PMC5828462_01
Initial (a) AP radiograph of the knee and (b) Lateral radiograph of the knee were normal.
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Initial plain radiographs of the knee did not show any obvious abnormality (Figure 1), and he was placed in a knee brace, recommended non-weight bearing, pending further investigation.
MRI (T2 Fat Sat; (a) axial and (b) coronal views) showing lateral and medial femoral bone oedema (osteochondral collapse of lateral femoral condyle).
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Magnetic resonance imaging (MRI) (Figure 2) suggested multiple areas of osteonecrosis in the subchondral portion of distal femur.
(a) and (b) Sagittal CT component of SPECT showing increased focal tracer uptake in the left medial femoral condyle.
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MRI (T2 Fat Sat; (a) axial and (b) sagittal images of left knee) showing medial femoral condyle marrow oedema.
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Six months after his initial presentation, he re-presented with bilateral knee symptoms and similar MRI changes (Figures 4 and 5).
(a) Coronal and (b) sagittal images of right knee showing lateral femoral condyle marrow oedema.
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Six months after his initial presentation, he re-presented with bilateral knee symptoms and similar MRI changes (Figures 4 and 5).
PMC5828462_02
Patient 2 initial presentation. (a) Anterior-posterior radiograph and (b) coronal CT scan.
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Delayed healing. (a) AP radiograph and (b) coronal CT scan before Exogen treatment.
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Low-intensity pulsed ultrasound therapy (Exogen, Bioventus LLC) was commenced four months after presentation due to a lack of radiological evidence of bone healing (Figure 7).
Post-Exogen therapy. (a) Coronal MRI T1 Fat Sat + Gad, (b) sagittal MRI coronal Fat Sat, (c) AP, and (d) lateral radiographs.
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Low-intensity pulsed ultrasound therapy was stopped after a three-month treatment as the radiographs showed good evidence of bone healing (Figure 8).
(a) AP and (b) lateral radiographs demonstrating intra-articular femoral and tibial fractures.
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She was managed in a long leg cast (Figure 9).
(a) AP and (b) lateral radiographs demonstrating ongoing nonunion and progressive deformity.
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Despite conservative treatment, there were no radiological or clinical signs of union, and she developed progressive deformity (Figure 10) and a nontender pseudoarthrosis with ongoing instability.