PURPOSE: To describe the MR findings of fibrous dysplasia. SUBJECTS AND METHODS: MR images of fibrousdysplasia in 13 pathologically proved cases were retrospectively analyzed regarding the signal intensity, hypointense rind, internal septations, cortical disruption, soft tissue extension, and the pattern of contrast enhancement. RESULTS: All cases showed low signal intensity on T1-weighted images. On T2-weighted images, 8cases(62%) were hyperintense and 5 cases(38%) hypointense. Hypointense rind was seen in 10 cases(77%), internal septations in 3 cases(23%), and cystic change in 2 cases(15%). Soft tissue extension was observed in fourcases(31%) including one case with pathologic fracture. After Gd-DTPA infusion, central contrast enhancement wasnoted in 8 cases(73%) and peripheral rim enhancement in 3 cases(23%). Pathologically, hypointensity on T2-weighted images was due to numerous bony trabeculae. CONCLUSION: Hypointensity on T1W1 and hyperintensity(62%) or hypointensity(38%) on T2W1 as well as contrast enhancement in fibrous dysplasia depend on degree of cellularity, collagen, cystic and hemorrhagic changes, and bony trabeculae.
Fractures, Spontaneous ; Gadolinium DTPA ; Radiography ; Retrospective Studies

We report a case of insufficiency fracture of the sternum in a 70-year-old female patient with a review of the literature. She complained of sudden onset chest pain and aggravating dyspnea. She has been managed with corticosteroid due to chronic obstructive pulmonary disease for 15 years. Diagnosis of sternal insufficiency fracture presented with thoracic kyphosis was made on the basis of absence of trauma history, radiologic findings of lateral chest radiograph, bone scintigraphy and chest computed tomography. Thoracic kyphosis and osteoporosis secondary to menopause, corticosteroid therapy and limited mobility due to chronic obstructive pulmonary disease were considered as predisposing factors of the sternal insufficiency fracture in this patient.
Aged ; Case Report ; Female ; Fractures, Spontaneous/radiography ; Fractures, Spontaneous/diagnosis* ; Fractures, Spontaneous/complications ; Human ; Kyphosis/complications ; Lung Diseases, Obstructive/complications ; Osteoporosis, Postmenopausal/complications ; Sternum/radiography ; Sternum/injuries*

Fibrous dysplasia is a skeletal developmental anomaly of the bone-forming mesenchyme that manifests as a defect in osteoblastic differentiation and maturation. It is a nonhereditary disorder of unknown cause. In fibrous dysplasia, the medullary bone is replaced by fibrous tissue, which appears various imaging findings. It is usually an incidental finding, generally not requiring further investigation. However, fibrous dysplasia may be complicated by pathologic fracture, and rarely by malignant degeneration. We present the image findings of a 44-year-old man who had a chondroblastic osteosarcoma arising from polyostotic fibrous dysplasia in the femur. Evidence of cortical destruction on plain radiography and soft tissue mass in the lesion on MR images suggested a tumor of malignant transformation.
Adult ; Chondrocytes ; Femur ; Fibrous Dysplasia, Polyostotic* ; Fractures, Spontaneous ; Humans ; Incidental Findings ; Mesoderm ; Osteoblasts ; Osteosarcoma* ; Radiography

PURPOSE: The purpose of this study was to evaluate the usefulness of MR imaging of pathologic fractures of the long bones. MATERIALS AND METHODS: In 18 patients aged between four and 75 (mean, 25.8) years with histologically confirmed pathologic fractures of the long bones, plain radiographs and MR images were retrospectively analyzed. The former were examined with regard to location and type of fracture, and the presence or absence of underlying disease causing fracture; and the latter in terms of underlying disease, extraosseous mass formation, and soft tissue change. RESULTS: The long bones involved were the femur in nine patients, the humerus in six, and the tibia in three. Underlying diseases were metastatic tumor (n=6), benign bone tumor (n=5), primary malignant bone tumor (n=4), osteomyelitis (n=2), and eosinophilic granuloma (n=1). Plain radiographs showed the fracture site as the metaphysis in ten cases, the diaphysis in five, and the metadiaphysis in one. Fractures were either transverse (n=10), oblique (n=3), spiral (n=1), vertical (n=1), or telescopic (n=1). In two cases, the fracture line was not visible. MR images revealed underlying diseases in all cases. A solid mass was present in all cases of malignant bone tumor, and an extraosseous mass in five such cases. Two benign bone tumors took the form of a cystic mass, two were a cystic mass containing an enhanced solid portion, and one was a solid mass. A soft tissue hematoma was seen in three cases. CONCLUSION: Where pathologic fracture of a long bone had occurred, or a pathologic fracture in which the findings of plain radiography were equivocal, MR imaging was useful for evaluating the pattern and extent of an underlying lesion.
Diaphyses ; Eosinophilic Granuloma ; Femur ; Fractures, Spontaneous* ; Hematoma ; Humans ; Humerus ; Magnetic Resonance Imaging* ; Osteomyelitis ; Radiography ; Retrospective Studies ; Tibia

