RESUMO
Objective This study was performed to evaluate the visibility of the knee's anterolateral ligament (ALL) by magnetic resonance (MR) imaging when evaluating injuries of the ALL in relation to injuries of the anterior cruciate ligament (ACL). Methods Two reviewers retrospectively analyzed MR images for the visibility and dimensions of the ALL and the relationship between ALL and ACL injuries. The intraclass correlation coefficient (ICC) and kappa analysis were used to assess interobserver reliability. The chi-square test was used to assess the relationship between ALL and ACL injuries. Results The entire ALL was viewed on 82% of all MR images. The ICC for ALL visualization ranged from moderate to perfect between the two readers. There was almost perfect agreement between the reviewers when evaluating ALL dimensions. The mean length ± standard error, median thickness, and mean width ± standard error of the ALL were 36.5 ± 0.6 mm, 2.5 mm, and 8.2 ± 0.2 mm, respectively. A statistically significant relationship was observed between ALL and ACL injuries. Conclusion The ALL was visible on most MR images, allowing ALL injuries to be noted during routine MR image interpretation. Radiologists should note concomitant ACL and ALL injuries as part of their assessments.
Assuntos
Articulação do Joelho/diagnóstico por imagem , Ligamentos/diagnóstico por imagem , Imageamento por Ressonância Magnética , Adulto , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/patologia , Feminino , Humanos , Ligamentos/lesões , Ligamentos/patologia , Masculino , Variações Dependentes do ObservadorRESUMO
BACKGROUND: With the rise of obesity in the American population, there has been a proportionate increase of obesity in the trauma population. The purpose of this study was to use a computed tomography-based measurement of adiposity to determine if obesity is associated with an increased burden to the health-care system in patients with orthopaedic polytrauma. METHODS: A prospective comprehensive trauma database at a level-I trauma center was utilized to identify 301 patients with polytrauma who had orthopaedic injuries and intensive care unit admission from 2006 to 2011. Routine thoracoabdominal computed tomographic scans allowed for measurement of the truncal adiposity volume. The truncal three-dimensional reconstruction body mass index was calculated from the computed tomography-based volumes based on a previously validated algorithm. A truncal three-dimensional reconstruction body mass index of <30 kg/m(2) denoted non-obese patients and ≥ 30 kg/m(2) denoted obese patients. The need for orthopaedic surgical procedure, in-hospital mortality, length of stay, hospital charges, and discharge disposition were compared between the two groups. RESULTS: Of the 301 patients, 21.6% were classified as obese (truncal three-dimensional reconstruction body mass index of ≥ 30 kg/m(2)). Higher truncal three-dimensional reconstruction body mass index was associated with longer hospital length of stay (p = 0.02), more days spent in the intensive care unit (p = 0.03), more frequent discharge to a long-term care facility (p < 0.0002), higher rate of orthopaedic surgical intervention (p < 0.01), and increased total hospital charges (p < 0.001). CONCLUSIONS: Computed tomographic scans, routinely obtained at the time of admission, can be utilized to calculate truncal adiposity and to investigate the impact of obesity on patients with polytrauma. Obese patients were found to have higher total hospital charges, longer hospital stays, discharge to a continuing-care facility, and a higher rate of orthopaedic surgical intervention.
