Evaluation of the SLAP Lesion Using a Low-field (0.2T) Magnetic Resonance System

PURPOSE: To evaluate the diagnostic capabilities of the low-field (0.2T) magnetic resonance (MR) system in the detection of the superior labrum anterior to posterior (SLAP) lesion. MATERIALS AND METHODS: One hundred fifty patients underwent magnetic resonance imaging of the shoulder over a 7-month period. Forty-six patients underwent arthroscopic surgery, and the surgical results were correlated with the findings of the MR imaging. Arthroscopic procedures were performed within a mean of 8 days after MR imaging. MR imaging of the shoulder was conducted as follows: shoulder coil; T1-weighted spin echo, coronal-oblique images; T2-weighted gradient echo, coronal-oblique and axial images; and T2-weighted spin echo, coronal-oblique and sagittal-oblique images. Prospectively, one radiologist interpreted the MR images. RESULTS: The results of surgery were as follows: SLAP II in 26 shoulders, SLAP III in 1 shoulder, SLAP IV in 1 shoulder, normal labrum in 6 shoulders. For SLAP lesions with a higher grade than type 2, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the low-field MRI were 85.7%, 55.5%, 75%, 71%, and 74%, respectively. CONCLUSION: There was relatively good agreement for the comparison of the MR results obtained using a low-field MR system with the surgical findings for identifying SLAP lesions.

Detection of Rib Fractures in Minor Chest Injuries: a Comparison between Ultrasonography and Radiography Performed on the Same Day

PURPOSE: We wished to compare the ability of ultrasonography and radiography performed on the same day to detect rib fractures in minor chest injuries. MATERIALS AND METHODS: Two hundred and fifteen patients with minor chest injuries were selected. Radiography and ultrasonography were performed on the same day with these patients. Chest wall pain was the only presenting symptom. Two radiologists performed ultrasonography. Fractures were identified by a disruption of the anterior margin of the rib and costal cartilage. The incidence and location of fractures and complications revealed by radiography and ultrasonography were compared. RESULTS: Radiographs revealed the presence of 70 rib fractures in 50 (23%) of 215 patients and ultrasonography revealed the presence of 203 rib fractures in 133 (62%) of 215 patients. Ultrasonography uniquely identified 133 rib fractures in 83 patients. Ultrasonography identified a 2.9 fold increase in the number of fractures in a 2.6 fold number of subjects as compared to radiography. Of the 203 sonographically detected fractures, 201 were located in the rib, one was located at the costochondral junction, and one in the costal cartilage. There were no complications seen by either radiography or ultrasonography. CONCLUSION: Ultrasonography reveals more fractures than those that may be overlooked on radiography for minor chest injuries.

Disturbance of Toe Walking in Mid-lumbar Spinal Stenosis: Three Cases Report / 대한척추외과학회지

We report three cases of toe walking disturbance due to mid-lumbar spinal canal stenosis, which is a condition rarely reported in the literature. A severe bilateral S1 root lesion, associated with spinal stenosis at L3-4, is described. The diagnosis was obtained using computed tomography myelography (CTM) and magnetic resonance imaging (MRI). The findings at L5-S1 were minimal, and did not justify the patients clinical symptoms (disturbance of toe walking), but a detailed radiological evaluation revealed severe spinal stenosis at L3-4, which was assumed to be the cause of the S1 nerve root compression. A decompressive laminectomy, posterolateral fusion and posterior stabilization were performed. The pain and claudication had disappeared at the last follow-up evaluation, but the clinical symptom associated with the S1 root (toe walking) had not recovered.

Total Hip Arthroplasty after Fracture of the Acetabulum / 대한정형외과학회잡지

Displaced acetabular fractures have given rise to difficulty to the management, It has been unique diagnostic and operative challanges for the surgeon. We made a retrospective study of hip arthroplasty in fourteen patients who had a history of previous acetabular fracture. The most of patients was sutfered from traumatic osteoarthritis, We performed two bipolar hemiarthroplasty, eleven non-cement cup and one case Charnley cup replacement were done. The purpose of this stady was to determine the outcome long-term cup. The clinical results showed that pain was most improved at foliow-up, but the incidence of radiographic loosening and revisions were higher 42.8% within 10 years. We conclude that a history of prior acetahular fracture has a significant adverse impact on the long term out come of acetabular cup in total hip arthroplasty.

