HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Pretorius, E. S. Articles by Fishman, E. K. Search for Related Content PubMed PubMed Citation Articles by Pretorius, E. S. Articles by Fishman, E. K. Related Collections Musculoskeletal Radiology Computed Tomography

Volume-rendered Three-dimensional Spiral CT: Musculoskeletal Applications¹

¹ From the Russell H. Morgan Department of Radiology and Radiologic Science, Johns Hopkins University School of Medicine, Baltimore, Md. Presented as a scientific exhibit at the 1997 RSNA scientific assembly. Received October 28, 1998; revision requested November 23 and received December 30; accepted January 26, 1999. Address reprint requests to E.K.F., Department of Radiology, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287.

View larger version (63K): [in a new window]   Figure 1a.   Diagrams of shaded surface rendering (a) and volume rendering (b) and the resulting 3D images show the variations between these 3D rendering techniques.

View larger version (67K): [in a new window]   Figure 1b.   Diagrams of shaded surface rendering (a) and volume rendering (b) and the resulting 3D images show the variations between these 3D rendering techniques.

View larger version (111K): [in a new window]   Figure 2.   Anterior volume-rendered spiral CT image of the sacrum reveals a subtle fracture of the right aspect of S1 (arrows). The fracture was not seen on conventional axial images because the fracture line lay relatively in the axial plane.

View larger version (117K): [in a new window]   Figures 3, 4.   (3) Scapular fracture in a pedestrian who was struck by an automobile. Posterior volume-rendered spiral CT image shows a complex fracture of the right shoulder. The scapular body is shattered (black arrows), and the scapular spine has become separated from the remainder of the bone. An associated ipsilateral rib fracture is also seen (white arrow). (4) Right posterior oblique volume-rendered spiral CT image of the shoulder shows a comminuted fracture of the scapular body (arrow). The scapular spine, coracoid process, and acromioclavicular joint are intact.

View larger version (118K): [in a new window]   Figures 3, 4.   (3) Scapular fracture in a pedestrian who was struck by an automobile. Posterior volume-rendered spiral CT image shows a complex fracture of the right shoulder. The scapular body is shattered (black arrows), and the scapular spine has become separated from the remainder of the bone. An associated ipsilateral rib fracture is also seen (white arrow). (4) Right posterior oblique volume-rendered spiral CT image of the shoulder shows a comminuted fracture of the scapular body (arrow). The scapular spine, coracoid process, and acromioclavicular joint are intact.

View larger version (91K): [in a new window]   Figures 5, 6.   (5) Inferior volume-rendered spiral CT image shows a comminuted fracture of the medial right clavicle (arrow). The medial aspect of the clavicle is displaced posteriorly with respect to the more lateral portions of the bone. The right sternoclavicular joint is disrupted, as manifested by widening of the joint space. The superior ribs and the great vessels were not injured. (6) Inferior volume-rendered spiral CT image shows posterior dislocation of the right sternoclavicular joint (white arrow). A mediastinal hematoma is present (arrowhead); axial contrast material-enhanced images (not shown) demonstrated the site of venous hemorrhage. There is an associated fracture of the right fourth rib (black arrows).

View larger version (104K): [in a new window]   Figures 5, 6.   (5) Inferior volume-rendered spiral CT image shows a comminuted fracture of the medial right clavicle (arrow). The medial aspect of the clavicle is displaced posteriorly with respect to the more lateral portions of the bone. The right sternoclavicular joint is disrupted, as manifested by widening of the joint space. The superior ribs and the great vessels were not injured. (6) Inferior volume-rendered spiral CT image shows posterior dislocation of the right sternoclavicular joint (white arrow). A mediastinal hematoma is present (arrowhead); axial contrast material-enhanced images (not shown) demonstrated the site of venous hemorrhage. There is an associated fracture of the right fourth rib (black arrows).

View larger version (102K): [in a new window]   Figure 7a.   Lateral (a) and dorsal (b) volume-rendered spiral CT images obtained for surgical planning show a comminuted, intraarticular fracture of the olecranon (arrow), which was identified on plain radiographs. The ulnar diaphysis is displaced distally and slightly volarly relative to the major proximal fracture fragment.

