RESUMEN
Plain radiography remains useful for the diagnosis of osteoarthritis, even if it is not always essential. It is moreover poorly correlated with symptoms, as it reflects rather the accumulation of damage then active processes. Similarly, it is a poor indicator of the progression of osteoarthritis. Modem imaging, particularly MRI, has allowed us to understand better the evolving processes, demonstrating a good correlation with symptoms and a better predictive value of clinical course. It has gradually replaced standard radiography in the study because it directly demonstrates sequelae and the active processes in all the structures of the joint. It remains clinically indicated only to exclude an alternative diagnosis or to determine a possible complication of osteoarthritis.
Asunto(s)
Imagen por Resonancia Magnética , Osteoartritis/diagnóstico , Diagnóstico Diferencial , Diagnóstico por Imagen/métodos , Progresión de la Enfermedad , Humanos , Osteoartritis/diagnóstico por imagen , Valor Predictivo de las Pruebas , Radiografía , Sensibilidad y Especificidad , Índice de Severidad de la EnfermedadRESUMEN
The purpose of this study was to determine the impact of axial traction during acquisition of direct magnetic resonance (MR) arthrography examination of the knee in terms of joint space width and amount of contrast material between the cartilage surfaces. Direct knee MR arthrography was performed in 11 patients on a 3-T MR imaging unit using a T1-weighted isotropic gradient echo sequence in a coronal plane with and without axial traction of 15 kg. Joint space widths were measured at the level of the medial and the lateral femorotibial joint with and without traction. The amount of contrast material in the medial and lateral femorotibial joint was assessed independently by two musculoskeletal radiologists in a semiquantitative manner using three grades ('absence of surface visualization, 'partial surface visualization or 'complete surface visualization'). With traction, joint space width increased significantly at the lateral femorotibial compartment (mean = 0.55 mm, p = 0.0105) and at the medial femorotibial compartment (mean = 0.4 mm, p = 0.0124). There was a trend towards an increased amount of contrast material in the femorotibial compartment with axial traction. Direct MR arthrography of the knee with axial traction showed a slight and significant increase of the width of the femorotibial compartment with a trend towards more contrast material between the articular cartilage surfaces.
Asunto(s)
Aumento de la Imagen/métodos , Traumatismos de la Rodilla/diagnóstico , Articulación de la Rodilla/patología , Tracción/métodos , Adolescente , Adulto , Artrografía/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Adulto JovenRESUMEN
Femur-acetabular impingement is a recently discovered etiology of early hip osteoarthritis. Patient history and clinical examination allow to make the diagnosis, whereas the radiological exams allow to find the etiology of impingement. Impingement is related to morphological alterations of the acetabular rim and/or proximal femur, leading to an abnormal contact between the articular components. The localisation of the abnormal morphology determines the type of impingement and the resulting articular damages. Because of the increasing risk of chondral lesions, only an early treatment may eventually improve the prognosis of the hip joint. If primary conservative treatment is unsuccessful in confirmed impingement cases, open or arthroscopic surgical treatment is indicated.
Asunto(s)
Acetábulo/anomalías , Acetábulo/cirugía , Cabeza Femoral/anomalías , Cabeza Femoral/cirugía , Osteoartritis de la Cadera/cirugía , Acetábulo/diagnóstico por imagen , Artroscopía , Diagnóstico Diferencial , Cabeza Femoral/diagnóstico por imagen , Humanos , Procedimientos Ortopédicos/métodos , Osteoartritis de la Cadera/diagnóstico , Radiografía , Resultado del TratamientoRESUMEN
Pain of the inguinal region is a frequent but difficult diagnostic problem. It may be induced by accidents, overload due to sports or profession as well as daily life activities. Numerous anatomic structures of the inguinal or hip region may be injured, but one should also think about adjacent structures as the bowel, uro-genital system, spine and nerves. The goal of this article is to describe which clinical and imaging parameters allow to establish a correct diagnosis for each patient.
