Association of the presence of bone bars on radiographs and hip fracture in postmenopausal Caucasian women.

AIM: To determine whether the presence of bone bars (BB) identified on anteroposterior hip radiographs are more prevalent in patients that have had a hip fracture as compared to patients without a fracture. MATERIALS AND METHODS: Ninety-two Caucasian women with a unilateral proximal femur fracture were retrospectively evaluated and randomly selected using radiology database records to comprise the investigational group. Ninety-eight age-matched Caucasian women without hip fracture were selected as a control group. Anteroposterior hip radiographs were evaluated for the presence of BBs by two musculoskeletal radiologists. Chi-square tests were used to assess whether fractures were more prevalent in patients with BB than those without BB. RESULTS: The patient population was comprised Caucasian women with a mean age of 79.8 ± 6.4 years in the control group and 79.9 ± 6.6 years in the investigational group. Regardless of the reader, BB were identified in a significantly higher percentage of women with a fracture (75 versus 39%, p < 0.001 or 53 versus 38%, p = 0.041) as compared to those without a fracture. CONCLUSION: BB are associated with hip fracture. Their presence is a trigger for requesting a dual-energy x-ray absorptiometry (DXA) examination to confirm or refute a diagnosis of low bone mineral density (BMD) and a subsequent increased risk of fracture.

Technetium-99m-diphosphonate accumulation in amyloid.

A well-documented case of multiple myeloma complicated by histologically demonstrable amyloidosis is presented. Technetium-99m-diphosphonate in the areas of amyloid deposition about the shoulders and hips is shown. This adds another dimension to the extraosseous sites without demonstrable calcification where accumulation of bone-seeking radiopharmaceutical can be observed. In patients where symmetrical uptake of such agents is noted in the periarticular soft tissue, particularly of the hips and shoulders, amyloidosis must become a diagnostic consideration. This is particularly true in patients presenting with undiagnosed arthralgia.

Rickets and osteomalacia are still around.

The terms rickets and osteomalacia describe gross, histologic, and radiologic abnormalities common to more than 50 diseases that vary in cause and clinical presentation. Rachitic and osteomalacic syndromes seen in current clinical practice usually are resistant to vitamin D forms and are most often caused by phosphate loss or 1,25(OH)2D deficiency, or both. Radiographic identification of rachitic or osteomalacic syndromes and accurate diagnosis of a particular cause is essential, as many patients' conditions can be improved or cured with proper therapy.

Rachitic and osteomalacic syndromes.

Today, the radiologist must not only be familiar with the radiologic features of rickets and osteomalacia, but should also have some understanding of the newer metabolic concepts. This article highlights advances in vitamin D metabolism, discusses the structural pathology of rickets and osteomalacia, correlates these changes with the radiographic appearance of these syndromes, and suggests a practical radiologic approach to them.

Radiologic reporting of skeletal trauma.

The radiologist's report of skeletal trauma should include accurate, appropriate comments directed to the clinical objectives of the referring physician. An organization of these reports is suggested, addressing general and specific description of fractures with a discussion of pertinent clinical considerations.

Imaging of the elbow with an emphasis on trauma.

This article provides a review of imaging of the elbow with an emphasis on trauma. The pertinent bone and soft-tissue anatomy of the elbow is discussed, with particular attention paid to the soft-tissue anatomy of imaging importance. The pediatric patient is considered and the basic radiographic examination is outlined. Finally, selected problems of elbow trauma are addressed and the various types of fractures are detailed.

Imaging of the pelvis and hip.

Imaging is basic in the orthopedic evaluation of hip disorders. For optimal evaluation of these images, the orthopedic surgeon must not only correlate normal anatomy and pathology with radiographic findings, but must also be familiar with the newer modalities of CT, magnetic resonance imaging and ultrasound and the role and place of these studies in the evaluation of musculoskeletal disorders. This article correlates normal anatomy of the hip with these modalities and discusses the details of these techniques, particularly CT and MRI, that are pertinent to the orthopedic surgeon.

Kyphosis and pulmonary function in cystic fibrosis.

Spine deformity and chronic pulmonary disease are commonly seen in patients with cystic fibrosis (CF). In order to assess the prevalence of kyphosis, a retrospective evaluation of all initial standing chest radiographs of our CF patients matched with our "reference" population was undertaken. We also studied the possible correlation between the degree of kyphosis and the pulmonary function tests ( PFTs ), consisting of thoracic gas volume and maximal expiratory flows. In our population, the study confirmed an increased prevalence of kyphosis in CF patients (p less than .01), which occurred mostly in girls after 12 years of age (p less than .018). The kyphosis appeared to be, in most instances, of mild degree and was not related to any of the PFTs . No measurable increase of kyphosis was observed over a 3-year period in the group. Longer prospective study and the relationship of kyphosis to endocrine function in CF at puberty should be undertaken.

Osteoporosis, osteomalacia, rickets, and Paget's disease.

Although the common form of osteoporosis associated with aging can be treated, it is best to avoid the problem by not letting the disease develop. Osteomalacia is caused by inadequate or delayed mineralization of bone and is treated by correcting the abnormal intake, loss, or metabolism of vitamin D, phosphate, and calcium. Paget's disease is characterized by osteoclastic resorption of bone with new bone laid down in a disorganized fashion.

Shotgun diagnosis: "it ought to be something else".

The problems encountered by the surgeon, the radiologist, and the pathologist in the interpretation of radiopaque fragments within tissue are illustrated by a case report. Deformation, particularly flattening, of round pellets should be recognized as a gross radiographic pitfall. The potential and actual external and internal tissue damage resulting from a close-range shotgun blast are also discussed. Careful study of the radiographs, examination of the weapon and ammunition, and the information obtained from good investigation by trained law-enforcement officers should prevent possible misinterpretation.

Molecular pathology of chondroid neoplasms: part 1, benign lesions.

This two-part review presents an overview of the molecular findings associated with both benign and malignant chondroid neoplasms. This first part presents a brief review of methods in molecular pathology along with a review of the cytogenetic and molecular genetic findings in benign chondroid neoplasms. Clinical aspects of the various lesions are briefly discussed, and each tumor is illustrated with representative radiographic and pathologic images. Malignant chondroid neoplasms will be considered in the second part of this review.

Molecular pathology of chondroid neoplasms: part 2, malignant lesions.

This is the second part of a two-part review presenting an overview of the molecular findings associated with both benign and malignant chondroid neoplasms. The first part presented a brief review of modern methods in molecular pathology, along with a review of the cytogenetic and molecular genetic findings in benign chondroid neoplasms. This second part reviews the cytogenetic and molecular genetic findings in malignant chondroid neoplasms. Clinical aspects of the various lesions are briefly discussed, and each tumor is illustrated with representative radiographic and pathologic images.

Calcified rims: characteristics but uncommon radiologic finding in pseudomyxoma peritonei.

Curvilinear calcifications on abdominal radiographs are described in a patient with pseudomyxoma peritonei, and the literature on the radiographic findings in this disease is reviewed. This sign is infrequent but characteristic. Other radiographic features of the case are also presented, as well as ultrasound and gallium scans. The latter have not been reported previously in pseudomyxoma peritonei and showed the uncommon finding of "cold" lesions.

Radiographic disease patterns at the carpus.

Radiographic analysis of the wrist includes evaluation of general nonspecific alterations of the carpus, changes specific to one or several diseases, the location of the abnormalities, and the pattern of disease. Correlation with clinical history is extremely important. Some diseases, such as gout, are usually detectable clinically. Others, such as chondrocalcinosis or chronic infection, may have been unrecognized prior to the radiographic study. Special investigations are necessary in difficult cases.