Evaluation of MRI Signal Changes of the Distal Biceps Tendon in Asymptomatic Patients.

PURPOSE: Magnetic resonance imaging (MRI) is used widely for complete ruptures of the distal biceps tendon. The validity of this investigation for bicipital bursitis and tendinosis is unknown. The purpose of present study was to assess the prevalence of incidental (asymptomatic) signal changes in the distal biceps tendon in patients who underwent MRI including the elbow. Our null hypothesis was that signal changes of the distal biceps tendon do not occur in asymptomatic patients. This would empower MRI as a diagnostic tool for bicipital bursitis and tendinosis as well as complete and partial distal biceps tendon ruptures. METHODS: We evaluated 1,191 elbow MRI scans including the distal biceps tendon insertion. The prevalence of incidental findings was calculated and sensitivity, specificity, positive predictive value, negative predictive value, false positive probability, and false negative probability were calculated. RESULTS: Signal changes of the distal biceps tendon or bursitis were identified in 8 of 1,191 asymptomatic patients (prevalence 0.6%). The sensitivity of MRI for distal biceps pathology was 97% (95% confidence interval [CI], 93%-99%), specificity 99% (95% CI, 98%-99%), positive predictive value 94% (95% CI, 89%-97%), negative predictive value 99% (95% CI, 99%-99%), false positive probability 6% (95% CI, 3%-10%), and false negative probability 0.3% (95% CI, 0.1%-0.9%). There was no correlation between explanatory variables, including age, sex, race, occupation, and inflammatory disease and incidental distal biceps tendon signal changes. CONCLUSIONS: The prevalence of distal biceps tendon signal changes on MRI in asymptomatic patients is very low. CLINICAL RELEVANCE: The negative predictive value of 99% shows that patients without signal changes on MRI may be assumed to have no distal biceps tendon pathology. MRI investigation of distal biceps tendon is a valuable tool in the diagnosis of tendinosis and bicipital bursitis.

The challenge of the infected pilon tibial non-union: treatment with radical resection, bone transport and ankle arthrodesis.

A significant number of patients with pilon tibial fractures develop complications, the most devastating being a combination of infection and non-union with bone loss. The results of the Ilizarov bone transport technique were retrospectively evaluated in ten patients. All underwent an extensive resection and reconstruction aiming at an ankle arthrodesis. The outcome was registered by clinical and radiographic examination as proposed by Paley's functional and bone results classification. A good healing at the level of the docking site could be obtained in all patients but with a re- intervention in 8 of the 10. In 5 of these patients, re-intervention with a transcalcaneal nailing leaded to the final healing. Other options are debridement of the docking site (2 patients) and a new Ilizarov procedure (1 patient). If patients are prepared to participate in a long-term treatment with the risk of multiple interventions a reconstruction can be performed, resulting in a limb with an acceptable function, allowing all activities of daily life and even a professional occupation. To obtain this final result with a definite union at the docking site a secondary retrograde intramedullary nailing is considered a valuable and safe procedure.

The effect of cup orientation on stability of trapeziometacarpal total joint arthroplasty: a biomechanical cadaver study.

It has been suggested that the cup of a trapeziometacarpal total joint replacement should be positioned parallel with the proximal articular surface of the trapezium to align it with the centre of motion. This would diminish the chance of dislocation. The goal of this study was to test this idea biomechanically. A linked trapeziometacarpal prosthesis was implanted in seven cadaver hands and combined with three-dimensional printed trapezium cups in 17 different orientations. For every combination, stability of the prosthesis was assessed through its entire passive range of motion. Dorsal inclination of the cup relative to the proximal articular surface increased the risk of dislocation with thumb flexion and opposition. The risk of dislocation was also increased with lateral or medial inclination of the cup exceeding 20°. Our results demonstrate that cup orientation is an important factor in prosthetic joint stability. Cup placement parallel to the proximal articular surface is ideal.

A clinical trial of tension and compression orthoses for Dupuytren contractures.

STUDY DESIGN: Randomized clinical trial on 2 patient groups with Dupuytren's disease. INTRODUCTION: Despite an unpredictable outcome, surgery remains an important treatment for Dupuytren's disease. Orthotic devices are a controversial noninvasive treatment method to influence the myofibroblasts in the nodules. PURPOSE OF THE STUDY: To detect how much improvement 2 types of orthotic device (tension and compression) as only treatment intervention can provide on a Dupuytren's contracture. Is a compression orthosis better than a tension orthosis? METHODS: Thirty patients with measurable flexion contractures of the fingers were identified. Both primary and recurrence cases were included. Patients were randomized in 2 groups of 15 patients. One group had a standard tension orthosis (Levame), the other group a newly designed silicon compression orthotic device. Patients were instructed to wear the orthotic devices 20 hours a day during 3 months. Data were collected at first visit and after 3 months of orthotic treatment. Primary outcomes were active extension deficit of each joint and total active extension (TAE) of the digit. Secondary outcome was patient satisfaction. Visual Analog Scale (VAS) score of function and esthetics (0-10 points) were recorded at the start and after 3 months. RESULTS: Flexion contracture was reduced at least 5 degrees in all patients. After 3 months, TAE was significantly reduced in both groups (both P < .001).The mean change in TAE was 32.36° in the tension group and 46.47° in the compression group. Although reduction of TAE deficit was bigger in the compression group, this difference was not statistically significant (P = .39). VAS scale of esthetics and functionality was significantly increased in both treatment groups. The functional VAS scale after 3 months was 11% higher in the compression group than in the tension group (P = .03). A major complication of a tension orthotic is skin ulcers. DISCUSSION: Too much tension may cause myofibroblast stimulation and disease progression, whereas continuous limited tension can improve flexion contractures. The idea of a compression device is based on the treatment concept of hypertrophic burn scars. CONCLUSION: Tension and compression orthotic devices can be used as a nonoperative treatment of Dupuytren's disease in both early proliferative untreated hands and aggressive postsurgery recurrence. Although there is no statistically significant difference, compression orthoses appear to be more effective and are better tolerated. Nevertheless, adjustment of orthotic design and research on long-term results are needed. LEVEL OF EVIDENCE: I (Randomized controlled trial, Therapeutic study).