Diagnostic and Therapeutic Foot and Ankle Injections.

For patients with disabling foot or ankle pain, medical or surgical treatment decisions can be difficult to make when multiple joints show changes of osteoarthritis or if the patient's pain clinically is related to a joint or tendon that is normal by other imaging studies. For these patients, injection of anesthetic, steroid, or both, into joints or tendon sheaths of the foot and ankle provides important diagnostic information and therapeutic relief. Diagnostic injections may show that the joints noted by other imaging studies have osteoarthritis that are not responsible for a patient's pain or that a normal joint is responsible.

Gaze dwell times on acute trauma injuries missed because of satisfaction of search.

Rationale And Objectives: The authors performed this study to determine whether satisfaction of search (SOS) errors in patients with multiple traumas are caused by faulty visual scanning, faulty recognition, or faulty decision making.

Materials And Methods: A series of radiographs were obtained in patients with multiple traumas. Radiologists interpreted each series under two experimental conditions: when the first radiograph in the series included a fracture, and when it did not.

Effect of knowledge of chronologic age on the variability of pediatric bone age determined using the Greulich and Pyle standards.

Objective: The purpose of this study was to investigate the impact of knowing chronologic age on the variability of pediatric bone age determination using the method of Greulich and Pyle.

Materials And Methods: Radiographs of the left hand of 107 patients were interpreted by four radiologists on two separate occasions, once with and once without knowledge of the patient's chronologic age at time of interpretation. Twenty-five radiographs were randomly selected and reevaluated twice by each radiologist.

High density polyetherurethane foam as a fragmentation and radiographic surrogate for cortical bone.

Background: Although one of the most important factors in predicting outcome of articular fracture, the comminution of the fracture is only subjectively assessed. To facilitate development of objective, quantitative measures of comminution phenomena, there is need for a bone fragmentation surrogate.

Methods: Laboratory investigation was undertaken to develop and characterize a novel synthetic material capable of emulating the fragmentation and radiographic behavior of human cortical bone.

Clinical failure after posterior wall acetabular fractures: the influence of initial fracture patterns.

Objective: To determine radiographic and clinical features that predict rapid failure after open reduction and internal fixation of posterior wall acetabular fractures.

Design: Retrospective radiographic review and patient follow-up study.

Setting: University hospital.

Contribution of individual projections alone and in combination for radiographic detection of ankle fractures.

Objective: We wanted to determine whether the standard three-view ankle radiographic series could be replaced by a two-view combination, and if so, which two-view combination (anteroposterior with lateral or mortise with lateral) would be superior.

Materials And Methods: During a 12-month period, we retrospectively reviewed 556 consecutive ankle radiographic studies consisting of anteroposterior, mortise, and lateral views. One hundred twenty patients with at least one ankle fracture were paired with 140 healthy control subjects.

A contaminated binormal model for ROC data: Part I. Some interesting examples of binormal degeneracy.

Rationale And Objectives: Receiver operating characteristic (ROC) data with false-positive fractions of 0 are often difficult to fit with standard ROC methods and are sometimes discarded. Some extreme examples of such data were analyzed to evaluate the nature of these difficulties.

Materials And Methods: Rating reports of fracture for single-view ankle radiographs were analyzed with the binormal ROC model and with two ROC models that keep the ROC curve from crossing the chance line.

The variable presentation and natural history of Langerhans cell histiocytosis.

Langerhans cell histiocytosis is not a well defined or predictable disease. Instead, it is a spectrum of disorders of unknown etiology that vary widely in presentation and natural history, but have in common the proliferation of histiocytic cells and infiltration of these cells into normal tissues. Although the lesions of Langerhans cell histiocytosis consist primarily of histiocytes, eosinophils are a prominent feature in some lesions.

Pains, strains, and fasciculations: lower extremity muscle disorders.

Muscle injuries that were suspected only on the basis of clinical examination are now readily demonstrated and characterized using MR imaging. Imaging is used not only for assessment of location, type, and severity of muscle injuries; it plays an important role in treatment planning, and the detection of complications. MR imaging also is useful in nontraumatic muscle disorders including congenital, inflammatory, and infectious myositis, and in cases of denervation, MR imaging is valuable for diagnosis, staging, and prognostication.

Radiographic abnormalities of the lumbar spine in college football players. A comparative analysis.

The purpose of this study was to make a direct comparison between lumbar spine radiographs of incoming college football players and of an age-matched control group to determine whether there is a higher prevalence of lumbar spine abnormalities in football players before competing at the Division I level. We reviewed 187 lumbar spine radiographs. Of these, 104 were taken as a standard part of the preparation physical examination for incoming college football players.

Imaging features of avulsion injuries.