View larger version (98K): [in a new window]   Figure 7b.   Lateral (a) and dorsal (b) volume-rendered spiral CT images obtained for surgical planning show a comminuted, intraarticular fracture of the olecranon (arrow), which was identified on plain radiographs. The ulnar diaphysis is displaced distally and slightly volarly relative to the major proximal fracture fragment.

View larger version (74K): [in a new window]   Figure 8.   Lateral volume-rendered spiral CT image shows an impacted, comminuted, intraarticular fracture of the distal radius with dorsal angulation of the distal fracture fragments (arrow). In this case, spiral CT required 2-mm-thick sections reconstructed at 1-mm intervals to provide detail of small bone structures. No evidence of associated carpal bone fracture was seen at spiral CT.

View larger version (140K): [in a new window]   Figure 9.   Dorsal volume-rendered spiral CT image shows an impacted fracture of the distal radius (thin arrows) with an associated fracture of the distal ulna (thick arrow). A small fracture fragment of the radial styloid process is also seen (arrowhead). The image was obtained through a cast, which would limit the usefulness of plain radiography.

View larger version (122K): [in a new window]   Figure 10.   Spinal fracture secondary to a gunshot wound. Inferior volume-rendered spiral CT image shows an impacted bullet at the pedicle of T11 with extradural extension of both bullet fragments and bone fragments (arrow). Streak artifact is minimal despite the large caliber of the bullet.

View larger version (109K): [in a new window]   Figure 11a.   (a) Lateral volume-rendered spiral CT image shows a flexion teardrop fracture at C6 with posterior displacement of the posterior portion of the vertebral body (arrow). (b) Cutaway anterior volume-rendered spiral CT image best shows the full extent of involvement.

View larger version (105K): [in a new window]   Figure 11b.   (a) Lateral volume-rendered spiral CT image shows a flexion teardrop fracture at C6 with posterior displacement of the posterior portion of the vertebral body (arrow). (b) Cutaway anterior volume-rendered spiral CT image best shows the full extent of involvement.

View larger version (122K): [in a new window]   Figures 12, 13.   (12) Sacral fracture in a 34-year-old woman who was unable to walk or control her bladder after a high-speed motor vehicle accident. Anterior volume-rendered spiral CT image with the pubis and ischium removed by editing shows a fracture of the right hemisacrum that extends through the neural foramina of S1-S4 (arrows). The patient was ultimately able to walk but did not regain normal bladder control. (13) Anterior volume-rendered spiral CT image shows a sacral stress fracture. The fracture lines extend through both the left and right foramina of S1 and S2 (arrows).

View larger version (126K): [in a new window]   Figures 12, 13.   (12) Sacral fracture in a 34-year-old woman who was unable to walk or control her bladder after a high-speed motor vehicle accident. Anterior volume-rendered spiral CT image with the pubis and ischium removed by editing shows a fracture of the right hemisacrum that extends through the neural foramina of S1-S4 (arrows). The patient was ultimately able to walk but did not regain normal bladder control. (13) Anterior volume-rendered spiral CT image shows a sacral stress fracture. The fracture lines extend through both the left and right foramina of S1 and S2 (arrows).

View larger version (108K): [in a new window]   Figures 14-16.   (14) Pelvic fracture in a 15-year-old boy who was struck by an automobile. Volume-rendered spiral CT image (superior view of left anterior oblique projection) shows the extent of an acetabular fracture (arrow), which was surgically repaired. (15a) Volume-rendered spiral CT image (angled inlet view) shows the extent of a right acetabular fracture (arrows). (15b) Edited right posterior oblique volume-rendered spiral CT image best shows the orientation of the fracture lines and the acetabulum. (16) Pelvic fracture with an intraar-ticular fragment in a 15-year-old boy who was struck by a bus. Inferior volume-rendered spiral CT image shows a posterior acetabular fracture (curved arrow). An intraarticular bone fragment is seen (straight arrow); this fragment was a result of the initial injury, which was a posterior fracture with dislocation.

