A clinical example is presented that demonstrates the capabilities of magnetic resonance imaging (MRI) in the diagnosis of a subchondral insufficiency fracture of the medial femoral condyle. An MR study protocol has been demonstrated that allows ensure successful diagnosis of this type of fracture.

Introduction. Standard spine radiography is the basic method of radiodiagnosis, used for screening. X-ray imaging allows you to assess the anatomy of spinal motion segments in the cervical spine, determine the period of osteochondrosis and the tactics of further examination and treatment. Various types of dislocation of vertebrae are much more common than can be determined by spinal radiography in standard projections; as a result of dislocation, a pain syndrome occurs. Aim. To study the effectiveness of conventional methods for diagnosis of instability in the spinal motion segment (SMS) in the cervical spine. Materials and methods. We observed 50 patients (mean age 50.6 ± 2.19 years) who were admitted to the Clinic of the Irkutsk Scientific Center for Surgery and Traumatology (Neurosurgical Department) with a diagnosis Adult osteochondrosis of spine (ICD-10 code – M42.1). Conventional methods were used to diagnose SMS instability: plain radiography in anteroposterior and lateral projections, functional cervical spine radiography. Results. It was stated that the most common changes are characteristic of II and III periods of osteochondrosis: straightening of cervical lordosis – in 48 patients (96%), decrease in intervertebral disc height – in 46 patients (92%), anterior wedging of vertebral bodies – in 48 patients (96%), endplate sclerosis – in 37 patients (74%), presence of marginal osteophytes – in 45 patients (90%). In maximum flexion and extension, the CII–CVI vertebrae were involved in the formation of pathological mobility of the intervertebral segments, while the CI and CVII vertebrae remained stable. Instability in one cervical vertebra was revealed in 15 patients (30%). Most often, excessive mobility of 2 vertebrae was observed – in 22 people (44%), less often of 3 vertebrae – in 5 patients (10%). The dislocation of 4 vertebrae was quite rare – in 2 patients (4%). When analyzing the data of functional cervical spine radiography, we have found that the SMS instability in patients with intervertebral disc degeneration develops most often in the following segments: CII–CIII – 13 people (26%), СIII–СIV – 34 people (70%), CIV–CV – 29 people (58%), СV–СVI – 12 people (24%). Conclusion. The SMS instability still remains an urgent problem in neurology and neurosurgery. Plain radiography reveals only indirect signs of SMS instability. Diagnosis by functional spondylography made it possible to verify the SMS instability only in 36% of cases.

Представлен многолетний опыт работы по выявлению пациентов с различной патологией надпочечников методом мультиспиральной компьютерной томографии. Мультиспиральная компьютерная томография-высокоинформативный метод выбора в диагностике опухолей надпочечников. Мультиспиральная компьютерная томография в перфузионном варианте опухолевого поражения надпочечников повышает точность диагностики, что оптимизирует тактику лечения. Усовершенствование алгоритма оценки перфузионных показателей надпочечниковых инциденталом с использованием мультиспиральной компьютерной томографии позволит оценить гистологический характер патологического процесса. Обосновано проведение перфузионного МСКТ-исследования у пациентов с объёмными образованиями надпочечников с целью дифференциальной диагностики гиперпластических и опухолевых процессов в них. Предпринята попытка разработки алгоритма МСКТ-диагностики надпочечниковых образований и определения его эффективности. Лучевая характеристика инциденталом надпочечников является отражением их морфологической структуры. Имеются статистически значимые различия альдостеронпродуцирующих и кортизолпродуцирующих аденом по размерам и КТ-плотности. Морфологические признаки дегенерации опухолей надпочечников коррелируют с функциональной активностью. Оперативное лечение абсолютно показано больным с инциденталомами, соответствующими лучевому фенотипу злокачественных опухолей, а также больным, у которых при комплексном обследовании выявлена гормональная активность. Динамическое наблюдение показано пациентам с гормонально-неактивными инциденталомами малого размера (< 4 см) при отсутствии лучевых признаков злокачественности. У больных с предельно высоким риском хирургического лечения целесообразны рентгенэндоваскулярные вмешательства, направленные на подавление гиперфункции надпочечников. Основными прогностическими факторами при инциденталомах надпочечников являются: лучевой фенотип, гормональная активность, длительность заболевания, выбор адекватной лечебной тактики. При хирургическом лечении прогноз зависит от морфологической характеристики инциденталом надпочечников.

Stress fractures are an actual problem of modern medicine. A fracture associated with insufficiency of the bone tissue of the knee condyles is a new type of stress fracture that occurs in people aged 50–55 years in response to a normal daily activity, but with damage to the weakened subchondral bone tissue of the joint caused by various reasons. This literature review is mainly based on data from foreign medical sources, since there is very little information on this type of fracture in Russian sources. This is primarily due to the fact that initially the world and Russian medical communities designated this type of fracture as a spontaneous osteonecrosis of the knee (SONK). In recent years, this term has been revised abroad and replaced by a more suitable one – subchondral insufficiency fracture of the knee (SIF/SIFK). According to modern concepts, it is necessary to clearly distinguish among the concepts of osteonecrosis and subchondral insufficiency fracture of the knee. The reason for this is not only differences in the pathogenesis of these pathologies, but also fundamentally different approaches to managing these patients. Thus, taking into account the fundamental differences in the treatment of patients with stress fracture associated with bone insufficiency and patients with osteonecrosis, and also the relevance of stress fracture of the knee condyles, we state the following aim – to study the available literature on this problem.

Subchondral stress insufficiency fracture of the knee is a new type of fracture that occurs in people of the older age group (from 50–55 years old) when exposed to a normal load on weakened bone trabeculae. In Russian sources, there is few information about this type of fracture. This is primarily due to the fact that initially the world and domestic medical communities designated this type of pathology as “spontaneous osteonecrosis of the knee”. In recent years, this term has been revised abroad and replaced by a more suitable one – “subchondral insufficiency fracture”. The etiology of insufficiency fracture is based on many diseases and conditions that lead to bone tissue weakening (osteoporosis, collagenosis, rheumatoid arthritis, post-radiation changes in bones, etc.). The main method for diagnosing this type of fracture is magnetic resonance imaging, since it is able to detect a fracture at any stage (especially at an early one). According to modern concepts, the terms “osteonecrosis” and “subchondral insufficiency fracture” require completely different approaches to the treatment. In the presence of complications, a fracture of insufficiency of the knee joint condyles threatens with subchondral collapse and secondary osteoarthritis, which leads to disability of a patient. Given the relevance of this medical problem, the aim of the review is to show the current state of literature data on the issue.