To the Editor.—
The Jan 7 TOPICS IN RADIOLOGY (1983;249:77) discussed causes for the "bone within a bone" appearance. I disagree with Frager and Subbarao's description of subcortical osteoporosis in the round bones of the carpus and tarsus as being indicative of acute reflex dystrophy syndrome (Sudeck's atrophy). This type of resorption of bone is commonly seen after immobilization, usually for treatment of fracture in the affected limb.The development of a zone of translucency beneath the subchondral plate of the talus in cases of talar fracture is considered a good prognostic sign and not a sign of reflex dystrophy. The term Hawkins' sign has been applied to this talar finding to indicate that avascular necrosis will not develop in the proximal fracture fragment.1Reflex sympathetic dystrophy is a clinical diagnosis based on the presence of burning pain, trophic changes with swollen, pale, stiff digits, and the roentgenographic sign
Kilcoyne RF. Sudek's Atrophy v Disuse Osteoporosis. JAMA. 1983;250(7):898–899. doi:10.1001/jama.1983.03340070016011
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