Sclerotic Margin Research Articles

Marsupialization Followed by Enucleation and Chemical Cauterization for Treatment of Odontogenic Keratocyst Involving Maxillary Sinus: A Case Report

Odontogenic keratocysts are odontogenic cysts which have locally infiltrative behavior. They mostly occur in second and fourth decades but can occur at any age throughout life. In majority of cases, they are located in the posterior region of mandible, but can also be found in the maxilla especially in the canine region. In this article, we have discussed the diagnosis and management of a large odontogenic keratocyst cyst involving the maxillary sinus. A 22 years old male patient presented with pain and swelling on right side of the face since last one year. There was history of pus discharge and gradual increase in size of the swelling since last 3-4 months. Patient took antibiotics but there was no improvement. Odontogenic keratocyst is a developmental pathology which arises from additional remnants of dental lamina of oral epithelium. They present with swelling, pain and pus formation/discharge as signs of infection. Often, when the lesion is large there can be paresthesia of the lower lip. These lesions can also be clinically asymptomatic. Mostly they appear as well-demarcated unilocular radiolucency having a thin, sclerotic well-defined margin. There are many treatment options like enucleation, marsupialization, decompression, curettage, use of chemical agents like Carnoy's solution, cryotherapy with liquid nitrogen or peripheral osteotomy and surgical resection of lesion.

Mandibular Bone Defect Imaging Features in Cone Beam Computed Tomography: A Case Report

Mandibular bone defect or Stafne bone defect is usually an incidental finding in imaging examinations due to its lack of symptomatology. It is often observed as a radiolucent lesion with well defined limits. In this report it is demonstrated a case of mandibular bone defect close to the mandible angle, in a 16-year old female, that performed cone beam computed tomography examination in order to verify the proximity of the third inferior molar to the mandibular canal. In this case, it was verified that the defect was continuous to the mandible border and it had a thick sclerotic margin. No treatment is necessary to mandibular bone defects, but regular follow-ups are strongly recommended.

Solitary plasmacytoma of maxillofacial bones: correlation of CT features with pathological findings.

To explore the CT features of solitary plasmacytoma (SP) of maxillofacial bones and correlation with pathological findings. We retrospectively reviewed the clinical, CT and pathological features of SP in the maxillofacial bones. 16 patients with clinically and histologically proven SP of maxillofacial bones were involved. They were aged from 27 to 79 years old (median 55.5 years old), and included 12 males and 4 females (males vs females: 3:1). All patients performed CT examination, in whom 13 patients underwent enhanced scanning and 3 plain scanning. The CT images were assessed for lesion location, size (maximum diameter), shape (round, oval and irregular), boundary (defined and illdefined), bone changes (bone destruction, residual bone, sclerotic margin and periosteal reaction), density of soft tissue mass and enhancement manifestations, and invasion of adjacent structures. 13 patients suffered from SP in the mandible, 2 in the zygoma, and 1 in the maxilla and hard palate. The maximum diameter of lesions ranged from 2.4 to 8.2 cm (mean 3.93 ± 1.435 cm). Most lesions were founded as a solitary osteolytic lesions (15/16, 93.75%) with round or ovoid shape (13/16, 81.25%), smooth margin (16/16, 100%) and defined boundary (16/16, 100%) in bone marrow. They destroyed bone cortex (15/16, 93.75%) and had residual bone (10/16, 62.5%), without sclerosis margin (15/16, 93.75%) and periosteal reaction (14/16, 87.5%). They easily formed soft tissue masses (16/16, 100%) and invade adjacent anatomical structures (15/16, 93.75%). The density of lesions was usually uniform (12/16, 75%) with strong enhancement. There was a significant difference in CT values between plain and enhanced scanning [50.75 ± 9.140 Hounfield unit (HU) vs 101.0 ± 28.830 HU; p < 0.001), with the mean difference of CT values 50.25 HU. SP is predominant in the mandible of elderly male patients. A solitary, round or ovoid, well-defined, osteolytic, invasive mass in bone marrow, which destroys bone cortex, has residual bone, no sclerosis margin and periosteal reaction, and shows strong enhancement, is suggestive of this diagnosis.

PEDIATRIC ACL RECONSTRUCTION: DOES THE FEMORAL PEEK IMPLANT CAUSE TUNNEL WIDENING?

