(BQ) Part 2 book Basic musculoskeletal imaging presents the following contents: Orthopedic hardware and complications, signs in musculoskeletal radiology, shoulder MRI, knee MRI, spine MRI, musculoskeletal ultrasound, musculoskeletal scintigraphy,...
ᮡ Orthopedic Hardware and Complications Reza Dehdari, MD Minal Tapadia, MD, JD, MA Introduction Joint Replacement Hip Prostheses Knee Prostheses Ankle Prostheses Shoulder Prostheses Elbow Prostheses Wrist and Hand prostheses INTRODUCTION Interpretation of postoperative orthopedic radiographs comprises a significant portion of the practice of not only subspecialized musculoskeletal radiologists but also general radiologists A good foundation and understanding of the most common performed orthopedic procedures is essential for accurate interpretation of postoperative radiographs This chapter reviews the basic concepts of joint replacement, spinal fusion, and fracture fixation, which are some of the most common procedures performed by orthopedic surgeons In addition, the postoperative evaluation of various orthopedic hardware including the imaging findings for common complications will be discussed JOINT REPLACEMENT Joint replacement is one of the most common orthopedic procedures performed Generalized indications for joint replacement include severe osteoarthritis, avascular necrosis, trauma, and inflammatory arthropathies such as rheumatoid arthritis Absolute contraindications for joint replacement 211 10 Joint Prosthetic Complications Spinal Fusion Spinal Instrumentation Surgical Approaches Postoperative Evaluation and Complications Fracture Fixation Techniques in Fracture Fixation Conclusion include active local or systemic infection Relative contraindications include obesity, remote infection, unrepaired ligamentous injuries, and neurologic impairment Prior to the advent of joint replacement, surgical management of a painful or nonfunctional joint included joint arthrodesis (e.g., joint fusion), osteotomy, nerve division, and joint debridement Patients were afforded significant improvement in quality of life with the development of joint replacement techniques; however, older joint replacement components often suffered from premature wear Recent advances in biomaterials and joint replacement technology have led to marked improvements in the longevity of joint prostheses Orthopedic surgeons can now choose between a vast array of prosthetic devices, many based on preference and familiarity Though it is impossible for the radiologist to become familiar with all the different devices in the market, the structural material and complications are shared among the variety of different prostheses The main components of any modern joint arthroplasty include a metal alloy and a plastic polyethylene liner The low coefficient of friction between the metal alloy component and the polyethylene component simulates movements of 212 ᮡ CHAPTER 10 normal joints Alloys represent the metallic component of the prostheses They are combinations of different metals such as chromium–cobalt, chromium–cobalt–titanium, or chromium–cobalt–molybdenum These different alloys have individual biomechanical properties based on their metal composition, and differ in terms of their resistance to stress, strain, and tension Polyethylene is the radiolucent liner of the prostheses In other words, it is not seen on the radiograph In order to secure the prosthesis, the prosthesis may either be press fit into the bone or cemented to the bone Polymethylmethacrylate is the most commonly used cement to secure the prosthesis into the medullary cavity of the bone Cement is seen as a radiopaque lining surrounding the prosthesis Alternatively, porous-coated press-fit cementless prostheses demonstrate an irregular surface coated with lucent bone growth-stimulating material to ensure adherence to the surface.2 Another concept to be familiar with is the resistance of a prosthetic implant to motion, whether in the anteroposterior (AP) direction or the axial direction A constrained prosthesis has two components that are directly linked together As a result, there is full range of motion in only one direction In a nonconstrained prosthesis, it is the muscles, ligaments, and tendons that provide stability with no connection between the two prosthetic parts This not only provides the greatest possible range of motion but is also most prone to joint subluxation or dislocation Semiconstrained prostheses allow intermediate motion in a given direction.3 The postoperative radiograph evaluation includes at least two radiographic views of the prosthesis at right angles to one another (e.g., orthogonal views) in addition to any specific views particular for the joint imaged For example, a complete examination of a total knee arthroplasty would include an AP view, a lateral view, and possibly a sunrise view for adequate visualization of the patella The entire prosthesis and surrounding bone need to be imaged on the examination The technical factors of the radiograph must allow the examiner to distinguish between metal–bone, metal–cement, and cement–bone interfaces Other radiologic examinations such as arthrography, ultrasonography, computed tomography (CT), magnetic resonance imaging, and nuclear scintigraphy also have specific roles in evaluating joint replacement HIP PROSTHESES Three types of hip prostheses exist: unipolar hemiarthroplasty, bipolar hemiarthroplasty, and total hip arthroplasty (Figures 10-1 and 10-2) A unipolar hemiarthroplasty involves replacement of the femoral head and neck without alteration to the native acetabulum The femoral component includes either a noncemented or cemented femoral stem with a femoral head that articulates directly with the native acetabulum This is the least common hip prosthesis and is typically performed in patients with femoral head or femoral neck fractures and decreased life expectancy A bipolar hip arthroplasty ᮡ Figure 10-1 Bipolar prosthesis AP view of the bipolar right hemiarthroplasty, with separate acetabular cup Note the radiolucent native articular cartilage surface includes a femoral stem with a small diameter femoral head and a separate acetabular cup (Figure 10-1) The outer portion of the acetabular cap articulates with the native acetabulum, while the inner portion articulates with the femoral head as one unit Again, the native acetabular surface is unaltered This design is most prone to dislocation as motion can occur between both the femoral head and acetabular component and external surface of the acetabular component and the native acetabulum The total hip arthroplasty is the most common type of performed hip arthroplasty (Figure 10-2) In a total hip arthroplasty, the articular surface of both the femur and the acetabulum is replaced These components may either be cemented or noncemented The metallic acetabular cup includes a radiolucent polyethylene liner that articulates directly with the metallic femoral head The postoperative radiograph of the hip includes AP and lateral view including the entire femoral stem and acetabular component The AP film is used to measure the angle of inclination that is optimal at 30–55° (Figure 10-2), and the lateral film is used to measure the angle of anteversion that is optimal around 15°.1,2 The femoral component should be ORTHOPEDIC HARDWARE AND COMPLICATIONS ᮡ 213 A ᮡ Figure 10-2 Total hip replacement AP view of the total hip arthroplasty, consisting of both the femoral and acetabular components The polyethylene liner separating the acetabular cup from the femoral head is radiolucent The AP view best illustrates the angle of inclination (normal between 30 and 55°) either parallel to the femoral shaft or in slight valgus Varus alignment increases the risk of stem migration, which can result in periprosthetic fractures (Figure 10-3) With varus alignment, the lateral femoral cortex is most often injured Regardless of the location of the periprosthetic fracture, revision to a longer-stemmed revision prosthesis is often needed The femoral component should also be symmetric in the center of the acetabular component Smooth mm or less radiolucent lines at the bone–cement interface can be normal if not progressive Subsidence (sinking in of the prosthesis) of less than mm is also within normal limits.4 B KNEE PROSTHESES Most knee replacements are total knee replacements involving resurfacing of the femoral condyle and the tibial plateau (Figure 10-4) The patella may either be simply resurfaced, or a patellar prosthesis (e.g., a button) may be attached (Figure 10-4C) The ᮡ Figure 10-3 Loose stem total hip prosthesis (A) AP radiograph shows significant femoral stem loosening (arrows) and varus alignment of the femoral stem tip (B) Arthrogram of the hip reveals contrast accumulation in between the bone and cement interface indicating loosening of the prosthesis stem (arrows) 214 ᮡ CHAPTER 10 A B ᮡ C patellar and tibial components may be cemented or cementless The metallic femoral component articulates with a metalbacked polyethylene tibial component, which is radiolucent Tricompartmental knee prostheses can further be subdivided into posterior cruciate ligament (PCL) sparing or sacrificing Figure 10-4 Total knee arthroplasty (TKA) AP (A), lateral (B), and sunrise (C) views of TKAs show cemented tibial and uncemented femoral components In all images, the polyethylene component is radiolucent and cannot be seen readily on radiograph (A) The femorotibial component should be aligned in 4–7° of valgus, and the articular surface of the tibial component should be aligned parallel to the ground TKAs may involve simple patellar resurfacing (B) or placement of a patellar button (C) Note in (C), patellar resurfacing and fracture of the patella are seen prostheses PCL sparing prostheses are most commonly performed and have slightly improved gait To differentiate between the two types of prostheses, a large box is seen in the femoral component on the lateral film that articulates with the polyethylene in the tibial tray that provides posterior stability.1,2 ORTHOPEDIC HARDWARE AND COMPLICATIONS A ᮡ 215 B ᮡ Figure 10-5 Unicompartmental knee arthroplasty (UKA) AP (A) and lateral (B) radiographs of UKA The radiopaque line between the femoral and tibial components seen on the AP view (A) corresponds to a metallic marker within the polyethylene component Additionally, on the AP view (A), note the periprosthetic lucency (arrows) that represents hardware loosening There is linear soft tissue calcification incidentally noted near the medial tibial condyle Standing AP (Figure 10-4A), lateral (Figure 10-4B), and patellar views (Figure 10-4C) are obtained when evaluating the postoperative knee The optimal alignment for the femorotibial component is 4–7° valgus in the AP projection (Figure 10-4A) and neutral to minimal flexion on the lateral radiograph (Figure 10-4B).2 In addition, the articular surface of the tibial component of the prosthesis should be parallel to the ground on the standing views (Figure 10-4A) The tibial component should also cover the entire surface of the tibia to provide adequate support The femoral component should be 90° to the long axis of the femoral shaft on the lateral view.1 Unicompartmental knee prostheses have been used in younger patients with isolated medial or lateral compartment arthritis (Figure 10-5) In these cases, a single femoral condyle and its tibial articulating surfaces are resurfaced Unicompartmental patellar prostheses have been shown to result in suboptimal outcomes and are not routinely used ANKLE PROSTHESES The ankle is a complex joint, and success rate for joint replacement has been suboptimal The lack of success is likely due to inability to duplicate the normal mechanics of the ankle joint and inability to restore the stabilizing effect of the ligaments Although second-generation ankle prostheses have had better outcomes than first-generation prostheses, ankle arthrodesis remains the treatment of choice in managing the painful ankle joint SHOULDER PROSTHESES Three types of surgeries exist for shoulder replacement: hemiarthroplasty (Figure 10-6), total shoulder arthroplasty (Figure 10-7), and reverse shoulder arthroplasty (Figure 10-8) A shoulder hemiarthroplasty is used in cases such as severe 216 ᮡ CHAPTER 10 ᮡ Figure 10-6 Shoulder hemiarthroplasty AP radiograph shows shoulder hemiarthroplasty Note the absence of any glenoid components Also note that the superior aspect of the prosthetic head lies above the greater tuberosity; this positioning helps prevent subacromial impingement ᮡ Figure 10-7 Total shoulder arthroplasty AP radiograph shows total shoulder arthroplasty Note the glenoid component contains radiopaque and radiolucent parts Also note minimal lucency surrounding the radiopaque glenoid component suggestive of loosening ᮡ Figure 10-8 Reverse total shoulder arthroplasty AP view shows reverse total shoulder arthroplasty Note the medialized center of rotation, which allows the deltoid muscle to substitute for the deficient rotator cuff musculature to facilitate shoulder abduction proximal humeral fractures and severe rotator cuff tear where the patient still possesses a normal glenoid The humeral component may be cemented or noncemented, and articulate with the native glenoid A total shoulder arthroplasty, usually performed in severe glenohumeral osteoarthritis, has a metal or polyethylene-backed glenoid component (Figure 10-7).3 The reverse shoulder arthroplasty is performed in patients with a nonfunctioning rotator cuff due to massive rotator cuff tear (Figure 10-8) In this case, the ball-shaped glenoid component aligns with the cup of the humeral component The cup of the humeral component is connected to the stem portion of the prosthesis Because these designs are held in place by the surrounding rotator cuff, they are either semiconstrained or unconstrained and are more prone to dislocation.1 Postoperative views of the shoulder prosthesis include AP view in internal and external rotation to evaluate for subsidence or upward migration of the humeral component In a patient with an intact rotator cuff, impingement ORTHOPEDIC HARDWARE AND COMPLICATIONS occurs if the most superior aspect of the prosthesis lies below the level of the superior tip of the greater tuberosity Trans-scapular Y or axillary views are also obtained to assess for dislocation ELBOW PROSTHESES Total elbow prostheses consist of both the humeral and ulnar components Elbow prostheses can be categorized by design, either as linked or nonlinked Linked elbow prostheses can be likened to constrained prostheses, whereas nonlinked elbow prostheses can be likened to nonconstrained prostheses The linked portions have a rigid hinge that connects the humeral component to the ulnar component (Figure 10-9) Loosening, especially at the humeral component, is a major problem The unlinked prostheses have stemmed ulnar and humeral components that articulate via an interposed polyethylene liner In this case, stability is provided by the adjacent muscles, and intact tendons and ligaments Finally, radial head prostheses may be performed in cases of comminuted radial head fractures (Figure 10-10) A 217 WRIST AND HAND PROSTHESES Wrist arthroplasty is usually performed in patients with rheumatoid arthritis or severe osteoarthritis For replacement of individual carpal bones due to avascular necrosis or trauma, Silastic prostheses have been used The metacarpophalangeal and interphalangeal joints are commonly performed arthroplasties in patients with severe rheumatoid arthritis There are no clear indications in management, and in most cases management often trends toward partial or total arthrodesis of the wrist and the hand JOINT PROSTHETIC COMPLICATIONS Bone fractures typically occur within the early postoperative period in patients with poor bone stock such as osteoporotic patients In the hip, excessive varus alignment of the femoral stem will eventually predispose to early periprosthetic fracture (Figure 10-3A), requiring a long-stem revision procedure Fractures of the prosthesis or cement are usually delayed complications secondary to long-term repetitive stress ᮡ Figure 10-9 Constrained left total elbow prosthesis AP (A) and lateral (B) radiographs of constrained left total elbow prosthesis Hinged prostheses often suffer from loosening, as exhibited by the periprosthetic lucency surrounding the humeral component that has led to periprosthetic fracture of the distal humeral shaft (arrow) ᮡ B 218 ᮡ CHAPTER 10 ᮡ Figure 10-10 Elbow radial head prosthesis AP view of the right elbow illustrating radial head prosthesis Loosening is a common delayed complication shared by all prostheses (Figures 10-3A,B, 10-5A, and 10-11) Repetitive mechanical stresses can cause loosening at the cement–bone, prosthesis–bone and cement–prosthesis interfaces Lucency that is less than mm in width and nonprogressive on followup radiographs is considered normal Progression of lucency greater than mm or development of new, irregular areas of lucency is likely secondary to loosening (Figures 10-3A,B, 10-5A, and 10-11).4 It is always important to have prior films available in addition to short-term follow-up films to assess progression of loosening In the hip, subsidence of the femoral portion of the prosthesis that is greater than mm is also indicative of loosening Subsidence of the acetabular component will also result in protrusio acetabuli, or migration of the