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ANSWER
The radiograph demonstrates no acute osseous injury, such as fracture or dislocation. Of interest and note is increased sclerosis within both femoral heads, more so on the left versus the right side. Given the patient’s young age, such findings could be related to early avascular necrosis. His clinical symptoms certainly correlate. MRI or bone scan, as well as orthopedic evaluation, is warranted in such a case.
Fortunately, subsequent MRI of both hips did not show any avascular necrosis but rather osteoarthritic changes. The MRI of his spinal column was negative as well.
ANSWER
The radiograph demonstrates no acute osseous injury, such as fracture or dislocation. Of interest and note is increased sclerosis within both femoral heads, more so on the left versus the right side. Given the patient’s young age, such findings could be related to early avascular necrosis. His clinical symptoms certainly correlate. MRI or bone scan, as well as orthopedic evaluation, is warranted in such a case.
Fortunately, subsequent MRI of both hips did not show any avascular necrosis but rather osteoarthritic changes. The MRI of his spinal column was negative as well.
ANSWER
The radiograph demonstrates no acute osseous injury, such as fracture or dislocation. Of interest and note is increased sclerosis within both femoral heads, more so on the left versus the right side. Given the patient’s young age, such findings could be related to early avascular necrosis. His clinical symptoms certainly correlate. MRI or bone scan, as well as orthopedic evaluation, is warranted in such a case.
Fortunately, subsequent MRI of both hips did not show any avascular necrosis but rather osteoarthritic changes. The MRI of his spinal column was negative as well.
A 30-year-old man is transferred to your facility for evaluation of reported paraplegia after a fall. The patient is an inmate at a local prison. He states he was sleeping on the top bunk when he rolled over and fell off the bed, landing flat on his back on the concrete floor. He immediately started having severe back and hip pain and noticed that he could not move his legs. His primary complaint is severe bilateral hip pain. He was initially evaluated at an outside hospital, where CT of his head, cervical spine, and lumbar spine was negative for any acute pathology. He was sent to your facility for an MRI to rule out contusion or acute herniated disc. The patient denies any significant medical history, including back trauma. Currently, he reports no bowel/bladder issues or saddle anesthesia. On initial exam, he is awake, alert, and oriented, with normal vital signs. Musculoskeletal exam demonstrates a moderate amount of paraspinous tenderness and bilateral hip/pelvis tenderness. There is no instability detected, nor any leg shortening or rotation. He does have bilateral weakness in both lower extremities on the magnitude of 3-/5, although his exam seems limited due to the severity of his hip pain. Sensation is completely intact in both lower extremities. While the patient is awaiting his MRI, you order a portable pelvis radiograph, since none was performed at the outside facility. What is your impression?