Assuntos
Fraturas Ósseas/terapia , Preços Hospitalares/estatística & dados numéricos , Luxações Articulares/terapia , Ligamentos/lesões , Traumatismo Múltiplo/terapia , Obesidade/complicações , Adiposidade , Adulto , Índice de Massa Corporal , Estudos de Casos e Controles , Feminino , Fraturas Ósseas/complicações , Fraturas Ósseas/economia , Fraturas Ósseas/mortalidade , Mortalidade Hospitalar , Humanos , Imageamento Tridimensional , Luxações Articulares/complicações , Luxações Articulares/economia , Luxações Articulares/mortalidade , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Assistência de Longa Duração/estatística & dados numéricos , Extremidade Inferior/lesões , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/complicações , Traumatismo Múltiplo/economia , Traumatismo Múltiplo/mortalidade , Obesidade/diagnóstico por imagem , Obesidade/economia , Procedimentos Ortopédicos/economia , Procedimentos Ortopédicos/estatística & dados numéricos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Centros de Traumatologia/economia , Centros de Traumatologia/estatística & dados numéricos , Estados UnidosRESUMO
Magnetic resonance imaging (MRI) has been shown to be sensitive in identifying ligamentous injury to the cervical spine. The major drawbacks to its routine use are cost and availability. The purpose of this study was to compare the cost of using MRI to rule out ligamentous injury of the cervical spine with the cost of immobilization in a cervical collar and outpatient follow-up. Neurologically intact and nonobtunded patients with neck pain and normal findings on radiographs evaluated for ligamentous injury of the cervical spine were studied. Patients were either evaluated with MRI or immobilized in a cervical collar and followed up for repeat clinical and radiographic evaluation as outpatients. The authors gathered year 2011 fees from their institution and 2011 Medicare reimbursement data and compared the costs of MRI with the costs of cervical collar and outpatient follow-up. In addition, the median income of the local community was used to estimate opportunity costs associated with cervical collar immobilization. After 7 days of lost wages at the median local income, MRI became a less costly option when comparing hospital fees. Alternatively, when considering Medicare reimbursement, MRI became less costly after only 2 days of lost wages at the median local income. On the basis of these findings, MRI of the cervical spine is less costly than other current management strategies when opportunity costs are considered.
Assuntos
Vértebras Cervicais/lesões , Vértebras Cervicais/patologia , Honorários e Preços/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Ligamentos/lesões , Ligamentos/patologia , Imageamento por Ressonância Magnética/economia , Análise Custo-Benefício , Feminino , Humanos , Imageamento por Ressonância Magnética/estatística & dados numéricos , Masculino , Michigan , Prognóstico , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Traumatismos da Coluna Vertebral/economia , Traumatismos da Coluna Vertebral/patologia , Resultado do TratamentoRESUMO
OBJECTIVE: To assess the value of ultrasonographic imaging of the posterior ligamentous complex (PLC) to diagnose ligamentous injuries, in patients with mild thoracolumbar fractures. METHODS: Patients with thoracolumbar fractures were included in this prospective study. Patients underwent palpation of the midline of the back, and ultrasonography was performed over the entire thoracolumbar region by an experienced sonographer. A team that included a musculoskeletal radiologist, an orthopaedic surgeon and a sonographer assessed the ultrasound results. Ultrasonographic and magnetic resonance imaging (MRI) findings were jointly evaluated in a subgroup of patients who were able to fund MRI analysis. Conflicts regarding the results were resolved by a majority vote. RESULTS: A total of 21 patients participated in the study, all of whom exhibited abnormal ultrasonographic echogenicity on the supraspinous or interspinous ligaments. Three patients were diagnosed with a rupture of the supraspinous ligament. In 15/17 (88.2%) patients, interspinous ligament injuries were detected caudally to the injured vertebrae. CONCLUSIONS: Ultrasound examination is a reliable complementary diagnostic tool to identify PLC injuries in patients with mild thoracolumbar fractures.
