Imaging skeletal trauma

241 Pages·2015·107.748 MB·English

by  Lee F. Rogers, O. Clark West

IMAGING
SKELETAL
TRAUMA
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IMAGING
SKELETAL
TRAUMA
Fourth Edition
Lee F. Rogers, MD
Professor Emeritus
Feinberg School of Medicine
Northwestern University
Chicago, Illinois
Wake Forest School of Medicine
Wake Forest University
Winston-Salem, North Carolina
O. Clark West, MD
Director
Emergency Radiology Section
Department of Diagnostic and Interventional Imaging
Level 1 Trauma Center
Memorial Hermann Hospital
Texas Medical Center
Professor
University of Texas Health Science Center
Houston Medical School
Houston, Texas
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
IMAGING SKELETAL TRAUMA, FOURTH EDITION ISBN: 978-1-4377-2779-1
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Previous editions copyrighted 2002, 1992, 1982 by Churchill Livingstone.
Library of Congress Cataloging-in-Publication Data
Rogers, Lee F., 1934- , author.
Imaging skeletal trauma / Lee F. Rogers, O. Clark West. -- Fourth edition.
p. ; cm.
Preceded by Radiology of skeletal trauma / [edited by] Lee F. Rogers. 3rd ed. c2002.
Includes bibliographical references and index.
ISBN 978-1-4377-2779-1 (hardback : alk. paper)
I. West, O. Clark, author. II. Radiology of skeletal trauma. Preceded by (work): III. Title.
[DNLM: 1. Bone and Bones--injuries. 2. Fractures, Bone--radiography. WE 175]
RD101
617.4’71044--dc23 2014037963
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Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
To my father, the late Doctor Watson F. Rogers, of Vienna, West Virginia,
a true physician; loved by his family, admired by his patients,
and respected by his colleagues. Born in St. Albans, Vermont, raised in Vergennes, Vermont,
and educated at the University of Vermont, he practiced medicine in Underhill,
Vermont, and Vienna and Parkersburg, West Virginia.
And the memory of our medical heritage, all physicians,
all Vermonters: my grandfather, Doctor Frank Matthew Rogers of St. Albans
and Vergennes, Vermont; my great uncle, Doctor Daniel Lee Rogers of Bolton Landing,
New York; my great uncle, Doctor Sam Rogers of Proctor, Vermont; my uncle,
Doctor Samuel Rogers of Stowe, Vermont; and to all those who may have suffered as we learned.
And to my grandchildren, Dean, Garrison, Megan, Westin, John, and Morgan,
in the fond hope that whatever they may become and wherever that might be,
they too find something as rewarding and meaningful to do
with their lives as those of us who have preceded them.
And last, to my wife, Donna B., who made this and all other of my works possible.
I am most grateful for her forbearance and tolerance of my preoccupations
through the four editions of this book. It is hard to imagine having completed
these works without her constant love, encouragement, and support.
Lee F. Rogers
To my recently deceased uncle, Emory Guth West, MD, FACR, born in Des Moines,
Iowa, and educated in Medicine and Radiology at Northwestern University in Chicago.
He practiced Radiology in Mountainview, California. In my “tween” years, spending days
watching him work in his office and conversing with him about “automotive medicine” – the precursor
of modern trauma care – provided the spark for my career.
To my father, George Guth West, MBA, JD, born in Des Moines,
Iowa, and currently resident of Henderson, Nevada. His support throughout my medical training
and his encouragement to pursue a career in an unorthodox field – academic
trauma imaging – have been invaluable.
To my wife, Victoria Kiechler West, and daughter, Rebecca Kathryn West,
for their unwavering love and support in all my professional endeavors.
And to all radiologists who think of themselves as Emergency Radiologists or
Trauma Radiologists. This book is for you – to provide the knowledge
base for excellence in imaging skeletal trauma.
