Clavicular fractures are occasionally responsible for lesions of the brachial plexus. The symptoms are usually delayed and due to compression by hypertrophic callus, nonunion or a subclavian pseudoaneurysm.We describe a patient in whom a displaced bone fragment was pressing on the retroclavicular part of the brachial plexus, leading to early symptoms of a lesion of the posterior cord. Internal fixation of the clavicle and external neurolysis of the brachial plexus gave an almost full recovery. CASE REPORTA 32-year-old, right-handed man sustained a closed comminuted fracture of the right clavicle in a fall. He was treated conservatively with a figure-of-eight bandage and sling. Three weeks later he was referred to us, complaining of continuous pain in the shoulder and right arm. He reported that immediately after the injury he had been aware of numbness in the distribution of the radial nerve in the forearm and hand, with weakness of the deltoid, triceps and wrist extension. These observations were confirmed by clinical examination, but there was no evidence of vascular injury. A plain radiograph (Fig. 1) and CT (Fig. 2) showed a sagittally orientated, intermediate bone fragment, and narrowing of the costoclavicular space. MRI confirmed impingement of the clavicular lesion on the brachial plexus (Fig. 3). EMG showed a lesion of the posterior cord, with signs of denervation in the radial and axillary nerves. Operation was undertaken one week later. A sharp fragment of bone, 2.5 cm long, was found to be pressing directly on the proximal part of the posterior cord (Fig. 4).Since there was no obvious sign of perineural injury, Fig. 1 Anteroposterior radiograph of the right clavicle, three weeks after injury, showing a displaced multisegmental fracture of the middle third. Three-dimensional reconstruction of a CT scan of the right clavicle showing the displaced bone fragment (arrow) narrowing the costoclavicular space.

A scaffold-free 3D graft made of AMSCs can be manufactured and used as a promising alternative for spinal fusion procedures. Nevertheless, further studies of a larger series of patients are needed to confirm its effectiveness.

In 15 hips with typical signs of avascular necrosis of the femoral head on plain radiographs and magnetic resonance (MR) images, gadolinium-enhanced spin-echo and fat-suppressed MR images were obtained and compared with nonenhanced T1- and T2-weighted images. Both enhanced and nonenhanced areas were consistently detected in the abnormal femoral heads. Enhanced areas showed a low signal intensity (SI) on T1-weighted MR images obtained before contrast material was administered and an intermediate to high SI on T2-weighted images. Nonenhanced areas showed an SI either identical (pattern 1) or hypointense (pattern 2) to that of fat on both sequences. Histologic correlation (six resected femoral heads) helped confirm that enhanced and nonenhanced areas corresponded respectively to viable and necrotic tissue. In most cases, SI analysis of nonenhanced T1- and T2-weighted images allows the differentiation of hypervascularized viable tissue from hypovascularized necrotic tissue of the sequestrum.

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