Most peripheral bones can be biopsied (1). A CT scan study and good knowledge of anatomy are useful in selecting the appropriate approach to the lesion. In lesions involving long bones, the needle is usually introduced perpendicular to the shaft to prevent it from sliding off the round cortex (Fig. 22). Use of BTN for cortical bone (Table 3) makes trephination of the cortex relatively easy and allows bone marrow aspiration. Once the cortex is trephinated, a soft tissue-cutting needle (Table 4) may be introduced through the outer cannula of the first needle to sample the medullar cavity or central soft lesion. Penetration of the medullar cavity of long bones is often very painful (especially in the case of osteomyelitis) and may require general anesthesia.
FIGURE 20 Biopsy of the sacroiliac joint with a posterior direct approach under computed tomography guidance.
FIGURE 21 Oblique transiliac approach to the sacroiliac joint. Postbiopsy computed tomography scan showing the biopsy tracks.
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