Modified carpal box technique in the diagnosis of suspected scaphoid fractures

2003 ◽  
Vol 44 (3) ◽  
pp. 319-325 ◽  
Author(s):  
F. Toth ◽  
S. Mester ◽  
G. Cseh ◽  
A. Bener ◽  
J. Nyarady ◽  
...  
Keyword(s):  
Interobserver Agreement ◽  
Diagnostic Algorithm ◽  
Referral Rate ◽  
Radiographic Evaluation ◽  
Diagnostic Modality ◽  
Non Union ◽  
Scaphoid Fractures ◽  
Sensitivity Specificity ◽  
Very High

Purpose: To establish and test the clinical efficacy of a new diagnostic algorithm with the extensive utilization of modified carpal box radiography (mX-CB) in the detection of scaphoid fractures. Material and Methods: Initial and early follow-up radiographic evaluation of 146 suspected scaphoid fractures were carried out by mX-CB. Patients with unconfirmed diagnosis were referred to CT. Patients were followed for 1 year after injury. Sensitivity, specificity and interobserver agreement of reading mX-CB images were determined statistically. Results: No non-union or avascular necrosis was seen at 1 year after the injury. 90% of the fractures were diagnosed by mX-CB, only 6.8% of the patients needed referral to CT. Sensitivity of mX-CB at initial presentation was 81.6%. Interobserver agreement was very high among evaluators of mX-CB images. Conclusion: Extensive utilization of mX-CB as primary and early follow-up investigation resulted in high initial diagnostic accuracy and low referral rate to a more expensive diagnostic modality.

scholarly journals Trigen Intertan Nail in Unstable Peritrochanteric femur fractures in the Elderly -functional and radiological outcomes in 50 cases

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0007
Author(s):  
Sanjeev Patnaik ◽  
Akash Panda
Keyword(s):  
Femoral Fractures ◽  
The Elderly ◽  
Harris Hip Score ◽  
Radiographic Evaluation ◽  
Non Union ◽  
Femur Fractures ◽  
Modified Harris Hip Score ◽  
Head Neck ◽  
Intertan Nail

INTRODUCTION: Peritrochanteric femur fractures have increased significantly in recent decades and the trend continues, due to rising age of the population. Surgical treatment, in the form of rigid internal fixation and early mobilization is now the gold standard. One of the recent implant developments is the Trigen Intertan Nail (Smith & Nephew) for the treatment of peri-trochanteric femur fractures that uses 2 cephalocervical screws in an integrated mechanism allowing linear intra-operative compression and rotational 3-point stability of the head/neck fragment. AIMS & OBJECTIVE: To analyse the functional & radiological outcomes using TRIGEN INTERTAN nail for the treatment of peri-trochanteric femur fractures in the elderly population. DESIGN: Prospective study. METHODS: Between March 1, 2016, and March 31, 2019, 50 patients with an intertrochanteric femur fracture were treated with Trigen InterTan Nail (Smith-Nephew). All fractures were classified by OTA/AO Classification. All surviving patients were followed up for a minimum of 6 months post-operatively. Functional and radiographic evaluation were performed at 3 months & 6 months follow up using the modified Harris hip score. RESULTS: The age of the patients was 60-85 years. 2 patients died due to other co-morbidites, 3 did not come for follow up, leaving 45 patients available for final evaluation. The surgical time was 60-90 minutes. All fractures showed radiological union within 12-16 weeks . Radiographic analysis at healing revealed no loss of reduction, no uncontrolled collapse , no non-union, no femoral shaft fractures, and no implant failures. 2 cases had trochanteric split intra-operatively, requiring cerclage wiring, 1 case was poorly reduced and had varus malalignment. Modified Harris hip score was excellent in 20 patients, good in 10 cases, fair in 9 cases and poor in 1 case. CONCLUSIONS: The Trigen Intertan nail appears to be a reliable implant for the treatment of peri-trochanteric femoral fractures. Its design provides for stability against rotation and minimizes neck mal-unions (shortening) through linear intraoperative compression of the head/neck segment to the shaft. As a result of the minimal complication rate and improved clinical and radiological outcomes, this implant is now used as the standard implant for most unstable peri-trochanteric femur fractures at our institution.

scholarly journals Clinical and Radiologic Outcomes of the Matti-Russe Technique for Scaphoid Nonunions in Pediatric Patients

