Comparison of 4 computed tomographic imaging protocols for lateral tibial plateau fractures.

OBJECTIVE: Many computed tomographic (CT) imaging protocols are used for pretreatment assessment of tibial plateau fractures. This study compares the diagnostic capabilities of 4 CT protocols. METHODS: Lateral tibial plateau fractures were induced in 19 knee specimens and CT scans were obtained with the following protocols: 1) 3-mm collimation, axial acquisition, 2) 3-mm collimation, helical acquisition, 3) mixed-increment collimation, axial acquisition, and 4) 3-mm collimation, helical acquisition with 50% overlap reconstruction of raw data. Two-dimensional coronal and sagittal reformations and 3-dimensional surface reconstruction images were analyzed for maximum fragment depression, peripheral fragment displacement, fracture pattern classification and quality of image. Specimen dissection established maximal articular surface depression, fragment displacement and actual fracture pattern. RESULTS: None of the 2-dimensional reformations from the 4 protocols proved statistically superior for determining maximal fracture depression, fragment displacement, or fracture classification. There was a trend toward more accurate fracture classification with the mixed-increment axial protocol and the overlap protocol than either of the 3-mm protocols, but this was not statistically significant. All protocols were statistically equivalent in predicting fracture pattern classification using 3-dimensional images. However, the 3-dimensional images were of significantly higher quality when obtained with either the mixed-increment axial protocol or the overlap protocol. CONCLUSIONS: There were no statistically significant differences in the objective assessment of tibial plateau fractures among the 4 different protocols. The 3-dimensional images derived from the mixed-increment axial protocol and the 3-mm helical protocol with 50% overlap reconstruction were of superior quality.

Radiologic case study. Fractures of the foot masquerading as ankle injuries.

An ankle radiographic series frequently is obtained when a patient presents with an acute ankle and foot injury. Although many fractures are confined to the ankle and are readily apparent, fractures of the foot can mimic ankle injuries. It is important to differentiate these fractures of the foot from the more common ankle sprain. Most ankle sprains are treated with ice, compression, and elevation, followed by range-of-motion exercises and progressive weight bearing as tolerated. When foot fractures are not identified, however, lack of appropriate treatment can result in late complications. Concentration on key areas as described here will reduce the incidence of missed fractures of the foot in these patients.

Tibial segmental defect repair: chondrogenesis and biomechanical strength modulated by basic fibroblast growth factor.

BACKGROUND: The effect of recombinant human basic fibroblast growth factor (bFGF) on cartilage development and bone biomechanical strength during healing of a tibial segmental defect was studied in the rat. Two reports on the effect of basic FGF administration during fracture healing and several reports on the effects of acidic FGF have documented different responses of callus cartilage to this important growth factor. This is the first report of the effect of bFGF on cartilage formation in the healing of a grafted segmental defect in the rat. METHODS: The tibiae of 80 male rats underwent segmental resection of the mid-diaphyseal region. One-half of this group consisted of controls that received insertion of an intramedullary wire with a coralline hydroxyapatite graft and Gelfoam without bFGF. The tibiae of the other half were treated identically but had the Gelfoam impregnated with 1 microgram bFGF. Animals were killed at 2, 4, and 8 weeks postoperatively. Histological sections were stained with toluidine blue to differentiate the cartilage. Areas of metachromatically stained extracellular matrix, cell areas, cell size, and cellularity were quantified by using image analysis. Unfixed treated and control tibiae were tested for bone failure strength by using four-point bending on an Instron machine. RESULTS: Control bone failure strength was significantly greater than bFGF-treated bones at 2 weeks and energy-to-failure was significantly decreased in treated bones at 2 weeks. Although strength increased with time in all groups, treated groups at 4 and 8 weeks did not differ from controls. Basic FGF treatment promoted an increase in the development of normal hyaline cartilage and vasculogenesis at 2 weeks as compared with controls. Total cartilage declined over time in all groups. Average cell size and cell number did not change with either treatment or time. Bone formation and healing was equivalent in treated and control groups at 8 weeks. CONCLUSIONS: The results indicate that bFGF released directly and initially but not continuously exerts a transient positive effect on hyaline cartilage formation at the expense of repair site strength and does not accelerate healing.

Lisfranc dislocation and associated metatarsophalangeal joint dislocations. A case report and literature review.

A case report of a 28-year-old man with associated dislocations of the tarsometatarsal (Lisfranc) and metatarsophalangeal joints is presented. The potential for disability after these injuries is very high when the diagnosis or treatment is delayed, the reduction is incomplete, or the dislocation recurs. Relevant aspects of diagnosis and treatment are discussed.

Inserting distal screws into interlocking IM nails--revisited. Methods to make it easier.

Inserting distal screws freehand is a difficult but necessary part of many intramedullary roddings. In the June 1992 issue of Orthopaedic Review, Edward Yang described an excellent protocol for performing this part of the procedure. Here, we describe more tips to make it easier and to prevent or correct problems.

A comparative study of clinical muscle testing and Cybex evaluation after shoulder operations.

One hundred consecutive patients treated with shoulder surgery were studied to determine their functional recovery. Their average age was 47.3 years, and the average follow-up period was ten months. Clinical grading of muscle strength was compared pre- and postoperatively with objective testing using the Cybex II Isokinetic System, with subjective functional assessment by dictation, and with the ability of the patient to return to work. The clinical grade of muscle strength increased postoperatively by approximately one-half of a grade in both forward flexion and external rotation. However, various Cybex parameters did not significantly improve. The postoperative values were significantly less for the operated side than for the uninvolved side. Only weak statistical correlations were found between the clinical muscle grading and objective Cybex evaluation. Pain relief was obtained in 87% of the patients. Eighty-six percent of the patients returned to work, although 43% returned to light duty only. Thirty-two percent of patients reported full recovery, while 58% had decreased but satisfactory function. The study showed that although the clinical assessment of muscle strength improved early after shoulder surgery, the clinical grading of muscle power did not correlate well with objective parameters of strength, endurance, ability to work, or functional assessment. Strength did not recover to the level of the uninvolved opposite shoulder. Endurance, which is not measured by clinical grading, may decrease. Longer follow-up and rehabilitation periods are required to optimize results.

Late flexor pollicis longus tendon rupture due to retained glass fragments.

A retained glass fragment caused a flexor pollicis longus tendon rupture 23 years after the patient's initial injury. A review of the literature shows that although previous cases of delayed damage from retained objects have been reported, this is the first report of a tendon injury that was preceded by such a long asymptomatic period. The lesion was treated with a flexor digitorum superficialis tendon transfer from the ring finger with excellent functional results.