Rotura traumática simultánea y bilateral del tendón del cuádriceps en un paciente fisicoculturista: informe de caso y revisión de la literatura / Simultaneous bilateral traumatic quadriceps tendon rupture in a bodybuilding patient: case report and literature review

La rotura traumática, simultánea y bilateral del tendón cuadricipital es una lesión infrecuente, generalmente asociada a otras enfermedades sistémicas tales como insuficiencia renal o trastornos endocrinos. Presentamos el caso de un varón sano y atleta de 38 años que sufrió esta lesión mientras realizaba una sentadilla en el gimnasio. (AU)

The traumatic bilateral and simultaneous quadriceps tendon rupture is a rare injury, usually associated with other systemic diseases such as renal insufficiency or endocrine disorders. We present the case of a 38-year-old healthy male athlete who sustained this injury while performing a squat at the gym. (AU)

Tumor de células gigantes / Giant Cell Tumor

Introducción: El tumor de células gigantes continúa siendo uno de los tumores óseos con muchas controversias en su diagnóstico y manejo, por ortopédicos, radiólogos y patólogos. Objetivo: Enriquecer el diagnóstico de esta enfermedad desde el aporte de las técnicas de imagen. Presentación de caso: Paciente masculino de 33 años de edad, remitido a la consulta de Ortopedia por presentar un aumento de volumen en la rodilla de meses de evolución, que empeoró progresivamente hasta llegar a la impotencia funcional. Al examen físico se constata un marcado aumento del volumen por lo que se indican estudios de imagen. Conclusiones: El diagnóstico temprano ayuda a mejorar el estilo de vida de estos pacientes. El tratamiento quirúrgico es el más indicado en tumores de células gigantes, ya que logra buenos resultados tanto en el tratamiento del tumor primario como de las recidivas (AU)

Introduction: The giant cell tumor continues to be one of the bone tumors with many controversies in diagnosis and management, by orthopedists, radiologists and pathologists. Objective: To enrich the diagnosis of this disease from the contribution of imaging techniques. Casereport: We report the case of a 33-year-old male patient, referred to the Orthopedics consultation for presenting an increase in volume in his knee, with months of evolution, which progressively worsened until functional impotence. Physical examination showed a marked increase in volume, so imaging studies are indicated. Conclusions: Early diagnosis helps to improve the lifestyle of these patients. Surgical treatment is the most indicated in giant cell tumors, since it achieves good results both in the treatment of the primary tumor and recurrences(AU)

Radiographic Evaluation of Postoperative Alignment in Total Knee Arthroplasty / Avaliação radiográfica do alinhamento pós-operatório na artroplastia total de joelho

Abstract Objective To demonstrate the greater accuracy of panoramic radiographs of the lower limbs (long) in relation to short radiographs of the knee in the measurement of the mechanical axis of the lower limb after total knee arthroplasty (TKA). Methods A retrospective study was conducted to evaluate the accuracy of long and short postoperative radiographic images of 70 patients submitted to TKA in our service. The images were analyzed at random, at different times, by three orthopedists. In all images, the mechanical axis of the limb, femur and tibia were traced and femorotibial angles (FTAs) were calculated. The intraclass correlation coefficient (ICC) was calculated to evaluate the agreement of the measurement of the inter- and intra-observer mechanical axis. Results It was observed that there was high intra and interobserver agreement when panoramic radiographs were used, with minimum intra and interobserver ICC of 0.89, equivalent to a very strong agreement. On short radiographs in the anteroposterior incidence (AP) of the knee, the ICC showed moderate agreement, obtaining a maximum value of 0.75. Conclusion There is a significant difference in accuracy for the measurement of the mechanical axis of the lower limb, comparing long and short radiographs of the lower limb. Thus, for the proper measurement of the mechanical axis of the lower limb, we suggest the performance of long radiography in the postoperative period of TKA.

Resumo Objetivo Demonstrar a maior acurácia das radiografias panorâmicas de membros inferiores (longas) em relação às radiografias curtas do joelho na medida do eixo mecânico do membro inferior após a artroplastia total de joelho (ATJ). Métodos Foi realizado um estudo retrospectivo para avaliar a acurácia de imagens radiográficas longas e curtas pós-operatórias de 70 pacientes submetidos à ATJ em nosso serviço. As imagens foram analisadas ao acaso, em momentos distintos, por três ortopedistas. Em todas as imagens, o eixo mecânico do membro, do fêmur e da tíbia foram traçado,s e os ângulos femorotibiais (AFTs) foram calculados. O coeficiente de correlação intraclasse (CCI) foi calculado para avaliar a concordância da medida do eixo mecânico inter e intraobservador. Resultados Observou-se que houve alta concordância intra e interobservador quando utilizamos radiografias panorâmicas, apresentando CCI mínimo intrae interobservador de 0,89, equivalente a uma concordância fortíssima. Já nas radiografias curtas na incidência anteroposterior (AP) do joelho, o CCI mostrou-se com concordância moderada, obtendo valor máximo de 0,75. Conclusão Existe uma diferença significativa na acurácia para a medida do eixo mecânico do membro inferior, comparando-se radiografias longas e curtas do membro inferior. Assim, para a adequada mensuração do eixo mecânico do membro inferior, sugerimos a realização de radiografia longa no pós-operatório de ATJ.

