Roentgen rounds #85. Compression fractures of lumbar vertebrae 3, 4, and 5.

Vertebral fractures in children are very rare and usually result from hyperflexion. Symptoms may be minimal, and most children are neurologically normal. Multiple vertebral fractures are common.

Carpal avascular necrosis: MR imaging.

The authors evaluated the use of magnetic resonance (MR) imaging in diagnosis of avascular necrosis (AVN) of carpal bones by examining 21 patients with wrist pain and two healthy volunteers. MR images were compared with conventional radiographs in every case and with bone scintigrams in 18 cases. MR imaging was slightly less sensitive than bone scintigraphy in depicting AVN, but in patients who were imaged with long repetition time (TR)/long echo time (TE) sequences in addition to short TR/short TE sequences, MR imaging was found to be more specific.

Breakage of the patellar component of a kinematic total knee arthroplasty. A case report.

Most complications of total knee arthroplasty have been of a general nature (ie, infection, pulmonary embolus, nerve palsy), or have involved either the tibial or femoral components. Occasionally, problems involving the patellar implant have been described including subluxation/dislocation, soft tissue impingement and patellar fractures. This article provides the first description of a new complication, fracture of the patellar implant at the stem-button interface.

Roentgen rounds #81. Posteromedial bowing of the tibia.

Posteromedial bowing of the tibia is a rare deformity which is being recognized more frequently. It is frequently associated with and may be the result of a calcaneovalgus foot deformity. It has a better overall prognosis than the other two categories of congenital angular deformity of the tibia.

Radiocarpal fracture--dislocation.

Radiocarpal fracture-dislocation was associated with fracture of the distal articular surface of the radius in five patients (six extremities). Closed manipulation resulted in satisfactory reduction of both the dorsal dislocation of the carpus on the distal radius and displaced articular fracture fragment(s) in two of four extremities. In four extremities, open reduction was necessary as the only means of satisfactorily managing this severe wrist injury.

The carpal boss: an overview of radiographic evaluation.

The carpal boss, an unmovable bony protuberance, is located on the dorsum of the wrist at the base of the second and third metacarpals adjacent to the capitate and trapezoid bones. This bony prominence may represent degenerative osteophyte formation and/or the presence of an os styloideum, an accessory ossification center that occurs during embryonic development. When this condition is symptomatic, patients present with complaints of pain and limitation of motion of the affected hand.

Musculoskeletal applications of three-dimensional surface reconstructions.

We have applied computer programs originally developed for craniofacial surgical planning and evaluation to complex musculoskeletal problems. These computer programs reformat ordinary CT scans into black and white images of the three-dimensional osseous surfaces found in the scanned volume. These reformatted three-dimensional CT scan images increase the utility of CT scan examinations of complex osseous structures, such as the wrist, spine, hip, knee, and shoulder.

Hexabrix as a contrast agent for ascending leg phlebography.

Fifty patients were analyzed after a randomized double-blind study comparing Hexabrix and Hexabrix-20 in ascending phlebography. Measures of safety and patient tolerance indicated that both concentrations of Hexabrix appeared safe and were well tolerated. All studies were diagnostic, and the image quality was rated as excellent in 80% of the Hexabrix group and 72% of the Hexabrix-20 group.

Ewing's sarcoma in bones of the hands and feet: a clinicopathologic study and review of the literature.

Review of current data from the Intergroup Ewing's Sarcoma Study (IESS) shows that Ewing's sarcoma (ES) is rare in bones of the hands and feet. Only 12 of 377 evaluable patients in the first two IESS studies had a primary tumor in these small, distal bones. The age distribution was typical for that seen in patients with ES at other sites.

Histiocytic reaction to hip arthroplasty.

Pain secondary to loosening of a total hip prosthesis is a common complaint and a major complication after surgery. Periprosthetic lucency is a well-recognized result of loosening of the prosthesis and of infection. We describe histiocytic proliferation as an additional cause of periprosthetic lucency and lytic change in two patients.

Radiographic appearance of Ewing sarcoma of the hands and feet: report from the Intergroup Ewing Sarcoma Study.

Review of current data from the Intergroup Ewing Sarcoma Study (IESS) shows that Ewing sarcoma is rare in bones of the hands and feet. The 12 patients from the IESS protocols with hand or foot Ewing sarcoma are comparable to those already reported in the literature. With the exception of lesions in the calcaneus, the prognosis for disease-free survival is excellent.

Synovial cysts of the hip joint and iliopsoas bursitis: a spectrum of imaging abnormalities.

Synovium-related soft tissue disease around the hip constitutes a spectrum ranging from isolated iliopsoas bursitis to pure articular synovial herniations without bursal involvement. The clinical, pathologic, and radiographic features of these entities are discussed as they pertain to the variety of underlying disorders which predispose to their occurrence. Nine case reports are utilized to illustrate the variable clinical and radiographic presentations which may be encountered.

Carpal ligamentous disruptions and negative ulnar variance.

Negative ulnar variance is a condition in which the ulna is relatively shorter than the radius at the carpus. It was found in 21% of 203 normal wrists. We have observed an increased incidence (49%) of this anomaly in patients with carpal ligamentous instabilities (dorsiflexion instability, palmar flexion instability, scapholunate dissociation with rotary luxation of the scaphoid, and lunate and perilunate dislocations).

Thrombolytic therapy for acute arterial occlusion.

To evaluate the role of selective intra-arterial low-dose thrombolytic therapy (SILDT) as an alternative to the surgical management of acute arterial occlusion, the hospital records of 40 patients who underwent 43 SILDT treatments with either streptokinase (36) or urokinase (7) between December 1979 and March 1984 were reviewed. Twenty-eight patients underwent 30 treatments (group 1) for native arterial occlusion and 12 patients underwent 13 treatments (group 2) for prosthetic or autogenous graft occlusions. Therapy was deemed successful if subsequent surgical therapy was obviated.

Synovial cysts of the knee: CT evaluation.

Eight patients with synovial cysts about the knee were studied by computed tomography (CT). Six of the eight patients had cysts in atypical locations, four medial and two anterior. Knee arthrography, performed on five patients, demonstrated the cyst in only two cases.

Local recurrence, rate and sites of metastases, and time to relapse as a function of treatment regimen, size of primary and surgical history in 62 patients presenting with non-metastatic Ewing's sarcoma of the pelvic bones.

This report reviews the experience of 62 patients who presented between 1972 and 1978 with non-metastatic Ewing's sarcoma of the pelvis and were entered on IESS I. Seventeen patients (27%) developed a local recurrence, 38 patients (61%) demonstrated metastases and 21 (34%) neither. In the dose range 4000 rad to 6000 rad no dose response could be detected for local control of tumor.

Three-dimensional imaging of the wrist.

The objective of this study was to determine the diagnostic quality of three-dimensional images of the carpal bones that could be constructed from raw data obtained from a computerized tomography scan. The quality of raw data collected was determined by collimation, slice interval, the number of projections, and x-ray tube operating specifications. The quality of two-dimensional images that were constructed from the raw data was determined by user-specified parameters including zoom or magnification factor, convolution kernels, and centering.

Cyst and cystlike lesions of the foot.

A variety of cyst and cystlike lesions may present in the osseous structures of the foot. Such lesions are infrequent in their occurrence, and often cannot be diagnosed on the basis of radiographic appearance. In addition to the morphologic data that can be derived from evaluation of standard radiographs, other diagnostic radiographic studies such as tomography, CT scanning, radionuclide bone imaging, angiography, or other studies may be required to ascertain the nature and extent of cystlike lesions of the foot.