Skeletal radiology
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Magnetic resonance imaging of 24 symptomatic lower limb amputations revealed that postamputation neuromas were easily diagnosed in above-the-knee amputees. Visualization of nerve trunks in below-the-knee amputees was difficult due to greater compactness of calf muscles. Neuromas on magnetic resonance imaging appeared ovoid or rounded and were usually heterogenous and isointense with muscle. Magnetic resonance imaging also showed additional causes of stump pain such as scar formation, fat in atrophied muscles, soft tissue abscesses, osteomyelitis, and hematomas.
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We present two cases of growth plate injury of the hand and wrist in young patients with renal rickets and osteodystrophy but no history of antecedent trauma. The postulated mechanism of injury is subclinical biomechanical stress on the involved extremity superimposed on the already weakened metaphysis and growth plate. Thus, the findings may be viewed as an insufficiency injury to the metaphysis and growth plate. Physicians should be aware that, in the absence of unusual athletic activity, epiphysiolysis of the upper extremity is uncommon and requires a search for underlying metabolic bone disease.
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Insufficiency fractures of the sacrum are a commonly recognized form of stress fracture typically occurring in elderly patients. As such patients usually present with low back pain, MR imaging is often performed initially as a means of evaluation. We present 5 patients with sacral insufficiency fractures imaged with MR. ⋯ Four of five patients underwent further evaluation with computed tomography (CT) or nuclear bone scanning, which confirmed the diagnosis of sacral insufficiency fracture. We conclude that MRI is sensitive but not specific in detecting sacral insufficiency fractures. As MR imaging is rapidly becoming the method of choice for evaluating back pain, it is important to consider this diagnosis in elderly persons.