Post-traumatic lipid inclusion cyst.

Post-traumatic lipid inclusion cysts are a rare entity seen following fractures in paediatric patients. They often occur in the distal radius, developing 1-3 months following an extra-articular fracture. Although benign and self-limiting in nature, adequate awareness and accurate radiographic interpretation is key in avoiding further unnecessary non-invasive or invasive investigations. We report on a case of post-traumatic lipid inclusion cyst and review the literature.

Imaging of postoperative avascular necrosis of the ankle and foot.

Avascular necrosis (AVN) of the ankle and foot is an uncommon and often unexpected postoperative complication in patients with persistent pain and disability postprocedure. Artifacts from metallic implants may obscure characteristic imaging signs of AVN, and radiography and computer tomography are the mainstay imaging modalities of the postoperative ankle and foot. MRI and nuclear medicine imaging play an important complementary role in problem solving and excluding differential diagnostic considerations including infection, nonunion, occult fracture, and secondary osteoarthritis.This review article evaluates different imaging modalities and discusses characteristic sites of AVN of the ankle and foot in the postoperative setting including the distal tibia, talus, navicular, and first and lesser metatarsals. Radiologists play a key role in the initial diagnosis of postoperative AVN and the surveillance of temporal evolution and complications including articular collapse and fragmentation, thus influencing orthopedic management.

Metal-on-Metal Disease in High-Motion Wrist Arthroplasty.

Metal-on-metal disease (MOMD) is a rare condition following arthroplasty and has predominantly been reported following hip and knee replacement. Isolated case reports exist with respect to MOMD following total wrist arthroplasty-however, the literature remains limited. Here, we present the history and radiographic and histopathologic features of such a case, and summarize the literature and provide management recommendations.

Chronic Pectoralis Major Rupture Reconstruction With Interpositional Acellular Dermal Allograft.

Background: Pectoralis major tendon (PMT) rupture commonly occurs in males 20 to 39 years of age. PMT rupture is most often associated with gym-based exercise, with attempted bench press being the most common causative event, but it is also associated with contact or impact sports. Delayed presentation, misdiagnoses, and chronic PMT rupture can result in a therapeutic dilemma. Case Series: We present 2 cases of chronic PMT rupture that were operatively managed using acellular dermal allograft as an interposition graft. Patients' final follow-ups were at 20 and 30 months, respectively. Strength in their pectoralis major muscle was well preserved on the contralateral side: 88% for patient 1 and 110% for patient 2. Conclusion: Our reported technique using an interpositional acellular dermal allograft is a good option to treat chronic PMT rupture.

Failure of Dermal Allograft Repair of Massive Rotator Cuff Tears in Magnetic Resonance Imaging and Clinical Assessment.

BACKGROUND: Massive retracted rotator cuff tears represent a therapeutic dilemma, particularly in the young and middle-aged patients who are not appropriate for a reverse total shoulder replacement. Interposition grafting using human dermal allograft offers an alternative treatment. METHODS: A retrospective review of all patients who underwent interposition grafting using human dermal allograft between December 2013 and May 2015 for massive rotator cuff tears at our tertiary referral center was performed. Preoperative and 6 month postoperative magnetic resonance imaging (MRI) assessments were performed in all patients, with postoperative graft integrity being the primary outcome measure. Clinical evaluation was performed using the Oxford shoulder score, Constant score, and Disabilities of the Arm, Shoulder and Hand (DASH) score. RESULTS: The mean age at the time of follow-up was 54 years. On MRI, 84% of grafts were seen to have failed at 6 months. Strength was grossly reduced on the operative side when supraspinatus and subscapularis were tested; despite this, Constant score (mean, 48.2) was comparable to that in the previous reports. DASH and Oxford scores were a mean of 24.94 and 37.16, respectively. CONCLUSIONS: Based on these results, in particular the MRI findings, we cannot advocate the use of dermal allograft as an interposition graft for the repair of massive rotator cuff tears.

Low prevalence of unexpected popliteal DVT detected on routine MRI assessment of the knee.

OBJECTIVE: The purpose of this study was to document the appearance and determine the prevalence of findings suspicious for popliteal vein thrombosis on magnetic resonance (MR) assessment of the knee joint. METHODS: A total of 2888 MR examinations were retrospectively reviewed and classified as illustrating either normal appearing popliteal vein or findings suspicious for popliteal vein thrombosis. RESULTS: A total of 2879 MR studies were assessed as having a normal appearing popliteal vein. Nine studies illustrated findings suspicious for popliteal vein thrombosis. CONCLUSION: Although the prevalence of MR findings is low (0.3%), our findings reiterate the need to interrogate the popliteal vein for evidence of thrombosis.

Body wall thickness in adults and children--relevance to penetrating trauma.

AIM: Although uncommon in children, penetrating trauma may be associated with considerable risk of morbidity and mortality. In part this reflects the child's thinner body wall. No data exists on the difference in body wall thickness in children as compared to adults. METHOD: Computer tomography (CT) scans (23 adults and 17 children) selected at random were reviewed. Measurements of the thickness of the skin and subcutaneous tissue were taken from anatomically defined regions on the thoracic and abdominal wall. The differences between adults and children were compared and analysed statistically. RESULTS: The mean ages were 51.3 years for an adult and 8.9 years for a child. Indications for the CT scans included malignancy, inflammatory conditions and blunt trauma. Statistically significant differences in the median thicknesses of adult and paediatric thoraco-abdominal wall were found in all of the regions measured. This difference ranged from 7 mm at the xiphisternum to 14 mm in the right and left axillary lines at the level of the iliac crests. CONCLUSIONS: The demonstrated difference in thickness of the thoraco-abdominal wall of an adult as compared to a child means that for a penetrating injury of equal depth, the body wall will be more easily breached and more organs potentially damaged in a child, particularly if the injury is sustained in the flanks. This supports the principle that all penetrating thoraco-abdominal wounds in children should be explored in the operating theatre under general anaesthesia to reduce the risk of a missed injury.