Detection of Distal Radius Fractures Trained by a Small Set of X-Ray Images and Faster R-CNN

Abstract Background: Although distal radius fractures (DRFs) are clinically common, DRFs accompanied by dorsally displaced free fragments beyond the watershed line are much less so. At present, it is very difficult to fix and stabilize the displaced free fragments far away from the watershed line with a plate. Our aim was to investigate the clinical effect of DRFs with distally displaced dorsal free mass treated with distal volaris radius (DVR) combined with turning of the radius via the distal palmar approach. Methods: From 2015 to 2019, 25 patients with distal radius fractures associated with dorsally displaced free fragments beyond the watershed line were selected and treated with distal volaris radius (DVR) combined with turning of the radius via the distal palmar approach. This study involved 14 males and 11 females, with an average age of 34.5 years (ranging from 21 to 50 years). The mean follow-up period was 16.5 months (ranging from 12 to 22 months). The dorsal displacement of the free fragments was analyzed by X-ray and three-dimensional computed tomography, allowing characterization of postoperative recovery effects by radial height, volar tilt and radial inclination. For the follow-up, we evaluated effects of the surgery by analyzing range of motion (ROM); Modified Mayo Wrist Score (MMWS); and Disabilities of Arm, Shoulder and Hand (DASH) score. Postoperative wound recovery and complications were also monitored to evaluate the clinical therapeutic effects of the surgical procedures. Results: X-ray showed that all patients showed reduced fractures, well-healed wounds and recovered function with no obvious complications. Based on the follow-up, patients had a mean radial height of 10.5mm (ranging from 8.1 to 12.6 mm), mean MMWS of 78.8° (ranging from 61 to 90°), mean DASH score of 16.25 (ranging from 11 to 21), mean ROM for volar flexion of 76.5° (ranging from 62 to 81°), mean ROM for dorsiflexion of 77.1° (ranging from 59 to 83) and mean VAS score of 1.4 (ranging from 1 to 3). Conclusion: Treatment of distal radius fractures with accompanying dorsally displaced free fragments beyond the watershed line with turning of the radius and the DVR plate system via the distal palmar approach is effective and has no obvious complications.

Download Full-text

Reference values for digital X-ray radiogrammetry parameters in children and adolescents in comparison to estimates in patients with distal radius fractures

Journal of Bone and Mineral Metabolism ◽

10.1007/s00774-014-0641-3 ◽

2015 ◽

Vol 34 (1) ◽

pp. 55-64 ◽

Cited By ~ 3

Author(s):

Diane M. Renz ◽

Ansgar Malich ◽

Andreas Ulrich ◽

Alexander Pfeil ◽

Hans-Joachim Mentzel ◽

...

Keyword(s):

Children And Adolescents ◽

Distal Radius ◽

Reference Values ◽

Distal Radius Fractures ◽

Radius Fractures ◽

X Ray

Download Full-text

Artificial intelligence to diagnosis distal radius fracture using biplane plain X-rays

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02845-0 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Kunihiro Oka ◽

Ryoya Shiode ◽

Yuichi Yoshii ◽

Hiroyuki Tanaka ◽

Toru Iwahashi ◽

...

Keyword(s):

Artificial Intelligence ◽

Diagnostic Accuracy ◽

Distal Radius ◽

Diagnostic Tests ◽

Styloid Process ◽

Final Diagnosis ◽

Distal Radius Fractures ◽

X Rays ◽

Radius Fractures ◽

X Ray

Abstract Background Although the automatic diagnosis of fractures using artificial intelligence (AI) has recently been reported to be more accurate than those by orthopedics specialists, big data with at least 1000 images or more are required for deep learning of the convolutional neural network (CNN) to improve diagnostic accuracy. The aim of this study was to develop an AI system capable of diagnosing distal radius fractures with high accuracy even when learning with relatively small data by learning to use bi-planar X-rays images. Methods VGG16, a learned image recognition model, was used as the CNN. It was modified into a network with two output layers to identify the fractures in plain X-ray images. We augmented 369 plain X-ray anteroposterior images and 360 lateral images of distal radius fractures, as well as 129 anteroposterior images and 125 lateral images of normal wrists to conduct training and diagnostic tests. Similarly, diagnostic tests for fractures of the styloid process of the ulna were conducted using 189 plain X-ray anteroposterior images of fractures and 302 images of the normal styloid process. The distal radius fracture is determined by entering an anteroposterior image of the wrist for testing into the trained AI. If it identifies a fracture, it is diagnosed as the same. However, if the anteroposterior image is determined as normal, the lateral image of the same patient is entered. If a fracture is identified, the final diagnosis is fracture; if the lateral image is identified as normal, the final diagnosis is normal. Results The diagnostic accuracy of distal radius fractures and fractures of the styloid process of the ulna were 98.0 ± 1.6% and 91.1 ± 2.5%, respectively. The areas under the receiver operating characteristic curve were 0.991 {n = 540; 95% confidence interval (CI), 0.984–0.999} and 0.956 (n = 450; 95% CI 0.938–0.973). Conclusions Our method resulted in a good diagnostic rate, even when using a relatively small amount of data.

