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Regional migrating osteoporosis (RMO) was observed in young man with episodes of bone pain in bearing joints, which migrated from hip to leg and subsequently to knee on the unilateral side. Dynamic scintigraphy (SPECT) carried out during relapse of pain demonstrated increased accumulation of radioizotope in Lisfrank joint, distal epiphysis of femur and proximal epiphysis of tibia on the unilateral side due to hyperperfusion and high metabolic turnover in these regions of the skeleton. Dia-gnosis of RMO was confirmed by magnetic resonance (MRI), which showed bone marrow edema of corresponding regions. Although RMO is relatively benign disease with spontaneous remissions, infection etiology or the more serious avascular necrosis should be taken into account.

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A group of 9 patients with a suspected fracture of the hip underwent radiography and subsequently magnetic resonance imaging (MRI) diagnosis. Radiographic findings were in 2 cases negative and in 7 cases the radiographs revealed a fissure or fracture of the greater trochanter. MRI proved a complete pertrochanteric fracture in 1 case, an incomplete pertrochanteric fracture in 8 cases and in all the 9 cases a fracture of the greater trochanter. Occult pertrochanteric fractures were readily demonstrated with frontal scans. Sagittal and transversal scans showed only more precisely the course of the fracture line and involvement of the intertrochanteric crest, if any. Among the 9 patients, 6 were managed conservatively and 3 patients were treated with a 2-hole DHS (dynamic hip screw). Indication for surgery was based primarily on the scope of the patients' subjective complaints and on their general condition. All the 9 patients healed without complications. The authors indicate MR imaging diagnosis in clinically suspected fractures of the proximal femur where the radiographic finding is negative. Fractures with a radiographic finding of a fissure or fracture of the greater trochanter should be examined by MRI that in most cases reveals an occult pertrochanteric fracture.

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Currently, conventional diagnosis of acetabular fractures is often supplemented and even replaced by CT examination, as this can provide a more detailed image of the extent of fracture and its morphology. Supported by developmental anatomy, Harris et al. proposed a new classification for acetabular fractures in which the pubic bone component of the acetabulum is shown to coincide with the anterior column of the acetabulum. There is no need to abandon the generally accepted and much used Letournel-Judet classification, but changes in the algorithm of acetabular fracture examination will certainly require that the CT classification of acetabular fractures is included. The Harris classification, based on evaluation of simple and unambiguous axial CT scans, is readily understood by both radiologists and orthopedic trauma surgeons and thus the use of it will foster greater interdisciplinary cooperation resulting in a better care for patients with acetabular fractures. Key words: acetabular fracture, CT-based classification, CT-based diagnosis.

