Thomas H. Berquist - Imaging of Orthopaedic Fixation Devices and Prostheses

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Library of Congress Cataloging-in-Publication Data

Imaging of orthopaedic fixation devices and prostheses / editor, Thomas H. Berquist.

p. ; cm.

Includes bibliographical references and index.

ISBN-13: 978-0-7817-9252-3 (alk. paper)

ISBN-10: (invalid) 0-7817-9252-3 (alk. paper)

1. Orthopedic apparatusImaging. 2. Musculoskeletal systemDiseasesImaging. 3. Musculoskeletal system DiseasesSurgery. I. Berquist, Thomas H. (Thomas Henry), 1945-[DNLM: 1. Musculoskeletal Diseasesdiagnosis. 2. Diagnostic Imaging. 3. Musculoskeletal Diseasessurgery.
4. Orthopedic Fixation Devices. WE 141 I301 2009]
RD755.5.I38 2009
617'.9dc22

2008024236

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I dedicate this text to my loving wife, Mary, for her continued support and understanding.

In 1995 we published an Atlas of Orthopaedic Appliances and Prostheses. This was a work dedicated to bridging the gap between orthopaedic surgeons and imagers. I have continued to dedicate efforts to improve the understanding of orthopaedic procedures and what the surgeon needs to know when ordering preoperative and postoperative imaging studies.

Orthopaedic instrumentation and prostheses continue to evolve, making it difficult for imagers to keep up with all possible implants that may appear on radiographs or other imaging modalities. With this in mind, it is essential for surgeons and radiologists to work closely and we, as imagers, need to become familiar with the instrumentation systems our surgeons prefer.

This edition is designed to be more concise than the prior atlas with no attempt to demonstrate every possible fixation device or prostheses. We review the important clinical and image features of orthopaedic devices including clinical concepts and patient selection, the normal appearance of orthopaedic devices and the image features, and most appropriate modalities for evaluating complications.

reviews clinical data, staging, and preoperative and postoperative imaging in patients with musculoskeletal neoplasms.

This text will be most useful to practicing radiologists and radiologists in training. Other physicians who deal with orthopaedic problems will also find the information provided in this text extremely useful.

Preparation of this text required the support of numerous individuals and colleagues. I first wish to thank my colleagues in musculoskeletal imaging at Mayo Jacksonville, Laura Bancroft, Mark Kransdorf, and Jeffrey Peterson for their support and assistance in providing the necessary images needed to fulfill the mission of this text. I also want to thank my colleagues in orthopaedic surgery, Mark Broderson, Stephen Trigg, Cedric Ortiguera, Peter Murry, Mary OConnor, Kurtis Blasser, and Joseph Whalen for their consultative support.

Daniel Huber and John Hagen were instrumental in providing images and art required to demonstrate anatomy, normal and abnormal image features for devices described in this text. The vendors of orthopaedic devices were also very helpful in providing photographs and artwork to assist with demonstration of devices and their indications to use along with the images in this text.

Finally, I wish to thank Ryan Shaw, Lisa McAlliser, and Kerry Barrett from Lippincott Williams & Wilkins for their assistance and support with this project.

ppropriate use of imaging techniques is essential for diagnosis, treatment planning, and follow-up of orthopaedic procedures. Basic techniques will be discussed in this chapter to avoid redundancy in anatomic chapters.

Routine Radiographs

Routine radiographs remain the primary screening examination for musculoskeletal disorders. Appropriate evaluation of radio-graphs may provide the diagnosis or allow selection of the next imaging procedure to completely evaluate the clinical problem. Specifically, radiographs are essential for proper interpretation of magnetic resonance (MR) images.

Currently, screen-film radiography is being replaced with computed radiography (CR) at many institutions. Regardless of the system used, it is essential to ensure proper patient positioning and accurate chronologic labeling of images. Multiple views (two to four) are required to evaluate osseous and articular anatomy. Specific views will be discussed in subsequent anatomic chapters. In certain cases, fluoroscopically positioned images are useful to optimize positioning and reduce bony overlap. This approach is useful in the foot and wrist. The technique is also appropriate to evaluate interfaces of arthroplasty components, fixation devices, and evaluate pin tracts when infection is suspected clinically. Fluoroscopic positioning is also useful when performing stress tests to assure that the joint is properly positioned. Stress studies are most often performed on the ankle, elbow, knee, and wrist (see ).