Case of the Week: 17 year old with chronic wrist pain

Chronic changes of juvenile idiopathic arthritis

Femoral/tibial torsion studies

,

Regarding Femoral/tibial torsion studies:

Dr. Stevens would like us to: 

1) Use the screen layout that I show in the second and third attachments 

2) Save our measurements when closing the study

3) Use the macro below

Also, please read the note on the first attachment regarding how he'd like us to measure the femoral neck.

PS: The line about P. STEVENS in the macro is because Aoki does it differently.

_____________________________
Examination: [<Right>] MRI lower extremity without contrast limited. [] hours.

Comparison: Contralateral side.

History: Femoral anteversion. [<Lower extremity torsion.>]

Technique: Oblique PD axial images were obtained through the [left/right] hip. Native axial images were obtained through the hip, knee, and ankle.

Findings: 

No fracture, periosteal reaction, or other acute osseous abnormality is present in the visualized portions of the lower extremities. Soft tissues are normal appearing.

BY THE METHOD OF P. STEVENS AND B. NIXON,

lower extremity anteversion and torsion angles are calculated as listed below:

Impression: Femoral [<anteversion >] is [] degrees.  There is [] degrees femoral [<internal>] torsion and [] degrees tibial [<external>] torsion. Please see separate dictation of the contralateral limb.

_____________________________

Bone age determination in infants

Count the visible ossification centers as in the schematic above.  Blackened centers are the only ones that count.  Then use the chart above and the macro below:


Findings: Using the method described by Elgenmark (Acta Paediat. 33:1, 1946), a child aged [<>] months should have [<>] ossified growth centers. This child has [<>], [<within 2 standard deviations of mean.>]

Impression: [<Normal bone age.>]

Code 10

Risser Classification

The iliac crest apophysis is unossified until adolescence. 

At about 14 years, ossification begins on the anterolateral aspect of the iliac crest and continues posteromedially.

Fusion of the ossified apophysis begins around the age of 15 years and may not be complete until 25 years.

Skeletal dysplasia: An update

The skeletal dysostoses and dysplasias are now classified as "Genetic Skeletal Disorders," a nod towards our better understanding of the human genome and the genetic basis of disease.  Check out the new standard for classifying these disorders online at:

http://www.isds.ch/Nosology2006.html