Foreword iv

Preface to the F1.-, ion . Preface vi

Acknowledgments vii

& v -

PA R 3 1 INTRODUCTION TO OR lPEDIC IMAGING 1

The dole of me unhopedic Raaiologisi Suggested Readings 14

C H A P T E R 2 Imaging Techniques in Orthopedics 15

Choice of lmaging Modality 15 Imaging Technlqwes 15 Conventional Radiography 15 Magnification Radiography 16 Stress Views 16 Scanogram 16 Fluoroscopy and Videotaping 16 Digital Radiography 16 Tomography 17 Computed Tomography 18 Arthrography 23 Tenography and Bursography 24 Angiography 25 Myelography 25 Diskography 25 Ultrasound 26 Scintigraphy (Radionuclide Bone Scan) 27

Diphosphonates 3 1 Gallium 67 32 Indium 32 Nanocolloid 32 lmmunoglobulins 32 Chemotactic Peptides 32 Iodine 32 Gadolinium 32

Positron Emission Tomography, PET-CT, and PET-MRI 32

Magnetic Resonance lmaging 34

Suggested Readings 42

CHAPTER 3 Bone Formation and Growth 45

Suggested Readings 47

4?#4AT I I TRAUMA 49 W r t . .

CHAPTER 4

Radiologic Evaluation of Trauma 51 ' ~~c Imaging Mbdalities 51

Radiography and Fluoroscopy 51 Computed Tomography 51

- * Scintigraphy 51 Arthrography 51 Tenography and Bursography 57 Myelography and Diskography 57 Angiography 57 Magnetic Resonance lmaging 57

Fractures and Dislocations 59 Diagnosis 59

Radiographic Evaluation o f Fractures 59 Indirect Signs as Diagnostic Clues 62 Radiographic Evaluation o f Dislocations 65

Monitoring the Results of Treatment 65 Fracture Healing and Complications 66 Other Complications o f Fractures and Disloc

Stress Fractures 84 lnjury to Soft Tissues 87 Practical Points to Remember 89 Suggested Readings 90

C H A P T E R 5

Upper Limb I 92 Shoulder Girdle 92 Anatomic-Radiologic Considerations 92 lnjury to the Shoulder Girdle 106

Fractures about the Shoulder 106 Dislocations in the Glenohumeral Joint 115 Impingement Syndrome 121 Rotator Cuff Tear 122 lnjury to the Cartilaginous Labrum 125 lnjury to the GHLs 127 Miscellaneous Abnormalities 129

Practical Points to Remember 134 Suggested Readings 135

C H A P T E R 6

Upper Limb I1 137 Elbow 137 Anatomic-Radiologic Considerations 137 lnjury to the Elbow 148

Fractures about the Elbow 148 Osteochondritis Dissecans of the Capitellum

C H A P T E R 1 0

Lower Limb I11 308 ical Points to Rem.embe,r 166 Ankle and Foot 308

gested Rqadingd 164 Anatomic-Radiologic Considerations 308 lmaging of the Ankle and Foot 310

lnjury to the Ankle 324 Fractures About the Ankle Joint 324 lnjury to the Soft Tissues About the Ankle Joir

Foot 337 lnjury to the Foot 343

pas uf the Distal Radius '/&I8 Fractures o f the Foot 343 Complications 353

ArTicufa7tbrr 184 Dislocations in the Foot 353 Tarsal Tunnel Syndrome 358 Sinus Tarsi Syndrome 358

Practical Points to Remember 360 durn af the Carpa/ B Q ~ H 1 Suggested Readings 361

~ M c k Qweamz 907 C H A P T E R 1 1

Spine 363 Cervical Spine 363 Anatomic-Radiologic Considerations 363 lnjury to the Cervical Spine 373

Fractures o f the Occipital Condyles 377 Occipitocervical Dislocations 377 Fractures of the C1 and C2 Vertebrae 379 Fractures of the Mid and Lower Cervical Spine Locked Facets 390

