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Ionizing radiation produces its deleterious biologic effects by both direct (DNA strand breaks) and indirect processes (formation of free oxygen radicals). Mitotically active cells are more susceptible to the detrimental effects of ionizing radiation. These effects are most severe locally within the treatment field but can also occur systemically, possibly reflecting hormonal influences and inflammatory cytokine mediators. Specific bone complications of radiation include osteopenia, growth arrest, fracture and malignancy. Some of these complications, such as osteopenia, are reversible and severity is dose dependent. Insufficiency fractures are a common complication after radiation therapy and generally affect those bones under most physiologic stress and with the highest ratio of trabecular to cortical bone. Familiarity with the radiographic appearance of irradiated bone, including computed tomography (CT) and magnetic resonance imaging (MRI), will improve image interpretation and facilitate accurate diagnosis.

Purpose Distal radius fractures are a common injury. In the emergency room, trainees regularly assess these fractures using visual estimation. Our hypothesis is that assessment of radiographic parameters has sufficient accuracy for rendering treatment consistent with formal measurements. Methods This study compared visual measurements made by 25 orthopaedic residents and attending physicians to formal measurements made by a single fellowship trained musculoskeletal radiologist in a series of patients with distal radius fractures. A search was performed utilizing the ICD-9 code for distal radius fracture in all patients presenting to a single institution emergency department. Participants used visual estimation to rate 25 radiographs. Parameters estimated included radial inclination, radial height, volar tilt, and the presence of intra-articular displacement. Analysis using Lin concordance coefficients, Bland Altman plots, and the Kappa statistic evaluated the agreement between visual estimation and formal measurements. The proportion of raters whose estimates would have resulted in a course of treatment that conflicted with the formal reading quantified the potential impact of visual estimation on treatment. Results Concordance coefficients were poor for radial inclination (ρc=0.13), radial height (ρc=0.24), and volar tilt (ρc= 0.46). The Kappa statistic for intra-articular displacement was 0.4. Analysis performed according to level of training did not result in substantial improvements in these statistics.Treatment based on visual estimates conflicted with formal readings 34 % of the time for radial inclination, 38 % of the time for radial height, 27 % of the time for volar tilt, and 31 % of the time for intra-articular displacement. Discussion Visual estimation is not an adequate form of measurement for evaluation of patients with distal radius fractures. Physicians should be mindful of these results when developing treatment plans based solely upon visual estimation.

Leiomyomas arising outside of the uterus and gastrointestinal tract are uncommon, though these benign soft tissue neoplasms have been reported in the lower extremity and foot. To our knowledge, the sonographic appearance of a lower extremity leiomyoma has not been described in the literature. This report involves a case of leiomyoma of the foot and its sonographic imaging features. MR correlative imaging and histopathology are also provided.

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