Acute Shoulder Injury.

Acute shoulder injury is commonly encountered by clinicians, surgeons, and radiologists. A comprehensive evaluation of the shoulder by the radiologist is essential to accurately relay findings that have a direct impact on acute and long-term management. In this review, imaging features of acute injuries involving the proximal humerus, glenohumeral joint, rotator cuff, tendon of the long head of the biceps brachii, and acromioclavicular joint are discussed. Modalities include ultrasound examination, conventional radiography, computed tomography scans, and MR imaging. Emphasis is placed on radiographic features that have an impact on patient management.

Filler Migration and Granuloma Formation After Gluteal Augmentation with Free-silicone Injections.

Gluteal augmentation may be performed using a variety of techniques, including implant-based, autologous fat grafting, local flaps, impermanent filler injection, or, as in this case, by way of permanent filler injection with free-silicone. Of these, free-silicone injections carry one of the highest complication rates, specifically regarding migration of the filler material from the native injection site and induction of painful reactive soft tissue changes at the new filler location. A radiologist providing this diagnosis may assist the clinician, who often cannot obtain a history of illicit silicone injection for gluteal augmentation unless the suspicion is raised. Presented here is a case of painful filler migration to the knee with granuloma formation after free-silicone gluteal injection.

Levels of Evidence in the Journal of Pediatric Orthopaedics: Update and Comparison to the Journal of Bone and Joint Surgery.

BACKGROUND: Periodic review of the published research in pediatric orthopaedics is helpful to evaluate the state of scientific methodology. The purpose of this paper was to review the levels of evidence (LOE) and types of evidence (TOE) published in the Journal of Pediatric Orthopaedics (JPO) from 2009 to 2013 and to compare the percentage of articles with each LOE to pediatric orthopaedic articles published in the Journal of Bone and Joint Surgery-American Volume (JBJS) during the same time. METHODS: All articles published in JPO from January 1, 2009, to December 31, 2013, were reviewed. Articles were classified as scientific studies, case reports, commentaries/letters to editor, reviews, expert opinion, and basic science articles. All scientific articles in the pediatrics section of the online version of JBJS were reviewed. If listed, the LOE was recorded from all clinical scientific studies. In addition, articles were abstracted for self-reported TOE (therapeutic, diagnostic, prognostic, or economic analysis). RESULTS: We found 850 citations in JPO over the study period; 646 (76%) were identified as scientific articles and, of those, 552 (85%) had a LOE listed. There were 18 level I articles (3%), 101 level II (18%), 184 level III (34%), and 289 level IV (45%). The TOE was listed in 213 (39%) articles: 114 (54%) therapeutic, 37 (17%) prognostic, 55 diagnostic (26%), and 7 (3%) economic analysis. Comparing 2009 to 2013, the percentage of scientific studies with a self-reported LOE improved significantly (from 81% to 93%, P=0.001). Compared with JPO, JBJS had a significantly higher rate of level I (12% vs. 3%, P=0.006) and a significantly lower rate of level III (23% vs. 34%, P=0.01) articles. CONCLUSION: From 2009 to 2013, 3% of articles in JPO were level I. Significantly more articles are now including a level of evidence designation. Approximately half of published studies are level IV, and most are therapeutic type. A higher percentage of level I studies were published in JBJS during the same time period.