Controversies

Richard H. Daffner, M.D., F.A.C.R.

Variety may be the spice of life, as the old adage goes. However, controversy adds excitement to the mix. Controversies may be simply an opinion that goes against the principle of “conventional wisdom” or, more commonly, it may be an entire school of thought or philosophy that is exactly opposite to the more popular idea. Witness the differences between two of the greatest Talmudic scholars Hillel and Shamei on their interpretation of Jewish Law (Torah).

Medical and radiological controversies abound as well. In many cases the controversies are the result of well-entrenched ideas that have become accepted by the majority as canon. As an example, most spine surgeons as well as most radiologists subscribe to the notion that there are three types of dens fractures as originally described by Anderson and D'Alonzo.[1] In fact, the so-called type I fracture does not exist. A careful review of their work shows that one of their type I fractures was a Mach band caused by the base of the skull and the other one was an os terminale at the tip of the dens. Interestingly, they reported that one fracture healed (the Mach band) and the other did not.

This issue of Seminars in Musculoskeletal Radiology contains a potpourri of six controversies in the musculoskeletal realm. Starting off is the chapter I authored on controversies in evaluating the cervical spine for trauma. This truly is a work in progress, with new reports both fueling the controversy as well as leading us in the direction of resolution. Dr. Arthur De Smet addresses the roles of conventional magnetic resonance imaging (MRI) versus magnetic resonance (MR) arthrography for evaluating postoperative joint problems. In the same vein, Dr. William Morrison writes on the relative merits of direct versus indirect MR arthrography. In a related article Dr. Garry Gold and colleagues present a detailed discussion on the advantages and disadvantages of various pulse sequences for the evaluation of cartilage. Jon Jacobson explores the relative merits of ultrasound versus MRI for evaluating ligament, tendon, and muscle abnormalities. Finally, Dr. John Harris gives us a new classification of acetabular fractures that challenges the long-standing Judet and Letournel classification.[2]

Each of these articles and their authors have been chosen to inform you about the latest information in each of these controversial areas. As you read each of these articles, your own concepts of the topics may either supported or challenged. It is up to you, as a practitioner of musculoskeletal imaging arts, to decide whether or not the concepts discussed in this issue will be applied to your individual practice. I trust that this issue will be both enlightening as well as entertaining. Enjoy!

REFERENCES

• 1 Anderson L D, D'Alonzo R T. Fractures of the odontoid process of the axis.  J Bone Joint Surg Am. 1974;  56 1663-1674
• 2 Judet R, Judet J, Letournel E. Fractures of the acetabulum: classification and surgical approaches for open reduction.  J Bone Joint Surg Am. 1964;  46 1615-1646