Background: Because of their strength, inertness and biocompatibility, polyetherketone (PEEK) implants have been increasingly used in orthopedics, especially trauma and spine surgeries. Their mechanical and chemical properties have been widely studied and compared to other materials since their accelerated development in the 1980s. Their use is relatively new in anterior cruciate ligament reconstructions (ACLR), and there is little literature to document their effect on tunnel widening in these procedures. Bone tunnel enlargement following ACLR is a widely reported phenomenon that has been negatively correlated with clinical outcome scores. A recent prospective study reiterated its stronger association with suture discs compared with methods using interference screws, cross-pins and buttons. There is only one paper that specifically reports the results of a study on PEEK implants in relation with tunnel widening and it did not demonstrate significant association. PEEK polymer has not yet been studied in pediatric knees, in which tunnel widening has more than the usual residual laxity and re-tear implications, as it can also cause physeal damage. The purpose of this study was to investigate the use of a femoral PEEK implant in ACLR performed on skeletally immature patients and to determine if it is associated with tunnel widening. As a secondary objective, this study aimed to assess the risk of growth complications associated with the use of PEEK. Methods: All patients who underwent all-epiphyseal ACLR surgery in a pediatric university hospital between March 2015 and January 2017 were included in this retrospective study. The all-epiphyseal ACL reconstruction procedures were done using a new instrumentation system that includes a titanium tibial anchor fixation and a femoral PEEK screw system. Femoral bone tunnel diameters were measured on postoperative lateral knee radiographs. The widest tunnel measurements were taken using the sclerotic tunnel margins as reference points and compared to the known sizes of the drill bits retrieved from operative protocols. Paired t tests were performed to assess bone tunnel widening. P-values &lt;0.05 were considered significant. SPSS 25.0 was used for statistical analysis. Results: Eighteen (19 knees) arthroscopic ACL reconstruction patients were included. Of the 18 all-epiphyseal ACL reconstruction patients, 4 (22.2%) were female and 14 (77.8%) were male. The chronological and bone ages at time of surgery (mean ± SD) were respectively 13.5 ± 1.6 and 13.3 ± 1.0 years. At a mean follow-up of 17.1 months, average tunnel enlargement was 1.8± 1.4 (0.0-4.2) mm at the femur and was found to be statistically significant (P&lt;0.001). There were no symptomatic growth abnormalities requiring intervention, but 2 unilateral early physeal closures at the distal femur (10.5%) were noted. These patients had notable femoral tunnel enlargement. One had a 3.0 mm of femoral tunnel widening and no observable growth disturbance. The other had an asymptomatic and non-progressive unilateral knee valgum of 5 degrees and 3.5 mm of femoral tunnel widening. Conclusions/significance: This study showed that the largest tunnel increase at a mean follow up of 17.1 months was 4.2 mm. It is not clear that this widening is clinically significant even though it is statistically significant. Also, association between femoral tunnel widening and physeal closure could not be formally established. Thus, further research on this potential risk factor is needed.

Squamous Odontogenic Tumor-Like Proliferation in a Dentigerous Cyst: a Case Report

Squamous odontogenic tumor (SOT) is a rare and benign neoplasm frequently occurring within the jaws. Interestingly, few case reports that describe SOT-like proliferations located in the wall of an odontogenic cyst have been published. A 42-year-old white man presented with bleeding of the upper gingiva on the right side. Radiographic examination showed a well-defined, circular, radiolucent area, with sclerotic margins involving tooth #18. Diagnosis of a benign cystic odontogenic lesion was made and was supported by results of biopsy using fine-needle aspiration. The entire lesion was excised; microscopy revealed SOT-like proliferations in a dentigerous cyst. After 6 months of follow-up, no recurrence or alteration was observed. To the best of our knowledge, this is the seventh case showing SOT-like proliferations in a dentigerous cyst; hence, this clinical entity should be recognized to avoid misdiagnosing a cystic odontogenic tumor.

X-ray analysis of foramen rotundum for preliminary diagnosis of fossa pterygopalatina lesions

