Sonoelastography of the Common Flexor Tendon of the Elbow with Histologic Agreement: A Cadaveric Study.

Purpose To determine the correlation of the results of conventional B-mode ultrasonography (US) and compression sonoelastography with histologic results in common flexor tendons of the elbow in human cadavers. Materials and Methods Twenty-five common flexor tendons were evaluated in 16 fresh, unembalmed cadavers of 11 women with a median age of 85 years (range, 71-101 years) and five men with a median age of 78 years (range, 70-88 years). Informed consent was provided according to the last will of the donors. B-mode US results were classified as grade 1, normal tendon with homogeneous fibrillar pattern; grade 2, tendon thickening or hypoechoic areas and/or calcifications in less than 30% of the tendon; or grade 3, hypoechoic areas and/or calcifications greater than 30% of the tendon. Sonoelastographic results were grade 1, blue (hardest) to green (hard); grade 2, yellow (soft); and grade 3, red (softest). The intraclass correlation coefficient was calculated to determine agreement with histologic findings for each B-mode US, sonoelastographic, and combined B-mode US and sonoelastographic examination. Histologic results were grade 1, normal, with parallel fibrillar pattern; grade 2, mild tendinopathy, with cellular infiltration, angiogenesis, or fatty vacuoles; or grade 3, severe tendinopathy, with loss of parallel collagen structure and necrosis. Results Histologic alterations were detected in 44% (11 of 25) of biopsy specimens. Intraclass correlation with histologic results was 0.57 for B-mode US, 0.68 for sonoelastography, and 0.84 for the combination of the two approaches. Conclusion The addition of sonoelastography to B-mode US provided statistically significant improvement in correlation with histologic results compared with the use of B-mode US alone (P \u3c .02). (©) RSNA, 2016 Online supplemental material is available for this article

Normalverlauf der Bandscheibendegeneration an der Lendenwirbelsäule in der Magnetresonanztomographie bei beschwerdefreien Patienten

Magnetresonanztomographische Untersuchung an 300 beschwerdefreien Probanden. Hierbei wurde die Signalintensitätsminderung, die Formveränderung der Bandscheibe sowie vorliegende Sequester und Stenosen und desweiteren die Rückenform untersucht. Fazit: Es wurde eine Altersabhängigkeit und eine Abhängigkeit der Segmenthöhe hinsichtlich der Bandscheibendegeneration heraus gefunden

Anterior thoracolumbar column reconstruction with the vertebral body stent-safety and efficacy.

PURPOSE The aim of this study was to assess safety and efficacy of vertebral body stenting (VBS) by analyzing (1) radiographic outcome, (2) clinical outcome, and (3) perioperative complications in patients with vertebral compression fractures treated with VBS at minimum 6-month follow-up. METHODS In this retrospective cohort study, 78 patients (61 ± 14 [21-90] years; 67% female) who have received a vertebral body stent due to a traumatic, osteoporotic or metastatic thoracolumbar compression fracture at our hospital between 2012 and 2020 were included. Median follow-up was 0.9 years with a minimum follow-up of 6 months. Radiographic and clinical outcome was analyzed directly, 6 weeks, 12 weeks, 6 months postoperatively, and at last follow-up. RESULTS Anterior vertebral body height of all patients improved significantly by mean 6.2 ± 4.8 mm directly postoperatively (p < 0.0001) and remained at 4.3 ± 5.1 mm at last follow-up compared to preoperatively (p < 0.0001). The fracture kyphosis angle of all patients improved significantly by mean 5.8 ± 6.9 degrees directly postoperatively (p < 0.0001) and remained at mean 4.9 ± 6.9 degrees at last follow-up compared to preoperatively (p < 0.0001). The segmental kyphosis angle of all patients improved significantly by mean 7.1 ± 7.6 degrees directly postoperatively (p < 0.0001) and remained at mean 2.8 ± 7.8 degrees at last follow-up compared to preoperatively (p = 0.03). Back pain was ameliorated from a preoperative median Numeric Rating Scale value of 6.5 to 3.0 directly postoperatively and further bettered to 1.0 six months postoperatively (p = 0.0001). Revision surgery was required in one patient after 0.4 years. CONCLUSION Vertebral body stenting is a safe and effective treatment option for osteoporotic, traumatic and metastatic compression fractures

