Case report 850. Giant cell tumor.
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Adult↗
Biomedical subjects
R H Daffner
Publications and source records attributed to R H Daffner.
Ankle trauma.
Fractures and dislocations about the ankle joint are common injuries. The radiographic "fingerprints" produced by these injuries are directly related to the mechanism that produced that injury. Radiologists must recognize all of the aspects of a particular injury and communicate this information to the orthopedic surgeon because treatment is predicated on recognition of all of the components of the injury. Treatment also depends on restoration of anatomic contour to the articular surface of the ankle joint as well as to reestablishing stability. Plain films, polydirectional tomography, CT, and MRI are useful for evaluating these abnormalities.
Adolescent↗
Ankylosing spondylitis complicated by trauma: MR findings correlated with plain radiographs and CT.
Four patients with ankylosing spondylitis sustained a traumatic spinal injury. In three cases, pseudoarthrosis developed at the discovertebral junction, while involvement of the neural arch occurred in the fourth. Although the diagnosis of ankylosing spondylitis was readily established on plain radiographs, magnetic resonance more effectively identified the complicating injury and in two cases demonstrated the presence of cord compression. Computed tomography was also contributory in delineating bony and ligamentous abnormalities of the neural arch.
Aged↗
Case report 790. Mesenchymal chondrosarcoma of the sacrum.
We have presented a case of mesenchymal chondrosarcoma of the sacrum in a 20-year-old woman. We have emphasized that CT and MR are the best imaging modalities for the assessment of the neoplasm and the surgical decision-making process. Histologic study is mandatory for diagnosis of the tumor, with its characteristic dual pattern of chondroid tissue and undifferentiated mesenchymal cells. The rarity of the neoplasm, its deep pelvic location and nonspecific symptomatology led to a late diagnosis and an unfortunate but necessary sacral amputation resulting in bladder and bowel functional sequelae.
Adult↗
Clandestine femoral neck fractures with ipsilateral diaphyseal fractures.
We present a protocol for diagnosis of all femoral neck fractures associated with ipsilateral femoral diaphyseal fractures. A 30% incidence of delayed diagnosis has been reported by other investigators. Between 1982 and 1990, we have treated 32 patients with ipsilateral femoral neck and shaft fractures due to blunt trauma. Only 22 femoral neck fractures were diagnosed on prediaphyseal fixation radiographs. This left the 10 patients in this study who had normal prediaphyseal fixation radiographs and were subsequently found to have femoral neck fractures. The ipsilateral femoral neck fractures were found through a retrospective chart and radiographic review of all 555 femoral diaphyseal fractures identified through our trauma and fracture registries. The clinical and radiologic techniques for diagnosing the femoral neck fractures were presented. The time to union of the femoral shaft and neck was determined, and a preliminary radiologic assessment of the vascularity of the femoral head was made. Ten femoral neck fractures (31%) with normal preoperative radiographs were diagnosed after femoral diaphyseal fixation. One patient did not have a post-diaphyseal fixation radiograph. An incidental radiograph at 6 weeks showed a mildly displaced femoral neck fracture in an asymptomatic patient. At 16 weeks the patient became symptomatic, and a repeat radiograph showed the fracture. Five fractures were diagnosed in asymptomatic patients on routine post-femoral fixation radiographs. Two patients had normal post-femoral fixation radiographs, became symptomatic, and had their femoral neck fractures diagnosed on repeat radiographs at 3 and 7 days. One patient had normal pre- and postfixation radiographs, and on a 25-day routine femoral radiograph, the femoral neck fracture was diagnosed.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Evaluation of cervical vertebral injuries.