The Significance of Space Available for the Spinal cord at the Injured Level in the Lower Cervical Spine Fractures and Dislocations / 대한정형외과학회잡지

PURPOSE: To evaluate the degree of injury of the spinal cord in relation with the space available for the spinal cord at the level of injury, the sagittal diameter of the spinal canal at the uninjured levels, and the Pavlov ratio at the uninjured levels in fractures and dislocations of the lower cervical spine. MATERIALS AND METHODS: We retrospectively reviewed the records and radiographs of patients who had sustained an acute fracture or dislocation of the cervical spine from 1990 to 1995. We collected patients from Orthopedic and Neurosurgical department of Chonbuk University Hospital and at Orthopedic department of Presbyterian Medical Center. Of the 69 patients analyzed, twelve had no neurological deficit, eleven had an isolated nerve-root injury, twenty-two had an incomplete injury of the spinal cord, and twenty-four had a complete injury. We measured above three parameters from the plain lateral radiographs and assessed the difference by one-way ANOVA and unpaired t-test. RESULTS: 1. The mean space available for the spinal cord at the level of injury was 12.9 millimeter for the complete injury of the spinal cord,13.8 millimeter for the incomplete injury, 14.7 millimeter for an isolated nerve-root injury, and 15.7 millimeter for no neurological deficit group. The overall difference among the groups was significant (F=6.98, P=0.0004). The patients who had a complete injury of the spinal cord and those who had an incomplete injury of the spinal cord were significantly different from the patients who had an isolated nerve-root injury and those who had no neurologic deficit (P=0.002). 2. The mean sagittal diameter of the canal at the proximal and distal uninjured level was 14.3 and 14.6 millimeter for the complete injury of the spinal cord, 14.9 and 14.9 millimeter for the incomplete injury, 15.5 and 16.6 millimeter for an isolated nerve-root injury, and 16.9 and 16.5 millimeter for no neurological deficit group. The patients who had a complete injury of the spinal cord and those who had an incomplete injury of the spinal cord were significantly different from the patients who had an isolated nerve-root injury and those who had no neurologic deficit (P=0.001). 3. The mean Pavlov ratio at the proximal and distal uninjured level was 0.90 and 0.86 for no neurologic deficit group, 0.85 and 0.87 for an isolated nerve-root injury, 0.76 and 0.75 for the incomplete injury of the spinal cord, and 0.76 and 0.76 for the complete injury. The patients who had a complete injury of the spinal cord and those who had an incomplete injury of the spinal cord were significantly different from the patients who had an isolated nerve-root injury and those who had no neurologic deficit (P=0.001). CONCLUSIONS: The patients who sustained a permanent injury of the cord usually had had a narrower sagittal diameter (<14mm) and a lower Pavlov ratio (<0.80) of the spinal canal before injury. Patients who had a large sagittal diameter of the canal may be more likely to be spared a permanent injury of the spinal cord following a fracture or dislocation of the cervical spine compared with patients who have a narrow canal. These findings demonstrated that the severity of the injury of the spinal cord was in part associated with the space available for the cord (at risk:<13mm) after the injury, as measured on plain lateral radiographs.

Salmonella Spondylitis on Thoracic Spine: A Case Report / 대한정형외과학회잡지

We report a case of bacteriologically proven salmonella infection on the thoracic vertebra in a patient with previous history of pulmonary tuberculosis, in the non-endemic area with no history of sickle cell disease and typhoid fever. A forty-three years old female patient was admitted because of severe back pain, chest pain, lower extremity weakness and intermittent high fever elevation. On plain X-ray there was narrowing of T11-12 disc space with adjacent vertebral body destruction localized centrally around the disc and paravertebral abscess. She had an old history of pulmonary tuberculosis and treated with antituberculosis medication twenty years ago. We treated this patient by abscess drainage, anterior curettage and iliac corticocancellous strut bone graft over the T11 to T12 by anterior transthoracic approach. Histopathological diagnosis was chronic vertebral osteomyelitis with chronic inflammatory reaction. Pus culture reported to have grown salmonella typhi group D, sensitive to ampicillin, chloramphenicol, gentamicin and tetracycline. We could establish the diagnosis and effectively treat the disease with early surgical intervention.