traumatic, infectious, inflammatory, and tumor-related emergencies. This chapter will review common potential errors in trauma radiology, including frequently missed fractures, as well as conditions which are radiographically occult, for which the radiologist should recommend a complementary imaging examination to confirm or refute a diagnosis.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Florschutz AV, Langford JR, Haidukewych GJ, Koval KJ. Femoral neck fractures: current management. J Orthop Trauma. 2015;29:121–9.
Sheehan SE, Shyu JY, Weaver MJ, Sodickson AD, Khurana B. Proximal femoral fractures: what the orthopedic surgeon wants to know. Radiographics. 2015;5:1563–84.
Parker MJ. Missed hip fractures. Arch Emerg Med. 1992;9:23–7.
Ha AS, Porrino JA, Chew FS. Radiographic pitfalls in lower extremity trauma. Am J Roentgenol. 2014;203:492–500.
Kirby MW, Spritzer C. Radiographic detection of hip and pelvic fractures in the emergency department. Am J Roentgenol. 2010;194:1054–60.
Deutsch AL, Mink JH, Waxman AD. Occult fractures of the proximal femur: MR imaging. Radiology. 1989;170:113–6.
Ward RJ, Weissman BN, Kransdorf MJ, et al. ACR appropriateness criteria acute hip pain-suspected fracture. J Am Coll Radiol. 2014;11:114–20.
Mlinek EJ, Clark KC, Walker CW. Limited magnetic resonance imaging in the diagnosis of occult hip fractures. Am J Emerg Med. 1998;16:390–2.
Khurana B, Okanobo H, Ossiani M, Ledbetter S, Al Dulaimy K, Sodickson A. Abbreviated MRI for patients presenting to the emergency department with hip pain. Am J Roentgenol. 2012;198:W581–8.
Hakkarinen DK, Banh KV, Hendey GW. Magnetic resonance imaging identifies occult hip fractures missed by 64-slice computed tomography. J Emerg Med. 2012;43:303–7.
Mandell JC, Weaver MJ, Khurana B. Computed tomography for occult fractures of the proximal femur, pelvis, and sacrum in clinical practice: single institution, dual-site experience. Emerg Radiol. 2018;25:265–73.
Feldman F, Staron RB. MRI of seemingly isolated greater trochanteric fractures. Am J Roentgenol. 2004;183:323–9.
LaLonde B, Fenton P, Campbell A, Wilson P, Yen D. Immediate weight-bearing in suspected isolated greater trochanter fractures as delineated on MRI. Iowa Orthop J. 2010;30:201–4.
Matcuk GR, Mahanty SR, Skalski MR, Patel DB, White EA, Gottsegen CJ. Stress fractures: pathophysiology, clinical presentation, imaging features, and treatment options. Emerg Radiol. 2016;23:365–75.
Pierce JL, McCrum EC, Rozas AK, Hrelic DM, Anderson MW. Tip-of-the-iceberg fractures: small fractures that mean big trouble. Am J Roentgenol. 2015;205:524–32.
Jarraya M, Diaz LE, Arndt WF, Roemer FW, Guermazi A. Imaging of patellar fractures. Insights Imaging. 2017;8:49–57.
Ostlere S. The extensor mechanism of the knee. Radiol Clin N Am. 2013;51:391–411.
Badillo K, Pacheco JA, Padua SO, Gomez AA, Colon E, Vidal JA. Radiographics. 2011;31:81–92.
Friedman MV, Chris S, Baker JC, Hillen TJ. Review of supplemental views and stress radiography in musculoskeletal trauma: lower extremity. Emerg Radiol. 2015;22:589–94.
Walter WR, Hirschmann A, Garwood ER, Rosenberg ZS. MRI evaluation of midtarsal (Chopart) sprain in the setting of acute ankle injury. Am J Roentgenol. 2018;210:386–95.
Kalia V, Fishman EK, Carrino JA, Fayad LM. Epidemiology, imaging, and treatment of Lisfranc fracture-dislocations revisited. Skelet Radiol. 2012;41:129–36.
Garretson RB, Williams GR. Clinical evaluation of injuries to the acromioclavicular and sternoclavicular joints. Clin Sport Med. 2003;22:239–54.
Morell DJ, Thyagarajan DS. Sternoclavicular joint dislocation and its management: a review of the literature. World J Orthop. 2016;7:244.
Salgado RA, Ghysen D. Post-traumatic posterior sternoclavicular dislocation: case report and review of the literature. Emerg Radiol. 2002;9:323–5.