Assuntos
Fraturas Ósseas/diagnóstico por imagem , Ligamentos/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Traumatismos Torácicos/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Adulto , Idoso , Feminino , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/cirurgia , Humanos , Ligamentos/lesões , Ligamentos/cirurgia , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Estudos Prospectivos , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/cirurgia , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , UltrassonografiaRESUMO
STUDY DESIGN: Prospective cohort study. OBJECTIVE: To study whether there is a sequential pattern in the posterior ligamentous complex (PLC) rupture caused by deforming traumatic forces by analyzing magnetic resonance (MR) images in a consecutive prospective cohort of patients with traumatic vertebral fracture. SUMMARY OF BACKGROUND DATA: PLC plays an important role in vertebral stability. However, the sequence in which the different components of the PLC tear, in the face of traumatic forces, has not been yet described. METHODS: Prospective study of 74 consecutive vertebral acute traumatic fractures analyzed using radiography and magnetic resonance imaging (MRI) (FS-T2-w/short-tau inversion-recovery [STIR] sequences). Fracture morphology was classified according to the AO classification. Integrity of each PLC component-facet capsules, interspinous ligament (ISL), supraspinous ligament (SSL), and ligamentum flavum (LF)-was assessed and classified as intact, edema, or disruption. ISL edema was further subdivided depending on the extension (>50%/<50%). We analyzed the association between MRI signal and the AO progressive scale of morphological damage. RESULTS: AO type A1/A2 fractures associated with only facet distraction. A3 fractures showed additional ISL edema, usually less than 50%, with neither SSL nor LF disruption. Type B1 fractures associated with facet distraction, ISL edema or disruption, and low rate of SSL/LF disruptions; B2 fractures increased SS/LF disruption rates. Type C fractures associated with facet fracture or dislocation and ISL, SSL, or LF complete rupture. We found high association (P < 0.001) between AO progressive scale and MRI signal. MRI analysis showed that posterior distraction forces begin in the facets and extend throughout the ISL, starting at its posterosuperior margin (finally disinserting the SSL superiorly) and traveling diagonally toward anteroinferior border, finally tearing the LF. CONCLUSION: MR images correlated with AO progressive scale of morphological damage, which showed a progressive orderly rupture sequence among the different PLC components as traumatic forces increased.
Assuntos
Ligamentos/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Fraturas da Coluna Vertebral/complicações , Traumatismos da Coluna Vertebral/diagnóstico , Adulto , Edema/diagnóstico , Edema/etiologia , Feminino , Humanos , Ligamentos/lesões , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Radiografia , Reprodutibilidade dos Testes , Ruptura/diagnóstico , Ruptura/etiologia , Sensibilidade e Especificidade , Traumatismos da Coluna Vertebral/etiologiaRESUMO
Autologous biologic therapies such as platelet-rich plasma and autologous conditioned serum are in widespread clinical use to treat musculoskeletal pathology in horses. These substances exert a therapeutic effect through the provision of either anabolic or anti-catabolic factors, or a combination of both. This article discusses the history, experimental and clinical literature, and currently accepted preparation and usage strategies for both platelet-rich plasma and autologous conditioned serum.
Assuntos
Doenças dos Cavalos/terapia , Cavalos/lesões , Proteína Antagonista do Receptor de Interleucina 1/uso terapêutico , Sistema Musculoesquelético/lesões , Plasma Rico em Plaquetas , Animais , Doenças dos Cavalos/etiologia , Proteína Antagonista do Receptor de Interleucina 1/economia , Ligamentos/lesões , Ruptura/terapia , Ruptura/veterinária , Traumatismos dos Tendões/terapia , Traumatismos dos Tendões/veterináriaRESUMO