Hand ◽  
2018 ◽  
Vol 14 (1) ◽  
pp. 73-79
Author(s):  
Irshad Shakir ◽  
Ugochi C. Okoroafor ◽  
Joao Panattoni
Keyword(s):  
Internal Fixation ◽  
Pediatric Population ◽  
Radiographic Evaluation ◽  
Dash Score ◽  
Scaphoid Nonunion ◽  
Scaphoid Fractures ◽  
Outcomes Measures ◽  
Classic Technique

Background: Scaphoid fractures are a common injury, and a known complication is nonunion. One option to treat this nonunion is with the Matti-Russe technique, which takes a corticocancellous graft and fits it into the defect without internal fixation. The advent of modern methods of fixation has led the classic Matti-Russe technique to fall out of favor. In this study, we describe the classic technique and evaluate the results of the Matti-Russe method for treatment of scaphoid nonunions specifically for the pediatric population. Our purpose was to evaluate the long-term clinical and radiologic outcomes after surgery for scaphoid nonunion using the Matti-Russe technique in the pediatric population. Methods: A retrospective review was performed of patients less than 17 years of age, with a scaphoid nonunion that was treated with the Matti-Russe technique. This technique consisted of open reduction with intercalated bone graft and no internal fixation with hardware. Union was determined by radiographic evaluation. Computed tomography was obtained in 7 of 10 patients in this series and showed bony bridging in more than 50% of the scaphoid width in 3 different views. Intrascaphoid, scapholunate, and radiolunate angles were calculated. We reviewed wrist range of motion and complications. We obtained postoperative Mayo and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Results: There were 10 patients who underwent the Matti-Russe technique. The average age was 14.7 years old (±1.34, range: 13-17). All 10 of these patients had a scaphoid waist nonunion. There were 9 males and 1 female with an average follow-up of 13 months. The average amount of time to surgery from the date of injury was 12.3 months. All 10 patients went on to radiographic union at or before 6 months from surgery. Preoperative intrascaphoid, scapholunate, and radiolunate angles were 29° (±5.38), 62° (±18.28), and 20° (±9.22). Postoperative intrascaphoid, scapholunate, and radiolunate angles improved to 16° (±6.89), 38° (±8.50), and 10° (±4.69), which was significant. Seven out of 10 patients completed postoperative outcomes measures. The average postoperative Mayo wrist score was 87.9 (±14.10, range: 60-100). The average postoperative DASH score was 1.9 (±2.03, range: 0-4.5). There were no associated complications nor reoperations. Conclusion: The Matti-Russe technique is a safe and effective treatment for scaphoid nonunion in the pediatric population. It facilitates scaphoid union without the need for screw fixation and avoiding potential complications with hardware.

Failure of Surgery for Scaphoid Non-Union is Associated with Smoking

2006 ◽  
Vol 31 (3) ◽  
pp. 252-255 ◽  
Author(s):  
C. P. LITTLE ◽  
B. J. BURSTON ◽  
J. HOPKINSON-WOOLLEY ◽  
P. BURGE
Keyword(s):  
Bone Grafting ◽  
Smoking Prevalence ◽  
Screw Fixation ◽  
Delayed Union ◽  
Proximal Pole ◽  
Non Union ◽  
Scaphoid Fractures ◽  
The Uk ◽  
Vascularized Bone

Scaphoid fractures predominantly affect young men, in whom the UK smoking prevalence approaches 40%. We examined the association between smoking and failure of non-vascularized bone grafting and screw fixation for scaphoid non-union and delayed union in a retrospective cohort study. Adequate follow-up was obtained in 64 of 87 patients treated (74%). Union was defined as the presence of trabecular continuity on at least two films from a four-view radiographic series. Union was achieved in 47 of 64 cases. Seventeen were smokers. Thirteen of the 17 patients with non-union were smokers (relative risk 3.7; 95% CI: 1.3–10.1, p = 0.005). Proximal pole fractures, long injury-grafting interval and non-compliance were not more frequent in smokers than non-smokers. Smoking is strongly associated with failure of union after screw fixation and non-vascularized bone grafting of the scaphoid. Smokers should be advised to avoid smoking pre-operatively and during the healing period.

