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48 year old woman with recurrent pain following fx tx
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48 year old woman with recurrent pain following fx tx - December 2, 2004 4:29:00 AM
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chiroortho
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How about here? Anything look unusual to you?
< Message edited by David Adamczyk -- July 6, 2007 7:50:48 AM >
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Greg Priest, DC, DABCO
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Re: 48 year old woman with recurrent pain following fx tx - December 2, 2004 6:19:00 AM
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tr6454
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Greg,
compression screw is bent or broken. This may not have anything to do with the pain. Probably occured during insertion which is why the second screw was placed across the fracture. Question is .. is the fracture healed? Can't tell on my view.
Terry
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Terry
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Re: 48 year old woman with recurrent pain following fx tx - December 2, 2004 6:32:00 AM
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PTupdate.com
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Yes the screw is broken, and not sure if the way she is positioned, but that side of the pelvis looks flared different than the other. Also, just in front of the screw (broken one) there is a little pocket of translucency.
Also, up on L5 there appears to be a grouping of what looks like grapes...could just be part of her clothing. Can't tell what sacral interface at L5 looks like on this view.
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
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John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: 48 year old woman with recurrent pain following fx tx - December 2, 2004 6:48:00 AM
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jma
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Hello,
Yes, the screw appears to be broken but not completely, as there is a small space of density on the left hand side of the screw. Around the lower lumber area, there seems to be something that either looks like grapes or an bracelet of some kind. Bellybutton ring perhaps?
Also, what is the blackened area in front of the lefts side of the sacrum? Is it part of the bowel or something else?
JMA
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Re: 48 year old woman with recurrent pain following fx tx - December 2, 2004 6:52:00 AM
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PTupdate.com
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Not to sound crude, but the black (I believe) represents either gas or fecal matter.
Duffy
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John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: 48 year old woman with recurrent pain following fx tx - December 2, 2004 7:00:00 AM
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chiroortho
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Well done. Here is a close up view: [IMG]http://www.rad.washington.edu/quickcases/cases/Case18/Detail.jpg[/IMG]
The black arrow points to the fractured dynamic screw, and the white arrow points to an ununited fracture line in left femoral neck.
The radiologist noted that 'Orthopaedic hardware does not fracture without reason. The usual reason is excessive motion about the fracture site, which may be due to an ununited fracture.'
As to the grape-like structures, my best guess would be low-lying gallstones.
The lucency over the sacrum is most assuredly bowel gas and completely normal. Clinical hint: when you see a lucency in the abdomen/pelvic basin that overlies bone, follow the margins of the lucency to see if it passes the edges of the bone. If it does (and no cortical margin is present to suggest an aneurysmal bone cyst or other tumor) then it's almost assuredly bowel gas.
Great job.
_____________________________
Greg Priest, DC, DABCO
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Re: 48 year old woman with recurrent pain following fx tx - December 2, 2004 7:21:00 AM
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jma
Posts: 2322
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From: NY
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Hello,
Thanks for the clinical tip, worth knowing. Would have never picked up the ununited fracture line. Most likely due to my computer screen. It just looked way to dark for me to see anything across that area. I'm sure the originals were much more clearer. Keep up the posts.
JMA
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