The Role of Cone-Beam Computed Tomography (CBCT) Scan for Detection and Follow-Up of Traumatic Wrist Pathologies.

Emergency diagnostics demand fast, easily available, and cost-effective procedures. The higher the accuracy of radiological imaging, the better it supports the surgeon in decision-making for further treatment. Cone-beam computed tomography has been proven to be a reliable tool in diagnosing fractures of the hand and distal forearm. It can be easily installed, has a high spatial resolution, and a potentially lower radiation dose when compared with multislice computed tomography or a series of plain x-rays. This review focuses on the value of conventional radiography, cone-beam computed tomography, and multislice computed tomography for diagnosing traumatic wrist pathologies.

Long-term results of revision total hip arthroplasty with a cemented femoral component.

INTRODUCTION: In revision total hip arthroplasty (THA), the cancellous bone is normally completely removed out of the femoral canal during stem extraction. This situation is comparable to primary THA following the shape-closed concept, with some authors advocating to remove the metaphyseal cancellous bone to enhance press-fit stability ("French paradox"). The aim of this study was to investigate the long-term outcome, regarding survival and radiological results, of a cemented straight stem when used for revision THA and to compare these results to the results of the same stem in primary THA. MATERIALS AND METHODS: 178 stem revisions performed between 01/1994 and 08/2008 using the Virtec straight stem were included. The cumulative incidence for re-revision was calculated using a competing risk model. Risk factors for re-revision of the stem were analyzed using an absolute risk regression model. Radiographs analyzed for osteolysis, debonding and subsidence had a minimum follow-up of 10 years. RESULTS: The cumulative incidence for re-revision due to aseptic loosening of the stem was 5.5% (95% CI, 2.9-10.2%) at 10 years. Aseptic loosening was associated with younger age, larger defect size and larger stem size. After a minimum 10-year follow-up, osteolysis was seen in 39 of 80 revision THA. Compared to the results in primary THA, the survival in revision THA with the same implant was inferior. CONCLUSIONS: Cemented straight stems used for revision THA showed excellent long-term results regarding survivorship and radiological outcome. This stem therefore offers a valuable and cost-effective option in revision THA.

Bone SPECT/CT in Advanced Diffuse Tenosynovial Giant Cell Tumor of the Wrist.

ABSTRACT: Tenosynovial giant cell tumor, previously known as pigmented villonodular synovitis, is a benign low-grade fibrohistiocytic proliferation with hemosiderin deposits in synovial joints. Mostly affecting the knee, it can also manifest in other synovial joints, infrequently also in the wrist. Tenosynovial giant cell tumor typically causes intense radionuclide uptake in all phases in planar bone scintigraphy, making a differentiation from other bone tumors or osteomyelitis difficult, especially in cases associated with extensive bone destruction. We present a case of an unusually advanced and extended tenosynovial giant cell tumor of the wrist in bone scintigraphy, SPECT/CT, radiograph, and MRI.

Surgical intervention for carpal tunnel syndrome in individuals with spinal cord injuries-patient characteristics, diagnostic considerations, and treatment outcomes.

STUDY DESIGN: A retrospective chart audit. OBJECTIVES: To characterize SCI patients with carpal tunnel syndrome (CTS) and evaluate the diagnostic rationale for surgical decision-making. SETTING: Swiss Paraplegic Centre, Nottwil, Switzerland. METHODS: Retrospective investigation of medical history, diagnostics, surgeries, and outcomes of surgical treatments of CTS in patients with para- and tetraplegia. RESULTS: We identified a total of 77 surgeries for CTS in 55 patients: 16 females (25 surgeries) and 39 males (52 surgeries) with spinal cord injury. The majority (47 persons, 68 surgeries) were paraplegic (level of lesion Th2 and below); 8 persons (9 surgeries) were tetraplegic (level of lesion Th1 and above). ASIA scores in the tetraplegic group were A: 0, B: 1, C: 4, D: 3 while complete lesions predominated in the paraplegic group (A: 32, B: 4, C: 5, D: 6). Sixty-six out of 77 patients reported total relief of symptoms. Neither nerve conduction velocity nor motor amplitude correlated well with the severity of CTS. Co-morbidity and specific risk factors were rare. CONCLUSIONS: SCI patients with CTS respond well to surgical decompression of median nerve regardless of level and type of spinal cord lesion and risk factors. Nerve conduction parameters and clinical findings can provide additional diagnostic support of CTS although nocturnal hand paresthesia, wrist pain at and after loading as well as failed conservative treatment are the main indications for surgical interventions. Based on symptomatology, clinical findings, and nerve conduction studies, we propose a decision-making tree for suggesting surgery or not.