What the Orthopaedic Doctor Needs to Know

The man of science in searching for the truth must ever be guided by the cold logic of facts, and be animated by scientific imagination. William J. Mayo1

Excellence in medicine is born of scientific endeavors and communication. This issue of Seminars in Musculoskeletal Radiology brings radiologists and orthopaedic physicians together to discuss current clinical problems. The goal of these articles is to cut through the esoteric and explore the most pertinent and important aspects of musculoskeletal imaging.

The diagnosis and workup of bone tumors can be a complex process that is of critical importance. Dr. Theodore Parsons and surgical colleagues from Wilford Hall Medical Center, Lackland Air Force Base, provide a practical, systematic approach to evaluating and staging musculoskeletal neoplasia.

Percutaneous biopsy of indeterminant masses is a relatively common procedure with a myriad of potential difficulties. Dr. Laura Bancroft with surgical and radiology colleagues from Mayo Clinic in Jacksonville review and direct the safest methods for biopsy based on the principles of compartmental anatomy. By following these principles, resection of the needle tract by the orthopaedic oncologist can be done using standard resection planes, thus increasing the chance of sparing the affected limb.

Along with tumor, osteomyelitis is another entity that can be challenging to diagnose, especially when involving the foot, where soft tissue infection and neuropathic changes can complicate the imaging appearance. Drs. Liu and Dorsey from Mayo Clinic in Arizona concentrate on improving the diagnosis of osteomyelitis in the foot by incorporating secondary imaging findings and the clinical presentation to produce more accurate imaging interpretation.

With the major topics of tumor and infection covered, this issue continues with joint specific topics covering the wrist, elbow, shoulder, hip, knee, and foot/ankle. Beginning with the wrist, Dr. Viviane Khoury along with her surgical and radiology colleagues in Montreal, provide a valuable guide in correlating cross-sectional imaging findings with arthroscopy. Dr. Sidney Jacoby with orthopaedic and radiology colleagues in Philadelphia tackle the complex topic of pediatric elbow trauma, with an emphasis on findings that are most pertinent to communicate to the treating physician. Drs. Vanderbeck and Fenlin from Thomas Jefferson University Hospital explore imaging of the shoulder with the goal of improved communication of clinically significant findings.

Moving on to the lower extremity, Drs. Pullido and Parvizi at the Rothman Institute at Thomas Jefferson University Hospital review the sometimes subtle yet important findings of femoroacetabular impingement that can be overlooked in young patients. The orthopaedic and radiologic authors at New York University Hospital for Joint Diseases, lead by Dr. Khoury, comprehensively cover the most useful information to be gleaned from knee magnetic resonance imaging studies. Finally, Drs. Bowers and Castro from Philadelphia present the mechanics of gastrocnemius contracture, thus integrating “form and function” with imaging of foot and ankle pathology.

It is my hope that this collection of articles enhances and enriches your practice and ultimately benefits your patients.

1 Perception. Collect Papers Mayo Clin & Mayo Found 1928;20:997-1006.