Osteonecrosis bilateral de rodilla tratada con descompresión y concentrado de aspirado de médula ósea / Bilateral knee osteonecrosis with decompression and bone marrow concentrate

Descripta por Ahlbäck en 1968, la osteonecrosis de rodilla es una patología con un gran potencial de morbilidad. Está dividida en tres grandes grupos: primaria/espontánea, postoperatoria y secundaria/atraumática. Esta última podría estar directamente relacionada con el consumo prolongado de corticoides. Su tratamiento constituye un desafío para el cirujano ortopedista. Va a depender del estadio de la enfermedad y del colapso articular, y se intentará siempre preservar la superficie articular nativa. Dentro de las distintas opciones terapéuticas, las terapias biológicas constituyen una herramienta potencialmente valiosa como complemento al tratamiento quirúrgico, y muestran resultados clínicos esperanzadores. Presentamos el caso de una paciente con una osteonecrosis de rodilla bilateral, secundaria al consumo crónico de corticoides, tratada con una artroscopía bilateral asociada a perforaciones subcondrales descompresivas y aplicación subcondral de concentrado de médula ósea (CMO), con evolución satisfactoria de los síntomas a los treinta meses de seguimiento en la rodilla derecha, mientras que en la rodilla izquierda presentó una evolución tórpida de los síntomas a partir de los veinticuatro meses, por lo que está en plan de reemplazo articular.

Described by Ahlbäck in 1968, osteonecrosis of the knee is a pathology with great potential for morbidity. It is divided into three large groups: primary/spontaneous, postoperative, and secondary/atraumatic. The latter might be directly related to prolonged consumption of steroids. Its treatment is a challenge for the orthopedist. It will depend on the disease stage and articular collapse, always trying to preserve the native articular surface. Within the different therapeutic options, biological therapies are a potentially valuable tool as a complement to surgical treatment, showing encouraging clinical results. We present the case of a female patient with bilateral osteonecrosis of the knee, secondary to chronic consumption of steroids, treated with bilateral arthroscopy associated with decompressive subchondral perforations and subchondral application of bone marrow concentrate (BMC), with a satisfactory evolution of symptoms after thirty months of follow-up in the right knee. However, the left knee showed a torpid evolution of symptoms after twenty-four months of follow-up, so she is on a joint replacement plan

Assessing the racial differences in Q angle measurements in relevance to articular cartilage of the femoral condyle: a retrospective ultrasound study / Evaluación de las diferencias raciales en las mediciones del ángulo Q en relación con el cartílago articular del cóndilo femoral: un estudio ecográfico retrospectivo

SUMMARY: The Q-angle is defined as the acute angle formed by the vectors for combined pull of the quadriceps femoris muscle and the patellar tendon. This study aimed to investigate the variations in Q angle with respect to race. Moreover, this study performed ultrasound to evaluate of the thickness of articular cartilage covering the medial and lateral femoral condyle in volunteers with an increased Q angle. The study included 487 Jordanian and 402 Malaysians with age range 18-23 years. Moreover, the study included 30 participants aged between 18 and 22 years, with a total of 15 volunteers with Q >14° and 15 patients with Q ≤14°. Both Q angle and condylar distance were measured by well-trained medical practitioners according to a well-established protocol. The thickness of articular cartilage covering the medial and lateral femoral condyle of the femoral bone was measured using ultrasound. Regardless of race, Q angle was greater in females. Furthermore, Q angle was significantly greater in Arab volunteers compared to Malay volunteers. Q angle significantly increase with increasing condylar distance in both races. Finally, the statistical analysis showed a significantly reduced thickness of articular cartilage on both medial and lateral femoral condyle (P = 0.05) in the Q >14° group. Multiple factors including race and condylar distance and even the articular cartilage of femoral condyle should be considered during the examination and management of knee fractures and condylar diseases.

