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It is well known that in femoral head osteonecrosis patients, necrosis and collapse are usually located in the anterosuperior portion of the femoral head. We evaluated the usefulness of a “look-up” plane X-ray view of osteonecrosis for early detection of femoral head collapse. We examined 20 joints in 17 patients. Osteonecrosis was classified into four stages according to radiographic signs (demarcation line, crescent line, collapse and joint space narrowing). Eight joints were classified as stage 2 and 12 joints as stage 3. Collapse, crescent line and demarcation line were evaluated on three types of radiographs; ordinary anteroposterior (AP) and lateral views and the “look-up” view. Seventeen of the 20 hips clearly showed more than 2mm collapse on the “look-up” view. The incidence of clear collapse was higher than that on the AP view. The incidence of crescent line was also higher. There were no significant differences in the demarcation line between the look-up view and AP view. Magnetic resonance imaging and tomography are useful and routinely used to define necrotic lesions. However, the “look-up” view is a simple and inexpensive method for the early detection of femoral head collapse in osteonecrotic patients.

Arthroscopic and arthrographic studies of the osteoarthritic hip joint showed that cartilage degeneration generally originates in the anterosuperior position of the weigth-bearing area. We evaluated the usefulness of a “look-up” plane X-ray view of osteoarthrotic hip joints for early detection of joint space narrowing or articular cartilage wear in the anterosuperior weight-bearing area of the joints. We examined 34 hips of 23 patients consisting of 6 normal joints and 28 coxarthrosis. The coxarthrosis were classified into four stages according to joint space narrowing: prearthritic stage (6 patients), early-stage (5 patients), advanced-stage (10 patients), and end-stage (7 patients). The wiath of the joint space was measured on four types of radiographs in each patient; lying down view, standing up view, lying down look-up view, and standing up look-up view. The joint space on the look-up view in most hips in the prearthritic stage tended to increase in comparison with anteroposterior radiograpf, while one hip joint judged as prearthritic stage showed narrowing of the jont space. The joint space of the hips in the early and advanced stages tended to decrease. There were two cases of early-stage whose look-up views showed joint space narrowing and were judged as advanced stage. In conclusion, the lool-up view reflects cartilage wear in the anterosuperior position and is useful for early detection of joint space narrowing.

We attempted to quantify periarticular bone atrophy from radiographs of the proximal phalanx in patients with rheumatoid arthritis (RA) by means of the National Institutes of Health (NIH) Image computer program. The degree of brightness or darkness in four squares, each 20 × 20 pixels, in the right third proximal phalanx was measured using NIH Image, and the mean value of the 400 pixels was defined as the brightness/darkness index (BDI). The BDI was used to express bone volume. The BDI value was set at zero for an area of complete darkness and at 255 for an area of maximum brightness. The mean coefficient of variation in our hospital was 2.28%. The BDI was measured in 54 RA patients and 146 normal volunteers. The mean BDI at the midpoint of the diaphysis was 100 in RA patients and 176 in normal volunteers, while at the medial side of the proximal end it was 75 and 145, respectively. The difference between normal volunteers and RA patients was greatest in younger people. In some young RA patients, the BDI was significantly low at the medial side of the proximal end, clearly demonstrating periarticular bone atrophy. Periarticular bone atrophy can be quantified using the NIH Image computer program.

Three cases of sternal segment dislocation in children are described. The primary mechanisms were direct blow in a 4-year-old boy, indirect forces in a 3-year-old boy, and osteomyelitis in a 10-year-old boy. The two former cases were dislocated at the junction of the manubrium with the sternal body, and the latter case was at the junction of the first and second sternal segments. The dislocated segments were gradually rotated for approximately 2 weeks and were finally stabilized after rotation. While in the dislocated state, the patients were observed conservatively, although all the dislocated segments were remodeled. Surgical treatment of sternal segment dislocation is not inevitable.