Download Full-text

The measurement of dorsal radial tilt by x-ray and computed tomography

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.64.11.1007 ◽

2018 ◽

Vol 64 (11) ◽

pp. 1007-1011

Author(s):

Jingning Li ◽

Zhenjie Ma ◽

Fei Gao ◽

Yuan Ji

Keyword(s):

Computed Tomography ◽

Distal Radius ◽

Distal Radius Fractures ◽

The Other ◽

Steel Plates ◽

Radius Fractures ◽

X Ray ◽

Left And Right ◽

The Right ◽

Two Sides

SUMMARY OBJECTIVE: We conducted this study to define and measure the dorsal radial tilt, and to guide the reduction of distal radius fractures and the pre-bending of steel plates used in surgery. METHODS: The dorsal radial tilt was measured using both computed tomography (CT) and x-ray from both left and right side. The differences and correlations of the data measured by those two methods and from two sides were analyzed. RESULTS: The tilts measured by x-ray were significantly bigger than those measured by CT from the left side (t=55.51, p < 0.01) and from the right side (t=49.81, p < 0.01). The tilts measured by those two methods from the left and right sides were correlated (r=0.85, p < 0.01; r=0.81, p < 0.01). The dorsal radial tilts measured from the left side were not significantly different from those measured from the right side by CT (t=1.49, p > 0.05) and by x-ray (t=1.51, p > 0.05). The dorsal radial tilts measured from the left side by CT were significantly different from those measured from the right side by x-ray (t=43.07, p < 0.01), and these two sets of data were correlated (r=0.71, p < 0.01). The dorsal radial tilts measured from the left side by x-ray was significantly different from that measured from right side by CT (t=40.43, p < 0.01), and those two sets of data were also correlated (r=0.75, p < 0.01). Conclusions: The dorsal radial tilts measured from one side by one method can be used to estimate the tilts measured from the other side / the same side by the same method / the other method.

Download Full-text

Positioning of a Volar Locking Plate with a Central Flexor Pollicis Longus Tendon Notch in Distal Radius Fractures

Journal of Wrist Surgery ◽

10.1055/s-0039-1694718 ◽

2019 ◽

Vol 08 (06) ◽

pp. 482-488 ◽

Cited By ~ 3

Author(s):

Peter Kaiser ◽

Hannes Gruber ◽

Fanny Loth ◽

Gernot Schmidle ◽

Rohit Arora ◽

...

Keyword(s):

Distal Radius ◽

Plate Osteosynthesis ◽

Distal Radius Fractures ◽

Ultrasound Images ◽

Flexor Pollicis Longus ◽

Volar Plating ◽

Radius Fractures ◽

Level Of Evidence ◽

X Ray ◽

Flexor Pollicis Longus Tendon

Abstract Background Volar locking plates with a central notch were designed to reduce the risk of flexor pollicis longus (FPL) tendon irritation after volar plating for distal radius fractures. Objective The purpose of this study was to evaluate the course of the FPL tendon after FPL-plate osteosynthesis to identify a plate position that avoids an impingement with the FPL tendon. Patients and Methods Nineteen patients treated with volar plating using an FPL plate for a distal radius fracture were evaluated. Transverse ultrasound images were used to assess whether the profile of the FPL tendon lied within the plate notch. The position of the FPL tendon on transverse ultrasound images was transferred onto postoperative dorsovolar X-ray images to define an FPL tendon corridor for a plate position not interfering with the FPL tendon. Results The FPL tendon was aligned inside the plate notch completely in three cases, partially in 11 cases, and missed the notch in five cases. An FPL corridor was defined at the level of the watershed line with all FPL tendons being completely (74%) or partially (26%) aligned inside that corridor. There was a moderate correlation between the plate notch being positioned inside this corridor and the FPL tendon being positioned inside the plate notch (r = 0.49; p = 0.033). Conclusion It seems advantageous to place the plate notch within a corridor parallel to the radial shaft between the ulnar edge of the scaphoid tubercle and the scapholunate interval for the FPL tendon protection. Level of Evidence This is Level IV study.

Download Full-text

Evaluation of the Sigmoid Notch Involvement in the Intra-Articular Distal Radius Fractures: The Efficacy of Computed Tomography Compared with Plain X-ray

Clinics in Orthopedic Surgery ◽

10.4055/cios.2012.4.1.83 ◽

2012 ◽

Vol 4 (1) ◽

pp. 83 ◽

Cited By ~ 9

Author(s):

Youn Moo Heo ◽

Jae-Young Roh ◽

Sang-Bum Kim ◽

Jin Woong Yi ◽

Kwang Kyoon Kim ◽

...

