Lateral elbow tendinopathy: surgery versus extracorporeal shock wave therapy

Lateral elbow pain caused by tendinopathy - tendinosis - or tennis elbow is a highly prevalent problem. Unfortunately, no treatment method can guarantee clinical success. Inspired by the lithotripsy technique used for kidney stones, extracorporeal shock wave therapy (ESWT) has been introduced as an alternative to surgical treatment 25 years ago. In a randomized prospective study, we compared 15 patients with lateral elbow tendinopathy who were operated and 14 who underwent ESWT. Almost all patients had good or excellent outcomes according to the criteria by Verhaar. Subjective improvement was 57% for the ESWT group and 76% for the surgery group. No significant differences between both groups were found (p = 0.07). We therefore recommend considering non-invasive techniques such as ESWT treatment prior to surgery in tennis elbow.

Ewing's sarcoma: imaging features

AIM

To define an imaging prototype of Ewing's sarcoma (ES).

MATERIALS AND METHODS

Sixty-four patients with a histopathologically and/or genetically proven diagnosis of ES were analyzed for clinical parameters (age, gender and location), radiographic and CT appearance (distribution, matrix, margins, periosteal reaction, articular extension, cortical reaction and the presence of a pathologic fracture). Size, local extension, signal intensity, degree and pattern of enhancement, and the presence of skip metastases were evaluated on MRI. Distant metastases were recorded on bone scintigraphy and chest CT scan.

RESULTS

Patient's age ranged between 7-67 (mean 17.9). Male/female ratio was 2.4/1. Location in the pelvis was most frequent (31%), followed by the femur (20%) and tibia (11%). Most tumors were mixed lytic-sclerotic (75%), and purely lytic in 25%. Plain films and CT scan showed a spiculated periosteal reaction in 50%. A Codman's triangle was seen in 27%. Articular extension was difficult to assess on radiographs. Cortical permeation and destruction is seen in respectively 31 and 42%, whereas cortical thickening is seen in 20%. Pathologic fracture occurred in 7.8%. MRI showed a large mass, with a soft tissue component of more than 50% in 67%. Degree and pattern of enhancement pattern was variable. Signal intensity on T1- and T2-WI was non-specific. Joint involvement was seen in 23%. Isolated involvement of the soft tissue (extraskeletal ES) was seen in 1.5%. Skip metastases at initial presentation were present at initial presentation in 14% and distant metastases in 22%.

CONCLUSIONS

ES occurs in young patients. On radiographs/CT, 37.5% are located in the axial skeleton and 62.5% in the peripheral skeleton. ES is mostly mixed sclerotic-lytic. A spiculated periosteal reaction is most frequent. The most characteristic finding on MRI is the presence of a large soft tissue mass.

A special case on the use of ultrasonography for evaluation of the spinal canal and its contents in adults

In this article we present a 70-year-old man with a history of severe trauma in the upper thoracic spine. This patient presented at our emergency department with a leaking wound in the lower neck after removal of osteosynthetic material. He had undergone a laminectomy of the third thoracic vertebra in the past. As an incidental finding, while examining the region of the lower neck by transcutaneous ultrasonography, we diagnosed a post-traumatic syrinx of the spinal medulla at this level.

Imaging in trauma of the pelvis and hip region

Trauma of the pelvis and the hip are frequent and the most common lesions are fractures and dislocations. There are other traumatic lesions around the pelvis, including epiphysiolysis of the femoral head and apophysiolysis of the common muscle insertions around the hip. Cartilaginous lesions and some less frequent fractures are also illustrated in this article. We are not claiming to give a complete overview of traumatic injuries to the pelvis and the hip, but want to illustrate some more and some less frequent lesions.

Fibrolipomatous hamartoma in the foot: atypical MR imaging findings

Lipomatosis of a nerve is a well-known but uncommon entity mostly seen in the median nerve. Magnetic resonance imaging (MRI) has been shown to provide pathognomonic features, obviating the need for diagnostic biopsy. We present a case of lipomatosis of a branch of the medial plantar nerve with an atypical appearance on magnetic resonance imaging.