Objectives: Fossa pterygopalatina is located posterior to maxillary sinus, anterior to pterygoid plates and inferior to greater sphenoid wing. Tumors that arise in fossa pterygopalatina are usually asymptomatic and often discovered at late stage. Because of its deep and relative inaccessible location, clinical examination of fossa pterygopalatina is difficult. Aplastic or nonvisible foramen rotundum may give an early indication for the regional tumors. Methods: In the present study, foramen rotundum was visualized as a round structure with prominent sclerotic margins located near ethmoid cells, maxillary sinus or orbital cavity in X ray images. X-rays (radiographs) of 17 dry skulls and 7 half dry skulls were performed with Phillips Digital Diagnost X-Ray device. All dry skulls were positioned similar to Caldwell’s view. We have designed a fixation apparatus to optimize the positioning of dry skulls and half skulls. After fixation of the skulls with the apparatus, the X-ray beam centered about 3–4 cm below the external occipital protuberance with an angle of 15 degrees to the chantomeatal line. Each radiologic image was examined for the location of foramen rotundum in relation with orbital cavity, ethmoidal cells and maxillary sinuses. We described the characteristic of foramen rotundum with count and percent values. Results: In the present study, 41 foramina rotunda were analyzed. Out of 41 foramina rotunda, twenty were right-sided, twenty one were left-sided. Of the 20 right-sided foramina rotunda, 19 were visible on X-ray images. On the other side 18 of 21 leftsided foramina rotunda were apparent. 14 of 19 visible right-sided foramina rotunda were identified in the orbital cavity (73.68%). Three of them were identified in ethmoidal cells, and two in the maxillary sinus. 11 of 18 visible left-sided foramina rotunda were identified in the orbital cavity (61.11%). Two of these were found in ethmoidal cells, eight in the maxillary sinus. Out of 17 dry skulls, one had bilateral nonvisible foramina rotunda. Conclusion: Foramen rotundum must be taken into consideration in evaluation of routine X-rays to prevent misdiagnosis of the patients with persistent non-specific symptoms.

Giant Cell Tumor of the Patella: An Uncommon Site

Primary tumors of the patella are rare of which Giant cell tumor is the most frequent. Patient usually presents with pain in anterior knee and swelling. Radiologically, Giant cell tumor usually presents as a well defined lytic lesion with no sclerotic margin, no periosteal reaction and no soft tissue involvement unless complicated by fracture and shows enhancement on post-contrast study. Herein, we report the case of a 31-year female with giant cell tumor of the patella (GCT) with its clinical and radiological features.

Congenital Cervical Vertebral Malformation in Lambs

Background: The occurrence of congenital defects in the sheep is estimated to be between 0.2% and 2%. For congenital anatomical alterations, diagnostic imaging allows objective understanding and evaluation, and is a great aid in the formulation of clinical decisions. Most of these anomalies are diagnosed by radiography; but computed tomography (CT) can provide important additional information. In the current literature there are no descriptions of the use of radiography andCT for a more detailed evaluation of the anatomical structures in cases of congenital cervical malformations in lambs. The objective of this study is to report the clinical, radiographic and tomographic findings in two cases of congenital cervical vertebral malformation in lambs.Cases: Two lambs with cervical morphological alterations since birth were attended. A 4-month-old mixed-breed lamb, weighing 11 kg, with lateroventrocaudal deviation of the neck was observed to the right side, not yielding to the attempt of repositioning. The owner reported that these changes were identified since birth, leading to difficulties in suckling colostrum, necessitating artificial feeding. With the growth of the animal, worsening of the cervical deviation resulted in the impossibility of grazing. The radiographs of the cervical spine identified marked scoliosis, and the axis presented small dimensions and morphological changes with a slight loss of atlantoaxial articular relationship. Spondylopathies were detectedalong the cervical spine. Other lamb of the Lacaune breed, weighing 4.2 kg, was presented shortly after birth with changes in the shape and posture of the neck, difficult locomotion and in sternal decubitus. The owner reported that the lamb came from a twin eutocic birth, with the other lamb being apparently normal. The animal was unable to ingest the colostrum, in which the sheep was milked and colostrum was offered through a bottle. Lateroventrocaudal deviation of the neck to the left side did not yield to the repositioning attempt, the mandible also presented left lateral deviation. The radiographs of the cervical spine showed morphological changes in atlas, and it was not possible to delimit its wings; itwas also observed that the dorsal blade was parallel to the spinal process of the axis. The presence of a hypoattenuating linear left lateral image of the dorsal arch and a right ventro-lateral aspect of the atlas body was identified with slightly irregular and sclerotic margins, suggesting fracture lines. The body of the axis presented a conformational alteration withirregular contours and a large free fragment in the cranial aspect, suggestive of being the odontoid process, with rotation and deviation to the left in relation to the atlas. The right lateral cranial articular process of the third cervical vertebra (C3) presented a conformational change and important lateral rotation of the axis. Mild stenosis of the medullary canal was observed in the segment adjacent to C3. The euthanasia was recommended.Discussion: Congenital cervical malformations in sheep are rare in the literature and may lead to serious decrease in the quality of life of the animals. Computed tomography was superior to radiography in morphological evaluation in cases of congenital cervical malformations in sheep. However, both diagnostic methods were important to establish the best clinical behavior. The etiology of most congenital malformations is unknown, simply because of the complexity of the mechanismsthat lead to the formation of an abnormality. The isolated episodes of this anomaly, in the herd without previous alterations, suggest a non-infectious cause, probably similar among the cases, but not established. The information presented can be used to validate clinical reasoning in future cases similar to those described, where imaging features are not available.Keywords: anomalies, fetus, radiography, computed tomography.