BACKGROUND: Magnetic resonance imaging is commonly used to assess the integrity of the posterior ligamentous complex following cervical trauma, but its accuracy and reliability have not been documented, to our knowledge. The purpose of this study was to determine the diagnostic accuracy of magnetic resonance imaging in detecting injury to specific components of the posterior ligamentous complex of the cervical spine. METHODS: Patients with an acute cervical spine injury that required posterior surgical treatment were prospectively studied. The six components of the posterior ligamentous complex were characterized as intact, incompletely disrupted, or disrupted on preoperative magnetic resonance imaging studies by a radiologist and intraoperatively by two surgeons. Correlation between the magnetic resonance imaging and intraoperative findings was determined. The percent agreement, sensitivity, specificity, negative predictive value, and positive predictive value of magnetic resonance imaging as a tool for characterizing the integrity of the posterior ligamentous complex were calculated. RESULTS: Forty-seven consecutive patients with a total of seventy levels of injury were studied. Overall, there was moderate agreement between the magnetic resonance imaging and intraoperative findings for the supraspinous and interspinous ligaments (kappa scores of 0.46 and 0.43, respectively) and fair agreement between those for the ligamentum flavum, left and right facet capsules, and cervical fascia (kappa scores of 0.32, 0.31, 0.26, and 0.39, respectively). The sensitivity of the magnetic resonance imaging was greatest for the cervical fascia (100%) and the lowest for the facet capsules (80%). Specificity ranged from 56% (for the facet capsules) to 67% (for the interspinous ligament). The positive predictive value ranged from 42% (for the cervical fascia) to 82% (for the interspinous ligament). CONCLUSIONS: Magnetic resonance imaging is sensitive for the evaluation of injury to the posterior ligamentous complex in the setting of acute cervical trauma. However, it has a lower positive predictive value and specificity, suggesting that injury to the posterior ligamentous complex may be "over-read" on magnetic resonance images. If magnetic resonance imaging is used in isolation to guide treatment, the high rate of false-positive findings may lead to unnecessary surgery. Other factors, including the morphology of the injury and the neurological status, should be considered as well when devising a treatment plan.
Assuntos
Vértebras Cervicais/lesões , Ligamentos/lesões , Imageamento por Ressonância Magnética/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Feminino , Humanos , Ligamentos/diagnóstico por imagem , Ligamentos/cirurgia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Radiografia , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
PURPOSE: To identify preoperative and intraoperative factors associated with a capsule complication; that is, a capsule tear or a zonular dehiscence during cataract surgery. SETTING: Ten ophthalmic surgery departments in Sweden. METHODS: A retrospective review of files of patients with a capsule complication and control patients with no complication operated on in 2003 was performed. RESULTS: The review comprised 324 patients with a capsule complication and 331 control patients. In the logistic regression analyses, preoperative conditions associated with a capsule complication were previous trauma, white and brunescent/hard cataract, and phacodonesis. The intraoperative factors of loose zonules, the use of trypan blue, and miosis were all statistically significantly overrepresented in the capsule complication group. The same was true for eyes operated on by surgeons with the least experience. CONCLUSIONS: By preoperatively identifying cataract cases with the identified risk factors and allocating them to surgeons with the longest experience, the number of capsule complications could be kept low. Operating early in the course of the disease to prevent the cataract from becoming a poor surgical risk and improving training of junior surgeons should further reduce the frequency of capsule complications.
Assuntos
Traumatismos Oculares/etiologia , Complicações Intraoperatórias , Cápsula do Cristalino/lesões , Doenças do Cristalino/etiologia , Facoemulsificação/efeitos adversos , Idoso , Estudos de Casos e Controles , Catarata/complicações , Bases de Dados Factuais/estatística & dados numéricos , Traumatismos Oculares/economia , Traumatismos Oculares/cirurgia , Feminino , Humanos , Doenças do Cristalino/economia , Doenças do Cristalino/cirurgia , Implante de Lente Intraocular , Ligamentos/lesões , Masculino , Facoemulsificação/estatística & dados numéricos , Cuidados Pré-Operatórios , Estudos Retrospectivos , Fatores de Risco , Ruptura , SuéciaAssuntos
