Carol A. Boles

Chondral and osteochondral injuries. Diagnosis and management.

Osteochondral lesions are relatively common and usually occur as a result of trauma. They often are unrecognized acutely and lead to osteochondral defects and eventually osteoarthritis. Detection of these lesions has been aided by bone scan, CT, and MR imaging. Acute osteochondral fragments can be replaced and internally fixed. Chronic osteochondral defects can be treated with several methods designed to stimulate healing by either fibrocartilage or healing by transplantation of bone and cartilage or cartilage alone. The goal of all treatment methods is to provide a stable, congruent joint surface, restore function, and prevent the evolution of osteoarthritis in the injured joint.

Magnetic resonance characteristics of medial plica of the knee: correlation with arthroscopic resection.

Objective: The purpose of this study was to determine if there are magnetic resonance (MR) characteristics of the medial plica that correlate with the likelihood of plica resection. Methods: Sixty-six knee MR examinations from patients who underwent subsequent knee arthroscopy were evaluated retrospectively for the presence of a medial plica. The plicae were then characterized by relative width, thickness, relation to the trochlear cartilage, associated cartilage changes, and effusion. The arthroscopy reports from each knee were reviewed for the presence, description, and resection of medial plicae. Results: A medial plica was demonstrated by MR in 46 of 66 (69.7%) cases. A medial plica was mentioned in 16 of 66 (24.2%) arthroscopic reports. No MR characteristics were significantly predictive of resection. Location of a plica adjacent to cartilage had a P value of 0.0786, plica width had a P value of 0.0858, and plica thickness had a P value of 0.1685. Conclusion: No MR characteristics of medial plicae were found to be predictive of subsequent resection at arthroscopy.

Osteochondritis dissecans of the tarsal navicular bone: imaging findings in four patients.

We report the imaging characteristics of osteochondritis dissecans of the tarsal navicular bone in four cases and review the current literature. Its radiological findings are similar to osteochondritis dissecans found in other sites: focal lucency that disrupts the sharp cortical line, the presence of sclerosis, and cortical depression.

Biceps Brachii Compartment Contrast Media Extravasation with Surgical Correlation.

We describe a case in which 120 ml of contrast media was extravasated into the biceps brachii compartment with a power injector during the course of an attempted CT angiogram. The patient underwent surgical fasciotomy and drainage. The radiographic appearance and clinical implications of this event are discussed.

Stress Injuries of the Pelvis: Beyond the Femoral Neck

There are two types of stress fractures: fatigue fractures, which occur with cyclic mechanical overloading of otherwise healthy bone; and insufficiency fractures, which occur with normal loading of fragile bone. Both types of stress fractures are found within the pelvis and proximal femora. Fatigue-related stress fractures in these areas are uncommon. They account for only 1% to 10% of all overuse fractures, a type of fracture classically seen in other bones in distance runners, military recruits, and dancers. Insufficiency fractures of the pelvis occur relatively frequently, however, particularly in postmenopausal women, patients receiving long-term oral corticosteroid therapy, and patients suffering from rheumatoid arthritis. These stress injuries occur in both cancellous and cortical bone, with the radiographic appearance determined by their location. The intimate interaction of the pelvic ring structures and their central role in virtually all weight-bearing activities account for the many cases in which two or more of these fractures are seen in conjunction. Because all such injuries have significant associated morbidity and may progress to complete fractures if improperly managed, early recognition is of paramount importance.

Musculoskeletal imaging: Case review series: Joseph Yu. St. Louis, Mosby, 2001, 304 pp.,

Abstract Arthroscopy: The Journal of Arthroscopic and Related surgery, Vol 18, No 6 (July-August), 2002: pp 680–681