These preliminary findings of decreased femoral cartilage thickness in SCD patients should be complemented with future studies. The possibility of early knee joint degeneration and eventual osteoarthritis in SCD should be kept in mind.

9. Hayter CL, Gold SL, Koff MF et al. MRI findings in painful metal on metal hip arthroplasty. AJR Am J Roentgenol 2012;199:884-893. 10. Hart AJ, Satchithananda K, Liddle AD et al. Pseudotumors in association with well-functioning metal-on-metal hip prostheses: A case-control study using three-dimensional computed tomography and magnetic resonance imaging. J Bone Joint Surg Am 2012;94:317-325.

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A 19-year-old man was evaluated due to pain in his left index finger. Medical history yielded a roller press injury to his left hand three weeks previously. Physical examination revealed pain with the palpation and motions of the second proximal phalanx, swelling and normal range of motion. Plain radiographs were not remarkable ( fig 1A,B). Longitudinal and axial ultrasound (US) images clearly designated cortical collapse at the dorsal surface of the proximal phalanx ( fig 1C,D) compared with the other side (Fig 1E,F). Overall, the patient was diagnosed with non-displaced stable fracture of the proximal phalanx and he was treated with static splinting for three weeks.As a rule plain radiographs are the initial imaging modality for the visualization of bone injuries [1,2]. Nonetheless, in case of high clinical suspicion -if the plain radiographs are normal -, advanced imaging modalities are usually required. Computed tomography and magnetic resonance imaging (MRI) are also utilized to provide a better evaluation of the fracture for optimal treatment planning when a more detailed evaluation of the fracture is needed. For instance MRI should be performed to provide the precise diagnosis of stress fractures in cases with normal radiographs [1]. On the other hand, US has become widely used and has increasingly gained importance for the injuries of the musculoskeletal system with several advantages (lack of ionizing radiation, patient friendly, ease of application, repeatable, cheaper than MRI and computed tomography, non-invasive, provides multi-planar and dynamic imaging). Likewise, US is very likely to detect cortical lesions of the bone [3].Accordingly, we suggest that US is a convenient imaging modality to visualize bone injuries for the initial evaluation if the plain radiographs are normal or not available.

A 55-year old male presented to the outpatient clinic with painful swelling and morning stiffness in both wrists and finger joints which had started 6 weeks ago. The morning stiffness in both hands and wrists lasted for up to 2 hours and improved with activity. Detailed questioning revealed no significant past medical history. On physical examination, there was deformity and swelling on the wrists and hands. Soft-tender swellings were determined in the metacarpophalangeal (MCP) and proximal interphalangeal joints of the second through fifth digits of both hands. The serum C-reactive protein (CRP) level, anti-CRP level and erythrocyte sedimentation rates (ESR) were increased (CRP=68 mg/L; ESR=87 mm/h; anti-CRP=364 UI/ mL). Rheumatoid factor levels were within the normal ranges. The leukocyte count, hepatitis markers, anti-nuclear antibodies, anti-dsDNA were also normal. Antero-posterior hand and wrist radiographs showed soft tissue swelling without erosion ( Figure 1a). Longitudinal ( Figure 1b) and axial ( Figure 1c) ultrasound (US) images showed effusion, and cortical bone erosion on the radial side of the 2 nd MCP joint (arrow).