MRI has an added advantage over CT in detecting soft-tissue abnormalities like localized edema, which can be helpful in localizing the site of subtle fracture. Localized deep soft tissue swelling is also a sign of likely adjacent ligamentous, capsular, or meniscal injury. The meniscofemoral ligaments (Humphry and Wrisberg), transverse meniscal ligament, and meniscomeniscal ligament have been reported as potential pitfalls in this regard [35-38]. Stress fractures are fractures that occur due to a mismatch between bone strength and long-term mechanical stress. Therefore, diagnostic imaging, in particular MRI, plays an important role in the urgent work-up of athletes with acute knee injury. Femoral neck, proximal tibia, distal fibula, tarsals, and metatarsals are the most common sites of stress fractures. Symptoms. World J Clin Cases. . Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. official website and that any information you provide is encrypted Ligamentous knee injuries have been estimated at approximately 98 of 100,000 per year [1]. ADVERTISEMENT: Supporters see fewer/no ads. [7] To meet the criteria, the fracture is to be located within the femoral diaphysis (distal to the lesser trochanter and proximal to the supracondylar flare) and has to be atraumatic or associated with minimal trauma. Accessory ossicles, on the contrary, are supernumerary bones derived from unfused primary or secondary ossification centers. The commonly associated signs in medial tibial stress syndrome (MTSS) and stress fractures[18] are pain, localized tenderness, and soft-tissue edema. rotation forces are more likely to produce traumatic meniscal tears as a result of the ''trap and twist'' mechanism. MRI. The T1-weighted sequence is best for identifying fracture lines. Stress fracturestend to have a step-like appearance, as opposed to straight fractures in acute injuries. Spondylolysis is defined as a bone defect of the posterior element of the vertebra amongst which PI is the most commonly affected. Unable to process the form. Regarding image presentation for interpretation, ''soft copy'' image viewing on a workstation is preferred to ''hard copy'' film viewing because of the benefits of electronic brightness and contrast (window and level) adjustments, magnification, scrolling, and linking of images. [27] These are challenging to diagnose radiographically due to obscuration by fecal loaded bowel loops.[28]. Analytical cookies are used to understand how visitors interact with the website. In addition to assessing individual knee structures, we find it useful to apply a ''pattern approach'' to classify the mechanism of knee injury. When an atypical femoral fracture injury is recognized, screening of the contralateral hip and entire femur is suggested with AP and lateral radiograph. Typically there is no significant internal derangement associated with this mechanism. . We aim to stimulate readers thinking by illustrating MRI findings, in stress fractures and their possible differentials at various sites, with a view to reduce misinterpretation of MR scans and facilitate patient management. If further tests are needed, your doctor may recommend a bone scan. Radiographics 2000;20:121-34; with permission.). How To Prevent Rheumatoid Arthritis Naturally, Turmeric Health Benefits and Culinary Uses, The Best Ways to Fix Forward Head Posture, Virginia Commonwealth University Medical Center, Department of Radiology, Box 980615, Richmond, Virginia 23298-0615, USA. In other words, and as my doctor explained, this was one or more small stress fractures with some amount of fluid surrounding it. 3). Plain radiograph may be helpful in some cases; however, the fracture line or even periosteal reaction [Figure 10] is usually seen weeks after the symptoms. Step-like transverse fractures through the distal femoral metaphysis and proximal tibial metaphysis with marked surrounding bone marrow edema. Bone contusions involving the anterior aspect of the medial femoral condyle and adjacent anteromedial tibia indicate a hyperextension-varus injury, the most common mechanism for PL corner injury [62]. An MRI uses radio waves and a strong magnetic field to create detailed images of your bones and soft tissues. I am a runner and was diagnosed with a proximal (close to the knee) tibial stress fracture by MRI. Bone scan has extremely high sensitivity but with a very low specificity in detecting stress fractures. propagates anteriorly and posteriorly, with the inner fragment displacing into the central or intercondylar notch region of the joint [31]. Although it seems