Vertical or horizontal orientation of foot radiographs does not affect image interpretation.

This study determined whether the orientation of dorsoplantar and oblique foot radiographs has an effect on radiograph interpretation. A test set of 50 consecutive foot radiographs were selected (25 with fractures, and 25 normal), and duplicated in the horizontal orientation. The images were randomly arranged, numbered 1 through 100, and analysed by six image interpreters. Vertical and horizontal area under the ROC curve, accuracy, sensitivity and specificity were calculated for each image interpreter. There was no significant difference in the area under the ROC curve, accuracy, sensitivity or specificity of image interpretation between images viewed in the vertical or horizontal orientation. While conventions for display of radiographs may help to improve the development of an efficient visual search strategy in trainees, and allow for standardisation of publication of radiographic images, variation from the convention in clinical practice does not appear to affect the sensitivity or specificity of image interpretation.

Combined syringe cement pressurisation and intra-osseous suction: an effective technique in total knee arthroplasty.

Our study looked at the short and medium-term results of a cost-effective technique of bone surface preparation and cement introduction in total knee arthroplasty (TKA). Numerous factors determine the outcome following TKA. Early failure and component loosening have been attributed to inadequate bone-cement and prosthesis-cement interfaces, established at the time of surgery. Various operative techniques have been reported to achieve effective cement penetration and inter-digitation into cancellous bone, with techniques of cement pressurization and intra-osseous suction being employed. We have devised a technique of cement pressurization using a modified standard 20 ml syringe, combined with intra-osseous suction. Retrospective evaluation of a series of 50 post-operative radiographs has shown that effective and even penetration of cement to a depth of 8.0 to 10.6 mm can be achieved consistently with this technique, during TKA, without the use of tourniquet. In addition evaluation of post-operative plain radiographs with minimum follow-up of 5 years showed 16 knees with minor, non-progressive lucent lines around the tibial component with a maximum Knee Society TKA Roentgenographic score of 2. To conclude we propose that this simple technique of surface preparation and cement introduction produces good results in the short and medium-term.

Spontaneous bilateral carotid and vertebral artery dissections associated with multiple disparate intracranial aneurysms, subarachnoid hemorrhage and spontaneous resolution. Case report and literature review.

Spontaneous bilateral carotid and vertebral artery dissections (CADs and VADs) are rare. A 29-year-old female presented with a collapse, 4 weeks after a sudden onset of severe neck and shoulder pain. CT scan revealed diffuse subarachnoid hemorrhage (SAH) and early hydrocephalus. Angiography revealed bilateral CADs and VADs, along with multiple fusiform and saccular aneurysms. Systemic vessels - including the renal arteries - were normal, and no risk factors or underlying vasculopathy were apparent. The presumed source of SAH (a posterior cerebral artery aneurysm) was successfully clipped. Each dissection, by contrast, was managed conservatively with heparin prophylaxis; and spontaneous CAD and VAD resolution occurred within 6 months. We present a unique case of four-vessel dissection associated with multiple disparate saccular and fusiform aneurysms. We suspect that underlying vasculopathy - perhaps novel - may become apparent with time.