Intraosseous schwannomas involving the sacrum: Characteristic imaging findings and review of the literature.

Background and purpose Sacral intraosseous schwannomas represent a rare subset of schwannomas. The existing literature detailing the radiographic appearance of intraosseous schwannomas is limited. The aim of this study is to formally characterize the radiological appearance of sacral intraosseous schwannomas to differentiate them from other lytic lesions. Materials and methods Imaging studies of 13 pathologically proven intraosseous schwannomas were reviewed from multiple institutions by fellowship-trained radiologists. A PubMed search was performed and identified four papers pertaining to the imaging characteristics of sacral intraosseous schwannomas. The results of these papers were compared to findings from our cases. Results All tumors had heterogeneous signals and were predominately solid but cystic components with fluid-fluid levels were present. The tumors caused a mass effect but none infiltrated the surrounding soft tissues. Post-contrast T1-weighted images revealed heterogeneous enhancement in all 13 tumors and four possessed non-enhancing cysts. A literature review identified 16 other cases of sacral intraosseous schwannomas forming a total of 29 cases examined. Conclusions Sacral intraosseous schwannomas should be considered in the differential diagnosis for both radiologists and pathologists when dealing with large expansile, lytic lesions, with well-defined sclerotic margins involving the sacrum. This is particularly important in middle-aged adults presenting with pathology centered around S2-3.

Tibial tunnel widening associated with anterior cruciate ligament reconstruction using autogenous hamstrings: A comparison between antero-medial portal and transtibial techniques

ObjectiveEvaluate the enlargement effect of the tibial tunnel emergence of 2 different of anterior cruciate ligament reconstruction techniques: antero-medial portal (AMP) vs. transtibial (TT) technique. MethodsA prospective, randomised controlled study was performed in 36 consecutive patients who underwent anterior cruciate ligament reconstruction with autologous hamstring tendon grafts employing the AMP and conventional TT techniques. Lateral and antero-posterior radiographs were obtained for each patient at 6 weeks and 12 months postoperatively. The sclerotic margins of the tibial tunnels were measured at the widest dimension of the tunnel as well as the diameter of the tibial emergence and were compared with the initially drilled tunnel size after correction for radiographic magnification. Statistical analysis was performed to compare the 2 groups by use of the independent-samples t test, with significance set at .05. ResultsThe mean percentage increase in the diameter of tibial tunnel emergence at 6 weeks after surgery was 8.1%±2.9 for the PAM technique and 21.20%±11.87 for the TT technique on the anteroposterior X-ray view. However, the mean percentage increase in the diameter of the tibial tunnel emergence on the lateral view was 7.1%±4.72 for the medial portal technique and 17.64%±11.48 for the transtibial technique. This difference was statistically significant on both anteroposterior and lateral views. ConclusionsThe diameter of the tibial tunnel emergence for hamstring autologous anterior cruciate ligament reconstructions was significantly lower for the medial portal technique when compared with the conventional TT technique.

Valoración de la apertura del túnel tibial tras la reconstrucción del ligamento cruzado anterior empleando isquiotibiales autógenos: Estudio comparativo entre la técnica de portal anteromedial y la técnica transtibial convencional

ObjectiveEvaluate the enlargement effect of the tibial tunnel emergence of 2 different of anterior cruciate ligament reconstruction techniques: antero-medial portal (AMP) vs. transtibial (TT) technique. MethodsA prospective, randomized controlled study was performed in 36 consecutive patients who underwent anterior cruciate ligament reconstruction with autologous hamstring tendon grafts employing the AMP and conventional TT techniques. Lateral and antero-posterior radiographs were obtained for each patient at 6 weeks and 12 months postoperatively. The sclerotic margins of the tibial tunnels were measured at the widest dimension of the tunnel as well as the diameter of the tibial emergence and were compared with the initially drilled tunnel size after correction for radiographic magnification. Statistical analysis was performed to compare the 2 groups by use of the independent-samples t test, with significance set at .05. ResultsThe mean percentage increase in the diameter of tibial tunnel emergence at 6 weeks after surgery was 8.1%±2.9 for the PAM technique and 21.20%±11.87 for the TT technique on the anteroposterior x-ray view. However, the mean percentage increase in the diameter of the tibial tunnel emergence on the lateral view was 7.1%±4.72 for the medial portal technique and 17.64%±11.48 for the transtibial technique. This difference was statistically significant on both anteroposterior and lateral views. ConclusionsThe diameter of the tibial tunnel emergence for hamstring autologous anterior cruciate ligament reconstructions was significantly lower for the medial portal technique when compared with the conventional TT technique.