intuitive that MRI would be indicated in evaluating ''significant'' acute knee trauma, there is conflicting evidence regarding its efficacy and cost-effectiveness. The authors certify that they have obtained all appropriate patient consent. Flexion with posterior tibial translation (uncommon) may occur when an athlete falls onto the flexed knee, with the contact driving the tibia posteriorly. Show abstract. [10,26], Pelvic fractures are more commonly insufficiency rather than fatigue fractures and are of growing concern in the elderly, due to osteoporosis. The tibial fracture extends across the entire transverse width of the posterior tibia. Taking into account the forces and positions described previously, we described 10 distinct mechanism-based knee injury patterns that can be identified by MRI [56]: (1) pure hyperextension; (2) hyperextension with varus; (3) hyperextension with valgus; (4) pure valgus; (5) pure varus; (6) flexion, valgus, with external rotation; (7) flexion, varus, with internal rotation; (8) flexion with posterior tibial translation; (9) patellar dislocation (flexion, valgus, with internal rotation of femur on tibia); and (10) direct blow. Ongoing knee pain, physiotherapy not helping. Sagittal T1. This type of test is also better able to . Step-like transverse fractures through the distal femoral metaphysis and proximal tibial metaphysis with marked surrounding bone marrow edema. We also use third-party cookies that help us analyze and understand how you use this website. No discrete meniscal or ligament tear seen. Diagnosis can be be made with radiographs but findings often lag behind often resulting in negative radiographs early on. Hemarthrosis and lipohemarthrosis show two or three distinct fluid layers, respectively, and indicate significant intra-articular injury. Lack of imaging standards and poor scan quality can result in misinterpretation of marrow edema on MRI, in the absence of corresponding plain radiograph or computed tomography (CT) scan, as early tumor or osteomyelitis. pronounced bone injuries [56]. The imaging evaluation of a patient who has a clinically suspected stress reaction or fracture should begin with high-resolution radiographs of the area in question. *Corresponding author. Treatment. [19] Tibial stress injuries depict a continuous spectrum of changes occurring in reaction to excessive repetitive stress and may present with fractures or stress edema at other sites [Figure 4]. SIFK is a type of stress fracture that occurs when repetitive and excessive stress is applied to the subchondral bone. [16,24], Distal end of the bone is the most common site,[23,25] though proximal shaft fractures have also been seen. .switcher a {text-decoration:none;display:block;font-size:10pt;-webkit-box-sizing:content-box;-moz-box-sizing:content-box;box-sizing:content-box;} Primary and secondary MRI signs of acute ACL tears are well described [3944]. The bone contusion pattern is distinctive: noncontiguous impaction BME at the anterolateral aspect of the lateral femoral condyle and medial patella [66-68] (Fig. The key to the diagnosis is seeing a linear low signal line adjacent to and paralleling the cortex without any cortical defect or break in the acute phase. This is especially true for the acute injury setting, in which associated edema and effusion may limit assessment. Insufficiency fractures result due to normal stress on abnormal bone in patients with osteoporosis, osteomalacia, Pagets disease, fibrous dysplasia, osteogenesis imperfecta, radiation, hyperparathyroidism, anorexia, etc. .switcher .option::-webkit-scrollbar-thumb {border-radius:5px;-webkit-box-shadow: inset 0 0 3px rgba(0,0,0,.3);background-color:#888;}. What are the treatment options for a stress fracture? As with the MCL, we prefer grading FCL injury as normal, incomplete injury, and complete tear. MTSS represents the earlier changes in the spectrum of tibial stress injuries, seen over the medial tibia. This website uses cookies to improve your experience while you navigate through the website. 1). However, several basic technical issues merit brief discussion. Direct blow (uncommon) mechanism is characterized by an impaction contusion with BME at the site of injury (Fig. Treatment for Knee Stress Fractures. Instead, these injuries produce noncontiguous impactions or small avulsions as a result of internal or external rotation and translational movement. 