Kevin Patrick Donahue MD, Presenter: Nothing to Disclose

Stephan Anderson MD, Abstract Co-Author: Nothing to Disclose

Holly Milch, Abstract Co-Author: Nothing to Disclose

Ali Guermazi MD, Abstract Co-Author: Stockholder, Synarc, Inc President, Boston Imaging Core Lab, LLC Research grant, General Electric Company Research Consultant, Merck KGaA

Zineb Dhina MD, PhD, Abstract Co-Author: Nothing to Disclose

Jorge A. Soto MD, Abstract Co-Author: Nothing to Disclose

To determine the utility of CT angiography (CTA) in detecting arterial injuries in the setting of lower extremity fracture and identify factors that portend poor healing.

Patients with acute fractures from the hip through the ankle who underwent lower extremity CTA from a period of 1/1/2006 through 12/31/2008 at our Level I trauma center were included. All examinations were acquired using 64MDCT technology (Lightspeed VCT, GE Medical Systems, Milwaukee, WI). 193 patients (149 male, 44 female) with a mean age of 36 years and a range of 14 to 88 years met the inclusion criteria. A total of 230 fractures were found in this patient population. Findings on admission CTA were retrospectively reviewed for the presence of vascular injury as well as signs of open fracture. Also, the radiologist was asked to grade the extent of atherosclerotic disease of the lower extremity arteries on a three point scale. Subsequently, serial radiographs were examined and assessed for fracture healing with successful healing and nonunion designated as the primary outcomes. Fisher’s exact test was used to test for association between age, presence of vascular injury on CTA, degree of atherosclerosis on CTA, the presence of an open fracture and subsequent bone healing.

Of the 230 fractures identified there were 110 open fractures, 47 fractures with associated vascular injury, and 5 cases of nonunion. No relationship between patient age or degree of atherosclerosis and failure of bony healing was seen. No significant relationship was demonstrated between the presence of an open fracture and the risk of nonunion. In assessing for a relationship between the presence of a vascular injury and subsequent bone nonunion, there was a strong trend toward significance (p=0.059). Of the 5 cases of fracture nonunion 3 were associated with vascular injury.

CTA performed in this setting demonstrates that vascular injury has a strong trend toward significant association with this outcome while the presence of an open fracture, degrees of atherosclerosis, or patient age are not statistically significantly associated with outcome.

There is a strong statistical trend that CTA provides information that predicts healing in the setting of acute lower extremity fracture.

Donahue, K, Anderson, S, Milch, H, Guermazi, A, Dhina, Z, Soto, J, Lower Extremity CT Angiography in Trauma: Predicting Bony Healing.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8010013.html