A-Z of Musculoskeletal and Trauma Radiology by James R D Murray; Erskine J Holmes; Rakesh R Misra

By James R D Murray; Erskine J Holmes; Rakesh R Misra

Sensible, easy-to-use reference for reading musculoskeletal issues, with high quality pictures and multidisciplinary writer team.

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Fracture – treat the fracture non-operatively and the cyst is likely to fill in as the fracture heals.  For recurrent fractures, curettage, grafting þ/À stabilisation is the treatment of choice.  27 I A–Z of Musculoskeletal and Trauma Radiology 28 Pathological fracture through a unicameral bone cyst within the distal clavicle. Note the callus formation superiorly as the fracture starts to consolidate. Unicameral bone cyst within the proximal humeral metaphysis, with an associated pathological fracture.

Usually solitary, commonest in the proximal femur and ilium. Clinical features Asymptomatic – incidental diagnosis, but these are important in the differential diagnosis of more sinister lesions.  Radiological features Sclerotic areas within bone which are well demarcated from surrounding normal bone (narrow zone transition). Classically the margin appears feathery.  No cortical involvement or periosteal reaction.  Often oval with the long axis parallel to the bone.  Bone scan – if large may show increased uptake.

Clinical features Predominantly females over 60 years of age. Three clinical situations: (i) Apparently inert and asymptomatic – incidental diagnosis usually with chondrocalcinosis found on a knee radiograph. (ii) Acute inflammatory synovitis – true ‘pseudogout’ with an acute largejoint monoarthritis; usually the knee. (iii) Chronic arthropathy – very often polyarticular, including shoulder, ankle and elbow. Severe joint destruction, sometimes with acute flare-ups alternating with chronic destruction, mimicking rheumatoid arthritis.

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