Selective arterial embolization in the treatment of an aneurysmal bone cyst of the pelvis

This case report deals with an aggressive aneurysmal bone cyst of the pelvis in a 20-year-old man causing considerable destruction of the left ilium and the anterior column of the acetabulum, with extension into the pelvis. The treatment of large pelvic aneurysmal bone cysts is challenging because of local destruction of adjacent structures and because of the risk of severe intraoperative bleeding. Therefore selective preoperative embolization may be a valuable tool in the management of aneurysmal bone cysts.

Non perforated septum supra-patellaris mimicking a soft tissue tumour

Plicae synoviales of the knee are well known to present as anterior knee pain but can also cause blocking, clicking, and swelling of the knee mimicking pathology such as meniscal tears or other internal derangements, and even mono-arthritis. Embryologically, the knee is divided into a medial and lateral compartment and a supra-patellar pouch by thin membranes of synovium. Incomplete involution of these membranes gives rise to a plica. When there is no involution at all, the membrane is called a septum. There are three frequent types of plicae/septa: a suprapatellar, a medial-patellar, and an infra-patellar type. We discuss on a patient with a non perforated septum supra-patellaris which resulted in a swelling above the knee, mistaken for a soft tissue tumour.

The meniscal ossicle revisited

The meniscal ossicle is an infrequent radiographic finding in humans. It often is mistaken for an intra-articular loose body. MR imaging is the ideal modality to differentiate between these entities. We report the imaging findings of a meniscal ossicle in a patient with emphasis on the MR imaging appearance. A review of the literature on meniscal ossicles is also presented.

Unilateral absence of the trapezius and pectoralis major muscle: a variant of Poland syndrome

We report a female patient with unilateral absence of the trapezius and pectoralis major muscles without other associated limb abnormalities. We believe that this anomaly belongs to the spectrum of anomalies resulting from disruption of the blood supply in the embryonic subclavian and vertebral arteries, as suggested in Poland syndrome.

Ultrasound in acute trauma of the ankle and hindfoot

Ultrasound is a rapid, widely available and inexpensive imaging modality for the evaluation of the ankle and hindfoot. Ultrasonography can be performed in acute, semiacute and chronic conditions. Ankle injuries can be evaluated with ultrasound combined with X-rays. In the emergency room, acute trauma of ankle and hindfoot is an important indication for ultrasound.

The axis ring: a forgotten semiologic sign in the detection of low odontoid fractures

The axis ring is a very important sign in the detection of low odontoid fractures. It can be the only radiological sign of a type III (low) odontoid fracture in a polytraumatised patient. As these are unstable fractures, their detection is important, even before a spiral CT is performed. Tracheal tube placement in patients with type III odontoid fractures should be performed very carefully to prevent displacement of the fracture. This sign, which has been published more than once in the radiological literature, seems to be not so well known by the physicians nor by a lot of radiologists. We can call it a forgotten semiologic sign. It is not even mentioned in the ATLS (Advanced Trauma Life Support) criteria for evaluation of the cervical spine.

Calcifying/ossifying synovial sarcoma shows t(X;18) with SSX2 involvement and mitochondrial calcifications

AIMS

Synovial sarcoma with extensive calcification and ossification is a rare variant, the ultrastructural, cytogenetic and molecular analysis of which has not been reported previously.

METHODS AND RESULTS

A large mass in the shoulder of a 20-year-old male patient led to a deformity of the chest wall, thus supporting the hypothesis that this is a slowly growing variant of synovial sarcoma. Nevertheless, the patient developed metastatic lung disease 7 months after resection. On histology, the monophasic spindle cell proliferation was in several areas obscured by the massive calcification and ossification. Immunohistochemistry showed keratin, epithelial membrane antigen, vimentin and CD99 expression. The cytogenetic analysis revealed a single t(X;18)(p11.2; q11.2), typical for synovial sarcoma. Additional fluorescence in-situ hybridization revealed SSX2 involvement. At the ultrastructural level, prominent needle-shaped intramitochondrial crystals were present, both in the cytoplasm and in the extracellular matrix.