RESUMEN: El ángulo Q se define como el ángulo agudo formado por los vectores de tracción combinada del músculo cuádriceps femoral y el tendón patelar. Este estudio tuvo como objetivo investigar las variaciones en el ángulo Q con respecto a la raza. Además, se realizó una ecografía para evaluar el grosor del cartílago articular que cubre los cóndilos femorales medial y lateral en voluntarios con un ángulo Q aumentado. El estudio incluyó a 487 jordanos y 402 malayos con un rango de edad de 18 a 23 años. Además, el estudio incluyó a 30 participantes con edades comprendidas entre 18 y 22 años, 15 voluntarios con Q> 14 ° y 15 pacientes con Q ≤ 14 °. Tanto el ángulo Q como la distancia condilar fueron medidos por médicos bien entrenados de acuerdo con un protocolo establecido. El grosor del cartílago articular que cubre los cóndilos femorales medial y lateral del fémur se midió mediante ecografía. Independientemente del grupo racial, el ángulo Q fue mayor en las mujeres. Además, el ángulo Q fue significativamente mayor en los voluntarios árabes en comparación con los voluntarios malayos. El ángulo Q se aumenta significativamente al incrementarse la distancia condilar en ambas grupos raciales. Finalmente, el análisis estadístico mostró una reducción significativa del grosor del cartílago articular en los cóndilos femorales medial y lateral (P = 0,05) en el grupo Q> 14. Durante la exploración y el tratamiento de las fracturas de rodilla y de las enfermedades condilares, se deben considerar múltiples factores, incluida la raza y la distancia condilar e incluso el cartílago articular del cóndilo femoral.

Analytical study of clinicopathological data of Saudi patients with osteoarthritis subjected to total knee arthroplasty / Estudio analítico de datos clínico-patológicos de pacientes sauditas con osteoartritis sometidos a artroplastia total de rodilla

Knee osteoarthritis (OA) is a common disabling disease. Epidemiological studies have revealed various risk factors for OA, including sex, aging, obesity, occupational illnesses, and chronic diseases. Here we evaluate the clinical, pathological, and radiological findings of knee OA in a subset of Saudi patients who were subjected to total knee replacement (TKA). The study population included 30 Saudi patients with knee OA who were operated by TKA (from June 2014 to December 2015) in the Department of Orthopedics, Faculty of Medicine, King Abdulaziz University, Saudi Arabia. Patient's clinical and radiological data were collected from the hospital files. Pathological examination of the excised superior articular surface of tibia and femoral condyles were done. Pearson Chi-squared analysis was used to test for differences between the variables in associated risk factors. There were more women than men. Sixty per cent of patients were older than 60 years [mean age, 59.2 (females) and 61.7 (men) years-old]. All patients exceeded obesity class 1, with females being more obese than males. Pathological examination of the superior articular surface of tibia and femoral condyles showed high score lesions, which was more apparent in females than in males. Radiological findings showed that most lesions were high grade. The findings of this study will help to understand the pathogenesis of OA and improve treatment decision making relevant to TKA in knee OA in Saudi Arabia and elsewhere.

La artrosis de rodilla (OA, por sus siglas en inglés) es una enfermedad invalidante común. Los estudios epidemiológicos han revelado diversos factores de riesgo para la OA, que incluyen el sexo, el envejecimiento, la obesidad, las enfermedades profesionales y las enfermedades crónicas. Aquí evaluamos los hallazgos clínicos, patológicos y radiológicos de la OA de rodilla en un subconjunto de pacientes sauditas que fueron sometidos a reemplazo total de rodilla (RTR). La población de estudio incluyó a 30 pacientes saudíes con OA de rodilla que fueron operados por RTR (desde junio de 2014 hasta diciembre de 2015) en el Departamento de Ortopedia, Facultad de Medicina, King Abdulaziz University, Arabia Saudita. Los datos clínicos y radiológicos de los pacientes se obtuvieron de las fichas hospitalarias. Se realizó examen patológico de la superficie articular superior de la tibia extirpada y cóndilos femorales. Se utilizó el análisis Chi-cuadrado de Pearson para probar las diferencias entre las variables en los factores de riesgo asociados. El número de mujeres era mayor que los hombres. El 60 % de los pacientes eran mayores de 60 años [edad media, 59,2 (mujeres) y 61,7 (hombres) años]. Todos los pacientes superaron la obesidad clase 1, siendo las mujeres más obesas que los hombres. El examen patológico de la superficie articular superior de la tibia y los cóndilos femorales mostraron lesiones con puntaje alto, que fue más evidente en mujeres que en hombres. Los hallazgos radiológicos mostraron que la mayoría de las lesiones eran de alto grado. Los hallazgos de este estudio ayudarán a comprender la patogenia de la OA y mejorarán la toma de decisiones sobre el tratamiento relevante para el RTR en la OA de rodilla en Arabia Saudita y en otros lugares.

