Spinal Involvement in Patients with Chronic Non-Bacterial Osteomyelitis (CNO): An Analysis of Distinctive Imaging Features.

Spinal involvement by chronic non-bacterial osteomyelitis (CNO) has been increasingly reported in recent years, often being presented as a diagnostic dilemma requiring differential diagnosis with bacterial spondylodiscitis and/or neoplasia. This study was aimed at identifying the imaging features of CNO facilitating its differentiation from other spinal diseases. Two radiologists assessed the imaging studies of 45 patients (16 male and 29 female, aged from 6 to 75 years, 15 children) with CNO collected from 5 referential centers. Spinal lesions were found in 17 patients (2 children and 15 adults), most often in the thoracic spine. In children, the lesions involved short segments with a destruction of vertebral bodies. In adults, the main findings were prominent bone marrow edema and osteosclerosis, endplate irregularities, and ankylosing lesions extending over long segments; paraspinal inflammation was mild and abscesses were not observed. In both children and adults, the involvement of posterior elements (costovertebral and facet joints) emerged as an important discriminator between CNO and neoplasia/other inflammatory conditions. In conclusion, a careful inspection of imaging studies may help to reduce the number of biopsies performed in the diagnostic process of CNO.

Femoral nerve palsy as a complication due to COVID-19 coagulopathy and iliopsoas muscle hematoma - case report.

BACKGROUND: COVID-19 (Coronavirus disease 2019) pandemic is the main medical problem around the world from the end of 2019. We found until now many symptoms of this disease, but one of the most problematic was thrombosis. Wide recommendation on COVID-19 treatment was pharmacological thromboprophylaxis. In some papers we found that clinicians face the problem of bleeding in those patients. Is still unknown that coronavirus could led to the coagulopathy. CASE PRESENTATION: We described case report of patient who with COVID-19 disease present femoral nerve palsy caused by the iliopsoas hematoma. There were no deviations in coaguology parameters, patient got standard thromboprophylaxis, besides above probably COVID-19 was risk factor of hematoma formation. Non-operative treatment was applied, thrombophylaxis was discontinued. In the follow up in the radiological exam we saw reduction of the haematoma and patient report decrease of symptoms. CONCLUSIONS: We should assess individually patient with COVID-19 according to thrombosis risk factors. Probably we should be more careful in ordering thrombophylaxis medications in COVID-19 patients.

Analysis of the appropriateness of orthopaedic computed tomography scans as exemplified by lower extremity bones and joints.

Purpose: The objective of this study is to analyse the appropriateness of lower extremity coputed tomography (CT) scans as performed in a large orthopaedic hospital. Material and methods: A total of 1410 CT scans acquired in the years 2014-2018 were analysed for compliance with the "Guidelines for Physicians Issuing Diagnostic Imaging Referrals" (iRefer). These guidelines were published by the Royal Radiologist Society and recommended for use by the Polish Medical Society of Radiology, the National Consultant for Radiology and Diagnostic Imaging, and the Minister of Health. In addition, the study involved the analysis of information provided on CT referrals by referring clinicians. Results: Nearly 21% of CT referrals were found to be unsubstantiated based on the diagnosis made by the referring physician, the body region of interest, and the clinical department. Most referrals identified as non-compliant with the guidelines were related to cancers followed by inflammatory conditions. The lowest number of unjustified exams was reported for endoprostheses and injury-related cases. Conclusions: The study revealed a significant degree of non-compliance with the diagnostic algorithm as defined in the iRefer guidelines, particularly in cases of cancers and inflammatory conditions. Consequently, the patient's exposure to ionizing radiation is increased. Incorrect decisions regarding the appropriate diagnostic imaging technique are founded on the lack of appropriate cooperation between the clinician and the radiologist, insufficiency or lack of information provided on the referral, as well as the defensive attitude of referring physicians. It is therefore necessary to change appropriate in-hospital management and cooperation models.

Pelvic incidence and pelvic tilt can be calculated using either the femoral heads or acetabular domes in patients with hip osteoarthritis.

AIMS: The aim of the study was to compare two methods of calculating pelvic incidence (PI) and pelvic tilt (PT), either by using the femoral heads or acetabular domes to determine the bicoxofemoral axis, in patients with unilateral or bilateral primary hip osteoarthritis (OA). METHODS: PI and PT were measured on standing lateral radiographs of the spine in two groups: 50 patients with unilateral (Group I) and 50 patients with bilateral hip OA (Group II), using the femoral heads or acetabular domes to define the bicoxofemoral axis. Agreement between the methods was determined by intraclass correlation coefficient (ICC) and the standard error of measurement (SEm). The intraobserver reproducibility and interobserver reliability of the two methods were analyzed on 31 radiographs in both groups to calculate ICC and SEm. RESULTS: In both groups, excellent agreement between the two methods was obtained, with ICC of 0.99 and SEm 0.3° for Group I, and ICC 0.99 and SEm 0.4° for Group II. The intraobserver reproducibility was excellent for both methods in both groups, with an ICC of at least 0.97 and SEm not exceeding 0.8°. The study also revealed excellent interobserver reliability for both methods in both groups, with ICC 0.99 and SEm 0.5° or less. CONCLUSION: Either the femoral heads or acetabular domes can be used to define the bicoxofemoral axis on the lateral standing radiographs of the spine for measuring PI and PT in patients with idiopathic unilateral or bilateral hip OA. Cite this article: Bone Joint J 2021;103-B(8):1345-1350.