Eva M. Escobedo

MRI IN ACUTE KNEE DISLOCATION: A PROSPECTIVE STUDY OF CLINICAL, MRI AND SURGICAL FINDINGS

We treated 17 knees in 15 patients with severe ligament derangement and dislocation by open repair and reconstruction. We assessed the competence of all structures thought to be important for stability by clinical examination, MRI interpretation, and surgery. Our findings showed that in these polytrauma patients clinical examination was not an accurate predictor of the extent or site of soft-tissue injury (53% to 82% correct) due mainly to the limitations of associated injuries. MRI was more accurate (85% to 100% correct) except for a negative result for the lateral collateral ligament and posterolateral capsule. The detail and reliability of MRI are invaluable in the preoperative planning of the surgical repair and reconstruction of dislocated knees.

Rotator Cuff Repairs in Individuals with Paraplegia

Shoulder pain and dysfunction are common problems among those individuals with a spinal cord injury (SCI). Among individuals with SCI who have shoulder pain, the prevalence of rotator cuff tears is 65 TO 71%. To date, there has been little discussion as to the efficacy of various treatments for shoulder pain used in the SCI population. The purpose of this retrospective study was to evaluate the outcome of rotator cuff repairs at the Spinal Cord Injury Center (Veterans Administration Puget Sound Health Care System). Five patients (six shoulders) were identified who had undergone shoulder surgery for rotator cuff tear since 1987. Four individuals (five shoulders) had large rotator cuff tears, and following surgery, none of these repairs resulted in improvement of shoulder function or improvement in active range of motion. The one patient with a smaller tear limited to the supraspinatus had a successful surgical outcome in that he had decreased pain, increased strength, and increased range of motion. There is a general lack of epidemiologic information about shoulder pain in individuals with paraplegia. There is also a remarkable lack of research as to the functional impact of shoulder pain and the outcome of nonsurgical and surgical treatments. This case series, drawn from a population of 511 individuals with spinal cord injury, demonstrates that poor outcome was more likely in those with supraspinatus atrophy, those with upward displacement of the humeral head on x-ray, and in those with tears involving more than one muscle. There is a need for further study of conservative treatment and development of selection criteria for those individuals who are being considered for surgery.

MR imaging of ulnar impaction

The ulnar impaction syndrome of the wrist is a well-recognized clinical entity, usually showing distinct radiographic features including a positive ulnar variance and degenerative subchondral changes of the distal ulna, proximal lunate, and proximal triquetrum. Confirmation of the clinical and plain film findings with advanced imaging is often necessary to exclude other entities with a similar clinical presentation. Although arthrography and bone scintigraphy are helpful in this work-up, magnetic resonance imaging (MRI) appears to be both a sensitive and a specific means of evaluation. The imaging studies in four patients with clinically and surgically diagnosed ulnar impaction are described, with emphasis on MRI findings. MRI appears to be the modality of choice in the evaluation of patients with suspected ulnolunate impingement.

Magnetic resonance imaging of dialysis-related amyloidosis of the shoulder and hip

Abstract Objective. The purpose of this study was to evaluate the usefulness of MRI in identifying abnormalities of the periarticular structures in patients with symptoms of dialysis-related amyloid arthropathy. Design and patients. MR images of shoulders and hips in 5 dialysis patients with symptoms of amyloid arthropathy were compared to images of shoulders and hips in 4 asymptomatic dialysis patients, shoulders in 9 nondialysis patients, and hips in 12 nondialysis patients. These were evaluated for the presence of focal periarticular osseous lesions, tendinous and capsular thickening, and periarticular fluid. Results. Increased thickness of the supraspinatus tendon was found in both symptomatic and asymptomatic patients. Capsular thickening at the hip was present in all symptomatic patients, and in 3 of 8 asymptomatic hips. Joint and bursal fluid was common in the symptomatic group, and was present in some asymptomatic individuals. Osseous lesions were detected in the absence of plain film findings, and demonstrated variable signal intensity. Conclusions. MRI is useful in detecting signs of dialysis-related amyloidosis. Findings of a milder degree in asymptomatic dialysis patients suggests that MRI may also be valuable in the early diagnosis of this syndrome.

