Ultrasonography of rotator cuff tears.

This is a prospective study of ultrasonography of the rotator cuff mechanism as an alternative to arthrography for screening rotator cuff tears. Seventy-two patients (40 men and 32 women) with possible rotator cuff tears were referred for shoulder arthrography. Before arthrography, bilateral shoulder sonography was performed by a technician under the direction of a radiologist. Arthrograms and sonograms were read separately, and a decision as to the absence or presence of a rotator cuff tear was made without knowledge of the results of the other examination. The results showed 90% sensitivity and 91% specificity, with a positive accuracy of 87%, and a negative accuracy of 93%. Ultrasonography of the rotator cuff is a noninvasive, painless, and cost-effective screening method for patients with a suspected rotator cuff tear.

Occult central acetabular fracture resulting in fracture-dislocation. A case report.

A 71-year-old white female experienced a nondisplaced right central acetabular fracture in a motor vehicle accident. Despite anteroposterior (AP) roentgenograms of the pelvis, Judet views, and plain tomograms, no fracture was detected. These negative findings did not entirely explain the continued presence of pain. The patient was treated with physical therapy and encouraged to bear weight on the leg as tolerated. The fracture then progressed to a central fracture dislocation readily apparent on AP views of the pelvis. This case illustrates the need for further diagnostic studies (bone scanning, computed tomography, and magnetic resonance imaging) when, despite negative objective findings, a high degree of suspicion persists.

Magnetic resonance imaging and contrast CT of the lumbar spine. Comparison of diagnostic methods and correlation with surgical findings.

Thirty-two patients with suspected lumbar disc herniation were studied with magnetic resonance imaging (MRI) and contrast computed tomography (CT). One hundred disc levels were evaluated. Twenty-five patients underwent surgery on 31 discs, allowing anatomic confirmation of the diagnosis. Surgical findings supported the MRI diagnosis at 28 of 31 levels (90.3% accuracy), whereas the CT diagnosis correctly reflected only 24 of 31 levels (77.4% accuracy). Discrepancy between MRI and CT interpretation occurred at ten levels that were surgically explored. Computed tomography (CT) was incorrect at seven levels, and MRI was in error at three levels. The sensitivity of MRI was 91.7%, compared with 83.3% for CT, and the MRI specificity of 100% was superior to 71.4% for CT. This study demonstrates the clinical superiority of surface coil MRI over contrast CT in the evaluation of lumbar disc herniation. Surface coil MRI can be used as the initial diagnostic procedure for a suspected herniated lumbar disc, using invasive contrast studies and CT, if required, to clarify an equivocal MRI finding.

Tibial fractures treated with pins and plaster.

The use of transfixing pins incorporated into a plaster cast has been considered a relatively risk-free treatment for tibial fractures. Reviews of this treatment report high union and low complication rates. This paper reports a retrospective review of 42 tibial fractures treated with pins and plaster, with a minimum follow-up of two years. We found a significant rate of nonunion, delayed union, malunion, and secondary surgical procedures. Local complications attributable to the use of pins were also present in this study. Based on our findings, we recommend the following: (1) accurate anatomic reduction (minimal displacement is acceptable but no distraction), (2) early weight bearing, (3) pin removal at six to eight weeks, and (4) limitation of pin-and-plaster treatment to low-energy fractures when the reduction cannot be held by casting.

Pseudomalignant tumor after biopsy of periostitis.

Periosteal reaction is a commonly encountered radiographic finding. Differential diagnoses include trauma, infection, and neoplasia. Biopsy may be necessary for the definitive diagnosis. Surgical trauma to an inflamed periosteum can stimulate a rapid and tremendous bone-forming response.

Incidence and natural history of "head at risk" factors in Perthes' disease.

Twenty-eight cases of Perthes' disease were evaluated roentgenographically a minimum of 4 years after diagnosis (range, 4-17 years). The original roentgenograms were examined to see if a prognosis was possible of the final result on the basis of: (1) "head at risk" factors, or (2) Catterall's degree of epiphyseal involvement. Five "head at risk" factors more accurately predicted the course of Perthes' disease than Catterall's degree of epiphyseal involvement. The latter may change as the disease progresses. There is a definite decreasing incidence of a good radiological result with an increasing number of risk factors. The 5 risk factors are: Gage's sign; lateral subluxation; calcification lateral to the epiphysis; diffuse metaphyseal reaction and a transverse epiphyseal plate. The ability to predict the probable course of the disease and the final result should allow early institution of a more rational treatment program.

Management of penetrating injuries of the knee.

One hundred and two patients with 121 known or suspected penetrating wounds of the knee demonstrated that successful results are dependent upon early diagnosis and surgical treatment. The willingness to act immediately on the basis of clinical judgment alone is important in order to avoid irreparable damage damage to the joint. The knee should be debrided and thoroughly irrigated. The menisci, articular cartilage and bony stock should be preserved as much as possible. The joint and skin are left open. If joint surfaces are damaged or infection is grossly purulent, the synovium is also left open. The dressing is dry fluff gauze, and a Jones compression dressing which allows drainage and prevents fluid accumulation. Early active mobilization of the joint is important.