O. Clark West
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Preface
I
t has been 12 years since the previous edition of this work. A lot has happened in the
interim. Microprocessors have revolutionized imaging; not only the means of medi-
cal imaging but how images are viewed and reported; how these reports are recorded,
transmitted, and communicated; how images are stored and retrieved; and even how one
seeks information regarding the imaging characteristics of disease or searches the literature
to learn of or substantiate their findings. Microprocessors have made images, reports, and
the clinical, pathologic, and imaging characteristics of disease instantaneously accessible.
We have achieved the potential of “real-time radiology.”
As a result of microprocessor-driven innovations in information accessibility, the nature
of textbooks has changed. Because of the online availability of medical images and accurate
and reliable information, the demand for and need of larger general texts has diminished
while readers’ requests for shorter, portable single-topic works that might be downloaded
on desktop computers, laptops, iPads, and smart phones has risen. Our work has been
revised in its fourth edition to accommodate readers’ requests.
But we did not start out that way. In planning for the fourth edition of my text I was
fortunate to secure the assistance of Professor O. Clark West of the University of Texas
Health Science Center at Houston Medical School, an internationally recognized authority
in the field of Emergency Radiology, as a partner and fellow author in this endeavor. Dr.
West heads the Emergency Radiology Section of the Department of Diagnostic and Inter-
ventional Imaging, which services the active Level 1 Trauma Center of Memorial Hermann
Hospital in Houston’s sprawling Texas Medical Center and has a particular interest and
extensive clinical experience in the application of multidetector CT (MDCT) to trauma
imaging. In view of his interest and expertise Dr. West accepted responsibility for author-
ship of the chapters devoted to the axial skeleton: cervical spine, thoracolumbar spine, and
pelvis, and I authored eight chapters devoted to the peripheral skeleton: shoulder, elbow,
wrist, hand, hip, knee, ankle, and foot.
The previous three editions of Radiology of Skeletal Trauma were two-volume texts of
1400 to 1700 pages. In preparing a manuscript for a fourth edition the publisher asked that
we provide a single-volume text of approximately 300 pages. This substantial reduction
presented a significant challenge. Dr. West and I hesitantly agreed to undertake the task.
We gave it our all, but found the results of the required shortening produced chapters far
short of our goal to provide a useful, informative, and instructional resource. The product
of our labors was simply unacceptable.
However, all was not lost. While working on the revision, I became increasingly aware
of the troubling thought that I had written three two-volume editions of a book containing
considerable information but had never informed the reader precisely how I used this infor-
mation in the assessment and interpretation of images of skeletal trauma. To this end we had
decided to add what I called a “primer” at the beginning of each chapter containing the basic
information needed to make an informed judgment and confident interpretation of images
of skeletal trauma. We then stopped working on the revision and turned our attention to
writing a primer for each anatomic area. It took three to four years to complete this undertak-
ing. Ultimately, we came to the conclusion that the primers alone had the making of a good
short text and abandoned our attempt to make a standard revision of the previous edition.
We define a primer as a small exploratory book on a subject – a collection of short infor-
mative pieces of writing that cover the basic elements. Our intent is that the information
provided in this primer should enable users to confidently and accurately identify as many
as 90% to 95% of fractures and dislocations that they encounter.
The Primer begins with checklists for each of the following:
1. Radiographic examination listing views required
2. Common injuries in adults
3. Common injuries in children and adolescents.
4. Injuries likely to be missed
5. Avoiding satisfaction of search: Now that you have seen this what else should you be
looking for
6. What you do when you see nothing at all: Indications for CT and MRI
vii
viii Preface
The checklists are followed by “The Primer,” a brief description with illustrative images
for each separate checklist.
I personally designed the layout for the Primer in a Word document. Then I typed the
manuscript, made the drawings, and downloaded the images into each primer. I used tif
images in the primer documents, the same high-quality images that would be sent to the
publisher for publication. This was done to show the publisher precisely how I wanted the
manuscript laid out.