CONCLUSION

The presence of the t(X;18) with SSX2 involvement definitively characterizes this tumour as a variant of synovial sarcoma. In addition, the needle-like mitochondrial calcifications give a possible clue to the pathogenesis of the extensive metaplastic ossification and calcification.

Cytogenetic-morphologic correlations in aneurysmal bone cyst, giant cell tumor of bone and combined lesions. A report from the CHAMP study group

Aneurysmal bone cyst and giant cell tumor of bone are relatively rare bone tumors that sometimes coexist. We examined the karyotypes of 3 aneurysmal bone cysts, 12 giant cell tumors, and 3 combined lesions. All aneurysmal bone cysts showed involvement of chromosome segments 17p11-13 and/or 16q22. In addition, in 1 of the 3 giant cell tumors with secondary aneurysmal bone cyst, both chromosome bands were rearranged as well, albeit not in a balanced translocation. Seven out of 12 giant cell tumors were characterized by telomeric associations. One giant cell tumor showed a dup(16)(q13q22), suggesting the presence of a (minor) secondary aneurysmal bone cyst component, despite the absence of histological proof. Our results, combined with literature data further substantiate that segments 16q22 and 17p11-13 are nonrandomly involved in at least some aneurysmal bone cysts, irrespective of subtype (primary, secondary, intra/extraosseous, solid or classic). These findings strongly suggest that some aneurysmal bone cysts are true neoplasms. In addition, telomeric associations are the most frequent chromosomal aberrations in giant cell tumor of bone, the significance of which remains elusive. In combined giant cell tumor/aneurysmal bone cyst each component seems to retain its own karyotypic abnormality.

Recurrent chromosome aberrations in fibrous dysplasia of the bone: a report of the CHAMP study group. CHromosomes And MorPhology

The nosologic status of fibrous dysplasia (FD), a well-known and relatively common bone lesion, is controversial. Information collected by the CHromosomes And MorPhology (CHAMP) study group on published and unpublished cases of fibrous dysplasia shows the presence of clonal chromosome changes in at least a proportion of these lesions. The chromosome aberrations found in FD lesions have been quite variable and have included both structural and numerical changes. Two of the three cases investigated at the study group had trisomy 2 as the sole acquired anomaly. Combined with previously published data, +2 and rearrangements involving chromosome band 12p13 have each been detected in 3 of 8 cases with abnormal karyotype of 11 in which chromosomal analysis has been performed, suggesting that FD is a neoplastic lesion rather than a "dysplastic" process, as has been generally believed and as implied by its very name.

Imaging in pelvic trauma

Pelvic injuries are an important issue in trauma patients, largely as a result of the major disruptive forces required to fracture the pelvic ring. Despite the growing influence of more sophisticated techniques such as CT and MR in the evaluation of pelvic trauma, conventional imaging remains important, especially in the initial detection of fractures. Several plain film incidences can be used to detect and evaluate a fracture, so that the exact diagnosis can be made in the emergency room. For operative planning CT and especially 3D reconstruction are very useful. Cystography can be used to detect bladder ruptures. Angiography can detect the bleeding site, and therapeutic embolization can stop bleeding. MR imaging is becoming more important, as it can detect occult fractures, especially in the elderly patient.

The role of the reversed oblique radiograph in trauma of the foot and ankle

The objective of this study was to demonstrate the statistical significance of a reversed oblique radiograph of the foot in patients with ankle or foot trauma. In 100 consecutive patients a reversed oblique radiograph of the foot was taken in addition to the conventional plain films. Ten of 29 fractures were not visualised on the conventional films of foot and ankle and could only be diagnosed on the reversed oblique film. In 7 of these 10 cases an avulsion fracture at the anterolateral aspect of the calcaneus was present. This additional reversed oblique film of the foot seems to be of considerable importance, especially when an anterolateral avulsion fracture of the calcaneus is clinically suspected.