Thoracolumbar Spine 392 Anatomic-Radiologic Considerations 392

mic-Radiologic Considerations 228 Injury to the Thoracolumbar Spine 397

to the Pelvis and Acetabulum 234 Fractures of the Thoracolumbar Spine 397

ssification of Pelvic Fractures 234 Fracture-Dislocations 402

ctures of the Pelvis 236 Spondylolysis and Spondylolisthesis 4 10 lnjury to the Diskovertebral Junction 4 13

uries of the Acetabular Labrum 239 Practical Points ta Remember 425 Suggested Readirugs 426

Fractures o f the Poximal femur 244

sted Readings 25'15

to the Knee 268

Osgood-Schlatter Disease 282

ical Points to Remember 305 gested Read-inss 306 .

! and

$ A R 'I' I I I ARTHRITIDES 429

C H A P T E R 1 2

Radiologic Evaluation of the Arthritides 431 Radiologic Imaging Modalities 431 Conventional Radiography 431 Magnification Radiography 431 Tomography, Computed Tomography, and

Arthrography 431 Scintigraphy 431 Ultrasound 438 Magnetic Resonance Imaging 438

The Arthritides 44.3 Diagnosis 443

Clinical Information 443 lrnaging Features 443

Management 454 Monitoring the Results o f Treatment 454 Complications o f Surgical Treatment 455

Practical Points to Remember 459 Suggested Readings ,460

C H A P T E R 1 3

Degenerative Joint Disease 461 Osteoarthritis 461 Osteoarthritis of the Large Joints 461

Osteoarthritis o f the Hip 46 1 Femoroacetabular Impingement Syndrome 466 Treatment 468 Osteoarthritis o f the Knee 470 Osteoarthritis o f Other Large Joints 474

Osteoarthritis of the Small Joints 474 Primary Osteoarthritis o f the Hand 474 Secondary Osteoarthritis o f the Hand 474 Osteoarthritis of the Foot 476

Degenerative Diseases of the Spine 476 Osteoarthritis of the Synovial Joints 476 Degenerative Disk Disease 476 Spondylosis Deformans 480 Diffuse Idiopathic Skeletal Hyperostosis 480 Complications of Degenerative Disease of the Spine 480

Degenerative Spondylolisthesis 480 Spinal Stenosis 483

Neuropathic Arthropathy 486 Practical Points to Remember 488 Suggested Readings 488

C H A P T E R 1 4

Inflammatory Arthritides 490 Erosive Osteoarthritis 490 Treatment 490

Rheumatoid Arthritis 491 Adult Rheumatoid Arthritis 491

Rheumatoid Factors 491 lmaging Features 491 Large Joint lnvolvement 491 Small Joint lnvolvement 497 lnvolvement o f the Spine 499 Complications o f Rheumatoid Arthritis 500

Rheumatoid Nodulosis 500 Juvenile Rheumatoid Arthritis 503

Still Disease 503 Polyarticular Juvenile Rheumatoid Arthritis 503 Juvenile Rheumatoid Arthritis With Pauciarticular

Onset 503 Other Types of Juvenile Rheumatoid Arthritis 503 lmaging Features 504 Treatment 504

Seronegative Spondyloarthropathies 506 Ankylosing Spondylitis 506

Clinical Features 506

lmaging Features 506 Reiter Syndrome (Reactive Arthritis) 508

Clinical Features 508 lmaging Features 508

Psoriatic Arthritis 508 Clinical Features 508 lmaging Features 514

Enteropathjc Arthropathies 516

Practical Paints to Remember 51 6 Suggested Readings 51 7

C H A P T E R 1 5

Miscellaneous Arthritides and Arthropathies 519 Connective Tissue Arthropathies 51 9 Systemic Lupus Erythematosus 51 9 Scleroderma 51 9 Polymyositis and Dermatomyositis 524 Mixed Connective Tissue Disease 524 Vasculitis 526

Metabolic and Endocrine Arthritides 526 Gout 526

Hyperuricemia 526 Examination o f Synovial Fluid 526 lmaging Features 527

CPPD Crystal Deposition Disease 531 Clinical Features 53 1 lmaging Features 532

CHA Crystal Deposition Disease 535 Hemochromatosis 535 Alkaptonuria (Ochronosis) 535 Hyperparathyroidism 537 Acromegaly 537