Increased Risk of Posterior Glenoid Labrum Tears in Football Players

OBJECTIVE This study was designed to test our hypothesis that football players with shoulder pain, shoulder instability, or both requiring MR arthrography for evaluation are at an increased likelihood relative to non-football players for having a tear of the posterior glenoid labrum. CONCLUSION We conclude that posterior glenoid labrum tears are more prevalent in football players than in non-football players.

Brachialis Muscle Rupture and Hematoma

We present the case of a rupture of the brachialis muscle in a 17-year-old male. We provide an overview of the current literature discussing previously reported cases, the clinical features, and recommended treatment. The anatomy and function of the brachialis muscle and possible mechanism of injury are also discussed.

Hoffa Fracture of the Femoral Condyle

In this report, we present a case of an uncommon coronal fracture of the femoral condyle, known as a Hoffa fracture. Classification of these injuries and commonly associated injuries are discussed. We describe previously proposed mechanisms of injury and review the current literature. The difficulty in establishing radiologic diagnosis on the basis of radiography exclusively is emphasized. Finally, current approaches to operative fixation are outlined.

Meniscal Ossicle in the Lateral Meniscus: An Unusual Variant of a Rare Entity

Meniscal ossicles are rare entities of the knee usually involving the medial meniscus. Lateral meniscal ossicles are exceedingly rare. We present a case of a lateral meniscal ossicle found incidentally after trauma. The etiology and characteristic findings on imaging are discussed.

Acute fracture of the os trigonum

A 21-year-old man presented with ankle pain after a motor vehicle accident. Imaging revealed an acute fracture of the os trigonum in addition to multiple, other lower-extremity fractures. In this case, the fracture of the os trigonum was a result of a significant traumatic injury. Thus, the presence of this fracture in an acute setting should prompt a search for other associated fractures.

Osteonecrosis of the femoral condyles following traumatic dislocation of the knee

A 31-year-old male logger in Alaska fell, injuring his right leg. Examination in the field revealed a grossly unstable knee, an open fracture of the ankle, and palpable pedal pulses. He was placed in traction and transported to a local hospital. Subsequent loss of distal pulses prompted exploration of the popliteal fossa, revealing a popliteal artery occlusion and a “contused” popliteal vein. An arterial shunt with IV tubing was used to restore circulation. Open reduction and internal fixation of an open Weber B fibular fracture and a four-compartment fasciotomy were also performed. He was transferred to Seattle, Washington by air. Upon arrival, physical examination revealed an anterior dislocation of his right knee (Fig. 1). Distal pulses were palpable and there was evidence of a peroneal nerve injury. Twenty hours following the initial trauma he underwent popliteal re-exploration. The foot was viable with detectable pulses. There was transection of the popliteal artery with a functioning interposition graft. Frank thrombosis of the popliteal vein was noted and a thrombectomy was performed. The tibial nerve was intact. The severed popliteal artery was severely damaged, and the proximal stump was retracted above the adductor hiatus. Therefore, a distal superficial femoral artery-popliteal artery saphenous vein graft was performed and thrombus removed from the artery. An external fixator was placed across the knee. Post reduction radiographs revealed normal osseous structures, including femoral condyles. On the second postoperative day he was taken to the operating room for closure of his fasciotomies. Delayed primary closure and splitthickness skin grafts for other wounds followed. No necrotic muscle was found at either procedure. He remained in the external fixator for 3 weeks. Soft tissue reconstruction of the knee was deferred because of posterior wound infection, which required surgical drainage approximately 2 weeks after the operation. The wound was left open to heal. Radiographs at the time of discharge were unremarkable except for mild osteopenia and a joint effusion. Skeletal Radiol (1996) 25:276–278