Routine Radiographic Evaluation Research Articles

The Knee: Breaking the MR Reflex

The knee is a large joint prone to trauma and arthritis. Although magnetic resonance (MR) imaging has revolutionized evaluation of knee structures and their abnormalities, imaging the knee makes use of all imaging modalities. Radiography remains important in the diagnosis of knee pathology. This section is dedicated to the initial radiographic evaluation and the sometimes subtle clues to underlying pathology. Knowledge of injury patterns and frequently missed findings will improve the radiologist’s ability to suggest the diagnosis on radiographs. Anatomy A routine radiographic evaluation of the knee includes an anteroposterior view, a lateral view, and a “sunrise” view. In the evaluation of osteoarthritis, weight-bearing views are usually obtained. The bones of the knee joint include the patella, femoral condyles, tibia, and fibula. The knee is composed of the medial tibiofemoral, lateral tibiofemoral, and patellofemoral joints. On AP view, the patella is centrally located between the femoral condyles. There is a slight overlappingoftheproximalfibularheadandlateraltibialplateau. The quadriceps and patellar tendons are seen best on lateral radiograph. The patellofemoral joint is best seen on “sunrise” and lateral views. Table 1 summarizes the important landmarks to evaluate on every radiographic examination of the knee.

Advancement and separation of apex hole eliminators with cementless Duraloc 100 cups. A report of nineteen cases.

From 1992 to 1996, we performed 541 cementless total hip arthroplasties using a Duraloc 100 acetabular component with an apex hole eliminator that did not have a positive stop design. During routine follow-up radiographic evaluation, we noted several hips with advanced or separated hole eliminators. This study presents the clinical consequences of this occurrence and its relationship to polyethylene wear and osteolysis. A total of 541 hips (358 with a minimum duration of follow-up of five years) were evaluated clinically with use of the method of Merle D'Aubigné and Postel. Anteroposterior pelvic and iliac oblique radiographs were used to evaluate polyethylene wear, osteolysis, hole eliminator position, and component stability. Nineteen hips that had been followed for an average of eighty-nine months showed advancement or complete separation of the hole eliminator on radiographic evaluation. In most hips, advancement of the hole eliminator was visible on only the iliac oblique radiograph. In all but one hip with separation of the hole eliminator, complete plug separation was detectable on both the iliac oblique and anteroposterior pelvic radiographs. No association was found between polyethylene wear and either advancement or separation of the hole eliminator. No osteolysis was visible radiographically in the hips with hole eliminator advancement, but osteolysis was always visible in the hips that had complete separation of the hole eliminator. The hole eliminator has been redesigned since November 1995 to prevent possible advancement. However, patients with earlier designs should be followed carefully because advancement or separation can be expected in about 5% of the patients who have been followed for a minimum of five years. Despite this complication, which is seen radiographically, all patients were satisfied with the function of the hip. We do not recommend surgery solely to remove or replace the hole eliminator.

The Fate of Pelvic Osteolysis After Reoperation; No Recurrence With Lesional Treatment

Twenty-three hips (21 patients) with 30 pelvic osteolytic lesions underwent reoperation and were observed prospectively for 25 to 74 months (average, 40 months) to assess the fate of pelvic osteolysis after reoperation. The average radiographic dimensions of the lytic lesions were 2.4 x 1.9 cm with the largest lesion measuring 7 x 5 cm. The porous ingrowth acetabular component shell had been left in situ in 15 hips and had been revised in eight. There was no difference in the average lesional size for hips with revised shells compared with those with unrevised shells. In cases where the shell was left in situ, the osteolytic lesions were curetted by working around the component perimeter or through holes in the shell. In 18 hips the bone defect(s) were grafted with autograft or allograft. Regardless of the management of the acetabular shell or the absence or presence of bone graft, none of the osteolytic lesions have progressed. Twenty-six of the 30 lesions have increased radiographic density. All acetabular components remain radiographically well fixed. There were no new osteolytic lesions. All hips were functioning well, and none have required subsequent reoperation for any reason. There was a statistically significant reduction in the operative time and the amount of blood loss when the acetabular component was not revised. It does not appear necessary to remove a well fixed and well positioned cementless acetabular component for the treatment of pelvic osteolysis. Debridement of periarticular inflammatory tissue and lesional curettage, either with or without bone graft, is effective in managing this type of bone loss. Revision of the acetabular component shell was associated with a significant increase in operative time and blood loss. These results support routine radiographic evaluation after total hip arthroplasty to monitor the development of osteolysis. On the basis of this experience, the authors recommend lesional treatment of progressive pelvic osteolysis to avoid more difficult surgery and minimize patient morbidity.