Restrepo CS, Martinez S, Lemos DF, et al. Imaging appearances of the sternum and sternoclavicular joints. Radiographics. 2009;29:839–59.
Friedman MV, Smith C, Hillen TJ, Baker JC. Review of supplemental views and stress radiography in musculoskeletal trauma: upper extremity. Emerg Radiol. 2015;22:583–8.
Rockwood CA. Dislocations of the sternoclavicular joint. In: Evans E, editor. American academy of orthopaedic surgeons instructional course lectures: volume XXIV. St. Louis, MO: CV Mosby; 1975. p. 144–59.
Mazzocca AD, Arciero RA, Bicos J. Evaluation and treatment of acromioclavicular joint injuries. Am J Sports Med. 2007;35:316–29.
Rockwood CA, Williams GR, Young DC. Acromioclavicular injuries. In: Rockwood CA, Green DP, Bucholz RW, Heckman JD, editors. Fractures in adults, 4th ed., vol. I. Philadelphia, PA: Lippincott-Raven; 1996. p. 1341–413.
Lafferty PM, Min W, Tejwani NC. Stress radiographics in orthopaedic surgery. J Am Acad Orthop Surg. 2009;17:528–39.
Kim AC, Matcuk G, Patel D, Itamura J, Forrester D, White E, Gottsegen CJ. Acromioclavicular joint injuries and reconstructions: a review of expected imaging findings and potential complications. Emerg Radiol. 2012;19:399–413.
Marinček B, Dondelinger RF. Emergency radiology, imaging and intervention. Berlin: Springer Verlag; 2007. p. 254–6.
Sheehan SE, Gaviola G, Gordon R, Sacks A, Shi LL, Smith SE. Traumatic shoulder injuries: a force mechanism analysis–glenohumeral dislocation and instability. Am J Roentgenol. 2013;201:378–93.
Kralinger FS, Golser K, Wischatta R, Wambacher M, Sperner G. Predicting recurrence after primary anterior shoulder dislocation. Am J Sports Med. 2002;30:116–20.
Rozing PM, De Bakker HM, Obermann WR. Radiographic views in recurrent anterior shoulder dislocation. Comparison of six methods for identification of typical lesions. Acta Orthop Scand. 1986;57:328–30.
Sandstrom CK, Kennedy SA, Gross JA. Acute shoulder trauma: what the surgeon wants to know. Radiographics. 2015;35:475–92.
Hawkins RJ, Neer CS 2nd, Pianta RM, Mendoza FX. Locked posterior dislocation of the shoulder. J Bone Joint Surg Am. 1987;69(1):9–18.
Cisternino SJ, Rogers LF, Stufflebam BC, Kruglik GD. The trough line: a radiographic sign of posterior shoulder dislocation. Am J Roentgenol. 1978;130:951–4.
Cole PA, Freeman G, Dubin JR. Scapula fractures. Curr Rev Musculoskelet Med. 2013;6:79–87.
Baldwin KD, Ohman-Strickland P, Mehta S, Hume E. Scapula fractures: a marker for concomitant injury? A retrospective review of data in the National Trauma Database. J Trauma. 2008;65:430–5.
Ropp AM, Davis DL. Scapular fractures: what radiologists need to know. Am J Roentgenol. 2015;205:491–501.
Herrera DA, Anavian J, Tarkin IS, Armitage BA, Schroder LK, Cole PA. Delayed operative management of fractures of the scapula. J Bone Joint Surg Br. 2009;91:619–26.
Gyftopoulos S, Chitkara M, Bencardino JT. Misses and errors in upper extremity trauma radiographs. Am J Roentgenol. 2014;203:477–91.
Tadros AM, Lunsjo K, Czechowski J, Corr P, Abu-Zidan FM. Usefulness of different imaging modalities in the assessment of scapular fractures caused by blunt trauma. Acta Radiol. 2007;48:71–5.
Goss TP, Owens BD. Fractures of the scapula. In: Rockwood Jr CA, Matsen III FA, Wirth MA, Lippitt SB, editors. The shoulder. 4th ed. Philadelphia, PA: Saunders Elsevier; 2009. p. 333–5.
Ideberg R, Grevsten S, Larsson S. Epidemiology of scapular fractures: incidence and classification of 338 fractures. Acta Orthop Scand. 1995;66:395–7.
Nork SE, Barei DP, Gardner MJ, Schildhauer TA, Mayo KA, Benirschke SK. Surgical exposure and fixation of displaced type IV, V, and VI glenoid fractures. J Orthop Trauma. 2008;22:487–93.
