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Background:: Controversies remain regarding the preferred treatment strategy for talus fractures. The primary goal of this study was to evaluate the long-term outcome after operative management of talus fractures. Secondarily, we identified those factors that affected the outcome and defined strategies to improve the outcome., Methods:: This is a retrospective outcome study of 84 patients with an average follow-up time of 9.1 years. We assessed the functional results, return to daily activities, and general health status using the Foot Function Index-5pt, a numeric rating scale for pain, and the Short Form-36 Health Survey. Furthermore, we conducted a correlation analysis between the outcomes and 14 demographic, clinical, and radiologic variables., Results:: We found moderate mean Foot Function Index pain and disability scores of 30.2 and 28.7, respectively. The mean numeric rating scale score was 3.2. Of all responders, 41% (27/66) did not return to their daily activities. We reported low physical, but good mental, Short Form-36 component summary scores of 42.7 and 48.3, respectively. We recorded a complication rate of 56%. Osteoarthritis, articular incongruence and talus body fractures correlated significantly with a poorer functional outcome. Delayed surgery after trauma was associated with better outcome measures., Conclusions:: Talus fractures have a major long-term impact on ankle and hindfoot function and on physical health. Success of operative treatment depends on the occurrence of osteoarthritis postoperatively, type of fracture, and quality of fracture reduction. Because only the latter is modifiable, efforts should be made to restore articular congruence in order to improve the outcome. Therefore, we recommend reviewing the quality of the reduction postoperatively on CT. Furthermore, talus fractures should not be considered operative emergencies, but rather treated after recovery of the soft-tissues., Level of Evidence:: Level III, comparative study.

Abastract: INTRODUCTION: Although regularly ignored, there is growing evidence that posterior tibial plateau fractures affect the functional outcome. The goal of this study was to assess the incidence of posterior column fractures and its impact on functional outcome and general health status. We aimed to identify all clinical variables that influence the outcome and improve insights in the treatment strategies., Methods: A retrospective cohort study including 218 intra-articular tibial plateau fractures was conducted. All fractures were reclassified and applied treatment was assessed according to the updated three-column concept. Relevant demographic and clinical variables were studied. The patient reported outcome was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS)., Results: Median follow-up was 45.5 (IQR 24.9-66.2) months. Significant outcome differences between operatively and non-operatively treated patients were found for all KOOS subscales. The incidence of posterior column fractures was 61.9%. Posterior column fractures, sagittal malalignment and an increased complication rate were associated with poor outcome. Patients treated according to the updated three-column concept, showed significantly better outcome scores than those patients who were not. We could not demonstrate the advantage of posterior column fracture fixation, due to a limited patient size., Conclusion: Our data indicates that implementation of the updated three-column classification concept may improve the surgical outcome of tibial plateau fractures. Failure to recognize posterior column fractures may lead to inappropriate utilization of treatment techniques. The current concept allows us to further substantiate the importance of reduction and fixation of posterior column fractures with restoration of the sagittal alignment., Level of Evidence: 3.

We present three cases of fracture of the proximal tibia in young children who were jumping on a trampoline. The typical radiological findings and the underlying mechanism of trauma are discussed. The key radiological features are: a transverse hairline fracture of the upper tibia often accompanied by a buckle fracture of the lateral or medial tibial cortex, buckling of the anterior upper tibial cortex and anterior tilting of the epiphyseal plate. New types of injuries related to specific recreational activities are recognized. It is often helpful to associate a typical injury with a particular activity. Trampoline related injuries have increased dramatically over the last years. The most common lesions are fractures and ligamentous injuries, in particular a transverse fracture of the proximal tibia. However the radiological findings can be very subtle and easily overlooked. It is therefore important to be aware of the typical history and radiological findings.

This case shows a typical presentation of an osteochondrosis dissecans lesion on the capitellum, with associated intra-articular loose bodie(s), diagnosed on plain film. Osteochondrosis dissecans (OCD) is a rather common entity. Mostly the knee joint is involved. Only 5% of OCD lesions occur in the elbow joint. Possible causes of osteochondrosis dissecans include (repetitive) trauma (e.g. in throwing sports or gymnastics), ischemia, ossification defects, and genetic factors. Conventional radiography mostly has a low sensitivity to detect OCD lesions, and is often normal in early stages. CT is more sensitive to detect intra-articular loose bodies. MRI detects very early stages of OCD and radiographically occult lesions that may not be evident on CT.

Calcific tendonitis of the longus colli muscle is an uncommon cause of sudden onset of neck pain. Differential diagnosis should include retropharyngeal abscess, traumatic injury or even meningitis. Diagnosis can be made radiographically with plain radiograph which reveals an amorphous calcification anteriorly to C1-C2 and severe swelling of the prevertebral soft tissue. Treatment of choice is conservative and consists of administration of nonsteroidal anti-inflammatory drugs. Clinically the complaints disappear after 1-2 weeks. Follow-up radiographs are, in fact, unnecessary but demonstrate complete resolution of the calcific density and normalization of the prevertebral swelling.

Background: In our department, axillary views of the shoulder in trauma patients are not performed on a routine base, but sometimes, they are ordered by the trauma surgeon. We usually perform an anteroposterior view of the shoulder, combined with a posterior and an anterior oblique view of the shoulder in trauma patients. Because the classical described axillary view of the shoulder is sometimes very painful for the patient, especially in patients with humeral fractures, we perform a less painful modified axillary view., Methods: We now perform the axillary view with the patient standing upright and bending forward and we give a craniocaudal tube inclination between 30 and 45 degrees. Doing so, we also have an "axillary" view on the shoulder, but without harm for the patient. We performed a retrospective study in 103 patients with a modified axillary view and the additional value was checked., Conclusion: We conclude that the modified axillary view is useful in 30 patients for detection of Hill-Sachs lesions or evaluation for displacement or angulation in proximal humeral fractures.

