• Undisplaced scaphoid fracture

• Acute boxer’s fracture

• Dorsal avulsion fracture of the triquetrum

• No abnormality

• Undisplaced scaphoid fracture – FALSE

• Acute boxer’s fracture – FALSE

• Dorsal avulsion fracture of the triquetrum (Red arrow) – TRUE

• No abnormality – FALSE

Explanation:

• Notice also the dorsal soft tissue swelling with air lucencies (Located inside the orange line).






Triquetral fractures:

• Second most common carpal bone fracture (after the scaphoid)

• Fall onto an outstretched hand in ulnar deviation and carpal extension or direct blow to the dorsum of the hand (latter in this case)

• Almost always dorsal avulsion type

• Usually only seen on lateral radiographs with the classic “pooping duck” sign

• Deep lateral notch (sulcus) sign on lateral projection

• Suprapatellar effusion

• MRI of the knee, due to high index of suspicion for ACL tear

Full-thickness ACL tear

• Patient had additional abnormalities of the knee not shown.

Capitellum fracture

The case represents a classic capitellum fracture, with a mildly displaced fragment on the lateral projection, which can easily be missed if one is not familiar with the double-arc sign.

D3/D4 intermetatarsal space

What is the most likely diagnosis?

Near-complete rupture of the right hamstring tendons with moderateretraction and preserved muscle bellies

Reference: https://radiologyassistant.nl/musculoskeletal/muscle/hamstring-injury

What is the next step?

MRI

What are the findings?

There is a complete tear in the anterosuperior labrum, located around the 2 o’clock position.

Reference: Schmaranzer F et al: Diagnostic performance of direct traction MR arthrography of the hip: detection of chondral and labral lesions with arthroscopic comparison. Eur Radiol. 25(6):1721-30, 2014

What is the underlying reason for the alterations observed in the bone marrow?

– A subchondral insufficiency fracture accompanied by bone marrow edema is noted
– The presence of additional bone marrow edema in the right femoral neck, particularly in the anterolateral region, is likely indicative of an insufficiency response
– Complete cartilage damage is observed

Pelvic insufficiency fractures

-Pelvic insufficiency fractures typically manifest in the lateral aspect of the femoral neck, while stress fractures tend to occur on the medial aspect

-Additionally, damage to the articular surface can result from cartilage loss, a condition distinct from osteonecrosis

Reference: Peh WC et al: Imaging of pelvic insufficiency fractures. Radiographics. 16(2):335-48, 1996

What should be the subsequent action to be taken?

– Perform an X-ray to exclude the presence of calcifications
– Confirm that there is no prior history of trauma

The patient had been involved in a car accident five months before the lump was detected