Pediatric extraskeletal osteosarcoma.

Extraskeletal osteosarcoma (ESOS) is a rare malignant tumor composed of mesenchymal cells comprising approximately 1% of soft-tissue sarcomas and 4% of all osteosarcomas. Primary osseous osteosarcomas more commonly develop in children and adolescents, but there are very few reports of ESOS occurring in those younger than 40 years. These variants of high-grade osteosarcoma are often characterized histopathologically by the production of an osteoid matrix and bone from malignant osteoblasts that by definition are present in the soft tissue outside the normal skeletal anatomy. We present a 13-year-old girl with a gradually enlarging, painless left thigh mass.

Magnetic resonance imaging of the collateral ligaments and the anatomic quadrants of the knee.

Injuries to the lateral and medial supporting structures of the knee can be significantly disabling and somewhat difficult to detect and evaluate clinically. An accurate imaging evaluation of these structures requires the use of the appropriate MR imaging sequences and the detailed knowledge of the anatomic structures that are present in these locations. Normal function is dependent on the integrity of the complex functional structures and effective clinical treatment, including surgical repair, of these structures is predicated on an optimal diagnostic evaluation. A successful diagnostic evaluation can expedite treatment and provide the best opportunity for a favorable long-term outcome.

Percutaneous augmentation of the superior pubic ramus with polymethyl methacrylate: treatment of acute traumatic and chronic insufficiency fractures.

The injection of polymethylmethacrylate (PMMA) is a minimally invasive image-guided procedure that is typically used to treat vertebral body fractures due to osteoporosis or neoplastic involvement. The injection of PMMA into various other locations including the sacrum, acetabulum, pedicles, femur and tibia has been reported previously, and these procedures have, overall, been highly effective at alleviating pain and discomfort. Although the injection of PMMA into the vertebral body is a very common procedure that has been performed for over 2 decades for the percutaneous treatment of vertebral body fractures, the percutaneous injection of PMMA has not been reported in the English literature as treatment for superior pubic ramus fractures. We report the percutaneous treatment of an acute superior pubic ramus fracture and of a chronic insufficiency fracture of the superior pubic ramus using a parasymphyseal approach to access the region of injury.

Magnetic resonance imaging of the collateral ligaments and the anatomic quadrants of the knee.

Injuries to the lateral and medial supporting structures of the knee can be significantly disabling and somewhat difficult to detect and evaluate clinically. An accurate imaging evaluation of these structures requires the use of the appropriate MR imaging sequences and the detailed knowledge of the anatomic structures that are present in these locations. Normal function is dependent on the integrity of the complex functional structures and effective clinical treatment, including surgical repair, of these structures is predicated on an optimal diagnostic evaluation. A successful diagnostic evaluation can expedite treatment and provide the best opportunity for a favorable long-term outcome.

Transoral vertebral augmentation with polymethylmethacrylate in the treatment of a patient with a dens fracture nonunion and subarticular vertebral body fracture of C2.

The injection of polymethylmethacrylate (PMMA) is a minimally invasive, image-guided procedure used to treat vertebral fractures due to osteoporosis, metastatic lesions, multiple myeloma, and benign but destabilizing bone tumors. The injection of PMMA into the C2 vertebral body using the transoral technique has been reported in three separate patients for treatment of benign tumors (a vertebral hemangioma and an aneurysmal bone cyst) and for multiple myeloma in the third patient. Although the injection of PMMA into the vertebral body is most commonly performed to treat benign vertebral compression fractures, a transoral C2 approach has not been reported in the English literature as a treatment for a benign fracture of C2. We report the treatment of a fracture and nonunion of the base of the dens and a subarticular fracture of the vertebral body of C2 using a bilateral transoral approach.

Contrast reaction from hip arthrogram.

Arthrography is considered a safe procedure with rare reactions to intra-articular contrast administration. Although the use of intra-articular contrast carries a small risk of reaction, no prior serious complications had been encountered in our experience with arthrography. We report a patient's prolonged reaction to contrast media after an arthrogram of the hip. Literature review demonstrated no prior report of contrast media reactions to hip arthrography. Therefore, we decided to review the literature and report our case.

Technical strategies and anatomic considerations for parapedicular access to thoracic and lumbar vertebral bodies.

OBJECTIVES: To investigate and illustrate a variation on the traditional percutaneous access to the vertebral body via a parapedicular approach. DESIGN: An effective parapedicular access technique that could safely and reliably guide the needle tip into the center of the vertebral body was developed from cadaver dissection observations for the purpose of clinical use. PATIENTS: A total of 102 vertebral compression fractures from T-4 to L-5 were treated via the parapedicular access at our institution between July 2005 and March 2006. There were 72 patients between the ages of 17 and 96 years (mean age: 68.2 years) who underwent treatment. RESULTS: The cadaver dissection revealed a relatively avascular and aneural portion of the vertebral body along the superior margin of the vertebral body-pedicle junction. A total 102 vertebral fractures were treated using the parapedicular access technique without any recognized clinical complications from the needle access or the instrumentation. CONCLUSIONS: The thoracic and lumbar vertebral bodies may be safely, reliably, and reproducibly accessed using a percutaneous parapedicular access technique. The technique presented represents a relatively avascular and aneural approach to vertebral body.

Magnetic resonance imaging of the rotator cuff interval.

The rotator cuff interval (RCI) is an important and anatomically complex region of the rotator cuff that is critically important to normal glenohumeral function. Recognition of common pathologies in this region on imaging examinations is especially important as injuries may be difficult to detect on clinical examination and even at arthroscopy. Familiarity with the magnetic resonance imaging appearance of the normal and abnormal RCI and the ability to convey findings to orthopedic and sports medicine referrers are essential to facilitate prompt creation of effective treatment plans.