Iatrogenic pseudoaneurysm in the upper arm: treatment by transcatheter embolization

A 32-year-old woman presented with a pulsatile, painful mass in her left upper arm, originating several days after removal of an Ilizarov external fixation. The diagnosis of a pseudoaneurysm was made by medical history and by physical and ultrasonographic examination of the mass. Angiography confirmed the presence of the pseudoaneurysm, originating from a branch of the arteria profunda brachii, and definitive treatment was performed by transcatheter embolization. Clinical follow-up showed absence of pulsation and pain in the upper arm and a gradual volume decrease of the mass lesion.

Langerhans cell histiocytosis of the clavicle: a case report

A case of Langerhans cell histiocytosis in a 47-year-old male presenting as an aggressive appearing lesion of the clavicle is reported. It illustrates the difficulties of the radiological diagnosis of a solitary bone lesion.

Langerhans cell histiocytosis of the cervical spine: case report of an unusual location

An unusual location for Langerhans cell histiocytosis of the cervical spine is presented. The osteolytic lesion, instead of being located in the vertebral body, was visualised in the left lateral mass of the fifth cervical vertebra, extending into the vertebral body and through the interapophyseal joint into the lateral mass of the fourth cervical vertebra.

Measurements of vertebral shape by radiographic morphometry: sex differences and relationships with vertebral level and lumbar lordosis

OBJECTIVE

To examine sex-related and vertebral-level-specific differences in vertebral shape and to investigate the relationships between the lumbar lordosis angle and vertebral morphology.

DESIGN AND PATIENTS

Lateral thoracic and lumbar spine radiographs were obtained with a standardized protocol in 142 healthy men and 198 healthy women over 50 years old. Anterior (Ha), central (Hc) and posterior (Hp) heights of each vertebra from T4 to L4 were measured using a digitizing technique, and the Ha/Hp and Hc/Hp ratios were calculated. The lumbar lordosis angle was measured on the lateral lumbar spine radiographs.

RESULTS

Ha/Hp and Hc/Hp ratios were smaller in men than women by 1.8% and 0.7%, respectively, and these ratios varied with vertebral level. Significant correlations were found between vertebral shape and the lumbar lordosis angle.

CONCLUSIONS

These results demonstrate that vertebral shape varies significantly with sex, vertebral level and lumbar lordosis angle. Awareness of these relationships may help prevent misdiagnosis in clinical vertebral morphometry.

Spontaneous resolution of a solitary osteochondroma

Spontaneous regression or resolution of a solitary osteochondroma is infrequent. A case of a surprisingly fast and complete resolution of an osteochondroma of the distal ulna in a 7-year-old boy is presented, with a review of previously reported cases.

Inflammatory myofibroblastic tumor of bone: report of two cases with evidence of clonal chromosomal changes

Inflammatory myofibroblastic tumor (inflammatory pseudotumor) is a pseudosarcomatous lesion that is recognized with increasing frequency in various anatomic locations. However, this lesion has not been previously reported in bone. We report on two cases of inflammatory myofibroblastic tumor occurring in bone in young adults. Both tumors presented as slightly painful, osteolytic, and well-delineated lesions of the distal femur, with a hyperintense signal on T2-weighted magnetic resonance imaging. The patients had an uneventful recovery after curettage. The follow-up time was 11 months for both patients, and no recurrence was noted. On histologic examination, the lesions were characterized by collagen-rich and generally poorly cellular tissue containing spindled to plump (myo)fibroblast-like cells and a variable admixture of inflammatory cells. Focal calcifications and reactive bone formation were present. Clonal, albeit different, chromosomal changes were found in both cases (47,XY,-9,-12,add(21)(q21),+der(?)t(?;9)(?;q11), +mar,+r and 47, XY, +r/47, idem, add(12)(p13)). The present and other reported cytogenetic findings suggest that inflammatory myofibroblastic tumors could well be neoplastic.

