Ethan M. Braunstein

Radiographic changes following anterior cervical fusion.

In nine patients who underwent anterior cervical fusions for cervical spondylosis, preoperative cervical spine films were compared with radiographs taken seven to 15 years after fusion. Eight of the nine patients were found to have radiographic evidence of increased degenerative diseases located primarily below the level of fusion but occasionally occurring both above and below the fusion. Whether these degenerative changes are the bodys response to altered mechanical forces on joints next to a now immobile spinal segment or whether these changes merely represent the natural progression of the degenerative disease process could not be ascertained from this study. Perhaps both factors contributed.

Magnetic resonance imaging of knee hyaline cartilage and intraarticular pathology.

Injuries to the hyaline cartilage of the knee joint are difficult to diagnose without invasive techniques. Even though these defects may be the most important prog nostic factors in assessing knee joint injury, they are usually not diagnosed until arthrotomy or arthroscopy. Once injuries to hyaline cartilage are found and/or treated, no technique exists to follow these over time. Plain radiographs, arthrograms, and even computed tomography fail to detail most hyaline cartilage defects. We used magnetic resonance imaging (MRI) to eval uate five fresh frozen cadaver limbs and 10 patients whose pathology was known from arthrotomy or ar throscopic examination. Using a 0.35 Tesla supercon ducting magnet and spin-echo imaging technique with a head coil, we found that intraarticular fluid or air helped to delineate hyaline cartilage pathology. The multiplane capability of MRI proved to be excellent in detailing small (3 mm or more) defects on the femoral condyles and patellar surface. Cruciate ligaments were best visualized on sagittal oblique projections while meniscal pathology was best seen on true sagittal and coronal projections. MRI shows great promise in providing a noninvasive technique of evaluating hyaline cartilage defects, their response to treatment, and detailed anatomical infor mation about cruciate ligaments and menisci.

Central carpal instability - Capitate lunate instability pattern: Diagnosis by dynamic displacement

Eleven patients have been diagnosed as having a central carpal instability that has, to our knowledge, not been previously described. The clinical symptom complex is one of pain and clicking in the region of the midcarpus and, at times, frank snapping, usually while lifting heavy objects. Tight grasping, especially in supination, tends to provoke the symptoms. In ten of the patients, the diagnosis of instability was demonstrated by a dynamic traction displacement technique with the aid of fluoroscopy, in one patient the instability pattern was recognized only at the time of surgical exploration of the carpus. One patient has undergone a surgical procedure to reinforce the dorsal ligamentous support at the capitate lunate area. The other ten patients have become asymptomatic as a result of modifying their activities. The capitate lunate instability pattern (CLIP wrist) is a definite and distinct entity, which may be diagnosed with appropriate studies.

Computed tomography and plain radiography in experimental fracture healing

We evaluated the relative contribution of plain radiographs and computed tomography to the assessment of fracture healing under experimental circumstances. In 15 sheep, we performed midshaft femoral osteotomies and internal fixation of the resultant segmental fractures. Radiographs were obtained preoperatively and immediately postoperatively. Animals were sacrificed at 3 weeks, 6 weeks, 12 weeks, 24 weeks, and 36 weeks after surgery, and the femoral specimens radiographed. After removal of the internal fixation devices, computed tomographic scans of the specimens were performed.By 3 weeks, callus was visible, but at 6 weeks, a trabecular pattern in the callus was seen on plain films but not on computed tomography. There was progressive organization of the callus on both studies. At 24 weeks, computed tomography demonstrated fracture lines not seen due to overlying callus on plain films and also more accurately showed incomplete union. By 36 weeks, healing was essentially complete according to both modalities, although there still were small gaps in the callus detectable on computed tomography but not on plain films.Computed tomography may be of value in the evaluation of fractures of long bones in those cases in which clinical examination and plain radiographs fail to give adequate information as to the status of healing.

Long term radiographic changes following anterior cervical fusion

Long-term follow-up radiographs of patients with anterior cervical fusions demonstrated progressive cervical spondylosis and osteophytes at levels above and below the fusion. The findings may represent a response to altered stresses imposed by the surgery.

Pneumatosis intestinalis in dermatomyositis

Pneumatosis intestinalis is a rare complication of collagen vascular disease. The current case is the third reported occurrence of pneumatosis in dermatomyositis (Mueller et al., 1972, Oliveros et al., 1973), and the first in which this finding was not preceded by steroid therapy. Unlike its appearance in scleroderma, pneumatosis in dermatomyositis seems to be associated with a benign course, but it must be distinguished from a perforated viscus. A twelve-year-old black female was admitted to the University of Michigan Hospital for evaluation of dermatomyositis diagnosed on muscle biopsy three years previously. She complained of difficulty swallowing but had no abdominal pain or other symptoms referable to the gastrointestinal tract. She had never been treated with systemic steroids.

Ultrasonographic Diagnosis of Extremity Masses

Radiographic examination of soft tissue extremity masses is frequently inconclusive. In 18 patients with normal or nonspecifically abnormal radiographs, gray scale ultrasonography provided useful additional information. It was possible to distinguish fluid collections from solid masses, and recurrent venous thrombosis from hematoma in anticoagulated patients. Occasionally, specific diagnoses were suggested on the basis of ultrasonic morphologic characteristics. Diagnoses included soft tissue neoplasms, hematomas, aneurysms, synovial cysts, abscesses, and a lymphocele.Ultrasonically guided percutaneous needle aspiration was diagnostic in two cases. Features of differential diagnostic value relative to extremity solid masses and fluid collections are discussed. Ultrasonography is useful in evaluating these soft tissue masses.

Intravenous methylmethacrylate after total hip replacement

In eight patients, radiographs made after total hip replacement revealed methylmethacrylate in the soft tissues of the thigh. In one of them the configuration of the density was that of a vein. In the other seven patients similar but less extensive soft-tissue densities were seen postoperatively. One patient had postoperative hypotension which was thought to be due to a myocardial infarction. In another patient, with a prior history of congestive heart failure, congestive heart failure developed again after total hip replacement. The relationship of these complications to the radiographic observations was not clear.

Radiologic features of a pyrophosphate-like arthropathy associated with long-term dialysis

In a series of 28 long-term dialysis patients with musculoskeletal complaints, the radiologic findings in six cases resembled those occurring in the arthropathy of idiopathic calcium pyrophosphate dihydrate deposition (CPPD) disease. These findings included osteophytes, subchondral cysts, and cartilage loss in the metacarpophalangeal joints, patellofemoral joints, wrists, and shoulders. Chondrocalcinosis was present in three of the six cases. There were no significant differences in renal function or levels of serum calcium, phosphorus, iron, ferritin, aluminum, or parathormone between these patients and a control group matched for sex and age. Long-term dialysis may be associated with a metabolic arthritis similar to the arthritis which occurs in CPPD deposition disease. The etiology may include deposition of CPPD crystals, hydroxyapatite, or other calcium-containing substances in joints, or it may be related to a number of dialysis-induced metabolic abnor-malities.

Giant Cell Tumour of the Triquetrum

A case of giant cell tumour involving the triquetrum is reported. Treatment consisted of resection of the triquetrum, followed by intercarpal arthrodesis.