Presencia, localización y biometría de la fabela en individuos chilenos: estudio radiológico / Presence, location and biometry of the fabella in Chilean individuals: radiological study

RESUMEN: Entre los huesos sesamoideos del cuerpo humano, se encuentra la fabela, hueso asociado al tendón de la cabeza lateral del músculo gastrocnemio. El objetivo del presente estudio fue localizar a este hueso, ya unilateral o bilateral, en relación al género y grupos etarios, además de registrar su longitud y anchura. Se utilizó una muestra de radiografías de 200 personas, de ambos sexos, 44 de sexo masculino y 156 de sexo femenino, cuyas edades fluctuaron entre los 10 y los 90 años. Del total de casos (200 personas), la presencia de la fabela fue observada en 75 (37,5 %), de las cuales 9 (12 %) eran del sexo masculino y 66 (88 %) del femenino. Su mayor presencia se observó en las personas con edades entre los 51 y 60 años, en las cuales se presentaron en 25 casos (18 de sexo femenino) y entre los 61 y 70 años con 29 casos (27 de sexo femenino). Los datos obtenidos complementarán el conocimiento morfológico acerca de este hueso sesamoídeo en la población Chilena.

SUMMARY: Among the sesamoid bones of the human body is fabela, a bone associated with the tendon of the lateral head of the gastrocnemius muscle. The objective of the present study was to locate this bone, either unilateral or bilateral, in relation to gender and age groups, in addition to recording its length and width. A sample of radiographs of 200 people, of both sexes, 44 male and 156 female, whose ages ranged from 10 to 90 years were used. Of the total cases (200 people), the presence of fabela was observed in 75 (37.5%), of which 9 (12%) were male and 66 (88%) female. Their greatest presence was observed in people aged between 51 and 60 years, in which they occurred in 25 cases (18 females) and between 61 and 70 years with 29 cases (27 females). The data obtained will complement the morphological knowledge about this sesamoid bone in the Chilean population.

Rótula bicapa bilateral / Rotule à double couche bilatérale / Bilateral Double-Layered Patella

Se presenta un escolar masculino de 12 años de edad, talla de 155 cm y 45 kg de peso que es traído a consulta externa de Ortopedia y Traumatología por presentar discreto aumento de volumen doloroso en ambas rodillas, profundo, en cara posterior de la rótula al movilizarla y al presionar sobre ella (en flexión y en extensión). Aumenta al subir y bajar escaleras. Signo de la butaca positivo y sensación de crepitación o chasquido. Se realizan estudios imaginológicos que conjuntamente con el cuadro clínico permiten llegar al diagnóstico(AU)

We present a 12-year-old male schoolchild, 155 cm in height and weighing 45 kg, who is brought to the outpatient clinic of Orthopedics and Traumatology for presenting a discreet increase in painful volume in both knees. His pain is deep in the posterior face of the patella, when mobilizing and pressing (in flexion and extension). It increases when going up and down stairs. The sign of the armchair is positive and there is a crackling or clicking sensation. Imaging studies and the clinical exam endorsed diagnosis(AU)

Un écolier âgé de 12 ans, avec 155 cm de taille et 45 kg de poids, vu en consultation externe d'orthopédie et traumatologie pour légère augmentation du volume des deux genoux, avec douleur profonde si mobilité ou pression (en flexion et extension) au côté postérieur de la rotule, est présenté. La douleur augmente à la montée-descente des escaliers. Le signe du cinéma est positif, et il y a aussi une sensation de crépitation ou claquement. On fait des études d'imagerie permettant, conjointement avec l'examen clinique, de faire un diagnostic(AU)

Do you know this syndrome? Nail patela syndrome: a pathognomonic dermatologic finding

Abstract: The nail-patella syndrome involves a clinical tetrad of changes in the nails, knees, elbows and the presence of iliac horns. Nail changes are the most constant feature: absent, hypoplastic, or dystrophic. A pathognomonic finding is the presence of the triangular lunula. The diagnosis of nail-patella syndrome is based on clinical findings. In this paper we will discuss a case report of this syndrome and its relation with a dermatological finding.

audit to evaluate the image quality of magnetic resonance of knee at radiology department of a tertiary care hospital

Objective: To evaluate the quality of MRI scans of knee, performed at Radiology Department of Jinnah Hospital in the light of recommendations of ACR

Study Design: A clinical audit

Place and Duration of Study: Department of Radiology, Jinnah Hospital, Lahore, from August 2015 to February 2016

Methodology: Scans of 20 patients who underwent MRI of knee in August 2015 were studied retrospectively to assess the quality of images obtained in the first audit. Based on the findings of this audit, recommendations were made and re audit was done 6 months later in February 2016 to look for improvement in local practice