We present the case of a 15-year-old boy who underwent shoulder surgery for repair of a Bankart lesion after dislocation of his right shoulder. A compress was left in the surgical wound. This case is presented to highlight an important pitfall in the diagnosis of gossypiboma (foreign body reaction): when the wires of a compress are visualized on X-ray, beware of the fact that it is possibly located inside the body. The diagnosis of an abscess was made by ultrasound. The compress wires were visualized on radiographs.

The purpose of this study was to evaluate whether requested radiological examinations for referred outpatients are in concordance with the guidelines as proposed by the consilium radiologicum. A second purpose was to evaluate the financial effect of strict guideline application. The radiological requests for 1000 referrals were evaluated by 2 radiologists. A consensus score of 74.4% guideline conformity was reached. A mean save of 9.5 Euro per patient was calculated after strict guideline application. It is concluded that guidelines are a valuable tool for patient management in referring for radiological examinations and have a substantial effect on the available budget. Further improvements and fine-tuning of the guidelines are mandatory to increase their validity.

Mediastinal widening is a frequent radiological finding in the emergency department patient. The causes of mediastinal widening can be divided into traumatic and nontraumatic mediastinal widening. An important association of moderate to high velocity trauma is the mediastinal haematoma. It may be the result of traumatic transsection of the aorta, or it may be due to bleeding from other mediastinal vessels. Before the era of multidetector spiral CT, angiography was the gold standard for the evaluation of patients with a widened mediastinum. Meanwhile, angiography as a risk-carrying invasive examination has widely been replaced by MDCT. However, conventional radiography remains an important diagnostic tool; so does angiography, especially in the context of interventional radiology. Multidetector spiral CT plays an important role (Alkadhi et al., Radiographics 2004; 24:1239-1255), but usually as a second line procedure. This article discusses the radiological signs of traumatic mediastinal widening. Different traumatic lesions resulting in a widened mediastinum are presented, and some nontraumatic causes of a widened mediastinum are shown, in order to facilitate the differentiation between both entities.

A four-year-old girl presents at the emergency department with left elbow pain after a fall. X-ray demonstrated an epiphysiolysis of the capitellum humeri, without a bony fragment, the so-called Salter Harris Type 1 fracture. The fracture was treated by open reduction and internal fixation. This case is unusual because avulsions of the capitellum are usually associated with a bony fracture.

Despite the fact that we are living in the era of spiral CT and multidetector spiral CT allowing us to scan the whole spine in less than a minute and to make high quality multiplanar reformatted images, plain films remain important in clearing the spine of polytraumatised patients. Particularly hemodynamic unstable patients that must be urgently transferred to the operation room need to be rapidly cleared for (cervical) spine lesions, without being transported to the CT unit which is--in most hospitals--located relatively far away from the emergency room and the operation rooms. In these patients, for the time being, spiral CT cannot replace conventional radiographs for the detection of sometimes subtle lesions. Knowledge of the direct but also the indirect signs of fractures remains important in the evaluation of these plain films. This article demonstrates some of these sometimes subtle signs that can help in making the diagnosis of these lesions.

A wide variety of primary bone tumours can involve the spine. The imaging features of these lesions are often characteristic. We present an overview of the primary benign bone tumours of the spine. The role of plain film, CT and MRI is discussed.

Trauma of the pelvis and the hip are frequent and the most common lesions are fractures and dislocations. There are other traumatic lesions around the pelvis, including epiphysiolysis of the femoral head and apophysiolysis of the common muscle insertions around the hip. Cartilaginous lesions and some less frequent fractures are also illustrated in this article. We are not claiming to give a complete overview of traumatic injuries to the pelvis and the hip, but want to illustrate some more and some less frequent lesions.

The aim of this work was to add to the body of data on the frequency and severity of degenerative radiographic findings at adjacent levels after anterior cervical interbody fusion and on their clinical impact and to contribute to the insights about their pathogenesis. One hundred eighty patients who were treated by anterior cervical interbody fusion and who had a follow-up of >60 months were clinically and radiologically examined by independent investigators. For all patients, the long-term Odom score was compared with the score as obtained 6 weeks after surgery. For myelopathic cases, both the late Nurick and the Odom score were compared with the initial postoperative situation. For the adjacent disc levels, a radiologic "degeneration score" was defined and assessed both initially and at long-term follow-up. At late follow-up after anterior cervical interbody fusion, additional radiologic degeneration at the adjacent disc levels was found in 92% of the cases, often reflecting a clinical deterioration. The severity of this additional degeneration correlated with the time interval since surgery. The similarity of progression to degeneration between younger trauma patients and older nontrauma patients suggests that both the biomechanical impact of the interbody fusion and the natural progression of pre-existing degenerative disease act as triggering factors for adjacent level degeneration.

We present the case of a 70-year-old woman with necrotizing fasciitis of the right leg, sepsis and bacteraemia with Escherichia coli. Chest wall emphysema, detected on standard radiograph and the presence of air in the soft-tissue of the foot was the reason for prompt surgical drainage in addition to standard fluid resuscitation and antibiotic therapy. There was no evidence of underlying diabetes mellitus, but unknown chronic renal failure and corticosteroid therapy for rheumatoid arthritis were considered predisposing factors. We present a short overview of this rare life-threatening condition with emphasis on radiological diagnostic modalities.

The meniscal ossicle is an infrequent radiographic finding in humans. It often is mistaken for an intra-articular loose body. MR imaging is the ideal modality to differentiate between these entities. We report the imaging findings of a meniscal ossicle in a patient with emphasis on the MR imaging appearance. A review of the literature on meniscal ossicles is also presented.