Nordqvist A, Petersson C. Fracture of the body, neck, or spine of the scapula: a long-term follow-up study. Clin Orthop Relat Res. 1992;283:139–44.
Ogawa K, Matsumura N, Ikegami H. Coracoid fractures: therapeutic strategy and surgical outcomes. J Trauma Acute Care Surg. 2012;72:E20–6.
Eyres KS, Brooks A, Stanley D. Fractures of the coracoid process. J Bone Joint Surg Br. 1995;77:425–8.
Ogawa K, Naniwa T. Fractures of the acromion and the lateral scapular spine. J Shoulder Elb Surg. 1997;6:544–8.
Kuhn JE, Blasier RB, Carpenter JE. Fractures of the acromion process: a proposed classification system. J Orthop Trauma. 1994;8:6–13.
Ogawa K, Yoshida A, Ikegami H. Isolated fractures of the greater tuberosity of the humerus: solutions to recognizing a frequently overlooked fracture. J Trauma. 2003;54:713–7.
Mattyasovszky SG, Burkhart KJ, Ahlers C, et al. Isolated fractures of the greater tuberosity of the proximal humerus: a long-term retrospective study of 30 patients. Acta Orthop. 2011;82:714–20.
Pitts SR, Niska RW, Xu J, Burt CW. National Hospital Ambulatory Medical Care Survey: 2006 emergency department summary. Natl Health Stat Report. 2008;7:1–38.
Struijs PA, Smit G, Steller EP. Radial head fractures: effectiveness of conservative treatment versus surgical intervention. A systematic review. Arch Orthop Trauma Surg. 2007;127:125–30.
Greenspan A, Norman A, Rosen H. Radial head-capitellum view in elbow trauma: clinical application and radiographic-anatomic correlation. Am J Roentgenol. 1984;143:355–9.
Doornberg JN, Ring D. Coronoid fracture patterns. J Hand Surg Am. 2006;31:45–52.
Bobyns JH, Linscheid RL. Fractures and dislocations of the wrist. In: Rockwood Jr CA, Green DP, editors. Fractures in adults. 3rd ed. Philadelphia, PA: Lippincott; 1984. p. 411–509.
Gelberman RH, Wolock BS, Siegel DB. Fractures and non-unions of the carpal scaphoid. J Bone Joint Surg Am. 1989;71:1560–5.
Bryan RS, Dobyns JH. Fractures of the carpal bones other than lunate and navicular. Clin Orthop Relat Res. 1980;149:107–11.
Cohen MS. Fractures of the carpal bones. Hand Clin. 1997;13:587–99.
Bain GI, McLean JM, Turner PC, Sood A, Pourgiezis N. Translunate fracture with associated perilunate injury: 3 case reports with introduction of the translunate arc concept. J Hand Surg Am. 2008;33:1770–6.
Mayfield JK. Mechanism of carpal injuries. Clin Orthop. 1980;149:45–54.
Mayfield JK. Patterns of injury to carpal ligaments. Clin Orthop. 1984;187:36–42.
Mayfield JK, Johnson RP, Kilcoyne RK. Carpal dislocations: pathomechanics and progressive perilunar instability. J Hand Surg Am. 1980;5:226–41.
Kitay A, Wolfe SW. Scapholunate instability: current concepts in diagnosis and management. J Hand Surg Am. 2012;37:2175–96.
Turecki MB, Taljanovic MS, Stubbs AY, et al. Imaging of musculoskeletal soft tissue infections. Skelet Radiol. 2010;39:957–71.
Rahmouni A, Chosidow O, Mathieu D, et al. MR imaging in acute infectious cellulitis. Radiology. 1994;192:493–6.
Schmid MR, Kossmann T, Duewell S. Differentiation of necrotizing fasciitis and cellulitis using MR imaging. Am J Roentgenol. 1998;170:615–20.
Loyer EM, DuBrow RA, David CL, et al. Imaging of superficial soft-tissue infections: Sonographic findings in cases of cellulitis and abscess. Am J Roentgenol. 1996;166:149–52.
Waldvogel FA, Medoff G, Swartz MN. Osteomyelitis: a review of clinical features, therapeutic considerations and unusual aspects. N Engl J Med. 1970;282:198–206.
Wheat J. Diagnostic strategies in osteomyelitis. Am J Med. 1985;78:218–24.
Baker JC, Hillen TJ, Demertzis JL. The role of imaging in musculoskeletal emergencies. Semin Roentgenol. 2014;49:169–85.
Morrison WB, Schweitzer ME, Bock GW, et al. Diagnosis of osteomyelitis: utility of fat suppressed contrast-enhanced MR imaging. Radiology. 1993;189:251–7.