Restaging of patients with lymphoma

2008 ◽  
Vol 47 (01) ◽  
pp. 37-42 ◽  
Author(s):  
T. Pfluger ◽  
V. Schneider ◽  
M. Hacker ◽  
N. Bröckel ◽  
D. Morhard ◽  
...  
Keyword(s):  
Low Dose ◽  
Non Hodgkin Lymphoma ◽  
Contrast Enhanced ◽  
Pet Ct ◽  
Significant Difference ◽  
18F Fdg ◽  
Sensitivity Specificity ◽  
Fdg Pet Ct

SummaryAim: Assessment of the clinical benefit of i.v. contrast enhanced diagnostic CT (CE-CT) compared to low dose CT with 20 mAs (LD-CT) without contrast medium in combined [18F]-FDG PET/CT examinations in restaging of patients with lymphoma. Patients, methods: 45 patients with non-Hodgkin lymphoma (n = 35) and Hodgkin's disease (n = 10) were included into this study. PET, LD-CT and CECT were analyzed separately as well as side-by-side. Lymphoma involvement was evaluated separately for seven regions. Indeterminate diagnoses were accepted whenever there was a discrepancy between PET and CT findings. Results for combined reading were calculated by rating indeterminate diagnoses according the suggestions of either CT or PET. Each patient had a clinical follow-up evaluation for >6 months. Results: Region-based evaluation suggested a sensitivity/specificity of 66/93% for LD-CT, 87%/91% for CE-CT, 95%/96% for PET, 94%/99% for PET/LD-CT and 96%/99% for PET/CE-CT. The data for PET/CT were obtained by rating indeterminate results according to the suggestions of PET, which turned out to be superior to CT. Lymphoma staging was changed in two patients using PET/ CE-CT as compared to PET/LD-CT. Conclusion: Overall, there was no significant difference between PET/LD-CT and PET/CE-CT. However, PET/CE-CT yielded a more precise lesion delineation than PET/LD-CT. This was due to the improved image quality of CE-CT and might lead to a more accurate investigation of lymphoma.

Neurological manifestation in severe hypothyroidism in pregnancy

2020 ◽  
Vol 13 (12) ◽  
pp. e238069
Author(s):  
Aparna Sharma ◽  
Nilofar Noor ◽  
Vatsla Dadhwal
Keyword(s):  
Peripheral Neuropathy ◽  
Facial Palsy ◽  
Caesarean Delivery ◽  
Thyroid Stimulating Hormone ◽  
Neurological Manifestations ◽  
Second Trimester ◽  
Pituitary Hyperplasia ◽  
Very High ◽  
In Pregnancy

Neurological manifestations of hypothyroidism include peripheral neuropathy and pituitary hyperplasia. However, these associations are rarely encountered during pregnancy. We report a case of a known hypothyroid with very high thyroid stimulating hormone (TSH) values (512 μIU/mL) in the second trimester. At 24 weeks she developed facial palsy and pituitary hyperplasia which responded to a combination of steroids and thyroxine. She had caesarean delivery at 35 weeks and 3 days gestation in view of pre-eclampsia with severe features and was discharged on oral antihypertensives and thyroxine. On follow-up at 5 months, TSH normalised and pituitary hyperplasia showed a greater than 50% reduction in size. To our knowledge, this is the first reported case of facial palsy and pituitary hyperplasia associated with hypothyroidism during pregnancy.

scholarly journals Treatment Outcomes of Lesser Tuberosity Osteotomy Nonunion After Total Shoulder Arthroplasty

2018 ◽  
Vol 2 ◽  
pp. 247154921880777
Author(s):  
Zachary J Bloom ◽  
Cesar D Lopez, BA ◽  
Stephen P Maier ◽  
Brian B Shiu ◽  
Djuro Petkovic ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Shoulder Arthroplasty ◽  
Surgical Repair ◽  
Total Shoulder Arthroplasty ◽  
Case Series ◽  
Radiographic Evaluation ◽  
Lesser Tuberosity ◽  
Conservative Care ◽  
Conservative Group