The use of imaging studies on patients with suspected cervical vertebral injury should be restricted to those patients who fall into the high-risk category for injury. Once a decision is made to obtain radiographs, a minimum of five views is required to adequately rule in or rule out injury. Complex imaging studies such as CT, polydirectional tomography, and MRI may be performed to confirm the initial impression based on plain radiographic findings. The diagnosis of cervical injuries may be facilitated by following a logical pattern of analysis searching for abnormalities of alignment and anatomy, of bony integrity, of the cartilage or joint spaces, and of the soft tissues. This ABCS approach should simplify an intimidating subject and insure a confident radiological diagnosis.
Cervical Vertebrae↗
Proximal and distal oblique radiography of the wrist: value in occult injuries.
Fractures of the scaphoid and capitate bones are frequently nondisplaced at the initial examination. In addition, obliquity of the fracture line may result in the fracture not being profiled on routine views. Angling the radiographic tube 30 degrees off the vertical toward the elbow results in elongation of the scaphoid and capitate bones and improves visualization of the scaphoid over routine posteroanterior radiographs. Reversing the angle of the tube to 30 degrees from the vertical toward the fingertips further elongates the capitate. This is useful for delineating occult fractures of the capitate.
False Negative Reactions↗
Stress fractures: current concepts.
Stress fractures are extremely common lesions that occur in specific areas and are related to specific activities. They are caused by increased muscular activity on bones that are not yet ready to take the increased pull of the involved muscles. The insufficiency type of stress fractures found in patients with bone of diminished mineral content is being recognized more often as increasing numbers of middle-aged and elderly persons are becoming more physically active. A variety of imaging studies can be used to diagnose stress fractures. Radionuclide bone scanning and MR imaging often show abnormalities early in the course of the injury. However, when radiographs appear normal, findings on scintigrams may be more suggestive of the proper diagnosis. In patients with suspected stress injury, radiographs should be obtained a second time, 1-2 weeks after the initial study. Biopsy should be avoided until evidence is clear-cut that the lesion has not changed over a short time.
Biomechanical Phenomena↗
Case report 654: Disseminated tuberculosis.
A case of disseminated tuberculosis with a psoas abscess and associated destruction of bone in a 28-year-old man has been presented. Multiple skeletal lesions and hilar adenopathy were observed. The initial diagnosis from pathological specimens was equivocal, since acid-fast bacilli were not demonstrated. However, special stains of biopsy specimens subsequently confirmed the diagnosis. The initial radiographs suggested disseminated malignancy. Good therapeutic results were obtained, utilizing surgical and chemotherapeutic methods. This case demonstrates the ability of disseminated tuberculosis to mimic other disease processes and shows the difficulty that may exist in establishing a diagnosis of tuberculosis, even with biopsy specimens.
Adult↗
Ipsilateral femoral neck and shaft fractures: an overlooked association.
A total of 304 patients with injuries to the femoral shaft and ipsilateral hip presented between 1984 and 1990. Some 253 of them suffered fractures of the femoral shaft and dislocated hips or fractures of the acetabulum, and 51 of these sustained fractures of the femoral shaft and neck or trochanteric region. Of this latter group, 20 patients had a combination of femoral shaft and neck fractures, and 31 had a combination of femoral shaft and trochanteric fractures. All of the trochanteric injuries were demonstrated on the initial radiographs. However, in 11 of the patients with combined femoral shaft and neck fractures, the diagnosis was delayed by as much as 4 weeks. This delay related to the fact that these fractures tended not to separate in the initial evaluation period and that there was external rotation of the proximal femoral fragment due to the femoral shaft fracture. Good preoperative and, in particular, good postoperative radiography of the hip is essential to make the diagnosis. Although orthopedic surgeons have been aware of this combination of injuries since 1953, radiologists have not.
Adult↗
The abduction lordotic view of the clavicle: a new technique for radiographic visualization.
The abduction lordotic view is a previously unreported radiographic technique for visualization of the clavicle. Use of this technique, a simple office procedure, combined with a standard anteroposterior view allows almost 90 degrees visualization of the clavicle. It is recommended particularly for the assessment of clavicular healing.
Clavicle↗
The radiologic assessment of post-traumatic vertebral stability.
