Posterior bow and vanishing line signs in diagnosis of burst fractures of the spine on plain radiographs

Tsung Jen Huang, Chao Yu Chen, Gwo Fong Fan, Yi Shyan Liao, Yuan Kun Tu, Ho Fai Wong, Robert Wen Wei Hsu

Research output: Contribution to journalArticle

Abstract

It is not uncommon to misdiagnose a burst fracture as a wedge compression fracture initially on plain film, resulting in a late progressive deformity and neurologic damage. The purpose of this study was to analyze the sensitivity, specificity and positive predictive value of plain radiographs in the diagnosis of thoracic and lumbar burst fractures using the posterior bow (PB) and vanishing line (VL) signs. Seven independent examiners, comprising three chief orthopedic residents, two radiologic third-year residents and two emergency attending physicians (orthopedists), randomly reviewed 26 sets of admission anteroposterior and lateral thoracolumbar spine radiographs taken in association with back injuries. They were asked to decide whether patients had a burst or a wedge compression fracture. All patients had computed tomography (CT) scans for diagnostic confirmation. The overall initial sensitivity using discriminant analysis in the diagnosis of burst fractures was 80%. This increased to 90% after the examiners were requested to use the PB and VL signs. The specificity decreased slightly from 75% to 71%, while the positive predictive value remained at 88%. Overdiagnosis of wedge compression fractures as burst fractures occurred, especially when the quality of the films was not ideal. We conclude that, with careful reading, the PB and VL signs help in identifying burst fractures on the initial plain film evaluation.

Original languageEnglish
Pages (from-to)929-932
Number of pages4
JournalJournal of the Formosan Medical Association = Taiwan yi zhi
Volume95
Issue number12
Publication statusPublished - Dec 1996
Externally publishedYes

Fingerprint

Compression Fractures
Spine
Motion Pictures
Back Injuries
Discriminant Analysis
Diagnostic Errors
Nervous System
Orthopedics
Reading
Emergencies
Thorax
Tomography
Physicians
Sensitivity and Specificity

Keywords

  • burst fractures
  • plain radiographs
  • posterior bow sign
  • thoracolumbar
  • vanishing line sign

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Posterior bow and vanishing line signs in diagnosis of burst fractures of the spine on plain radiographs. / Huang, Tsung Jen; Chen, Chao Yu; Fan, Gwo Fong; Liao, Yi Shyan; Tu, Yuan Kun; Wong, Ho Fai; Hsu, Robert Wen Wei.

In: Journal of the Formosan Medical Association = Taiwan yi zhi, Vol. 95, No. 12, 12.1996, p. 929-932.

Research output: Contribution to journalArticle

Huang, Tsung Jen ; Chen, Chao Yu ; Fan, Gwo Fong ; Liao, Yi Shyan ; Tu, Yuan Kun ; Wong, Ho Fai ; Hsu, Robert Wen Wei. / Posterior bow and vanishing line signs in diagnosis of burst fractures of the spine on plain radiographs. In: Journal of the Formosan Medical Association = Taiwan yi zhi. 1996 ; Vol. 95, No. 12. pp. 929-932.
@article{402c170a38ec40b49c2abb806be4a29c,
title = "Posterior bow and vanishing line signs in diagnosis of burst fractures of the spine on plain radiographs",
abstract = "It is not uncommon to misdiagnose a burst fracture as a wedge compression fracture initially on plain film, resulting in a late progressive deformity and neurologic damage. The purpose of this study was to analyze the sensitivity, specificity and positive predictive value of plain radiographs in the diagnosis of thoracic and lumbar burst fractures using the posterior bow (PB) and vanishing line (VL) signs. Seven independent examiners, comprising three chief orthopedic residents, two radiologic third-year residents and two emergency attending physicians (orthopedists), randomly reviewed 26 sets of admission anteroposterior and lateral thoracolumbar spine radiographs taken in association with back injuries. They were asked to decide whether patients had a burst or a wedge compression fracture. All patients had computed tomography (CT) scans for diagnostic confirmation. The overall initial sensitivity using discriminant analysis in the diagnosis of burst fractures was 80{\%}. This increased to 90{\%} after the examiners were requested to use the PB and VL signs. The specificity decreased slightly from 75{\%} to 71{\%}, while the positive predictive value remained at 88{\%}. Overdiagnosis of wedge compression fractures as burst fractures occurred, especially when the quality of the films was not ideal. We conclude that, with careful reading, the PB and VL signs help in identifying burst fractures on the initial plain film evaluation.",
keywords = "burst fractures, plain radiographs, posterior bow sign, thoracolumbar, vanishing line sign",
author = "Huang, {Tsung Jen} and Chen, {Chao Yu} and Fan, {Gwo Fong} and Liao, {Yi Shyan} and Tu, {Yuan Kun} and Wong, {Ho Fai} and Hsu, {Robert Wen Wei}",
year = "1996",
month = "12",
language = "English",
volume = "95",
pages = "929--932",
journal = "Journal of the Formosan Medical Association",
issn = "0929-6646",
publisher = "Elsevier Science Publishers B.V.",
number = "12",

