The use of ultrasound in the diagnosis of atypical pathology in the unossified skeleton

Congenital differences about the elbow

The elbow is frequently affected by congenital differences that limit flexion-extension and supination-pronation. The limitation can occur in utero or develop over time. Delayed causes usually gradually disrupt the anatomy and function of the paired bone forearm. Accurate diagnosis is based on a careful examination and perusal of radiographs. Certain diagnoses can be helped by surgery and will result in improved limb usage and function. In contrast, other diagnoses are recalcitrant to modern operative techniques but will benefit from occupational therapy and adaptive equipment to enhance independence and activities essential to daily life. This article discusses diagnosis and treatment of synostosis, arthrogryposis, pterygium, multiple hereditary exostosis, and the unsalvageable forearm.

Ultrasonographic study of the femoro-patellar joint and its attachments in infants from birth to 24 months of age. Part II: children with Down syndrome

An ultrasonographic study was carried out in 25 infants (50 knees) with Down syndrome, whose age ranged from zero to 24 months, average being 13.2 months; 13 were males and 12 were females. The ultrasonographic investigation was performed with the knee being in full extension for the transversal view and in 30 degrees flexion for the sagittal view. The Insall-Salvati index and femoral cartilaginous sulcus angle were measured. Insall-Salvati index values ranged from 1.06 to 1.15 (average 1.10), with standard deviation of 0.16. No significant differences were observed with regard to Insall-Salvati index values in normal children. The femoral cartilaginous sulcus angle in infants with Down syndrome ranged from 152.7 to 155.8 degrees (average 154.3) with standard deviation of 7.959. In Down syndrome we noticed significant difference as compared to the normal values. The authors suggest that ultrasonography is useful in Down syndrome for an early diagnosis of instability of the patella.

Magnetic resonance imaging of bilateral lateral congenital dislocations of unossified patellae

We describe our experience using magnetic resonance imaging (MRI) to evaluate the unossified dislocated cartilaginous patella in a 6-year-old male patient with restricted extension and flexion deformity of both knees. MRI is used widely in the visualization of cartilage since it can show cartilage directly. In addition, FS FLASH 3D sequence has recently been accepted as a suitable sequence in the evaluation of hyaline cartilage. MRI makes it possible to evaluate ligamentous, tendinous, muscular, and cartilaginous structures as well as the abnormalities related to them. We applied this technique in our case and found it very effective in locating the unossified dislocated cartilaginous patella. We also observed structural changes such as bilateral lateral displacement of short quadriceps tendon inserting into diminutive patella, insertion of bilateral patellar tendons into anterolateral tibia, and a stretching of the medial collateral ligament associated with valgus stress.

Congenital dislocation of the patella

OBJECTIVE

Our objective was to present the imaging findings for congenital dislocation of the patella, an uncommon condition with variable clinical manifestations in patients of different ages.

CONCLUSION

Sonography can clearly illustrate the presence and location of the laterally displaced patella and the anatomy of adjacent joint structures. The high resolution for soft-tissue, cartilaginous, and bony structures of the immature skeleton makes sonography a valuable tool in the management of congenital dislocation of the patella. Conventional radiography is a simple method for diagnosis once ossification of the patella has commenced and for postoperative follow-up. MRI allows visualization of fine anatomic details and relationships between the involved structures of the extensor mechanism and is the technique of choice for preoperative planning.

Congenital dislocation of the patella

Congenital dislocation of the patella may occur as a persistent lateral dislocation of the patella that presents with a knee flexion contracture and the patella tethered lateral to the femoral condyles or as an intermittent dislocation of the patella. In the latter syndrome, the patella dislocates completely with each flexion and extension cycle of the knee and is best termed obligatory dislocation of the patella, because the patient has no control over the patella dislocating as he or she moves the knee. The first type of congenital dislocation, which is fixed, often is associated with syndromes such as arthrogryposis and should be corrected surgically by lateral release and realignment of the patella. Obligatory dislocation of the patella tends to be an isolated dysplastic anomaly and may be relatively well tolerated. Rebalancing of the patella usually is done at a later age because of less interference with function. The current author describes the natural history of patella femoral dysplasia, detailing the pathologic changes that are present, and recommends surgical techniques for correcting both types of congenital dislocation of the patella.

Joint sonography

Sonographic evaluation of joint and periarticular pathology clearly has applications in numerous clinical scenarios, not only for diagnosis but in some situations for US-guided biopsy, aspiration, and injections. It is a rapid, inexpensive technique that with adequate equipment, training, and expertise makes it compelling for use as a first-line imaging modality for the assessment of periarticular masses, localized pain, possible infection, joint swelling, as well as posttraumatic articular and periarticular lesions.

Sonography of patellar abnormalities in children

OBJECTIVE

We describe our experience using sonography to evaluate the patella and patellofemoral joint in three children with congenital abnormalities of the extensor mechanism of the lower extremity.

CONCLUSION

Sonography can be used to evaluate the extensor mechanism and unossified patella in young children. Advantages of sonography over MR imaging are no need for sedation, speed of examination and ability to compare with the contralateral knee, low cost, and the sonographer's ability to dynamically evaluate the extensor mechanism.