High-resolution ultrasound approach to quadrangular joint in carpal boss: Everything musculoskeletal sonographer should know.

At the quadrangular joint (QAJ) of the carpus, a rare bony protuberance called carpal boss (CB) may occur. This bone abnormality may be due to osteophytes development or os styloideum. Symptomatic patients may complain pain, swelling, and restrictions in hand motion. These symptoms result from joint degenerative-inflammatory changes, development of ganglion cyst/bursitis, or tendons pathology. Correct diagnosis and appropriate management can be achieved through high-resolution ultrasonography (HR-US). The purpose of this review is to define the pathology spectrum around and within the QAJ in CB. The role of HR-US is highlighted and the standard technique for the QAJ assessment is described.

Paraneoplastic musculoskeletal disorders: review and update for radiologists.

Rheumatic paraneoplastic syndromes are rare syndromes that occur at distant sites from the underlying tumor and may involve the bones, joints, fasciae, muscles, or vessels. In the absence of a known tumor, early recognition of a rheumatic syndrome as paraneoplastic permits dedicated work-up for, and potentially early treatment of an occult malignancy. Although there is a continuously growing list of paraneoplastic rheumatic disorders, not all of these disorders have a well-established association with a neoplastic process. The goals of this article are to review the clinical characteristics, diagnostic work-up, and imaging findings of well-documented rheumatic paraneoplastic disorders.

Low-velocity, civilian firearm extremity injuries-review and update for radiologists.

Firearm injuries are a preventable epidemic in the USA. Extremities are commonly affected in gunshot injuries. Such injuries may be complex with concomitant osseous, soft tissue, and neurovascular components. The maximum wounding potential of a projectile is determined by its kinetic energy and the proportion of the kinetic energy that is transmitted to the target. Accurate assessment of ballistic injuries is dependent on utilizing the principles of wound ballistics, accurate bullet count, and ballistic trajectory analysis. The goals of this article are to review wound ballistics and the imaging evaluation of extremity civilian firearm injuries in the adult population, with emphasis on ballistic trajectory analysis, specific ballistic fracture patterns, and diffuse, secondary soft tissue ballistic injuries.

Meniscal Allograft Transplantation: A Pictorial Review.

Meniscal allograft transplantation may be indicated in a subset of patients with high-grade meniscectomy or irreparable meniscal injury and persistent knee pain that is resistant to conservative management. Meniscal allograft transplantation has demonstrated good to excellent results in short-term to midterm follow-up studies and satisfactory outcomes in long-term studies. The goals of this article are to review the indications, preoperative imaging assessment, surgical techniques, and postoperative assessment of uncomplicated and complicated meniscal allograft transplants.

3-T MRI of the Ankle Tendons and Ligaments.

Ankle sprain is the most common injury in athletic populations. Ligament and tendon pathologies of the ankle are common, ranging from traumatic injuries to degeneration leading to chronic pain and acquired foot deformities. MRI is the imaging modality of choice to evaluate tendon and ligament pathology of the ankle, specifically derangements of tendons and ligaments. 3-T MRI offers improved imaging characteristics relative to 1.5-T MRI, allowing for better delineation of anatomic detail and pathology. This article provides a review of the anatomy and common pathologies of the ankle ligaments and tendons using high-resolution 3-T MRI.

Circulating and Intratumoral Adrenal Androgens Correlate with Response to Abiraterone in Men with Castration-Resistant Prostate Cancer.

