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Abstract
Radiograph remains an important diagnostic tool for detection of musculoskeletal diseases despite recent advances in computed tomography (CT) or magnetic reso-nance imaging (MRI). Many musculoskeletal disorders are primarily diagnosed by identifying characteristic features on radiographs, which are known to have diagnos-tic value. In addition, radiographs provide basic information for determining the ne-cessity of cross-sectional imaging such as CT or MRI. Therefore, radiologists should be aware of the radiographic findings of musculoskeletal diseases and they should apply them to establish the diagnosis. This article presents a review of the important radiographic findings that enable the diagnosis of musculoskeletal diseases of the lower extremity.
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Fig. 2.
Acetabular fracture: both column fracture of the associated type. Both column fracture of the right acetabulum is seen on (A) anteropos-terior radiograph and (B) CT sagittal reformation image (arrows). On CT sagittal reformation image, fracture lines extending into the ischium (ar-row) and ilium (hollow arrows) are seen. CT = computed tomography
Fig. 4.
Avulsion fracture of the ischial tuberosity. There is an avulsion fracture of the left ischial tuberosity (arrow) on which the left hamstring muscle originates.
Fig. 6.
Femoral neck fracture, Garden stage IV. There is a completely dis-placed fracture of the left femoral neck on the anteroposterior radiograph.
Fig. 7.
Bisphosphonate-related fracture. A. There is focal thickening of the lateral cortex of the right proximal femur (arrow) on the AP radiograph. B. After three months, a transverse fracture is seen on the AP radiograph. AP = anteroposterior
Fig. 8.
Legg-Calvé-Perthes disease. A. Sclerosis of the proximal epiphysis of the left femur is seen on the AP radiograph. B. Fragmentation and flattening of the proximal epiphysis of the left femur (arrow) are seen on the nine-month follow-up AP radiograph. AP = anteroposterior
Fig. 9.
Slipped capital femoral epiphysis. The left femoral head is dis-placed medially compared to the right femoral head. The growth plate of the left femur is also widened compared to that of the right femur. The right Klein line (A) intersects the right femoral head; however, the left Klein line (B) does not intersect the left femoral head.
Fig. 10.
Femoral head avascular necrosis, stage III. A. The shape of the left femoral head is different from normal sphericity and the superior articular surface is flattened (arrows). B. Flattening of the femoral head and low signal intensity caused by bone marrow edema are observed on T1-weighted coronal magnetic reso-nance image. There is a subchondral fracture on the superior aspect of the femoral head (arrowhead).
Fig. 11.
Rheumatoid arthritis of the hip joint. A. Symmetric joint space narrowing of bilateral hip joints in the axial direction is seen on the anteroposterior radiograph. B. Symmetric joint space narrowing of bilateral hip joints in the axial direction is also seen on fat-suppressed T2-weighted coronal magnetic reso-nance image. Synovial proliferation (arrow) and a subchondral cyst (arrowhead) in the acetabulum of the right hip joint are noted.
Fig. 12.
Distal femur fracture, AO/OTA classification, type C3. There is a complex fracture with displacement (arrows) involving the medial con-dyle, the lateral condyle, and the intercondylar area on (A) anteroposterior and (B) lateral radiographs. An abnormal opacity is seen in the soft tissue area on the lateral aspect of the lateral condyle (arrowheads).
Fig. 14.
Tibial plateau fracture, Schatzker classification, type IV. The fracture line is seen in the medial tibial plateau (arrows) and the intercondy-lar eminence (hollow arrow) on the (A) anteroposterior radiograph and (B) the oblique radiograph.
Fig. 15.
Physeal injury of the knee joint, Salter-Harris classification, type I. The medial aspect of the growth plate of the left distal femur is wid-ened (arrows) on the (A) anteroposterior radiograph and (B) the left lateral radiograph compared with the growth plate of the right distal femur.
Fig. 16.
Patellar complex fracture. A complex fracture (arrows) is seen on anteroposterior (A) and lateral (B) radiographs. Soft tissue swelling (arrowhead) in the prepatellar area is also seen on the lateral radiograph.
Fig. 17.
