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Letters Reply to “Upper Extremity Trauma Radiographs” We thank Dr. Hall [1] for his comments on our recent AJR article, “Misses and Errors in Upper Extremity Trauma Radiographs” [2]. We agree that an elbow effusion in the setting of recent trauma is highly suggestive of a fracture even if it is not clearly seen on radiographs. It has been our experience, however, that finding the location of the fracture (typically the radial head in the adult population) is useful to the referring physician and patient for two reasons: It gives a definitive diagnosis, and it avoids having the patient undergo further imaging and its additional cost as well as, in the case of radi-
ography and CT, additional radiation. Given these reasons, we believe that the Greenspan and Norman [3] view is useful and should be included in the imaging assessment of the patient suspected of a radial fracture. It is indeed correct that the anatomy of the talus is similar to that of the scaphoid in terms of having a tenuous blood supply. We also agree that the scaphoid view description should state 45° of tube “angulation” rather than “extension.” Lastly, we agree with Dr. Hall [1] that the 25% miss rate of perilunate dislocation on initial radiographs seems high and not likely representative of current radiographic diagnostic performance. Soterios Gyftopoulos
Munish Chitkara Jenny Bencardino NYU Langone Medical Center, New York, NY DOI:10.2214/AJR.14.13887 WEB—This is a web exclusive article.
References 1. Hall FM. Upper extremity trauma radiographs. (letter) AJR 2015; 204:[web]W374 2. Gyftopoulos S, Chitkara M, Bencardino JT. Misses and errors in upper extremity trauma radiographs. AJR 2014; 203:477–491 3. Greenspan A, Norman A. The radial head, capitellum view: useful technique in elbow trauma. AJR 1982; 138:1186–1188
AJR 2015; 204:W375 0361–803X/15/2043–W375 © American Roentgen Ray Society
AJR:204, March 2015 W375
Letters Reply to “Upper Extremity Trauma Radiographs” We thank Dr. Hall [1] for his comments on our recent AJR article, “Misses and Errors in Upper Extremity Trauma Radiographs” [2]. We agree that an elbow effusion in the setting of recent trauma is highly suggestive of a fracture even if it is not clearly seen on radiographs. It has been our experience, however, that finding the location of the fracture (typically the radial head in the adult population) is useful to the referring physician and patient for two reasons: It gives a definitive diagnosis, and it avoids having the patient undergo further imaging and its additional cost as well as, in the case of radi-
ography and CT, additional radiation. Given these reasons, we believe that the Greenspan and Norman [3] view is useful and should be included in the imaging assessment of the patient suspected of a radial fracture. It is indeed correct that the anatomy of the talus is similar to that of the scaphoid in terms of having a tenuous blood supply. We also agree that the scaphoid view description should state 45° of tube “angulation” rather than “extension.” Lastly, we agree with Dr. Hall [1] that the 25% miss rate of perilunate dislocation on initial radiographs seems high and not likely representative of current radiographic diagnostic performance. Soterios Gyftopoulos
Munish Chitkara Jenny Bencardino NYU Langone Medical Center, New York, NY DOI:10.2214/AJR.14.13887 WEB—This is a web exclusive article.
References 1. Hall FM. Upper extremity trauma radiographs. (letter) AJR 2015; 204:[web]W374 2. Gyftopoulos S, Chitkara M, Bencardino JT. Misses and errors in upper extremity trauma radiographs. AJR 2014; 203:477–491 3. Greenspan A, Norman A. The radial head, capitellum view: useful technique in elbow trauma. AJR 1982; 138:1186–1188
AJR 2015; 204:W375 0361–803X/15/2043–W375 © American Roentgen Ray Society
AJR:204, March 2015 W375