Miscellaneous Conditions 538 Amyloidosis 538 Multicentric Reticulohistiocytosis 538 Hemophilia 539 Jaccoud Arthritis 540 Arthritis Associated With Acquired Immunodeficiency

Syndrome 540 Infectious Arthritis 541

Practicql Points to Remember 541 Suggested Readings 542

' A R t I Y TUMORS AND C TUMOR-LIKE LESIONS 545

C H A P T E R 1 6

Radiologic Evaluation of 'hmors and Tumor-like Lesions 547 Classification of Tumors and Tumor-like Lesions 547 Radialogic lmaging Modalities 547 Conventional Radiography 547 Computed Tomography 549 PET and PET-CT 550 Arteriography 550

letal Scintigraphy 559

nical Information 563 aging Modalities 563 diographic Features o f Bone Lesions 564

esults o f Treatment 573

ical Points to Remember 586 gested Readings 586

Bone-Forming (Osteoblastic)

rential Diagnosis 594

rential Diagnosis 606

lcal Points to Remember 61 I w e d Readings 61 1

droma (Chondroma) 61 4

ndroblastoma 629

sted Readings 638

C H A P T E R 1 9

Benign lhmors and Tumor-like Lesions I11 641 Fibrous Cortical Defect and Wonossifying

Fibrama 641 Complications and Treatment 641

Benign Fibrous Histiocytoma 641 Pe.riosteal Demoid 646 Differential Diagnosis 646

Fibrous Dysplasia 647 Monostotic Fibrous Dysplasia 647 Polyostotic Fibrous Dysplasia 647

Complications 655 Associated Disorders 657

Albright-McCune Syndrome 657 Mazabraud Syndrome 657

Osteofibrous Dysplasia 658 Complications and Treatment 658

Desmoplastic Fibroma 658 Practical Poi'nts to Remember 664 Suggested Readings 664

C H A P T E R 2 0

Benign 'I'umors and lhmor-like Lesions N 667 Simple Bone Cyst 667

Complications and Differential Diagnosis 667 Treatment 667

Aneurysmal Bone Cyst 667 Complications and Differential Diagnosis 675 Treatment 675

Solid Variant of ABC 676 Giant Cell Tumor 680 Differential Diagnosis 680 Treatment and Complications 683

Fi brocartilag inous Mesench ymoma 68.4 Hemangioma 687 Differential Diagnosis 695 Treatment 695

lntraosseous Lipoma 695 Nonneoptastic Lesions Simulating Tumors 697 lntraosseous Ganglion 697 Brown Tumor of Hyperparathyroidism 697 Langerhans Cell Histiocytosis (Eosinophilic Granuloma) 697 Chester-Erdheim Disease (Lipogranulomatosis) 700 Medullary Bone Infarct 701 Myositis Ossificans 701

Practical Points to Remember 702 Suggested Readings 703

C H A P T E R 2 1

Malignant Bone lhmors I 706 Osteosarcomas 706 Primary Osteosarcomas 706

Conventional Osteosarcoma 706 Low-Grade Central Osteosarcoma 714

Telangiectatic Osteosarcorna 7 14 Small Cell Osteosarcorna 715 Fibrohistiocytic Osteosarcoma 718 lntracortical Osteosarcorna 71 8 Gnathic Osteosarcorna 718 Multicentric (Multifocal) Osteosarcoma 718 Surface (Juxtacortical) Osteosarcornas 718 Soft-Tissue (Extraskeletal) Osteosarcorna 724 Osteosarcornas with Unusual Clinical

Presentation 727 Secondary Osteosarcomas 727

Chondrosarcomas 728 Primary Chondrosarcomas 728

Conventional Chondrosarcorna 728 Clear Cell Chondrosarcoma 729 Mesenchyrnal Chondrosarcoma 733 Dedifferentiated Chondrosarcoma 735 Periosteal Chondrosarcoma 735

