- Asploro Journal of Biomedical and Clinical Case Reports
- ISSN: 2582-0370
- Article Type: Case Report
- DOI: 10.36502/2022/ASJBCCR.6271
- Asp Biomed Clin Case Rep. 2022 Aug 03;5(2):91-93
Fracture Diagnosis Using Magnetic Resonance Imaging: A Case Report
1Department of Medical Technology, Teikyo University, Japan
Corresponding Author: Eisuke Hiruma
Address: Department of Medical Technology, Teikyo University, 359 Otsuka, Hachioji-shi, Tokyo, 192-0395, Japan.
Received date: 13 June 2022; Accepted date: 29 July 2022; Published date: 03 August 2022
Citation: Hiruma E. Fracture Diagnosis Using Magnetic Resonance Imaging: A Case Report. Asp Biomed Clin Case Rep. 2022 Aug 03;5(2):91-93.
Copyright © 2022 Hiruma E. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium provided the original work is properly cited.
Keywords: Bone Fracture, Magnetic Resonance Imaging, Radiography, Range of Motion, Case Report
Falling is likely to occur in daily life and sports activities cause from right injury to severe injury in the upper extremity. The injuries from falls can range from contusion and sprain to fracture and dislocation. The injury occurs on the upper extremity more than on the lower extremity because people put their hands out to protect themselves from the body. Radiography (X-ray) can quickly diagnose a fracture because of the fracture line. In this case report, a 20-year-old woman slipped and put her hand to protect her body during ice-skating. The radius is a fine fracture line that could not be diagnosed by X-ray in this case even though magnetic resonance imaging (MRI) presented a fracture line.
Falling is an accident that is likely to occur when walking or climbing stairs in daily life. It also tends to occur in sports activities on the water. Injuries from this fall range from mild to severe injuries requiring hospitalization or surgery. Interviews, palpitations, and diagnostic imaging are used for these diagnoses. X-ray has been used as the primary imaging technique for accurate evaluation and localization of patients with a suspected fracture. Ultrasonography (US) procedures were utilized to rule out deep tissue. MRI has been used as an imaging modality for soft tissue damage such as tendinous and ligamentous. MRI, recently, has become an imaging modality choice for identifying occult fractures which are missed on X-ray [1,2].
In this case study, I would like to present the diagnostic imaging of MRI in the radial injury caused by a fall.
A 20-year-old healthy and active woman did not have any medication and treatment. She visited a clinic at the university with severe pain in the left hand and wrist. She slipped down by herself and hit her hips and palms with a full extension on the ice during ice-skating. She had severe pain and mild swelling in the hand and wrist of her left limb with difficulty in moving her fingers and wrist. Immediately after being injured, she was put on ice with a splint and bandage to stabilize her left wrist and arm.
She had severe pain and mild swelling in the hand and wrist of her left limb with difficulty in moving her fingers and wrist. During the physical examination by the orthopaedic doctor, there was tenderness in the palm, the wrist, and the distal part of the radius with palpation, but not tingling. The injured hand was not able to close (flex) because of the increase in severe pain. No fracture line and dislocation in the injured palm, wrist, ulnar, and radius on radiography (X-ray). Ultrasonography (US) procedures were utilized to rule out deep tissue. The US revealed a shadow part in the radius. A magnetic resonance image (MRI) demonstrated many small fracture lines of the distal part of the radius (Fig-1).
She was treated with the conservative methods of resting, cold pad, plastic splint, compression and sling (triangle bandage) [3,4].
Falling during sports activity and/or daily living is possible to cause a fracture in the upper extremity. Although injuries to the upper extremity are the costliest, the picture of the upper extremity injury problem remains incomplete . Ice skating is a most popular winter sport; related fractures have been reported as high as 82.8% of all sports-related fractures . The most common fractures in ice skating in adults have involved upper (80%) and lower extremity injuries (11%). The majority of the upper injuries has been distal radius fracture . Another sports-related fracture in the upper extremity is soccer. Soccer is a popular sport in the world, and related injuries which were 35% upper extremity and 53% lower extremity injuries were recorded . Fractures were more frequently diagnosed in the upper than in the lower extremities (44% and 14%, respectively), especially in children. Falling was the main cause of upper extremity injury. Andersson et al.  presented the relationship between injury incidents and layoff time. Injuries to the hand, and upper extremity constituted less than 1% of all time-loss injuries in male professional soccer players. However, fractures are the most common injuries that occur in the upper extremity such as the hand (54.1%), wrist (60.0%), and forearm (85.7%). In addition, the layoff time for injured soccer players with upper extremities was hand (16±27 days), wrist (15±18 days), and forearm (45±8days). Therefore, although the rate of injury in the upper limbs is low, when an injury occurs, the fracture is severe and the period of layoff time is long. The last study presents that children injured their upper extremities during physical activity. Of the upper extremity injuries, 55% were sprain, 47% occurred in the hand/wrist, and 53% of cases were caused by a fall .
