In this case study, we show the importance of infrared thermography as a diagnostic support tool in the case of a patella fracture.

We have a thermal image of the subject before the accident that she suffered in her left knee: no significant asymmetry in the region (+0,15ºC). Immediately after the accident (she tripped and fell hitting her knee on a stone), she visited the emergency unit of a hospital. She was treated because of the superficial wound on the knee, but other injury/damage was ruled out. Four weeks after the accident, the wound was healed but she still referred significant pain in the region. A thermal evaluation revealed a hyperthermic asymmetry of more than 1ºC (1,38ºC) on the left knee.

Some days after, a magnetic resonance confirmed the fracture of the patella of the left knee (as we can see in image 1). Sadly, the first assessment performed right after the accident underestimated the injury severity.

Image 1. Magnetic resonance image showing the fracture of the patella

As Sillero-Quintana and collaborators (2015) described in a study with Emergency unit patients, bone fractures showed a significant hyperthermic asymmetry (+0 9ºC).

Therefore infrared thermography can be used to support the diagnosis process, saving time and avoiding false negatives is as this case.

Sillero-Quintana et al. (2015)

ThermoHuman software allows us to quantify the evolution of knee asymmetry over time. The thermal asymmetries showed on the 4th week after the accident (+1,38ºC) are similar to the evolution described by Haluzan and collaborators (2015) in a study focused on radius fractures. In addition to that, the recent new knee protocol from ThermoHuman shows us more detailed data and segmentation, so we can even observe a 2,17ºC hyperthermic asymmetry on the patella region (figure 2).

Figure 2. ThermoHuman avatar and thermal image of the knees, showing an asymmetry of 2.17ºC in the right patella (injured one).

If thermography had been used during the first evaluation in the hospital, the bone injury would not have been ruled out. Unfortunately that was not the case, and when the thermographic evaluation was carried out (4 weeks later) it was too late: the subject had to be operated to reconstruct her patella. The use of infrared thermography is extremely interesting in cases like this one, in order to support diagnosis, to save time, and to avoid false negatives and the health and economic problems linked to such situations (Sillero et al., 2015; Haluzan et al., 2015).

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References:

- Haluzan, D., Davila, S., Antabak, A., Dobric, I., Stipic, J., Augustin, G., ... & Prlic, I. (2015). Thermal changes during healing of distal radius fractures—Preliminary findings. Injury, 46, S103-S106.

- Sillero-Quintana, M., Fernández-Jaén, T., Fernández-Cuevas, I., Gómez-Carmona, P. M., Arnaiz-Lastras, J., Pérez, M.-D., & Guillén, P. (2015). Infrared Thermography as a Support Tool for Screening and Early Diagnosis in Emergencies. Journal of Medical Imaging and Health Informatics, 5(6), 1223-1228. doi: 10.1166/jmihi.2015.1511