Secondary Chondrosarcomas 735

Practical Points to Remember 736 Suggested Readings 737

C H A P T E R 2 2

Malignant Bone M o r s I1 740 Fibrosarcoma and Malignant Fibrous

Histiocytoma 740 Differential Diagnosis 740 Complications and Treatment 740

Ewing Sarcoma 743 Differential Diagnosis 743 Treatment 747

Malignant Lymphoma 747 Differential Diagnosis 747 Treatment 751

Myeloma 751 Differential Diagnosis 752 Complications and Treatment 754

Adamantinoma 754 Treatment 755

Chordoma 755 Complications and Treatment 757

Primary Lisiomyosarcoma of Bone 757 Hemangioendothelbma and

Angiosarcoma 757 Benign Conditions With Malignant

Potential 759 Medullary Bone Infarct 759 Chronic Draining Sinus Tract of Osteomyelitis 760 Plexiform Neurofibromatosis 760 Paget Disease 760 Radiation-Induced Sarcoma 762

Skeletal Metastases 762 Complications 763

Pra&cal Points to Remember 767 Suggested Readings 768

C H A P T E R 2 3

fimors and Tumor-like Lesions of the Joints 771 Benign Lesions 771 Synovial (Osteo) Chondromatosis 771

Differential Diagnosis 771 Pigmented Villonodular Synovitis 776

Differential Diagnosis 777 Treatment 777

Synovial Hemangioma 777 Differential Diagnosis 779

Lipoma Arborescens 779

Malignant Tumors 782 Synovial Sarcoma 782 Synovial Chondrosarcoma 782

Differential Diagnosis 785 Malignant PVNS 785

Practical Points to Remember 785 Suggested Readings 785

C H A P T E R 2 4

Radiologic Evaluation of Musculoskeletal Infections 789 Musculoskeletal lnfections 789 Osteomyelitis 789 Infectious Arthritis 789 Cellulitis 789 lnfections of the Spine 789

Radiologic Evaluation of lnfections 791 Conventional Radiography and Arthrography 791 Radionuclide Imaging 791 Arteriography, Myelography, Fistulography, and US 794 Magnetic Resonance lmaging 794 lnvasive Procedures 796

Monitoring the Treatment and Complications of Infections 796

Practical Points to Remember 798 Suggested Readings 798

C H A P T E R 2 5

Osteomyelitis, Infectious Arthritis, and Soft-Tissue Infections 800 Osteomyelitis 800 Pyogenic Bone lnfections 800

Acute and Chronic Osteornyelitis 800 Subacute Osteornyelitis 800

Nonpyogenic Bone lnfections 800 Tuberculous lnfections 800 Fungal lnfections 800 Syphilitic Infection 806

Differential Diagnosis of Osteomyelitis 806

Infectious Arthritides 808

)genic Joint lnfections 808 :omplications 808 lnpyogenic Joint lnfections 808 ruberculosis Arthritis 808 3ther Infectious Arthritides 809

ctions o f the Spine 87 2

I ryogenk lnfections 812

t honpyogenic lnfections 81 2 'uberculosis o f the Spine 8 12 k-Tissue lnfections 81 2

Etical Points t o Remember 81 8

F sted Readings 81 8

'PART V I METABOLIC AND U ENDOCRINE DISORDERS 82 1

luation of Metabolic and Endocrine

d Production of Bone 823 etabolic and Endocrine Disorders 823

tof Bone Mineral

ionuclide and X-ray Techniques 828

titative Ultrasound Technique 830

1 Points to Remember 830

ed Osteoporosis 832

and Osteomalaeia 838

ntile Rickets 838 min &Resistant Rickets 839

al Osteodystrophy 842

ical Points t o Remember 844 wted Readings 844

logy of Calcium Metabolism 846 iographk Evaluation 847

CONTENTS

tornplications 847 Pradcal Points to Remember 851 Suggested keadings 851

C H A P T E R 2 9

Paget Disease 852 Pathophysiology 852 Radiologic Evaluation 852 Differential Diagnosis 859 Complications 859 Pathologic Fractures 859 Degenerative Joint Disease 859 Neurologic Complications 863 Neoplastic Complications 863

