The accuracy of routine knee MR imaging in detection of acute neurovascular injury following multiligamentous knee injury.

Objective: To assess the accuracy of routine knee MRI in detecting acute popliteal artery and/or common peroneal nerve (CPN) dysfunction following multiligamentous knee injury (MLKI), with correlation of MRI findings to clinical outcome.

Materials And Methods: Routine MRI knee examinations in 115 MLKI patients (54/115 with acute neurovascular injury, 61/115 without neurovascular injury) were retrospectively reviewed. Cases were classified by injury mechanism and ligamentous injuries sustained.

MR imaging in the presence of ballistic debris of unknown composition: a review of the literature and practical approach.

Due to a combination of increasing indications for MR imaging, increased MRI accessibility, and extensive global armed conflict over the last few decades, an increasing number of patients now and in the future will present with retained metallic ballistic debris of unknown composition. To date, there are no guidelines on how to safely image these patients which may result in patients who would benefit from MRI not receiving it. In this article, we review the current literature pertaining to the MRI safety of retained ballistic materials and present the process we use to safely image these patients.

Imaging of the Postoperative Condition of Posterolateral Corner Injuries.

Posterolateral corner (PLC) injuries of the knee are often sustained in combination with anterior or posterior cruciate ligament injuries. A variety of surgical techniques including acute repair, nonanatomical reconstructions, and anatomical reconstructions have been used to treat grade III PLC injuries. Scant literature is available on postoperative imaging of the PLC.

Meniscal root tears occur frequently in multi-ligament knee injury and can be predicted by associated MRI injury patterns.

Purpose: The frequency of meniscal root tears in association with multi-ligament knee injury has not been established but adds to the complexity of surgical reconstruction and may have long-term consequences. Therefore, identifying root tears, on preoperative imaging, is important. The aim of this study was to identify the frequency of meniscal root tears, on preoperative magnetic resonance imaging, following multi-ligament injury and distinguish associated injury patterns that may aid detection.

Bone mineral density predicts fractures in chronic kidney disease.

Fractures are common in chronic kidney disease (CKD). The optimal methods by which to assess fracture risk are unknown, in part, due to a lack of prospective studies. We determined if bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA), and/or high-resolution peripheral quantitative computed tomography (HRpQCT) could predict fractures in men and women ≥18 years old with stages 3 to 5 CKD.

Imaging of postoperative avascular necrosis of the ankle and foot.

Avascular necrosis (AVN) of the ankle and foot is an uncommon and often unexpected postoperative complication in patients with persistent pain and disability postprocedure. Artifacts from metallic implants may obscure characteristic imaging signs of AVN, and radiography and computer tomography are the mainstay imaging modalities of the postoperative ankle and foot. MRI and nuclear medicine imaging play an important complementary role in problem solving and excluding differential diagnostic considerations including infection, nonunion, occult fracture, and secondary osteoarthritis.

The radiographic quantification of scapular malalignment after malunion of displaced clavicular shaft fractures.

Background: Malunion after displaced fractures of the clavicle can result in varying degrees of scapular malalignment and potentially scapular winging. The purpose of our study was to quantify the scapular malalignment in patients with midshaft clavicle malunions showing scapular winging.

Methods: Eighteen patients with symptomatic midshaft clavicle malunions showing scapular winging were identified and underwent standardized computed tomography scanning of the thorax.

Computer navigation in the reduction and fixation of femoral shaft fractures: a randomized control study.

Objectives: We investigated the accuracy of reduction of intramedullary nailed femoral shaft fractures in human cadavers, comparing conventional and computer navigation techniques.

Methods: Twenty femoral shaft fractures were created in human cadavers, with segmental defects ranging from 9 to 53 mm in length (Winquist 3-4, AO 32C2). All fractures were fixed with antegrade 9 mm diameter femoral nails on a radiolucent operating table.

Injury patterns to the posteromedial corner of the knee in high-grade multiligament knee injuries: a MRI study.

Injury patterns to the posteromedial corner of the knee have not been previously studied in the context of multiligament knee injuries. We performed a retrospective magnetic resonance imaging and clinical review of a consecutive series of 27 dislocatable knees presenting to a single level-one trauma center from 2005 to 2008. Post-injury magnetic resonance imaging studies were reviewed by two fellowship-trained musculoskeletal radiologists to assess injury patterns to the posteromedial corner.

Cellular markers of muscle atrophy in chronic obstructive pulmonary disease.

Skeletal muscle atrophy in individuals with advanced chronic obstructive pulmonary disease (COPD) is associated with diminished quality of life, increased health resource use, and worsened survival. Muscle wasting results from an imbalance between protein degradation and synthesis, and is enhanced by decreased regenerative repair. We investigated the activation of cellular signaling networks known to mediate muscle atrophy and regulate muscle regenerative capacity in rodent models, in individuals with COPD (FEV(1) < 50% predicted).

Weightbearing CT scan of severe flexible pes planus deformities.

Background: The three-dimensional relationships of the bones in the foot in a flatfoot deformity are difficult to assess with standard radiographs. CT scans demonstrate these relationships but are typically made in a nonweightbearing mode. Our objective was to assess the use of a weightbearing CT apparatus to image the feet in patients with severe flexible pes planus deformities and to better define the anatomical changes that occur.

Prevalence of vertebral fractures in adults with cystic fibrosis and their relationship to bone mineral density.

Study Objectives: The objectives of this study were to determine the prevalence of morphometric vertebral fractures in a large cohort of adult cystic fibrosis (CF) patients, and to examine the association between fractures and bone mineral density (BMD).

Design: Cross-sectional retrospective study.

Setting: A tertiary care academic hospital.

The indications for and the prognostic significance of amputation as the primary surgical procedure for localized soft tissue sarcoma of the extremity.

Background: The indications for primary amputation of a localized soft tissue sarcoma (STS) of the extremity are not well defined in the literature. However, it has been suggested that patients who require an amputation to treat an STS are at increased risk for developing metastases. We categorized the main indications for primary amputation in our patient population and compared their oncological outcome with the outcome of patients who underwent limb-sparing surgery.

Avascular necrosis of the talus: a pictorial essay.

The talus is predisposed to avascular necrosis (AVN), or bone death due to ischemia, owing to its unique structure, characteristic extraosseous arterial sources, and variable intraosseous blood supply. Both traumatic and atraumatic causes have been implicated in talar AVN. The risk of posttraumatic AVN can be predicted using the Hawkins classification system.

Distinguishing transient osteoporosis of the hip from avascular necrosis.

Introduction: To review the circumstances surrounding the misdiagnosis of transient osteoporosis of the hip (TOH) as avascular necrosis (AVN) and to increase physician awareness of the prevalence and diagnosis of this condition in young men, we reviewed a series of cases seen in the orthopedic unit at St. Michael's Hospital, University of Toronto.

Methods: We studied the charts of patients with TOH referred between 1998 and 2001 with a diagnosis of AVN for demographic data, risk factors, imaging results and outcomes.