Clinical significance of signal changes in the quadratus femoris muscle on MR.

OBJECTIVES: To evaluate the clinical significance of quadratus femoris muscle signal changes (QFMC) on MRI. METHODS: 204 consecutive bilateral MRI hip examinations (132 female, 72 male) were reviewed in retrospect for QFMC. Inclusion imaging parameters were edema or atrophy of the quadratus femoris muscle. The presence or absence of symptoms and additional ipsilateral and/or contralateral imaging findings were used to differentiate between isolated symptomatic, co-incidental and asymptomatic QFMC. RESULTS: 24 (11.8%) patients and 30 (7.3%) hips demonstrated QFMC. Atrophy was present in 5 symptomatic hips. Female to male ratio was 23:1. Isolated symptomatic QFMC: 4 hips (13.3%), 1 bilateral. Clinical symptoms in this group were non-specific greater trochanter pain and stiffness of the hip. Co-incidental QFMC: 19 symptomatic hips, ipsilateral associated findings present in 18 hips (94.7%) and contralateral additional findings present in 8 hips (42.1%). Asymptomatic QFMC: 7 hips (23.3%), ipsilateral associated asymptomatic findings in 5 hips (71.4%) and contralateral associated symptomatic findings in 6 hips (85.7%). Edema around the greater trochanter and hamstring insertions were the most frequent associated findings. CONCLUSION: In this study, most cases of QFMC were co-incidental or asymptomatic. In isolated symptomatic QFMC clinical complaints were non-specific. Atrophy was found only in the symptomatic hips.

The floating radial head prosthesis for comminuted radial head fractures: a multicentric study.

We report our experience with the floating radial head prosthesis of Judet for comminuted fractures of the radial head. We present the results in 15 patients with a mean follow-up of 25.2 months. Thirteen prostheses were inserted for acute Mason III fractures of the radial head, and 2 were inserted for chronic problems after radial head fracture. According to the Mayo Elbow Performance Index there were 7 excellent, 3 good, 1 fair and 2 poor results in the group with acute injuries. In this group, one prosthesis was removed after 8 months for severely decreased elbow function. In the group with chronic problems, there were 2 fair results. There were no dislocations or prosthesis fractures. None of the prostheses showed signs of loosening. Three patients in the acute group developed wrist pain, and in one patient in the chronic group, preexisting wrist pain disappeared after insertion of the radial head prosthesis. Our short-term results suggest that the floating radial head prosthesis is a suitable solution for early or delayed treatment of Mason type III fractures, either isolated or associated with more complex injuries.

Graft selection in anterior cruciate ligament reconstruction--prospective analysis of patellar tendon autografts compared with allografts.

A prospective study of 73 arthroscopic anterior cruciate ligament reconstructions using either a patellar tendon autograft or an allograft was made to assess any difference in clinical outcome. Allocation was by availability of an allograft. There were 48 autografts and 25 allografts. Evaluation was by clinical examination and physical tests. At follow-up 2 years after operation, there were no statistically significant differences between the two groups in mobility or in physical tests, but KT-1000 evaluation showed a slightly greater anterior translation in the autografts at 6 months and one year, although at 2 years the allografts developed greater anterior laxity. Cybex testing showed greater quadriceps strength at 6 months and one year in the allografts, but at 2 years the strength was greater in the autografts. Re-rupture occurred in 3 allografts. ACL reconstruction with a patellar tendon allograft does not produce a significant functional deficit. Full quadriceps recovery takes 2 years. Allografts are not recommended as stability deteriorates with time.

The volar wrist ganglion: just a simple cyst?

The results of operation on 71 volar wrist ganglia are reported. The recurrence rate was 28%, occurring between 1 and 144 months (median: 5 months). The highest risk of recurrence is in a male patient, under 30 years of age, in a manual occupation, operated on by a junior surgeon. The use of a post-operative plaster slab seemed to be followed by significant wrist stiffness. 28% of the patients had evidence of damage to the palmar cutaneous branch of the median nerve. It is suggested that this could be avoided by positive identification of this nerve at operation.