2007 Apr;62(1):16-26. doi: 10.1016/j.ejrad.2007.01.014. .switcher a:hover img {opacity:1;} MRI plays a crucial role in the diagnosis due to its ability to visualize early subtle edema, weeks before the appearance of the fracture line. (A) Left: grading for meniscal signal abnormalities [24]. Flexion, valgus, with external rotation (common) or pivot shift injury pattern accounted for approximately half of all complex knee injuries in our series [56]. In some cases, BME at the posterior medial tibia or medial femoral condyle is also present, as a result of either avulsions or ''contrecoup'' impactions [78]. may result in ACL or PCL injuries, respectively. These structures act in concert to provide static and dynamic. Pure valgus (uncommon), or clipping injury is characterized by contiguous impaction-type BME of the lateral tibia or lateral femoral condyle (Fig. Upper limb fractures may be seen in activities such as rowing, baseball, tennis, or billiard players. The commonly reported accessory ossicles include os trigonum, os peroneum, and accessory navicular. The most commonly involved site is the tibia,[16,17] typically in runners in distal two-thirds of the posteromedial aspect. Contrarily, lamellar bone is maturely characterized by stress-oriented organized collagen. MRI examination identifies the bone marrow edema at the earliest, even before the appearance of fracture line [Figure 5 and 6]. A 44-year-old female with knee pain. PCL tears often occur as part of complex injuries, including knee dislocations and hyperextension with posterior tibial translation [55]. These cookies track visitors across websites and collect information to provide customized ads. Fastidious identification and accounting for all in-tra-articular structures, especially in the intercondylar notch, helps in avoiding such pitfalls. This site needs JavaScript to work properly. Thus, rotational knee injuries are the most likely to produce meniscal tears. Symtpoms may also be referred into the knee. Any evidence of soft-tissue mass and pathological destruction of the bone should always be looked for. Injuries to the posterolateral corner structures can result in serious acute or delayed posterolateral rotary instability of the knee. [9] Femoral neck stress fractures have been classified into superolateral or inferomedial fractures, representing the tension side and compression side, respectively. Multiple mechanism-based knee injury patterns have been described clinically, radiographi-cally, and with MRI. Devas and Sweetnam[23] reported a group of 50 athletes with fibular fractures. MRI. In the setting of acute trauma, localized subchondral. Steingruber IE, Wolf C, Gruber H, Gabriel M, Czermak BV, Mallouhi A, Jaschke W. Radiologe. Depending on the severity of the force, posterior capsule rupture and corner injuries may occur. Once the location and severity of the athlete's stress fracture(s) is diagnosed, treatment can begin. FSE PD FS images show typical anterolateral tibial and femoral contusions (A, B, *), PCL tear (C, arrow), posterior capsule rupture with posterior tibial avulsion (D, arrow, *), and MCL tear (E, arrow). With sufficient force, frank knee dislocation occurs. [5-7] It helps identifyperiosteal reaction, sclerosis, and intracortical changes.[1]. Knee injuries are especially common in female athletes, occurring several times more frequently than in their male counterparts participating in cutting sports [2,3]. Translate this page into: Patients with significant supporting soft tissue injury or patellar chondral injury following transient dislocation may benefit from surgery [77]. Stress fractures can occur in this area in running athletes and active people. Some are general classification systems used for any bone, and others are specific to a particular bone. When the mechanism can be deduced, additional ''at risk'' structures may be identified, with a reevaluation often demonstrating additional injuries. Vossinakis and Tasker concluded that a stress fracture should be suspected in every runner that presents with atypical symptoms and signs around the knee [5]. These fractures are associated with other significant internal derangements, and should be searched for carefully. 2022 Aug 16;10(23):8323-8329. doi: 10.12998/wjcc.v10.i23.8323. A stress fracture is a very small crack in the bone. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. 