$occult tibial plateau fracture$

$occult tibial plateau fracture$ $occult tibial plateau fracture$

This finding indicates an intra-articular fracture in which marrow fat and blood are extruded into the joint. A lipohemarthrosis is evidenced by a fat-fluid level on a cross-table lateral view with a horizontal beam.

$occult tibial plateau fracture$

Joint effusion is manifested as loss of the clear plane of demarcation between the quadriceps tendon and the suprapatellar fat pad, with an ovoid density filling in the normal space. The lateral view is used to evaluate the soft tissues, particularly the extensor mechanism, and to define the presence of joint effusion. The notch view demonstrates the posterior aspect of the femoral condyles and enables evaluation of the tibial spines and the intercondylar notch. Assessment of the weight-bearing surfaces of the tibiofemoral joint space is obtained from the anteroposterior film. Plain film imaging options for assessment of the knee include the anteroposterior and lateral views, the sunrise view and the notch, or tunnel, view. However, with their higher spatial resolution, CT scan and magnetic resonance imaging (MRI) increasingly are being chosen to investigate stress fractures. The investigation of choice is scintigraphy, which shows a linear area of increased radionuclide uptake at the fracture site. Over time, radiographs may demonstrate a subtle increase in bone reaction along the outer cortex of the involved bone, with the subsequent development of linear sclerosis and new bone formation. This often results in a delay in diagnosis and, consequently, a delay in the institution of appropriate treatment. Most cases of the classic, horizontally oriented stress fracture and the longitudinal stress fracture cannot be seen on plain radiographic films until weeks after the onset of symptoms. 4 These longitudinal stress fractures usually occur in slightly older patients and almost exclusively involve the tibial shaft ( Figure 4). 3 Although a horizontal orientation is typically demonstrated, longitudinally oriented stress fractures are becoming more common. Multiple stress fractures are less frequent. This type of fracture is better demonstrated by bone scintigraphy, which reveals the characteristic “H” or “Honda” sign that appears as a result of intense radiopharmaceutical uptake, or by computed tomographic (CT) scanning ( Figure 1). Irregularity of the contour or an actual break in the sacral arcuate lines and/or patchy sclerosis in an H-shaped configuration may be seen. Plain radiographs often appear normal in these cases.

$occult tibial plateau fracture$

This is in contrast to the fatigue fracture, in which a fracture occurs in normal bone (bone with normal elastic resistance) that has been subject to abnormal stresses. Insufficiency fractures occur when abnormal bone (bone with decreased elastic resistance) is subject to normal stress. Insufficiency fractures of the sacrum typically occur in post-menopausal, osteoporotic women or in patients taking long-term corticosteroid treatments, those with rheumatoid arthritis or those who have undergone radiation therapy. Sacral pathology may occur in the form of an insufficiency stress fracture.

$occult tibial plateau fracture$

Occult tibial plateau fracture