Primary osteorhabdomyosarcoma (malignant mesenchymoma) of bone: a case report and review of the literature

Primary malignant mesenchymoma of bone is a rare neoplasm consisting of two or more unrelated malignant mesenchymal components other than fibrosarcoma or malignant fibrous histiocytoma. The literature reports fewer than 15 cases, most of which were composed of osteosarcoma and liposarcoma. We report an exceedingly rare case of primary malignant mesenchymoma of bone composed of osteosarcoma and rhabdomyosarcoma (osteorhabdomyosarcoma), arising in the right proximal tibia of a 21-year-old woman. We review the literature and compare primary malignant mesenchymoma of bone with dedifferentiated chondrosarcoma and conventional intramedullary osteosarcoma.

Prediction of vertebral strength in vitro by spinal bone densitometry and calcaneal ultrasound

Spinal bone mineral density (BMD) measurements and calcaneal ultrasound were compared in terms of their ability to predict the strength of the third lumbar vertebral body using specimens from 62 adult cadavers (28 females, 34 males). BMD was measured using dual X-ray absorptiometry (DXA) in both vertebra and calcaneus. Quantitative computed tomography (QCT) was used to determine trabecular BMD, cortical BMD, cortical area, and total cross-sectional area (CSA) of the vertebral body. Bone velocity (BV) and broadband ultrasonic attenuation (BUA) were measured in the right calcaneus. Vertebral strength was determined by uniaxial compressive testing. Vertebral ultimate load was best correlated with DXA-determined vertebral BMD (r2 = 0.64). Of the QCT parameters, the best correlation with strength was obtained using the product of trabecular BMD and CSA (r2 = 0.61). For vertebral ultimate stress, however, the best correlation was observed with QCT-measured trabecular BMD (r2 = 0.51); the correlation with DXA-determined BMD was slightly poorer (r2 = 0.44). Calcaneal ultrasound correlated only weakly with both ultimate load and stress with correlation coefficients (r2) of 0.10-0.17, as did calcaneal BMD (r2 = 0.18). Both spinal DXA and spinal QCT were significantly (p < 0.001) better predictors of L3 ultimate load and stress than were either calcaneal ultrasound or calcaneal DXA. Multiple regression analysis revealed that calcaneal ultrasound did not significantly improve the predictive ability of either DXA or QCT for L3 ultimate load or stress. Calcaneal DXA BMD, bone velocity, and BUA correlated well with each other (r2 = 0.67-0.76), but were only modestly correlated with the DXA and QCT measurements of the vertebra. These data indicate that spinal DXA and spinal QCT provide comparable prediction of vertebral strength, but that a substantial proportion (typically 40%) of the variability in vertebral strength is unaccounted for by BMD measurements. Ultrasonic measurements at the calcaneus are poor predictors of vertebral strength in vitro, and ultrasound does not add predictive information independently of BMD. These findings contrast with emerging clinical data, suggesting that calcaneal ultrasound may be a valuable predictor of vertebral fracture risk in vivo. A possible explanation for this apparent discrepancy between in vivo and in vitro findings could be that current clinical ultrasound measurements at the calcaneus reflect factors that are related to fracture risk but not associated with bone fragility.

Giant schwannoma of the lower leg

Schwannomas are relatively common, benign, peripheral nerve sheath tumours. They usually range in size from 2 to 20 cm, but when localised in the lower legs the maximum length is less than 10 cm. The case reported here was a giant fusiform schwannoma of the left fibular nerve with a length of 25.5 cm. In contrast to the usual findings of giant schwannomas, no cystic, haemorrhagic or necrotic changes could be found by ultrasonography, computed tomography or magnetic resonance imaging. The combination of tumour size, location and radiological presentation is very unusual and, to our knowledge, has never been reported before in the literature.

Ultrasonography of the knee

A comprehensive review of ultrasonography of the knee is presented and includes the choice of equipment and best patient positioning as well as a review of the normal anatomy and major disorders involving the knee, menisci and ligaments.