Keyword(s):

Computed Tomography ◽

Distal Radius ◽

Distal Radius Fractures ◽

Radius Fractures ◽

X Ray ◽

Sigmoid Notch

Download Full-text

The Dorsal Tangential X-Ray View to Determine Dorsal Screw Penetration During Volar Plating of Distal Radius Fractures

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2014.10.021 ◽

2015 ◽

Vol 40 (1) ◽

pp. 27-33 ◽

Cited By ~ 23

Author(s):

Alexander Brunner ◽

Christin Siebert ◽

Claudia Stieger ◽

Alexander Kastius ◽

Björn-Christian Link ◽

...

Keyword(s):

Distal Radius ◽

Distal Radius Fractures ◽

Volar Plating ◽

Radius Fractures ◽

X Ray ◽

Screw Penetration

Download Full-text

The treatment of complex intra-articular distal radius fractures with turning radius and distal volaris radius plate fixation

European Journal of Medical Research ◽

10.1186/s40001-020-00470-x ◽

2020 ◽

Vol 25 (1) ◽

Author(s):

Zhaofeng Jia ◽

Shijin Wang ◽

Wei Jiang ◽

Chuangli Li ◽

Jiandong Lin ◽

...

Keyword(s):

Distal Radius ◽

Plate Fixation ◽

Postoperative Recovery ◽

Distal Radius Fractures ◽

Therapeutic Effects ◽

Dash Score ◽

Radius Fractures ◽

X Ray ◽

Palmar Approach

Abstract Background Although distal radius fractures (DRFs) are clinically common, intra-articular DRFs accompanied by dorsally displaced free fragments are much less so. At present, it is very difficult to fix and stabilize the intra-articular distal radius fractures accompanying dorsally displaced free fragments with a plate. Our aim was to investigate the clinical effect of DRFs with distally displaced dorsal free mass treated with distal volaris radius (DVR) combined with turning of the radius via the distal palmar approach. Methods From 2015 to 2019, 25 patients with intra-articular distal radius fractures associated with dorsally displaced free fragments were selected and treated with distal volaris radius (DVR) combined with turning of the radius via the distal palmar approach. This study involved 14 males and 11 females, with an average age of 34.5 years (ranging from 21 to 50 years). The mean follow-up period was 16.5 months (ranging from 12 to 22 months). The dorsal displacement of the free fragments was analyzed by X-ray and three-dimensional computed tomography, allowing characterization of postoperative recovery effects by radial height, volar tilt and radial inclination. For the follow-up, we evaluated effects of the surgery by analyzing range of motion (ROM); Modified Mayo Wrist Score (MMWS); and Disabilities of Arm, Shoulder and Hand (DASH) score. Postoperative wound recovery and complications were also monitored to evaluate the clinical therapeutic effects of the surgical procedures. Results X-ray showed that all patients showed reduced fractures, well-healed wounds and recovered function with no obvious complications. Based on the follow-up, patients had a mean radial height of 10.5 mm (ranging from 8.1 to 12.6 mm), mean MMWS of 78.8° (ranging from 61° to 90°), mean DASH score of 16.25 (ranging from 11 to 21), mean ROM for volar flexion of 76.5° (ranging from 62° to 81°), mean ROM for dorsiflexion of 77.1° (ranging from 59 to 83) and mean VAS score of 1.4 (ranging from 1 to 3). Conclusion Treatment of the intra-articular distal radius fractures accompanying dorsally displaced free fragments with turning of the radius and the DVR plate system via the distal palmar approach is effective and has no obvious complications.

Download Full-text

Distal radius fracture: An opportunity for osteoporosis intervention

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1177/22104917211035549 ◽

2021 ◽

Vol 28 ◽

pp. 221049172110355

Author(s):

Marvin MT Chung ◽

Dennis KH Yee ◽

Evan Fang ◽

Frankie Leung ◽

Christian Fang

Keyword(s):

Postmenopausal Women ◽

Distal Radius Fracture ◽

Distal Radius ◽

Fragility Fractures ◽

Dual Energy ◽

Distal Radius Fractures ◽

Radius Fracture ◽

Radius Fractures ◽

Osteoporosis Medication ◽

X Ray

Background Distal radius fractures have been reported as a predictor of subsequent osteoporotic fragility fractures. This retrospective study evaluated the proportion of patients with distal radius fractures at a government hospital in Hong Kong who received diagnostic evaluation or treatment for osteoporosis within 1 year. Methods Five hundred sixty-one postmenopausal women aged >50 years admitted to a public hospital between 2013 and 2017 for a low-energy distal radius fracture were analysed for initiation of osteoporosis medications and/or arrangement of dual-energy X-ray absorptiometry screening within 1 year of injury. Results Within 1 year, 8.4% of patients were prescribed osteoporosis medication and 6.1% of patients had dual-energy X-ray absorptiometry arranged. Patients with a previous fracture were more likely to receive osteoporosis medication (18.6% vs 7.5%, P = 0.012) and either intervention (screening or medication) overall (23.3% vs 10.4%, P = 0.011). Conclusions Few postmenopausal women who suffered a distal radius fracture received osteoporosis intervention within 1 year. Orthopaedic surgeons should be aware of the possibility of underlying osteoporosis and opportunity for intervention when managing fragility distal radius fractures.

Download Full-text