Closed partial rupture of a common digital nerve in the palm: a case report.

Nerve injuries in the upper extremity after trauma are common. Typically nerve damage is the result of traction, crush injury, ischemic insult, or direct laceration of the peripheral nerve. Examination of the literature shows that nerve damage in closed traumatic injury is much less common than in open trauma, especially when this standard is applied to closed nerve injuries distal to the wrist.

The incidence of soft tissue injury in operative tibial plateau fractures: a magnetic resonance imaging analysis of 103 patients.

Objectives: The goal of this study was to determine the incidence of injury to soft tissue structures of the knee in tibial plateau fractures scheduled for surgery.

Design: Prospective cohort.

Setting: Level I academic medical center.

The effect of intraoperative heparin administered during total hip arthroplasty on the incidence of proximal deep vein thrombosis assessed by magnetic resonance venography.

Intraoperative, unfractionated heparin, administered intravenously before the femoral work, has demonstrated to be effective in reducing the strong thrombotic stimulus that occurs during total hip arthroplasty (THA) surgery. This randomized, double-blind, prospective study included only THA patients with significant comorbidities predisposing them to deep vein thrombosis (DVT). The 2 groups consisted of study patients who received a single dose of intravenous, intraoperative, unfractionated heparin and control patients who received a single dose of intravenous, intraoperative saline.

Vascularity of the hip labrum: a cadaveric investigation.

Purpose: The purpose of this study was to define the vascularity of the hip labrum and to identify regional differences in vascular penetration that may have implications for the healing potential of this structure.

Type Of Study: Injection study of human cadavers to investigate the vascularity of the hip labrum.

Methods: Twelve hips from 6 human frozen cadavers devoid of severe articular pathology were used.

Magnetic resonance imaging after total hip arthroplasty: evaluation of periprosthetic soft tissue.

Background: The evaluation of periprosthetic osteolysis in patients who have had a total hip arthroplasty is challenging, and traditional imaging techniques, including magnetic resonance imaging and computerized tomography, are limited by metallic artifact. The purpose of the present study was to investigate the use of modified magnetic resonance imaging techniques involving commercially available software to visualize periprosthetic soft tissues, to define the bone-implant interface, and to detect the location and extent of osteolysis.

Methods: Twenty-eight hips in twenty-seven patients were examined to assess the extent of osteolysis (nineteen hips), enigmatic pain (five), heterotopic ossification (two), suspected tumor (one), or femoral nerve palsy (one).

Teres minor denervation on routine magnetic resonance imaging of the shoulder.

Objective: To try to define an association between clinical history and the finding of isolated teres minor denervation on routine magnetic resonance (MR) examination of the shoulder.

Design: A retrospective review of all shoulder MR examinations performed at our institution over a 2-year period ( n=2,563)

Patients: All patients and MR examinations demonstrating isolated denervation of the teres minor muscle as determined by review of this subset of patients ( n=61)

Results: A 3% incidence of isolated teres minor denervation was found. No patient had a clinical history concerning the classic quadrilateral space syndrome, and no patient had a structural lesion in the quadrilateral space.

Magnetic resonance imaging appearance of cartilage repair in the knee.

Assessment of surgically repaired cartilage lesions with standardized cartilage sensitive magnetic resonance imaging was done to evaluate the integrity, morphologic features, and signal of the articular surface, thereby obtaining information about the natural history of these procedures in the knee. Magnetic resonance imaging also assessed the interface between the repaired and native cartilage, changes in the subchondral bone, and the appearance of cartilage over the opposite and adjacent (native) surfaces. One hundred eighty magnetic resonance imaging examinations were obtained in 112 patients who had cartilage-resurfacing procedures, including 86 microfractures and 35 autologous chondrocyte implantations, at a mean of 15 and 13 months after surgery, respectively.

MR imaging of ligament injuries to the elbow.

MR imaging is a highly valuable tool in the evaluation of ligamentous injuries of the elbow. Proper coil selection, patient positioning, and pulse sequence parameters are essential for optimization of image quality. Clinical evaluation of ligamentous injuries is often difficult and visualization at surgery may be limited.

Temperature along the axillary nerve during radiofrequency-induced thermal capsular shrinkage.

Background: There have been reports of axillary nerve palsy after thermal capsular shrinkage with radiofrequency energy-generating devices. The exact cause of this is unknown.

Hypothesis: The temperature of the axillary nerve increases during shoulder capsular shrinkage at various degrees of shoulder abduction.

Magnetic resonance imaging of the elbow.

Despite being one of the more commonly injured joints in recreational and elite athletes, diagnosis of soft-tissue injuries of the elbow remains problematic. Although plain radiographs remain the initial mainstay for imaging of the elbow, the superior soft-tissue contrast and direct multiplanar capabilities of magnetic resonance (MR) imaging has afforded the ability to more accurately diagnose the site and extent of soft-tissue pathology, including tendinous injuries and trauma to the static stabilizers. In addition, the ability of MR imaging to noninvasively assess the integrity of the articular cartilage provides for more comprehensive information that was previously unavailable and has prognostic significance in the athlete.

MR imaging of the sternoclavicular joint following trauma.

The purpose of this study is to describe the magnetic resonance imaging (MRI) findings of the sternoclavicular (SC) joint seen in patients who presented to our department with joint pain related to trauma. Clinical history and MRI findings on 41 patients were reviewed retrospectively to establish types and frequencies of soft tissue injuries and subluxations. Because both SC joints were imaged, the asymptomatic joints were used as a control group.

Correlation of interosseous membrane tears to the level of the fibular fracture.