prosthesis into the pelvic cavity Other signs of loosening in the hip prosthesis include cement fracture and sclerosis (pedestal formation) at the tip of the prosthesis.4 Infection is a serious delayed complication of any joint replacement There is considerable overlap in differentiating infection from loosening Additional clinical information, ᮡ Figure 10-11 Loose femoral component of total knee arthroplasty (TKA) Lateral view of the TKA illustrating loosening of the anterior aspect of femoral component at the site of the bone–metal interface (arrow), as evidenced by the lucency between the femoral cortex and prosthesis including laboratory analysis, is needed to assess the likelihood of infection Radiographically, the presence of irregular periprosthetic lucency, periosteal reaction, and bone destruction is suggestive of infection rather than loosening (Figure 10-12A,B) Focal areas of lucency are more suggestive of loosening than the generalized lucency seen in infection Additional signs of infection include soft tissue swelling, large joint effusion (Figure 10-12B), and abscess formation Joint aspiration is the most definitive technique to diagnose septic arthritis Arthrography can also be used to diagnose both loosening and infection Initially, the joint is aspirated for laboratory analysis Next, iodinated contrast is injected into the joint Contrast accumulation around in the region of periprosthetic lucency is suggestive of loosening (Figure 10-3B) or infection Antibiotic-laced cement may be used after removal of infected prosthesis (Figure 10-13) Other methods ORTHOPEDIC HARDWARE AND COMPLICATIONS A ᮡ 219 B ᮡ Figure 10-12 Infected total knee arthroplasty (TKA) AP (A) and lateral (B) views of the TKAs (A) Both the femoral and tibial components of the TKA exhibit irregular periprosthetic lucency (arrows), suggestive of infection (B) The lateral view readily reveals a large posterior effusion (arrow) and bony destruction that are hallmarks of infected joint prostheses to diagnose prosthetic infection include ultrasound-guided joint fluid aspiration and nuclear scintigraphy.5 Another relatively common complication of joint replacement is particle disease that is a host inflammatory osteolytic response, which occurs after shedding of portions of the prosthesis (Figure 10-14) It is usually a response to the radiolucent polyethylene liner or methylmethacrylate Although they occur more commonly in hip prostheses, particle disease can also occur in any other prostheses Particle disease usually manifests as multiple well-defined lucencies that not conform to the shape of the prosthesis (Figure 10-14) Additional foci of endosteal scalloping may also be seen Unlike infection, a periosteal reaction is not seen in cases of particle disease Along the same lines, polyethylene wear is a common entity seen in both the hip and knee prosthesis (Figure 10-15) Dislocation or subluxation may occur in either the early or late postoperative period This is a greater problem in semiconstrained or nonconstrained arthroplasties such as the shoulder or the elbow if the surrounding muscles, tendons, and ligaments not have the adequate strength to prevent subluxation and dislocation Another complication seen in various joint replacements is heterotopic ossification seen around the periprosthetic region Heterotopic ossification can also be seen with other types of hardware as well (Figure 10-16) Patients at higher risk of heterotopic ossification include patients with a history of ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis (DISH), and hypertrophic osteoarthritis.1 In advanced cases, heterotopic ossification can limit mobility of the joint and may eventually cause joint fusion 220 ᮡ CHAPTER 10 ᮡ Figure 10-13 Infected total knee arthroplasty (TKA) with antibiotic cement spacer AP view of the infected TKA with antibiotic cement spacer Infected TKAs are often revised in a staged fashion: first, the infected TKA is removed and an antibiotic spacer is placed as illustrated, and subsequently once the infection has been eradicated with irrigation, debridement and antibiotics, the revision surgery takes place SPINAL FUSION Spinal fixation procedures are commonly encountered in today’s radiologic practice The most common indication for spinal surgery today is degenerative disk disease There are various other indications for spinal surgery including trauma, tumors, infection, scoliosis, and spondylolisthesis The goal of spinal fixation devices is to restore anatomic alignment; stabilize the bone during fusion; and replace bone defects in cases of trauma, tumor, or infection The same principles that apply to other joints also apply to the spine Fusion of a diseased joint will eliminate pain by eliminating the motion between the painful joint, such as severely diseased disks within the lumbar spine.6 It usually takes 6–9 months for solid fusion to be seen radiographically The other important concept to realize is that the spinal hardware is used to provide ᮡ Figure 10-14 Aggressive granulomatosis (particle disease) in total hip arthroplasty (THA) AP view of the left hip arthroplasty with particle disease, as evidenced by lucencies around the prosthesis components and multiple metallic particles in the joint space temporary fixation and stability by immobilizing the bone The function of the hardware is complete when osseous fusion occurs Most intact implants are generally left in place after bony fusion due to the morbidity involved in recurrent spinal surgery This section will discuss the procedures and range of hardware devices used in spinal fixation The postoperative complications will then be discussed SPINAL INSTRUMENTATION Although many spinal fusion instrumentation systems exist, the basic components of each system can be classified into a few general categories Interpedicular screws are connected either by rods or plates that span single or multiple vertebral body segments (Figures 10-17 to 10-22) Plates are also commonly used in conjunction with cortical screws in anterior fusion of the cervical spine (Figure 10-17A,B) There are various sizes of plates that can be used for both the anterior and MUSCULOSKELETAL SCINTIGRAPHY B C ᮡ D Figure 20-16 (Continued) ᮡ 451 452 A ᮡ ᮡ CHAPTER 20 B Figure 20-17 Vertebral body compression fractures Multiple studies from a 79-year-old man with prostate cancer complaining of acute onset mid back pain (A) Conventional bone scintigraphy delayed phase images as labeled after injection of 24.7 mCi of Tc99m-MDP There is marked linear uptake of radiopharmaceutical over the superior endplates of T9, T10, and T11 There is mild linear uptake at the superior endplates of several other superior thoracic vertebrae (B) Coronal view from a concurrent CT study of the chest showing diffuse osteopenia and mild compression deformities of the T9, T10, and T11 superior endplates There is no evidence of blastic metastatic disease on the CT study These findings are most consistent with acute or subacute vertebral compression fractures MUSCULOSKELETAL SCINTIGRAPHY ᮡ ᮡ 453 Figure 20-18 Sacral insufficiency fracture Conventional bone scintigraphy whole body delayed phase images as labeled after injection of 26.2 mCi of Tc99m-MDP in a 81-year-old woman with a history of chronic low back and pelvic pain She had a moderately low T score on femoral neck bone densitometry The right set of images is reproduced at a higher intensity level to accentuate lower activity lesions There is marked focal increased uptake in the bilateral sacral ala There is moderate horizontal linear uptake in the central sacrum Taken together these uptakes form the H shaped pattern (green H) classically described for sacral insufficiency fractures Please note that insufficiency fracture may occur in single or multiple portions of the sacrum, and therefore the classically described pattern of uptake may not be seen in many patients (see color insert) 454 ᮡ CHAPTER 20 A B ᮡ Figure 20-19 Complex regional pain syndrome (CRPS) (Sudeck atrophy, reflex sympathetic dystrophy) (A) Conventional bone scintigraphy flow phase images at seconds per frame of the palmar hands Early abnormal increased flow is seen in the affected left upper extremity (arrow) (B) Pool phase image (left) showing diffuse increased uptake in the left upper extremity Delayed phase image (right) shows diffuse increased periarticular bone uptake in the left hand and wrist compared with the right All three phases of the bone scan are positive, findings consistent with a clinical diagnosis of CRPS MUSCULOSKELETAL SCINTIGRAPHY METABOLIC/VASCULAR/NEUROGENIC ᮣ Complex Regional Pain Syndrome Complex regional pain syndrome (CRPS), formerly known as Sudeck atrophy or reflex sympathetic