Results: In the first audit, images were acquired in all the three necessary planes and the sagittal and coronal images had appropriate slice thickness, interslice gap as well as adequate anatomical coverage in all the patients. However, FOV [field of view] was appropriately set in 66% of cases in axial plane, 5% in sagittal plane, and 0% in coronal plane. Also, the anatomical coverage was not upto the mark in axial plane with 13 studies [66%] having adequate superior coverage, and 16 cases [80%] having recommended inferior anatomical coverage. The re audit performed 6 months later showed improvement with 100% compliance to standards

Conclusion: The first audit showed many shortcomings in acquiring of MRI data in patients undergoing knee MRI with FOV requiring a decrease in all planes and anatomical coverage increase in axial plane. These recommendations were made in departmental meetings and re-audit was done after 6 months. This second audit showed 100 % compliance

Utilidad de la resonancia magnética en pacientes con prótesis de rodilla dolorosa mediante la utilización de un protocolo optimizado: estudio preliminar / Usefulness of magnetic resonance in patients with painful knee prosthesis using an optimised protocol: a preliminary study

Objetivo: Establecer la utilidad de la resonancia magnética (RM) en pacientes con reemplazo total de rodilla (RTR) dolorosa tras la aplicación de un protocolo optimizado y determinar en qué medida estos hallazgos modifican la conducta terapéutica. Materiales y métodos: Se analizaron con protocolo optimizado las RM de 15 pacientes con RTR dolorosa, realizadas entre marzo de 2013 y febrero de 2014. La evaluación fue hecha por un especialista en musculoesquelético y los hallazgos fueron registrados. Resultados: De nuestra población, el 74% eran mujeres y la media de edad fue de 74 +/ - 7 años. Se identificaron posibles causas de dolor en el 80% de los casos y se modificó la conducta médica en el 33%. Se encontró líquido articular en el 93% y signos de sinovitis en el 33%. Los tendones rotuliano, cuadricipital y poplíteo se vieron correctamente en el 77%, 92% y 69%, respectivamente; mientras que los ligamentos colaterales medial y lateral fueron visibles en el 46% y 54%, respectivamente. Discusión: Si bien hay publicaciones con diferentes prevalencias de sinovitis y demás hallazgos, la mayoría ha demostrado que la RM de rodilla con un protocolo optimizado permite generar cambios en la conducta terapéutica. A su vez, el método siempre ha visualizado los ligamentos y tendones de la rodilla con un éxito similar al de nuestro trabajo. Conclusión: Aun careciendo de softwares comerciales específicos que reduzcan el artificio metálico, la aplicación de un protocolo optimizado logra identificar hallazgos que guían el tratamiento y permite evaluar las estructuras ligamentarias.

Objective: To establish the usefulness of magnetic resonance (MR) in patients with total knee replacement (TKR) pain after applying an optimised protocol, and to determinate which of the findings influence medical decision. Materials and methods: Fifteen patients suffering knee pain after TKR were studied using an optimised MR examination protocol from March 2013 to February 2014. The MR was interpreted by a musculoskeletal radiologist and findings were registered. Results: Out of the 15 patients, 74% were female. Mean age was 74 +/ - 7 years. The cause of pain was identified in 80% of the cases, and the medical decision was changed in 33%. Increased intra-articular fluid was seen in 93%, and signs of synovitis in 33%. The patellar, quadricipital, and popliteal tendons were correctly assessed in 77%, 92%, and 69% of patients, respectively, while the tibial and the fibula collateral ligaments were correctly assessed in 46% and 54% of patients, respectively. Discussion: Despite other articles showing a different prevalence of synovitis and MR findings, most of them showed that an optimised protocol impacted on clinical care. Also, most of the adjacent anatomical structures were successfully observed, as in our case. Conclusion: Even in the absence of metal reduction tailored sequences, an optimised protocol manages to diagnose conditions that alter clinical decisions and allows the identification of adjacent anatomical structures.

Is Routine Thromboprophylaxis Needed in Korean Patients Undergoing Unicompartmental Knee Arthroplasty?

