The aim was to analyze patients with clinical diagnosis of triangular fibrocartilage complex (TFCC) lesion using standard x-ray, ultrasound, conventional magnetic resonance imaging (MRI) and MR ...arthrography (MRA); to evaluate the accuracy of MRA compared with MRI in the diagnosis of this lesion; and to evaluate ultrasound as a method of diagnosing TFCC lesion. We analyzed 72 patients (46 female and 26 male; age range, 22-61 years; mean age 37 years; 50 right and 22 left wrists) with suspected TFCC lesion with clinical examination, standard x-rays, and ultrasound. We confirmed patients with traumatic TFCC injury on MRI and MRA. Ultrasound found 13 lesions in 72 patients with suspected TFCC lesions. Conventional MRI found 66 and MRA 68 TFCC lesions. Ultrasound is useful for visualizing intra-articular effusion, soft tissue, bone surface, and for early detection of occult fractures. MRI is a better diagnostic modality, fully able to visualize the TFCC cartilage and ligaments. MRA is consistently and accurately able to visualize structural abnormalities of TFCC. Key words: Magnetic resonance imaging; Arthrography; Triangular fibrocartilage complex; Diagnostic imaging; Ultrasound
Abstract The purpose of this study was to compare imaging modalities in the diagnosis of occult radial head and neck fractures and to assess the diagnostic value of ultrasound in diagnosing occult ...fractures of the radial head and neck. The study included 193 patients (101 male, 92 female) who were referred by trauma surgeons from January 2011 to July 2014 and presented with history of acute elbow trauma. The mean age of the patients was 37 years (range 15–82 years); 95 right and 98 left elbows were included in the study. Clinical examinations and standard radiograms were conducted. The anteroposterior radiographic view revealed no visible signs of fracture. The lateral radiographic view showed displacement of the anterior and posterior fat pads (fat pad sign) due to joint effusion, which is an indirect sign of fracture. In all 193 cases, ultrasound examination showed intraarticular effusion. In 176 cases (91%), there was effusion in both the olecranon bursa and the elbow joint. In 10 patients (5%), there was effusion only inside the elbow joint and in seven cases (4%) there was effusion only in the olecranon bursa. Cortical discontinuity (a direct sign of fracture) was clearly visualised in 157 cases (82%), in the radial neck in 108 cases and in the radial head in 49 cases. Ultrasound findings of fracture were questionable in 36 cases (18%). Step-off deformities, tiny avulsed bone fragments, double-line appearance of cortical margins, and diffuse irregularity of the bone surfaces were identified as auxiliary ultrasound findings (indirect signs of fracture). Standard radiograms were repeated after 7–10 days. In 184 cases (95%), there was a clearly visible fracture: a fracture of the radial neck in 111 cases (58%) and a fracture of non-displaced radial head in 73 cases (37%). In nine cases (5%), radial fracture was not confirmed on radiogram and MRI was performed in these patients. In conclusion, ultrasound imaging proved to be an effective method for diagnosing occult fractures of the radial head or neck when initial radiograms showed only intraarticular effusion. Ultrasound imaging is a cost-effective, easy-to-use and radiation-free method. For these reasons we recommend it for early detection of occult fracture in the emergency room.
This retrospective study investigated the impact of age on fracture occurrence through the comparison of two patient groups, 17-64 and 64+ age groups. Study data covered all fractures treated at a ...large hospital in eastern Croatia. A total of 15,519 patients with fractures were treated at the trauma department (inpatient and outpatient), with a total of 17,257 fractures presented, 71% managed as outpatients and 29% as inpatients. A total of 11,046 outpatients were treated for 12,187 fractures and a total of 4473 inpatients were treated for 5070 fractures. The group of 17-64-year old males had 5787 fractures, accounting for 34% of all fractures presented. The group of 17-64-year old females had 4094 fractures, accounting for 24% of total fractures. The group of 65+ year-old males had 2659 fractures, accounting for 15% of all fractures presented and the group of 65+ year-old females presented with 4717 fractures, accounting for 27% of all fractures presented. The 'fall in level' was the predominant cause of injury in all patients. The characteristics of osteoporotic bone fractures were evident in the population of 65+ females and to a lesser degree in 65+ males. The 17-64 age group, both males and females, had more fractures considered as high-energy fractures.