Asunto(s)
Traumatismos en Atletas/fisiopatología , Conducto Inguinal/lesiones , Dolor , Traumatismos en Atletas/diagnóstico por imagen , Diagnóstico Diferencial , Humanos , Conducto Inguinal/diagnóstico por imagen , Conducto Inguinal/fisiopatología , RadiografíaRESUMEN
Femoro-acetabular impingement is an etiology of early osteoarthritis. It is a dynamic theory of development of arthritis due to bony deformations of the acetabulum or the proximal femur. The impingement is diagnosed clinically by the impingement and apprehension tests. The realisation of reproducible and technically irreproachable standard X-Rays is of first importance to detect the subtle but present signs of impingement. The MR arthrography is the best exam for detection of intra-articular pathologies with radial sequences allowing to establish a precise topography of the lesions. The treatment is most of the time surgical to avoid progression of cartilage lesions, either by an open surgical dislocation or arthroscopically for selected cases.
Asunto(s)
Diagnóstico por Imagen/métodos , Articulación de la Cadera/patología , Artropatías/diagnóstico , HumanosRESUMEN
Sacral insufficiency fracture is a debilitating injury for which no active treatment is currently available. It frequently causes significant pain and limits activities of daily living in patients with osteoporosis. Percutaneous vertebroplasty is a common procedure to alleviate the pain associated with thoracic and lumbar vertebral compression fractures. The sacral percutaneous cimentoplasty procedure (sacroplasty) has recently been introduced as an alternative to medical management of osteoporotic sacral insufficiency fractures. The purpose of this article is to illustrate the effectiveness and the utility of percutaneous sacroplasty in this kind of pathology and to show how this procedure can provide symptom relief without having major complications.
Asunto(s)
Procedimientos Ortopédicos , Sacro/cirugía , Fracturas de la Columna Vertebral/cirugía , Cementos para Huesos/uso terapéutico , Humanos , Sacro/lesionesRESUMEN
BACKGROUND: Previous experimental studies have been conducted to evaluate the biomechanical effects of posterior cruciate ligament reconstruction; but no consensus has been reached on the preferred method of reconstruction. METHODS: The 3D finite element mesh of a knee joint was reconstructed from computed tomography and magnetic resonance images. The ligaments were considered as hyperelastic materials. The tibiofemoral and patellofemoral joints were modeled with large sliding contact elements. The 3D model was used to simulate knee flexion from 0 degrees to 90 degrees in four cases: a knee with a "native" posterior cruciate ligament, a resected posterior cruciate ligament, a reconstructed single graft posterior cruciate ligament, and a reconstructed double graft posterior cruciate ligament. FINDINGS: A resected posterior cruciate ligament induced high compressive forces in the medial tibiofemoral and patellofemoral compartments. The pressures generated in the tibiofemoral and patellofemoral compartments were nearly the same for the two reconstruction techniques (single graft and double graft). The single graft resulted in lower tensile stresses inside the graft than for the double graft. INTERPRETATION: Firstly, a resected posterior cruciate ligament should be replaced to avoid excessive compressive forces, which are a source of cartilage degeneration. Secondly, the two types of posterior cruciate ligament reconstruction techniques partially restored the biomechanics of the knee in flexion, e.g. contact pressures were restored for pure flexion of the knee. The reconstruction techniques therefore partially restore the biomechanics of the knee in flexion. A double graft reconstruction is subjected to the highest tensile stresses.
Asunto(s)
Articulación de la Rodilla/fisiopatología , Articulación de la Rodilla/cirugía , Modelos Biológicos , Procedimientos de Cirugía Plástica/métodos , Ligamento Cruzado Posterior/fisiopatología , Ligamento Cruzado Posterior/cirugía , Terapia Asistida por Computador/métodos , Fuerza Compresiva , Simulación por Computador , Diagnóstico por Computador/métodos , Análisis de Elementos Finitos , Humanos , Estrés Mecánico , Resultado del Tratamiento , Soporte de PesoRESUMEN
Clinical evaluation is an integral part of medical practice. However, recent data have demonstrated that a systematic and standardized evaluation modifies the prognosis of our rheumatoid arthritis patients. The systematic use of activity indexes allows us to better appreciate the needs of our patients and the necessity to optimize and intensifie treatment. Likewise, auto-evaluations tools bring useful information to patient management.