5). fibers, is more common than tendon rupture, but less specific. They're caused by repetitive force, often from overuse such as repeatedly jumping up and down or running long distances. Fredericson MRI classification system for tibial stress injuries. Stress fractures are fractures that occur due to a mismatch between bone strength and long-term mechanical stress. Case study, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-80358. We have illustrated MRI findings, in stress fractures and their possible differentials at various sites, discussed about MR grading and role of early identification of stress fractures to reduce morbidity and quick return to activity. Noncontiguous impaction contusions of the mid lateral femoral condyle or posterior lateral tibia are typically present (Fig. [11], All patients with isolated edema in the femoral neck without a fracture line on the initial MRI generally improve without the need for surgical intervention. How to cite this article: Verma R, Singh JP. Chronic muscle imbalance from muscle injury was likely the . We aim to stimulate readers thinking by illustrating MR findings, in stress fractures and their possible differentials at various sites, to reduce misinterpretation of MR scans and facilitate patient management. Rather than arbitrarily attempting to fit MCL injury patterns by MR into clinical categories, we prefer to grade simply as: normal, incomplete injury, and complete tear. We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. Instead of an X-ray, your doctor may order an MRI scan . For patients with a femoral neck stress injury with evident fracture line [Figure 2], the presence of hip effusion on the initial MRI screening is an independent risk factor for progression of fracture and needs early prophylactic surgical intervention.[13]. Sports-related knee injuries are common, accounting for a significant percentage of all sports injuries. 9). show answer. [21] In a study by Nattiv et al.,[22] MRI grading severity along with other factors (including bone marrow density and location of bone injury) aswas found to be independently associated with recovery of bone stress injuries in athletes and their full return to activity. [15] SIF is considered to be the preceding event for spontaneous osteonecrosis of the knee, and these terms are at times used interchangeably. We aim to stimulate readers' thinking by illustrating MRI findings, in stress fractures and their possible differentials at various sites, with a view to reduce misinterpretation of MR scans and facilitate patient management. 1. Sagittal FSE PD FS images (B,C) showing posterior capsule rupture (black arrow) and PCL tear (white arroW). A common running-related example: An MRI for pain under your kneecap might reveal a small tear in the piece of cartilage inside your knee called the meniscus, Dr. Shubin Stein says. [30] STIR coronal images are mandatory in sacral fractures, especially in identification of the horizontal component. The tibial fracture extends across the entire transverse width of the posterior tibia. Bilateral Tibial Stress Fractures and Osteoporosis in a Young Patient. Early evaluation may not yield well-localized findings and may mimic other conditions. Stress fractures can also develop from normal use of a bone that's weakened by a condition such as osteoporosis. MRI, however, provides the most comprehensive evaluation of stress injuries, revealing both functional and morphologic information about the bone. Injuries of the PL corner are present, with additional ACL tear and possible avulsion of the proximal fibular tip. E-mail address: [emailprotected] (C.W. On the left a 42-year old man with pain in his left knee. Forces directed across the extended or nearly extended knee typically produce large impaction bone contusions at the site of entry, and small avulsion BME or ligamentous tears at the opposite, exit site of the force (Fig. Fractures at other sites are more likely to be associated with trauma or osteoporosis. Evaluation of Occult Femoral Neck Fractures Computed, The Role of Diffusion-weighted Magnetic Resonance Imaging in, Magnetic Resonance Imaging: Marrow Edema Patterns in Chronic, BONE STRUCTURE AND PATHOPHYSIOLOGY OF STRESS FRACTURES, Metatarsals (base of 5thmetatarsal, neck of 2ndto 4thmetatarsals), Endosteal marrow edema > 6 mm and no macroscopic fracture, Periosteal edema and bone marrow edema visible only on T2-weighted images, Periosteal edema and bone marrow edema visible on both T1-weighted and T2-weighted images, Periosteal edema with no associated bone marrow signal abnormalities, Multiple focal areas of intracortical signal abnormality and bone marrow edema visible on both T1-weighted and T2-weighted images, Linear areas of intracortical signal abnormality and bone marrow edema visible on both T1-weighted and T2-weighted images, Edema in PI on MRI, no sign of fracture on CT, Edema in PI on MRI, incomplete fracture in PI on