Patellofemoral dysfunction (PFD) is a common cause for medical consultation and in a broad sense it refers to a condition in which the patella fails to engage securely in the trochlear groove. This is a topic in which IntroducciónEl dolor anterior de rodilla es una causa muy frecuente de consulta en ortopedia y traumatología. La disfunción patelofemoral (DPF) se refiere, en grandes rasgos, a una patología en la cual la patela falla en la correcta entrada en la tróclea. Es un tema complejo, en el que la terminología suele ser ambigua y confusa. Esta falta de claridad se debe, entre otras cosas, a la discrepancia entre la sintomatología, la imaginología y el examen físico.En las alteraciones de esta articulación existe menos conocimiento que en cualquier otra condición patológica de la rodilla. La mecánica patelofemoral

Guidelines of the Chilean EndocrinologySociety for the correct clinical use of bone densitometryOsteoporosis is a silent and frequent disease, which increases fracture risk. Approximately half of women and one of five men over 50 years old will suffer an osteoporotic fracture throughout their lives. Dual-energy x-ray absorptiometry (DXA) allows a real bone mineral density (BMD) measurement in different parts of the skeleton and is considered the "gold standard" for quantifying osteoporosis with high accuracy and precision. The Board of the Chilean Society of Endocrinology and Diabetes (SOCHED) required from the Bone Disease Study Group to develop a consensus about the "Correct use of bone densitometry in clinical practice in Chilean population". Therefore, we elaborated 25 questions which addressed key aspects about the indications for a DXA scan, and the details of how to perform and report this test. Since some of the evidence obtained was of low quality or inconclusive, we decided to create a multidisciplinary group of national experts in osteoporosis to develop a consensus in this subject. The group consisted of 22 physicians including endocrinologists, gynecologists, geriatricians, radiologists, rheumatologists and nuclear medicine specialists. Using the Delphi methodology to analyze previously agreed questions, we elaborated statements that were evaluated by the experts who expressed their degree of agreement. The final report of this consensus was approved by the SOCHED board.

The purpose of this study was to determine the frequency, concordance and discordance of breast lesions during automated core biopsy . A USguided 14 -gauge automated core needle biopsy was performed on 188 lesions. Only in 1 of 120 bening diagnosed cases imaging-histologic discordance was present. This lesion underwent surgical excision and the case was diagnosed as having carcinoma in situ, as a definitive histological diagnosis. Assessment of correlation between imaging studies and histologic findings, as well as determination of concordance, are required to minimize diagnostic errors.Resumen: El propósito de nuestro estudio fue determinar la frecuencia, concordancias y discordancias de las lesiones mamarias. Se realizaron 188 biopsias core con aguja de 14G. Sólo 1 de las 120 lesiones benignas diagnosticadas fue discordante; se recomendó escisión quirúrgica cuyo resultado definitivo demostró carcinoma in situ. Para minimizar errores diagnósticos, se requiere evaluar la correlación entre las imágenes y el resultado histológico, además de establecer la concordancia.

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Category Sports; Trauma Introduction/Purpose: Turf Toe remains a diagnostic challenge for the orthopedic surgeon. A high index of suspicion is needed, in addition to adequate imaging strategies to characterize the broad spectrum of injuries involving this pathology. MRI imaging provides excellent static soft-tissue details and it has become widely used to determine the anatomical structures damaged. However, defining the stability of the 1st metatarsophalangeal (MTP) plantar plate complex is difficult without proper dynamic evaluation and this is crucial to define between conservative or operative management. Since there is no current consensus regarding the optimal imaging assessment to optimize turf toe diagnosis we present the results of an imaging protocol, including dynamic fluoroscopy and ultrasound (US), to enhance the identification of unstable Turf Toe injuries. Methods: A prospective imaging protocol consisting of bilateral comparative weightbearing x-rays, US examination, and mobilization under fluoroscopy was designed. The inclusion criterion was any patient with clinical findings consistent with plantar plate injury after forced hyperextension of the hallux. All studies were informed and performed by trained musculoskeletal radiologists. Location and symmetry of the sesamoids under the metatarsal, increased distal sesamoid-to-phalanx distance and proximal migration of one or both sesamoids were suggestive findings of unstable plantar plate rupture on weightbearing x-rays. Ultrasound examination was performed to address soft tissue injuries, characterize the magnitude of the plantar plate rupture and for dynamic/comparative stability assessment. A comparative dynamic fluoroscopic evaluation was performed to evaluate the behavior of the sesamoids under maximal dorsiflexion and plantarflexion of the hallux on the lateral view. MRI was also done in all of the patients with positive findings of instability. Results: Eighteen patients (11M/7F) were evaluated under suspicion of turf toe injury from August 2016 to November 2019. The mean age was 31 years old (range:14-50). Weightbearing X-rays were positive for sesamoid complex instability in one patient. Four patients (22,2%) had positive findings for instability in fluoroscopy and US. The agreement between US and fluoroscopy was excellent (kappa coefficient 1). Assuming fluoroscopy examination as the gold standard for instability, the US was highly effective at detecting unstable injuries (Sensitivity 100%, Specificity 100%, PPV 100%, NPV 100%). Four patients positive for instability received operative treatment. Conclusion: In our series, dynamic ultrasound and fluoroscopy allowed detection of 4/18 unstable turf toe injuries compared to Weightbearing X-rays that detected only one unstable injury. US examination is highly sensitive for instability being comparable to fluoroscopic examination. Dynamic testing, with either US or fluoroscopy, in turf toe may improve the diagnosis of severe injuries, leading to higher detection of patients requiring surgical stabilization of the plantar complex.