PURPOSE: In metastatic castration-resistant prostate cancer (mCRPC) low serum androgens prior to starting abiraterone acetate (AA) is associated with more rapid progression. We evaluated the effect of AA on androgens in castration-resistant prostate cancer (CRPC) metastases and associations of intratumoral androgens with response. EXPERIMENTAL DESIGN: We performed a phase II study of AA plus prednisone in mCRPC. The primary outcome was tissue testosterone at 4 weeks. Exploratory outcomes were association of steroid levels and genomic alterations with response, and escalating AA to 2,000 mg at progression. RESULTS: Twenty-nine of 30 men were evaluable. Testosterone in metastatic biopsies became undetectable at 4 weeks (P < 0.001). Serum and tissue dehydroepiandrosterone sulfate (DHEAS) remained detectable in many patients and was not increased at progression. Serum and tissue DHEAS in the lowest quartile (pretreatment), serum DHEAS in the lowest quartile (4 weeks), and undetectable tissue DHEAS (on-therapy) associated with rapid progression (20 vs. 48 weeks, P = 0.0018; 20 vs. 52 weeks, P = 0.0003; 14 vs. 40 weeks, P = 0.0001; 20 vs. 56 weeks, P = 0.02, respectively). One of 16 men escalating to 2,000 mg had a 30% PSA decline; 13 developed radiographic progression by 12 weeks. Among patients with high serum DHEAS at baseline, wild-type (WT) PTEN status associated with longer response (61 vs. 33 weeks, P = 0.02). CONCLUSIONS: Low-circulating adrenal androgen levels are strongly associated with an androgen-poor tumor microenvironment and with poor response to AA. Patients with CRPC with higher serum DHEAS levels may benefit from dual androgen receptor (AR)-pathway inhibition, while those in the lowest quartile may require combinations with non-AR-directed therapy.

Non-interventional Radiology Fellowship Programs: What Is Out There?

OBJECTIVE: To determine the spectrum of non-interventional radiology fellowship programs in institutions that offer both a radiology residency program and one or more non-interventional radiology fellowship programs. METHODS: Institutions offering both radiology residency and non-interventional radiology fellowship programs were identified using publicly available websites. The non-interventional radiology fellowship programs were categorized into "traditional" (neuroradiology, breast imaging, abdominal imaging, musculoskeletal imaging, thoracic imaging, pediatric radiology, and nuclear medicine) and "nontraditional" fellowship programs. The nontraditional programs were stratified into four categories: a) Combinations of traditional fellowships; b) Focused nontraditional fellowships; c) Combinations of traditional and focused nontraditional fellowships (excluding traditional-traditional combinations); and d) Mandatory two-year fellowships. The distributions of the different types of traditional and nontraditional fellowship programs were evaluated. RESULTS: 555 fellowship programs were identified in 113 institutions that offered both radiology residency and non-interventional radiology fellowship programs. 73.33% (407/555) of the programs were traditional fellowships, and 26.66% (148/555) were nontraditional fellowships. The 148 nontraditional fellowship programs were comprised of 41 different types of programs, 23 types of which were unique to and offered exclusively at specific institutions. 38.08% of the traditional fellowship programs were Accreditation Council for Graduate Medical Education (ACGME) accredited, while only 16.21% (24/148) of the nontraditional fellowship programs were ACGME-accredited. CONCLUSIONS: The nontraditional non-interventional radiology fellowship programs are formed by a heterogeneous group of programs, some of which are offered exclusively at a single institution. Awareness of the types of existing programs would help radiology residents in making a more informed decision regarding their fellowship training.

3T Magnetic Resonance Imaging of the Wrist Tendons.

Magnetic resonance imaging (MRI) is frequently used in the imaging evaluation of wrist pain. The complex anatomy of the wrist can be demonstrated by MRI. Three tesla (3 T) MRI offers increased signal-to-noise ratio relative to 1.5 T MRI allowing for higher soft tissue contrast and better spatial resolution. The resulting increase in conspicuity of fine anatomic detail may improve the detection and characterization of wrist pathology. In this article, we will review the anatomy, normal variants, and common pathologies of the wrist tendons as evaluated on 3 T MRI.

Surgical techniques for management of acromioclavicular joint separations: review and update for radiologists.

Imaging plays a central role in the postoperative management of acromioclavicular (AC) joint separations. There are more than 150 described techniques for the surgical management of AC joint injuries. These procedures can be categorized as varying combinations of the following basic techniques: a) soft-tissue repair, b) trans-articular AC joint fixation, c) coracoclavicular (CC) fixation, d) non-anatomic reconstruction of the CC ligaments, e) anatomic reconstruction of the CC ligaments, f) distal clavicle resection, and g) dynamic muscle transfer. The goals of this article are to describe the basic techniques for the surgical management of AC joint separations with an emphasis on technique-specific complications and postoperative imaging assessment.

External fixators: looking beyond the hardware maze.

