Intraosseous hibernoma: A metastatic mimicker to consider on the differential.

Intraosseous hibernoma is an uncommon brown fat tumor that with about 2-dozen case reports described in the literature. Hibernomas are more commonly found in soft tissues of the thigh, shoulder, and back. However, more cases of intraosseous hibernomas are coming to light as a result of work-up due to pain or as an incidental lesion finding. Herein, we present a case of a thoracic intraosseous hibernoma suspicious for an isolated ovarian cancer metastasis, successfully treated with radiofrequency ablation and kyphoplasty.

A Thoroughbred racehorse with a unicortical palmar lateral condylar fracture returned to training 14 days after surgery: a hypothesis on the role of a single bone screw on crack propagation.

A 2-year-old Thoroughbred racehorse had LF lameness that began post high-speed exercise and persisted for two days before the horse once again became sound. Diagnostic analgesia localized the lameness to the LF distal metacarpus, and a standing MRI identified a unicortical condylar fracture. A single 5.5 mm cortical screw was placed in lag fashion. The horse began hand walking at 14 days, racetrack jogging at 30 days, and racing at 5 months after the day of surgery. Placement of a single lag screw ahead of the tip of the crack in unicortical condylar fracture may be useful for reducing the recovery period for horses returning to training and racing.

Association of catastrophic condylar fracture with bony changes of the third metacarpal bone identified by use of standing magnetic resonance imaging in forelimbs from cadavers of Thoroughbred racehorses in the United States.

OBJECTIVE To compare bony changes of the third metacarpal bone (MC3) of Thoroughbred racehorse cadavers with (cases) or without (controls) catastrophic condylar fracture by use of standing MRI. SAMPLE 140 forelimbs from 26 case horses (both forelimbs) and 88 control horses (single forelimb). PROCEDURES Bone marrow lesions (BMLs), identified as a decrease in T1-weighted (T1W) signal and increases in T2*-weighted (T2*W) and short tau inversion recovery (STIR) signals, and dense bone volume percentage (DBVP), identified as decreases in T1W, T2*W, and STIR signals, in the distopalmar aspect of MC3 were recorded. Logistic regression was used to compare fractured and nonfractured limbs of cases and fractured limbs of cases with randomly selected limbs of controls. RESULTS Among cases, fractured limbs were significantly more likely to have BMLs (26/26 [100%]) than were nonfractured limbs (7/26 [27%]). Fractured limbs of cases were significantly more likely to have BMLs (26/26 [100%]) than were limbs of controls (6/88 [7%]). Among cases, there was no significant difference in DBVP between fractured and nonfractured limbs in lateral (26% vs 21%, respectively) or medial (25% vs 20%, respectively) condyles. However, DBVP was significantly greater in fractured limbs of cases than in limbs of controls for lateral (26% vs 16%, respectively) and medial (25% vs 18%, respectively) condyles. CONCLUSIONS AND CLINICAL RELEVANCE Standing MRI revealed a significantly greater degree of bone change in racehorses with condylar fracture when comparing fractured and nonfractured limbs of case horses and fractured limbs of case horses with randomly selected limbs of control horses.

Correlation Between Standard Upper Extremity Impairment Measures and Activity-based Function Testing in Upper Extremity Cerebral Palsy.

BACKGROUND: Although the treatment of cerebral palsy should be based on improving function as assessed by measures of impairment, activity, and participation, the standard indications for surgical treatment of upper extremity cerebral palsy (UECP) are impairment measures, primarily active and passive range of motion (ROM). Recently, validated activity measures have been developed for children with UECP. The purposes of this study were to determine the relationship between impairment and activity measures in this population, and whether measures of activity correlate with each other. METHODS: A total of 37 children, ages 5 to 16 years, who met standard ROM surgical indications for UECP were evaluated with the impairment measures of active and passive ROM and stereognosis, as well as 3 activity measures [Assisting Hand Assessment (AHA), Box and Blocks test, and the Shriners Hospitals Upper Extremity Evaluation Dynamic Positional Analyses (SHUEE DPA)]. Impairment measures were correlated with activity measures using Spearman rank correlation coefficients. RESULTS: Impairment measures showed inconsistent correlation with activity measures. Of the 12 comparisons, only 4 correlated: active forearm supination (ρ=0.47, P=0.003), wrist extension (ρ=0.55, P=0.001), and stereognosis scores (ρ=0.54, P=0.001) were correlated with AHA; and wrist extension was correlated with the SHUEE DPA (ρ=0.41, P=0.01). When the results of activity tests were compared, the AHA was correlated with the Box and Blocks tests (ρ=0.63, P<0.001), and the SHUEE DPA and Box and Blocks tests were correlated with each other (ρ=0.35, P=0.04). CONCLUSIONS: The goal of surgery in UECP is to improve the child's ability to perform activities, and ultimately to participate in life situations. Impairment measures, such as ROM, were inconsistently correlated with validated measures of activity. Some activity measures correlated with each other, although they did not correlate with the same impairment measures. We conclude that impairment measures, including ROM, do not consistently predict functional dynamic ROM used to perform activities for children with UECP. Activity limitation measures may provide more appropriate indicators than impairment measures for upper extremity surgery for this population. LEVEL OF EVIDENCE: Level II-diagnostic.

Association of catastrophic biaxial fracture of the proximal sesamoid bones with bony changes of the metacarpophalangeal joint identified by standing magnetic resonance imaging in cadaveric forelimbs of Thoroughbred racehorses.

OBJECTIVE: To compare bony changes in the metacarpophalangeal joint (MCPJ) of racehorses with (cases) and without (controls) biaxial proximal sesamoid bone (PSB) fracture as determined by 2 grading scales applied to images of cadaveric forelimbs obtained by means of standing MRI (sMRI). DESIGN: Case-control study. SAMPLE: Forelimbs from 74 Thoroughbred racehorses (21 cases and 53 controls) that were euthanized at a Florida racetrack. PROCEDURES: Both forelimbs were harvested from cases and controls. Each forelimb underwent sMRI to obtain images of the MCPJ. Two grading scales were described and used for image evaluation; one assessed the density of the PSBs, and the other assessed the integrity of the subchondral bone (SCB) plate at the distopalmar aspect of the third metacarpal bone (MC3). Logistic regression was used to compare the grades between case and control limbs. RESULTS: Biaxial PSB fracture was associated with a total PSB grade (sum of lateral and medial PSB grades) ≥ 5 for the fractured limb, total MC3 SCB grade (sum of lateral and medial MC3 SCB grades) ≥ 5 for the contralateral limb, and the presence of orthopedic disease in the contralateral MC3. CONCLUSIONS AND CLINICAL RELEVANCE: For cases with biaxial PSB fracture, the density of the PSBs in the affected limb was greater and the MC3 of the contralateral limb was more likely to have orthopedic disease, compared with those for controls. Further evaluation of sMRI as a screening tool for identification of racehorses at risk of biaxial PSB fracture is warranted.