View larger version (105K): [in a new window]   Figures 14-16.   (14) Pelvic fracture in a 15-year-old boy who was struck by an automobile. Volume-rendered spiral CT image (superior view of left anterior oblique projection) shows the extent of an acetabular fracture (arrow), which was surgically repaired. (15a) Volume-rendered spiral CT image (angled inlet view) shows the extent of a right acetabular fracture (arrows). (15b) Edited right posterior oblique volume-rendered spiral CT image best shows the orientation of the fracture lines and the acetabulum. (16) Pelvic fracture with an intraar-ticular fragment in a 15-year-old boy who was struck by a bus. Inferior volume-rendered spiral CT image shows a posterior acetabular fracture (curved arrow). An intraarticular bone fragment is seen (straight arrow); this fragment was a result of the initial injury, which was a posterior fracture with dislocation.

View larger version (115K): [in a new window]   Figures 14-16.   (14) Pelvic fracture in a 15-year-old boy who was struck by an automobile. Volume-rendered spiral CT image (superior view of left anterior oblique projection) shows the extent of an acetabular fracture (arrow), which was surgically repaired. (15a) Volume-rendered spiral CT image (angled inlet view) shows the extent of a right acetabular fracture (arrows). (15b) Edited right posterior oblique volume-rendered spiral CT image best shows the orientation of the fracture lines and the acetabulum. (16) Pelvic fracture with an intraar-ticular fragment in a 15-year-old boy who was struck by a bus. Inferior volume-rendered spiral CT image shows a posterior acetabular fracture (curved arrow). An intraarticular bone fragment is seen (straight arrow); this fragment was a result of the initial injury, which was a posterior fracture with dislocation.

View larger version (101K): [in a new window]   Figures 14-16.   (14) Pelvic fracture in a 15-year-old boy who was struck by an automobile. Volume-rendered spiral CT image (superior view of left anterior oblique projection) shows the extent of an acetabular fracture (arrow), which was surgically repaired. (15a) Volume-rendered spiral CT image (angled inlet view) shows the extent of a right acetabular fracture (arrows). (15b) Edited right posterior oblique volume-rendered spiral CT image best shows the orientation of the fracture lines and the acetabulum. (16) Pelvic fracture with an intraar-ticular fragment in a 15-year-old boy who was struck by a bus. Inferior volume-rendered spiral CT image shows a posterior acetabular fracture (curved arrow). An intraarticular bone fragment is seen (straight arrow); this fragment was a result of the initial injury, which was a posterior fracture with dislocation.

View larger version (149K): [in a new window]   Figure 17.   Anterior volume-rendered spiral CT image of the pelvis shows that the osseous and major vascular structures are normal. In this trauma case, evaluation of the aorta and major pelvic vasculature was performed at the same time as evaluation of the osseous pelvis.

View larger version (84K): [in a new window]   Figures 18-20.   (18) Knee fracture in a patient with a history of a gunshot wound. Anterior (a) and lateral (b) volume-rendered spiral CT images show a comminuted fracture of the distal femur (arrow). (19) Anterior (a) and lateral (b) volume-rendered spiral CT images clearly show a comminuted fracture of the tibial plateau (arrow). Because of the presence of a partial cast, the examination would have been extremely limited if performed with plain radiography. (20) Knee fracture in a 12-year-old boy who hit a stationary automobile while riding a moped. Anterior (a) and posterior (b) volume-rendered spiral CT images show a fracture of the lateral aspect of the distal femur (arrow in a). Avulsion of the tibial spines is best seen on the posterior view (arrow in b).

View larger version (77K): [in a new window]   Figures 18-20.   (18) Knee fracture in a patient with a history of a gunshot wound. Anterior (a) and lateral (b) volume-rendered spiral CT images show a comminuted fracture of the distal femur (arrow). (19) Anterior (a) and lateral (b) volume-rendered spiral CT images clearly show a comminuted fracture of the tibial plateau (arrow). Because of the presence of a partial cast, the examination would have been extremely limited if performed with plain radiography. (20) Knee fracture in a 12-year-old boy who hit a stationary automobile while riding a moped. Anterior (a) and posterior (b) volume-rendered spiral CT images show a fracture of the lateral aspect of the distal femur (arrow in a). Avulsion of the tibial spines is best seen on the posterior view (arrow in b).

