George Y. El-Khoury

Treatment options in primary Ewing's sarcoma of the spine: report of seven cases and review of the literature.

Primary Ewings sarcoma of the spine is reviewed, and seven cases are presented. Ewings sarcoma of the spine is a rare condition that appears with a clinical triad of local pain, neurological deficit, and a palpable mass. The clinical picture, imaging characteristics, and management are discussed. The definitive management of Ewings sarcoma of the spine, as in other locations, could include three main modalities: surgery, radiotherapy, and combination chemotherapy. In the presence of acute neurological decompensation, decompressive surgery via an appropriate approach should be performed. Because Ewings sarcoma is usually sensitive to chemotherapy, initial chemotherapy, in neurologically stable patients, could be attempted first without surgical resection. Further management could then be gauged according to the response.

Arthrotomography of the wrist: An experimental and preliminary clinical study

Experimental arthrotomography including posteroanterior and lateral projections was completed in 18 fresh-frozen wrists from cadavers with an average age of 65 years at death. Arthrotomographic findings were correlated with anatomic dissections. Three types of defects of the triangular fibrocartilage complex were clearly defined in 38% of wrists. Chondromalacia was present in 24% of wrists, in all cases on the ulnar half of the proximal surface of the lunate bone. The palmar radiocarpal ligaments (radiocapitate and radiotriquetral) were visible in all specimens. Experimental arthrotomography appears to be useful in defining the nature and location of soft tissue pathology in clinical practice. Clinical arthrotomography was performed in 16 patients, all with a syndrome of chronic wrist pain. Pathologic findings were observed in 11 wrists, including four perforations of the triangular fibrocartilage complex, two cases of chondromalacia of the lunate, one tear in each of the scapholunate and lunotriquetral ligaments, three occult palmar ganglia, and one recurrent dorsal ganglion. The soft tissues in five wrists were normal. The preliminary clinical experience with wrist arthrotomography has yielded results that have significantly affected the care of patients, including the planning of operative treatment and patient counseling.

Rare bilateral C6 spondylolysis and spondylolisthesis in an adolescent athlete: evaluation with magnetic resonance imaging and multidetector computerized tomography.

Study design. Case report. Objective. To show a rare case of cervical spondylolysis and spondylolisthesis secondary to bilateral stress fractures at the pedicle laminar junction of C6 in a 16-year-old athlete playing high school baseball. Summary of Background Data. The patient presented with 3 months of neck pain and intermittent right arm radicular symptoms. Methods. Plain radiographs and multidetector computerized tomography (CT) of the cervical spines. Results. Plain radiographs revealed loss of lower cervical lordosis. Multidetector CT indicated bilateral C6 spondylolysis. Magnetic resonance imaging showed bilateral marrow edema at the pedicle laminar junction of C6. Treatment included placing his neck in a Philadelphia collar for 6 weeks. Follow-up CT revealed progression of healing. Conclusion. Early diagnosis and appropriate management of these cases are important to promote healing.

An unusual cause of the quadrilateral space impingement syndrome by a bone spike

The quadrilateral space impingement syndrome is a clinical syndrome resulting from compression of the axillary nerve and the posterior circumflex humeral artery, with subsequent focal atrophy of the teres minor, with or without involvement of portions of the deltoid muscle. This entity has many etiologies. We are reporting a case of this syndrome caused by a bone spike from a malunited old scapular fracture following a motor vehicle accident. The bone spike impinged on the axillary nerve as it passes through the quadrilateral space, causing focal atrophy of the teres minor muscle. The abnormality was well demonstrated by MD-CT.

Arthrotomography of the Wrist: The Triangular Fibrocartilage Complex

Eighteen fresh cadaver wrists were radiographically studied using both arthrography and arthrotomography, to evaluate the results of the two techniques. With arthrography, communications between the distal radioulnar and radiocarpal joints were discovered in eight of the 18 wrists (44%). Although defects in the triangular fibrocartilage complex (TFCC) could be inferred from the arthrograms, the locations and dimensions of the defects could not be assessed satisfactorily. Using arthrotomography, three distinct patterns of TFCC defects were observed radiographically, which correlated with subsequent anatomic dissections of the cadaver specimens. Type I defects, located near the radial margin of the TFCC, are long, narrow posteroanterior fissures with thick regular borders that readily appose. Type II defects, located more centrally in the TFCC, are wide defects with thin irregular margins. Type III defects represent a communication between the prestyloid recess and the distal radioulnar joint. Arthrotomography of the wrist accurately delineates TFCC defects in cadaveric specimens and may become a valuable clinical radiographic procedure.

Partial tear of the quadriceps tendon in a child

We present a case of partial rupture of the quadriceps tendon in an 8-year-old girl. This is one of the youngest patients reported with a quadriceps tendon rupture, an entity seen predominantly in middle-aged people. The strength of the muscle tendon unit in a child makes tendon injuries extremely unusual as compared to apophyseal avulsions. The MR imaging findings of this unusual pediatric injury are illustrated.

Locked facets in the thoracic spine: report of three cases and a review.

Facet dislocation is a rare finding in the thoracic spine. This article presents three cases of bilateral locked facets in the thoracic region. Two were due to car accidents and the third was secondary to a vertical fall. The level of the injury was T2-T3 in two cases and T9-T10 in the third. Two patients were completely paraplegic on admission, whereas the third was neurologically intact. All patients had various associated injuries and fractures. The diagnosis of locked facets was not suspected in any of the cases, but was later made by computerized tomography with parasagittal reconstructions. All patients underwent surgery. The radiological diagnosis was confirmed intraoperatively in two cases. The facets were relocated by manual traction in one case and by Harrington distraction in the other. Fixation and fusion were performed in all three. Stability and vertebral alignment were achieved in all cases postoperatively.

Satisfaction of search errors detecting subtle fractures diminish in the presence of more serious injuries

Satisfaction of search (SOS) occurs when an abnormality is missed because another abnormality has been detected in radiology examinations. This research includes our study of whether the severity of a detected fracture determines whether subsequent fractures are overlooked. Each of 70 simulated multitrauma patients presented radiographs of three anatomic areas. Readers evaluated each patient under two experimental conditions: when the images of the first anatomic area included a severe fracture (the SOS condition), and when it did not (the control condition). The SOS effect was measured on detection accuracy for subtle test fractures presented on examinations of the second or third anatomic areas. SOS reduction in ROC area for detecting subtle test fractures with the addition of a major fracture to the first radiograph was not observed. The same absence of SOS that had been observed when high-morbidity added fractures were presented on CT was replicated with the high-morbidity added fractures presented on radiographs. This finding rules out the possibility that there was no SOS in the prior study with CT because SOS effects do not extend from one imaging modality to another. Taken together, the evidence rejects the hypothesis that the severity of a detected fracture determines the SOS for subsequently viewed fractures.