背景:跟骨是最常见的骨骨折。由于细微的影像学变化,诊断通常具有挑战性,需要及时识别以防止并发症。包括距下关节炎,神经血管损伤,malunion,骨髓炎,和室综合征。治疗方法因骨折类型而异,非移位应力性骨折的非手术方法和移位或关节内骨折的手术干预。
方法:这项研究利用了诊断成像模拟(WIDISIM)平台的智慧,紧急成像模拟,旨在评估放射科居民对独立呼叫的准备。在8小时的模拟中,对65例居民进行了不同复杂性的各种影像学检查,包括正常的研究。单身,独特的跟骨骨折病例在4年的测试中被纳入模拟范围.病例由亚专业放射科教师使用标准化分级规则进行评估,错误随后按类型分类。
结果:在5个不同的患者中,共有1279名居民接受了5例跟骨骨折的测试。分析揭示了在所有训练年中漏诊的一致模式,主要归因于观测错误。训练进展的改善有限,因为所有训练年的平均表现水平相似。
结论:跟骨骨折由于其频繁的细微影像学表现,对诊断提出了挑战。尤其是应力性骨折。使用WIDISIM进行的基于模拟的评估突显了放射科居民诊断跟骨骨折的熟练程度所面临的挑战。通过有针对性的教育和接触各种病例来应对这些挑战对于提高诊断准确性和减少跟骨骨折并发症至关重要。
BACKGROUND: The calcaneus is the most commonly fractured tarsal bone. Diagnosis is often challenging due to subtle radiographic changes and requires timely identification to prevent complications, including subtalar arthritis, neurovascular injury, malunion, osteomyelitis, and compartment syndrome. Treatment varies based on fracture type, with non-surgical methods for non-displaced stress fractures and surgical interventions for displaced or intra-articular fractures.
METHODS: This study utilized the Wisdom in Diagnostic Imaging
Simulation (WIDI SIM) platform, an emergency imaging
simulation designed to assess radiology resident preparedness for independent call. During an 8-hour
simulation, residents were tested on 65 cases across various imaging modalities of varying complexity, including normal studies. A single, unique case of calcaneal fracture was included within the
simulation in four separate years of testing. Cases were assessed using a standardized grading rubric by subspecialty radiology faculty, with errors subsequently classified by type.
RESULTS: A total of 1279 residents were tested in five separate years on the findings of calcaneal fractures of 5 different patients. Analysis revealed a consistent pattern of missed diagnoses across all training years, primarily attributed to observational errors. There was limited improvement with training progression as all training years exhibited similar average performance levels.
CONCLUSIONS: Calcaneal fractures pose a diagnostic challenge due to their frequent subtle radiographic findings, especially in stress fractures.
Simulation-based evaluations using WIDI SIM highlighted challenges in radiology residents\' proficiency in diagnosing calcaneal fractures. Addressing these challenges through targeted education and exposure to diverse cases is essential to improve diagnostic accuracy and reduce complications with calcaneal fractures.