View larger version (89K): [in a new window]   Figures 18-20.   (18) Knee fracture in a patient with a history of a gunshot wound. Anterior (a) and lateral (b) volume-rendered spiral CT images show a comminuted fracture of the distal femur (arrow). (19) Anterior (a) and lateral (b) volume-rendered spiral CT images clearly show a comminuted fracture of the tibial plateau (arrow). Because of the presence of a partial cast, the examination would have been extremely limited if performed with plain radiography. (20) Knee fracture in a 12-year-old boy who hit a stationary automobile while riding a moped. Anterior (a) and posterior (b) volume-rendered spiral CT images show a fracture of the lateral aspect of the distal femur (arrow in a). Avulsion of the tibial spines is best seen on the posterior view (arrow in b).

View larger version (101K): [in a new window]   Figures 18-20.   (18) Knee fracture in a patient with a history of a gunshot wound. Anterior (a) and lateral (b) volume-rendered spiral CT images show a comminuted fracture of the distal femur (arrow). (19) Anterior (a) and lateral (b) volume-rendered spiral CT images clearly show a comminuted fracture of the tibial plateau (arrow). Because of the presence of a partial cast, the examination would have been extremely limited if performed with plain radiography. (20) Knee fracture in a 12-year-old boy who hit a stationary automobile while riding a moped. Anterior (a) and posterior (b) volume-rendered spiral CT images show a fracture of the lateral aspect of the distal femur (arrow in a). Avulsion of the tibial spines is best seen on the posterior view (arrow in b).

View larger version (102K): [in a new window]   Figures 18-20.   (18) Knee fracture in a patient with a history of a gunshot wound. Anterior (a) and lateral (b) volume-rendered spiral CT images show a comminuted fracture of the distal femur (arrow). (19) Anterior (a) and lateral (b) volume-rendered spiral CT images clearly show a comminuted fracture of the tibial plateau (arrow). Because of the presence of a partial cast, the examination would have been extremely limited if performed with plain radiography. (20) Knee fracture in a 12-year-old boy who hit a stationary automobile while riding a moped. Anterior (a) and posterior (b) volume-rendered spiral CT images show a fracture of the lateral aspect of the distal femur (arrow in a). Avulsion of the tibial spines is best seen on the posterior view (arrow in b).

View larger version (104K): [in a new window]   Figures 18-20.   (18) Knee fracture in a patient with a history of a gunshot wound. Anterior (a) and lateral (b) volume-rendered spiral CT images show a comminuted fracture of the distal femur (arrow). (19) Anterior (a) and lateral (b) volume-rendered spiral CT images clearly show a comminuted fracture of the tibial plateau (arrow). Because of the presence of a partial cast, the examination would have been extremely limited if performed with plain radiography. (20) Knee fracture in a 12-year-old boy who hit a stationary automobile while riding a moped. Anterior (a) and posterior (b) volume-rendered spiral CT images show a fracture of the lateral aspect of the distal femur (arrow in a). Avulsion of the tibial spines is best seen on the posterior view (arrow in b).

View larger version (81K): [in a new window]   Figures 21, 22.   (21) Anterior (a) and superior (b) volume-rendered spiral CT images obtained through a cast show a comminuted, impacted fracture of the distal tibia (arrows in a). (22) Lateral (a) and anterior (b) volume-rendered spiral CT images show a Salter II fracture of the distal tibia (arrows in a, solid arrow in b) with considerable anterior and lateral displacement and angulation of distal fracture fragments. The anterior view also clearly shows an associated fibular injury (open arrow in b).

View larger version (102K): [in a new window]   Figures 21, 22.   (21) Anterior (a) and superior (b) volume-rendered spiral CT images obtained through a cast show a comminuted, impacted fracture of the distal tibia (arrows in a). (22) Lateral (a) and anterior (b) volume-rendered spiral CT images show a Salter II fracture of the distal tibia (arrows in a, solid arrow in b) with considerable anterior and lateral displacement and angulation of distal fracture fragments. The anterior view also clearly shows an associated fibular injury (open arrow in b).