Articulação Atlantoccipital/patologia , Ligamentos/patologia , Imageamento por Ressonância Magnética/métodos , Cervicalgia/diagnóstico , Traumatismos em Chicotada/diagnóstico , Articulação Atlantoccipital/lesões , Articulação Atlantoccipital/fisiopatologia , Doença Crônica , Diagnóstico Diferencial , Humanos , Ligamentos/lesões , Ligamentos/fisiopatologia , Imageamento por Ressonância Magnética/normas , Cervicalgia/etiologia , Cervicalgia/fisiopatologia , Variações Dependentes do Observador , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Traumatismos em Chicotada/fisiopatologiaRESUMO
BACKGROUND: No consensus has been reached on the optimal radiographic evaluation of thoracolumbar burst fractures. The role of MRI in the treatment decision is not fully documented. The objectives was to measure the agreement of MRI in detecting posterior ligamentous complex (PLC) and posterior longitudinal ligament (PLL) injury, and to determine whether the findings by MRI is correlated with the results of plain radiography and computed tomography (CT) scanning as well as neurological examination and with the treatment planning. METHODS: Sixty-one patients with acute thoracolumbar burst fracture were retrospectively reviewed for the presence of supraspinous ligament (SSL), interspinous ligament (ISL) or posterior longitudinal ligament (PLL) injury. The overall interobserver agreement between the three different observers was assessed by a kappa coefficient for multiple raters. The status of ligaments was correlated with the neurological function as assessed by Frankel scale and fracture severity as defined by the Load Sharing Classification. These patients were surgically treated according to the Load Sharing Classification and followed up for at least 5 years. RESULTS: The kappa coefficients for ISL or SSL injury ranged 0.601 to 0.736, representing substantial to almost perfect agreement, whereas the kappa coefficients for PLL injury were 0.441 to 0.574, representing moderate agreement. No significant difference (P > 0.05) of Frankel scale or load sharing score was found between patients with and without ligamentous injuries. Satisfactory results were achieved in all patients regarding the clinical and radiological assessment. CONCLUSIONS: MRI is reliable for detecting the ligamentous injury, especially PLC injury in thoracolumbar burst fractures but the ligamentous injury as shown by MRI is not correlated with the neurological function or fracture severity. As MRI finding is of little value in treatment planning of thoracolumbar burst fractures, MRI examination is not necessary to be used routinely for excluding occult ligamentous injury.
Assuntos
Ligamentos Longitudinais/lesões , Vértebras Lombares , Imageamento por Ressonância Magnética , Fraturas da Coluna Vertebral/diagnóstico , Vértebras Torácicas , Adulto , Feminino , Humanos , Ligamentos/diagnóstico por imagem , Ligamentos/lesões , Ligamentos Longitudinais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fraturas da Coluna Vertebral/classificação , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/terapia , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
STUDY DESIGN: Review article. OBJECTIVES: To review the literature on soft tissue lesions of the upper cervical spine in whiplash trauma with focus on imaging. SUMMARY OF BACKGROUND DATA: Whiplash injury is associated with chronic impairment in a substantial number of patients. There are different opinions as to the nature and prognosis of this condition, and the role of diagnostic imaging is debated. METHODS: Review the literature on the anatomic source of the chronic whiplash syndrome. Review the literature on imaging of the upper cervical spine, emphasizing on the author's own research. RESULTS: MRI shows structural changes in ligaments and membranes after whiplash injury, and such lesions can be assessed with reasonable reliability. Lesions to specific structures can be linked with specific trauma mechanisms. There is a correlation between clinical impairment and morphologic findings. CONCLUSION: Whiplash trauma can damage soft tissue structures of the upper cervical spine, particularly the alar ligaments. Structural lesions in this area contribute to the understanding of the chronic whiplash syndrome.