Orthopedic Management 863 '

Practical Points t o Remember 866 Suggested Readings 866

C H A P T E R 3 0

Miscellaneous Metabolic and Endocrine Disorders 868 Familial Idiopathic Hyperphosphatasia 868 Imaging Evaluation 868 Differential Diagnosis 868

Acromegally 868 Radiographic Evaluation 868

G-aucher Disease 872 Classificatim 872 Radiologic Evaluation 873 Complications 874 Treatment 875

Tumoral Calcinosis 875 Pathophysiology 875 Radiographic Evaluation 875 Treatment 875

Hypothyroidism $76 Pathophysiology 876 Radiographic Evaluation 876 Complications 876

Scurvy 876 Pathophysiology 876 Radiographic Evaluation 878 Differential Diagnosis 878

Practical Points t o Remember 879 Suggested Readings 879

P A f? T Y I 1 CONGENITAL AND DEVELOPMENTAL ANOMALIES 88 1

C H A P T E R 31

Radiologic Evaluation of Skeletal Anomalies 883 Classification 883

Radiologic lmaging Modalities 883 Practical Points to Remember 895 Suggested Readings 895

C H A P T E R 3 2

Anomalies of the Upper and Lower Limbs 896 Anomalies of the Shoulder Girdle and Upper

Limbs 896 Congenital Elevation o f the Scapula 896 Madelung Deformity 896

Anomalies o f the Pelvic Girdle and Hip 896 Congenital Hip Dislocation (Developmental Dysplasia of the

Hip) 896 Radiographic Evaluation 896 Measurements 900 Arthrography and Computed Tomography 90 1 Ultrasound 903 Classification 905 Treatment 905 Complications 907

Proximal Femoral Focal Deficiency 907 Classification and Radiographic Evaluation 907 Treatment 908

Legg-Calve-Perthes Disease 908 Radiologic Evaluation 908 Classification 91 0 Differential Diagnosis 910 Treatment 91 0

Slipped Capital Femoral Epiphysis 91 1 Radiologic Evaluation 91 1 Treatment and Complications 914

Anomalies of the Lower Limbs 91 5 Congenital Tibia Vara 91 5

Imaging Evaluation and Differential Diagnosis 915 Classification 91 9 Treatment 91 9

Dysplasia Epiphysealis Hemimelica 91 9 Radiographic Evaluation and Treatment 919

Talipes Equinovarus 920 Measurements and Radiographic Evaluation 920 Treatment 920

Congenital Vertical Talus 922 Radiographic Evaluation 922 Treatment 924

Tarsal Coalition 924 Calcaneonavicular Coalition 924

Talonavicular Coalition 925 Talocalcaneal Coalition 925

Practical Points to Remember 928 Suggested Readings 928

C H A P T E R 3 3

Scoliosis and Anomalies with General Affliction of the Skeleton 931 Scoliosis 931

Idiopathic Scoliosis 931 Congenital Scoliosis 931 Miscellaneous Scolioses 931 Radiologic Evaluation 931

Measurements 931 Treatment 938

Anomalies wSth General Affliction of the Skeleton 939 Neurofibromatosis 939 Osteogenesis lmperfecta 942

Classification 943 Radiologic Evaluation 943 Differential Diagnosis 943 Treatment 945

Achondroplasia 945 Mucopolysaccharidoses 948 Fibrodysplasia Ossificans Progressiva (Myositis Ossificans

Progressiva) 950 Radiologic Evaluation 950 Histopathology 951

Sclerosing Dysplasias of Bone 951 Osteopetrosis 95 1 Pycnodysostosis (Pyknodysostosis) 951 Enostosis, Osteopoikilosis, and Osteopathia

Striata 953 Progressive Diaphyseal Dysplasia (Camurati-Engelmann

Disease) 957 Hereditary Multiple Diaphyseal Sclerosis

(Ribbing Disease) 958 Craniometaphyseal Dysplasia 958 Melorheostosis 958 Other Mixed Sclerosing Dysplasias 959

Practical1 Points to Remember 963 Suggested Readings 964

Figure Credits 967

Index 968