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MRI may detect severe bone injuries in ice hockey players
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Results from this retrospective cross-sectional study of ice hockey players indicated MRI could be used to detect severe bone injuries that are not radiographically visible and that most fractures and high-grade contusions sustained in the study group occurred in the medial ankle and midfoot.
Three independent observers reviewed MRI examinations of the feet and ankles of 27 elite ice hockey players with 31 acute injuries and no radiographically visible fractures. The severity and location of bone injuries were observed with MRI. The Fisher exact test was used to determine correlations between the mechanism of injury and the bones involved. Investigators used a t-test determine whether MRI evidence of a severe bone injury correlated with longer recovery for cases in which return-to-play data were available.
Of the 31 MRI examinations, investigators found at least one bone injury in 27 examinations, with 10 radiographically occult fractures. There was substantial agreement among the three observers for the categorization of injuries. Direct blows were the cause of 17 injuries, which resulted in six fractures and six high-grade bone contusions.
According to the researchers, direct impaction showed statistically higher odds of resulting in severe bone injuries and involving the medial foot and ankle compared with other injury mechanisms. Return-to-play data were available for 20 injuries and showed players with severe bone injuries missed a mean of 10.6 games while other players missed a mean of 2.4 games. ‒ by Monica Jaramillo
Disclosure: The researchers report no relevant financial disclosures.
Perspective
Back to TopElizabeth A. Arendt, MD
This article recognizes the value of MRI in identifying severe bone contusions and, at times, occult nondisplaced fractures that help explain pain and disability associated with an acute foot and ankle injury. Injuries are most often caused by contact with a puck and most severe when involved with the medial ankle. This study was retrospective, with incomplete details on mechanism of injury and follow-up. However, in this cohort of mostly elite ice hockey players, understanding the severity of the injury and its potential time table for return to play is crucial for the team. The authors detail several examples where the MRI was valuable in further treatment. The authors encourage the use of MRI when there is a history of a direct blow to the ankle, especially the medial side, with negative radiographs and greater than expected disability.
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