About Paolo Minafra

Musculoskeletal Radiologist - Sport Medicine Physician

Imaging of TFCC Injury of the Wrist

about dynamic cone-beam ct imaging of TFCC wrist injury

It’s always difficult to combine clinical aspects and diagnostic imaging, approaching wrist joint pathology; in many circumstances the orthopaedic surgeon needs to directly visualize what’s happened during the joint motion, especially in a complex region such as the wrist.

I show you an example in which a complex tear of the triangular fibrocartilage complex (TFCC) is evident, togheter with a positive ulnar variance. TFCC is a complex of a fibrocartilaginous disk in association with several ligamentous structures, acting as a  stabilizers of the distal radioulnar joint, and transmitting axial loading from carpus to the ulna.

TFC Injury

Coronal T1w (left) and 3D SHARC (right) Mri scans (0.3 Tesla).

The dedicated Mri examination (0.3 Tesla), depicts the pathologic picture; the ulnar plus defines the reduction of the quadrilateral ulno-carpal space, and the consequent complex tear of the TFCC at its ulnar attachment; but what happens during the active movements? I usually perform also the dynamic evaluation, both with ultrasound and Mri exams. In this case the Cone-beam CT (CBCT) dynamic acquisitions give the answer.

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Bipartite Hallux Sesamoid Injury

about dynamic ultrasound and MRi findings of post-traumatic injury of a medial bipartite hallux sesamoid bone

Today I show you the injury of a medial bipartite hallux sesamoid bone in a professional football player; extremely painful after trauma, it takes time to heal.

Sesamoid

Standard X-Ray exam after trauma.

Medial Bipartite Sesamoid MRI

Sagittal (left) and Coronal (right) Ge-Stir Mri sequences (0.3 Tesla); bone marrow edema of the medial sesamoid is evident.

I always perform also the dynamic evaluation, both with ultrasound and Mri exams.

 

Dynamic MSK Imaging of Metacarpal Fracture

About dynamic msk imaging modalities in the study of post-traumatic metacarpal fracture

4th metacarpal fracture

Acute 4th metacarpal spiroid fracture of a professional football goalkeeper; first diagnosis was made directly on pitch with an ultrasound examination. Plain radiographs and Mri exam were performed just one hour after trauma.

One month after surgical fixation the fracture is studied with dynamic US, Mri and Cone-Beam CT imaging. The US and MR dynamic evaluations, show a regular tendon sliding over the fixation devices.

No metal-induced artifacts were seen, allowing a perfect visualization of the implanted devices.

CBCT Reconstruction

Cone-Beam CT Sagittal (left) and Coronal (right) reconstructions.

The study was completed with dynamic Mri (0.3 Tesla) and Cone-Beam CT scans, performed with active flexion-extension of carpal-metacarpal joint structures.