Bisphosphonate-related bilateral atypical femoral fractures : be aware and beware

Although bisphosphonates have a well established therapeutic role in the prevention of osteoporosis-related fractures, several reports published over the past 5-6 years suggest a possible causative relationship between long-term use of bisphosphonates and development of ‘atypical’ subtrochanteric and femoral diaphyseal fractures. A high level of clinical suspicion and prompt imaging when these patients present with groin/thigh pain should lead to a timely diagnosis. Appropriate elective management to mitigate against the increased risks of these fractures becoming complete could then be instituted. We present a case of complete bilateral atypical subtrochanteric fractures in a patient on long-term bisphosphonates for osteoporosis. Our objective is to highlight the fracture risk of this patient population; present the current knowledge; and discuss the dilemmas in management of both femora.peer-reviewe

Magnetic resonance imaging of the musculo-skeletal system

MRI is likely to be one of the safest methods of extracting information from the human body. High contrast high resolution images depend on tissue relaxation times which reflect fundamental differences in tissue properties. The versatility to obtain a wide spectrum of information combined with the ability to image in any plane with no apparent hazard makes the technique an exciting advance for radiology and confirms that this is the "Golden Age of Radiology”. Newer developments in magnetic design and sophistication as well as further technological advances, with soft ware up-dates and alternative acquisition sequences will definitely increase the applications of MRI to musculo-skeletal disease.peer-reviewe

Computed Tomography and MR Imaging in Spondyloarthritis

This article provides an overview of the computed tomography (CT) and magnetic resonance (MR) imaging appearances suggestive of spondyloarthritis, with a specific emphasis on the MR imaging findings of vertebral and sacroiliac involvement, and presents relevant clinical features that assist early diagnosis. CT is a sensitive imaging modality for assessment of structural bone changes, but its clinical utility is limited. MR imaging is the modality of choice for early diagnosis, because of its ability to depict inflammation long before structural bone damage occurs, for monitoring of disease activity, and for evaluating therapeutic response

Intraosseous lipomas originating from simple bone cysts

PurposeFatty or part-fatty intraosseous lesions are occasionally encountered while imaging the skeletal system. A number of case reports have proposed involution of calcaneal bone cysts to intraosseous lipomas, but this has never been proven. This paper sets out to prove that simple bone cysts (SBCs) can involute to fatty lesions indistinguishable from intraosseous lipomas.Materials and methodsThe pathology and PACS databases at 2 specialist orthopedic hospitals were retrospectively interrogated for all cases of intraosseous lipomas or SBCs with cross-sectional imaging follow-up for SBCs and precursor or follow-up imaging for intraosseous lipomas, in the time period from August 2007 to December 2016. For intraosseous lipoma cases, these were only included if change in imaging appearances was observed.ResultsThere was no case of change in the appearance in intraosseous lipomas. Six cases of SBC with cross-sectional imaging follow-up were identified in one participating hospital and none in the other. The 6 cases were comprised of 4 male and 2 female patients. Two were located in the proximal humerus, one in the proximal tibia, and 3 in the os calcis. All cases demonstrated filling in of the cystic lesion with fat from the periphery, in 2 cases complete filling in, and in 4 cases partial fatty conversion.ConclusionSBCs can heal with fatty conversion of the cystic cavity, with partly cystic remnants. It is proposed that at least part of the so-called intraosseous lipomas are healed simple bone cysts