We compared ultrasound (US) with magnetic resonance (MR) findings of muscle tendon and ligaments (mt&l) of 17 men and 13 women, 16-66 years old, who suffered from acute ankle injury without bone ...fracture visible on conventional radiographs. Joint effusion (JE), and injury of the Tibials anterior muscle tendon (TAmt), Calcaneofibular ligament (CFl), Long flexor of the great toe muscle tendon (LFGTmt), Short peroneus muscle tendon (SPmt), Long peroneus muscle tendon (LPmt), and Anterior talofibular ligament (ATFl) were assessed by the US, at seven days, and MR, at seventeenth day. Grading of ligament and muscle tendon injury as stretching (Grade 1), partially ruptured (Grade 2), and complete rupture (Grade 3); no lesion was considered to be Grade 0. Joint effusion and ATFl were the most common lesions whereas the TAmt lesion was the least frequent: JE approximately ATFl > SPmt approximately LPmt > LFGTmt approximately CFl approximately TAmt. Both US and MR were equally sensitive in detecting the presence (or absence) of the mt&l ankle injury, whereas US was less specific than MR in detecting G3 injury.
Unstable pelvic fractures very frequently occur with haemorrhage, not only from the broken pelvis but from the presacral venous plexus and/or iliac arterial or venous branches which may cause ...hypotension and increases the mortality rate. Very often this type of injury is concurrent with injuries in other organ systems. The compounded nature of these injuries makes it necessary for doctors who may encounter this type of patient to be educated in the techniques to effectively stabilise and treat the patient's complex injuries. After completing the international standard ATLS (Advanced Trauma Life Support) primary survey to identify a haemodinamically unstable patient with pelvic fracture, we discuss adequate replenishment of lost blood volume and standards of care for such a patient. The best diagnostics are described from transport immobilisation to the placement of external fixators or C-clamps. Likewise indication for intervention of pelvic angiography and therapeutic embolisation are also discussed. The direct surgical hemostasis method of pelvic packing is described in detail. All presented methods are mutually complementary in today's treatment of these patients.
Between January 2005 and May 2009, a total of 26 patients, 21 males and 5 females, were admitted for treatment of Lisfranc lesion. All patients were radiologically evaluated and classified according ...to the criteria proposed by Myerson: 5 (19.2%) patients had a type A injury, 2 patients (7.7%) presented with a type B1 injury, 17 (65.4%) sustained the most common type B2 injury and 1 (3.8%) patient suffered from a type C1 and C2 injury. Taking radiological and clinical findings in account, fifteen patients were elected for operative treatment and eleven patients were treated conservatively. According to type of fracture we established three groups; in group I metatarsal fracture was found in fourteen (53.9%) patients, group II with phalangeal fracture in three (11.5%) cases, whereas in group III nine (34.6%) patients sustained combined metatarsal, navicular and, most commonly, a cuneiform fracture. Using the American Orthopedic Foot and Ankle Society (AOFAS) midfoot scoring scale and SF-36 questionnaire, the functional outcome was assessed. The mean value for age distribution was 42.7 +/- 13.2 years and the mean follow up was 27.9 +/- 12.4 months. A p value < 0.005 was regarded as statistically significant for the analysis of the results. We found by means of SF 36 questionnaire a statistically significant difference in the role limitation due to existence of pain (p = 0.04) and poor general health (p = 0.013) in the group of patients that sustained combined foot fracture. The purpose of this study is to assess the treatment of Lisfranc injuries in our patients, according to SF36 and AOFAS criteria, clinical outcome was evaluated. In the group I the mean AOFAS score was 74.0 +/- 9.1 and in the group II it reached 72.0 +/- 5.2 signifying fair outcome! Poor outcome was present in the group III with mean AOFAS score 67.1 +/- 9.0. All unstable injuries require surgery. Clinical outcome is highly dependent on the restoration of normal anatomic alignment.
Tarlov cysts (TCs) are a rare but intensive cause of chronic low back pain or lumbosacral radiculopathy and should be considered in the differential diagnosis of radicular symptoms. Magnetic ...resonance imaging (MRI) is the radiologic study of choice to visualize these cysts. In the current study, we describe a case of a 49-year-old patient with intermittent pain on his coccigeal region, right buttock, and intensive pain in the right hip and inner side of the thigh, in 1.5 years of duration. MRI of the lumbosacral spine and hip showed right-sided, sacral S2 and S3 perineural cysts, the largest located at the right S2 nerve root. Conservative treatment of sacral perineurial cysts should be the first choice. The surgical treatment is recomended in cases when MRI scans reveal a large (1.5 cm) cyst associated with neurological symptoms and no response on conservative treatment.