Simple bone cyst was first described by Virchow over a century ago and has been the subject of numerous articles. Nevertheless considerable confusion still exists regarding its etiology. clinical behavior and optimal management. Eighteen cases of pathologically proven simple bone cyst were treated in the Department of Orthopedic Surgery, Seoul National University Hospital during the thirteen year period from June 1966 to May 1979, and following results were obtained. 1. Age distributions were between five and forty-three years (Average ; seventeen years), and 72.2% (thirteen cases) were during first two decades of life. 2. Male to female ratio was 2.6 to 1 3. The most frequently involved location was proximal humerus followed by proximal femur. 4. Pathologic fracture, pain, incidental roentgenography and swelling were the first clues of diagnosis in our series. 5. In twelve cases curettage and fresh autogenous iliac bone graft was performed and good results were obtained in all of them. Of five cases only curettage had been done, no case recurred, another case showed residual cystic area, and the rest healed without further event. In one case with huge cyst curettage, iliac and fibular bone graft and bone cementing was performed with satisfactory result. 6. Bone shortening was noticed in two cases of active bone cysts in proximal humerus 2cm and 3cm, respectively.
Age Distribution ; Bone Cysts ; Curettage ; Diagnosis ; Female ; Femur ; Fractures, Spontaneous ; Humans ; Humerus ; Male ; Orthopedics ; Radiography ; Seoul ; Transplants

BACKGROUND: We are presenting our experience in the use of locking compression plate (LCP) after juxta-articular oncological resections in addition to its use in pathologic fracture. METHODS: A retrospective audit of skeletal reconstruction using LCP in 25 cases of long bone tumors was performed from 2008 to 2010. Reconstruction following limb salvage surgery was done in 17 patients and internal fixation of pathological fracture was done in 8 patients. All patients were available for > 12 months of follow-up, and thus assessed for union at the resected ends. RESULTS: There were 8 males and 17 females in the study. The average age at the time of surgery was 30 years (range, 9 to 66 years). The minimum follow-up was 12 months (range, 12 to 32 months). All patients except three went on to heal successfully. Complications occurred in those three patients: wound infection in one, nonunion in another, and periprosthetic fracture in the other patient. In the remaining patients, union was achieved at an average of 6.5 months after reconstruction in curative resection and 4.75 months after fixation of pathological fractures. CONCLUSIONS: Joint sparing limb salvage surgery was made successfully possible after sekeletal reconstruction with LCP. Its use was also quite effective in pathological fractures with poor bone quality. Use of locking plates for musculoskeletal oncological reconstruction resulted in a good and predictable rate of union.
Adolescent ; Adult ; Aged ; Bone Neoplasms/complications/radiography/*surgery ; Bone Plates ; Child ; Female ; Fractures, Spontaneous/etiology/radiography/*surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

The bone is the dynamic living tissue which is always maintained bone mineral content by bone resorption and formation. It has been well known that the bone mineral content is decreased very slowly with aging. It is very difficult to diagnose the osteopenia because it is almost subclinical. Another important problem in the osteopenia is the fracture occurring spontaneously. The quantitative method of bone mineral mass provide an information to diagnose the osteopenia and predict the risk of spontaneous fracture. Various methods have been used to access the degree of bone atrophy but have not been routinely available for clinical application in the hospital. The microdensitometric method is a noninvasive, easy, accurate, and objective one to monitor the degree of changes in the skeletal mass quantitatively. So, we measured the 7 indices at the middle site of the 2nd metacarpal bone with a microdensitometer and computer on an X-ray film of the hands and studied the correlations between the age and indices of those under 30 and over 30 yrs old in healthy and fracture groups. The results were obtained as follows : 1. There was a significant high correlation between age and indices in healthy and fracture groups. 2. The measurement of age by microdensitometric method was highly correlated with the chronological age. 3. Comparing both groups, There was a significant correlation of D (P<0.001), MCI(P<0.01), and d (P<0.01) over 30 yrs in male and GSmin (P<0.001) and ΣGS/D (P<0.01) over 30 yrs in female. 4. In fracture group, 1) The index of bone width(D) was slightly larger than in the healthy group. 2) The metacarpal index(MCI) was lower than in the healthy group. 3) The index of medulla width(d) was wider than in the healthy group. 4) The density index of cortex(GSmax) was smaller than in the healthy group. 5) The density index of cortex and medulla(GSmin) was smaller than in the healthy group. 6) There was no considerable difference in ΣGS/D between healthy and fracture groups. 7) The densitometric pattern was more aggrevated than in the healthy group.
Aging ; Atrophy ; Bone Density ; Bone Diseases, Metabolic ; Bone Resorption ; Female ; Fractures, Spontaneous ; Hand ; Humans ; Male ; Methods ; Miners ; Radiography ; X-Ray Film

