Orthopedic hardware in trauma – A guided tour for the radiologist-Associated complications (Part 2)

Abstract

With the increasing number of options available for surgical management of fractures now available, it is imperative that radiologists should familiarize themselves with the various hardwares used to provide a good support system for orthopedic surgeons. Understanding fracture union and “why a device may fail” are basic concepts that have been discussed in this review article, as their success is mutually dependent. While it may be easy to identify frank loosening, fracture, or migration of the hardware, it is more important to identify any early signs of these complications. However, before that, as a radiologist, one should be able to accurately identify the hardware type, assess their position, and then identify any potential complications. Another important aspect that is clinically important is the ability to differentiate between aseptic and septic loosening. Apart from these, avascular necrosis, pseudoaneurysms, bursitis, muscle impingement with atrophy, adverse reaction to metal debris, nerve impingements, traumatic neuroma formation, tendon impingement, snapping syndromes, and sarcoma are uncommon complications that may be rarely encountered. While conventional radiology is still the backbone of radiological evaluation, CT, MRI, and Ultrasound can be used as problem-solving tools, further aiding in the diagnosis of any hardware-related complications. In this series, we have also described a checklist based approach of reporting so that the radiologist can accurately identify the hardware, assess their position, and identify any potential complications. We hope that this learning will facilitate the interobserver consensus and standardization of reports.