This study was undertaken to determine the prevalence and the natural course of venous thromboembolism (VTE) without thromboprophylaxis to ascertain whether routine thromboprophylaxis is necessary following unicompartmental knee arthroplasty (UKA) in Korean patients. The medical records and multidetector row computed tomography (MDCT) imaging of the consecutive 77 UKAs in 70 patients were reviewed. In all patients, MDCTs were undertaken preoperatively and at 1-week after surgery, and VTE symptoms were evaluated. At postoperative 6-months, follow-up MDCTs were undertaken in all patients in whom VTEs were newly detected after surgery. VTE lesions were newly detected in 18 (26%) of the 70 patients. However, none of the patients complained of VTE-related symptoms and MDCT demonstrated that all VTEs were small and involved limited portion without lower leg edema or pleuroparenchymal complication. At the 6-month follow up MDCT, all types of VTEs were shown to be completely resolved, regardless of their location. All of the VTE lesions maintained an asymptomatic status for 6-month after surgery. VTE following UKA in Korean patients who do not receive thromboprophylaxis seems to occur frequently, but all of the VTEs are clinically insignificant and all VTEs are spontaneously regressed. Routine thromboprophylaxis or thrombolytic treatment in Korean patients undergoing UKA may not be necessary.

Síndrome del cíclope: hallazgo sin el antecedente quirúrgico de ligamento cruzado anterior / Cyclops syndrome: finding no surgical history ACL

La presencia de un nódulo fibrovascular llamado cíclope, a nivel del espacio intercondíleo anterior, es un hallazgo ampliamente descrito en la literatura médica como una complicación en casos con antecedente de reconstrucción del ligamento cruzado anterior (LCA). Sin embargo, como sucedió en nuestro paciente, en la actualidad se han comunicado algunos pocos casos con injuria del LCA y lesión cíclope, pero sin el antecedente quirúrgico. Nuestro paciente tuvo un trauma directo en su rodilla seis meses antes de la consulta médica y una injuria del LCA, que podrían haber estado vinculados con la etiopatogenia de la formación de un nódulo fibroso. En el examen físico se observó una limitación en la extensión de la rodilla y en la resonancia magnética (RM), una formación redondeada bien definida, en íntimo contacto con el LCA desgarrado, correspondiente a síndrome cíclope.

The presence of a fibrovascular nodule called Cyclops at the level of anterior intercondylar space, is a finding widely described in the literature as a complication in patients with previous anterior cruciate ligament reconstruction (ACL). However, at present, it has been described some patients with ACL injury and cyclops lesión but without surgical history, as in our case. Our patient had a history of direct trauma in his knee six months before medical consultaron, which could be linked to the pathogenesis of fibrous nodule formation. On physical examination, there was a limitation on the extensión of the knee and a well defined rounded neoformation, closed to the torn ACL corresponding to Cyclops syndrome was observed with magnetic resonance imaging (MRI).

Software to browse the pictures of two knees in diverse states of dissection, flexion and rotation / Programa para navegar las imágenes de dos rodillas en diversos estados de disección, flexión y rotación

The aim of this study was to produce pictures of the knees from an embalmed cadaver and another fresh cadaver with various levels of dissection, flexion, and rotation, consequently to aid medical students and doctors in studying knee anatomy. In this study, we intended to improve the accessibility of the numerous knee photographs, by entering them into our own made browsing software. This software could be downloaded for free from the website (anatomy.co.kr). In the software, a displayed array consisted of four pictures: a knee at three different depths of dissection and the same knee in flexed state. The knee could be rotated interactively at every 5° angle. Annotation of important knee structures could be seen at 90° angle intervals. With the browsing software, users were able to observe detailed and realistic features of the dissected and flexed knees. Furthermore, the comparison of embalmed and fresh knees enhanced understanding of the genuine appearance of the knee. The software and extractable image data can be used as anatomy education materials for various purposes.

El objetivo de este estudio fue producir imágenes de las rodillas de un cadáver embalsamado y otro de cadáver fresco, con diversos niveles de disección, flexión y rotación, con el fin de ayudar a los estudiantes de medicina y a los médicos, en el estudio de la anatomía de la rodilla. En este estudio, la intención fue mejorar la accesibilidad de las numerosas fotografías de la rodilla, mediante la introducción de éstas, producidas en nuestro propio programa de navegación. El programa se puede descargar de forma gratuita desde la página web (anatomy.co.kr). En el programa, una matriz que constaba de cuatro fotografías: una rodilla a tres profundidades diferentes de disección y la misma rodilla en el estado flexionado. La rodilla podía girar de forma interactiva en cada ángulo de 5°. Anotación de las estructuras importantes de la rodilla podían ser vistas a intervalos de 90° de ángulo. Con el software de navegación, los usuarios pudieron observar características detalladas y realistas de las rodillas flexionadas y disecadas. Además, la comparación de las rodillas embalsamadas y frescas mejora la comprensión de la apariencia real de la rodilla. Los datos del programa y de imagen extraíble se pueden utilizar como materiales de educación en anatomía para diversos fines.