The stability of the vertebral column depends upon the integrity of the bones, ligaments, and joints. The vertebral column can be divided into three distinct anatomic zones: anterior, middle, and posterior. Disruption of any single zone does not produce instability. Disruption of two contiguous zones will, however, significantly decrease the load-carrying capability of the spine and result in instability. Five radiographic signs indicative of vertebral instability have been identified: (1) displacement implies injury to major ligamentous and articular structures; (2) a wide interlaminar space implies injury to the posterior ligamentous structures and the facet joints; (3) wide facet joints imply injury to the posterior ligamentous structures; (4) a disrupted posterior vertebral body line implies burst injury with disruption of anterior bony and posterior ligamentous structures; (5) a wide vertebral canal implies injury to the entire vertebra in the sagittal plane. Each of these signs indicates disruption of a major skeletal, ligamentous, or articular structure and the presence of only one is sufficient to establish a diagnosis of instability. These conclusions are based upon a study of 138 injuries observed in 125 patients.
Fractures, Bone↗
Case report 592: Bone graft donor site of tibia.
A case is presented in which a donor site for a bone graft from the proximal end of the tibia caused diagnostic difficulty. The bony defect produced in such procedures is easily confused with a variety of neoplastic and neoplasm-like lesions. The clinical history, use of immediate postoperative films, and knowledge concerning the common sites for obtaining bone graft donor tissue are critical in offering the correct diagnosis.
Adult↗
Absent cord sign in acute spinal trauma.
Review of magnetic resonance imaging (MRI) findings in 100 patients suffering acute spinal trauma from 1985 to 1987 revealed four patients who had suffered thoracic spine fractures and acute subarachnoid hematomas. The spinal cord was not demonstrated on the T1-weighted sagittal MRI due to the similarities in signal intensity between the spinal cord and acute hemorrhage. Nonvisualization of the thoracic cord should not be presumed to be artifactual until subarachnoid hematoma is excluded.
Acute Disease↗
Imaging of acute spinal trauma: an evolving multi-modality approach.
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Diagnostic Imaging↗
Thoracic and lumbar vertebral trauma.
Injuries to the thoracic and lumbar vertebral column are common. They are all the result of increased loading on structures with limited flexibility. The majority of these injuries are related to hyperflexion. Plain radiography remains the mainstay of diagnosis of vertebral injuries. However, CT and MR imaging have important places in assessing patients with vertebral injuries. The radiographic assessment of these injuries is made easier by the fact that each injury occurs in a predictable and reproducible pattern that is defined by the mechanism. These features are termed the "fingerprints" of injury and indicate the full extent of damage. By recognizing the fingerprints and carefully evaluating the patient for abnormalities of alignment, bony integrity, cartilage or joint space, and soft tissues, it is possible to determine rapidly the full extent of injury and plan further evaluation and treatment. Instability may be assumed if there is displacement, widening of the interspinous space, widening of facet joints, widening of the interpediculate distance, or disruption of the posterior vertebral body line.
Humans↗
Ankle trauma.
Fractures and dislocations about the ankle joint are common injuries. The radiographic findings produced by these injuries are type-specific--that is, directly related to the mechanism that produced the injury. It is important for radiologists to recognize all of the aspects of a particular injury and to communicate this information to the orthopedic surgeon because treatment is predicated upon recognition of all the components of the injury. Treatment also depends upon restoration of anatomic contour to the articular surface of the ankle joint as well as to reestablishment of stability. Plain films, polydirectional tomography, CT, and MR imaging are useful for evaluating these abnormalities.
Ankle Injuries↗
Hyperextension injuries of the cervical spine. Magnetic resonance findings.
Eleven patients with acute cervical hyper-extension injury underwent magnetic resonance examination. Magnetic resonance was particularly helpful in diagnosing both intrinsic cord contusion and extradural compression. When spinal cord compromise was present, surgery was undertaken without resort to myelography.
Adult↗