Orthopaedic nuclear medicine: The pelvis and hip

Bone scintigraphy is a sensitive method useful in the diagnosis of specific skeletal problems encountered in orthopaedic and sports medicine. Often, in these situations, routine radiographic evaluation may provide negative or questionable information. Bone scintigraphy is also useful in the evaluation of patients with ill-defined or persistent bone pain not satisfactorily explained by positive radiologic evaluation. In these situations, because of its ability to image the whole body, bone scintigraphy may reveal additional unsuspected traumatic pathology, Finally, nuclear medicine physicians need to be prepared to properly interpret findings unrelated to trauma and to direct the evaluation of patients toward the correct diagnosis and subsequent management. These goals can be achieved by using optimal imaging technique, by becoming familiar with the patient's clinical presentation, by understanding the biomechanics and pathophysiology of the entities encountered, by proper use of alternative diagnostic procedures, and by establishing good rapport with referring physicians.

Soft Tissue Injuries of the Tarsus

Contrast radiography provides a clear survey of the size, shape, and location of extratendovaginal fluid-filled cavities, distended bursa, and tendon sheaths and demonstrates intersynovial communication. Ultrasonography effectively demonstrates Achilles tendon injury, slippage of the SDFT off the summit of the calcaneus, assorted ligamentous injuries, and cystic or solid extratendovaginal masses. It will also demonstrate distended bursae and tendon sheaths, but it is not as effective in demonstrating a synovial herniation, or a narrow synovial fistula. Contrast radiography may prove to be the imaging modality of choice for examination of fluctuating swellings, whereas ultrasonography is preferred for the assessment of firm swellings. Routine radiographic evaluation in the clinical assessment of soft tissue injuries in the hock region continues to play an invaluable diagnostic role.

Radiological findings in jaws and skull of neurofibromatosis type 1 patients.

Maxillary and mandibular lesions in neurofibromatosis Type 1 (NF1) in patients are described. Radiographic manifestations include radiolucent lesions with well-defined, poorly-defined or irregular diffuse borders. Mandibular lesions were not associated with the inferior alveolar nerve as it coursed within the mandible. In three patients the lesions extended considerably into the cranial bones. The necessity for routine radiographic and CT evaluation of NF1 patients is emphasized.

Roentgenographic evaluation of the cervical spine. A selective approach.

To determine if routine radiographic evaluation of the cervical spine could be eliminated in the alert, sober trauma patient who has no neck pain, tenderness, or other major injuries without a significant increase in missed occult injury. Prospective cohort study. Emergency department and general surgery service at a military tertiary medical center. Those patients with cervical spine injuries. Sixteen patients (2%) had cervical spine injuries, all had signs and/or symptoms of their injury on presentation. Ninety-six patients (14%) who were not intoxicated and had no neck pain, tenderness, or other major injuries were evaluated. None of these patients had abnormal cervical spine studies. Two hundred ninety patients (43%) were followed up between 30 to 150 days. No missed injuries were noted. These results indicate that blunt trauma patients may not require cervical spine roentgenography if they meet the following criteria: absence of mental status changes, intoxication, neck pain or tenderness, neurologic signs or symptoms, or simultaneous major distracting injury. Because of the small incidence of cervical spine injuries, further studies are necessary to evaluate the positive predictive value of history and physical examination of the cervical spine in a trauma patient.

Retained ligature wire and periodontal health: Report of a case

Routine radiographic evaluation 15 years after orthodontic treatment revealed a circumferentially placed ligature wire situated at the crest of bone on the upper right lateral incisor. The wire was surgically exposed via a modified Widman flap technique and subsequently removed without adverse consequences relative to esthetics or periodontal support. It is of interest that the retention and location of this wire over such a long period of time resulted in no loss of periodontal support, especially since circumferential ligature placement is used experimentally to help promote periodontal breakdown.