ABSTRACT
BACKGROUND: Injections of the acromioclavicular joint (ACJ) are performed routinely in patients with ACJ arthritis, both diagnostically and therapeutically. The aim of this prospective controlled study was to estimate the frequency of successful intra-articular ACJ injections with the aid of sonographic guidance versus non-guided ACJ injections. MATERIALS AND METHODS: A total of 80 cadaveric ACJs were injected with a solution containing methylene blue and subsequently dissected to distinguish intra- from peri-articular injections. In 40 cases the joint was punctured with sonographic guidance, whereas 40 joints were injected in the control group without the aid of ultrasound. RESULTS: The rate of successful intra-articular ACJ injection was 90% (36 of 40) in the guided group and 70% (28 of 40) in the non-guided group. Ultrasound was significantly more accurate for correct intra-articular needle placement (P = .025). DISCUSSION: The use of ultrasound significantly improves the accuracy of ACJ injection.
Subject(s)
Acromioclavicular Joint/diagnostic imaging , Anti-Inflammatory Agents/administration & dosage , Arthritis/drug therapy , Ultrasonography, Interventional , Aged , Aged, 80 and over , Arthritis/diagnostic imaging , Cadaver , Female , Humans , Injections, Intra-Articular , Male , Middle Aged , Prospective Studies , Reproducibility of ResultsABSTRACT
BACKGROUND: Transitional fractures typically occur in patients with partially closed growth plates. In case of displacements >2 mm, osteosynthesis is recommended. Open reduction and stabilization with lag screws is the most common approach. Infection and paraesthesia are common complications of this method. This study describes an alternative approach by closed reduction and cannulated screw fixation. METHODS: All patients with transitional fractures treated by closed reduction and cannulated screw fixation were identified. All patients with >1 year after implant removal were included in this investigation. Of 27 patients treated by this technique, 21 met the inclusion criteria and were sent a standardized questionnaire including the Foot Function Index (FFI). All cases with impairments in the FFI were invited for a follow-up examination. RESULTS: Postoperative complications occurred in two patients (8.3%): one reported paraesthesia of the hallux and one showed skin irritations above the screw insertion. Average follow-up time was 3.8 years after implant removal. Of 21 patients who returned the questionnaire, three patients (14.3%) had impairment in the FFI and were invited for clinical follow-up: one patient showed mild signs of osteoarthritis without visible gaps of the joint surface, one patient had minimally restricted pronation, and one had neither clinical nor radiologic correlates for the impairment reported. Sports activity was reduced in one patient. CONCLUSION: If closed reduction can be achieved fixation with cannulated screws proved to be a satisfactory method with little scars and good clinical results.
Subject(s)
Epiphyses/injuries , Epiphyses/surgery , Fracture Fixation, Internal/methods , Tibial Fractures/surgery , Adolescent , Bone Screws , Casts, Surgical , Child , Female , Fluoroscopy , Fracture Fixation, Internal/instrumentation , Humans , Male , Minimally Invasive Surgical Procedures , Postoperative Complications , Radiography, Interventional , Statistics, Nonparametric , Surveys and Questionnaires , Tibial Fractures/diagnostic imaging , Tibial Fractures/etiology , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
PURPOSE: The aim of this study was to describe typical age-related sonographic features of the Achilles tendon and calcaneal apophysis in children, providing a reference for the assessment of heel pathologies during the growth period. METHODS: The calcaneal apophysis and Achilles tendon insertion of 100 children 2 months to 18 years old were examined by high-frequency gray-scale and color Doppler sonography along both the longitudinal and transverse planes. The thicknesses of the apophyseal cartilage at the calcaneal tuberosity and of the Achilles tendon were measured. Also, the sonographic appearance of the bone-cartilage interface was studied. RESULTS: In children 2 months to 3 years old, the cartilage of the calcaneal tuberosity apophysis was anechoic, with small scattered echoes. In 19 of these 25 children (76%), the echogenic areas contained at least 1 small vessel, visualized on color Doppler sonography. In 15 of 25 children (60%) 4-6 years old, a wavy interface was noted at the junction of the calcaneus and the apophyseal cartilage. CONCLUSIONS: High-frequency sonography can yield reliable information about the bone-cartilage interface and the Achilles tendon insertion site at the calcaneal tuberosity in children. The sonographic features of the normal heel described here may contribute to improved assessment of pathologies in this anatomic region.