dystrophy, is a syndrome involving autonomic, sensory, and motor abnormalities, usually of an extremity The syndrome may be associated with a history of previous trauma The classic symptoms include chronic pain, vasomotor abnormality with resulting chronic atrophic changes, and finally manifestation of obvious radiographic abnormalities Three-phase bone scintigraphy offers imaging diagnosis of this syndrome before the trophic and radiographically obvious abnormalities manifest These early findings when present, approximately 50% of the time, include symmetric diffuse abnormal increased blood flow in the affected region with associated diffuse increased periarticular uptake on delayed phase imaging (Figure 20-19).16 PEARLS ᮣ ᮣ ᮣ CRPS classic symptoms include chronic pain and vasomotor abnormality usually in an extremity with a history of trauma Chronic atrophic changes lead to radiographically apparent changes Earlier diagnosis may be achieved in approximately 50% of cases where three-phase bone scintigraphy shows increased blood flow and diffuse increased periarticular uptake in the affected limb REFERENCES Palestro CJ, Love C Radionuclide imaging of musculoskeletal infection: conventional agents Semin Musculoskelet Radiol 2007;11:335-352 van der Bruggen W, Bleeker-Rovers CP, Boerman OC, Gotthardt M, Oyen WJ PET and SPECT in osteomyelitis and prosthetic bone and joint infections: a systematic review Semin Nucl Med 2010; 40(1):3-15 Donohoe KJ, Brown ML, Collier BD, et al Society of Nuclear Medicine procedure guideline for bone scintigraphy Version 3.0, approved June 20, 2003 http://interactive.snm.org Accessed December 14, 2011 ᮡ 455 Palestro CJ, Brown ML, Forstrom LA, et al Society of Nuclear Medicine procedure guideline for 111in-leukocyte scintigraphy for suspected infection/inflammation Version 3.0, approved June 2, 2004 http://interactive.snm.org Accessed December 14, 2011 Palestro CJ, Brown ML, Forstrom LA, et al Society of Nuclear Medicine procedure guideline for gallium scintigraphy in inflammation Version 3.0, approved June 2, 2004 http://interactive snm.org Accessed December 14, 2011 Palestro CJ, Love C, Tronco GG, Tomas MB, Rini JN Combined labeled leukocyte and technetium-99m sulfur colloid marrow imaging for diagnosing musculoskeletal infection: principles, technique, interpretation, indications and limitations Radiographics 2006;26(3):859-870 Even-Sapir E, Mishani E, Flusser G, Metser U 18F-Fluoride positron emission tomography and positron emission tomography/ computed tomography Semin Nucl Med 2007;37(6):462-469 Segall G, Delbeke D, Stabin MG, et al Society of Nuclear Medicine practice guideline for 18F-Flouride PET/CT bone scans Version 1.1, approved December 3, 2010 http://interactive.snm org Accessed December 14, 2011 Langsteger W, Heinisch M, Fogelman I The role of fluorodeoxyglucose, 18F-dihydroxyphenylalanine, 18F-choline, and 18Ffluoride in bone imaging with emphasis on prostrate and breast Semin Nucl Med 2006;36(1):73-92 10 Delbeke D, Coleman RE, Guiberteau MJ, et al Society of Nuclear Medicine procedure guideline for tumor imaging with 18F-FDG PET/CT 1.0, approved February 11, 2006 http://interactive.snm org Accessed December 14, 2011 11 Even-Sapir E PET/CT in malignant bone disease Semin Musculoskelet Radiol 2007;11:312-321 12 Chua S, Gnanasegaran G, Cook GJ Miscellaneous cancers (lung, thyroid, renal cancer, myeloma, and neuroendocrine tumors): Role of SPECT and PET in imaging bone metastases Semin Nucl Med 2009;39:416-430 13 Ma JJ, Kang BK, Treves ST Pediatric musculoskeletal nuclear medicine Semin Musculoskelet Radiol 2007;11:322-334 14 Murphey MD, Nomikos GC, Flemming DJ, et al From the archives of the AFIP imaging of giant cell tumor and giant cell reparative granuloma of bone: radiologic-pathologic correlation Radiographics 2001;21:1283-1309 15 Jadvar H, Gamie S, Ramanna L, Conti PS Musculoskeletal system Semin Nucl Med 2004;34:254-261 16 Van der Wall H, Fogelman I Scintigraphy of benign bone disease Semin Musculoskelet Radiol 2007;11:281-300 17 Cook GJ, Gnanasegaran G, Chua S Miscellaneous indications in bone scintigraphy: metabolic bone diseases and malignant bone tumors Semin Nucl Med 2010;40:52-61 18 Van der Wall H, Lee A, Magee M, et al Radionuclide bone scintigraphy in sports injuries Semin Nucl Med 2010;40:16-30 19 Campbell SE, Fajardo RS Imaging of stress injuries of the pelvis Semin Musculoskelet Radiol 2008;12(1):62-71 This page intentionally left blank Index Note: Page numbers in italics refer to figures; page numbers followed by t indicate tables A Abduction and external rotation (ABER), 275, 284 Abscess, 318 Accessory navicular, 402 Accessory soleus muscle, 402, 405, 405–406 Acetabular fractures, 29–30, 30, 227 Acetabular retroversion, 368 Acetabular roof, 29 Achilles tendon injuries, 383 Acromegaly, 184 Acromioclavicular joint (ACJ), 15, 17, 284 Acromioclavicular separation, 284, 284 Acromion, 278, 278 Acroosteolysis, 98 Acroosteolysis, of distal phalanges, 170 Acute traumatic tears, 398 Adamantinoma, 118t, 149, 149 Ameloblastoma, 118t, 150, 150 Aneurysmal bone cyst (ABC), 118t, 146–147, 146 Ankle impingement, 389–391, 392 Ankle prostheses, 215 Ankle retinacula, 381 Ankle syndesmosis, 381 Ankle tendons, 380–381 Ankylosing spondylitis, 87–90, 89–91, 321, 323 Anterior ankle impingement syndrome, 391 Anterior cruciate ligament (ACL), 236, 290, 298 Anterior hip dislocations, 30, 31 Anterior horn sign, 301 Anterior interosseous nerve (AIN), 20–21 Anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion, 281 Anterior shoulder dislocation, 16, 17–18 Anterior superior iliac spine (ASIS), 59, 60 Anterior superior internal impingement, 281 Anterior talofibular (ATFL), 385, 387 Anterolateral ankle impingement syndrome, 390–391 Anteromedial ankle impingement syndrome, 391 Anteroposterior (AP) film, 212 Anticyclic citrullinated protein antibody (anti-CCP), 73 Apophysis, 58 Arachnoid cysts, 326, 329 Arthritis, 285–286, 285 Arthrocentesis, 83 Arthrography, 218 Arthropathy, 82 Athletic pubalgia, 370–372, 371 Atlantodental (atlantoaxial) subluxation, 44, 44 Atlantodental dislocation, 44 Avascular necrosis (AVN), 185, 286–287, 287, 351, 354 of ankle, 205 of femoral head, 204–205, 207 of humeral head, 204 of scaphoid, 202, 202, 203 Axial skeletal trauma, 41 B Baastrup disease, 104, 105 Baker cyst, 309 Baseball finger, 26 Basicervical fracture, 31 Bence-Jones protein, 156 Benign bone tumors, 433–434, 433–434, 435–437 giant cell tumor, 435, 435, 437 osteoid osteoma, 433, 433–434 Benign cartilaginous neoplasms chondroblastoma, 135–136, 135–136 chondromyxoid fibroma, 137, 138 enchondroma, 132–133, 133 osteochondroma, 130–131, 131 Benign epiphyseal lesions, 116t Benign fibrous neoplasms desmoplastic fibroma, 141 fibrous dysplasia, 142, 142 nonossifying fibromas (NOFs), 140, 141 osteofibrous dysplasia, 143–144 Benign osseous neoplasms osteoblastoma, 124, 124 osteoid osteoma, 121, 122–123, 122–123 osteoma, 125, 125 Benign peripheral nerve sheath tumors (BPNST), 163 Benign soft tissue masses deep fibromatosis, 161–161, 162 elastofibroma, 160, 160 fibromatosis, 161–162, 161–162 hemangioma, 158, 160 lipoma, 158, 159 schwannoma, 163, 163 Bennett fracture, 24, 25 Biceps brachialis tear, 339 Biceps bursitis, 341 Biceps distal insertion tear, 340 Biceps femoris tendon, 291 Biceps partial tear, 340 Biceps pulley injury, 281 Biceps tendinopathy, 285 Biceps tendon tear, 338–341, 339, 340, 341 457 Biceps tenosynovitis, 285, 285 Biconcave osteoporotic compression fracture, 52 Biconcave vertebral endplates, 47 Bilateral laminectomies, 221 Bilateral locked facets, 46 Bipolar hemiarthroplasty, 212, 212 Blount disease, 201–202, 202 Bone erosions, 79 Bone grafts, 221, 223 Bone healing, 225 Bone infection, 110 Bone marrow edema (BME), 79 Bone marrow edema syndrome, 364–365, 366 Bone metastasis, 155, 155 Bone resorption, 170 Bone scan, 10–12, 12 Bone tumors adamantinoma, 149, 149 ameloblastoma, 150, 150 benign versus malignant lesions, 118–120 bone metastasis, 155, 155 cartilaginous neoplasms, 130–140 cystic bone lesions, 145, 147 eosinophilic granuloma (EG), 148, 148 Ewing sarcoma, 151–154, 152–153 fibrous neoplasms, 140–144 giant cell tumors (GCTs), 147, 147 hemangioma, 151, 151 multiple myeloma (MM), 156, 157 osseous neoplasms, 121–125 primary bone lymphoma, 154, 154 soft tissue tumors, 118t, 157–163 tips for differential diagnosis, 117–118 Bones fractures, 421 normal appearance, 421, 421 Bony Bankart lesion, 16 Boxer fracture, 24, 26 Brachial plexus injuries, 15 Broken screw, 226 Brown tumors, 171, 172, 173–174 Bucket handle tear, 301, 306, 307 Buckle fracture, 57, 58 Buford complex, 277 Bular collateral ligament, 291 Burst fractures, 47, 49–50 C Calcaneal fractures, 35–36, 37, 385 Calcaneofibular (CFL), 381 Calcaneonavicular coalition, 389 Calcifying giant cell tumor, 135 458 ᮡ Calcium pyrophosphate dihydrate (CPPD) deposition disease, 80–81, 81, 82, 83, 84 Callus healing, 225 Callus-free bone healing, 225 Calvarial lesions, 151 Cam-type FAI, 368 Cancellous (trabecular) bone resorption, 171 Cancellous screws, 226 Carpal dislocation, 21 Carpal tunnel syndrome, 183, 359, 360 Carpometacarpal (CMC) dislocations, 22, 25 Cement, 212 Cerclage wires, 229 Chance fracture, 47, 51 Charcot joint, 100 Chondroblastoma, 135–136, 135–136 Chondrocalcinosis, 81, 175 Chondromalacia, 293 Chondromyxoid fibroma, 119, 137, 138 Chondrosarcoma, 138–140, 139 Chronic muscle atrophy, 276 Chronic osteomyelitis, 110, 111, 113 Chronic tenosynovitis, 385 Clavicle, 15 Clavicle fractures, 15 Clay shoveler fracture, 46, 49 Coarse syndesmophytes, 92 Codman triangle, 120, 122, 152 Codman tumor, 135 Colles fracture, 21, 21 Complex pelvic fractures, 227 Complex regional pain syndrome (CRPS), 454, 455 Computed tomography (CT), 2, bone or soft tissue tumor assessment, bony lesions, evaluating, 156 complex fractures, findings of bone sign, blister of, 239 button sequestrum, 242 drunken waiter sign, 250 fluid-fluid level, 253 incomplete ring sign, 256 liposarcomas, 163–164 occult fractures, Congenital, 331 Connective tissue disorders dermatomyositis, 98–99, 99 mixed connective tissue disease, 99 polymyositis, 98–99 scleroderma, 98, 99 systemic lupus erythematosus (SLE), 97–98, 98 systemic sclerosis, 98 Contiguous spread, 110 Conventional chondrosarcomas, 138 Conventional osteosarcoma, 125, 126–127 Coracoacromial arch, 277 Cord compression, 44 Coronary ligament, 291 INDEX Cortical bone, 225 Cortical osteoid osteomas, 122 Cortical screws, 226 Cotton fracture, 34 CREST syndrome, 98 Cushing syndrome differential diagnosis, 185–186 imaging findings, 185 Cyclops lesion, 298, 299 Cystic bone lesions aneurysmal bone cyst (ABC), 146–147, 146 unicameral bone cyst, 145, 145 D David Letterman sign, 22, 23 De Quervain tenosynovitis, 355–356, 357 Dead arm, 284 Deep fibromatosis, 161–162, 162 Deep infrapatellar bursa, 290 Degenerative disease, 316–318, 316, 317 Degenerative joint disease (DJD), 72 Deltoid ligamentous complex, 387 Dens fractures, 44 Depressed skull fracture, 41, 42 Depression fractures, 32 Dermatomyositis, 98–99, 99 Desmoid tumor See Deep fibromatosis Desmoplastic fibroma, 141 Diabetic foot infections, 441 Diabetic neuropathy, 100 Diffuse idiopathic skeletal hyperostosis (DISH), 104, 105 Direct fracture healing, 225 Discectomy, 221 Disease of octogenarians, 81 Disease-modifying antirheumatic drugs (DMARD), 79 Disk spacers, 221 Dislocation, 219 anterior hip dislocations, 30, 31 anterior shoulder, 16, 17–18 atlantodental, 44 carpal, 21 carpometacarpal (CMC), 22, 25 inferior shoulder, 18, 18 lunate dislocation, 22, 24 perilunate, 21–22, 22 peroneal tendon, 385 posterior hip dislocations, 30, 30 posterior shoulder, 18, 18 spinal, 47 sternomanubrial, 41, 43 subtalar dislocation, 36, 37 thoracic spine fracture, 52 thoracolumbar spine, 52 transscaphoid perilunate, 22, 23 Dislocation of the distal radioulnar joint (DRUJ), 20 Distal biceps tendon tears, 338, 340 Double posterior cruciate ligament sign, 301 Dynamic flow phase scan, 11 E Elastofibroma dorsi, 160, 160 Elbow, skeletal trauma, 19 Elbow prostheses, 217 Enchondroma, 118, 118t, 119, 132–133, 133 Enchondromatosis, 135, 135 Endosteal scalloping, 132 Enteropathic spondyloarthropathy, 97 Enthesis, 413, 414 Entrapment syndromes, 417–418, 418 Eosinophilic granuloma (EG), 148, 148 Ependymoma, 326–327 Epicondylitis, 336 Epidural abscess, 318 Epidural lipomatosis, 330 Epiphyseal injuries, 57 Erosive osteoarthritis, 72, 72 Escherichia coli, 108 Ewing sarcoma, 120, 151–154, 152, 153, 286 Extension teardrop fracture, 46 Extensor digitorum tendon, 26, 26 External impingement, 277 Extradural lesions, 327 F Failed back surgery syndrome (FBSS), 318 Fatigue fracture, 65 Femoral acetabular impingement (FAI), 368 cam-type FAI, 368 pincer-type FAI, 368 secondary signs in, 368, 369 Femoral component, 212–213 Femoral intramedullary nails, 228 Femoral neck fractures, 30–31, 31 Femoral shaft fractures, 31, 32 Fibromatosis, 161, 161–162 Fibrosarcoma, 144, 144 Fibrous dysplasia, 118, 119, 142, 142–143 Fibrous scars, 416 Fish vertebra, 47, 181 Flat foot deformity, 399 Flexion teardrop fracture, 46, 47 Flexor hallucis longus tendon injuries, 385 Flipped meniscus sign, 301 Fluorine 18-labeled fluorodeoxyglucose (FDG), 426, 431 Fluorine-18 sodium fluoride (18F-NaF), 12, 426 Fluorine-18-fluorodeoxyglucose (18F-FDG), Forestier disease, 104 Fractures, 421 acetabular, 29–30, 30, 227 basicervical, 31 Bennett, 24, 25 boxer, 24, 26 buckle, 57, 58 calcaneal, 35–36, 37 clavicle, 15 Colles, 21, 21 complex pelvic, 227 cotton fracture, 34 INDEX dens, 44 depressed skull, 41, 42 depression, 32 fatigue, 65 femoral neck, 30–31, 31 femoral shaft, 31, 32 fixation, techniques in, 225–230 flexion teardrop, 47 Galeazzi, 21 greenstick, 57 Hangman, 45, 45 insufficiency, 65 intertrochanteric, 31, 32, 227 intracapsular, 31 Jefferson, 44–45 Jones fracture, 36, 37 juvenile Tillaux, 63 lateral malleolus, 33 lateral tibial plateau, 32, 32, 33 linear skull, 41, 41 Lisfranc, 36–37, 38 maisonneuve, 33, 35 medial plateau, 32 midcervical, 31 nutcracker fracture, 36 patella, 33, 34 pelvic avulsion, 61 pilon fractures, 34–35, 36 radiation-induced, 375 sacral, 51, 55 sacrum insufficiency, 374, 375 Salter I, 59 Salter II, 59 Salter III, 60 Salter IV, 60 scaphoid, 21, 21 scapular, 15, 16 Segond fracture, 33, 33, 34 split, 32 stable fracture, 31 stress, 65, 449, 450–451 subcapital, 31 subtrochanteric, 31 tibial plateau, 32 toddler’s fracture, 63 torus, 57, 58 trimalleolar, 34, 35, 36 triplane, 63 unstable fracture, 31 weber type C, 33 Fragment in notch sign, 301 Freiberg infraction, 196, 198 G Galeazzi fracture–dislocation, 20 Gallium-67 (Ga-67) citrate, 426 Ganglion cysts, 356, 357, 393 Gardner syndrome, 162 Geodes, 69–70 Giant cell tumors (GCTs), 120, 435, 435–436 Glenohumeral joint, 285 instability, 281 Glenoid labrum, 277 Glenolabral articular disruption (GLAD) lesion, 281 Glucose transporter protein one (GLUT1), 432 Glucose transporter protein one (GLUT1), 426 Gonococcal arthritis, 109 Gout, 82–86, 85, 86, 170 Grade injury, 293 Grade injury, 293 Gradient echo (GRE) images, 358 Gradient recalled echo (GRE) sequences, 312 Greenstick fracture, 57, 59 Guillain–Barré syndrome, 321, 323 Gullwing sign, 72 Guyon canal syndrome, 360 H Haglund syndrome, 393, 395 Hamstring edema, 373 Hamstring injury, 372–373, 373 Hamstring rupture, 373 Hamstring tendinosis, 372, 373 Hand, skeletal trauma, 24–26 Hand prostheses, 217 Hand–Schuller–Christian disease, 148 Hangman fracture, 45, 45 Hansen disease, 112, 114 Hardware fracture, 224 Haversian system, 225 Hemangioma, 118t, 151, 151, 158–160, 160, 326 Hematogenous dissemination, 155 Hematoma, 415 Hemochromatosis, 81–82, 84 Hemodialysis, 176 Hemophilia, 102 Hemophilic arthritis, 102, 102–104 Hereditary multiple exostosis (HME), 132, 132 Herniated discs, 316 Heterotopic ossification, 219 Hexokinase two (HKII), 426 Hidden lesion, 281 Hill–Sachs lesion, 16, 18 Hip prostheses, 212–213, 212, 213 Hoffa fat pad, 290 Hoffa syndrome, 201 Honda sign, 187, 449 Hondrocalcinosis, 81 Horizontal fracture, 47 Hounsfield units (HU), Humeral avulsion of the glenohumeral ligament (HAGL) lesion, 282 Hyaline articular cartilage, 292–293 Hyaline cartilage, 420, 421 Hydroxyapatite arthropathy, 86 Hydroxyapatite deposition disease (HADD), 86, 87–89, 286 Hyperemia, 73 ᮡ 459 Hyperparathyroidism, 169 differential diagnosis, 173–174, 174 imaging findings, 170–173, 170–173 subligamentous resorption, 171 subtendinous resorption, 171 Hyperpituitarism, 183 differential diagnosis, 185 imaging findings, 184, 184 Hyperthyroidism differential diagnosis, 182, 182, 182t imaging findings, 181–182 Hypertrophic pulmonary osteoarthropathy (HPOA), 182 Hypoparathyroidism differential diagnosis, 179–180, 180t imaging findings, 179 Hypopituitarism, 185 Hypothyroidism differential diagnosis, 183 imaging findings, 183 I Iliotibial band, 291 Ilizarov device, 230 Impingement, 277–281 Indirect fracture healing, 225 Indium-111-labeled white blood cells, 425–426 Infection, 224, 318, 320–321 osteomyelitis diabetic foot infections, 441 infected neuropathic joint, 441, 445–446 joint prosthesis loosening, 445 spinal osteomyelitis, 447, 447 Inferior glenohumeral ligament, 277 Inferior shoulder dislocation, 18, 18 Inflammatory bowel disease (IBD), 97 Inflammatory disease, 318, 321, 325, 324–325 Infraspinatus, 276 Instability, 281–284 Insufficiency fracture, 65, 374–375 Intercarpal ligamentous injury, 22 Intercondylar femoral notch, 290 Interfragmentary screw, 227 