Asunto(s)
Artritis Reumatoide/diagnóstico , Humanos , Índice de Severidad de la EnfermedadRESUMEN
Magnetic Resonance Imaging (MRI) is the best imaging method in early detection and management of rheumatoid arthritis (RA). There are other imaging methods available as ultrasound, scintigraphy, computed tomography and plain radiography for imaging RA but MRI provides the best sensitivity in detecting inflammatory changes in the joints. MRI shows the best intra and interobserver reliability and low variation between repetitive examinations. MRI has shown the best visualisation and the greater sensitivity to detect erosion in early RA, compared to standard radiography. The use of a contrast agent further increases the sensitivity in detecting erosions and differentiate synovial proliferation from fluid collections. Otherwise, intraossous cyst, tenosynovitis, bone marrow edema, that are concomitant manifestations of the disease, are best imaged by MRI. MRI assists in the early detection of rheumatoid arthritis, which allows earlier initiation of treatment.
Asunto(s)
Artritis Reumatoide/diagnóstico , Imagen por Resonancia Magnética , HumanosRESUMEN
Rheumatoid arthritis occurs frequently in women in childbearing years. With the improvement of the treatments, more patients with rheumatoid arthritis consider a pregnancy. Close co-operation between the physician and the obstetrician caring for the mother and the foetus is necessary. The disease should be well controlled at the time of the conception, although an amelioration of rheumatoid arthritis occurs in about 75% of pregnancies, in the first trimester. Some medications can be used during pregnancy and lactation. There is no indication of any adverse effects of rheumatoid arthritis on pregnancy outcome. The mother needs to be followed up regularly after delivery because of the high risk of post-partum flare.
Asunto(s)
Artritis Reumatoide/tratamiento farmacológico , Complicaciones del Embarazo/tratamiento farmacológico , Femenino , Humanos , EmbarazoRESUMEN
Tumors and tumor-like lesions of the hand are more frequently benign lesions. Plain film X-rays must be obtained in all patients since they are extensive and panoramic. Ultrasound can accurately assess the internal structure of the mass and its relation with adjacent nerves and vessels. MRI is particularly sensitive to bone marrow and is highly effective in characterizing a wide variety of soft tissue conditions. However, CT remains the method of choice for evaluating bone involvement of soft tissue tumors and small bone tumors such as osteoid oteoma. Where a malignant tumor is considered, thoraco-abdominal and/or bone scintigraphy are essential to evaluate the presence of metastatic lesions.
Asunto(s)
Neoplasias Óseas/diagnóstico por imagen , Mano/patología , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Neoplasias Óseas/patología , Humanos , Imagen por Resonancia Magnética , Cintigrafía , Neoplasias de los Tejidos Blandos/patología , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
Osteoid osteoma and radiofrequency Osteoid osteoma relates to a benign skeletal neoplasm, smaller than 2 cm in diameter, composed of osteoid, highly vascularized connective tissue and surrounded by a ring of bone sclerosis. Its aetiology remains unknown. It affects twice more males than female patients and occurs usually between 5 and 40 years old. Long bones and spine are the most involved areas but the whole skeleton can be involved. Clinical manifestations can include local pain (increased at night and decreased by activity) and relief with salicylates administration. CT guided radiofrequency ablation of osteoid osteoma is in comparison to surgery less invasive, time saving and economic technique with excellent long term results.
Asunto(s)
Neoplasias Óseas/cirugía , Ablación por Catéter/métodos , Osteoma Osteoide/cirugía , Neoplasias Óseas/patología , Ablación por Catéter/economía , Femenino , Costos de la Atención en Salud , Humanos , Masculino , Osteoma Osteoide/patología , Dolor/etiología , Salicilatos/uso terapéutico , Factores Sexuales , Tomografía Computarizada por Rayos XRESUMEN
Although vertebroplasty was initially a treatment of vertebral haemangioma or metastases, this procedure is now frequent option to the treatment of osteoporotic vertebral fractures. In this review article, we will discuss the indication, the techniques and the follow-up of the vertebroplasty. This is a risky procedure, which should be performed by experimented physicians working with high-resolution fluoroscopic equipments, by biplane fluoroscopy, to reduce the risk and irradiation to the patient. According to the available follow-up studies, there is clear evidence of a strong improvement of quality of life after vertebroplasty by rapid decreasing of back pain at least during the first six months. Other new studies will analyze the long-term follow-up after vertebroplasty.