Prevalence of bipartite patella in Turkish population: analysis of bilateral knee radiographs in 897 subjects / Prevalencia de patela bipartita en una población turca: análisis de radiografías bilaterales de rodilla en 897 sujetos

Bipartite patella is a normal anatomic variant of patella. There are various data about the prevalence of bipartite patella in the literature. The aim of this study was to investigate its prevalence, type distribution and sex predilection in Turkish population. Bilateral knee radiographs were retrospectively reviewed of 897 consecutive adult patients. Cases with bipartite patella were categorized according to the Oohashi classification. Medical records were examined in order to differentiate symptomatic and asymptomatic bipartite patellae. We contacted symptomatic patients by telephone to learn continuity of knee pain. We identified 11 cases (7 male, 4 female) of bipartite patella among the 283 male and 614 female patients. No bilateral cases were identified. The prevalence of bipartite patella was 1.22% overall, 2.47% in males, and 0.65% in females. The most common type was superolateral bipartite patella as seen in 9 patients (81.8%). One subject had lateral bipartite and one subject had superolateral tripartite patella. Painful bipartite patella was found in only 2 patients (18%). One of them had continuing symptoms even after 12 months. In conclusion, we found that the prevalence of bipartite patella in Turkish population was approximately 1%. Both inclusion of only adult (skeletally mature) subjects and assessment with bilateral imaging increased the reliability of this value. In accordance with the literature, bipartite patella was found significantly more frequent in males and mostly in superolateral type. More studies are needed in order to obtain the prevalence, type and sex distribution of bipartite patella in different populations.

La patela bipartita es una variante anatómica normal. En la literaturahay varios datos sobre la prevalencia de patela bipartitae. El objetivo de este estudio fue investigar la prevalencia, distribución y aparición según sexo en la población turca. Se revisaron retrospectivamente radiografías bilaterales de rodilla de 897 pacientes adultos. Los casos con patela bipartita se clasificaron de acuerdo a la clasificación de Oohashi. Fueron examinados los registros médicos de los pacientes con el fin de diferenciar los casos de patela bipartita sintomática y asintomática. Se estableció contacto con los casos sintomáticos por teléfono para conocer la continuidad del dolor de rodilla. Se identificaron 11 casos (7 varones, 4 mujeres) de patela bipartita entre 283 hombres y 614 pacientes de sexo femenino. No se identificaron casos bilaterales. La prevalencia de patela bipartita fue de 1,22% en total, 2,47% en varones y 0,65% en las mujeres. El tipo más común fue la patela bipartita superolateral en 9 pacientes (81,8%). Un sujeto presentó patela bipartita lateral y en otro caso, patela tripartita superolateral. La patela bipartita dolorosa fue encontrada en sólo 2 pacientes (18%). Uno de ellos presentó síntomas que continuaron incluso después de 12 meses. En conclusión, se encontró que la prevalencia de la patela bipartita en la población turca fue de aproximadamente un 1%. La inclusión en esta investigación de solo sujetos adultos (con el esqueleto maduro) y el estudio de imágenes bilaterales aumentó la fiabilidad de estos parámetros. De acuerdo con la literatura, la patela bipartita se encontró significativamente de manera más frecuente en hombres y en su mayoría se trató del tipo superolateral. Se necesitan más estudios para obtener la prevalencia, tipo y distribución por sexo de la patela bipartita en diferentes poblaciones.

Prediction of the presence of plantaris tendon through examination of palmaris longus tendon: is there a link? / Predicción de la presencia del tendón del músculo plantar mediante el examen del tendón del músculo palmar largo: ¿hay una relación?

The purpose of this study was to investigate the relationship between palmaris longus (PL) and plantaris (P) tendons and test the clinical usefulness of symmetry patterns between these tendons in Turkish population. This prospective study comprised a total of 240 adult patients (120 men and 120 women) who were admitted to our outpatient clinic with bilateral knee complaints that required bilateral knee MR examination during two years. Standard test (Schaefer's test, oppose the thumb to the little finger while flexing the wrist) was used to assess the presence of the PL tendon both with inspection and palpation. Knee MRI was used to determine the presence of P muscle belly on both sides. We have analyzed symmetric distribution pattern using Mc-Nemar test. The PL was absent unilaterally in 34 subjects (14.2%), while it was absent bilaterally in 17 subjects (7.1%). The P was absent unilaterally in 51 subjects (21.3%), while it was absent bilaterally in 10 subjects (4.2%). If PL was absent in one hand, the chance of having an ipsilateral P tendon was 70.6%. If PL was present in one hand, the chance of having an ipsilateral P tendon was 87.6%. The Mc-Nemar test for symmetry yielded a p value of 0.841 for ipsilateral PL and P muscles. A clear-cut link between Palmaris longus and plantaris tendons could not be demonstrated in this study. Both muscles show different variations independent from each other.

