Glenn M. Garcia

Association of Tibialis Posterior Tendon Pathology with Other Radiographic Findings in the Foot: A Case-Control Study

The purpose of this study was to analyze the prevalence of spring ligament pathology and other radiographic changes related to flatfoot deformity in the presence of different degrees of tibialis posterior tendon pathology. A total of 72 patients (24 with tibialis posterior tendon abnormality and 48 sex- and age-matched controls) were evaluated for tibialis posterior tendon pathology, spring ligament pathology, and plain pedal radiographic angles, including cuboid abduction, talar declination, calcaneal inclination, and Mearys angles. The patients with tibialis posterior tendon pathology were subdivided into either minor (Type I) or severe (Type II/III), according to the Conti classification of tibialis posterior tendon pathology on MRI. All the continuous data of radiographic angles were dichotomized into either a flatfoot group or normal/cavus foot group. Associations between these nominal variables were analyzed. There was no association between Type I tibialis posterior tendon pathology and spring ligament pathologies (OR = 0.8, 95% CI = 0.15-4.65). Conversely, every patient with Type II/III tibialis posterior tendon pathology had spring ligament abnormality. Type II/III group also showed statistically significant associations with both increased talar declination angle (OR = 10.4, 95% CI = 1.62-109.22) and Mearys angle (OR = 7.5, 95% CI = 1.35-51.12), while no such associations were found with Type I tibialis posterior tendon pathology (OR = 1.0, 95% CI = 0.18-6.18 with talar declination angle; OR = 3.9, 95% CI = 0.65-27.71 with Mearys angle). In this investigation, only advanced tibialis posterior tendon pathology was statistically significantly associated with adult-acquired flatfoot deformity and spring ligament pathology.

Imaging of the Diabetic Foot Diagnostic Dilemmas

Multiple diagnostic imaging modalities are available and beneficial for the evaluation of the diabetic foot. There is not yet “one best test” for sorting out the diagnostic dilemmas commonly encountered. The differentiation of cellulitis alone from underlying osteomyelitis and the early detection of abscesses remain important diagnostic goals. Equally important, differentiation of osteomyelitis and neuroarthropathy remains a difficult job. This is often compounded by postoperative diabetic foot states status after reconstruction. Diagnostic evaluation often involves multiple studies that are complementary and that include conventional radiography, computed tomography, nuclear medicine scintigraphy, magnetic resonance imaging, ultrasonography, and positron emission tomography.

Epithelioid sarcoma. Flow cytometric study of dna content and regional dna heterogeneity

The DNA content and regional DNA heterogeneity in correlation with clinicopathologic parameters and patient survival were investigated in epithelioid sarcoma. Such neoplasms preponderantly manifest diploid DNA content and a remarkably stable intratumoral and inter‐tumoral DNA content. Small tumor size (< 5.0 cm) and low S‐phase fraction (< 5%) were significant prognostic factors in this study. Ploidy status, mitotic rate, age, and postsurgical treatment were not significantly correlated with survival.

Understanding Hallux Valgus Deformity: What the Surgeon Wants to Know from the Conventional Radiograph

Hallux valgus deformity is a common and a significant source of symptoms. It can interfere with daily activities and affects the quality of life of many people. Imaging evaluation is performed almost exclusively by conventional radiography and systematic evaluation of the conventional radiograph can provide the clinician with the necessary information to choose the correct surgical procedure. The radiologist should appreciate the various sites of angular deformity that can be associated with hallux valgus deformity, the nature of the articulations within the first ray, the presence of a bunion, the degree of sesamoid subluxation, and the quality of the bone stock. Systematic radiographic evaluation is vital for ensuring a good surgical outcome. All the conventional radiographic features that influence management are defined and quantified within this review and, importantly, their clinical significance is highlighted, allowing for a more purposeful radiographic interpretation.

Less Is More: Knee MRI Utilization by PCPs Versus Orthopaedic Surgeons: Commentary on an article by Timothy T. Roberts, MD, et al.: "MRI for the Evaluation of Knee Pain. Comparison of Ordering Practices of Primary Care Physicians and Orthopaedic Surgeons".