Since the fracture due to X-ray could not be confirmed, it was diagnosed as sprain or bruise, and it is possible to return to practice or the game early by fixing with splint and bandage. Therefore, another fall may result in a more severe fracture. In that case, fixing the plate by surgery increases the physical and mental stress and financial burden. Distal radius fractures in adults are among the most common fractures encountered by orthopedic surgeons. Treatment options vary depending on injury severity and stability of the fracture reduction. Common surgeries include pinning with and without external fixation. Dorsal plating with low profile plates and fragment-specific techniques, also, can be successful in treating distal radius fractures . However, it is necessary to make a decision of surgical treatment with the consideration of bone growth and development, if the patient is a growing child.
Falling is the cause of facture in the upper extremity. The risk factors should be taken into account when diagnosing and managing injuries in the upper extremity.
- Fracture of the distal part of the radius without the dislocation is seen regularly in fall down in soccer and ice-skating.
- MRI have been used as the primary imaging modality for evaluation of patients with the acute injury.
The author has not declared a specific grant for this case report from any funding agency in the public, commercial or not-for-profit sections.
Conflict of Interest
The author has contributed equally in preparing the manuscript research, review, writing and all of them have approved the final draft of the article. The author has no conflicts of interest to declare.
Patient Consent for Publication
 Bucholz RW, Heckman JD, Court-Brown CM, Tornetta P, McQueen MM, Ricci WM. Rockwood and Green’s fractures in adults. 7th ed. Philadelphia: Wolters Kluwer Health/Lippincott, Williams & Wilkins, c2010; 2012.
 Sadineni RT, Pasumarthy A, Bellapa NC, Velicheti S. Imaging Patterns in MRI in Recent Bone Injuries Following Negative or Inconclusive Plain Radiographs. J Clin Diagn Res. 2015 Oct;9(10):TC10-13. [PMID: 26557590]
 DerSarkissian C. Understanding Bone Fractures: Diagnosis and Treatment. New York, United States: WebMD, LLC; 2021. Available from: https://www.webmd.com/a-to-z-guides/understanding-fractures-treatment
 Schwarzkopf R, Nacke EA, Tejwani NC. The impact of orthopaedic injuries sustained at an urban public ice skating rink: is it really free? Bull Hosp Jt Dis (2013). 2014;72(4):263-65. [PMID: 25986349]
 Nauta J, Jespersen E, Verhagen E, van Mechelen W, Wedderkopp N. Upper extremity injuries in Danish children aged 6-12, mechanisms, and risk factors. Scand J Med Sci Sports. 2017 Jan;27(1):93-98. [PMID: 26648482]
 Barr LV, Imam S, Crawford JR, Owen PJ. Skating on thin ice: a study of the injuries sustained at a temporary ice skating rink. Int Orthop. 2010 Jun;34(5):743-46. [PMID: 20143231]
 Sytema R, Dekker R, Dijkstra PU, ten Duis HJ, van der Sluis CK. Upper extremity sports injury: risk factors in comparison to lower extremity injury in more than 25 000 cases. Clin J Sport Med. 2010 Jul;20(4):256-63. [PMID: 20606510]
 Andersson JK, Bengtsson H, Waldén M, Karlsson J, Ekstrand J. Hand, Wrist, and Forearm Injuries in Male Professional Soccer Players: A Prospective Cohort Study of 558 Team-Seasons From 2001-2002 to 2018-2019. Orthop J Sports Med. 2021 Jan 25;9(1):2325967120977091. [PMID: 33553455]
 Wulf CA, Ackerman DB, Rizzo M. Contemporary evaluation and treatment of distal radius fractures. Hand Clin. 2007 May;23(2):209-26. [PMID: 17548012]