![]() ![]() 2 sides: If unsure regarding a potential pathologic finding, compare to another side.2 joints: Image above and below the injury.2 abnormalities: If you see one abnormality, look for another.MRI hip protocols can be done in as little as 5-15 minutes.īefore we begin: Make sure to employ the rule of 2’s Consider MRI for patients with significant hip pain and negative x-rays. 2% of occult hip fractures will be missed by CT.Compared with CT, pelvic radiographs have a sensitivity of 64% to 78% for the identification of pelvic fractures in blunt trauma.Hip fractures have a very high one-year mortality.Hip and thigh pain are common complaints in the ED.Why the hip matters and the radiology rule of 2’s The Hip Identify clinical scenarios in which an additional view might improve pathology diagnosis.Interpret traumatic hip x-rays using a standard approach.When applicable, it will provide pertinent measurements specific to management, and offer a framework for when to get an additional view, if appropriate. The key feature is that it produces no secondary bone response.This is EMRad, a series aimed at providing “just in time” approaches to commonly ordered radiology studies in the emergency department. The condition tends to occur between 1 and 5 years after surgery and is associated with smooth endosteal scalloping. Radiographically these aggressive granulomatous lesions present as focal radiolucencies around the prosthesis. Nowadays it is mostly seen in non-cemented hips as a reaction to small polyethylene wear particles. It is a histiocytic response that occurs as a result of macrophage reaction to any of the components, that are shed of the surface of the components of the arthroplasty. Originally this was called cement disease or aggressive granulomatosus. You have to be familiar with the normal and abnormal changes in the types of prostheses, that are used by your orthopaedic surgeons. The figure on the left sums all the findings in some of the non-cemented prostheses, that can be normal. This fibrous tissue presents as a lucent zone at the interface.Īgain it should be stable and well within a range of 1 -2 mm. In stable non-cemented hip arthroplasties lucent zones at the metal-bone interface do occur, as it usually is a combination of bone ingrowth and fibrous tissue ingrowth, that provides the fixation in most cases. The distal part of the femoral prosthesis is not 'loaded', so there will be no distal stress loading. In an effort to avoid these changes, most modern cementless prosthesis only have fixation proximally, so you usually will not find proximal stress shielding. Stress loading distally may result in cortical thickening and bridging sclerosis at the tip of the prosthesis ( called pedestal). Stress shielding proximally may result in proximal osteoporosis and calcar resorption. The implantation of a bone ingrowth prosthesis results in altered stress distribution to the native bone, especially in the older models with non tapered and fully coated femoral stems. Rare complications include bowel fistulas, encasement of neurovascular structures and bladder wall burn. This defect is filled with bone chips, cement or bone transplant.Ĭement extrusion is usually asymptomatic. When the acetabulum is prepared for placement of the cup a perforation may occur. Most intraoperative fractures occur on the femoral side. The incidence of fractures ranges from 0.1 to 1.0 percent for cemented components and 3 to 18 percent for uncemented components. They are also more common in non-cemented femoral stems, as these have to fit exactly and can cause a fracture during insertion. When the anatomy is abnormal as in hip dysplasia. How to Differentiate Carotid Obstructionsĭislocation can occur as a late complication in prostheses that are not well positioned, but it is most common in the immediate postoperative period (incidence 3%).įractures may be seen postoperatively in patients with poor bone stock and long stem revision prostheses or.Ankle fractures - Weber and Lauge-Hansen Classification.Ankle Fracture Mechanism and Radiography.TI-RADS - Thyroid Imaging Reporting and Data System.Head Neck tumors - When to think of malignancy.Anatomy and Pathology of the Infrahyoid Neck.Esophagus II: Strictures, Acute syndromes, Neoplasms and Vascular impressions.Pulmonary nodule - Benign versus Malignant. ![]() Mediastinal Masses - differential diagnosis.Esophagus II: Strictures, Acute syndromes, Neoplasms and Vascular impressions.Esophagus I: anatomy, rings, inflammation.Vascular Anomalies of Aorta, Pulmonary and Systemic vessels.Contrast-enhanced MRA of peripheral vessels.Ischemic and non-ischemic cardiomyopathy.Coronary Artery Disease-Reporting and Data System 2.0.Bi-RADS for Mammography and Ultrasound 2013.Transvaginal Ultrasound for Non-Gynaecological Conditions.Acute Abdomen in Gynaecology - Ultrasound.Appendicitis - Pitfalls in US and CT diagnosis. ![]()
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