Objectives: To correlate interosseous membrane (IOM) tears of the ankle to the height of fibular fractures in operative ankle fractures.

Design: Prospective clinical trial.

Setting: University Level 1 trauma center.

Traumatic posterior hip subluxation in American football.

Background: Traumatic posterior hip subluxation is a potentially devastating injury that is often misdiagnosed as a simple hip sprain or strain. The purpose of the present study was to outline the injury mechanism, pathoanatomy, clinical and radiographic findings, and treatment of traumatic hip subluxation in an athletic population.

Methods: Over a nine-year period, eight participants in American football who had sustained a traumatic posterior hip subluxation were evaluated and treated.

Radiographic evaluation of the acromioclavicular and sternoclavicular joints.

Plain radiography is useful for the initial assessment of suspected disorders of the sternoclavicular and acromioclavicular joints. Other modalities are often required to further assess more complex pathologies involving these joints, however. Ultrasound has been described as a screening tool to assess possible sternoclavicular joint dislocation; however, it is usually used only if CT and MRI are not readily available.

Osteochondral lesions of the talus: a new magnetic resonance grading system with arthroscopic correlation.

Purpose: The purpose of this study was to show that magnetic resonance imaging (MRI) can accurately and noninvasively evaluate the articular cartilage overlying osteochondral lesions of the talus, using arthroscopy as the standard, and provide information about lesion stability. A classification system applicable to both MRI and arthroscopy is proposed.

Type Of Study: Retrospective review with MRI and arthroscopy correlation.

T2 quantitation of articular cartilage at 1.5 T.

Purpose: To evaluate sources of error when using a multiecho sequence for quantitative T2 mapping of articular cartilage at 1.5 T.

Materials And Methods: Phantom measurements were used to assess the contribution of stimulated echoes to inaccuracy of T2 measurements in cartilage using a multiecho sequence.

Magnetic resonance imaging of total knee arthroplasty.

Evaluation of painful total knee arthroplasty can be clinically difficult, and traditional imaging techniques such as conventional radiographs, arthrography, and bone scintigraphy are limited by poor contrast resolution and specificity. Traditional magnetic resonance imaging techniques often are nondiagnostic because of significant metal artifact. Forty-one patients (46 knees) had magnetic resonance imaging, tailored to reduce metallic susceptibility artifact, after total knee arthroplasty, and the findings and clinical and surgical followup were reviewed.

Effect of mechanical compression on the prevalence of proximal deep venous thrombosis as assessed by magnetic resonance venography.

Background: Patients have been shown to be at greater risk for deep venous thrombosis, particularly proximal thrombosis, after total hip arthroplasty. Proximal thrombi are more likely to develop into pulmonary emboli than are distal thrombi. The purpose of this randomized, prospective study was to compare the prevalence of pelvic and proximal lower-extremity deep venous thrombosis after primary total hip arthroplasty between patients treated with an impulse mechanical compression device for prophylaxis and those treated with prophylactic stockings.

Impact of MRI on treatment plan and fracture classification of tibial plateau fractures.

Objective: To evaluate the interobserver agreement for both treatment plan and fracture classification of tibial plateau fractures using plain radiographs, computed tomography (CT) scan, and magnetic resonance imaging (MRI).

Design: Prospective study to assess the impact of an advanced radiographic study on the agreement of treatment plan and fracture classification of tibial plateau fractures among three orthopaedic surgeons.

Setting/participants: Patients presenting with tibial plateau fractures to a level I trauma center were evaluated with plain knee radiographs (anteroposterior, lateral, two oblique views), CT scan, and MRI.

Magnetic resonance imaging of painful shoulder arthroplasty.

Specialized magnetic resonance imaging (MRI) was performed in 42 painful shoulder arthroplasties, 22 of which underwent subsequent revision surgery, allowing surgical confirmation of the pathology identified on MRI. One hemiarthroplasty was excluded because of motion artifact, leaving 21 studies (19 patients) to be correlated retrospectively to the surgical findings. At the time of revision surgery, there were full-thickness rotator cuff tears in 11 of 21 shoulders; MRI correctly predicted these in 10 of 11 shoulders.

Interosseous-lumbrical adhesions of the hand: contribution of magnetic resonance imaging to diagnosis and treatment planning.

Previous investigators have not found magnetic resonance imaging (MRI) to be helpful in the diagnosis of interosseous-lumbrical tendon adhesions of the hand. We present 2 cases in which preoperative magnetic resonance images correlated with the clinical diagnosis and intraoperative finding of adhesions between the interosseous-lumbrical tendons at the level of the metacarpal head. Because there are no specific signs for the diagnosis, no palpable lesion, and no specific provocative test, the MRI acted to confirm the diagnosis in the presence of vague, nonspecific symptoms and provide objective evidence of the source of the patient's discomfort.

Imaging of elbow injuries in the child and adult athlete.

Because of the often complex and sometimes poorly remembered history of trauma to the elbow, imaging beyond conventional plain film radiographs is often needed. Usually, this consists of high-resolution MR imaging to evaluate the articular cartilage, supporting ligaments, and tendons about the elbow. Sonography, however, can also be used, especially when there is a targeted clinical question as to the presence of epicondylitis, or to provide guidance for diagnostic or therapeutic injections.

MRI assessment of the posterior acetabular wall fracture in traumatic dislocation of the hip in children.

Traumatic hip dislocations associated with posterior wall fractures of the acetabulum in the pediatric population are in general a consequence of high-energy trauma. After expeditious reduction, instability mandates for further diagnosis and intervention. Plain radiographs or computerized tomography (CT) scans can misjudge the involvement of the posterior wall of the acetabulum due to the partially calcified nature of the pediatric bone.