Introduction Lesser tuberosity osteotomy (LTO) during anatomic total shoulder arthroplasty has a 13% nonunion rate. Treatment for LTO nonunion is controversial and poorly described in the literature. The purpose of this study was to compare the surgical and nonsurgical treatment outcomes of LTO nonunion. Methods A retrospective case series of 9 consecutive patients with LTO nonunion after primary anatomic shoulder arthroplasty at 1 institution from 2010 to 2016 were studied. Outcomes measured were radiographic evaluation of LTO on axillary X-ray, clinical range of motion (ROM), subscapularis strength, and pain at the time of LTO nonunion diagnosis and after either conservative care or surgical repair of the LTO nonunion. Results LTO nonunion was treated surgically in 4 and conservatively in 5 patients with average follow-up of 30 and 22 months, respectively. There were no significant differences in age, sex, or smoking status between groups. Treatment decision was a shared model of surgeon and patient. Displaced LTO nonunion was treated surgically in 2 and conservatively in 3 patients. There were no differences in LTO union rate of 50% in the surgical versus 60% in the conservative group. Abdominal compression test was abnormal in 50% of surgical versus 40% of conservative groups. At follow-up, ROM was lower in the surgical group with 128° forward elevation (FE) and 33° external rotation (ER) compared to 148° FE and 62° ER. Only 1 patient with LTO nonunion required conversion to reverse replacement. Conclusion LTO nonunion after shoulder arthroplasty is rare. Surgical repair of LTO nonunion does not significantly improve clinical or radiographic outcomes compared to conservative care.

scholarly journals Failure analysis and recommendations for treatment of posttraumatic non-unions of the distal humerus during childhood

2021 ◽  
Vol 47 (2) ◽  
pp. 313-324 ◽  
Author(s):  
Dirk Walther Sommerfeldt ◽  
Peter Paul Schmittenbecher
Keyword(s):  
Failure Analysis ◽  
Revision Surgery ◽  
Distal Humerus ◽  
Implant Removal ◽  
Supracondylar Fractures ◽  
Stable Fixation ◽  
Non Union ◽  
Pediatric Traumatology ◽  
Clinical Cases

Abstract Purpose Non-unions of the distal humerus are rare complications of common children’s fractures such as radial condyle fractures and supracondylar fractures. The aim of this paper was to update the knowledge about etiology, reasons, management, and results of these troublesome, and sometimes debilitating entities. Methods The sparse literature concerning nonunions following condylar or supracondylar fractures was analyzed together with the presentation of some typical clinical cases. Results In most of the cases, non-unions were induced by neglect, unstable fixation, too early implant removal, too much revision surgery, and an inconsequent transfer of follow-up algorithms, or combinations of the above. Treatment of non-union should start as early as possible because the effort of required surgery increases with time that the nonunion has been neglected. Often a combination of stable fixation of the pseudarthrosis and correction of the elbow axis are necessary to achieve a satisfying outcome. Conclusion In pediatric traumatology, qualified and consequent care for children’s fractures of the distal humerus can prevent rare complications such as non-unions in almost any situation. If such a disturbance of healing is noticed, immediate and adequate, i.e. children specific surgical consequences achieve best results.

scholarly journals Role of MRI in the diagnosis of adult traumatic and obstetric brachial plexus injury compared to intraoperative findings

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Doria Mohammed Gad ◽  
Mostafa Thabet Hussein ◽  
Nagham Nabil Mahmoud Omar ◽  
Mohamed Mostafa Kotb ◽  
Mohamed Abdel-Tawab ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Tissue Characterization ◽  
Brachial Plexus Injury ◽  
Imaging Modality ◽  
Preoperative Evaluation ◽  
Diagnostic Modality ◽  
Non Invasive ◽  
Upper Limb Function ◽  
Obstetric Brachial Plexus ◽  
Sensitivity Specificity

Abstract Background Brachial plexus injury occurs following birth trauma or adult trauma as well, surgical repair is important to regain upper limb function, and preoperative evaluation with MRI is important and considered the accurate and safe imaging modality. Thirty-seven patients with clinically suspected obstetric (15 patients) or adult traumatic (22 patients) brachial plexus injury were included in our study; all of them underwent MRI examination including T1WI, T2WI, STIR, DWIBS, 3D STIR SPACE, and MR myelography sequences. Results In obstetric cases, MRI sensitivity, specificity, and accuracy for preganglionic injury were 63%, 89%, and 82%, respectively, while for postganglionic lesions, MRI sensitivity, specificity, and accuracy were 60%, 99%, and 95%, respectively. In adult cases, MRI sensitivity, specificity, and accuracy for preganglionic injury were 96%, 95%, and 95% respectively, while for postganglionic injury, MRI sensitivity, specificity, and accuracy were 60%, 100%, and 99%, respectively. Conclusion MRI represents a safe, non-invasive, diagnostic modality having the multiplanar capability and better soft tissue characterization.

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