No abstract

The clinical and radiographic records of 23 patients (15 women, eight men) with rapidly destructive hip disease (RDHD) were retrospectively reviewed. Criteria for RDHD included a history of hip pain of 1-6 months duration and the radiographic appearance of a rapidly progressive atrophic form of bone destruction involving both the femoral head and the acetabulum. Radiographs of the remainder of the appendicular skeleton were assessed in 14 patients. The mean patient age was 72 years. The average time from clinical presentation to the appearance of severe hip destruction was 14 months. Five patients demonstrated similar atrophic bone destruction around other articulations. No patients had clinical or laboratory evidence of sepsis or neurologic disease. Although previous reports have suggested that RDHD is degenerative in nature, similar involvement of other articulations suggests that it may represent a focal finding of a more generalized process.

Ulnar collateral ligament (UCL) injury of the first metacarpophalangeal joint (gamekeeper thumb) is common. If the UCL becomes displaced superficially to the adductor pollicis aponeurosis, surgical treatment has been advocated. Radiography cannot help differentiate between displaced and nondisplaced tears. The authors investigated the use of magnetic resonance (MR) imaging in the evaluation of UCL injury. Ten displaced and six nondisplaced UCL tears were surgically created in 16 nonembalmed cadaveric specimens. Twelve unaltered specimens served as controls. Coronal MR images were obtained and interpreted by two observers. The MR images were compared with corresponding anatomic slices. MR imaging depicted UCL displacement in all 10 specimens with displaced tears. A displaced tear was interpreted in one control specimen. Non-displaced tears were diagnosed in four control specimens. Although MR imaging was only 67% specific for all tears, it was 100% sensitive and 94% specific for depicting UCL displacement and, therefore, may be useful for evaluating gamekeeper thumb.

This report describes the natural history of the Segond fracture and documents the radiographic appearance of the healed Segond fracture. The clinical and radiographic records of 129 patients with acute anterior cruciate ligament (ACL) injuries were reviewed. Four (3.1%) of these patients had Segond fractures. On follow-up radiographic examination, seven patients demonstrated a characteristic bone excrescence arising 3-6 mm inferior to the lateral tibial plateau. In four of the five patients for whom acute injury films were available this excrescence arose at the site of the earlier Segond fracture. Healing of such fractures is associated with a characteristic bone excrescence distinct from an osteophyte. This excrescence implies significant internal derangement of the knee.

We describe two patients with an Essex-Lopresti fracture dislocation in association with a dislocation of the elbow. This combination of injuries has not been previously reported. The Essex-Lopresti fracture is a rare injury, and the associated distal radioulnar dislocation is often missed. Meticulous radiographic evaluation of the wrist, including dynamic stress radiographs of the forearm, can lead to an earlier diagnosis and improved care of these patients.