Asunto(s)
Procedimientos Ortopédicos , Fracturas de la Columna Vertebral/cirugía , Humanos , Osteoporosis/complicaciones , Selección de Paciente , Fracturas de la Columna Vertebral/etiologíaRESUMEN
Intracranial aneurysms, cervical carotid stenosis and acute cerebral ischemia constitute the three main and more frequent diseases in which the endovascular approach is considered a valuable alternative to the surgical or pharmacologic treatment. With the introduction of balloon assistance techniques, even intracranial large neck aneurysms can be currently suitable to endovascular treatment. Stent angioplasty is widely used in whole Europe in the treatment of cervical carotid artery stenosis. Mechanical endovascular embolectomy techniques are actually available to be used alone or in combination with pharmacologic thrombolysis in the treatment of acute cerebral ischemia. This article discuss on the new technical possibilities concerning the endovascular approach in these aforementioned diseases.
Asunto(s)
Radiografía Intervencional , Aneurisma Roto/terapia , Isquemia Encefálica/terapia , Estenosis Carotídea/cirugía , Endarterectomía Carotidea , Humanos , Aneurisma Intracraneal/terapia , StentsRESUMEN
We carried out a retrospective review of 155 patients with lumbar spinal stenosis who had been treated surgically and followed up regularly: 77 were evaluated at a mean of 6.5 years (5 to 8) after surgery by two independent observers. The outcome was assessed using the scoring system of Roland and Morris, and the rating system of Prolo, Oklund and Butcher. Instability was determined according to the criteria described by White and Panjabi. A significant decrease in low back pain and disability was seen. An excellent or good outcome was noted in 79% of patients; 9% showed secondary radiological instability. Surgical decompression is a safe and efficient procedure. In the absence of preoperative radiological evidence of instability, fusion is not required.
Asunto(s)
Estenosis Espinal/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Dorso , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Calidad de Vida , Estudios Retrospectivos , Factores de TiempoAsunto(s)
Coagulantes/uso terapéutico , Factor VIII/uso terapéutico , Hemofilia A/complicaciones , Osificación Heterotópica/complicaciones , Heridas no Penetrantes/complicaciones , Adulto , Hematoma/etiología , Articulación de la Cadera , Humanos , Imagen por Resonancia Magnética , Masculino , Músculo Esquelético/lesiones , Osificación Heterotópica/diagnóstico por imagen , Dolor/tratamiento farmacológico , Dolor/etiología , Pelvis , Tomografía Computarizada por Rayos XRESUMEN
Pregnancy-associated osteoporosis usually appears during the first pregnancy and does not affect the followings. We report two cases where non-traumatic fractures have been diagnosed shortly after delivery of second pregnancies. Wide investigations could not find a cause of secondary osteoporosis. In the first case we came to the diagnosis of pregnancy-associated osteoporosis and an intravenous treatment of ibandronate has been prescribed. In the second case the bone mineral density (BMD) being almost normal and the localisation of the fracture being atypical, we concluded to a fracture of non-osteoporotic origin, probably due to mechanical stress during pregnancy. No therapy against osteoporosis has been prescribed.