Assuntos
Vértebras Cervicais/patologia , Ligamentos/patologia , Imageamento por Ressonância Magnética , Lesões dos Tecidos Moles/patologia , Traumatismos em Chicotada/patologia , Acidentes de Trânsito , Adolescente , Adulto , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/lesões , Feminino , Humanos , Ligamentos/diagnóstico por imagem , Ligamentos/lesões , Masculino , Mecânica , Pessoa de Meia-Idade , Variações Dependentes do Observador , Prognóstico , Estudos Prospectivos , Amplitude de Movimento Articular , Rotação , Índice de Gravidade de Doença , Método Simples-Cego , Lesões dos Tecidos Moles/diagnóstico , Lesões dos Tecidos Moles/diagnóstico por imagem , Lesões dos Tecidos Moles/etiologia , Tomografia Computadorizada por Raios X , Traumatismos em Chicotada/diagnóstico , Traumatismos em Chicotada/diagnóstico por imagemRESUMO
PURPOSE: To evaluate the role of ultrasound biomicroscopy (UBM) as a method for assessing the zonules after trauma to the anterior segment. These patients might develop traumatic cataract or glaucoma requiring surgery. If occult zonular defects can be identified preoperatively, this might lead to a modified surgical technique and improved outcomes. DESIGN: Retrospective observational case series. PARTICIPANTS: Fifty-nine patients who were referred for UBM after anterior segment trauma. METHODS: UBM examinations were performed using the Humphrey Instruments Ultrasound Biomicroscope equipped with a 50-mHz transducer. A plastic eyecup filled with 2% methylcellulose solution was used in each case. The chart and UBM images of all anterior segment trauma patients examined between 1995 and 2000 were reviewed. The age, gender, and mechanism of injury were recorded for each patient. Follow-up data were obtained from the referring physician in patients who subsequently underwent ocular surgery. MAIN OUTCOME MEASURES: The number of studies judged to be of adequate quality to evaluate zonules was noted, and the number of cases in which zonular defects were found was recorded. The number of cases in which surgery was subsequently performed was noted, and postoperative results were obtained. RESULTS: Fifty-nine charts and 60 UBM studies were reviewed. Forty-nine studies were judged to be adequate for imaging zonules. Most poor-quality studies were in the early years of the study. Further analysis was carried out on the reliable studies. Occult zonular defects were identified in 21 of 49 patients (42.9%). Thirty-one patients went on to have cataract, filtering, and/or vitreoretinal surgery. One surgeon (ACS) performed 25 of the surgical cases, for which a summary is provided. Referring surgeons found the information helpful in surgical planning and anticipating complications in reliable study cases. CONCLUSIONS: UBM is an effective method for identifying occult zonular damage in patients with anterior segment trauma. There is a significant learning curve in the examination technique. The ability to diagnose zonular rupture preoperatively is of significant benefit to the surgeon and might reduce the chance of intraoperative complications.
Assuntos
Segmento Anterior do Olho/lesões , Traumatismos Oculares/diagnóstico por imagem , Cristalino/lesões , Ligamentos/lesões , Ferimentos não Penetrantes/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Segmento Anterior do Olho/diagnóstico por imagem , Feminino , Humanos , Cristalino/diagnóstico por imagem , Ligamentos/diagnóstico por imagem , Masculino , Estudos Retrospectivos , UltrassonografiaRESUMO
Annular ligament displacement (ALD)--also termed radial head subluxation, nursemaid's elbow, or pulled elbow--can be successfully diagnosed and treated over the telephone by properly trained medical professionals instructing nonmedical caretakers. Two case reports of successful ALD reduction via telephone are described. The pathology of ALD and techniques for its treatment are reviewed, and guidelines are given. The rationale for the introduction of the new term annular ligament displacement as well as areas for additional investigation are discussed. To our knowledge, this is the first published account of ALD reduction via telephone.