Effects of anteversion on femoral bone mineral density and geometry measured by dual energy X-ray absorptiometry: a cadaver study

The effect of femoral neck anteversion on bone mineral density (BMD) and geometry as measured by dual energy X-ray absorptiometry (DXA) was assessed using 64 right proximal femora from 36 male and 28 female cadavers. The anteversion angle was measured on computed tomography (CT) images, and DXA measurements were made both in the neutral position (i.e, at 0 degree anteversion, femoral neck axis parallel to the table) and in the simulated anteverted position (i.e., femoral shaft axis parallel to the table, greater and lesser trochanters in contact with the table, and femoral neck free). The mean anteversion angle measured by CT was 19.3 degrees (range 6 degrees-38 degrees). Anteversion was associated with a significant elevation in femoral neck BMD of +2.8% (range -5.3%-(+)9.8%) (p < 0.05), and the femoral neck BMD increased with increasing anteversion (p < 0.01). Trochanteric BMD was less affected by anteversion, with an average increase of only 0.2% (range -5%-5.9%) (p = n.s.) in the anteverted position, but there was a significant positive association between the change in trochanteric BMD and the anteversion angle (p < 0.01). Anteversion produced a mean reduction of -2.4% (range -7.6%-(+)4.3%) (p < 0.001) in apparent femoral neck axis length, while femoral neck width remained generally unaffected. These data confirm that femoral BMD as measured by DXA is affected by femoral anteversion with a lesser magnitude than previously reported. The use of trochanteric BMD may minimize the influence of anteversion. While the mean changes in BMD and neck axis length attributable to anteversion are modest, the considerable interindividual variability in the magnitude of the effects demonstrates that other factors, such as, the complex geometry of femoral neck modifies the effect of anteversion on BMD measurements. The error in BMD introduced femoral anteversion may represent a significant confounding influence in cross-sectional and longitudinal studies. Careful repositioning of the foot and leg is essential in monitoring changes in BMD longitudinally. Knowledge of the effects of femoral anteversion may assist in understanding the relation of femoral BMD and neck axis length to hip fracture.

Hip fracture and osteoporosis in a XIIth Dynasty female skeleton from Lisht, upper Egypt

Osteoporosis and complications arising from loss of bone mass have been present in human populations for thousands of years. However, reports of this disease in antiquity remain uncommon. The purpose of this report is to describe an important case of osteoporosis in ancient Egypt because of its intrinsic interest and to provide perspectives on factors contributing to this condition today. The case providing the focus for this report is from Lisht, Upper Egypt and is dated to the XIIth Dynasty (1990-1786 B.C.). Methods used to characterize the pathology include gross anatomical study, radiology, and radiographic measurements. Observations, measurements, and indices all indicate osteoporosis complicated by fracture of the femoral neck and compression fractures of some vertebrae. The Lisht case adds to a small corpus of reports on osteoporosis and complicating factors of this disease in antiquity. Long-term survival of an extracapsular fracture of the femoral neck in this case is remarkable and may reflect supportive social conditions.

An unusual localisation and presentation of an osteoid osteoma

A case of osteoid osteoma of the scaphoid was discovered, in the absence of radiological (conventional and CT-scan) alterations. MRI findings were not conclusive.

Anteromedial tibial tubercle transfer in patients with chronic anterior knee pain and a subluxation-type patellar malalignment

We performed a prospective analysis of 29 Fulkerson anteromedial tibial tubercle transfers in patients with chronic anterior knee pain. The average followup was 32 months (range, 25 to 44). Fourteen patients (Group 1) had subluxation-type malalignment (congruence angle > 20 degrees, tilt angle > 8 degrees) and were treated with an isolated anteromedial tibial tubercle transfer. Fifteen patients (Group 2) had combined subluxation and tilt malalignment (congruence angle > 20 degrees, tilt angle < 8 degrees) and underwent anteromedial tibial tubercle transfer combined with a lateral release. Pre- and postoperative evaluations included clinical and radiographic examinations, Lysholm and Kujala patellofemoral scores, and standing-alignment computed tomography scans in 15 degrees of flexion taken transversely at the midpatellar. In all but one patient a dramatic improvement in Lysholm and Kujala scores was noted. The congruence angle improved in all patients except one, with an average improvement of 16 degrees in Group 1 and of 14 degrees in Group 2. The tilt angle remained relatively unchanged (change, -0.5 degree) in Group 1, but it improved by 11 degrees in Group 2. We conclude that an isolated anteromedial tibial tubercle transfer can consistently improve patellar subluxation and, when combined with a lateral release, can improve patellar subluxation and tilt, resulting in improved functional scores for patients with chronic anterior knee pain.