Stafne bone defects radiographic features in panoramic radiographs: Assessment of 91 cases.

BackgroundTo evaluate 91 cases of Stafne bone defect (SBD) in panoramic radiographs (PR) to determine the prevalence of different SBD variants, considering age, gender, and side. Additionally, to assess the most frequent imaging features of SBD.Material and MethodsParticipant data were collected from 91 SBD cases with PR imaging. First, SBDs were classified according to their location, as anterior, posterior, or ramus variant. SBD imaging features were classified according to radiographic imaging findings, assessing margins, degree of internal radiolucency, shape, topographic relationship between the defect and mandibular border, location of the defect according to mandibular teeth, and locularity. The topographic relationship between the SBD and the mandibular canal was described for the inferior variant only. Mean sizes were also described.ResultsA total of 92 SBD cases were evaluated from 91 radiographs. One case presented multiple defects. Mean patient age was 60.80 years. Men were more affected than women. The most frequent SBD variant was the posterior variant, and the least frequent was the ramus variant. The most observed radiographic features were thick sclerotic bone margin in the entire contour of the defect, partially radiolucent internal content, oval shape, continuity with mandible base without discontinuity of mandible border, third molar region location, and unilocular shape. With the posterior variant only, the most common topographic relationship between the defect and the upper wall of the mandibular canal was the defect located below the upper wall and continuous with the inferior wall of the mandibular canal.ConclusionsThe knowledge of common SBD radiographic imaging features in PR can help dental practitioners with the differential diagnosis of SBD. Key words:Panoramic radiograph, mandible, bone cysts, salivary glands, Stafne bone defect.

Utility of CT imaging in differentiating sacroiliitis associated with spondyloarthritis from gouty sacroiliitis: a retrospective study.

Sacroiliitis is one of the criteria for classification as spondyloarthritis (SpA), though not unique to SpA. Other conditions including gout may be erroneously diagnosed as SpA due to sacroiliitis. The objective was to identify specific CT findings in sacroiliitis associated with SpA and gout. In this retrospective study, CT images of patients with sacroiliitis and clinical diagnosis of gout or SpA from 2010 to 2015 were independently reviewed by two radiologists, blinded to diagnosis. Axial and coronal oblique images were analyzed for characteristics of erosions. The receiver operator characteristic curve was constructed to analyze the discriminating ability of radiological findings. CT SI joint images of 11 patients with gout and 224 patients with SpA were re-analyzed. There was excellent agreement between the radiologists (ICC from 0.78 to 1). Erosions were more numerous in SpA. Erosions in gout were associated with tophi in 65.7% (73/111). Erosions in gout were para-articular and had sclerotic margins, overhanging edges, and multilobulated base (P<0.0001 for all). Length and depth of erosions were more in gout as compared to SpA. AUCs for length, depth of erosions, and subchondral sclerosis were 0.665, 0.694, and 0.991, respectively. Subchondral sclerosis ≤4.5mm had a sensitivity and specificity of 100 and 96%, respectively, for diagnosis of gout. In addition to known radiological features of gout, multilobulated base of erosions and absence of subchondral sclerosis could possibly distinguish sacroiliitis in SpA from gout. Our limited analysis suggests that CT imaging could help in differentiating the two.

