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Darwich A, Nörenberg D, Adam J, Hetjens S, Schilder A, Obertacke U, Gravius S, Jawhar A. A Multi-Disciplinary MRI Assessment May Optimize the Evaluation of Chondral Lesions in Acute Ankle Fractures: A Prospective Study. Diagnostics (Basel) 2023; 13:3220. [PMID: 37892043 PMCID: PMC10605548 DOI: 10.3390/diagnostics13203220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
Chondral lesions (CL) in the ankle following acute fractures are frequently overlooked immediately after the injury or diagnosed at a later stage, leading to persistent symptoms despite successful surgery. The literature presents a wide range of discrepancies in the reported incidence of CLs in acute ankle fractures. The objective of this prospective study is to provide a precise assessment of the occurrence of chondral lesions (CLs) in acute ankle fractures through MRI scans conducted immediately after the trauma and prior to scheduled surgery. Furthermore, the study aims to highlight the disparities in the interpretation of these MRI scans, particularly concerning the size and extent of chondral damage, between radiologists and orthopedic surgeons. Over the period of three years, all patients presenting with an unstable ankle fracture that underwent operative treatment were consecutively included in this single-center prospective study. Preoperative MRIs were obtained for all included patients within 10 days of the trauma and were evaluated by a trauma surgeon and a radiologist specialized in musculoskeletal MRI blinded to each other's results. The location of the lesions was documented, as well as their size and ICRS classification. Correlations and kappa coefficients as well as the p-values were calculated. A total of 65 patients were included, with a mean age of 41 years. The evaluation of the orthopedic surgeon showed CLs in 52.3% of patients. CLs occurred mainly on the tibial articular surface (70.6%). Most talar lesions were located laterally (11.2%). The observed CLs were mainly ICRS grade 4. According to the radiologist, 69.2% of the patients presented with CLs. The most common location was the talar dome (48.9%), especially laterally. Most detected CLs were graded ICRS 3a. The correlation between the two observers was weak/fair regarding the detection and classification of CLs and moderate regarding the size of the detected CLs. To enhance the planning of surgical treatment for ankle chondral lesions (CLs), it may be beneficial to conduct an interdisciplinary preoperative assessment of the performed scans. This collaborative approach can optimize the evaluation of ankle CLs and improve overall treatment strategies.
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Affiliation(s)
- Ali Darwich
- Department of Orthopedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany; (J.A.); (A.S.); (U.O.); (S.G.); (A.J.)
| | - Dominik Nörenberg
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany;
| | - Julia Adam
- Department of Orthopedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany; (J.A.); (A.S.); (U.O.); (S.G.); (A.J.)
| | - Svetlana Hetjens
- Institute of Medical Statistics and Biomathematics, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany;
| | - Andreas Schilder
- Department of Orthopedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany; (J.A.); (A.S.); (U.O.); (S.G.); (A.J.)
| | - Udo Obertacke
- Department of Orthopedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany; (J.A.); (A.S.); (U.O.); (S.G.); (A.J.)
| | - Sascha Gravius
- Department of Orthopedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany; (J.A.); (A.S.); (U.O.); (S.G.); (A.J.)
| | - Ahmed Jawhar
- Department of Orthopedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany; (J.A.); (A.S.); (U.O.); (S.G.); (A.J.)
- Department of Orthopedics, Traumatology and Sports Medicine, Marienhaus Hospital Hetzelstift/Teaching Hospital University Mainz, Stiftstraße 10, 67434 Neustadt an der Weinstraße, Germany
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Stevens BJ. Radiograph report style preferences of referrers at a district general hospital in the West Midlands, England, UK. Radiography (Lond) 2021; 28:296-303. [PMID: 34674945 DOI: 10.1016/j.radi.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/21/2021] [Accepted: 10/02/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Many articles and guidelines have been published proposing suggestions for the optimal radiology report style; it is likely that different referrers will prefer different styles owing to a number of clinical variables. The aim of this study is to assess the x-ray report style preferences of referrers at a district general hospital. METHOD This electronic survey study used convenience sampling. An email invitation was sent to all referrers who had requested imaging examinations in the six months prior to the study start date. Participants were asked their opinions on the inclusion of recommendations and advice and to indicate their preferences of mock reports with combinations of the following; short/long, in-depth/brief and paragraph/bullet points. Manual analysis was undertaken in Excel. RESULTS There were 114 participants from the identified population of 356, giving a response rate of 32%. Nearly all participants find the inclusion of recommendations and advice to be useful (n = 109, 96%). Seventy-nine participants (69.3%) request skeletal x-ray examinations, and 100 (87.7%) request chest x-ray examinations. More than half of skeletal referrers (n = 42, 53.2%) and the majority of chest referrers (n = 45, 45%) prefer reports with short sentences, brief, bullet point format. CONCLUSION The most preferred report style for skeletal and chest x-ray reports is short sentences, brief with bullet-point format. These findings add to the current knowledge base and provide different report style options. Tailoring report styles could optimise service users' experience depending on clinical variables and might improve reporting workflow. IMPLICATIONS FOR PRACTICE Potential differences in style preferences may exist between community and hospital referrers. Consequently, focussed research regarding the report style preferences of GPs is recommended as an area for further research.
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Affiliation(s)
- Barry J Stevens
- Manor Hospital, Walsall Healthcare NHS Trust, Moat Road, Walsall, West Midlands WS2 9PS, UK.
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