Anatomical variations related to pathological conditions of the peroneal tendon: evaluation of ankle MRI with a 3D SPACE sequence in symptomatic patients.

OBJECTIVE: To evaluate anatomical variations in the lateral ankle and their relationships with pathological conditions of the peroneal tendon on magnetic resonance imaging (MRI) in symptomatic patients. MATERIALS AND METHODS: Sixty-nine ankles MRIs of 60 adult patients with symptomatic ankles were included. The presence and sizes of peroneal tubercle and retrotrochlear eminence (RTE), the prevalence of peroneus quartus (PQ), os peroneum, and boomerang-shaped peroneus brevis (PB) tendon, the shape of the retromalleolar fibular groove (RMFG), and the location of the PB muscle-tendon junction were evaluated. The relationships of these variations with peroneal tendinopathies were assessed. The correlations between pathological peroneal conditions on MRI and clinical findings were evaluated. RESULTS: Peroneal tubercle (mean size, 3.2 mm) and RTE (mean size, 4.5 mm) were identified in 58 (84%) and 69 (100%) ankles respectively. PQ muscle, os peroneum, and boomerang-shaped PB tendon were found in 9 (13%), 7 (10%), and 24 (34.8%) ankles respectively. The RMFG was concave, flat, convex, and irregular in 14 (20.3%), 40 (58%), 13 (18.8%), and 2 (2.9%) ankles respectively. Sixteen (23.2%) patients had low-lying PB muscle belly. Only boomerang-shaped PB tendons showed a significant relationship with peroneal tendinopathies. MRI and clinical findings had a poor correlation in pathological peroneal conditions and both had low sensitivity in diagnosis. CONCLUSION: Lateral ankle anatomical variations are common and cannot be attributed to pathological conditions of the peroneal tendon, except for boomerang-shaped PB tendons. Both clinical and MRI findings have low sensitivity in the diagnosis of peroneal tendinopathies, which are often incidental findings on MRI.

[Is there a correlation between severity of trauma and serum trace element levels?]. / Travma siddeti ile serum eser element düzeyi iliskili mi?

OBJECTIVES: Trace elements zinc and copper are effective in wound and fracture healing. In this prospective study, correlations between mangled extremity severity score (MESS) and mangled extremity syndrome index (MESI) and serum zinc and copper levels were investigated in trauma patients. METHODS: Seventeen trauma patients (11 females, 6 males; mean age 41.6 years; range 11 to 73 years) were evaluated with respect to MESS and MESI scores. On the seventh day of trauma, serum samples were obtained to determine zinc and copper levels by atomic absorption spectrophotometry. RESULTS: Serum levels of zinc and copper showed significant negative correlations with both MESS (r=-0.65 and r=-0.76, respectively) and MESI (r=-0.83 and r=-0.77, respectively) scores (p<0.05). CONCLUSION: The severity of trauma is associated with significant decreases in serum levels of trace elements. Thus, trace element supplementation may be an important aspect of treatment in trauma patients.

Do atypical femoral fractures in patients with prolonged alendronate treatment heal?

Osteoporosis, which is a major health problem, may have an adverse impact on the economic status of the society and the quality of the life of the patients. Long-term alendronate use may cause an increased susceptibility to fractures with an increased risk of delayed union. In this article, we describe two patients on long-term alendronate therapy which were treated for atypical femoral fractures healed with surgical treatment plus calcium, vitamin D support, and alendronate discontinuation.