The ponticulus posticus: implications for screw insertion into the first cervical lateral mass.

BACKGROUND: The arcuate foramen is an important osseous anomaly of the first cervical vertebra (the atlas) that must be taken into consideration during placement of lateral mass screws into the atlas. METHODS: The prevalence of this anomaly in our patient population was determined through a retrospective review of 464 lateral radiographs of the neck. The anatomy of the arcuate foramen was identified in a study of cadavers. RESULTS: Seventy-two arcuate foramina, complete or incomplete, were identified on the 464 lateral radiographs of the neck; thus, the prevalence was 15.5% in our patient population. CONCLUSIONS: Although the arcuate foramen is a common anomaly, it is often not recognized. Proper identification of this anomaly on preoperative lateral radiographs should alert the surgeon to avoid using the ponticulus posticus as a starting point for a lateral mass screw in order to not injure the vertebral artery.

Meningioma associated with abscess formation--a case report.

A rare case of meningioma associated with both intratumoral and peritumoral abscess formation occurred in a 38-year-old man presenting with signs and symptoms of elevated intracranial pressure, intracranial infection, and right temporal pole mass lesion. The mass lesion was totally removed, revealing a meningioma. Group B streptococcus and peptostreptococcus were cultured from both the tumor and peritumoral white matter. Hematogenous spread of the organisms related to recent dental work was the likely mechanism.

Degenerative disc disease in childhood and adolescence.

Degenerative disk disease (DDD) is a common cause of low back pain and leg pain in children and infants. DDD is often unrecognized and under-diagnosed. This paper presents six cases of DDD in children and discusses the clinical presentation and pathophysiology of DDD.

National Football League athletes' return to play after surgical reattachment of complete proximal hamstring ruptures.

Although hamstring strains are common among professional football players, proximal tendon avulsions are relatively rare. Surgical repair is recommended, but there is no evidence on professional football players return to play (RTP). We hypothesized that surgical reattachment of complete proximal hamstring ruptures in these athletes would enable successful RTP. Ten proximal hamstring avulsions were identified in 10 National Football League (NFL) players between 1990 and 2008. Participating team physicians retrospectively reviewed each player's training room and clinical records, operative notes, and imaging studies. The ruptures were identified and confirmed with magnetic resonance imaging. Of the 10 injuries, 9 had palpable defects. Each of the ruptures was managed with surgical fixation within 10 days of injury. All of the players reported full return of strength and attempted to resume play at the beginning of the following season, with 9 of the 10 actually returning to play. However, despite having no limitations related to the surgical repair, only 5 of the 10 athletes played in more than 1 game. Most NFL players who undergo acute surgical repair of complete proximal hamstring ruptures are able to RTP, but results are mixed regarding long-term participation. This finding may indicate that this injury is a marker for elite-level physical deterioration.

Treatment of isolated ulnar nonunions using wave plate osteosynthesis: a report of four cases.

With current operative techniques, it is rare that treatment of diaphyseal forearm fractures results in nonunion. Because the rate of nonunion is low, there are only a few published articles that help guide management of forearm nonunions. We describe a new application of wave plate osteosynthesis in the treatment of isolated atrophic nonunions of the ulna. This biologic plating concept restores anatomic alignment without standard rigid fixation and aims to take advantage of the vascularity of the surrounding soft tissues to achieve union by secondary healing. This technique can be most useful in nonunions secondary to segmental bone defects or to large areas of nonviable bone.