Ossifying fibroma – diagnosis, treatment, and follow-up: case report and literature review

OBJECTIVE: This article presents a case of ossifying fibroma (OF), including its diagnosis, treatment, and 15-month clinical and radiographic follow-up as well as a review of the literature about this pathology.CASE REPORT: A routine panoramic radiograph of a 27-year-old, systemically healthy, white woman revealed a radiolucent lesion with well-defined sclerotic margins of approximately 3 × 2 cm in the mandible. The histopathological diagnosis revealed it was an OF. Lower Right Canine and Lower Right First Premolar teeth were endodontically treated for later surgical removal of the tumor. There was no history of trauma in the region.CONCLUSION: OF is a benign fibro-osseous tumor of the craniofacial bones commonly involving the jaws, especially the mandible. The diagnosis is based on a combination of clinical, radiographic and histologic criteria. Conservative treatment is an effective option that reduces morbidity and simplifies postoperative rehabilitation. We emphasize the importance of properly documenting individual cases and interpreting postoperative radiographic images along with the patients in order to avoid possible confusion between areas of bone repair and of potentially suspicious lesions in the future.

Long-term Osseous Remodeling after Femoral Head-neck Junction Osteochondroplasty

Objectives:Cam-type femoroacetabular impingement (FAI) is characterized by bony deformity of the proximal femoral head-neck junction. Osteochondroplasty at this level removes the impinging bone and has been associated with excellent clinical outcomes. Little is known about how the resection site remodels over long periods of time. Our objective was to describe the osseous remodeling of the femoral head-neck junction after osteochondroplasty at longterm follow-up (minimum of 7-years follow-up).Methods:A retrospective review of all patients that underwent femoral head-neck osteochondroplasty between October 2004 and December 2006 at our institution was performed. All patients with a minimum 7-year frog-leg lateral radiographic follow-up were included. Head-neck offset (HNO), head-neck offset ratio (HNOR) and α angle were measured on all frog-leg lateral radiographs preoperatively and postoperatively. The degree of cortical remodeling at the osetochondroplasty site was also graded as either none (no sclerotic margin was noted at the resection site), partial (sclerosis was present but in ), or (a continuous cortical line was noted) on the frog-leg lateral radiograph. A paired sample t-test was used for all continuous variables. Longitudinal analyses for HNO, HNOR and α angle were carried out using repeated measures ANOVA. An a priori power analysis utilizing data from a previous short-term study showed that 17 hips were required in order to obtain a power > 85% to find a change in HNOR of 0.02.Results:Eighteen hips, 10 left and 8 right, in 17 patients met inclusion criteria. The average age at the time of surgery was 26.8±SD10.3 years (range, 14-43 years) including nine females and eight males. Average radiographic follow-up was 112.1± SD17.4 months (range, 84-143 months). Initial radiographic correction of the cam-deformity was significant for HNO (7.0±SD2.5 vs. 11.3±SD2.5, p < .001), HNOR (0.12±.04 vs. 0.20±.04, p < .001), and α angle (53.2±14.0 vs. 38.9±5.7, p < .001). A small and gradual change in HNO (11.29±SD2.50 vs. 10.56±SD7.16), HNOR (0.199±.039 vs. 0.195±.138) and α angle (38.92±5.70 vs. 39.36±16.68) was observed across longitudinal follow-up but was not statistically significant (p = .645, p = .851; and p = .835; respectively) (see Figure 1). Only two hips (11%) demonstrated a decrease in HNOR > 0.02. One of these hips had an osteophyte in a patient with progression of osteoarthritis who subsequently underwent total hip arthroplasty three months later. After removing the osteoarthritic patient as an outlier, we continued to observe only small and gradual change in HNO (11.27±SD2.59 vs. 12.13±SD3.56), HNOR (0.20±SD.04 vs. 0.22±SD.70), and α angle (38.8±SD5.9 vs. 35.4±SD4.7) that was not statistically significant (p = 0.631, p = 0.312, p = 0.162; respectively). Recorticalization was present in 78% of hips (13 partial and 1) at an average follow-up of 22.8 months (range, 10-36 months). Recorticalization was present in 100% of hips (6 partial and 12 ) at final follow-up.Conclusion:Our study of osseous remodeling of the femoral head-neck junction after osteochondroplasty demonstrated insignificant postoperative changes in HNO, HNOR, and α angle over long-term follow-up. The head-neck junction predictably remodeled to cortical bone at the resection site. This study provides us with additional confidence that an osteochodroplasty at the femoral head-neck junction is durable over long periods of time.

