Melissa DuBois

Fabella fracture with CT imaging: a case report

Fracture of the fabella is rare, may be easily overlooked, and can be a clinically important cause of posterolateral knee pain following traumatic injury or total knee arthroplasty. To date, nine case reports of fabella fracture with radiographic documentation have been reported in the literature. This report documents a 55-year-old male pedestrian who was struck by an automobile and presented with radiographs demonstrating depressed lateral tibial plateau and proximal fibula fractures. Computed tomography (CT) was performed for surgical planning and demonstrated the additional finding of a radiographically occult nondisplaced fabella fracture. To the best of our knowledge, this is the first case in which CT documentation of a fabella fracture is reported. Fracture of the fabella is a rare but important clinical entity which may be overlooked clinically and radiographically. Clinical information can provide a high index of suspicion, and when coupled with radiographic and CT findings, may lead to the correct diagnosis. CT imaging of the knee may confirm a suspected fabella fracture or may help detect a radiographically occult fracture.

Iliotibial band avulsion fracture: a case report with differential diagnosis

Avulsion injuries of the knee are common sequelae of significant trauma given the number of ligamentous and tendinous insertions around the joint. Commonly discussed avulsion fractures of the lateral knee include the Segond fracture of the lateral tibial plateau and the arcuate complex avulsion fracture of the fibular styloid process. A less common avulsion fracture is the iliotibial (IT) band avulsion fracture involving the anterolateral corner of the tibia (Gerdy’s tubercle). It is crucial to identify IT band avulsion fractures because of the frequent associated internal derangements of the knee. This case report describes the imaging of an acute IT band avulsion fracture and compares these findings with other lateral knee avulsion fractures.

Tumor Increase on MRI after Neoadjuvant Treatment is Associated withGreater Pathologic Necrosis and Poor Survival in Patients with Soft TissueSarcoma

Purpose: MRI is often used to evaluate sarcoma response to neoadjuvant treatment, however its role to predict for pathologic response and survival is unclear. Methods and materials: From 2003-2010, 116 patients with STS were treated with neoadjuvant therapy (NAT). 62 patients who had an MRI before and after radiotherapy were analyzed. Radiographic change was correlated with survival and necrosis and fibrosis on pathology. ROC curve analysis was used to assess change in volume that best predicted for pathological necrosis. Results: Median follow-up was 33 months. There was median tumor volume decrease of 15.08 cm3 after treatment. Increase in tumor size and volume was associated with greater necrosis (p<0.03, p=0.001, respectively) and less fibrosis (p<0.001) on pathology. High-grade tumors had more necrosis (p<0.001) and comprised the majority of patients with tumor increases following NAT (88%). Tumor increase of at least 66% predicted for ≥ 70% necrosis with 94% specificity. The 3-year OS was 65% vs. 93% in patients with a decrease in size and volume (p=0.004). In tumors with ≥ 70% necrosis, the 3-year OS was 38% vs. 91% if necrosis was <70% (p<0.001). Conclusions: MR-based tumor increase following NAT was associated with greater % necrosis and less fibrosis on pathology. This tumor increase was more likely high-grade and associated with worse survival.

Glenoid avulsion of the glenohumeral ligament (GAGL): a case report and review of the anatomy

Shoulder dislocations are frequently seen in the general population and can be a cause of instability. Instability can lead to debilitating symptoms and morbidity as a result of progressive damage to the shoulder. Anterior shoulder dislocations are the most frequent type of dislocations and have been studied extensively with MRI. The soft tissue Bankart lesion is the most well-known entity associated with anterior instability; however, additional structural lesions arising from traumatic events have been described in recent literature which also predispose to anterior shoulder instability. One of these lesions, the glenoid avulsion of the glenohumeral ligament (GAGL), involves avulsion of the inferior glenohumeral ligament from the glenoid and involves separation from an intact labrum. In contrast to the Bankart lesion, there has been limited discussion of the GAGL lesion in the literature and very few imaging examples. We report a case of a GAGL diagnosed on MRI and confirmed with arthroscopy. It is discussed in the context of the anatomy of the inferior glenohumeral ligament and the imaging findings.

Complications in Musculoskeletal Intervention: Important Considerations

Musculoskeletal (MSK) intervention has proliferated in recent years among various subspecialties in medicine. Despite advancements in image guidance and percutaneous technique, the risk of complication has not been fully eliminated. Overall, complications in MSK interventions are rare, with bleeding and infection the most common encountered. Other complications are even rarer. This article reviews various complications unique to musculoskeletal interventions, assists the reader in understanding where pitfalls lie, and highlights ways to avoid them.