Does the external remote controller's reading correspond to the actual lengthening in magnetic-controlled growing rods?

PURPOSE: Magnetic-controlled growing rods (MCGRs) are now routinely used in many centres to treat early-onset scoliosis (EOS). MCGR lengthening is done non-invasively by the external remote controller (ERC). Our experience suggests that there may be a discrepancy between the reported rod lengthening on the ERC and the actual rod lengthening. The aim of this study was to investigate this discrepancy. METHODS: This was a prospective series. Eleven patients who were already undergoing treatment for EOS using MCGRs were included in this study. RESULTS: One hundred and ninety-two sets of ultrasound readings were obtained (96 episodes of rod lengthening on dual-rod constructs) and compared to their ERC readings. Only 15/192 (7.8%) readings were accurate; 27 readings (14.9%) were false positive; and 8 readings (4.2%) were an underestimation while 142 readings (74.0%) were an overestimation by the ERC. Average over-reporting by the ERC was 5.31 times of the actual/ultrasound reading. When comparing interval radiographs with lengthening obtained on ultrasound, there was a discrepancy with an average overestimation of 1.35 times with ultrasound in our series. There was a significant difference between ERC and USS (p = 0.01) and ERC and XR (p = 0.001). However, there was no significant difference between USS and XR (p > 0.99). CONCLUSION: The reading on the ERC does not equate to the actual rod lengthening. The authors would recommend that clinicians using the MCGR for the treatment of early-onset scoliosis include pre- and post-extension imaging (radiographs or ultrasound) to confirm extension lengths at each outpatient extension. In centres with ultrasound facilities, we would suggest that patients should have ultrasound to monitor each lengthening after distraction but also 6-month radiographs. These slides can be retrieved under Electronic Supplementary Material.

Frequently missed findings in acute ankle injury.

Most acute ankle injuries involve the lateral ligament complex. There are several other structures that can be injured during acute ankle trauma and therefore can be responsible for the patient's acute presentation or for continuing pain. Some of these injuries are less common than others and thus can be more frequently missed during the initial patient presentation. Continued pain and disability following acute ankle trauma that is not responding to routine conservative treatment should alert the clinician and the radiologist for the possibility of injuries other than the common lateral ligament sprain. In this article we describe those injuries that are often overlooked during acute ankle assessment. These include the less common ankle ligaments injuries, fractures, and tendon-related abnormalities.

Persistent ankle pain following a sprain: a review of imaging.

The initial diagnosis of an "ankle sprain" is not always correct. Prolonged pain, swelling and disability sufficient to limit the activity and refractory to treatment following an ankle injury are not typical of an ankle sprain and should alert the clinician of the possibility of an alternative or an associated diagnosis. There are several conditions that can be misdiagnosed as an ankle sprain and those include ankle syndesmosis injuries, sinus tarsi syndrome, ankle and hind foot fractures, osteochondral lesions, posterior tibialis and peroneal tendons abnormalities, spring ligament damage, impingement syndromes and reflex sympathetic dystrophy. In this review, we discuss the imaging features of these conditions that can clinically mimic an ankle sprain. It is crucial to remember that unresolved ankle pain following an injury is not always just due to a "sprain".

Morel-Lavallee lesion in an adolescent with ultrasound and MRI correlation.

The Morel-Lavallee lesion is a serous collection in the region of the greater trochanter, resulting from a closed degloving injury at the deep fascial interface. Imaging demonstrates characteristic appearance in relation to this lesion, differentiating it from other mass lesions. We report a case of Morel-Lavallee lesion in an adolescent, with ultrasound and MRI correlation.