Totally implanted central venous access devices for chemotherapy (chemoport) are being used increasingly in lung cancer patients. Vascular catheters are associated with various complications including infection, thrombosis as well as spontaneous fractures and embolization of the catheter, which is known as 'pinch-off syndrome'. 'Pinch-off syndrome' refers to the compression of a subclavian central venous catheter between the clavicle and first rib resulting in an intermittent or permanent obstruction, which can lead to tears, transection, or embolization. We report two cases of fractured and embolized implanted subclavian venous catheters in which the fragments were removed percutaneously. A 62-year-old man presented with back pain with a duration of a few weeks. The chest radiograph revealed complete transsection and embolization of the catheter into the right atrium. In addition, a 47-year-old woman with a chemoport had a grade 3 pinch-off sign in a chest radiograph demonstrating complete transsection and embolization of the catheter into the pulmonary artery. Both cases were managed by retrieving the embolized distal fragment percutaneously and removing the proximal section of the catheter.
Back Pain ; Catheters ; Central Venous Catheters ; Clavicle ; Drug Therapy ; Female ; Fractures, Spontaneous ; Heart Atria ; Humans ; Lung Neoplasms* ; Lung* ; Middle Aged ; Pulmonary Artery ; Radiography, Thoracic ; Ribs ; Thrombosis ; Vascular Access Devices

PURPOSE: To analyze the clinical features and treatment outcome of Langerhans' cell histocytosis. MATERIALS AND METHODS: From August 1996 to June 2013, 28 patients who histologically proven with LCH were analyzed of medical records, radiography, pathologic character retrospectively. RESULTS: A total of 28 cases of LCH including 22 child has been reported. Onset age was 0.6 to 51 years old, occurred in the average age was 14.8 years. Follow-up period was 6 months to 134 months average was 44.6 months. The M:F ratio was 2.5:1. The initial symptoms was pain in 18 cases, 5 cases of pathologic fracture, 3 case of palpable mass, 1 case of discovered by accident in radiography, 1 case of torticollis. In radiological examination osteolysis was seen all cases, 7 cases showed a periosteal reaction, 1 case showed soft tissue extension. Clinical type of all cases were eosinophilic granuloma. 25 cases were classified as unifocal disease and 3 cases were multifocal single systemic diseases. In all cases, incisional biopsy was performed. After histologic confirmed, 14 cases was treated with curettage or surgical excision of the lesion and the other 14 cases were followed up without treatment. There is no death during follow up period. 11 cases has no radiological improvement after 3-6 months observation, intralesional steroid injection was performed. CONCLUSION: Patients with LCH who has rapid systemic onset is very rare, so if you meet the young children who suspected LCH, you shoulder avoid the examination which cause excessive radiation exposure to the young patient. In order to confirm the diagnosis of disease, biopsy is needed. Close observation after confirmed by histological method will bring the satisfactory results. But the patients who had pathologic fracture or wide bone destruction already may need curettage and bone grafting to lesion or internal fixation. The lesion which has no radiological improvement after 3-6 months observation or appear with pain interferes daily life may need local steroid injection as a good treatment.
Age of Onset ; Biopsy ; Bone Transplantation ; Child ; Curettage ; Diagnosis ; Eosinophilic Granuloma ; Follow-Up Studies ; Fractures, Spontaneous ; Histiocytosis, Langerhans-Cell ; Humans ; Medical Records ; Osteolysis ; Radiography ; Retrospective Studies ; Shoulder ; Torticollis ; Treatment Outcome*

Aged ; Aged, 80 and over ; Female ; Fractures, Spontaneous ; diagnostic imaging ; surgery ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Osteoporosis ; diagnostic imaging ; surgery ; Radiography, Thoracic ; Thoracic Surgery ; Thorax ; Tomography, X-Ray Computed