MEDICAL RADIOLOGY. Diagnostic Imaging and Radiation Oncology - Softcover Edition. A. L. Baert, Leuven EH. W. Heuck, Stuttgart. J. E.

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1 MEDICAL RADIOLOGY Diagnostic Imaging and Radiation Oncology - Softcover Edition Editorial Board Founding Editors L. W. Brady, M. W. Donner (t), H.-P. Heilmann, EH. W. Heuck Current Editors Diagnostik Imaging Radiation Oncology A. L. Baert, Leuven EH. W. Heuck, Stuttgart J. E. Youker, Milwaukee L. W. Brady, Philadelphia H.-P. Heilmann, Hamburg

2 Springer Berlin Heidelberg New York Barcelona Hong Kong London Milan Paris Singapore Tokyo

3 Radiology of Trauma With Contributions by A.L. Baert J. Brossmann C.H. Buitrago-Tellez A. Chavan U. Dietrich F.J. Ferstl A. Fink M. Freund M. Galanski S. Gryspeerdt F. Häckl K.D. Hagspiel M. Heller K.-F. Kreitner M. Langer R. Low Y. Metz C. Muhle R.H. Oyen S. Palmie M. Reuter H. Schwarzenberg L. Yan Hoe F. Zanella Edited by M. Heller and A. Fink Foreword by Albert 1. Baert With 450 Figures in 843 Separate Illustrations, 1 in Colour Springer

4 Professor Dr. med. MARTIN HELLER Dr. med. ANDREAS FINK Klinik für Diagnostische Radiologie Klinikum an der Christian-Albrechts-Universität zu Kiel Arnold-Heller-Straße Kiel Germany MEDICAL RADIOLOGY. Diagnostic Imaging and Radiation Oncology Continuation of Handbuch der medizinischen Radiologie Encyclopedia of Medical Radiology ISSN ISBN -13: e-isbn-13: DOI: / Library of Congress Cataloging-in-Publication Data applied for Die Deutsche Bibliotbek - CIP-Einheitsaufnahme Radiology of trauma / with contributions by A. L. Baert... Ed. by M. Heller and A. Fink. Foreword by Albert L. Baert. - Berlin; Heidelberg; New York; Barcelona; Hong Kong; London; Milan; Paris; Singapore; Tokyo: Springer, (Medical radiology). ISBN-13: This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under tbe provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under tbe German Copyright Law. Springer-Verlag Berlin. Heidelberg 2000 The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and tberefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. Cover-Design: Joan Greenfield, New York Typesetting: Best-set Typesetter Ud., Hong Kong SPIN: /3135/SPS Printed on acid-free paper

5 Foreword Trauma is a very common condition in medical practice and a frequent cause of death, morbidity and dis ability. Although most radiologists will spend a considerable amount of their time dealing with trauma patients, this topic has not acquired "prestige" status in radiological meetings, journals or books. This is regrettable because the radiologist is frequently able to make a specific and very valuable contribution to the handling and management of trauma patients admitted to the emergency departments of our hospitals. Indeed, the radiologist, by virtue of his specific expertise, is able to provide excellent advice to clinicians concerning the choice and the sequence of examinations. He can thereby provide qualified support for rapid decisions that may be either vital for the patient's outcome or decisive for an early recovery without dis ability or long-iasting sequelae. This book is unrivalled in its complete and meticulous coverage of the diagnostic imaging methods used in trauma patients. It is written by outstanding European experts and provides comprehensive coverage of all anatomical areas that may be involved in patients with skeletal or visceral traumatic lesions. Professor M. Heller, Dr. A. Fink, and their team in Kiel have long-standing experience and a solid international reputation in the field of radiological imaging and management of trauma. They have been assisted in their task by several other well-known specialists in this area. This book will certainly be welcomed by all general radiologists and by radiologists in training since it will fully update their knowledge in trauma radiology, based on the progress achieved by the new imaging modalities. Leuven ALBERT L. BAERT

6 Preface The care, diagnosis, and treatment of patients with multiple traumatic injuries are challenging tasks. When dealing with acutely and severely injured patients, many decisions have to be made under severe time constraints. Nurses, technicians, and physicians of different specialities have to cooperate and communicate very efficiently, and medical supplies, operating rooms, and technical equipment need to be available at short notice and at all times. A great deal of knowledge, experience, and teamwork is necessary to provide good emergency services. The editors of and contributors to this book have acquired their experience mainly in large hospitals that serve as major trauma centers. The book is designed to assist the general radiologist and in particular those in training to prepare for the diagnosis of trauma victims, increasing their confidence and practical knowledge. However, those in other disciplines should also benefit from this book in that they williearn what radiology now has to offer. Communication and cooperation are much easier if one specialist knows what to expect from another, what question to ask, and which information to supply. We have tried to provide an update of modern trauma diagnostics. Against the background of conventional radiology, the book points out the opportunities that modern equipment has to offer: the advantages of fast (spiral or helical) CT, the value of threedimensional CT in assisting surgeons to plan operations, and the current status of ultrasonography and how it compares with CT and peritoneallavage. MRI is covered, with discussion of when and how it can replace arthrography or stress examinations. Knowledge of pitfalls and regular follow-up are equally important in the achievement of good results in trauma patients. It should, however, be pointed out that not only patients with life-threatening injuries are covered by this volume; much attention is given to sprained ankles, broken arms, etc. If not diagnosed and treated adequately, these injuries can cause lifelong sequelae. We are indebted to those who taught us and to those whose books we read during our training. Our goal was to concentrate on significant and relevant issues while leaving out as much academic discussion as possible. We have tried to pass on our experience and opinions to others, and would welcome criticisms and suggestions as to how this book might be further improved. We would like to thank the editors of Medical Radiology, and in particular Prof. A.L. Baert, for their encouragement and support, and U.N. Davis and R. Mills from Springer Verlag for their help and patience. Last but not least, we feel that a word on the ubiquitous subject of health care costs is warranted: In many hospitals, both large ones that serve as trauma centers and smaller ones, a great many people spend more time working at unsocial hours than in most other professions and work with great motivation. They work at Christmas and at weekends for not more than a regular wage because they accept the responsibility that comes with their job. A community has a right to expect good medical service and these people stand ready to do their best, but this service is not and never will be cheap. Kiel, J une 1996 MARTIN HELLER ANDREAS FINK

7 Contents 1 General Aspects of Trauma Radiology M. HELLER and A. FINK Skull, Brain, and Face F. ZANELLA and U. DIETRICH 5 3 Spine C.H. BUITRAGO-TELLEZ, F.J. FERSTL, and M. LANGER 59 4 Neck C.H. BUITRAGO-TELLEZ, F.J. FERSTL, and M. LANGER 95 5 Chest M. GALANSKI and A. CHAVAN Abdominal Trauma K.D. HAGSPIEL Retroperitoneal Trauma L. V AN HOE, S. GRYSPEERDT, R.H. OYEN, and A.L. BAERT The Shoulder Girdle K.-F. KREITNER and R. Löw Elbow S. P ALMIE and M. HELLER Distal Forearm, Wrist, and Hand V. METZ Pelvis, Hip and Proximal Femur J. BROSSMANN, H. SCHWARZENBERG, and M. HELLER Knee Induding Distal Femur, Proximal Tibia, and Fibula C. MUHLE, M. REUTER, and M. HELLER Ankle A. FINK, F. HÄCKL, and M. HELLER Foot M. FREUND and M. HELLER Subject Index List of Contributors