A primer on skeletal dysplasias.

Skeletal dysplasia encompasses a heterogeneous group of over 400 genetic disorders. They are individually rare, but collectively rather common with an approximate incidence of 1/5000. Thus, radiologists occasionally encounter skeletal dysplasias in their daily practices, and the topic is commonly brought up in radiology board examinations across the world.

Bone contusion progression from traumatic knee injury: association of rate of contusion resolution with injury severity.

Background: Bone contusions are frequently encountered in magnetic resonance imaging (MRI) evaluation of knee anterior cruciate ligament (ACL) injuries. Their role as indicators of injury severity remains unclear, primarily due to indeterminate levels of joint injury forces and to a lack of preinjury imaging.

Purpose: The purpose of this study was to 1) quantify bone contusion pathogenesis following traumatic joint injuries using fixed imaging follow-ups, and 2) assess the feasibility of using longitudinal bone contusion volumes as an indicator of knee injury severity.

Pediatric stress fractures: a pictorial essay.

More children are participating in organized and recreational athletics at a younger age. It has been well documented that increased athletic specialization and year-round activities have resulted in higher incidences of overuse injuries, including stress fractures and stress reactions. Initially, stress fractures can be radiographically occult.

Diagnostic accuracy of 3D color volume-rendered CT images for peroneal tendon dislocation in patients with acute calcaneal fractures.

Background: Use of three-dimensional (3D) color volume-rendered (VR) images has been reported to be more time-efficient compared to that of cross-sectional computed tomography (CT) images for the diagnosis of peroneal tendon dislocation. However, the diagnostic performance of this technique has not been studied.

Purpose: To test diagnostic accuracy of 3D color VR CT images of ankle for peroneal tendon dislocation in patients with acute calcaneal fractures.

Masses in the extensor mechanism of the knee: an unusual presentation of gout.

Tophaceous gout presenting as a soft tissue mass in an unusual location can pose a diagnostic challenge for radiologists. Tophi sometimes occur in a variety of unusual anatomic locations making them difficult to distinguish from tumors such as sarcomas. We report two cases of gout in the extensor mechanism of the knee, with imaging findings that were initially concerning for a neoplasm.

Clinical role of radiography for thoracic spine fractures in daily practice in the MDCT era: a retrospective review of 255 trauma patients.

Purpose: To retrospectively assess the diagnostic efficacy of radiography in detecting vertebral body fractures of the thoracic spine compared with MDCT, to assess the confounding factors reducing the diagnostic efficacy, and to investigate the outcomes of radiographically overlooked patients.

Materials And Methods: Two hundred fifty-five patients suspected of thoracic spine fractures were enrolled. We assessed the diagnostic efficacy of radiography for the patients sub-grouped based on five confounding factors: chest abnormalities, head injuries, cervical spine fractures, upper extremity injuries, and age of 65 years or older.

SAPHO syndrome--a pictorial assay.

SAPHO (synovitis, acne, pustulosis, hyperostosis and osteitis) syndrome is a distinct clinical entity representing involvement of the musculoskeletal and dermatologic systems. It is well known to rheumatologists because of characteristic skin manifestations and polyarthropathy. However, few reports exist in the orthopaedic literature.

Early spondylodiscitis presenting with single vertebral body involvement: a report of two cases.

Infectious spondylodiscitis is an uncommon disease with increasing incidence that typically presents with abnormalities in two adjacent vertebral bodies and the intervening disk. We describe two cases that initially presented with imaging abnormalities in only a single vertebral body. Both patients had a history of lumbar back pain and elevated inflammatory markers, but the lack of classical spondylodiscitis imaging findings led to diagnostic delay and confusion.

Cervical facet joint septic arthritis: a case report.

Facet joint septic arthritis is a rare but severe infection with the possibility of significant morbidity resulting from local or systemic spread of the infection. Pain is the most common complaint on presentation followed by fever, then neurologic impairment. While the lumbar spine is involved in the vast majority of cases presented in the literature, the case presented here occurred in the cervical spine.

Conical utility of CT-guided biopsies in orthopaedic oncology.

Background: CT-guided biopsy is a minimally invasive diagnostic method of evaluating musculoskeletal lesions. Other options include incisional and excisional biopsy with the possibility of intraoperative frozen section. The clinician's decision to order a CT-guided biopsy requires an understanding of the likelihood that this biopsy will affect treatment This requires an understanding of both diagnostic yield and accuracy.

Musculoskeletal CT: recent advances and current clinical applications.

This article discusses the indications for CT in the management of acute fractures and postoperative complications related to orthopedic procedures. The current clinical use of CT in spine injuries, pelvic/acetabular fractures, and major fractures in the extremities is discussed. Multidetector CT techniques to minimize metal artifacts and common hardware complications are reviewed.

Radiologic evaluation of chronic foot pain.

Chronic foot pain is a common and often disabling clinical complaint that can interfere with a patient's routine activities. Despite careful and detailed clinical history and physical examination, providing an accurate diagnosis is often difficult because chronic foot pain has a broad spectrum of potential causes. Therefore, imaging studies play a key role in diagnosis and management.

Role of magnetic resonance imaging in musculoskeletal trauma.

