HiRes Infrared Imaging for Wrist Injuries in Children v2
Condition: Fractures, Bone
MeSH terms: Fractures, Bone; Wrist Injuries
Study type: Interventional

Summary: 
      When assessing an injured child, doctors must decide whether or not there is an underlying
      bony fracture. The current way of doing this is by x-ray. In 2011, 46,000 children attended
      Sheffield Children's Hospital Emergency Department and 10,400 x-rays were taken -
      predominately for diagnosis of fractures. For foot and wrist, 2,215 x-rays were 'normal' with
      no fracture, at a cost of £119,610 (at a tariff of £54 per x-ray). Considering the cost and
      undesired effect of radiation exposure, a better way to discriminate those patients with
      fracture is needed. The non-invasive technique of thermal imaging holds promise as a putative
      technique.

      The investigators have earlier demonstrated the potential of thermal imaging for vertebral
      fractures, diagnosing limp and measuring respiration rate. This study investigates thermal
      imaging to screen for wrist fractures. The objectives are: (i) accurately identify fracture
      location, (ii) exclude cases that are sprain and thus reduce the need for their x-ray. The
      confirmation of a fracture would still require a x-ray. As the study is in collaboration with
      Sheffield Children's Hospital, only children will be included, however the findings will also
      be applicable to adults. Thermal imaging is a completely safe and harmless operation, as the
      camera is non-contact and emits no radiation.

      Any trauma, such as a wrist fracture, results in changes in blood flow that in turn affects
      the skin surface temperature of the skin overlying the injury. These changes affect the
      amount of emitted infrared radiation and will be recorded and explored to find a marker to
      differentiate fractures and sprains.
    

Detailed description: 
      Thermal (IR) imaging is based on recording and processing of a part of electromagnetic
      spectrum below visible light, i.e. infrared band. Objects with a temperature above -273°C (-
      459.67°F) emit thermal radiation. In thermography a camera that is sensitive to the mid (3-5
      μm) and long (7-14 μm) infrared bands of the electromagnetic spectrum is used. The detection
      of an injury using thermal imaging relies on underlying physiology of temperature
      differentials.

      Dermal temperature differentials usually do not exceed 0.25°C, while differentials in excess
      of 0.65°C are consistently related to pathology. Therefore observation of a significant
      temperature differential is an indication of injury. The use of Infrared for musculoskeletal
      medical diagnosis and monitoring has been reported in many studies in children and adults.

        -  Vertebral fractures were detected using thermal imaging • Thermal imaging assisted in
           diagnosis of the causes of limp including bone fracture.

      Thermography has detected a direct correlation between an increase in skin temperature and
      the existence of anterior) knee pain after implantation of artificial knee joints. It is
      suggested that thermal imaging is potentially valuable for a rapid, inexpensive and
      non-invasive diagnosis of pain and inflammation. Infrared spectroscopic analysis has been
      reported to be is a powerful tool for establishing the material properties that contribute to
      bone strength and so it thus has been helpful in improving the understanding of the changes
      in fragile bone.

      • The temperature of the bone during drilling could increase above 47oC. This can cause
      irreversible osteonecrosis. A study used infrared thermal imaging to determine spatial
      distribution of increase in bone temperature during drilling.

      Blood convection warms the skin by transfer of heat from the core and this process plays the
      major role in determining skin temperature. Skin's has a thermoregulation role, i.e. it
      generates, absorbs, conducts and radiates heat. Changes in the skin surface temperature are
      valuable in detecting physiological and pathological state such as inflammation.

      With recent developments in thermal imaging devices, the use of infrared imaging for injury
      examination is gaining a growing interest, with more evidence supporting its use. However,
      the data in children is limited, with the investigators' research group undertaking the
      majority of work in this field currently.

      In this study the infrared emission (characterised by heat radiation) from skin at the site
      of injury is imaged and analysed to differentiate between wrist fracture and sprain. The
      hypothesis is that the inflammation and blood perfusion in sprain and bone fracture at the
      site of injury are different leading to distinct temperature gradients at the site.
    

Intervention name(s): Thermal Imaging; X-RAY
Intervention type(s): Device; Diagnostic Test
Intervention description(s): Thermal Imaging device used to evaluate fracture in those presenting with proposed wrist fracture in the emergency department.; Routine X-RAY
Allocation: Non-Randomized
Intervention model: Single Group Assignment
Intervention model description: Comparison between thermal imaging and x-ray.
Masking: Single (Care Provider)
Primary purpose: Diagnostic