Occult isolated fracture of the trapezoid diagnosed by ultrasonography.

PURPOSE: To describe a patient with an occult isolated trapezoid fracture of the wrist. Isolated trapezoid fractures are very difficult to detect without advanced radiological imaging, since the fragment displacement does not occur in the sagittal plane. A discussion regarding the investigation of trapezoid fractures utilizing multiple imaging modalities includes the first demonstration of its detection via ultrasonography (US). METHODS: A 26-year-old male presented to a chiropractic teaching clinic with pain involving the left wrist, after vaulting over the handlebars of his bicycle 2 days prior. The mechanism of injury was hyperflexion of the left wrist. Left wrist pain, reduced range of motion, and dorsal soft tissue edematous changes were identified at examination. Although the initial radiographic examination was negative, elevated clinical suspicion triggered an US examination 4 days later. The US exam demonstrated an isolated 1.8 mm dorsal trapezoid fracture, which was minimally displaced by 0.7 mm. RESULTS: Following the US diagnosis of an isolated trapezoid fracture, the wrist was immobilized. The patient elected to not pursue an orthopedic consultation. Conservative care included ice and Class IV therapeutic laser therapy. The patient reported complete alleviation of clinical symptoms after approximately 2 weeks of splinting and treatment. CONCLUSION: We emphasize the limitations of radiography in the diagnosis of this fracture. To our knowledge, this is the first case to describe the use of US in the diagnosis of an isolated trapezoid fracture.

An Unusual Case of Polyostotic Fibrous Dysplasia in a 53-Year-Old Woman With Low Back Pain.

OBJECTIVE: The purpose of this case report is to describe the features of an unusual presentation of fibrous dysplasia. CLINICAL FEATURES: A 53-year-old woman had low back pain and numbness in the anterior upper left thigh that started 3 years earlier after a fall. She experienced pain during active lumbar flexion and extension range of motion. Radiographic examination demonstrated an oval geographic osteolytic lesion in the left ilium and abnormal trabecular architecture with variable-sized osteolytic lesions and both ill-defined and well-defined borders along the sacroiliac joint margin. INTERVENTION AND OUTCOME: Because of the aggressive osteolytic appearance, magnetic resonance imaging of the pelvis with gadolinium contrast was obtained for additional characterization of the lesions. There were 3 additional mixed signal lesions located within the left femoral neck and extending to the greater trochanter that enhanced with contrast. Because of the suspicion of malignancy, needle biopsy was performed. The pathologic findings in combination with the radiographic appearance confirmed the diagnosis of polyostotic fibrous dysplasia. CONCLUSION: This case demonstrated a rare aggressive appearance of polyostotic fibrous dysplasia located in the left innominate and the left proximal femur that prompted a diagnostic imaging workup and biopsy for suspected skeletal malignancy. These lesions may require careful evaluation by an experienced team of physicians, radiologists, and pathologists to ensure proper diagnosis and treatment.