Use of a Template-Matching Clavicle Fracture Atlas for Surrogate Dating of Humeral and Femoral Fractures in Young
Jade Iwasaka-Neder1,2, Shaoju Wu1, Sila Kurugol1
1Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115.
Insights
A new atlas significantly improves radiologists' ability to date infant fractures, aiding in suspected abuse cases. This tool enhances accuracy for clavicle, humerus, and femur fractures.
Area of Science:
- Radiology
- Pediatric Imaging
- Forensic Radiology
Background:
- Accurate fracture dating is crucial in evaluating suspected infant abuse.
- Birth-related clavicle fractures are common and can serve as indicators for dating other infant fractures.
- Existing methods for dating infant fractures may lack precision, necessitating improved tools.
Purpose of the Study:
- To evaluate the effectiveness of a novel template-matching clavicle fracture timeline atlas.
- To assess the impact of this atlas on radiologists' accuracy in dating birth-related clavicle, humerus, and femur fractures in infants.
- To determine if clavicle fracture healing patterns can be used as surrogates for dating long bone fractures.
Main Methods:
- Retrospective analysis of infant radiographs (age ≤90 days) with birth-related clavicle, humerus, or femur fractures.
- Development of a fracture dating atlas using non-rigid image registration of clavicle fracture radiographs.
- Independent review of radiographs by six readers (trainees and pediatric radiologists) with and without the atlas.
- Assessment of interreader agreement using intraclass correlation coefficients (ICCs) and fracture dating performance using mean absolute errors (MAEs).
Main Results:
- The study included 145 infants and 269 fracture radiographs.
- Interreader agreement significantly improved from moderate (ICC=0.69) without the atlas to excellent (ICC=0.91) with the atlas.
- Mean absolute errors (MAEs) in fracture dating were significantly reduced with the atlas for clavicle, humerus, and femur fractures across all readers.
Conclusions:
- The developed fracture dating atlas substantially enhances radiologists' performance in dating infant fractures.
- The atlas improves accuracy and interreader reliability for dating clavicle, humerus, and femur fractures.
- Clavicle fracture healing characteristics can serve as valuable surrogates for dating long bone fractures in infants, particularly in abuse investigations.
Abstract:
BACKGROUND. Fracture dating is important in suspected infant abuse. Birth-related clavicle fractures are common and may provide surrogates to aid long bone fracture dating in infants. OBJECTIVE. The purpose of this study was to assess the impact of a template-matching clavicle fracture timeline atlas on radiologists' performance in dating birth-related fractures of the clavicle, humerus, and femur in young infants. METHODS. This retrospective study included infants 90 days old or younger who underwent radiography of a birth-related clavicle fracture from April 1, 2021, to July 31, 2024 or a birth-related fracture of the humerus or femur from December 1, 2011, to July 31, 2024. All eligible radiographs of each fracture were identified, representing distinct observations for the purposes of analysis. Patient age (expressed as days) at the time of radiograph acquisition served as the reference standard for fracture ages. A nonrigid image registration technique was applied to a nonoverlapping preassembled database of radiographs of birth-related clavicle fracture, to create a fracture dating atlas. Six readers (three trainees and three pediatric radiologists) independently reviewed the radiographs in separate sessions without and with use of the atlas to estimate fracture ages. Interreader agreement was assessed using intraclass correlation coefficients (ICCs). Fracture aging performance was assessed using mean absolute errors (MAEs). RESULTS. The analysis included 145 infants (87 male and 58 female infants) with 269 fracture radiographs (104 of the clavicle, 128 of the humerus, and 37 of the femur). The mean fracture age was 26 ± 19 [SD], 22 ± 14, and 21 ± 13 days for clavicle, humerus, and femur fractures, respectively. Interreader agreement for estimating fracture ages improved from moderate (ICC = 0.69) without use of the atlas to excellent (ICC = 0.91) with use of the atlas. The MAE in fracture dating was significantly lower (p < .05) with than without use of the atlas for all six readers for clavicle fractures (range, 4.8-5.5 vs 5.8-10.1 days), for all six readers for humeral fractures (range, 6.0-12.1 vs 3.0-3.8 days), and for five of six readers for femur fractures (range, 7.4-17.2 vs 3.3-4.8 days). MAE without and with use of the atlas was 8.8 versus 4.3 days, respectively, across trainee readers and 8.4 versus 4.0 days, respectively, across attending physician readers. CONCLUSION. The fracture dating atlas yielded significant improvements in radiologists' performance for dating infant clavicle, humerus, and femur fractures. CLINICAL IMPACT. Clavicle fracture healing patterns can serve as surrogates for dating long bone fractures commonly encountered in infant abuse.
Related Concept Videos
01:09Changes in the Appendicular Skeleton with Age
Initially, the limb buds consist of a core of mesenchyme covered by a layer of ectoderm. The ectoderm at the end of the limb bud thickens to form a narrow crest called the apical ectodermal ridge. This ridge stimulates the underlying...
01:19Bones of the Upper Limb: Humerus
01:27Fractures: Bone Repair
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...