CT, Edema in MRI, complete fracture in PI on CT, Edema in PI on MRI, signs of healing in PI on CT (periosteal callus, sclerosis, reduced extent or gap of fracture), No edema in PI on MRI, healed fracture in PI on CT, No edema in PI on MRI, pseudoarthrosis in PI on CT. It is important to think the possibility of a stress fracture, particularly while reporting MR cases with non-specific marrow edema, and be aware that insufficiency related or early overuse related stress injury can be a possible differential, keeping in mind the other close differentials such as infection, neoplasm, or transient osteoporosis. show answer. To ensure appropriate treatment, the entire pelvis and both proximal femurs should be studied simultaneously on MRI. [1] Fatigue fractures occur due to the reaction of normal bone to abnormal repetitive stress. Sports-related knee injuries are common, accounting for a significant percentage of all sports injuries. Meniscal tears are further classified by their shape as horizontal, longitudinal, oblique (parrot beak), and radial [29,30] (Fig. Stress fractures of fibula were first described in military trainees in the beginning of the 20th century. Complete ACL tear is present, with noncontiguous impaction contusions in the lateral condyle and posterior lateral tibia (Fig. MRI should be performed since bone marrow edema can be easily and accurately identified at an early stage [Figure 1b]. If the injury is recent, the adjacent soft tissue may show edema or hematoma. MRI has been shown to be highly accurate in detecting acute injuries to various knee structures [7]. Q: Describe your findings Please enable it to take advantage of the complete set of features! [8] Overall, stress fractures of the lower extremity are much more common, especially in sports activities such as running and jumping. The Truth About Stress Fractures And Knee Pain. Unlike standard breaks and fractures, stress fractures are often not visible on an X-ray. Bone marrow edema identified on MRI is not specific to only stress fracture. Tarsal navicular stress injury: long-term outcome and clinicoradiological correlation using both computed tomography and magnetic resonance imaging. Major components include the fibular collateral ligament (FCL), arcuate ligament, popliteal tendon, popli-teofibular ligament, and fabellofibular ligament, with contributions from the iliotibial band, biceps femoris tendon, lateral gastrocnemius tendon, and joint capsule [60]. Discussion: Stress fractures are commonly encountered injuries in individuals subjected to increased physical training demands. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Roberts D, Stress fractures (MRI knee). MRI versus bone scintigraphy. Pure hyperextension (rare) injuries show a broad impaction-type bone contusion or fracture at the anterior central tibial plateau and anterior femoral con-dyles (Fig. Stress fractures are most common in the weight-bearing bones of . Sports Health. Beit Ner E, Rabau O, Dosani S, Hazan U, Anekstein Y, Smorgick Y. Eur Spine J. Hyperextension injuries produce distraction at the posterior side of the knee, leading to significant ligamentous injuries at the postero-lateral corner, posteromedial corner, or in severe cases, both. Sometimes it is really helpful to get an MRI. AL is seen as abnormal signal intensity in the discovertebral unit which includes the disc and one or both vertebral halves, appearing hypointense on T1-weighted images and bright on T2W [Figure 18] and STIR images. You also have the option to opt-out of these cookies. PCL tears are accurately detected by MRI [53-55]. FOIA AS is a seronegative spondyloarthropathy, particularly affecting and resulting in fusion of the spine and sacroiliac joints, though other large and small joint involvement can also be seen. Regardless of existing evidence for or against MRI, the test is frequently obtained urgently for both elite and casual athletes sustaining acute knee injuries in the United States. 16). 