The unique ability of magnetic resonance (MR) imaging to visualize injuries of bone, cartilage, bone marrow, and supporting soft tissue structure makes it ideally suited for the evaluation of musculoskeletal trauma. Magnetic resonance imaging also offers exquisitely detailed anatomical information on the musculoskeletal system. The widespread availability of MR imaging and the constantly improving technology make it the imaging modality of choice for the patients with a musculoskeletal trauma.

Occult fractures of extremities.

Recent advances in cross-sectional imaging, particularly in CT and MR imaging, have given these modalities a prominent role in the diagnosis of fractures of the extremities. This article describes the clinical application and imaging features of cross-sectional imaging (CT and MR imaging) in the evaluation of patients who have occult fractures of the extremities. Although CT or MR imaging is not typically required for evaluation of acute fractures, these modalities could be helpful in the evaluation of the occult osseous injuries in which radiographic findings are equivocal or inconclusive.

Imaging of the acetabulum in the era of multidetector computed tomography.

Acetabular fractures are often complex injuries and the result of high-energy trauma with associated injuries. Understanding and classification of these rare injuries using radiography can be difficult and are much facilitated by the addition of computed tomography (CT). The purpose of this paper is to briefly review some of the underlying physical principles and technical factors for multidetector CT (MDCT) and to describe its use and imaging findings in the evaluation of acetabular fractures.

Sleeve fracture at the superior pole of the patella.

We present a sleeve fracture at the superior pole of the patella in a 12-year-old boy. Sleeve fractures at the inferior pole of the patella have been well described in the orthopedic and radiologic literature. However, a similar injury at the superior pole of the patella is relatively rare.

A single fracture in the ring of vertebrae below the atlas: report of four cases.

A single fracture of the ring of a vertebra is a rare injury of the spine. In this report, we present five single fractures of the posterior ring of the cervical spine below the atlas from four patients after motor vehicle accidents. Initial radiographs failed to show any of these fractures; all were detected by computed tomography.

A single fracture in the atlas ring: report of two cases and a review of the literature.

Atlas fractures commonly present more than two breaks in its ring structure because of the unique anatomy and the mechanism of injury. The incidence of a single break in the atlas ring is exceedingly rare. However, we encountered two cases of a single fracture of the atlas.

Peroneal tendon subluxation and dislocation: detection on volume-rendered images--initial experience.

Institutional review board approval was received and informed consent was not required for this Health Insurance Portability and Accountability Act-compliant study. The purpose of this study was to retrospectively assess the time efficiency of three-dimensional volume-rendered images obtained from multi-detector row computed tomographic data for the diagnosis of peroneal tendon subluxation or dislocation by using the consensus interpretation of multiplanar reformatted (MPR) images as the reference standard. The reference standard was provided by two musculoskeletal radiologists, and two less experienced readers evaluated 37 images in 32 patients (24 men, eight women; mean age, 41 years; age range, 18-75 years) with acute calcaneal fractures.

Imaging of cervical spine injuries of childhood.

Cervical spine injuries of children, though rare, have a high morbidity and mortality. The pediatric cervical spine is anatomically and biomechanically different from that of adults. Hence, the type, level and outcome of cervical spine injuries in children are different from those seen in adults.

Interobserver agreement for Letournel acetabular fracture classification with multidetector CT: are standard Judet radiographs necessary?

Purpose: To retrospectively evaluate interobserver agreement for Letournel acetabular fracture classification with radiography alone and multidetector computed tomography (CT) alone and to retrospectively assess whether standard Judet views lead to a change in the classification.

Materials And Methods: Institutional review board approval was obtained; informed consent was not required for this HIPAA-compliant study, which included 101 imaging studies performed in 99 patients (78 male, 21 female; mean age, 43 years; age range, 15-86 years) with acetabular fractures. Two musculoskeletal radiologists independently classified the fractures with radiography alone and multidetector CT alone.

MDCT in the evaluation of skeletal trauma: principles, protocols, and clinical applications.

Multidetector computed tomography (MDCT) scanners have made volume imaging possible and are used extensively to study polytrauma patients, especially in the evaluation of the spine and peripheral skeleton. An MDCT scanner coupled with a modern workstation has become an essential diagnostic tool for any emergency department. Familiarity with the basic physical principles of MDCT such as projection data, section collimation, and beam collimation is important to achieve high-quality imaging while keeping unnecessary radiation to a minimum.

Axial loading with hyperflexion injury to the atlas resulting in crushed lateral masses.

A 40-year-old man was involved in an ATV accident, in which he landed on the top of his head. There was no neurological deficit. A plain radiograph showed prevertebral soft tissue swelling at the atlas and axis level.

Osteoblastomatosis of bone. A benign, multifocal osteoblastic lesion, distinct from osteoid osteoma and osteoblastoma, radiologically simulating a vascular tumor.

Two adult patients are described with multifocal osteolytic lesions radiologically simulating a vascular tumor. One patient had multiple bones involved. Histologically, the individual lesions had the features of the nidus of osteoid osteoma/osteoblastoma.

Horizontal fracture of the anterior arch of the atlas associated with a congenital cleft of the anterior arch.

We report a rare combination of a horizontal fracture of the anterior arch of the atlas associated with a congenital cleft of the anterior arch. Sagittally reformatted computed tomography (CT) images demonstrated a fracture of the anterior arch of the atlas and a type II odontoid process fracture. There was also a smoothly marginated midline cleft of the anterior arch just above the fracture consistent with a congenital variant.