PURPOSE: To illustrate the variety of posterior cruciate ligament (PCL) injuries and assess the type and frequency of associated knee injuries. MATERIALS AND METHODS: In a retrospective review of 1,950 magnetic resonance (MR) examinations of the knee, 47 patients with MR imaging findings of PCL injury were identified. In 24 patients, the findings on MR images were correlated with athroscopic findings (n = 14) or findings at physical examination (n = 10). Patterns of associated injuries were described and tabulated. RESULTS: Twenty-one patients (45%) had complete PCL tears; 22 patients (47%), partial tears; and four patients (9%), bone avulsion. Associated injuries were seen in 34 patients (72%). Patterns of injuries differed from those seen in anterior cruciate ligament injury and correlated with the mechanism of trauma. CONCLUSION: MR imaging proved accurate in assessment of the PCL in patients with clinical correlation and demonstrated patterns of associated injury that may affect management strategy.

Humans↗

PubMed1994

Imaging of epiphyseal injuries.

There have been many advances in the diagnosis and treatment of epiphyseal injuries in the 30 years since the publication of the landmark article by Drs Robert Salter and William Harris. They are the subject of this review. The anatomic features of the physis, epiphysis, and metaphysis are presented, and histologic studies of human and experimental physeal injuries are described. The recently recognized histologic, anatomic, and imaging characteristics of bone bridging of the physis resulting in growth disturbances are reviewed. Modification in and additions to the original Salter-Harris classification system have been proposed. The role and technique of computed tomography and magnetic resonance imaging in the assessment of the initial injury and analysis of subsequent growth disturbance are discussed.

Adolescent↗

PubMed1994

Fracture of the spine in patients with ankylosis due to diffuse skeletal hyperostosis: clinical and imaging findings.

OBJECTIVE: Only 12 patients with a fracture through a portion of the spine ankylosed by diffuse idiopathic skeletal hyperostosis have been reported. The purpose of this study was to determine the types of causative trauma, spinal sites at risk for fracture, complications mortality, diagnostic difficulties, and abnormalities identified only with special imaging studies in a group of 15 patients with this complication seen at our institution. MATERIALS AND METHODS: The study included 15 patients with diffuse idiopathic skeletal hyperostosis who had a spinal fracture through an area of ankylosed spine. The criteria for diffuse idiopathic skeletal hyperostosis include flowing calcification or ossification along the anterolateral margin of at least four contiguous vertebral bodies; preservation of disk height in the involved areas; and absence of bony ankylosis of the apophyseal joint and erosion, sclerosis, or bony fusion of the sacroiliac joints. All spinal radiographs, tomograms, CT scans, and MR images obtained in these patients were reviewed to determine diagnostic difficulties, site and level of fracture, displacement of fractures, and extent of anatomic injury. The hospital charts of all patients were reviewed for history, physical examination, clinical status, treatment, and outcome. RESULTS: Fourteen fractures of the cervical spine, one of the thoracic spine, and one of the lumbar spine occurred in 15 patients. Five fractures were caused by high-energy trauma and 11 fractures by low-energy, seemingly trivial injuries. The spinal fracture caused complete quadriplegia in seven patients, incomplete quadriplegia in one patient, complete paraplegia in two patients, a central cord syndrome in two patients, and no neurologic deficit in three patients. In two of three patients in whom fracture diagnosis was delayed, paraplegia developed during the delay. Three patients died within 1 week and three more died within 6 months after injury. CT and conventional tomography enabled diagnosis of posterior element fractures not seen on plain radiographs in five patients. All fractures healed, except those in the three patients who died within a week of injury. CONCLUSION: Trivial trauma was the most common cause of fracture in the spine ankylosed by diffuse idiopathic skeletal hyperostosis. The severity of spinal cord injury in our patients was greater than in previous reports. We suggest that this may be a function of the relatively long segments of ankylosed spine (average, 16 vertebrae) in our patients providing a long lever arm for any traumatic force to act on. Patients with shorter ankylosed segments had less severe cord injuries. Delay in diagnosis of a fracture through an area of ankylosed spine associated with diffuse idiopathic skeletal hyperostosis was common if no neurologic deficit was present, and led to permanent paraplegia in two of three patients. CT and MR studies were useful in determining the anatomic abnormalities present, but were performed only in a limited number of patients.

Aged↗