ARRS 2022 Abstracts

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E1219. Lower Extremity Fracture Diagnosis and Reporting: Beyond the Basics
Authors
  1. Cameron Overfield; Mayo Clinic
  2. Rupert Stanborough; Mayo Clinic
  3. Ronnie Sebro; Mayo Clinic
  4. Joseph Bestic; Mayo Clinic
  5. Jeffrey Peterson; Mayo Clinic
  6. Daniel Wessell; Mayo Clinic
  7. Hillary Garner; Mayo Clinic
Background
Acute fractures are one of the most common indications for musculoskeletal imaging in the United States. In general, multiview radiographs are usually sufficient for accurate diagnosis and treatment planning of many lower extremity fractures. When acute fractures demonstrate severe comminution, displacement, or associated joint dislocation or involve anatomic regions where there are adjacent at-risk soft tissue structures, advanced imaging with CT or MRI is indicated. Early detection of fracture complications can help reduce morbidity such as chronic pain and loss of function. The purpose of this exhibit is to provide a review on the imaging evaluation and comprehensive reporting of acute lower extremity fractures with both radiographs and advanced imaging.

Educational Goals / Teaching Points
After reviewing this educational exhibit, the reader will have a greater understanding of lower extremity anatomy, fracture mechanism and classification, and potential concomitant soft tissue injuries that could impact management. The reader will view radiographs of lower extremity fractures that have high risk of associated soft tissue injury and examples of comprehensive radiographic reports that address this risk. The corresponding advanced imaging study(ies) with associated comprehensive reporting will also be illustrated.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Accurate diagnosis and appropriate treatment planning for lower extremity fractures relies heavily on imaging. An understanding of fracture mechanisms and patterns and how the adjacent soft tissue anatomy may be impacted by the fracture is essential and should be reflected in the imaging report. For example, if a fracture-dislocation at the knee is present on radiographs, it is important to specifically comment on the associated risk of popliteal artery injury as well as nerve and ligamentous injuries and recommend advanced imaging, possibly with an angiographic technique. As another example, if there is a fracture of the talus noted radiographically, then it is valuable to specifically comment on the fracture pattern and to recommend urgent advanced imaging to better visualize the full extent of the fracture to help determine the risk for osteonecrosis. Communicating the potential complications related to certain fracture locations and fracture patterns will enhance the value of the radiologist to the health care team.

Conclusion
Knowledge of lower extremity fracture mechanisms and patterns and the potential impact on the vascular supply and other adjacent soft tissues is key for comprehensive reporting of imaging studies. Effective communication regarding the indications for advanced imaging and regarding the evaluation of at-risk structures can enhance patient care as well as the perceived value of radiologists on the care team.