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Suggest Treatment For Injury In Knee

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Posted on Fri, 21 Aug 2015
Question: My 3yr old grandson fell and broke his knee over 10 weeks ago... Four weeks ago they took his cast off, well he was complaining his leg still hurt him and he couldn't run and he started limping alot.. So they did an mri and it showed an abnormality in his bone marrow.. what does this mean for him?What can we expect from his recovery?
doctor
Answered by Dr. Muhammad Hanif (29 minutes later)
Brief Answer:
MRI report is needed for proper diagnosis.

Detailed Answer:
Dr. Hanif warmly Welcomes you!

Thanks for consulting at my virtual clinic. I have carefully worked through your case, and can realize your health worries. Being your physician, I will take care all of your medical concerns.

As far as his fracture is concerned,he has a very great chance of recovery as the bones in this age are still growing at a very fast pace and you can judge it from his taking off of the cast in a few weeks only.

So in my view there should be no problem with the bone itself and it should have to be restored to its original healing position up to now.

Regarding MRI/bone marrow issue they talked about, can you please attach the MRI report so that I may have a look on it to diagnose what it actually was. I can help you in a better way in this regard after that.


I also suggest you to go for another MRI right now to see all what is going on inside there.


Have a wonderful time ahead. Hope I answered all of your questions. Let me know if you have any further clinical concerns. I will be happy to get back to you shortly. If satisfied here, please give a five star rating and don't forget to close the discussion.

Regards!
DR. XXXXXXX HANIF
USA

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Muhammad Hanif (2 days later)
Thank you.. here is what the report says from the MRI...please help me read this and understand it.......
Findings: The overall development of the knees are symmetric and normal.
Initial T1 sequences demonstrate patchy areas of decreased signal within the distal femoral epiphysis and proximal tibial epiphysis, which otherwise demonstrate appropriate fatty marrow conversion. There is corresponding increased signal on the long TR sequences in these same areas.
After the administration of contrast, there is a mild patchy enhancement corresponding with the areas of signal alteration within both the distal left femur and proximal left tibial. ( No abnormal enhancement within the diametaphyseal regions of the left leg or in the right knee region.)
There is a mild abnormal increased signal along the medial aspect of the proximal tibial metaphysis. The overlying cortex has uniform decreased signal. Mild edema in the proximal popliteus muscle near this region. No corresponding plain film abnormality in this region on today's images.
The slight heterogeneous signal within the diametaphysis of the distal femur and proximal tibia represent normal physiologic change due to incomplete red to yellow marrow conversion.
The cartilage of the distal left femur and proximal left tibia are normal and symmetric as compared to the right side.
While the sequences are optimized for bone marrow, there is no XXXXXXX internal derangement of the left knee.
No evidence of a joint effusion...

A four view left knee were obtained as outside images are not available. These demonstrate normal developmental anatomy. The slight irregularity of the femoral epiphysis is a normal developmental finding at this age. No evidence of periosteal change or other focal ossific abnormality in the medial tibial metaphysis where there is some mild medullary signal change on the MRI. Similarly, no focal abdomen on the is seen within the femoral epiphysis or tibial epiphysis in the areas of heterogeneous signal alteration on the MRI....

IMPRESSION:

Patchy altered signal within the distal femoral epiphysis and proximal tibial epiphysis, with corresponding mild patchy enhancement. The pattern is not nonspecific, but not typical of infection, metastatic deposits or malignant infiltration. Altered marrow signal is known to occur after disuse/immobilization due to altered mechanics and/or blood flow, although is better described in adult literature than pediatric literature. Given the nonspecific nature of the MR findings, however, clinical and plain film follow-up will be warranted to confirm that the mineralization and progressive development remain normal.
Mild focal bone marrow edema in the medial tibial metaphysis with mild edema in the adjacent origin of the medial tibial metaphysis with mild edema in the adjacent origin of the proximal portion of the popliteus muscle. It is possible this is residual edema from the primary injury, or subsequent mild trauma to this region....
doctor
Answered by Dr. Muhammad Hanif (19 hours later)
Brief Answer:
There is not at all, any kind of developmental abnormality in bone marrow.

Detailed Answer:
I welcome you with a follow up query and really appreciate the effort you put in to upload this MRI report of the kid.


In a very simplified way and briefly, I will describe the main points of clinical importance in the MRI report. But let me make you feel relax in the very beginning that there is nothing wrong with this report and there isn't any kind of abnormality in this MRI. I am unable to understand who told you that the kid has some bone marrow problems.


This report shows mild accumulation of fluid in the knee area around the bones of the knee joint, in the bone marrow, and the muscles over there. Let me add clearly that this is not an abnormal thing. It is the accumulation of fluid in response to the inflammation due to recent injury to the knee. It is a kind of swelling I must say in simple words.

They have seen some changed behaviour of bone ends in the knee joint. Let me explain that if they had not seen this kind of physiological change, that was a problem. Because these are normal physiological changes in the bones when they are growing at this age group. So, is not an unusual change. It is rather a good thing in the report and was an expected finding at this age group.

There are some altered bone marrow signals seen on MRI in the region of the knee which are due solely to the immobilization of the joint and bone after injury, and it was due to the Plaster Cast to limit the activity. When bones remain inactive for some weeks due to any reason, this kind of MRI signals are seen. No infection, cancer, or other abnormality seen on MRI.


Final Words:
I am feeling happy to inform you that there is nothing wrong with the bones, joint, and bone marrow of your grandson and he is doing very well. His prognosis of recovery from the knee injury is very high/good and in the normal limits. There is no need for any kind of intervention. Just keep a follow up and let me know for any future assistance.

Have a wonderful time ahead. Hope I answered all of your questions. Let me know if you have any further clinical concerns. I will be happy to get back to you shortly. If satisfied here, please give a five star rating and don't forget to close the discussion.

Regards!
DR. XXXXXXX HANIF
USA
Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Raju A.T
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Answered by
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Dr. Muhammad Hanif

General & Family Physician

Practicing since :2009

Answered : 2369 Questions

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Suggest Treatment For Injury In Knee

Brief Answer: MRI report is needed for proper diagnosis. Detailed Answer: Dr. Hanif warmly Welcomes you! Thanks for consulting at my virtual clinic. I have carefully worked through your case, and can realize your health worries. Being your physician, I will take care all of your medical concerns. As far as his fracture is concerned,he has a very great chance of recovery as the bones in this age are still growing at a very fast pace and you can judge it from his taking off of the cast in a few weeks only. So in my view there should be no problem with the bone itself and it should have to be restored to its original healing position up to now. Regarding MRI/bone marrow issue they talked about, can you please attach the MRI report so that I may have a look on it to diagnose what it actually was. I can help you in a better way in this regard after that. I also suggest you to go for another MRI right now to see all what is going on inside there. Have a wonderful time ahead. Hope I answered all of your questions. Let me know if you have any further clinical concerns. I will be happy to get back to you shortly. If satisfied here, please give a five star rating and don't forget to close the discussion. Regards! DR. XXXXXXX HANIF USA