Lumbosacral nerve root avulsions: MR imaging demonstration of acute abnormalities

Most of the previously reported lumbosacral nerve root avulsions presented with pseudomeningoceles at the time of delayed initial imaging. We report a case of traumatic lumbosacral nerve root injury associated with an isolated femur fracture and demonstrate the evolution of pseudomeningoceles following nerve root avulsions and edema in the perineural fat identified on the initial MR imaging.     

Stress fractures of the femoral neck: A scintigraphic sign for early diagnosis

Two patients with hip pain are presented; both patients were on steroid therapy. The diagnosis of a stress fracture was initially missed because the patients were not exceedingly active and the plain roentgenograms were essentially normal. The bone scan demonstrated a discretely localized area of increased radionuclide uptake in the femoral neck, which alerted us to the correct diagnosis. This scintigraphic sign is helpful in arriving at an early diagnosis and preventing prolonged disability.     

Sacral cysts with exophytic components

Sacral cysts are rare lesions. Two cases are presented, an aneurysmal bone cyst and a simple cyst. Simple cysts have not previously been described in the sacrum. Both cysts were asymptomatic, had similar radiographic appearances, and displayed significant exophytic components.     

Anterior process fractures of the calcaneus

Fractures of the anterior process of the calcaneus are often missed. This error follows from the tendency to focus exclusively on the mortise and malleoli when a history of ankle trauma is supplied. Seven patients with this fracture are presented. The anatomy, mechanism of injury, clinical presentation, and the radiographic features of this injury are discussed.     

Missed fractures resulting from satisfaction of search effect

This study assessed whether subtle fractures are mised in multitrauma patients because other fractures are detected. Sixty-five simulated trauma patients were each depicted in series of radiographs that were assembled from radiographs of several actual patients. The radiographs were selected to look like they belonged to a single patient. Forty-six cases included a radiograph showing a subtle fracture (which we called the “target”). In one experimental condition, none of the other radiographs in the patient’s series contained a fracture. In a second experimental condition, a radiograph containing an additional fracture (called the “distracter”) was substituted for a radiograph that had no fracture in the first experimental condition. The accuracy of detecting the target fractures was significantly reduced for cases in which the distracter fracture was reported. Awareness of the nature of this type of miss may lead to realistic strategies to avoid it. Supported by U.S. Public Health Service Grant RO1 CA 42453 from the National Cancer Institute, Bethesda, MD.     

Combined Lisfranc and medial cuneiform fracture dislocation

Lisfranc fracture dislocations are uncommon foot injuries and can be difficult to diagnose clinically and radiographically. Associated dislocation of the medial cuneiform is rare and also is difficult to diagnose. We present a case of combined Lisfranc and medial cuneiform fracture dislocation; the dislocation of the medial cuneiform was overlooked on initial radiographs. Subsequent CT examination showed the degree of midfoot disruption better than plain radiographs.