ABSTRACT
BACKGROUND: Adolescent athletes are a high-risk population for stress fractures. We report four cases of stress fractures of the second proximal phalanx, which had not been previously diagnosed as the location of the stress fracture of the foot, in teenage athletes. CASE REPORT: All fractures were on the plantar side of the proximal phalangeal base, and the oblique images of the plain radiograph clearly depicted the fractures. Notably, three out of the four patients had histories of stress fracture of other locations. While three athletes with acute cases were able to make an early return to play with simple conservative management, the chronic case required surgical treatment for this rare injury. CONCLUSION: Although a rare injury, it is important that clinicians be aware of this type of stress fracture, as a timely diagnosis can avoid the need for surgical treatment and allow an early return to play.
ABSTRACT
BACKGROUND: Imaging is of great importance in diagnosing meniscal tears. The aim of this study was to assess the accuracy of high-resolution ultrasound in the diagnosis of meniscal tears, with arthroscopic examination as the standard reference, after resolution was confirmed with a target-mounted reference phantom. An additional goal was to elucidate the area of the meniscus that could be visualized with the same ultrasound machine after placement of markers into the menisci of cadaveric knees. METHODS: Seventy patients were included for the assessment of the accuracy of a high-resolution ultrasound machine with a 14.0 to 6.0-MHz linear transducer. The preoperative ultrasound diagnosis, in terms of the presence and type of tear, was compared with that in the surgical reports. In the cadaveric studies, nine needles were placed in the peripheral zone of the menisci at regular intervals and the number of needles that could be observed with the system was recorded. RESULTS: The overall sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound examination for meniscal tears were 88%, 85%, 85%, and 88%, respectively. These statistical parameters did not differ significantly between the medial and lateral menisci. The sensitivity for diagnosing horizontal, vertical, radial, flap, bucket-handle, and complex tears and for detecting discoid lateral menisci was 83%, 64%, 0%, 64%, 54%, 90%, and 80%, respectively. Ten percent of the lateral menisci could not be evaluated because of poor images. The cadaveric studies revealed that the ultrasound visualized the entire meniscus except for the anterior horn. CONCLUSIONS: The findings of this study suggest that ultrasound examination may be suitable for screening for meniscal tears. The fact that almost 10% of the lateral menisci could not be evaluated because of poor images appears to be a weakness of ultrasound.
Subject(s)
Menisci, Tibial/diagnostic imaging , Adult , Arthroscopy , Cadaver , Female , Humans , Male , Needles , Radiography , Rupture/diagnostic imaging , Sensitivity and Specificity , UltrasonographyABSTRACT
BACKGROUND: In recent years, double-bundle (anteromedial bundle [AMB], posterolateral bundle [PLB]) anterior cruciate ligament reconstruction has developed into an accepted practical surgical procedure; therefore, its efficacy needs to be established. HYPOTHESIS: Multiple-sliced 2-dimensional magnetic resonance imaging allows evaluation of each bundle separately. Both bundles are important for knee stability, and each bundle has a role in the prevention of knee instability. Knee laxity testing will correlate with the magnetic resonance imaging appearance of the individual graft bundles. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: A total of 97 double-bundle anterior cruciate ligament reconstructions were evaluated 1 year after surgery, including side-to-side difference of KT-2000 arthrometer and pivot shift test. T2-weighted 2-dimensional magnetic resonance images were captured in the middle plane of each bundle to express magnetic resonance signals of each bundle. The magnetic resonance signals were divided into 3 grades: grade I, low-intensity signal; grade II, high-intensity signal within 50%; and grade III, high-intensity signal greater than 50%. RESULTS: Anterior laxity in AMB grade II (PLB I, 3.5 +/- 1.7 mm; PLB II, 4.5 +/- 1.9 mm) was significantly larger than in AMB grade I (PLB I, 1.9 +/- 1.7 mm; PLB II, 2.1 +/- 1.7 mm) with statistical difference (P = .025 in PLB I; P = .002 in PLB II). A positive rate in pivot shift test in PLB II (48%) was significantly larger than in PLB I (21%) with statistical difference (P = .031). CONCLUSIONS: Varying magnetic resonance signals according to the bundle indicate role differences of each bundle in knee stability. These results imply that the AMB has a major role in preventing anterior translation of the tibia and the PLB has a major role in preventing anterolateral rotatory instability.