Transoral unilateral lag screw osteosynthesis for coronal split fracture of the lateral mass of the atlas – case report, operative technique and review of the literature

Introduction: Atlas ring fractures, which account for 1.3% of all spinal fractures, are predominantly managed conservatively. However, in certain cases, surgical treatment may be necessary depending on the type of fracture, degree of comminution, fracture location, and associated ligamentous injuries. Surgical stabilization frequently results in a posterior C1-2 or C0-2 fusion, which restricts movement, particularly craniocervical rotation. Coronal split fractures of the lateral mass need to be reduced and fixed due to dislocation, instability and secondary osteoarthritis. The preferred treatment approach involves internal fixation of the reduced fracture fragments, while avoiding restriction of the upper cervical spine's range of motion (ROM). Research question: Is unilateral anterior transoral lag screw for treatment of unstable coronal split fracture of lateral mass of the atlas feasible and a safe treatment option? Case Report: Material and Methods: We report on a 55-year-old female suffering from polytrauma with multiple spinal and extremity injuries. Results: A coronal split fracture of the lateral mass of the atlas was treated minimally invasive with a transoral lag screw technique to reduce and fix the fracture that has a tendency for fracture gap widening. Stable fixation and fracture union and thus restoration of function was achieved. Discussion and conclusion: Transoral lag screw osteosynthesis for coronal split fracture of the lateral mass of the atlas is a potential treatment option in selected cases to preserve mobility in the upper cervical spine after spinal trauma

Open Reduction and Screw Fixation of a Diastatic Bipartite Hallux Sesamoid in Turf Toe Injury: A Case Report

We present a case of a 25-year-old male professional soccer player who complained of severe pain over the first metatarsal head after opponent contact during a soccer game. Clinical findings showed swelling and tenderness. Initial radiographs showed a diastasis of a bipartite medial sesamoid between the fragments as compared to radiographs taken 4 years earlier of the same foot. A computed tomography scan was performed objectifying the widened interval and also showing an angulation of the proximal fragment. Open reduction and screw fixation were performed, leading to adequate positioning of the 2 bipartite fragments. The patient showed good clinical recovery and returned to the same performance level. Turf toe injury with diastasis of a medial bipartite sesamoid can be treated successfully with this operative technique. Levels of Evidence: Level V: Case report </jats:p

Thermic effect on metal body piercing by electro-coagulation: An ex vivo study on pig skin and bovine liver.

BACKGROUND Piercings are placed at different body sites often invisible to medical staff. They may cause additional injuries in trauma and emergency surgery by electro-cautery. OBJECTIVE To clarify whether electro-coagulation will have a direct damaging effect to the skin around a pierced skin area. METHODS Metallic piercings were fixed at defined distances from the neutral and active electrode on abdominal pig skin. The distance of the active electrode was reduced by 5 mm increments to 0. The respective increases in temperature were determined with a thermal camera. A macroscopic and histological analysis of the area around the piercing to detect thermal damage was carried out. RESULTS Significant increases in temperature and visible changes in the tissue around the piercing only occurred when the active electrode was in direct contact with the piercing (increase of 47.3∘C). Electro-cautery in distance of 5 to 10 mm to the piercing showed only temperature increases of less than 5∘C. CONCLUSIONS If metallic piercings are not directly touched by the active electrode and the distance is more than 5-10 mm, no clinically relevant effect is created on the tissue in direct proximity to the piercings by electro-cautery. In an emergency surgery situation, a piercing not fixed in direct proximity to the surgical field may likely be ignored