Avulsion injuries are common among participants in organized sports, especially among adolescent participants. Imaging features of both acute and chronic avulsion injuries of the pelvis, knee, ankle and foot, shoulder, and elbow were evaluated to help distinguish these injuries from more serious disease processes such as neoplasm and infection. At radiography, acute injuries (ie, those resulting from extreme, unbalanced, often eccentric muscular contractions) may be associated with avulsed bone fragments, whereas subacute injuries have an aggressive appearance that may include areas of mixed lysis and sclerosis.

Non-traumatic lesser trochanter avulsion: a report of three cases.

Avulsion fractures of the lesser trochanter in adults are almost always due to metastatic bone disease. Familiarity with this characteristic association can lead to early diagnosis and assist the orthopaedist in implementing effective management. We report three patients with avulsion of the lesser trochanter due to neoplasm.

Elastofibroma dorsi: prevalence in an elderly patient population as revealed by CT.

Objective: We wanted to determine the prevalence and appearance of elastofibroma dorsi in an elderly patient population (n = 258) who underwent CT of the chest for reasons other than to evaluate posterolateral chest wall pain, stiffness, or a mass.

Conclusion: Five elastofibromas were detected in four patients; none of these elastofibromas were noted at initial examination. Our study suggests that the prevalence of elastofibroma dorsi revealed by CT is 2%, which is lower than the 11-24% found in autopsy series but higher than expected for such a rare tumor.

Longitudinal tibial stress fractures: a report of eight cases and review of the literature.

Purpose: We present the imaging features of longitudinal stress fractures in eight patients and evaluate the literature to determine which tests are most useful for making this diagnosis.

Method: Three musculoskeletal radiologists retrospectively reviewed eight cases of longitudinal tibial stress fractures presenting between 1988 and 1994. Reports on 36 cases, cited in the literature between 1960 and 1996, also were reviewed.

Assessment of the AO/ASIF fracture classification for the distal tibia.

Objectives: The purpose of this study was to assess the interobserver reliability and intraobserver reproducibility of the AO/ASIF and Rüedi and Allgöwer classifications for fractures of the distal tibia, and to determine the benefit of a computed tomography (CT) scan and experience on observer agreement for several fracture characteristics, including classification.

Methods: The radiographs of forty-three fractures of the distal tibia, fourteen of which had CT scans, were assessed by groups of experienced and less-experienced observers. Each case was classified according to the AO/ASIF and Rüedi and Allgöwer systems.

Modified technique for fluid aspiration from the hip in patients with prosthetic hips.

A modified technique was used for diagnostic aspiration of fluid from the hip in 185 patients who had previously undergone total hip arthroplasty. The aspiration needle was advanced past the lateral aspect of the shaft of the prosthesis and into the dependent portion of the joint. Fluid was successfully aspirated in 181 of 185 patients; thus the dry-tap rate was 2.

Stress and insufficiency fractures.

Stress fractures of the axial and appendicular skeleton typically present as localized pain that develops without a history of specific acute injury. The differential diagnosis includes primary or metastatic neoplasms, infections, musculoskeletal soft tissue injuries, nerve compression syndromes and joint diseases. Plain radiographs may demonstrate changes consistent with fracture, including a fracture line or fracture callus.

Role of MR imaging in acute injuries to the appendicular skeleton.

Clinical applications of MR imaging in the setting of acute extremity injuries are discussed in general and by anatomic regions. General indications include physeal injuries, occult fractures, stress fractures, musculotendinous injuries, and ligamentous injuries. Indications of MR imaging in the acute injury setting have been expanding.

Pelvic and acetabular trauma.

Blunt pelvic trauma may lead to disruption of the pelvic ring, acetabular fracture, and significant soft tissue injury. The radiologist must be familiar with not only the imaging approach to these lesions but also the anatomy, biomechanics of injury, and fracture classification to communicate effectively with trauma surgeons and to participate as a member of the trauma team.

Thoracic and lumbar spine trauma.

The thoracic and lumbar regions of the spine have unique anatomic and biomechanical features that result in different characteristic patterns of injury. This article reviews common injuries to the thoracic and lumbar spine and emphasizes the relationship between anatomic features and characteristic patterns of injury. An approach to imaging of the trauma patient is presented, focusing on detection and classification of spinal injuries.

Pediatric radiology at a rural hospital: value of teleradiology and subspecialty consultation.

Objective: We performed a field study and subsequent laboratory investigation of pediatric radiology at a small rural hospital. Our investigation had three components: to describe the characteristics of pediatric radiology in a rural primary care facility, to test the diagnostic accuracy of interpretation of pediatric images transmitted by teleradiology, and to compare relative diagnostic accuracy of general and pediatric radiologists who interpreted pediatric images at a rural institution.

Materials And Methods: All 196 pediatric radiographs obtained during a 4-month period comprised the database from which we determined practice characteristics.