Aim of our study was to compare anterior cervical fusion with fusion augmented with dynamic implants and with the first generation-plate. Methods. Patients with radiculopathy and/or myelopathy were ...included in a prospective cohort study. Clinical outcome was assessed according to the Nurick, Odom, and SF 36 scales. Rotation and translation of screws, and quality of fusion (Tribus) were assessed at the 6-week and 4-year follow-up examinations. Neurodecompression was performed in 81 patients (one-level N = 45, two-level N = 26 and multi-level N = 10) in the period from January 2001 to September 2003. 50 male and 31 female patients were divided into three groups, depending upon type of fusion: 1. Augmented with dynamic implants (N = 33), 2. Augmented with H-plate (N = 33), and 3. Non-augmented (N = 15), one-level. There were no significant differences in clinical outcomes between the groups. Dynamization was detected in both augmented groups: axial in the dynamic implant group (mean translation +/- SD = 2.67 +/- 0.79 mm), and angular in the H-plate group (angle of rotation 7.2 degrees +/- 3.04 degrees). Six-week fusion was significantly better in the dynamic implants and non-augmented groups, as compared with the H-plate group. Two patients in the H-plate group developed pseudoarthrosis, 7 patients in the dynamic implant group had supradjacent segment heterotopic ossification and two of these additional ankylosis. Three patients in the non-augmented group had dislodgement of the bone graft with transient dysphagia in one of them. Our results suggest that selection of implants is not crucial for clinical outcome. Subsidence is allowed with both fixation systems. Fusion is faster and more effective in the axially dynamized group.
Cervical spondylosis is common condition rarely associated with radiculomyelopathy which surgical treatment, according to meta-analysis, is not better than nonsurgical. Our hypothesis was that ...neurodecompression which type is chosen according to spinal alignment should result in better functional improvement comparing with nonsurgical treatment. Between January 1, 1998 and December 31, 2007 a total of 77 patients with spondylogenic myelopathy were selected for the study. The inclusion criteria were symptoms and signs of myelopathy Ranawat grade III. Exclusion criteria were amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS). The curvature of the cervical spine was determined by Ishihara index. Anterior corpectomies and fusion was performed in the kyphotic spines, laminectomy with fusion in patients with neutral position, and open door laminoplasty in lordotic spines. Clinical improvement was assessed as differences between preoperative and 1-year follow up Nurick, modified Japanese Orthopedic Association (mJOA) myelopathy scales and walking test. Preoperative and postoperative transverse cord area and subarachnoid space were measured. Forty-four male and 31 female patients were surgically treated. Two patients with electrophysiological signs of ALS were excluded. Preoperative and postoperative mean +/- SD mJOA index was 9.15 +/- 1 and 13.01 +/- 1.4 (p < 0.001), Nurick grading scale 3.05 +/- 0.7 and 1.8 +/- 0.6 (p < 0.001), walking time (sec) 64.4 +/- 3.2 and 46.2 +/- 3.3 (p < 0.001), and number of steps 69.7 +/- 4.4 and 57.6 +/- 2.8 (p < 0.001) respectively. Preoperative and postoperative transverse cord area (mean +/- SD, mm2) was 46.7 +/- 5.4 and 60.2 +/- 2.6 (p < 0.001), and subarachnoid space 48.0 +/- 4.9 and 68.8 +/- 8.5 (p < 0.001) respectively. Our results showed that surgical treatment is beneficial for patients with spondylogenic myelopathy.
Adult deformities of the spine, especially in older population, significantly contribute to morbidity of these patients. Although the spectrum of causes is diverse, most often these are newly formed ...deformations based on degenerative changes of the spine. Apart from pain, feelings of tension and other unpleasant symptoms of adult deformity, they result in biomechanical disorders, reduced mobility, and sometimes neurological deficits. Overall, spinal deformities in adults cause significant disability and poor quality of life (physical and psychological), while on the other hand, they are relatively neglected in everyday practice. Therefore, in this paper we give a narrative review of the latest findings on etiopathogenesis, clinical picture, imaging diagnostics, treatment (conservative and surgical), and postoperative rehabilitation of patients with adult spine deformities of the most common causes.
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