One day I was reading out with a resident, Dr. Ravi Shastri, now a Fellow in Neurora-
diology at the University of Michigan. Ravi had seen printouts of a few of the chapters. He
asked if he could download one of the primer Word documents on his iPad to show me
what it would look like. I was curious. “Why not?” We copied one of the documents on his
thumb drive and soon thereafter he showed me the primer document on his iPad. I was
amazed. The images were dazzling. The ability to enlarge the images on the iPad was spec-
tacular. Dr. Shastri’s demonstration on the iPad convinced me of the advantages and added
value of the digital electronic presentation. I then showed the primers on my iPad to many
radiologists—residents, fellows, and experienced practitioners—and all were impressed
and found this format potentially useful.
Subsequently, I met with Don Scholz and Jacob Hart of Elsevier to show them several
primer chapters on an iPad. They were also impressed. Ultimately Elsevier decided that
the fourth edition of the text, now named Imaging of Skeletal Trauma would be published
and available in both print and electronic forms. We are pleased by Elsevier’s decision to
proceed in this fashion and grateful for their support.
Each chapter describes what I refer to as a “directed search” in viewing and interpreting
radiographs of musculoskeletal trauma. Know specifically what you are looking for and
look for it. Know what images to obtain, what injuries are likely and what they look like,
what injuries are likely to be missed and why, how to avoid satisfaction of search—where
else to look when you find certain injuries, and when to obtain CT and MRI.
This work would be of value to physicians in Emergency Medicine and Orthopedics as
well as Diagnostic Radiologists. As written it is suitable for self-instruction or self-e valuation
as well as an everyday go-to aid in the throes of reading images of musculoskeletal trauma
from emergency rooms and elsewhere during the regular workday or when on call at night
or weekends. This work could also form the basis of an introductory instructional course
for beginners as well as a refresher course for the more experienced.
Dr. West and I could not have completed this work without the assistance of many oth-
ers. My particular thanks to Michele Dalmenday for her attention to detail and exceptional
secretarial support and to Duane Cookman for his assistance in acquiring the numerous
images that were required from the files of the Department of Medical Imaging at the Uni-
versity of Arizona Medical Center in Tucson. The vast majority of the images are new; less
than 10% were repeated from the third edition.
Dr. West’s principle coauthors were Susanna C. Spence for the spine chapters and
Suresh K. Cheekatla for the pelvis chapter. His colleagues Naga Ramesh Chinapuvvula and
Nicholas M. Beckmann contributed case material and their ideas.
The noun “primer” is recognized by many as a small book used to teach children to read
such as the McGuffey Readers, so popular in elementary schools in the latter nineteenth
and early twentieth centuries. McGuffey’s Readers may have been small but they produced
essentially universal literacy among the American populace, no small achievement. Dr.
West and I can only hope that we should be so fortunate as to achieve similar results with
this primer, the elimination of “illiteracy” among those who interpret images of skeletal
trauma and a noticeable improvement and greater confidence in the performance and
interpretation of imaging examinations in skeletal trauma.
Read, mark, and inwardly digest. Dr. West and I are pleased to be of service.
Lee F. Rogers, MD
Tucson, Arizona
June 8, 2014
Contents
CHAPTER 1 Introduction .............................................................................001
CHAPTER 2 The Shoulder ...........................................................................005
CHAPTER 3 The Elbow ...............................................................................015
CHAPTER 4 The Wrist .................................................................................024
CHAPTER 5 The Hand .................................................................................035
CHAPTER 6 The Cervical Spine...................................................................043
CHAPTER 7 The Thoracolumbar Spine .......................................................090
CHAPTER 8 The Pelvis ................................................................................128
With Suresh K. Cheekatla, MD
CHAPTER 9 The Hip ....................................................................................172
CHAPTER 10 The Knee .................................................................................186
CHAPTER 11 The Ankle ................................................................................199
CHAPTER 12 The Foot ..................................................................................211
ix