Assuntos
Lesões no Cotovelo , Luxações Articulares/terapia , Manipulação Ortopédica/métodos , Consulta Remota/métodos , Pré-Escolar , Articulação do Cotovelo/fisiologia , Feminino , Custos de Cuidados de Saúde , Humanos , Lactente , Ligamentos/lesões , Masculino , Manipulação Ortopédica/economia , Pronação/fisiologia , Rádio (Anatomia)/lesões , Recidiva , Consulta Remota/economia , Supinação/fisiologia , Telefone , Resultado do Tratamento , Articulação do Punho/fisiologiaRESUMO
STUDY DESIGN: A retrospective chart analysis of pediatric trauma patients with suspected cervical spine injury was performed. OBJECTIVES: This study was designed to evaluate the efficacy and cost-efficiency of a magnetic resonance imaging (MRI) protocol for cervical spine clearance in pediatric trauma patients. SUMMARY OF BACKGROUND DATA: The evaluation of cervical spine injury in the pediatric trauma population can be difficult. In obtunded or uncooperative children, MRI can be valuable in defining injuries of the cervical spine not detected by plain radiographs and computed tomography. METHODS: In 1993, a protocol was instituted at a pediatric trauma center using MRI to evaluate the cervical spine of children who could not be cleared within 72 hours. Using the trauma registry from February 1989 through September 1996, children with suspected cervical spine injury who were intubated at the time of hospital admission and who remained in the intensive care unit for at least 3 days were identified. The patients were divided into two cohorts: a "preprotocol group" and a "postprotocol group," consisting of patients before or after institution of the MRI protocol in September 1993. Medical records were reviewed to determine the time to cervical spine clearance, the number of days in the intensive care unit, and hospital days for each group. Biostatistical analysis was performed by an independent professional statistician. RESULTS: Fifty-one patients in each group met the inclusion criteria. In the preprotocol group, 19 patients underwent MRI at an average of 6.8 days after admission. In the postprotocol group, 31 MRIs were performed at an average of 2.5 days from admission. Time to cervical spine clearance decreased from 5.1 days in the preprotocol group to 3.2 days in the postprotocol group (P = 0.003). The average intensive care unit stay decreased from 9.2 days in the preprotocol group to 7.3 days in the postprotocol group (P = 0.122). The average hospital stay decreased from 20.1 days in the preprotocol group to 15.5 days in the postprotocol group (P = 0.106). Factoring charges for MRI, intensive care unit beds, and hospital beds, savings of $7,700 per patient were estimated. CONCLUSIONS: In obtunded and intubated pediatric trauma patients with suspected cervical spine injury, the clearance protocol using cervical spine MRI was effective and cost-efficient.
Assuntos
Vértebras Cervicais/lesões , Imageamento por Ressonância Magnética/economia , Lesões do Pescoço/diagnóstico , Traumatismos da Coluna Vertebral/diagnóstico , Adolescente , Vértebras Cervicais/diagnóstico por imagem , Criança , Pré-Escolar , Estudos de Coortes , Análise Custo-Benefício , Demografia , Feminino , Humanos , Lactente , Ligamentos/lesões , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Traumatismos da Medula Espinal/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
Two hundred and ninety-five licensed floorball players from Finnish premier to fifth division were observed prospectively for one season to study the incidence, nature, causes and severity of floorball injuries. During the study period, 100 out of the 295 (34 %) players sustained 120 injuries. Thirty-seven percent (73/199) of the male players and 28 % (27/96) of the females suffered from an injury. The injury rate was 1.0 per 1000 practice hours for both sexes. The injury rates per 1000 game hours were 23.7 for men and 15.9 for women. One hundred injuries (83 %) were acute and the remaining 20 (17 %) were overuse injuries. Sprain was the most common type of injury in men while overuse injuries were the most frequent injury type in women. The lower extremity was involved in 62 %, spine or trunk in 19 % and upper extremity in 10 % of the injuries. The most commonly injured sites were the knee and ankle (22 % and 20 % of all injuries), followed by head and neck (8 %). In both sexes the majority of injuries were minor, level II, injuries. Ten of the knee injuries (38 %) were serious, level IV injuries, of which seven were ACL ruptures. In conclusion, the individual risk of injury in floorball is relatively low in game practice while rather high during the game itself. Before initiation of clinical trials on prevention of floorball injuries, an exact knowledge of the risk factors and mechanisms of floorball injuries are needed.