External fixation has a wide variety of orthopedic applications. Although external fixator frames may have a complex appearance, these constructs are formed from several basic components and can be broadly categorized into unilateral, circular, or hybrid designs. The introduction of computer-aided circular external fixation devices (hexapod frames) has simplified the treatment of multiaxial and especially rotational deformities. Serial radiography plays a central role in the evaluation of callus formation (at the level of treated fracture or nonunion as well as the regenerate and docking site with distraction osteogenesis), tailoring the rate and rhythm of distraction during distraction osteogenesis, evaluation of frame complications, and determination of the timing of frame removal. The goals of this article are to review: the components, types, and relevant terminology of external fixator constructs with special emphasis on the Taylor spatial frame, the principles and techniques of distraction osteogenesis, and complications of external fixation.

Clavicle fixation screw impingement causing subclavian artery pseudoaneurysm.

Vascular injuries are an extremely rare complication of clavicle osteosynthesis, though several cases are reported in the literature. Cadaver studies have established recommended safe lengths for clavicle screws based on precise measurements of bone thickness and distance from subjacent neurovascular structures. We present the case of a 27-year-old female who underwent orthopedic plate and screw fixation of a clavicle fracture and subsequently sustained iatrogenic vascular injury from one of the screws. This necessitated endovascular repair and orthopedic revision. This case underscores the importance of selecting appropriate screws based on available imaging.

Ankle medial flexor retinaculum avulsion fracture.

Medial flexor retinaculum injuries are not uncommon, but medial flexor retinaculum periosteal avulsion injuries are rare. This patient sustained a medial flexor retinaculum tear readily characterized at computed tomography by an associated proximal retinacular avulsion fracture from the posteromedial tibia. Medial flexor retinaculum injury is often also associated with superficial deltoid pathology and/or medial malleolar fracture. An additional significant complication of medial flexor retinaculum tear is anterior dislocation of the tibialis posterior tendon, which heralds a tibialis posterior fibro-osseous tunnel injury.

Incidental discovery of isolated talonavicular coalition: Report of two cases.

Tarsal coalitions may cause altered foot biomechanics leading to patient disability from osteoarthritis and other sequelae. While some types of coalition are common, isolated talonavicular coalitions are relatively rare. We present two cases of osseous talonavicular coalition that were incidentally discovered in adults and were most likely asymptomatic. Talonavicular coalition may have a hereditary component and may be associated with other anomalies, but many seem isolated, asymptomatic, and incidental.

Multiple open wrist fractures and dislocation of the distal radioulnar joint from a dog bite injury.

Dogs are commonly kept as household pets, but sometimes pet dogs bite people. We report the case of a 69-year-old man who was bitten by his pet pit bull terrier. The dog bite resulted in multiple open wrist fractures and dislocation of the distal radioulnar joint, requiring surgical debridement, open reduction and internal fixation, and bone grafting. CT of the fractures showed that the dog's maxillary canine teeth had been deeply embedded in the hamate and second metacarpal bones, requiring that the dog's mouth be opened and the teeth disengaged in order to remove the injured limb from the dog.

Scapulothoracic dissociation.

Scapulothoracic dissociation is a rare and potentially limb- and life-threatening injury, that results from high-energy trauma. Scapulothoracic dissociation has the potential to be overlooked in the acute setting, especially in the setting of polytrauma. Therefore, a careful search for this condition should be performed in all patients with high-energy shoulder girdle injuries. The goals of this article are to review the anatomy of the scapulothoracic articulation as well as the spectrum, imaging evaluation, differential diagnosis and management of scapulothoracic dissociations.

The floating shoulder.

The floating shoulder refers to a subset of complex shoulder injuries that typically occur in the setting of high-energy trauma. Identification of the full extent of complex shoulder injuries with computed tomography may have critical implications in patient management. The goals of this article are to review the anatomy, definition, imaging evaluation, and treatment of floating shoulder injuries.

Thoracic cage injuries.

Rib fractures are the most common form of blunt thoracic injury. Multiple rib fractures are an important indicator of trauma severity, with increased morbidity and mortality occurring with increasing numbers of rib fractures, especially in the elderly. Thoracic cage injuries may be associated with concomitant and potentially life-threating injuries. In the acute setting, correct recognition of the pattern, extent and severity of thoracic cage injuries, may aid in more accurate delineation of concomitant injuries.