View larger version (85K): [in a new window]   Figures 21, 22.   (21) Anterior (a) and superior (b) volume-rendered spiral CT images obtained through a cast show a comminuted, impacted fracture of the distal tibia (arrows in a). (22) Lateral (a) and anterior (b) volume-rendered spiral CT images show a Salter II fracture of the distal tibia (arrows in a, solid arrow in b) with considerable anterior and lateral displacement and angulation of distal fracture fragments. The anterior view also clearly shows an associated fibular injury (open arrow in b).

View larger version (99K): [in a new window]   Figures 21, 22.   (21) Anterior (a) and superior (b) volume-rendered spiral CT images obtained through a cast show a comminuted, impacted fracture of the distal tibia (arrows in a). (22) Lateral (a) and anterior (b) volume-rendered spiral CT images show a Salter II fracture of the distal tibia (arrows in a, solid arrow in b) with considerable anterior and lateral displacement and angulation of distal fracture fragments. The anterior view also clearly shows an associated fibular injury (open arrow in b).

View larger version (135K): [in a new window]   Figure 23.   Ankle fracture in a patient with a history of a fall from a height of several meters. Lateral volume-rendered spiral CT image obtained through a cast shows a comminuted fracture of the calcaneus (arrows). The subtalar joint appears to be intact.

View larger version (133K): [in a new window]   Figure 24a.   Superior (a) and posterior (b) volume-rendered spiral CT images obtained through a cast show the extent of a comminuted calcaneal fracture (arrow), which was the result of a three-story jump from a burning building. The orientation of the fracture fragments seen on these views is helpful for presurgical planning, and the intraarticular nature of the fracture (arrow in b) is best seen in the posterior projection.

View larger version (136K): [in a new window]   Figure 24b.   Superior (a) and posterior (b) volume-rendered spiral CT images obtained through a cast show the extent of a comminuted calcaneal fracture (arrow), which was the result of a three-story jump from a burning building. The orientation of the fracture fragments seen on these views is helpful for presurgical planning, and the intraarticular nature of the fracture (arrow in b) is best seen in the posterior projection.

View larger version (161K): [in a new window]   Figure 25.   Anterior volume-rendered spiral CT image shows osteomyelitis with bone erosion in the thoracic spine. The infection proved to be due to Staphylococcus aureus.

View larger version (139K): [in a new window]   Figure 26.   Osteomyelitis in a patient with a history of intravenous drug abuse. Anterior volume-rendered spiral CT image shows osteomyelitis with erosion of the proximal right clavicle and the manubrium (arrow). The infection was due to S aureus.

View larger version (113K): [in a new window]   Figure 27a.   Soft-tissue abscess in a patient with a history of drug use and shoulder pain. Lateral (a) and posterior (b) volume-rendered spiral CT images obtained after administration of intravenous contrast material show a large abscess that involves the right shoulder. The full extent of the abscess is seen, including involvement of the supraspinous (arrowheads), infraspinous (solid arrow), and teres minor (open arrow) muscles. Blood cultures were positive for S aureus.

View larger version (106K): [in a new window]   Figure 27b.   Soft-tissue abscess in a patient with a history of drug use and shoulder pain. Lateral (a) and posterior (b) volume-rendered spiral CT images obtained after administration of intravenous contrast material show a large abscess that involves the right shoulder. The full extent of the abscess is seen, including involvement of the supraspinous (arrowheads), infraspinous (solid arrow), and teres minor (open arrow) muscles. Blood cultures were positive for S aureus.

View larger version (126K): [in a new window]   Figure 28a.   Soft-tissue abscesses in a 33-year-old woman with systemic lupus erythematosus, which was being treated with steroids. The patient presented with shoulder and arm pain, and the steroid dosage was increased to treat the suspected flare of the disease. Anterior (a) and inferior (b) volume-rendered spiral CT images obtained after administration of intravenous contrast material show multiple hypoattenuating, rim-enhancing abscesses in the right arm and chest wall (arrows). These abscesses, which track through the arm musculature, are seen to be interconnected. Group A streptococci were cultured from the abscesses.