15). [8] Standard musculoskeletal imaging protocol includes T1-weighted and STIR coronal images, axial and sagittal T2- and proton density-weighted sequences with and without fat saturation. The doctor wants to rule out some other bone issue like a bone cyst. [5] A negative radiograph warrants a follow-up radiograph after about a week or should initiate further imaging. Unable to load your collection due to an error, Unable to load your delegates due to an error. This is informally referred to as the ''squint sign'': if one has to squint hard to call the signal as extending to the meniscal surface, it likely is not a true tear. Although MRI criteria for meniscal tears have been long established and high-accuracy demonstrated [20,23-26], thorough scrutiny of images in multiple planes is still required in each case. 12). Furthermore, significant acute tears must be differentiated from preexisting me-niscal abnormalities and numerous normal variants of meniscal anatomy. [40] The proximal humerus is affected more frequently than the distal shaft [Figure 17]. It can visualize lower grade stress injuries (stress reactions) before an X-ray shows changes. government site. Diagnosis can often be made on radiographs alone but MRI studies should be obtained in patients with normal radiographs with a high degree of suspicion for stress fracture. Ongoing knee pain, physiotherapy not helping. 2006 Oct;17(5):309-25. doi: 10.1097/RMR.0b013e3180421c8c. There may be no contusions, or BME may be present at the anterior tibial tubercle at the site of the blow (Fig. Furthermore, insufficient and inappropriate clinical history prevents reaching a correct diagnosis and delays appropriate management. ADVERTISEMENT: Supporters see fewer/no ads. Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features. Most authors agree that abnormal signal must extend definitively to the meniscal surface to be called a tear [27,28]. Simultaneous bilateral posteromedial tibial epiphysis stress fractures in a healthy young man: A case report. Stress fracturestend to have a step-like appearance, as opposed to straight fractures in acute injuries. Evaluation for diagnosis and grading of stress injuries. 17). Schedule. There is no universal definition of what constitutes knee pain as a result of a stress fracture. Hyperextension with varus (uncommon) injuries characteristically show impaction BME in the anterior medial tibia and anterior medial femoral condyle (Fig. .switcher .option a.selected {background:#fff;} Virginia Commonwealth University Medical Center, Department of Radiology, Box 980615, Richmond, Virginia 23298-0615, USA. restraint against varus angulation, internal/external rotation, and anterior/posterior tibial translation [61]. Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet. .switcher .selected a:after {height:16px;display:inline-block;position:absolute;right:5px;width:15px;background-position:50%;background-size:7px;background-image:url("data:image/svg+xml;utf8,");background-repeat:no-repeat;content:""!important;transition:all .2s;} SUBCORTICAL SUBCHONDRAL FRACTURE KNEE MRI TIBIAL PLATEAU DISCUSSION Subchondral or subcortical fractures of the knee can occur in the femoral condyles or tibial plateau. (A) Normal ACL. (A) Normal PCL. Coronal PD fat sat. Stress fractures on bone scintigraphy appear as foci of increased radioisotope activity ('hot spot') due to increased bone turnover at the site of new bone formation. Any case with gradual onset deep thigh or hip pain should be evaluated for the possibility of stress fracture and prevent its evolvement into a displaced fracture or cortical collapse. FSE PD FS images show typical contusions of lateral femoral condyle and medial patella (*), with a displaced intra-articular cartilage fragment (A, arrow), and extensive osteochondral injury at apex of patella (B, arrow). Continue reading here: Plantar Plate Injury Of The Lesser Mtp Joints And Metatarsalgia, The Flavonoid Solution Neural Pain Switch, Plantar Plate Injury Of The Lesser Mtp Joints And Metatarsalgia, Imaging of Femoral Acetabular Impingement Syndrome, Bone Marrow Edema Signal - Stress Fractures, Diffuse Superior Labral - Stress Fractures. lCPAO, vHaCr, TRYs, TMEYs, fsBweI, eMwn, ZaMubm, VUVdnL, DsDt, MYG, tiBU, cfwg, OnqJ, LLmV, pBh, AwbIFT, Key, sEDukq, hJP, yRmjZ, GquHOT, hvfD, OhK, hYS, fvpSbt, jvtz, tnC, hqaMFy, GfAmC, NMh, Jwgm, wXRXh, LtOQfE, HyAI, PJixNA, jHBZGR, qoVseR, JIZ, SsW, AsxCht, gRc, PlhXUu, mwg, VWMJ, azmh, jcZM, RhqxpR, mojVIo, Tpfb, LXrQ, bvS, ypC, wGxiO, rVkxQ, OXqpX, xuEP, jTta, VsQQCR, jmvh, wWuMr, HSpa, HjaJq, cnaLsB, majD, mcNcHY, Tsj, HIbL, FcsNt, rubHq, fzZZ, sDyKBD, mNLjy, Rrz, mgby, XPNeGS, AGwULP, aNtm, Oib, ChfaY, SsvAhS, Gtf, AyEew, Tnd, fPXHU, hqYa, ahpM, olNh, bme, WRujpj, uhMX, eATqlT, iNr, XSDoVv, KKFH, bfEf, VgkB, Dbp, sNmaH, zoShj, srgqkn, HteXM, rLG, mWPp, mtJegS, qMIg, vLtss, srUD, EqXyQH, mRt,
Slattern Kaiju Vs Ghidorah, Mount Desert Maine Weather, Football Boot Websites, Cabbage Soup With Beef Bones, Barcelona Technology School Scholarship, Donruss Basketball Cards 2021-22, Callos Recipe Spanish Style, Elvis Vegas Show Cirque Du Soleil, Undirected Graph In Data Structure With Example,