Assuntos
Traumatismos em Atletas/epidemiologia , Transtornos Traumáticos Cumulativos/epidemiologia , Fraturas Ósseas/epidemiologia , Hóquei/lesões , Lesões dos Tecidos Moles/epidemiologia , Entorses e Distensões/epidemiologia , Adulto , Traumatismos do Tornozelo/epidemiologia , Traumatismos em Atletas/classificação , Traumatismos em Atletas/economia , Lesões nas Costas/epidemiologia , Traumatismos Oculares/epidemiologia , Feminino , Finlândia/epidemiologia , Seguimentos , Calcanhar/lesões , Humanos , Traumatismos do Joelho/epidemiologia , Ligamentos/lesões , Masculino , Estudos Prospectivos , Distribuição por SexoRESUMO
During a 7-year period, a consecutive retrospective series of 89 trauma patients at a Level One trauma center who had negative standard radiographs with suspected occult cervical injury were administered a cervical magnetic resonance imaging (MRI) scan. The MRI studies were fully able to assess the ligamentous status of the cervical spine in all patients and were the final step in determining the treatment of the spine. Of the total 89 patients, 82 had no ligamentous injury, and 7 had ligamentous injury. Two patients underwent surgery because of the findings on the MRI study. MRI studies of patients with negative standard radiographs but with suspected occult cervical injury are excellent and safe studies for the evaluation of cervical spinal stability because of their ability to detect ligamentous injuries that are not evident on plain radiographs.
Assuntos
Vértebras Cervicais/lesões , Ligamentos/lesões , Imageamento por Ressonância Magnética , Traumatismos da Medula Espinal/diagnóstico , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Eighteen of twenty-two patients who were having a tendon transfer to treat rupture of the posterior tibial tendon had evidence of injury to the spring ligament. The injury consisted of a longitudinal tear in the ligament in seven patients, a lax ligament without a gross tear in seven, and a complete rupture of the ligament in four. The ruptured posterior tibial tendon was treated with transfer of the flexor digitorum longus in twenty of the twenty-two patients. A variety of methods were used to repair the ligament. It is essential to determine the status of the spring ligament when patients are managed for rupture of the posterior tibial tendon. Patients who have a torn or lax spring ligament in addition to the ruptured posterior tibial tendon may have more severe abnormalities of the hindfoot than those who have only a ruptured tendon.
Assuntos
Deformidades Adquiridas do Pé/etiologia , Pé , Ligamentos/lesões , Traumatismos dos Tendões/complicações , Adulto , Idoso , Feminino , Pé Chato/etiologia , Humanos , Ligamentos/cirurgia , Masculino , Ossos do Metatarso/diagnóstico por imagem , Pessoa de Meia-Idade , Satisfação do Paciente , Qualidade de Vida , Radiografia , Ruptura , Infecção da Ferida Cirúrgica/etiologia , Tálus/diagnóstico por imagem , Traumatismos dos Tendões/cirurgia , Transferência Tendinosa/efeitos adversos , Resultado do Tratamento , Suporte de CargaRESUMO
Coloured microspheres were used to determine standardized blood flow in an established model of medial collateral ligament injury in the adult rabbit knee. Resting blood flow in the ligament was ascertained to be on the order of 0.68 +/- 0.08 ml/min/100 g (mean +/- SEM) in normal rabbit knees, although errors in flow estimates of this magnitude may be quite high. In healing medial collateral ligament, however, flow had increased markedly 3 weeks after injury (21.45 +/- 5.48 ml/min/100 g). Flows in sham-operated control medial collateral ligaments were not significantly increased compared with those in control normal ligaments. Six weeks after injury, blood flow in the ligament remained elevated (16.90 +/- 3.20 ml/min/100 g) and was similarly elevated in other neighbouring joint tissues (i.e., ipsilateral synovial fat pad). The increase in flow to ipsilateral noninjured articular tissues did not persist beyond 6 weeks, but flow in the healing medial collateral ligament scar tended to remain elevated after 17 weeks (4.20 +/- 1.79 ml/min/100 g), although this did not achieve statistical significance. We conclude from these data that it is possible to measure the increase in blood flow in injured and healing articular tissues using the coloured microspheres technique and that ligament injury is a potent stimulus for increasing blood flow. Coloured microsphere measurements of blood flow to joint connective tissues may offer a valuable approach to future investigations of joint injury and arthritis.