In their retrospective investigation, Roberts and colleagues analyzed surgical and nonsurgical outcomes on the basis of whether magnetic resonance imaging (MRI) of the knee joint done prior to treatment had been ordered by an orthopaedic surgeon or by a primary care practitioner (PCP). Of 1592 patients included in this study, 747 had been originally evaluated and referred to the authors’ practice by a PCP and 845 had been initially evaluated by an orthopaedic surgeon in their practice. These two subgroups were equally matched demographically. The MRI ordering trends were tracked for both groups. The results revealed more frequent arthroscopic interventions on the basis of the MRI results ordered by the orthopaedic surgeons. Specifically, the orthopaedic surgeons were more likely to order MRI studies for younger patients, patients with acute symptoms, and those with a history of trauma. This subgroup of patients more often …

Associated capitellar and elbow ligamentous injuries in isolated type 1 radial head fractures based on MRI

Background:In our experience, there is a clinical subset of patients with type 1 radial head fracture who continue to have chronic elbow ache and pain with lifting. As advanced imaging has become more common in orthopaedic practices, there is a heightened awareness of associated injuries and the need to define such relationships. Using MRI, we sought to further describe the incidence of and characterize associated elbow injuries with a focus on insult to the capitellum and elbow collateral ligaments. Methods:Seventeen patients with 17 Mason type 1 radial head fractures underwent MRI of the affected elbow after being diagnosed by physical examination and orthogonal plain radiographs. Results:The incidence of associated elbow injuries was 100%. Capitellar injuries occurred in 82% of patients. Chondral injury occurred in 36%, and subchondral fracture in 6%. Medial collateral ligament (MCL) injury occurred in 88% of patients and in 86% of patients with capitellar injuries. All (100%) elbows had lateral ulnar collateral ligament (LUCL) injury with four complete tears. Conclusions:The incidence of capitellar and MCL injury is higher than previously reported in patients with isolated Mason type 1 radial head fractures. Patients diagnosed with such injuries should be followed closely and evaluated with advanced imaging if there is a failure of motion progression or persistent pain. Long-term clinical outcome of such patients with osteochondral damage of the capitellum should be investigated. Level of Evidence:IV, Case Series, Diagnostic Study.

Understanding Hallux Valgus Deformity

Hallux valgus deformity is a common and a significant source of symptoms. It can interfere with daily activities and affects the quality of life of many people. Imaging evaluation is performed almost exclusively by conventional radiography and systematic evaluation of the conventional radiograph can provide the clinician with the necessary information to choose the correct surgical procedure. The radiologist should appreciate the various sites of angular deformity that can be associated with hallux valgus deformity, the nature of the articulations within the first ray, the presence of a bunion, the degree of sesamoid subluxation, and the quality of the bone stock. Systematic radiographic evaluation is vital for ensuring a good surgical outcome. All the conventional radiographic features that influence management are defined and quantified within this review and, importantly, their clinical significance is highlighted, allowing for a more purposeful radiographic interpretation.

Original articleUnderstanding Hallux Valgus Deformity: What the Surgeon Wants to Know from the Conventional Radiograph

Hallux valgus deformity is a common and a significant source of symptoms. It can interfere with daily activities and affects the quality of life of many people. Imaging evaluation is performed almost exclusively by conventional radiography and systematic evaluation of the conventional radiograph can provide the clinician with the necessary information to choose the correct surgical procedure. The radiologist should appreciate the various sites of angular deformity that can be associated with hallux valgus deformity, the nature of the articulations within the first ray, the presence of a bunion, the degree of sesamoid subluxation, and the quality of the bone stock. Systematic radiographic evaluation is vital for ensuring a good surgical outcome. All the conventional radiographic features that influence management are defined and quantified within this review and, importantly, their clinical significance is highlighted, allowing for a more purposeful radiographic interpretation.