The adult hip: an anatomic study. Part I: the bony landmarks.

A comprehensive anatomic, pathologic and radiographic study of the adult hip was undertaken to define bony landmarks which, when altered, are reliable indicators of disease. Methodology included radiography of cadaveric specimens and analysis of over 300 anteroposterior (AP) radiographs of "normal" adult hips. This information was applied to clinical situations with the following conclusions: (a) The diagnosis of protrusio acetabuli is warranted if the acetabular line projects medial to the ilioischial line by 3 mm or more in men and by 6 mm or more in women. (b) In acetabular trauma, an AP and two oblique radiographs (30 degrees anterior oblique and 30--45 degrees posterior oblique) are required for complete evaluation. (c) Characteristic alterations in the joint space allow accurate diagnosis of disease.

The adult hip: an anatomic study. Part II: the soft-tissue landmarks.

A comprehensive anatomic, pathologic, and radiographic study was undertaken to define reliable soft-tissue landmarks about the hip. Methodology included an analysis of 300 "normal" adult hip radiographs, tissue maceration, cadaveric intra-articular injection studies and review of selected clinical cases. Results, when applied to clinical situations, indicate: (a) The iliopsoas and "capsular" fat planes are poor indicators of small to moderate amounts of intra-articular fluid in the adult. (b) The "capsular" fat plane is not associated with the joint capsule, but in fact is a fat plane between two muscle bundles anterior to the articulation. (c) Distinct soft-tissue planes are available for dissemination of fluid from the hip joint. These include the iliopsoas bursa, which may distend in association with articular disease, and the fat plane of the obturator externus muscle.

Septic arthritis of the glenohumeral joint. Unique clinical and radiographic features and a favorable outcome.

Seven patients (eight shoulders) with sepsis of the glenohumeral joint were studied clinically and radiographically. Despite the advanced age of the patients, the presence of gram-negative organisms, and multiple risk factors in each patient (including serious chronic underlying diseases), needle drainage and parenteral antibiotics were all that were required for successful management, provided early diagnosis with prompt institution of antibiotics and drainage occurred. Contrast arthrography safely guided therapy and revealed rotator cuff tears in four of six shoulders as well as frequent extra-articular extensions of the disease. A nonleukemic patient with Aeromonas hydrophilia sepsis and arthritis is reported who survived with eradication of infection and preservation of joint function. A poor prognosis for shoulder sepsis is not substantiated.

Extaarticular manifestations of septic arthritis of the glenohumeral joint.

Five patients with septic arthritis involving the glenohumeral joint are described. Although initial plain films were normal in all six involved joints, abnormalities were frequent on subsequent examinations, including demineralization (five joints), joint space narrowing (three joints), superior subluxation of the humeral head (three joints), osseous erosion (two joints), and inferior subluxation of the humeral head (one joint). Arthrography was helpful in documenting intraarticular placement of the needle for aspiration, synovial abnormalities, and extraarticular extension of disease. Particularly noteworthy was the occurrence of rotator cuff tears in four of six shoulders, suggesting a possible relationship between joint infection and disruption of the rotator cuff.

Utility of bone scanning in disseminated coccidioidomycosis: case report.

Five cases of disseminated coccidioidomycosis (DC) are presented, to illustrate the complementary nature of bone scanning and radiography in the assessment of skeletal involvement. As shown in other unflammatory and neoplastic processes, bone scanning is more sensitive than radiography in the detection of early skeletal disease, but correlation with radiographs remains a necessity.