View larger version (106K): [in a new window]   Figure 28b.   Soft-tissue abscesses in a 33-year-old woman with systemic lupus erythematosus, which was being treated with steroids. The patient presented with shoulder and arm pain, and the steroid dosage was increased to treat the suspected flare of the disease. Anterior (a) and inferior (b) volume-rendered spiral CT images obtained after administration of intravenous contrast material show multiple hypoattenuating, rim-enhancing abscesses in the right arm and chest wall (arrows). These abscesses, which track through the arm musculature, are seen to be interconnected. Group A streptococci were cultured from the abscesses.

View larger version (115K): [in a new window]   Figure 29.   Anterior volume-rendered spiral CT image shows a large lytic lesion involving the superior aspect of the sacrum (arrow). No matrix was seen. This finding proved to be a giant cell tumor. On the basis of the CT appearance, the differential diagnosis would also include metastatic disease, chordoma, and neurofibroma.

View larger version (109K): [in a new window]   Figure 30.   Metastasis in a patient with known carcinoma of the breast. Anterior volume-rendered spiral CT image shows a sclerotic metastasis to the left ischium (arrow).

View larger version (118K): [in a new window]   Figures 31-34.   (31) Posterior volume-rendered spiral CT image shows a sclerotic lesion within the left aspect of the transitional L5 vertebral body (arrows). The study was performed for preoperative planning. The lesion represented a Ewing sarcoma, which appeared to be localized to this vertebral body. (32) Anterior volume-rendered spiral CT image shows a destructive, midline lesion of the sacrum (arrow). The lesion was a biopsy-proved chordoma. (33) Superior volume-rendered spiral CT image shows extensive replacement and destruction of the scapula by advanced multiple myeloma. (34) Lateral volume-rendered spiral CT image shows a mixture of sclerotic (thin arrows) and lytic (thick arrow) lesions within the lumbar spine, findings consistent with the patient's known lymphoma. The superior end plate of the L3 vertebral body has collapsed (top thin arrow).

View larger version (125K): [in a new window]   Figures 31-34.   (31) Posterior volume-rendered spiral CT image shows a sclerotic lesion within the left aspect of the transitional L5 vertebral body (arrows). The study was performed for preoperative planning. The lesion represented a Ewing sarcoma, which appeared to be localized to this vertebral body. (32) Anterior volume-rendered spiral CT image shows a destructive, midline lesion of the sacrum (arrow). The lesion was a biopsy-proved chordoma. (33) Superior volume-rendered spiral CT image shows extensive replacement and destruction of the scapula by advanced multiple myeloma. (34) Lateral volume-rendered spiral CT image shows a mixture of sclerotic (thin arrows) and lytic (thick arrow) lesions within the lumbar spine, findings consistent with the patient's known lymphoma. The superior end plate of the L3 vertebral body has collapsed (top thin arrow).

View larger version (124K): [in a new window]   Figures 31-34.   (31) Posterior volume-rendered spiral CT image shows a sclerotic lesion within the left aspect of the transitional L5 vertebral body (arrows). The study was performed for preoperative planning. The lesion represented a Ewing sarcoma, which appeared to be localized to this vertebral body. (32) Anterior volume-rendered spiral CT image shows a destructive, midline lesion of the sacrum (arrow). The lesion was a biopsy-proved chordoma. (33) Superior volume-rendered spiral CT image shows extensive replacement and destruction of the scapula by advanced multiple myeloma. (34) Lateral volume-rendered spiral CT image shows a mixture of sclerotic (thin arrows) and lytic (thick arrow) lesions within the lumbar spine, findings consistent with the patient's known lymphoma. The superior end plate of the L3 vertebral body has collapsed (top thin arrow).

View larger version (122K): [in a new window]   Figures 31-34.   (31) Posterior volume-rendered spiral CT image shows a sclerotic lesion within the left aspect of the transitional L5 vertebral body (arrows). The study was performed for preoperative planning. The lesion represented a Ewing sarcoma, which appeared to be localized to this vertebral body. (32) Anterior volume-rendered spiral CT image shows a destructive, midline lesion of the sacrum (arrow). The lesion was a biopsy-proved chordoma. (33) Superior volume-rendered spiral CT image shows extensive replacement and destruction of the scapula by advanced multiple myeloma. (34) Lateral volume-rendered spiral CT image shows a mixture of sclerotic (thin arrows) and lytic (thick arrow) lesions within the lumbar spine, findings consistent with the patient's known lymphoma. The superior end plate of the L3 vertebral body has collapsed (top thin arrow).