Asunto(s)
Lactancia Materna , Fracturas por Estrés/diagnóstico , Vértebras Lumbares , Fracturas Osteoporóticas/diagnóstico , Complicaciones del Embarazo/diagnóstico , Tercer Trimestre del Embarazo , Trastornos Puerperales/diagnóstico , Fracturas de la Columna Vertebral/diagnóstico , Absorciometría de Fotón , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Vértebras Lumbares/patología , Imagen por Resonancia Magnética , Embarazo , Sacro/patologíaRESUMEN
OBJECTIVE: To report a rare case of lumbar vertebral subluxation associated with spontaneous reduction in an adolescent treated conservatively. CLINICAL PRESENTATION AND INTERVENTION: A 14-year-old male victim of a snowboard accident, which caused a lumbar spinal injury, was referred to the emergency room with significant lumbar pain. Neurologic examination was normal. Radiographic assessment at admission showed a unilateral left lateral subluxation of the L2-L3 vertebrae without associated fractures. These findings were confirmed by CT scan and a surgical management was decided. The preoperative MRI performed 24 h after the accident, however, revealed the spontaneous reduction of the subluxation, and an associated tear of the quadratus lumborum and the psoas muscles on the right side at the level of L2, L3 and L4. Following these findings conservative treatment with a plaster brace for 2 months was carried out. The brace was removed after 2 months. The patient had no pain and the range of motion of his lumbar spine was normal. Three months after injury, sports activities were resumed. At follow-up of 24 months, the patient was free of pain and radiographs showed a right positional bending without rotational or translation anomaly. CONCLUSION: To date, this is the first case of subluxation without fracture in a child, presenting without neurological deficit and where spontaneous reduction occurred. In this case, conservative treatment was effective and the outcome at 2-year follow-up was excellent.
Asunto(s)
Luxaciones Articulares/patología , Vértebras Lumbares/lesiones , Traumatismos Vertebrales/patología , Adolescente , Humanos , Luxaciones Articulares/diagnóstico por imagen , Vértebras Lumbares/diagnóstico por imagen , Masculino , Radiografía , Traumatismos Vertebrales/diagnóstico por imagenRESUMEN
OBJECTIVE: To present four cases of tuberculosis of the greater trochanter. CASE PRESENTATION AND INTERVENTION: The four cases (3 females and 1 male), aged 45-70 years, presented with mechanical pain in the trochanteric area associated with progressive swelling in the 3 female patients in whom mobility was also restricted. X-ray revealed a mass in 2 females; CT scan and MRI exhibited an abscess in the 3 females. Histological and bacteriological examinations showed Mycobacterium bovis in the 3 females and M. tuberculosis in the male. In the females, tritherapy and surgery were performed, while in the male quadritherapy and surgery. All the patients recovered and were followed up for 4-9 years. CONCLUSION: These cases show that both chemotherapy and surgery must be synergic if tuberculosis is diagnosed and an abscess is confirmed by imaging.
Asunto(s)
Fémur , Tuberculosis Osteoarticular/diagnóstico , Tuberculosis Osteoarticular/terapia , Anciano , Terapia Combinada , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mycobacterium bovis/aislamiento & purificación , Mycobacterium tuberculosis/aislamiento & purificación , Tuberculosis Osteoarticular/microbiologíaRESUMEN
We report preliminary results for unstable sacral fractures treated with a modified posterior triangular osteosynthesis. Seven patients were admitted to our trauma center with an unstable sacral fracture. The average age was 31 years (22-41). There were four vertical shear lesions of the pelvis and three transverse fracture of the upper sacrum. The vertical shear injuries were initially treated with an anterior external fixator inserted at the time of admission. Definitive surgery was performed at a mean time of 9 days after trauma. The operation consisted in a posterior fixation combining a vertebropelvic distraction osteosynthesis with pedicle screws and a rod system, whereby the transverse fixation was obtained using a 6 mm rod as a cross-link between the two main rods. Late displacement of the posterior pelvis or fracture was measured on X-ray films according to the criteria of Henderson. The patients were followed-up for a minimum time of 12 months. Four patients who presented with a pre-operative perineal neurological impairment made a complete recovery. No iatrogenic nerve injury was reported. One case of deep infection was managed successfully with surgical debridement and local antibiotics. All patients complained of symptoms related to the prominence of the iliac screws. The metalwork was removed in all cases after healing of the fracture, at a mean time of 4.3 months after surgery. No loss of reduction of fracture was seen at final radiological follow-up. The preliminary results are promising. The fixation is sufficiently stable to allow an immediate progressive weight-bearing, and safe nursing care in polytrauma cases. The only problem seems to be related to prominent heads of the distal screws.