Assessment of the strength of proximal femur in vitro: relationship to femoral bone mineral density and femoral geometry

Femoral neck axis length, neck width, and neck-shaft angle were measured on radiographs of right proximal femora from 64 cadavers (28 female, 36 male). Bone mineral density (BMD) was measured using dual energy X-ray absorptiometry (DXA) for various regions of interest, and quantitative computed tomography (QCT) was used to determine BMD and bone areas for cortical and trabecular bone at the trochanter and femoral neck. The strength of the femur was determined by a mechanical test simulating a fall on the greater trochanter, and the fracture type (cervical or trochanteric) was subsequently determined from radiographs. Twenty-six cervical fractures and 38 trochanteric fractures were observed, with no significant sex difference in the distribution of fracture types. Femoral strength was significantly elevated in males compared to females. DXA trochanteric BMD was more strongly (p < 0.05) correlated with femoral strength (r2 = 0.88) than were any of the other DXA BMD measurements (r2 = 0.59-0.76). In multiple regression models, a combination of different DXA BMD measurements produced only a small increase (1%) in the explained variability of femoral strength. Of the QCT measurements, trochanteric cortical area yielded the optimal correlation with femoral strength (r2 = 0.83). Weak, but significant, correlations were observed between femoral strength and cortical BMD at trochanteric (r2 = 0.28) and neck regions (r2 = 0.07). In multiple regression models, combining QCT parameters yielded, at best, an r2 of 0.87. Of the geometrical parameters, both neck axis length and neck width were significantly correlated with femoral strength (r2 = 0.24, 0.22, respectively), but no significant correlation was found between strength and the neck-shaft angle. Combining DXA trochanteric BMD with femoral neck width resulted in only a small increase in the explained variability (1%) compared to trochanteric BMD alone. The results demonstrated that DXA and QCT had a similar ability to predict femoral strength in vitro. Trochanteric BMD was the best DXA parameter, and cortical area (not cortical BMD) was the optimal QCT parameter. Geometric measurements of the proximal femur were only weakly correlated with the mechanical strength, and combinations of DXA, QCT, and geometric parameters resulted in only small increases in predictive power compared to the use of a single explanatory variable alone.

Ultrasonography of the knee

Despite the increasing use of MRI in knee disorders, ultrasonography remains the first choice examination technique in para-articular disease. The technique is fast, cheap, easily accessible and usable in the acutely injured patient. The choice of equipment, positioning of the patient and some characteristics of normal anatomy are described. The routine applications of ultrasonography include different types of tendon disease, trauma of the collateral ligaments, bursal pathology, joint effusions and synovitis, evaluation of the popliteal fossa and para-articular swellings. Other possible applications, somewhat more depending on the examiner's experience, are meniscal disease, trauma to the cruciate ligaments and evaluation of the articular cartilage and synovial plicae.

Radiological prevalence of lumbar intervertebral disc calcification in the elderly: an autopsy study

OBJECTIVE

The objective of this study was to investigate the in vitro radiological prevalence of lumbar intervertebral disc calcification (IDC) in the elderly and its relation to osteoarthritis (OA).

MATERIALS AND METHODS

Lumbar spine segments comprising L2-4 were resected from 60 cadavers (30 males, 30 females; average age 67 years) and investigated with high-contrast radiography and computed tomography (CT).

RESULTS AND CONCLUSIONS

IDC was found in 58.3% of the patients using high-contrast radiography and in 46.7% of the patients using CT. IDC prevalence and OA grades in the lumbar spine and right hand were found to increase with age. IDC prevalence and OA grades for L2-3 were not significantly different from those for L3-4. No significant sex difference was found for IDC prevalence and OA grades. The results indicate that IDC is significantly underestimated in vivo by conventional radiography and the intervertebral disc calcification may be a common phenomenon in aging. The exact relation IDC to OA remains undetermined.