View larger version (97K): [in a new window]   Figures 35-37.   (35) Complex pelvic injury reduced intraoperatively. Spiral CT with 3D reconstruction was performed to determine if the reduction was successful. Despite extensive metal artifact due to plates and screws in the pubic symphysis, both iliac crests, and the sacrum, superior (a) and inferior (b) volume-rendered spiral CT images show successful reduction of the fractures. Specific detail, especially that of the left sacral fracture (arrows in a), is well defined. (36) Anterior volume-rendered spiral CT image (transparent mode) shows a pin inserted through an impacted fracture of the left femoral neck. The study was performed to confirm accurate placement of the pin, which is well seen on this image. No streak artifact from the pin is seen. (37) Anterior volume-rendered spiral CT image shows a failed right hip prosthesis, which is superiorly displaced relative to the osseous acetabulum. Several cerclage wires are broken. A slight streak is visible, but osseous detail in the region of the prosthesis failure can still be seen.

View larger version (112K): [in a new window]   Figures 35-37.   (35) Complex pelvic injury reduced intraoperatively. Spiral CT with 3D reconstruction was performed to determine if the reduction was successful. Despite extensive metal artifact due to plates and screws in the pubic symphysis, both iliac crests, and the sacrum, superior (a) and inferior (b) volume-rendered spiral CT images show successful reduction of the fractures. Specific detail, especially that of the left sacral fracture (arrows in a), is well defined. (36) Anterior volume-rendered spiral CT image (transparent mode) shows a pin inserted through an impacted fracture of the left femoral neck. The study was performed to confirm accurate placement of the pin, which is well seen on this image. No streak artifact from the pin is seen. (37) Anterior volume-rendered spiral CT image shows a failed right hip prosthesis, which is superiorly displaced relative to the osseous acetabulum. Several cerclage wires are broken. A slight streak is visible, but osseous detail in the region of the prosthesis failure can still be seen.

View larger version (76K): [in a new window]   Figures 35-37.   (35) Complex pelvic injury reduced intraoperatively. Spiral CT with 3D reconstruction was performed to determine if the reduction was successful. Despite extensive metal artifact due to plates and screws in the pubic symphysis, both iliac crests, and the sacrum, superior (a) and inferior (b) volume-rendered spiral CT images show successful reduction of the fractures. Specific detail, especially that of the left sacral fracture (arrows in a), is well defined. (36) Anterior volume-rendered spiral CT image (transparent mode) shows a pin inserted through an impacted fracture of the left femoral neck. The study was performed to confirm accurate placement of the pin, which is well seen on this image. No streak artifact from the pin is seen. (37) Anterior volume-rendered spiral CT image shows a failed right hip prosthesis, which is superiorly displaced relative to the osseous acetabulum. Several cerclage wires are broken. A slight streak is visible, but osseous detail in the region of the prosthesis failure can still be seen.

View larger version (91K): [in a new window]   Figures 35-37.   (35) Complex pelvic injury reduced intraoperatively. Spiral CT with 3D reconstruction was performed to determine if the reduction was successful. Despite extensive metal artifact due to plates and screws in the pubic symphysis, both iliac crests, and the sacrum, superior (a) and inferior (b) volume-rendered spiral CT images show successful reduction of the fractures. Specific detail, especially that of the left sacral fracture (arrows in a), is well defined. (36) Anterior volume-rendered spiral CT image (transparent mode) shows a pin inserted through an impacted fracture of the left femoral neck. The study was performed to confirm accurate placement of the pin, which is well seen on this image. No streak artifact from the pin is seen. (37) Anterior volume-rendered spiral CT image shows a failed right hip prosthesis, which is superiorly displaced relative to the osseous acetabulum. Several cerclage wires are broken. A slight streak is visible, but osseous detail in the region of the prosthesis failure can still be seen.