Emergency and Trauma in MSK Radiology

Musculoskeletal (MSK) emergencies and trauma are a major public health problem globally, contributing a large burden of disability and suffering.

Although MSK injuries needing urgent care are among the most common conditions at first referral health facilities, specialists trained to handle these emergencies properly are often lacking.

In this setting, radiologists on the frontline have the difficult task of providing their best support in terms of appropriateness, efficiency, and a deep knowledge of radiologic semiology.

This special issue, which shares its topic with the annual European Society of Musculoskeletal Radiology meeting in June 2017 in Bari, Italy, benefits from contributions from world-renowned experts in the field.

Pediatric MSK injuries of the upper and lower extremities represent one of the most important challenges for physicians, specifically for the radiologist, because a missed diagnosis can lead to delayed complications such as arrested growth and osteoarthritis. Correct interpretation of MSK imaging studies of children requires extensive knowledge of normal skeletal growth and the physiologic changes that take place in growing bones.

Several articles in this issue are dedicated to traumatic and nontraumatic emergencies of the cervical and thoracolumbar spine, focusing on imaging techniques and the various classifications and injury severity score systems that have been proposed to standardize the management of patients when assessing stable/unstable and surgical/nonsurgical fractures. Special focus has been provided on percutaneous mini-invasive treatments developed to improve the quality of life of patients affected by stable fractures to recover mobility rapidly and prevent deformity of the spinal column.

Subsequent articles offer a comprehensive overview of the imaging patterns of cage and pelvic ring injuries associated with a high rate of morbidity and mortality due to associated vascular and visceral lesions.

The spectrum of disorders in musculotendinous trauma includes acute traumatic and subacute/chronic lesions caused by repetitive microtrauma. Although magnetic resonance imaging still remains invaluable for assessing severity and for planning management, ultrasonography (US) is helpful in exploring superficial structures such as tendons, particularly if dynamic studies are required. Moreover, several US-guided procedures were recently introduced that are cost effective and readily available.

Although they affect patients of both sexes at any age and represent some of the most common causes of visits to the emergency department, upper and lower extremity injuries often present pitfalls and challenges for the radiologist in the process of diagnosis and guiding the clinician. Complex anatomy, mechanics of the injuries, and the broad array of conditions extending from fractures to ligament, tendon, and neurovascular injuries require extensive knowledge. Accurate imaging evaluation is therefore essential to classify the lesions and direct the patient to the most effective therapeutic management.

Conventional radiology (CR) is traditionally the first imaging technique for the evaluation of small bones and small joint trauma. Although multidetector computed tomography (MDCT) has better sensitivity than CR in detecting fractures and evaluating complex fractures, high levels of radiation prevent the systematic use of MDCT in these situations. Cone beam CT has been gaining a role in trauma settings because it combines high spatial resolution and a relatively low radiation dose. This technique fits perfectly in the assessment of small bones and joints in patients with negative or ambiguous radiographs and a high clinical suspicion for fractures, when complex fractures are suspected.

The final set of articles present a comprehensive overview on other upper and lower extremities MSK emergencies such as vascular injuries, compartment syndrome, diabetic myonecrosis, and rhabdomyolysis that require complex imaging assessment for the differential diagnosis and could benefit from endovascular treatment.

We thank all the authors for their superb job, and we hope readers will find this issue a valuable resource in their clinical practice.