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PURPOSE OF THE STUDY: The treatment of chondral defects by transplantation of autologous chondrocytes has recently shown further development. Various biomaterials are used as carriers facilitating attachment and even distribution of chondrocytes in the defect. Since 2003 Hyalograft C, hyaluronan-based scaffolds, has been used, in a clinical study, for implantation of autologous chondrocytes in the treatment of deep chondral lesions of the knee at our department. MATERIAL: Eight patients (7 men and 1 woman; average age, 31 years) followed up for at least 9 months were evaluated. The lesions with an average size of 3.9 cm2 were localized on femoral condyles. METHODS: The outcome of surgery was evaluated on the basis of the IKDC Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS) and Lysholm knee score. The patients underwent MR examination preoperatively and at 3, 6 and 12 months after surgery. The newly-formed cartilage was assessed by International Cartilage Repair Society (ICRS) visual scores at second-look arthroscopy carried out at 9 to 12 months following transplantation. Consistency of the new cartilage developing in the defect and that of healthy cartilage around the defect was compared by means of a special indentation probe in three patients. A biopsy sample was collected from the grafted site for histological, histochemical and immunohistochemical examination. RESULTS: All patients reported improvement in knee function on average at 10 months after surgery. The average IKDC subjective score increased from 46 points preoperatively to 74 points postoperatively. The KOOS evaluation showed pain relief and improved function. In quality of life evaluation the average score of 35 points before surgery increased to 70 points after it. The average Lysholm knee score was 61 points before and 83 points after surgery. MR findings correlated well with arthroscopic findings. Second-look arthroscopy showed a normal appearance of the newly-formed cartilage in six, and an abnormal appearance in two patients. The average ICRS visual score was 9.4 points. No graft failure was recorded. The newly-produced tissue had the histological characteristics of a mixed hyaline and fibrous cartilage in seven patients, and of hyaline-like cartilage in one patient. DISCUSSION: The ICRS visual repair assessment of the newly-formed tissue showed that our results were better than the one-year outcomes reported by Bartlett et al. (11 patients after transplantation of a collagen bilayer seeded with chondrocytes), but worse than the results of an Italian multi-center study (55 patients with Hyalograft C-based grafts followed up on average for 14 months). At almost one year, implantation of on a Hyalograft C resulted in the production of mixed cartilage incorporated well in the subchondral bone. Only one patient had mature hyaline cartilage. One year is too short to allow for complete remodeling of the newly formed cartilage into a mature hyaline cartilage. This is in agreement with other studies suggesting that the new cartilage continues to mature and remodel for a time longer than one year. CONCLUSIONS: Based on our results we suggest that the use of Hyalograft C is a safe and effective option for treatment of deep chondral defects of the knee; it is particularly useful in patients in whom the primary defect treatment has failed. The application of Haylograft C is relatively quick and easy; this is convenient when surgery involves more than one procedure (ligament reconstruction, osteotomy). However, a definite evaluation of this method will be possible only after long-term results are available. Key words: deep cartilage defects, chondral defects, cartilage repair, autologous chondrocyte transplantation, hyaluronan- based scaffold, Hyalograft C, cartilage repair assessment, ICRS.

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We present a case of a 15-year-old girl with osteoid osteoma in an unusual subchondral localization of the olecranon. Unspecific complaints and minimal X-ray findings at the onset of the disease led to an incorrect diagnosis and more than 2 years of inefficient treatment.

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The authors report on a case of a complete protrusion of the cup of the hip joint into pelvis. Angiographic examination documents a considerable displacement of iliac vessels caused by the pressure of the displaced acetabular cup which poses a great risk of the injury of vessels during the revision surgery. As a solution of this complication the authors used a separate extraperitoneal approach described in literature as an approach to iliac vessels after Leitz allowing a safe removal of the acetabular cup and the ball of the prosthesis. For the removal of the stem the transgluteal approach was used. Key words: Pelvic protrusion of the acetabular cup, angiography, extraperitoneal release of iliac vessels.

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The article presents a most detailed description of the individual radiologic methods used for the examination of the fractures of the thoracolumbar spine, i.e. CAT examination including 3-D reconstruction and magnetic resonance. Apart from technical procedures and the assessment of individual methods the article also shows their comparison.

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One hundred and forty consecutive DSA examinations of various musculoskeletal diseases were analyzed with respect to the contributions and/or limits of this modern diagnostic imaging modality. Angiography remains the imaging tool of choice for many benign and malignant orthopedic conditions of bones and soft tissues, mainly when MRI is still not generally available. It remains indispensable for embolization and/or local chemotherapy. DSA has the advantage of being less invasive and it also surpasses analog arteriography in better visualization of vascular patterns hidden in hyperostosis, sclerosis, and metallic shadows. Angiographic investigations, when necessary, should therefore start with DSA.

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Digital subtraction angiography (DSA) performed with modern sophisticated equipment has been improved substantially in its ability to document also small vessels and pathologic vascularization patterns in tumorous conditions of the locomotor apparatus. Its domain is in imaging vascular patterns hidden by structural (mainly sclerotic) shadows in their vicinity. In 152 patients out of the total patient collective in the Bone Tumor Register in Prague having a bone tumor or a tumor-like condition, DSA proved to be a mild method of choice for the diagnostic imaging of vascular patterns of the lesions and/or combined diapeutic interventions and has not lost its raison d'être in the era of CT and MRI.

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The authors describe a case of a recurrent posterior traumatic dislocation of the hip in a child in whom early arthrography demonstrated a large defect of the posterior capsule. The authors emphasize the necessity of prolonged immobilization and long-term follow-up. The operation of the patient was performed on the 7th day after the third recurrence of the dislocation. Revision and suture of the capsular defect from Gibson's approach were done.

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