Reliability of measuring volume by different methods for tumors of the musculoskeletal system.

In the present study different methods for determining the volume of a tumor were evaluated. For 12 models, the real volume, the volume according to measurement of the surface area on MRI, an ellipsoid and a cylindrical approximation of the volume, as well as the maximum diameter, were determined. There appeared to be a good correlation between all calculated volumes and the real volume. The error (mean: 17%) and the standard deviation (SD: 14%) on this error were smallest if the volume was determined by means of determination of the surface area. The ellipsoid approximation resulted in a smaller error (mean: 0%) but a higher standard deviation (SD: 27%). The cylindrical approximation resulted in unacceptable deviations (mean: 51%; SD: 40%). Volume was significantly related to the maximal diameter to the power of 2.3. Volume calculated according to this power resulted in an error of 18%. Standard deviation in this case however was unacceptable (SD: 89%). Volume calculation based upon the determination of the surface area has given the best and most reliable results. Ellipsoid approximation was less reliable, but faster and cheaper. Cylindrical approximation was unacceptable. Size, expressed as maximal diameter of the tumor, was also unacceptable as a parameter for volume.

Hyperbaric oxygen (HBO) as useful, adjunctive therapeutic modality in compartment syndrome.

The authors describe a compartment syndrome progressively developed after a long-term surgical procedure, with a patient positioned in supine position with calf rest, who was successfully treated with hyperbaric oxygenation. This approach saved the patient from a more invasive therapeutic intervention.

Nonoperative treatment of active spondylolysis in elite athletes with normal X-ray findings: literature review and results of conservative treatment.

The purpose of this study was to evaluate the healing capacity of fatigue fractures of the pars interarticularis in young elite athletes. Between 1991 and 2000, a fatigue fracture of the pars interarticularis was diagnosed in 34 highly competitive athletes. The study group included 28 athletes with a mean age of 17.2 years at diagnosis (range 12-27 years). The average time per week dedicated to sports was 10.9 h. Diagnosis was made with both planar and single-photon-emission computed tomographic (SPECT) bone scintigraphy and computed tomographic (CT) scan. Lesions were classified into three groups according to their distribution on the scintigram: unilateral, bilateral, or "pseudo-bilateral" (asymmetrical tracer uptake). The study was limited to athletes with subtle fractures, which means that they had normal radiographs and positive bone scans. All subjects were braced for a mean time of 15.9 weeks (range 12-32 weeks). We looked at healing of the fracture, subjective outcome, and sports resumption in the three groups. The athletes were reviewed after an average of 13.2 months (range 3-51 months), and a second CT scan was performed to evaluate osseous healing. Healing of the fracture was noted in all 11 athletes with a unilateral lesion, in five out of nine athletes with a bilateral lesion and in none of the eight athletes with a pseudo-bilateral lesion. Twenty-three athletes (82.2%) rated the outcome as excellent, three athletes (10.7%) as good, and two (7.1%) as fair. Twenty-five athletes (89.3%) managed to return to their same level of competitive activity within an average of 5.5 months after the onset of treatment. There was no difference in outcome or in sports resumption between the three groups. Our data suggest that osseous healing is most likely to occur in unilateral active spondylolysis. Chances of bony healing diminish when the fracture is bilateral, and diminish even further when it is pseudo-bilateral. Non-union does not seem to compromise the overall outcome or sports resumption in the short term.

Current concepts in the treatment of radial head fractures in the adult. A clinical and biomechanical approach.

The treatment of simple radial head fractures type Mason-Hotchkiss 1 and 2 is unequivocal. In the case of a displacement of less than 2 mm (Mason-Hotchkiss 1), functional conservative treatment is indicated. If the displacement is more than 2 mm (Mason-Hotchkiss 2) internal fixation is indicated, combined with treatment of the soft-tissue injuries. The treatment of comminuted radial head fractures Mason-Hotchkiss type 3 is more controversial, as they are usually associated with ligament injuries. Conservative treatment appears to have unsatisfactory results. Opinions differ on surgical treatment, i.e. 1) excision of the radial head; 2) reconstruction by means of internal fixation; 3) excision and reconstruction with a prosthesis. Basic experimental research on human cadaver elbows shows the importance of the conservation of the radial head, especially in case of associated soft tissue injuries. In most cases a stable osteosynthesis is impossible, and in case of associated ligament disruptions, resection and reconstruction by means of a rigid radial head prosthesis should be considered. Experimental research demonstrates promising results for rigid radial head prostheses in human cadaver elbows with a resected radial head and failing medical collateral ligament. Short-term clinical studies seem to confirm this, but long-term results are as yet unknown.

Treatment of advanced impingement syndrome by arthroscopic subacromial decompression.

