Jerry S. Apple

Cervical spine fractures and dislocations in children

A retrospective analysis of pediatric admissions over 10 years revealed 29 patients with cervical spine injuries. Eleven patients were below 12 years of age, and 10 of these had injuries involving C1, C2, or the occipitoatlantal articulation. Eighteen patients were between 12 and 16 years of age with injuries distributed throughout the cervical spine similar to injuries in the adult population. Our results suggest that teenagers with suspected cervical injuries are best evaluated by an adult radiographic series including trauma oblique views. In younger patients, careful evaluation of occipitoatlantoaxial alignment and the prevertebral soft tissues is required for diagnosis and selection of additional imaging evaluation.

Osteoarthritis of the sternoclavicular joint. Radiographic features and pathologic correlation.

Osteoarthritis (OA) of the sternoclavicular (SC) joint has been extensively characterized in the pathology literature, but the radiographic appearance of this entity has received comparatively little attention. To define the radiographic patterns of OA at this joint, we used high resolution PA radiographs (industrial grade film) to examine 55 SC joints obtained by block resection at autopsy. Ten of these also were selected for coronal complex motion tomography. Fifty cases were histologically correlated. Radiographic and pathologic material was evaluated by four criteria characteristic of OA: joint-space narrowing, osteophytes, sclerosis, and cysts. Each criterion was independently assessed for severity and distribution. Moderate or severe radiographic changes of OA were uncommon in specimens younger than age 40, but present in 53% older than age 60. Changes were typically bilateral, although a mild degree of asymmetry was common. OA was most severe along the inferior portion of the clavicular head, which comprises its articulating margin with the sternum. Complex motion tomography was generally more accurate than plain radiography for assessing OA in the ten specimens in which comparison was performed.

Bilateral avulsion fractures of the anterior superior iliac spines in sprinters

Three cases of bilateral pelvic avulsion fractures in adolescent sprinters are reviewed. Anacute avulsion fracture of the anterior superior iliac spine (ASIS) occurred during active running in three teenaged sprinters. Radiography confirmed a healed fracture of the contralateral ASIS. The clinical features and radiologic appearances are characteristic. The pathophysiology of this type of unique pediatric fracture is discussed. Conservative treatment is successful.

Synovial plicae of the knee

This report describes the anatomy, pathophysiology, clinical, and radiographic findings, and treatment of the synovial plicae of the knee joint. The suprapatellar plica is a synovial fold present in the suprapatellar pouch of the knee joint in approximately 20% of the population. This fold may become symptomatic after injury and cause symptoms similar to other common internal derangements of the knee. Double contrast arthrography of the knee can be used to identify the presence of plicae. Although arthrography can identify the presence of a plica, its clinical significance requires close correlation with symptoms and an accurate clinical examination.

Case report 376

A 24-year-old woman school teacher noticed swelling behind her left ankle when she started jogging two or three miles a day, approximately nine months prior to admission. She stopped jogging for three months, and the swelling receded. However, the swelling returned along with pain, when she resumed jogging three months before to admission. The ankle also became swollen and painful when she attended classes for physical exercise. The patient denied any ecchymosis, numbness or weakness of the left foot or ankle. Physical exami-

Occult carpal pathology: tomographic evaluation

Pluridirectional tomography in coronal and sagittal planes has been used to identify occult carpal pathology in 23 patients with chronic wrist pain following recent or remote trauma. The tomographic studies have detected or further defined the carpal pathology in 22 of the 23 patients studied adding useful information concerning their clinical management.

An unusual presentation of thyroid papillary carcinoma: enlargement of a cervical intervertebral foramen.

Isolated enlargement of the cervical intervertebral foramen is frequently associated with dumbbell neurogenic tumors. We present an unusual case of isolated enlargement of a cervical intervertebral foramen in a 77-year-old male with an aggressive papillary thyroid carcinoma. To our knowledge, this represents the first case describing a thyroid process as a cause of foraminal enlargement.

PROTRUSIO ACETABULI IN SICKLE CELL ANEMIA

Of 155 adults with sickle-cell anemia (SS, SC), radiographs of the pelvis or hip demonstrated protrusio acetabuli on at least one side in 14 (3 men and 11 women), as indicated by projection of the acetabular line medial to the ilio-ischial line by greater than or equal to 3 mm in men and greater than or equal to 6 mm in women. All 14 patients had bone changes attributable to sickle-cell anemia, including marrow hyperplasia and osteonecrosis; however, the severity of femoral or acetabular osteonecrosis did not appear directly related to the protrusion. The authors conclude that sickle-cell anemia can predispose to development of protrusio acetabuli.