El propósito de este estudio fue investigar la relación entre los tendones del músculo palmar largo (MPL ) y músculo plantar (MP) y poner a prueba la utilidad clínica de los patrones de simetría entre estos tendones de la población turca. Estudio prospectivo realizado sobre 240 pacientes adultos (120 hombres y 120 mujeres) que ingresaron en la clínica por síntomas de dolor en la rodilla bilateralmente, quienes requerían un examen de RM de rodilla durante dos años. Se utilizó la prueba estándar (prueba de Schaefer, se oponen el pulgar hasta el dedo mínimo, mientras se flexiona la muñeca) para evaluar la presencia del tendón MPL tanto con la inspección y palpación. La RM de la rodilla se utilizó para determinar la presencia de vientre muscular plantar en ambos lados. Se analizó el patrón de distribución simétrica mediante la prueba de McNemar. El tendón del MPL estuvo ausente de manera unilateral en 34 pacientes (14,2%) y bilateralmente en 17 pacientes (7,1%). El tendón del MP estuvo ausente de manera unilateral en 51 pacientes ( 21,3 %) mientras que bilateralmente no estaba en 10 pacientes (4,2%). Si el tendón del MPL estuvo ausente en un lado, la probabilidad de tener un tendón del MP ipsilateral fue del 70,6 %. Si el tendón del MPL estaba presente en un lado, la probabilidad de tener un tendón del MP ipsilateral fue 87,6%. La prueba de McNemar - simetría produjo un valor p de 0,841 para los músculos PL y P ipsilaterales. Una relación directa claro entre los tendones de los músculos PL y P no se pudo demostrar en este estudio. Ambos músculos muestran diferentes variaciones independiente uno del otro.

Incidental Findings on Knee Radiographs in Children and Adolescents

BACKGROUND: Despite the wide use of knee radiography in children and adolescent patients visiting the outpatient clinic, there has been no analysis about the prevalence and type of incidental findings yet. This study was performed to investigate the incidental findings on knee radiographs in children and adolescents according to age. METHODS: A total of 1,562 consecutive patients younger than 18 years of age were included. They who visited Seoul National University Bundang Hospital's outpatient clinic with a chief complaint of knee pain or malalignment between 2010 and 2011. We reviewed the knee radiographs and analyzed the prevalence and type of incidental findings, such as metaphyseal lucent area, epiphyseal cortical irregularity, osteochondroma and Harris growth arrest line. RESULTS: The mean age of the patients was 10.2 years (range, 1 month to 18 years). We identified 355 incidental findings in 335 patients (21.4%) and 98 abnormal findings (6.3%). The most common incidental finding was metaphyseal lucent area (131, 8.4%), followed by epiphyseal cortical irregularity (105, 6.7%), Harris growth arrest line (75, 4.8%), and osteochondroma (44, 2.8%). An epiphyseal cortical irregularity tended to have a higher prevalence at younger age (p < 0.001) and the prevalences of metaphyseal lucent area and Harris growth arrest line were also higher at a younger age (p = 0.001 and p < 0.001, respectively). However, the osteochondroma tended to have a higher prevalence at an older age (p = 0.004). CONCLUSIONS: This study describes the incidental findings on knee radiographs in children and adolescents and provides effective information from a viewpoint of an orthopedic doctor. The authors recommend considering those incidental findings if unfamiliar findings appear on a knee radiograph in the pediatric outpatient clinic.

A Case of IgM Deficiency with B Cell Deficiency Detected by ABO Discrepancy in a Patient with Acute Osteomyelitis

ABO discrepancy refers to an inconsistency between red cell and serum typings and has various causes, including hypogammaglobulinemia. IgM deficiency is a rare disorder that may accompany several conditions such as infection and autoimmune disorders. Here, we describe a case of IgM deficiency discovered during the evaluation of an ABO discrepancy in a 16-yr-old Korean boy. ABO blood grouping showed that while his cell type was O+, serum typing detected only anti-A (3+). Anti-B was not detectable at room temperature but was graded at 1+ at 4degrees C. ABO genotyping revealed an O/O genotype. His serum IgG, IgA, and IgM concentrations were 770 mg/dL (reference range: 800-1,700 mg/dL), 244 mg/dL (reference range: 100-490 mg/dL), and 13.5 mg/dL (reference range: 50-320 mg/dL), respectively. He was diagnosed with acute osteomyelitis on the basis of clinical presentation and imaging studies. The symptoms gradually improved within 3 weeks of treatment. However, the ABO discrepancy and IgM deficiency persisted even 6 months after recovery and lymphocyte subset analysis revealed CD19+ B cell deficiency. To the best of our knowledge, IgM deficiency detected by ABO discrepancy in a patient with acute osteomyelitis has not been reported before.