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BACKGROUND: The diagnosis of Morton's neuroma is based primarily on clinical findings. Ultrasonography (US) and magnetic resonance image (MRI) studies are considered complementary diagnostic techniques. The aim of this study was to establish the correlation and sensitivity of both techniques used to diagnose Morton's neuroma. MATERIALS AND METHODS: Thirty seven patients (43 intermetatarsal spaces) with Morton's neuroma operated were retrospectively reviewed. In all cases MRI or ultrasound was performed to complement clinical diagnosis of Morton's neuroma. In all cases, a histopathological examination confirmed the diagnosis. Estimates of sensitivity were made and correlation (kappa statistics) was assessed for both techniques. RESULTS: Twenty seven women and 10 men participated with a mean age of 60 years. Double lesions presented in six patients. The second intermetatarsal space was affected in 10 patients and the third in 33 patients. An MRI was performed in 41 cases and a US in 23 cases. In 21 patients, both an MRI and a US were performed. With regard to the 41 MRIs performed, 34 were positive for Morton's neuroma and 7 were negative. MRI sensitivity was 82.9% [95% confidence interval (CI): 0.679-0.929]. Thirteen out of 23 US performed were positive and 10 US were negative. US sensitivity was 56.5% (95% CI: 0.345-0.768). Relative to the 21 patients on whom both techniques were carried out, the agreement between both techniques was poor (kappa statistics 0.31). CONCLUSION: Although ancillary studies may be required to confirm the clinical diagnosis in some cases, they are probably not necessary for the diagnosis of Morton's neuroma. MRI had a higher sensitivity than US and should be considered the technique of choice in those cases. However, a negative result does not exclude the diagnosis (false negative 17%).
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INTRODUCTION: We present a review of Monteggia fractures treated in our hospital between 1992 and 1998. PATIENTS AND METHODS: Fifty four patients with a Monteggia fracture were treated in our hospital with an average follow-up of 24 months (12-48 months). The average age was 41 years (18-81 years). According to the classification of Bado, there were 24 type I, 20 type II, 6 type III and 4 type IV. The etiology was in 27 cases a motor-vehicle and motorcycle accident, five a pedestrian struck by a car, 21 by a causal fall and only one by a direct hit by an iron bar in an assault. In 56% of the patients, the lesions were associated with polytrauma. In all the cases, treatment consisted of open reduction and internal fixation of the ulnar fracture using different methods of osteosynthesis (3.5 mm DCP, 3.5 mm reconstruction plates, 6.5 mm cancellous screw, tension band technique with Kirschner wires, and one-third tubular plates). Initial treatment of the radial head dislocation was attempted by closed reduction and verification under fluoroscopy. Subsequent open reduction and osteosynthesis were performed in 10 cases, and resection of radial head was necessary in three cases as the initial treatment. There were six open fractures with one case developing chronic infection. RESULTS: Results were evaluated according to the criteria of Anderson (union fracture, elbow and wrist flexion/extension). The results were excellent in nine patients (17%), satisfactory in 33 (61%), unsatisfactory in nine (17%) and failure in three (5%). Complications could be attributed to the severity of injury, type of fixation and errors in technique (four non-union, three failure of one-third tubular plates, one distal radioulnar instability) and to some features peculiar to this lesion (five nerve injuries, three redislocations of the radial head and four radioulnar synostosis). We needed to perform 14 reoperations to resolve some of the above mentioned complications.