Diagnóstico radiográfico e tomográfico de osteocondrose dissecante em tarso de cão

Background: The tarsal joint is the third most commonly joint affected by osteochondrosis in dogs. This joint is affected in 4 to 9% of the cases, and in 50% of these cases the disease is bilateral. Radiological signs include defect in the subchondral bone, sclerotic margin, and fragment of mineralized cartilage. Dorsoplantar in flexion and oblique radiologic images are necessary to show tarsal osteochondrosis. Computed tomography avoid overlap of bone structures and allows better visualization of subchondral lesions, showing the exact location, size and number of fragments. The objective of this study is to report a case of bilateral osteochondrosis dissecans in tarsal joint in Rottweiler.Case: A female Rottweiler was examined and presented a history of pain and difficulty in raising the pelvic limbs. There was pain in the right tibiotarsal joint (RTJ) with evident joint cracking and, after three months, the left pelvic limb started to show the same signs. Radiographic examination of the RTJ showed a small osteochondral fragment in the distal medial border of the medial malleolus of the tibia, subchondral sclerosis with radiolucent area in the medial malleolus of the tibia, and a small lateral periarticular osteophyte in the intertarsal joint. The left tibiotarsal joint (LTJ) showed mild articular incongruity and minor increase in radiological interlinear space, diffuse sclerosis in the medial malleolus and in the subchondral surface of the trochlear crest. This exam also showed a small radiolucent area in the medial malleolus of the tibia, a small fragment of radiopaque adjacent bone, and minor subchondral bone irregularity in the medial margin of the medial trochlea. The radiographic examination of the RTJ was inconclusive. Computed tomography was requested and suggested the diagnosis of medial osteochondritis dissecans in the distal talus. The most important tomographic signs were irregularity of the subchondral bone in the caudal region of the distal talus associated to isolated bone fragment, irregularity of the distal and caudal portion of the medial malleolus of the tibia associated with the presence of free adjacent osteophyte.Discussion: Only 4 to 9% of the dogs that develop osteochondrosis present this lesion in the tarsus. The Rottweiler is the breed most affected by this disease, such as the subject of this case report, and is also the breed most frequently affected in the lateral region of the tarsus. It is a fast-growing large breed, a common characteristic in animals affected by osteochondrosis. Bilateral cases are most common in young dogs, such as the patient of this case report. Clinical manifestation of pain and lameness is frequent in this type of disease, and lameness can occur in only one of the affected limbs. The dog of this study presented lesion in the medial region of the trochlea of the talus, one of the regions that present high incidence of osteochondrosis. Radiographic examination was efficient to suggest lesions in the medial region of the talus. However, only 10% of the dogs with osteochondrosis of the tarsus are diagnosed by this technique. The definitive diagnosis was not provided by radiographic examinations in this patient. Computed tomography has several advantages over conventional radiography, such as eliminating overlap of structures, decreasing image complexity, and increasing the ability to identify specific structures. This examination allowed us to reach the diagnosis of osteochondrosis dissecans in the right talus of this dog. A scan was not performed on the contralateral limb (LTJ), because the lesions observed on radiographic examination were similar to the lesions observed in the right pelvic limb.

CT manifestation for excavated-type of rhomboid fossa of the clavicle

To explore the manifestation of CT for excavated-type of rhomboid fossa of the clavicle. Nine cases with rhomboid fossaes of the clavicle of 8 patients accepted CT and 1 case added MRI together;all 8 patients were male who aged from 17 to 70 years old with mean age of 42.5 years old;three dimensional reconstruction of all CTs were made, the distance between focus and inside end of clavicle and the size of all focus were measured respectively, then the position, shape, margin of focus were analyzed. All focuses located near the inside end of clavicle and the distances between focus and inside end of clavicle were lower than 2 cm and the mean value was 1.3 cm, the size of all focuses was from 1.05 to 3.45 cm and the mean value was 2.18 cm. All 9 focuses of 8 patients located in the posterior and nether edge of inside end of clavicle, 5 cases located in right and 4 cases located in left side(both right and left side occurred in 1 patient. Seven focuses showed "fishhook sign" and the rest 2 focuses were small and without fishhook shape;the cortex of clavicle of all 9 cases showed local minus and nearly marrow showed integrated sclerotic margin. Regular soft tissue as strip can be seen in 7 focuses and the rest small focuses without the symptom. CT could show certain characteristics for excavated-type of rhomboid fossa of the clavicle and certain value for its diagnosis and identification.