Segond fracture. A. A segond fracture is seen on the lateral aspect of the lateral tibial plateau on the anteroposterior radiograph (arrow). B. There is a rupture in the proximal portion of the anterior cruciate ligament (hollow arrows) on T2-weighted sagittal magnetic resonance images.
Fig. 18.
Osteochondritis dissecans. The bone fragment makes contact with the articular surface of the femoral condyle and is surrounded by the radiolucent line (arrows) on the anteroposterior radiograph.
Fig. 19.
Patella alta. The longest length of the patella (A) is 4.2 cm and the longest length of the patellar tendon (B) is 6.4 cm on the lateral ra-diograph; therefore, the Insall-Salvati index is 1.52. A diagnosis of pa-tella alta can be made because the Insall-Salvati index is more than 1.2.
Fig. 20.
Degenerative osteoarthritis of the knee joint. There is progres-sive joint space narrowing at the medial aspect of the knee joint com-pared to the lateral aspect of the knee joint. Also, there are osteo-phytes (arrows) on the medial aspect of the knee joint. The diagnosis of Kellgren-Lawrence grade 3 osteoarthritis in bilateral knee joints can be made.
Fig. 21.
Rheumatoid arthritis of the knee joint. There is symmetric joint space narrowing of bilateral knee joints. Subchondral cysts (arrows) and sclerosis are seen in the bilateral lateral tibial plateau.
Fig. 23.
Ankle joint fracture: supination–external rotation. A. A spiral fracture of the lateral malleolus (arrow) and a transverse fracture of the medial malleolus (hollow arrow) are seen on the anteroposte-rior radiograph. B. A fracture of the posterior tibial lip (arrowhead) is noted.
Fig. 24.
Ankle joint fracture: pronation–external rotation. A. The distance between the lateral border of the medial malleolus and the medial border of the talus (medial clear space, arrow line) is 8.5 mm, and the distance between the lateral border of the tibia and the medial border of the fibula (tibiofibular overlap, white line) is 6.3 mm on the an-kle AP radiograph. Therefore, a tibiofibular syndesmosis injury is suspected. B. A fracture of the proximal fibula (arrow) is seen on the entire AP radiograph of the tibia and fibula. AP = anteroposterior
Fig. 25.
Calcaneal complex fracture. There is a calcaneal complex fracture (arrows) on the (A) lateral radiograph and (B) computed tomography sagittal reformation image.
Fig. 26.
Calcaneal stress fracture. An increased opacity line, which is parallel to the posterior border of the calcaneus (arrows), is noted.
Fig. 27.
Osteochondral lesion of the talus. An oval-shaped decreased opacity lesion with a peripheral sclerotic border (arrow) is seen on the medial talar dome.
Fig. 28.
Freiberg disease. The flattening of 2nd metatarsal head (arrows) is seen on foot anteroposterior radiograph (A) and internal oblique ra-diograph (B). The widening of 2nd MTP joint is seen compared with other MTP joints. MTP = metatarsophalangeal
Fig. 29.
Talocalcaneal coalition. A. The C-sign indicates continuation between the talar dome and the sustentaculum tali (arrows) on the lateral radiograph. B. There is continuation between the talar dome and the sustentaculum tali (hollow arrow) on the fat-suppressed proton density weighted coro-nal magnetic resonance image.
Fig. 30.
Hallux valgus. The angle between the longitudinal axis of the 1st metatarsal bone and the longitudinal axis of the 1st proximal pha-lanx (hallux valgus angle) on the foot anteroposterior radiograph is 36 degrees on the right and 35 degrees on the left, respectively. In addition, the angle between the longitudinal axes of the 1st and 2nd metatarsal bones (first–second intermetatarsal angle) is 18 degrees on the right and 17 degrees on the left, respectively. Hallux valgus angles of bilateral feet are more than 15 degrees and first–second intermeta-tarsal angles are more than 10 degrees; therefore, a diagnosis of bilat-eral hallux valgus can be made.
Fig. 31.
Gout. There are several soft tissue opacities (arrows) on the medial and lateral aspects of bilateral feet. There are soft tissue opaci-ties and erosion on the lateral aspect of the right 1st proximal phalanx (arrowhead). The characteristic “overhanging edge” (hollow arrow) is seen on the medial aspect of the left 1st metatarsal head.
Table 1.
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