Interlocking screws, multiple fractures of, 226 Internal fixation, 226 Internal impingement, 277–278 Interphalangeal joints, 217 Intertrochanteric fractures, 227 Intertrochanteric fractures, 31, 32 Intracapsular fractures, 31 Intracortical resorption, 170 Intradural extramedullary tumors, 326 Intramedullary nails, 228 Intramedullary tumors, 326 Ischial tuberosity, 59 Ivory vertebra, 190, 190t J Jaffe–Campanacci syndrome, 140 Jefferson fracture, 44–45 460 ᮡ Joint ankylosis, 80 Joint capsule, 277 Joint effusion, 419, 419 Joints, 419 arthroplasty, 211 hyaline cartilage, 420, 421 joint effusion, 419, 419 marginal bone erosions, 420, 420 prosthetic complications, 217–219, 218, 219 replacement, 211–212 synovitis, 419, 420 Jones fracture, 36, 37 Judet views, 29 Juvenile idiopathic arthritis, 80 Juvenile rheumatoid arthritis, 80 Juvenile Tillaux fracture, 63 K K-wires, 229 Kienböck disease, 196, 199, 354, 355 “Kissing spines”, 104, 105 Knee joint capsule, 290 Knee prostheses, 213–215, 214, 215 Kohler disease, 197, 199 Kümmell disease, 208, 208 L Labral tears, 283 Lamellated periosteal reaction, 120 Langerhans cell histiocytosis, 120 Lateral collateral ligament (LCL), 336–338, 336, 337, 338 Lateral knee, 292 Lateral malleolus fracture, 33 Lateral tibial plateau fracture, 32, 32, 33 Lateral ulnar collateral ligament (LUCL), 338 Legg–Calvé–Perthes disease, 196, 197, 198 Leprosy See Hansen disease Leptomeningeal carcinomatosis, 328 Lesser trochanteric apophyseal avulsions, 60 Letterer–Siwe disease, 148 Ligament of Humphrey, 290, 298 Ligamentous injury, 359, 360 Linear skull fracture, 41, 41 Lipoma, 158, 159, 326, 329 Lipomyelomeningocele, 332 Liposarcoma, 163, 165 Lisfranc fracture, 36–37, 38 Little league elbow, 344–345 Looser zones, 175, 175 Lower extremity, skeletal trauma ankle, 33–36 femur, 31–32 foot, 36–37 hip, 30–31 knee, 32 pelvis, 29–30 Lunate dislocation, 22, 24 Luxatio erecta, 18 Lymphoma, 330 INDEX M Maffucci syndrome, 135 Magnetic resonance imaging (MRI), 6–8 of ankle, 379 accessory soleus muscle, 402, 405, 405–406 ankle impingement, 389–391, 392 Haglund syndrome, 393, 395 imaging techniques, 379 ligament anatomy, 381, 382 ligamentous injuries, 385, 387 os navicularis syndrome, 401–402, 403 os peroneum syndrome, 402, 404 os trigonum syndrome, 393, 395, 396 planovalgus (flat foot) deformity, 399–401 plantar fascia tendinosis and tear, 387, 388 sesamoid avascular necrosis, 398–399 sesamoid fracture, 398, 398 sinus tarsi syndrome, 399, 400 tarsal coalition, 389, 390 tarsal tunnel syndrome, 393, 394 tendon anatomy, 379–381 tendon pathology, 381, 383–385, 386 turf toe, 395, 397–398, 397 bony lesions, evaluating, 156 of elbow biceps tendon tear, 338–341, 339, 340, 341 epicondylitis, 336 imaging protocol, 335–336 little league elbow, 344–345 medial and lateral collateral ligament tears, 336–338, 336, 337, 338 olecranon bursitis, 345–346, 345–346 panner disease, 343–344, 343–344 triceps tears, 341–343, 342 on fibromatosis, 161 findings of absent bow tie sign, 234 anterior drawer sign, 236 bone bruise sign, 239 bow tie sign, 241 cotton wool sign, 243 crescent sign, 245 double PCL sign, 247 drunken waiter sign, 250 fluid-fluid level, 253 fragment-in-notch sign, 253 lateral capsular sign, 258 hemangioma, 158 of hip, 363 athletic pubalgia, 370–372, 371 avascular necrosis (AVN), 363, 364t, 365 bone marrow edema syndrome, 364–365, 366 femoral acetabular impingement (FAI), 368–369, 369 hamstring injury, 372, 373 imaging techniques, 363 osteitis pubis, 370–371, 371 osteoid osteomas, 367, 367 stress and insufficiency fractures, of sacrum, 374–375, 375 of knee, 289 cartilage, internal derangement of, 292–293 intercondylar femoral notch, 290–291 lateral knee, 292 ligaments and tendons, 292–298 medial knee, 291–292, 291 meniscus, 298–309 patellofemoral articulation, 290, 290 lipoma, 158 liposarcomas, 163–164 of shoulder pathology, 275 acromioclavicular separation, 284, 284 anatomy, 276–277, 277 arthritis, 285–286, 285 avascular necrosis, 286–287, 287 biceps tendinopathy, 285 biceps tenosynovitis, 285, 285 dead arm, 284 impingement, 277–281 instability, 281–284 neoplasia, 286, 286 pectoralis major rupture, 284, 285 radiologic technique, 275–276, 276 surgical procedures, 287 for soft tissue tumor, 8, 9, 156 of spine, 311 anatomy and technique, 311–312, 312, 313 congenital, 331 degenerative disease, 316–318, 316, 317 infection, 318, 320–321 inflammatory disease, 318, 321 , 325, 324–325 neoplasm, 325–327, 325, 326–327, 328, 329, 330 trauma, 312, 314, 315, 316, 316 vascular disease, 327, 331 of wrist, 349 anatomy, 349–351, 350, 351 avascular necrosis, 351 carpal tunnel syndrome, 359, 360 De Quervain tenosynovitis, 355–356, 357 ganglion cysts, 356, 357 Guyon canal syndrome, 360 Kienböck disease, 354, 355 ligamentous injury, 359, 360 occult fracture, 354–355 rheumatoid arthritis (RA), 355, 356 scaphoid fracture, 351–352, 354 tendon rupture, 356 triangular fibrocartilage complex (TFCC), 358, 358 ulnar impaction syndrome, 358, 359 Maisonneuve fracture, 33, 35 Malignant bone lesions, 116t Malignant bone tumors, 427–428, 427, 428 Malignant cartilaginous neoplasms, 138, 139 INDEX Malignant fibrous histiocytoma (MFH), 163, 164 Malignant fibrous neoplasms, 144, 144 Malignant osseous neoplasms, 125–129 osteosarcoma, 125, 126 conventional osteosarcoma, 125, 126–127 management of, 130 parosteal osteosarcoma, 126, 128 periosteal osteosarcoma, 128, 129 telangiectatic osteosarcoma, 129, 130 Malignant soft tissue tumors, 435, 437, 439–440 liposarcoma, 163–164, 165 malignant fibrous histiocytoma (MFH), 163, 164 synovial sarcoma, 164, 166 Mallet finger, 26, 26 Marginal bone erosions, 420, 420 Mazabraud syndrome, 142 McCune–Albright syndrome, 142 Medial collateral ligament (MCL) complex, 291 , 336–338, 336, 337, 338 Medial knee, 291–292, 291 Medial patellar plicae, 291 Medial plateau fractures, 32 Medial tibial stress syndrome (MTSS), 455 Medial tibiofemoral joint, 70 Meniscal cyst, 307 Meniscal root tear, 303 Menisci, 234 Meniscotibial ligament, 291 Meniscus tears descriptive lexicon of, 304 horizontal, 304 radial, 305 vertical, 305 Metabolic bone diseases Cushing syndrome, 185–186 hyperparathyroidism, 169–174 hyperpituitarism, 183–185 hyperthyroidism, 181–182 hypoparathyroidism, 179–180, 180t hypopituitarism, 185 hypothyroidism, 183 osteogenesis imperfecta (OI), 189–190 osteoporosis, 186–188 Paget disease, 190–191, 191 pregnancy, 186 pseudohypoparathyroidism, 180, 180, 180t renal osteodystrophy, 174–179 scurvy, 188–189 Metabolic- and crystal-associated disease calcium pyrophosphate dihydrate (CPPD) deposition disease, 80–81, 81, 82, 83, 84 gout, 82–86, 85, 86 hemochromatosis, 81–82, 84 hydroxyapatite deposition disease (HADD), 86, 87–89 Metacarpophalangeal joints, 217 Metastatic bone tumors, 429, 432 Microinstability, 282 Midcervical fracture, 31 Middle glenohumeral ligament, 277, 277 Mixed connective tissue disease, 99 Molecule methylene diphosphonate (MDP), 10 Monostotic fibrous dysplasia, 142 Morton neuroma, 418 plantar digital nerve, 418 Moth-eaten pattern, 120, 121 Mouse ear erosions, 91 Multidirectional instability, 284 Multiple enchondromas, 135, 135 Multiple myeloma (MM), 156, 157, 428, 429–430 Multiple neurofi bromas, 326 Multiple sclerosis (MS), 318, 321, 323 Multiple tophi, 85 Muscle fibers, 420 Muscle herniation, 416 Muscle injuries, 414 extrinsic, 415 intrinsic, 414, 415t Muscles muscle atrophy and fatty replacement, 416, 416 normal appearance, 414 traumatic lesions, 414–416, 416 Musculoskeletal imaging bone scan, 10–12, 12 computed tomography (CT), 2, bone or soft tissue tumor assessment, complex fractures, occult fractures, intravenous (IV) contrast in, 2, magnetic resonance imaging (MRI), 6–8 for soft tissue tumor, molecular imaging positron emission tomography (PET), 10 single photon emission computed tomography (SPECT), 10 PET scan, 12, 13 radiographs, arthritis assessment, bone fixation, examinations for fractures, joint dislocations, ultrasound, Musculoskeletal radiology, signs in, 233 absent bow tie sign, 234 anteater nose, 235, 235 anterior drawer sign, 236, 236 bamboo spine, 236–237, 236 bite sign, 237, 237 bone bruise sign, 239, 239 bone sign, blister of, 237–239, 238 bone-in-bone sign, 239–240, 240 boutonniere deformity, 240, 240 bow tie sign, 241, 241 brim sign, 241, 241 button sequestrum, 241–242, 242 C-Sign, 242, 242 ᮡ 461 cockade sign, 242–243, 242 cortical ring sign, 243, 243 cotton wool sign, 243, 244 crescent sign, 243–245, 244 crowded carpal sign, 245, 245 Cupid’s bow sign, 245, 246 dagger sign, 245–246, 247 deep lateral femoral notch sign, 247, 248 deep sulcus sign, 247 double PCL sign, 247, 249 drooping shoulder sign, 247–248, 249 drunken waiter sign, 248–250, 249 elbow fat pad sign, 250, 250 fallen