Intraosseous haemangioma of the proximal femur: imaging findings

Haemangiomas of bone are uncommon lesions, accounting for approximately 1% of all primary bone tumours. The most frequent sites of involvement are the calvaria and the vertebral column. When haemangiomas involve long tubular bones, they are usually found in the diaphysis or metadiaphysis. Juxta-articular or epiphyseal location for a long bone haemangioma is rare. We present the imaging findings in a case of a histopathologically proven juxta-articular intraosseous haemangioma of the proximal femur. We believe ours is the first report of a haemangioma involving the proximal end of the femur.

Changing epidemiology of neonatal septic arthritis

PURPOSE

To study the changing epidemiological pattern of micro-organisms as an aetiology of septic arthritis, and to correlate the pattern with the outcome of neonatal septic arthritis, in terms of joint function and morphology.

METHODS

15 consecutive cases of neonatal septic arthritis of hip admitted between 1999 and 2002 were studied. Diagnosis of septic arthritis was made on the basis of Morrey's criteria. All patients were treated by arthrotomy after aspiration of purulent fluid from the joint. Patients were followed up for a mean period of 2.4 years. Clinical and radiological examinations were performed at follow-up.

RESULTS

The mean age of the 15 patients was 20.35 days. 13 (87%) patients had primary septic arthritis, while only 2 (13%) had associated osteomyelitis. Culture reports revealed that the spectrum consisted of 33% gram-negative organisms, 7% fungal, and only 20% gram-positive organisms-Staphylococcus aureus in 3 patients, Klebsiella in 2 patients, one each of Proteus, Candida, Escherichia coli, and Enterobactor. Six patients were pus-cell positive with negative culture. No organism was found in 6 (40%) cases. Investigations showed leukocytosis, raised C-reactive protein and erythrocyte sedimentation rate in all 15 patients. 12 patients had normal clinical and radiological parameters at follow-up. Three patients had delayed surgical drainage of more than 72 hours due to late presentation, and showed various radiological sequelae with terminal restriction of joint movements.

CONCLUSION

There are more cases of primary septic arthritis than secondary septic arthritis. Clinicians should be alert of the aetiology shift to gram-negative organisms, in addition to fungal and gram-positive ones. Arthrotomy to drain pus from the joint should not be delayed. Better long-term results can be achieved by early surgical drainage and immediate antibiotic coverage.

Magnetic resonance arthrography in recurrent anterior shoulder instability as compared to arthroscopy: a prospective comparative study

AIM

To evaluate the accuracy of magnetic resonance (MR) arthrographic imaging in the diagnosis of glenoid labral and ligament tears in recurrent shoulder instability.

SETTINGS AND DESIGN

Prospective, comparative study at a tertiary care centre.

MATERIAL AND METHODS

Patients with three or more episodes of anterior shoulder dislocation were enrolled in the study. They were subjected to magnetic resonance arthrography (MRA) for delineation of abnormalities. The findings obtained at MRA were compared with those found at arthroscopy and surgical exploration.

RESULTS

MRA detected glenoid tears in all 22 patients with 20 (90%) patients having antero-inferior tears, 3 (14%) patients had superior labral involvement and 2 (10%) patients had posterior labral abnormality. On arthroscopy, antero-inferior, superior and posterior labral tear were found in 21 (95%), 5 (22%) and 7 (32%) patients respectively. MRA showed a sensitivity of 95%, and a specificity of 100% for the detection of the antero-inferior labral tears. The sensitivity of MRA for the detection of superior, middle and inferior glenohumeral ligament tear was 83%, 80% and 86% with a specificity of 100%, 71% and 93% respectively. MRA was 100% sensitive for the detection of rotator cuff injuries and detection of bony lesions like Hill-Sach's and bony Bankart's lesion.

CONCLUSIONS

MRA is a sensitive and specific modality for evaluation of anterior shoulder instability.