Craig JG, Amin MB, Wu K, et al. Osteomyelitis of the diabetic foor: MR imaging-pathologic correlation. Radiology. 1993;203:849–55.
Torralba KD, Quismorio FP. Soft tissue infections. Rheum Dis Clin N Am. 2009;35:45–62.
Voros D, Pissiotis C, Georgantas D, et al. Role of early and extensive surgery in the treatment of severe necrotizing soft tissue infections. Br J Surg. 1993;80:1190–1.
Kim KT, Kim YJ, Won Lee J, et al. Can necrotizing infectious fasciitis be differentiated from nonnecrotizing infectious fasciitis with MR imaging? Radiology. 2011;259:816–24.
Fugitt JB, Puckett ML, Quigley MM, et al. Necrotizing fasciitis. Radiographics. 2004;24:1472–6.
Learch TJ, Farooki S. Magnetic resonance imaging of septic arthritis. Clin Imaging. 2000;24:236–42.
Karchevsky M, Schweitzer ME, Morrison WB, et al. MRI findings of septic arthritis and associated osteomyelitis in adults. Am J Roentgenol. 2004;182:119–22.
Elliott KG, Johnstone AJ. Diagnosing acute compartment syndrome. J Bone Joint Surg Br. 2003;85:625–32.
Olson SA, Glasgow RR. Acute compartment syndrome in lower extremity musculoskeletal trauma. J Am Acad Orthop Surg. 2005;13:436–44.
Shadgan B, Menon M, O'Brien PJ, Reid WD. Diagnostic techniques in acute compartment syndrome of the leg. J Orthop Trauma. 2008;22:581–7.
Patel RV, Haddad FS. Compartment syndromes. Br J Hosp Med (Lond). 2005;66:583–6.
Mubarak SJ, Hargens AR. Acute compartment syndromes. Surg Clin North Am. 1983;63:539–65.
May DA, Disler DG, Jones EA, et al. Abnormal signal intensity in skeletal muscle at MR imaging: patterns, pearls, and pitfalls. Radiographics. 2000;20:S295–315.
Baker JC, Demertzis JD, Rhodes NG, et al. Diabetic musculoskeletal complications their imaging mimics. Radiographics. 2012;32:1959–74.
Schlager D. Ultrasound detection of foreign bodies and procedure guidance. Emerg Med Clin North Am. 1997;15:895–912.
Blankenship RB, Baker T. Imaging modalities in wounds and superficial skin infections. Emerg Med Clin North Am. 2007;25:223–34.
Jacobson JA, Powell A, Craig JG, et al. Wooden foreign bodies in soft tissue: detection at US. Radiology. 1998;206:45–8.
Young AS, Shiels WE II, Murakami JW, et al. Self-embedding behavior: radiologic management of self-inserted soft-tissue foreign bodies. Radiology. 2010;257:233–9.
Mirels H. Metastatic disease in long bones: a proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop Relat Res. 1989;249:256–64.
Jawad MU, Scully SP. In brief: classifications in brief: Mirels’ classification: metastatic disease in long bones and impending pathologic fracture. Clin Orthop Relat Res. 2010;468:2825–7.
Damron TA, Morgan H, Prakash D, et al. Critical evaluation of Mirels’ rating system for impending pathologic fractures. Clin Orthop Relat Res. 2003;415(suppl):S201–7.
Kompel A, Murakami A, Guermazi A. Magnetic resonance imaging of nontraumatic musculoskeletal emergencies. Magn Reson Imaging Clin N Am. 2016;24:369–89.
Daffner RH. Stress fractures: current concepts. Skelet Radiol. 1978;2:221–9.
Porrino JA, Kohl CA, Taljanovic M, et al. Diagnosis of proximal femoral insufficiency fractures in patients receiving bisphosphonate therapy. Am J Roentgenol. 2010;194:1061–4.
Umans HR, Kaye JJ. Longitudinal stress fractures of the tibia: diagnosis by magnetic resonance imaging. Skelet Radiol. 1996;25:319–24.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Hillen, T.J., Friedman, M.V., Baker, J.C. (2019). Errors in Acute Musculoskeletal Imaging. In: Patlas, M., Katz, D., Scaglione, M. (eds) Errors in Emergency and Trauma Radiology. Springer, Cham. https://doi.org/10.1007/978-3-030-05548-6_9
Download citation
DOI: https://doi.org/10.1007/978-3-030-05548-6_9
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-05547-9
Online ISBN: 978-3-030-05548-6
eBook Packages: MedicineMedicine (R0)