}

TY - JOUR

T1 - Posterior bow and vanishing line signs in diagnosis of burst fractures of the spine on plain radiographs

AU - Huang, Tsung Jen

AU - Chen, Chao Yu

AU - Fan, Gwo Fong

AU - Liao, Yi Shyan

AU - Tu, Yuan Kun

AU - Wong, Ho Fai

AU - Hsu, Robert Wen Wei

PY - 1996/12

Y1 - 1996/12

N2 - It is not uncommon to misdiagnose a burst fracture as a wedge compression fracture initially on plain film, resulting in a late progressive deformity and neurologic damage. The purpose of this study was to analyze the sensitivity, specificity and positive predictive value of plain radiographs in the diagnosis of thoracic and lumbar burst fractures using the posterior bow (PB) and vanishing line (VL) signs. Seven independent examiners, comprising three chief orthopedic residents, two radiologic third-year residents and two emergency attending physicians (orthopedists), randomly reviewed 26 sets of admission anteroposterior and lateral thoracolumbar spine radiographs taken in association with back injuries. They were asked to decide whether patients had a burst or a wedge compression fracture. All patients had computed tomography (CT) scans for diagnostic confirmation. The overall initial sensitivity using discriminant analysis in the diagnosis of burst fractures was 80%. This increased to 90% after the examiners were requested to use the PB and VL signs. The specificity decreased slightly from 75% to 71%, while the positive predictive value remained at 88%. Overdiagnosis of wedge compression fractures as burst fractures occurred, especially when the quality of the films was not ideal. We conclude that, with careful reading, the PB and VL signs help in identifying burst fractures on the initial plain film evaluation.

AB - It is not uncommon to misdiagnose a burst fracture as a wedge compression fracture initially on plain film, resulting in a late progressive deformity and neurologic damage. The purpose of this study was to analyze the sensitivity, specificity and positive predictive value of plain radiographs in the diagnosis of thoracic and lumbar burst fractures using the posterior bow (PB) and vanishing line (VL) signs. Seven independent examiners, comprising three chief orthopedic residents, two radiologic third-year residents and two emergency attending physicians (orthopedists), randomly reviewed 26 sets of admission anteroposterior and lateral thoracolumbar spine radiographs taken in association with back injuries. They were asked to decide whether patients had a burst or a wedge compression fracture. All patients had computed tomography (CT) scans for diagnostic confirmation. The overall initial sensitivity using discriminant analysis in the diagnosis of burst fractures was 80%. This increased to 90% after the examiners were requested to use the PB and VL signs. The specificity decreased slightly from 75% to 71%, while the positive predictive value remained at 88%. Overdiagnosis of wedge compression fractures as burst fractures occurred, especially when the quality of the films was not ideal. We conclude that, with careful reading, the PB and VL signs help in identifying burst fractures on the initial plain film evaluation.

KW - burst fractures

KW - plain radiographs

KW - posterior bow sign

KW - thoracolumbar

KW - vanishing line sign

UR - http://www.scopus.com/inward/record.url?scp=0030498018&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0030498018&partnerID=8YFLogxK

M3 - Article

C2 - 9000810

AN - SCOPUS:0030498018

VL - 95

SP - 929

EP - 932

JO - Journal of the Formosan Medical Association

JF - Journal of the Formosan Medical Association

SN - 0929-6646

IS - 12

ER -