Arthroscopic Excision of Osteoid Osteoma of the Elbow

Osteoid osteoma has been reported infrequently around the elbow joint, and is usually treated with radiofrequency ablation or open excision. Elbow arthroscopy is useful for excision of accessible lesions, and the accompanying elbow stiffness can be treated concurrently. This report describes an arthroscopic excision of an osteoid osteoma located in the juxta-articular distal humeral bone. An initial adhesiolysis and capsulectomy is performed to gain access to the region above the capitellar articular margin. A 70° arthroscope is necessary to visualize this region via the anteromedial portal. An accessory lateral portal is used to detach the capsule from the distal humerus; the scar tissue overlying the lesion is debrided and the circumferential lesion is visualized and probed for identification of its extent. A biopsy is performed, and thereafter the lesion is excised piecemeal. The sclerotic margins are curetted, and radiofrequency ablation is performed. The technique is cosmetic and minimally invasive, and can be performed in revision scenarios involving recurrences after open surgery or needle radiofrequency thermal ablation. Early rehabilitation restores range of motion and strength. Technical tips for identification and curettage of the lesion are presented.

Benign or Malignant: A Case Report of Multifocal Epithelioid Hemangioma of Fibula

Case Presentations: A 63-year-old female with no significant prior trauma and relevant past medical history presented with a 2-month history of severe, persistent, gradually worsening, sharp and non-radiating pain over her left distal fibula. Physical examination revealed extreme tenderness to palpation over the lateral distal fibula. There was soft tissue prominence over the mid to lower third of the fibula. Results: Left lower leg radiographs depicted two ill-defined osteolytic destructive lesions measuring 29 and 37 mm in length in the fibular diaphysis. A pathologic fracture was present through the distal lesion. A laboratory test, including serum protein electrophoresis, alkaline phosphatase and basic metabolic profile, was ordered to evaluate for multiple myeloma. CT scans of the chest and abdomen were obtained to evaluate for primary malignancy or any evidence of metastatic disease. The results of these tests were unremarkable. Image-guided biopsy of the lesions was performed and revealed epithelioid hemangioma (EH). The patient was initially managed with a walker boot. At the 2-month follow-up, an additional third smaller lesion was detected along with an interval increase in size of the two previously seen lesions. The patient proceed with preoperative embolization followed by surgical curettage and open reduction and internal fixation. Angiogram was done and tumor feeding artery was identified but tumor embolization was unsuccessful. The patient underwent fibular bone lesion curettage, PRO-DENSE bone grafting and open reduction and internal fixation with the left fibular diaphyseal plate. Radiographs revealed continued healing with bone graft incorporation at 1.5-, 3- and 7-month follow-ups. The patient was permitted to return to all activities without restriction 1.5 months after the surgery. Conclusions: EH is an uncommon, slow-growing vascular tumor that generally presents on the skin and the subcutaneous soft tissues of the head, with osseous EHs being rare. Although osseous EHs can present as multifocal lesions, the majority of bony EHs are solitary and arise in the diaphysis or metaphysis of long tubular bones, with a predilection for the lower extremity. Radiographically, EH may present as well-defined lytic lesions with sclerotic margins or mixed lytic and sclerotic lesions. These lesions are often located eccentrically and may demonstrate a disrupted or intact cortex.

Iliac Crest Regeneration: A Retrospective Study of 14 Years of Follow-up.

This is a retrospective study analysis. The purpose of our study was to evaluate the healing process of the ilium after being used as a bone graft donor site in the treatment of adolescent idiopathic scoliosis. Iliac crest bone grafts have been proven to be the most reliable means for solid fusion in spine surgery. Nevertheless, few reports in the literature describe the ability of the iliac crest to regenerate. Thirty-one patients with a mean age of 15.1 years had undergone posterior spinal fusion for idiopathic scoliosis. An autogenous bone graft was harvested from the right posterior iliac crest in all cases. Computed tomography scans of the pelvis were performed preoperatively and shortly after operation to evaluate the presence of any deformity and the size of the defect formed during surgery, respectively. All patients were reexamined 14 years postoperatively, and computed tomography scans were performed to evaluate the status of ossification at the donor site. In 21 cases (67.74%), bone deficits were fully restored (mean volume 12.053 cm), whereas partial regeneration was present in the remaining 10 cases (mean volume 8.766 cm). Hounsfield units (HUs) revealed that cancellous bone quality had been restored in 21 cases, whereas cysts with sclerotic bone margins were present in the remaining 10 cases. Immature patients [Risser sign (RS) 3, 4] have greater ability in restoring bone stock compared with patients with almost complete growth (RS 5; P<0.001). In addition, the gluteus maximus muscle preserved its volume and quality in cases with complete bone restoration (volume 51.3 cm, HU 55.9) compared with cases with partial regeneration (volume 43.43 cm, HU 38.35; P<0.001). The iliac wing of skeletally immature patients has considerable ability to fully regenerate and could probably be used as a graft donor site again.