MRI-guided percutaneous retrograde drilling of osteochondritis dissecans of the talus: a feasibility study.

OBJECTIVES: The purpose of this study was to evaluate the feasibility of MRI guidance for percutaneous retrograde drilling in the treatment of osteochondritis dissecans of the talus (OCDT). METHODS: Four patients, one juvenile and three adults, with one OCDT lesion each and persisting ankle pain after conservative treatment, were treated with MRI-guided retrograde drilling. All lesions were stable and located in the middle or posterior medial third of the talar dome. Pain relief and the ability to return to normal activities were assessed during clinical follow-up. MRI and plain film radiographs were used for imaging follow-up. RESULTS: Technical success was 100% with no complications and with no damage to the overlying cartilage. All patients experienced some clinical benefit, although only one had complete resolution of pain and one had a relapse leading to surgical treatment. Changes in the pathological imaging findings were mostly very slight during the follow-up period. CONCLUSIONS: MRI guidance seems accurate, safe and technically feasible for retrograde drilling of OCDT. Larger series are needed to reliably assess its clinical value. KEY POINTS: • MRI serves as a useful guidance method for numerous mini-invasive applications. • Retrograde drilling is a cartilage-sparing alternative in the treatment of osteochondritis dissecans. • MRI guidance seems feasible for treatment of osteochondritis dissecans of the talus.

[Acute hematogenous osteomyelitis in children]. / Lasten akuutti hematogeeninen osteomyeliitti.

In children, osteomyelitis is usually acute and hematogenous, the metaphysis of long bones being the most common location. Common symptoms include limb pain and fever. Essential investigations include laboratory tests measuring inflammation, and blood culture. Although osteomyelitis is initially undetectable by plain X-ray, the investigation is nevertheless necessary, e.g. in order to exclude fractures. Magnetic resonance imaging is useful especially in cases of suspected complications. A bone scan is utilized in unclear cases. Treatment of the disease is started with an intravenous antimicrobial medication directed against the most common causative agent, Staphylococcus aureus.

[Removal of osteosynthesis material in children and young people]. / Osteosynteesimateriaalin poisto lapsilta ja nuorilta.

Metallic osteosynthesis materials, i.e. implants used in the treatment of fractures and correction of bone position in children have traditionally been subsequently removed in a further operation. The necessity for the removal of orthopedic implants left completely under the skin is arguable and research-based evidence is scarce. Treatment practices vary. We present our literature- and experience-based recommendation on the removal of implants or leaving them in position. The removal of an implant should, however, always be decided on an individual basis.

[Trampoline injuries in children]. / Lasten trampoliinivammat.

Trampolines for home use have become common in Finland during the past ten years, being especially favored by children. Trampoline jumping is beneficial and constructive physical exercise, but poses a significant risk for injuries. The most common injuries include sprains and strains. During summertime, trampoline injuries account for as many as 13% of children's accidents requiring hospital care. Fractures are by far the most common trampoline injuries requiring hospital care. Injuries can be prevented by using safety nets. Only one child at a time is allowed to jump on the trampoline.