fragment sign, 250–251, 251 fat–blood interface (FBI) sign, 251, 252 fish vertebra, 251–252, 252 fluid-fluid level, 253, 253 fragment-in-notch sign, 253, 253 grass sign, blade of, 237, 238 H-shaped vertebra, 253–254, 254 hair on end, 254, 254 half-moon sign, 254–255, 255 heel pad sign, 255–256, 255 Hill–Sachs deformity, 256, 256 incomplete ring sign, 256, 256 intravertebral vacuum cleft sign, 256–257, 257 Inverted Napoleon hat sign, 257–258, 257 ivory phalanx sign, 258, 258 ivory vertebra sign, 258, 259 lateral capsular sign, 258–260, 259 metacarpal sign, 260, 260 pedestal sign, 260, 261 pneumoarthrogram sign, 260, 261 pronator sign, 261, 262 rim sign, 262, 262 Rugger Jersey spine, 262–263, 263 sail sign, 264, 264 sausage digit, 363–264, 263 Scotty dog sign, 264, 265 signet ring sign, 243 swan neck deformity, 264–266, 266 teardrop sign ankle, 266–267, 267 orbits, 266, 266 Terry-Thomas sign, 267–268, 267 tooth sign, 268, 268 trolley-track sign, 268, 268 trough line, 268–269, 269 tumbling bullet sign, 269, 270 vacuum phenomenon, 269, 271, 271 Musculoskeletal scintigraphy benign bone tumors, 433, 433–434 complex regional pain syndrome (CRPS), 454, 455 imaging agents fluorine 18-labeled fluorodeoxyglucose (FDG), 426 fluorine-18 (F-18) sodium fluoride, 426 gallium-67 (Ga-67) citrate, 426 462 ᮡ Musculoskeletal scintigraphy (continued ) indium-111-labeled white blood cells, 425 technetium -99m hydroxymethylene diphosphonate (HDP), 425 technetium-99m (Tc-99m) methylene diphosphonate (MDP), 425 technetium-99m sulfur colloid, 426 imaging techniques PET-CT imaging, 427 planar imaging, 426 SPECT imaging, 431 SPECT-CT imaging, 427 three-phase bone scan, 426–427 infection/inflammation diabetic foot infections, 441 infected neuropathic joint, 441, 443, 445 joint prosthesis loosening, 445 spinal osteomyelitis, 447, 447 malignant bone tumors, 427–428, 427, 428 malignant soft tissue tumors, 435–437, 439–440 metastatic bone tumors, 429 Paget disease, 448, 448 trauma/iatrogenic pelvic insufficiency fracture, 449, 453 stress fractures, 453 vertebral compression fractures, 449 Musculoskeletal ultrasound, 407 bones fractures, 421 normal appearance, 421, 421 enthesis, 413, 414 joints, 419 hyaline cartilage, 420, 420 joint effusion, 419, 419 marginal bone erosions, 420, 420 synovitis, 419, 420 ligaments, 413, 413 muscles atrophy and fatty replacement, 416, 416 normal appearance, 416 traumatic lesions, 417–418 nerves entrapment syndromes, 417–418, 418 nerve instability, 418–419 nerve tumors, 419, 419 normal appearance, 416–417, 417 traumatic lesions, 417, 417 soft tissue masses, 421–422, 421 tendons appearance, 408–409, 408, 409 disorders, 409–413 ultrasound technique advantages, 408 general aspects, 407 limitations, 408 Mycobacterium leprae, 112 Myeloma, 156 INDEX N Neer capsular shift procedure, 287 Neisseria gonorrheae, 109 Neoplasia, 286, 286 Neoplasm, 325–327, 325, 326–327, 328, 329, 330 Nerve instability, 418–419 Nerve sheath tumors, 326, 393 Nerve tumors, 419, 419 Nerves entrapment syndromes, 417–418, 418 nerve instability, 418–419 nerve tumors, 418, 419 normal appearance, 416–417, 417 traumatic lesions, 417, 417 Neurofibromas, 163 Neuropathic (Charcot) arthropathy, 100–102, 100, 101 99mTc MDP radiotracer, 10, 11 Non-bony Bankart lesions, 16 Nonosseous Bankart, 281 Nonossifying fibromas (NOFs), 140, 141 Nuclear medicine, 10 Nutcracker fracture, 36 O Occult fracture, 354–355 Olecranon bursitis, 345–346, 345–346 Ollier disease, 135 “Onion skin” type, 120, 152 Onossifying fibromas (NOFs), 140 Open book injury, 29 Orthopedic hardware and complications ankle prostheses, 215 elbow prostheses, 217 fracture fixation, 225–230 hand prostheses, 217 hip prostheses, 212–213, 212, 213 joint prosthetic complications, 217–219, 218, 219 joint replacement, 211–212 knee prostheses, 213–215, 214, 215 shoulder prostheses, 215–217, 216 spinal fusion, 220 spinal instrumentation, 220–221, 221 surgical approaches, 221, 223, 225 wrist prostheses, 217 Os acetabuli, 370 Os acromiale, 278, 279 Os navicularis syndrome, 401–402, 403 Os peroneum syndrome, 402, 404 Os tibiale externum, 401 Os trigonum syndrome, 393, 395, 396 Osgood–Schlatter disease, 201 Osseous Bankart, 281, 281 Osteitis condensans ilii, 186 Osteitis deformans, 190 Osteitis pubis, 186, 370–372, 371 Osteoarthritis, 69–72, 70, 71, 285 Osteoblastoma, 124, 124, 118t Osteochondritis dissecans (OCD), 193, 293, 295, 343, 344 anatomy, 194, 194, 195 pathology, 193–194 radiological findings, 194, 196 Osteochondroma, 130–131, 131 Osteochondrosis, 343 Blount disease, 201–202, 202 Freiberg infraction, 196, 198 Kienböck disease, 196, 199 Kohler disease, 197, 199 Legg–Calvé–Perthes disease, 196, 197, 198 Osgood–Schlatter disease, 201 osteochondroses involving osteonecrosis, 196 involving trauma, 201 Panner disease, 198, 200 Scheuermann disease, 198, 201, 201 Sinding—Larsen–Johansson syndrome, 201 Osteochondrosis deformans tibiae See Blount disease Osteofibrous dysplasia, 118t, 143–144 Osteogenesis imperfecta (OI), 189–190, 189 Osteoid osteoma, 120, 122–123, 122–123, 367, 367, 433, 433–434 Osteoma, 125, 125, 118t Osteomalacia, 175 Osteomyelitis, 110–113, 110–113 Osteonecrosis, 202 complications, 205, 207 of knee, 207, 207 Osteopenia, 80, 186 Osteophytes, 70, 72 Osteoporosis, 47, 85, 182, 185, 186–188, 187, 188, 455 Osteoporosis circumscripta, 190 Osteosarcoma, 118, 118, 125, 126 conventional osteosarcoma, 125, 126–127 management of, 130 parosteal osteosarcoma, 126, 128 periosteal osteosarcoma, 128, 129 telangiectatic osteosarcoma, 129, 130 Outerbridge grading system, 293 P Pachydermoperiostotis, 182 Paget disease, 174, 174, 190, 448, 448 differential diagnosis, 190–191, 191t imaging findings, 190, 190, 191 Palmar fibromatosis, 161 Panner disease, 198, 200, 343–344, 343–344 Pannus formation, 79 Paralabral cysts, 283 Parathyroid carcinoma, 170 Parathyroid hormone (PTH), 169 Parosteal osteosarcoma, 118t, 125, 126, 128 “Parrot beak” tear, 301 Pars interarticularis defect, 47, 51, 54 Partial tendon tear, 383 Patella fractures, 33, 34 Patellofemoral articulation, 290, 291 Pectoralis major rupture, 284, 285 INDEX Pediatric bones fracture patterns buckle or torus fracture, 57 greenstick fracture, 57 plastic deformity, 57 Pediatric skeletal trauma, 57–67 Pelvic avulsion fracture, 61 Pelvic insufficiency fracture, 449, 453 Pencil-in-cup deformity, 91, 94 Perilunate dislocation, 21–22, 22 Periosteal osteosarcoma, 128, 129 Periosteal reaction, 120, 135, 152 Peripheral arthritis, 90 Peritendinitis, 383 Peroneal tendon injuries, 385 Pes planus, 399 Picture archiving and communication systems (PACS), Pigmented villonodular synovitis (PVNS), 105, 106–107 Pilon fractures, 34–35, 36 Pincer-type FAI, 368 Planar imaging, 426 Planovalgus (flat foot) deformity, 399–401 Plantar calcaneal spur, 92 Plantar capsule, 397 Plantar fascia tendinosis and tear, 387, 388 Plantar fasciitis, 387 Plantar fibromatosis, 161, 161 Plantar plate, 397 Plastic deformity, 57 Plates, for bone fractures, 227 Plexiform neurofibroma, 163 Podagra, 85 Polyethylene, 212 Polymethylmethacrylate, 212 Polymyositis, 98–99 Polyostotic disease, 190 Polyostotic fibrous dysplasia, 142, 142, 143 Popliteal hiatus, 291 Positron emission tomography (PET), 10, 12, 13, 426 Posterior ankle impingement syndrome, 393 Posterior cruciate ligament (PCL), 214, 290 Posterior hip dislocations, 30, 30 Posterior longitudinal ligament (OPLL), 318, 319 Posterior lumbar spinal fusion, 221 Posterior shoulder dislocations, 18, 18 Posterior superior internal impingement, 281 Posterior talofibular (PTFL), 381, 385, 386 Posterior tibialis tendon (PTT), 381, 383–384, 400, 401, 402 Posteromedial ankle impingement syndrome, 391 Postmenopausal osteoporoses, 187 Postoperative re-tear, 307 Pregnancy differential diagnosis, 186 imaging findings, 186 Primary bone lymphoma (PBL), 154, 154 Primary hyperparathyroidism, 169–170, 175t Primary hypertrophic osteoarthropathy, 182 Primary impingement, 278 Proton density (PD) sequences, 7, 312 Proton density-weighted images (PDWIs), 358 Protrusio acetabuli, 186 Pseudofractures, 175 Pseudogout, 81 Pseudohypoparathyroidism differential diagnosis, 180 imaging findings, 180, 180, 180t Pseudomonas aeruginosa, 108 Pseudo-pseudohypoparathyroidism, 180 Psoriatic arthritis, 91–92, 93–96 “Pump bump”, 393 Pyrophosphate dihydrate crystal deposition disease (CPPD), 170, 174 Q Quadriceps fat pad, 290 R Radial head fracture, 19, 19 Mason classification, 19, 20t Radial neck fractures, 19, 19–20 Mason classification, 19, 20t Radial tear, 300 Radiographs, arthritis assessment, bone fixation, Cushing syndrome, 185 examinations for fractures, findings of anteater nose, 235 bamboo spine, 236–237 bite sign, 237 bone sign, blister of, 239 bone-in-bone sign, 240 boutonniere