Skeletal radiology
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Initially the distal tibial physis is a relatively transverse structure. As the epiphysis matures, undulations develop within the physis and lappet formation occurs peripherally. Within the first two years a significant physeal undulation develops anteriorly above the medial malleolus. ⋯ As in the medial malleolus, there may be accessory ossification at the tip of the fibula. While this usually is a normal variant of secondary ossification, occasionally it also may result from trauma. Extensive porosity of the distal fibular metaphysis predisposes to buckling or torus injuries that may have severe, multiangular deformation.
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Central acetabular fracture-dislocations resulting from convulsions are rare. The literature is reviewed in this regard and we add two additional cases in which hyponatremia was the cause of seizure activity. In most cases this type of injury is seen in bone already weakened by underlying disease.
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Five cases of transscaphoid, transcapitate, perilunate fracture dislocation have been presented with a discussion of the radiologic findings, mechanism of injury, and method of treatment. Although a total of only 23 cases have now been reported in the literature, this type of injury is probably not rare as we have seen two cases within a span of six months. It is important to recognize the radiologic features of this fracture dislocation so appropriate therapy may be instituted.
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Five cases of a rare developmental anomaly involving extraskeletal bone formation are described--four in the pelvis and one arising from the 12th rib. Three of these bony growths, called "Pelvic digits" had well developed "joints" or pseudoarticulations. The similarity of this anomaly to posttraumatic myositis ossificans and avulsion injuries of the pelvis (rectus femoris) is pointed out and a differential diagnosis offered.
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The weight of the head and trunk is transferred to the lower extremities through that segment of the spine articulating either directly or indirectly with the ilii. When a lumbosacral transitional vertebra is present the position of the weight-bearing platform usually changes. ⋯ This segment is designated as the transitional lumbosacral osseous complex. Measurements of its length in the three phylogenetic categories in man, including measurements of the articulating portion of the sacrum in the human mode, showed a range of 68 mm to 157 mm and variations from 2.0 to 3.7 in vertebral lengths.