The authors report a prospective study on 40 patients to investigate shoulder function after arthroscopic subacromial decompression for advanced impingement syndrome (stage II) using a posterolateral and a posteromedial portal. There were no intraoperative or postoperative complications related to the use of these portals. All patients were assessed preoperatively and at 6 months postoperatively using the Constant-Murley Score and the revised ASES Score. Before operation the mean Constant-Murley Score was 49.3. This improved to 78.2 at 6 months postoperatively (p < 0.0001). The ASES score improved from 35.6 preoperatively to 80.6 at 6 months postoperatively (p < 0.0001). Patient satisfaction, reflected by the affirmation that they would have the same operation again, was 85%. Comparison between the scoring systems using the Spearman rank correlation coefficient revealed a good correlation between the Constant-Murley score and the modified ASES score. The Spearman rank correlation coefficient for the pre- and postoperative scores was 0.995. (p < 0.0001).

Central retinal artery occlusion after spinal surgery.

Central retinal artery occlusion can be caused by excessive extrinsic pressure on the eyeball during surgery. It is a rare and severe complication after elective spinal surgery. The authors report a case of central retinal artery occlusion in an adult after posterior lumbar spinal fusion in which a rectangular headrest was used.

Rapidly progressive destruction of the hip. Case report and review of the literature.

A case of total destruction of the femoral head over a period of eight weeks is described. The diagnosis of avascular necrosis was made on the pathological examination. In the literature, four mechanisms of rapid destruction of the femoral head are mentioned.

Central retinal artery occlusion after back surgery: a case report.

Central retinal artery occlusion can be caused by excessive extrinsic pressure on the eyeball during surgery. It is a well-known and severe complication after elective back surgery. The authors report a case of central retinal artery occlusion in an adult after posterior lumbar fusion in which a rectangular headrest was used.

Arthroscopic treatment of metacarpophalangeal arthropathy in haemochromatosis.

A 37-year-old sports teacher suffering from idiopathic haemochromatosis with arthropathy of the MP joints has been treated and followed-up by us for 4 years. Three out of four affected MP joints were treated with arthroscopic operations; one of these had been treated elsewhere previously by arthrotomy. This article presents a brief review of the condition and its treatment by arthroscopic surgery with detailed technique. We believe that MP joint arthroscopy in certain cases is an alternative to open surgery and gives excellent results. No specific instruments are needed apart from a standard small joint arthroscopy set.

The open palm technique in the treatment of Dupuytren's disease.

Twenty-eight patients (33 hands) were reviewed an average 2.5 years after an open palm technique combined with partial fasciectomy for the correction of Dupuytren's disease. They were assessed by diathesis evaluation and Tubiana's score. Results show a recurrence rate of 33.5% (3% severe), an extension rate of 51.5% and an overall complication rate of 21% without reflex sympathetic dystrophy. Fifteen percent and 12% had an important deficit in flexion and extension respectively. These findings are comparable to those found in the literature.

Anomalous origin of a lumbrical muscle as cause of a trigger finger.

We report a case of a trigger finger due to an anomalous origin of the fourth lumbrical muscle. Total excision of the involved muscle fibers gave complete relief of symptoms.

Subacromial impingement: open versus arthroscopic decompression.

An analysis of the follow-up results of 53 patients treated by an arthroscopic decompression (AD) and 53 patients treated by an open decompression (OD) is presented. Patients were evaluated pre- and postoperatively with the UCLA Shoulder Rating Scale, which includes an assessment of pain, function, range of motion, strength, and patient satisfaction. After an average of 20.1 months for the AD group and 27.3 months for the OD group, good or excellent results were found in 83.1% in the AD group and in 81.1% in the OD group. Patient satisfaction was 88.3% (AD) compared with 94.3% (OD). Results of decompression in both groups were not influenced by associated pathologies (acromioclavicular degeneration, frozen shoulder, calcified tendinitis, rotator cuff lesions).

Shoulder impingement syndrome.

An analysis of the results of 53 patients treated by an open Neer decompression for chronic impingement of the shoulder is presented. Patients were evaluated pre- and post-operatively on the UCLA Shoulder Rating Scale, which includes an assessment of pain, function, range of motion, strength and patient satisfaction. After an average period of 27.3 months, good or excellent results were found in 81.1%. Satisfactory results (according to Neer) were found in 94.3%. Differential diagnosis of acromioclavicular pathology and cervical syndromes is important.

Acquired contracture of the infraspinatus muscle. A case report and review of the literature.

Congenital contracture of the infraspinatus muscle has been reported by K. Kitano et al. (1988). We describe a patient with an acquired contracture of the infraspinatus muscle causing posterior subluxation of the glenohumeral joint.