deformity, 240 brim sign, 241 C-Sign, 242 cockade Sign, 243 cortical ring sign, 243 cotton wool sign, 243 crescent sign, 245 crowded carpal sign, 245 Cupid’s bow sign, 245 dagger sign, 246 drooping shoulder sign, 248 elbow fat pad sign, 250 fallen fragment sign, 251 fat–blood interface (FBI) sign, 251 fish vertebra, 252 grass sign, blade of, 237 H-shaped vertebra, 254 hair on end, 254 half-moon sign, 254 heel pad sign, 255 Hill–Sachs deformity, 256 intravertebral vacuum cleft sign, 257 ᮡ 463 inverted Napoleon hat sign, 258 ivory phalanx sign, 258 ivory vertebra sign, 258 lateral capsular sign, 258 metacarpal sign, 260 pedestal sign, 260 pneumoarthrogram sign, 260 pronator sign, 261 rim sign, 262 Rugger Jersey spine, 262–263 sail sign, 264 sausage digit, 263–264 Scotty dog sign, 264 swan neck deformity, 266 teardrop sign, 266, 267 Terry-Thomas sign, 267–268 tooth sign, 268 trolley-track sign, 268 trough line, 269 tumbling bullet sign, 269 vacuum phenomenon, 269 hyperparathyroidism, 170–173, 170–173 hyperpituitarism, 184, 184 hyperthyroidism, 181–182 hypoparathyroidism, 179–180, 180t hypothyroidism, 183 joint dislocations, osteomalacia, 175 osteoporosis, 187–188, 187, 188 Paget disease, 190, 190, 191 pregnancy, 186 pseudohypoparathyroidism, 180, 180, 181t renal osteodystrophy, 174–177, 174–177 scurvy, 189, 189 Radiotracers, 10 Reactive arthritis, 95–97, 96–97 Reiter syndrome, 95 Renal osteodystrophy, 174 differential diagnosis, 177–179, 178, 179 imaging findings, 174–177, 174–177 Retrolisthesis, 41 Reverse shoulder arthroplasty, 215, 216, 217 Rheumatoid arthritis (RA), 286, 355, 356 Rheumatoid arthritis, 73–79, 79–80, 74–79 Rheumatoid factor, 73 Rheumatoid variants, 86–87 Rib fractures, 41, 43 Rickets, 175, 175, 176 Rind sign, 142 Rugger jersey spine, 173, 175 S Sacral ala fractures, 187 Sacral fractures, 51, 55 Sacral insufficiency fracture, 453 Sacral stress fractures, 374 Sacroiliitis, 97 Salter–Harris classification system, 57 Salter injuries, 57 Salter V injury, 58 Sarcoidosis, 321, 324 464 ᮡ Sarcomas, 427, 428 Sausage digit, 91 Scalloped, 140 Scaphoid fracture, 21, 21, 351–352, 354 Scapholunate (SL) dissociation, 360 Scapholunate advance collapse (SLAC), 81 Scapular fractures, 15, 16 Scapulothoracic dissociation, 15, 16 Scheuermann disease, 198, 201, 201 Schwannoma, 163, 163, 326, 327, , 419, 419 Scleroderma, 98, 99 Sclerosis, 72 “Scotty dog lost its collar” sign, 51 Screws, 226 Scurvy, 188–189, 189 “Seatbelt” fracture, 47 Secondary hyperparathyroidism, 170, 175t Secondary impingement, 278 Secondary osteoarthritis, 69 Secondary synovial chondromatosis, 107 Segond fracture, 33, 33, 34 Senile osteoporoses, 187 Septic arthritis, 108–110, 108–109 Seronegative HLA-B27 spondyloarthropathies, 86 ankylosing spondylitis, 87–90, 89–91 enteropathic spondyloarthropathy, 97 psoriatic arthritis, 91–92, 93–96 reactive arthritis, 95–97, 96–97 Serpiginous, 140 Sesamoid avascular necrosis, 398–399 Sesamoid fracture, 398, 398 Shallow retromalleolar sulcus, 385 Shepherd’s crook deformity, 142 Shin splints, 455 Shiny corner sign, 89 Short tau inversion recovery (STIR), 311 Shoulder hemiarthroplasty, 215–216, 216 Shoulder prostheses, 215–217, 216 Shoulder, skeletal trauma, 15–18 SICK scapula, 284 Sinding—Larsen–Johansson syndrome, 201 Single photon emission computed tomography (SPECT), 10, 11 Single photon emission computed tomography (SPECT), 10, 427 Sinus tarsi syndrome, 399, 400 Soft tissue tumors, 156 benign soft tissue masses deep fibromatosis, 161–162, 162 elastofibroma, 160, 160 fibromatosis, 161, 161 hemangioma, 158, 160 lipoma, 158, 159 schwannoma, 163, 163 malignant soft tissue masses liposarcoma, 163–164, 165 malignant fibrous histiocytoma (MFH), 163, 164 synovial sarcoma, 164, 166 Solitary bone cyst See Unicameral bone cyst INDEX Solitary plasmacytoma, 156 Spinal canal tumors, 325 Spinal dislocation, 47 Spinal dural arteriovenous fistula, 327, 331 Spinal fusion, 220 Spinal instrumentation, 220–221, 221 Spinal MS, 318 Spinal osteomyelitis, 447, 447 Split fracture, 32 Spondylolisthesis, 41 Spondylolysis, 51, 54 Spontaneous osteonecrosis, 207 Sprains, 293 Spring calcaneonavicular complex, 387 Spring calcaneonavicular ligament complex, 381 Spring ligament complex, 387 Spurs, 92 Stable fracture, 31 Staphylococcus aureus, 108, 110 Staphylococcus epidermidis, 108 Static phase scan, 12 Sternoclavicular joint, disruption of, 42–43 Sternomanubrial dislocation, 41, 43 Strains, 293 Stress fractures, 65, 67, 374, 453, 450–451 Subacromial impingement, 278, 279 Subcapital fracture, 31 Subchondral cysts, 69–70 Subchondral resorption, 170–171 Subcoracoid external impingement, 281 Sublabral foramen, 277 Sublabral recess, 277 Subperiosteal resorption, of cortical bone, 170 Subscapularis, 276 Subtalar dislocation, 36, 37 Subtrochanteric fractures, 31 Superficial fibromatosis, 161 Superior glenohumeral ligament, 277 Superior labral anterior cuff (SLAC) tears, 282, 283 Superior labral anterior to posterior (SLAP) tears, 282, 283, 283 Supracondylar fracture, of elbow, 62 Suprapatellar fat pad, 290 Supraspinatus, 276 Surgical procedures, 287 Swan neck deformity, 73 Syndesmophyte, 89 Syndesmosis injury, 387 Syndesmotic ankle impingement syndrome, 391 Syndesmotic screws, breakage of, 226 Synovial chondromatosis, 106–107, 107–108 Synovial osteochondromatosis, 107 Synovial sarcoma, 164, 166 Synovitis, 419, 420 Syringomyelia, 100 Systemic lupus erythematosus (SLE), 97–98, 98 Systemic sclerosis, 98 T Taenia solium, 318 Talocalcaneal coalition, 389 Tarsal coalition, 389, 390 Tarsal tunnel syndrome, 393, 394 Technetium -99m hydroxymethylene diphosphonate (HDP), 425 Technetium-99m (Tc-99m) methylene diphosphonate (MDP), 122, 425 Technetium-99m sulfur colloid, 426 Telangiectatic osteosarcoma, 129, 130 Tendon rupture, 356 Tendonitis, 293 Tenosynovitis, 73, 79, 293 Teres minor, 276–277 Terry Thomas sign, 22 Tertiary hyperparathyroidism, 170 Tethered spinal cord, 331, 332 Thoracic spine fracture dislocation, 52 Thoracolumbar spine dislocation, 52 Three-phase bone scan, 11–12, 426–427 Thurston-Holland fragment, 57 Thyroid acropachy, 181 Tibia vara deformity See Blount disease Tibial intramedullary nails, 228 Tibial plateau fractures, 32, 32t Tillaux fracture, 64–65 Toddler’s fracture, 63, 64 Tophi, 85 Tophus formation, 85 Torus fracture, 57, 58 Total elbow prostheses, 217 Total hip arthroplasty, 212, 213 Total knee arthroplasty (TKA), 214, 218, 219 Total knee replacements, 213 Total shoulder arthroplasty, 215, 216, 217 Transient osteoporosis, 188, 364–365, 366 Transscaphoid perilunate dislocation, 22, 23 Transverse carpal ligament, 351, 352 Transverse myelitis, 318, 322–323 Traumatic lesions, 417, 417 Traumatic neuromas, 417 Triangular fibrocartilage complex (TFCC), 73, 358, 358, 358 Triceps avulsion fracture, 342 Triceps tears, 341–343, 342 Tricompartmental knee prostheses, 214 Trimalleolar fracture, 34, 35, 36 Triplane fracture, 63, 64, 65–66 Tuberculous osteomyelitis, 112, 112 Tumoral calcinosis, 176 Turf toe, 395, 397–399, 397 Type II odontoid fracture, 45 U Ulnar deviation, 73 Ulnar impaction syndrome, 358, 359 Ultrasound advantages, 408 assessment of disorders calcifying tendinopathy, 409, 410 ᮡ INDEX complete tears, 410, 411 paratendinopathy, 413, 413 partial tears, 410, 411 peritendinopathy, 412 tendinosis, 409, 409 tendon instability, 412, 412 tenosynovitis, 410, 412 general aspects, 407 limitations, 408 Unicameral bone cyst, 145, 145 Unicompartmental knee arthroplasty (UKA), 215 Unicompartmental knee prostheses, 215, 215 Unicompartmental patellar prostheses, 215 Unilamellated periosteal reaction, 120, 122 Unipolar hemiarthroplasty, 212 Unstable fracture, 31 Upper extremity, skeletal trauma elbow, 19 hand, 24–26 shoulder, 15–18 wrist, 20–23 V Varus alignment, 213 Vascular disease, 327, 331 Vascular disruption, 15, 16 Vertebral body compression fractures, 451 465 Vertebral compression fractures, 449, 451 Volar rotation, 22 W Weber type C fracture, 33 Wires, 228–229 Wrist arthroplasty, 217 Wrist prostheses, 217 Wrist, skeletal trauma, 20–23 Z Zone fractures, 51 Zone fractures, 51 Zone injuries, 51 ... 1987;7:1107-1 127 Taljanovic MS, Jones MD, Hunter TB, et al Joint arthroplasties and prostheses Radiographics 20 03 ;23 (5): 129 5-1314 Ostlere S, Soin S Imaging of prosthetic joints Br Inst Radiol 20 03;15 :27 0 -28 5... post-traumatic osteoarthritis ᮡ 23 1 REFERENCES Bonakdarpour A, ed Diagnostic Imaging of Musculoskeletal Radiology: A Systematic Approach New York, NY: Springer; 20 09 :20 3 -23 9, 497- 525 Rabin D, Calire S,... Fracture fixation Radiographics 20 03 ;23 (6):15691590 12 Lakatos R, Keenan M General Principles of Fracture Fixation http://emedicine.medscape.com/article/ 126 9987-overview# aw2aab6b3 This page intentionally