Targeted computerised tomography scanning of the ankle syndesmosis with low dose radiation exposure.

OBJECTIVES: To devise a new protocol for targeted CTscanning of the distal tibiofibular syndesmosis with minimal radiation exposure to patients. We also aimed to correlate the reduction of the syndesmosis as seen on CT scans with the functional outcome of patients. MATERIALS AND METHODS: Prospective study. Forty adults undergoing surgical stabilisation of an acute distal tibiofibular syndesmosis injury were recruited. A targeted five-cut computerised tomography scan protocol was developed. The radiation exposure to the patient with this protocol was only 0.002 mSv. Scans were performed 12 weeks after surgery. The contralateral ankle of every patient was used as a control to determine the accuracy of the reduction of the syndesmosis for that individual patient. American Orthopaedic Foot and Ankle Society (AOFAS) scores were obtained at a minimum of 1 year after surgery. RESULTS: After considering the exclusions, 36 patients formed the study group. A wide variation was observed in the anatomy of the normal syndesmosis. If we considered a difference of more than 2 mm between the normal and injured syndesmosis relationship as significant, 15 (41.6 %) of our patients had a significant difference between the injured and normal sides. AOFAS scores were available for 13 of these patients and were good to excellent in 11(84.6 %). CONCLUSION: Our study describes a reliable new CT scanning technique for the distal tibiofibular syndesmosis using only five cuts and a low-radiation-dose protocol. Clinical correlation of the findings on the scan with functional outcomes suggests that routine post-operative CT of the syndesmosis is probably not justified.

Should a Lumbar MRI for back pain routinely include the sacro-iliac joint?

BACKGROUND: Back pain is a common problem and has been shown to affect approximately 85% of the adult population at any one time. The source of this pain can be difficult to identify and the sacroiliac joint (SIJ) has been proposed as a possible pain source. Its percentage contribution to lower back pain is controversial. Clinical provocative tests for SIJ pathology have been developed but these have high intra and inter-observer variability and the significant of positive findings is unclear. This study proposes that the SIJ should not be imaged as part of a routine MRI lumbar spine series. METHODS: We retrospectively reviewed the images of 353 patients who had MRI lumbar spine scans. 130 had the SIJ imaged. We recorded the clinical findings and diagnosis at referral. We reviewed the images and documented the radiological findings. RESULTS: SI joint pathology was most frequently identified when clinical suspected. Overall SIJ pathology found on MRI in only 0.02% of patients. CONCLUSIONS: We conclude that routinely imaging the SIJ in MRI lumbar spine series is not cost-effective or a useful use of resources. The SIJ should be imaged only if significant clinical findings are demonstrated.

Avulsion of the L4 spinous process: an unusual injury in a professional rugby player: case report.

STUDY DESIGN: A case of L4 spinous process avulsion following a hyperflexion injury treated with surgical excision. OBJECTIVE: To show that single photon emission computerized tomography is essential for the diagnosis and that excision can provide a successful outcome. SUMMARY OF BACKGROUND DATA: The avulsion resulted from a forced hyperflexion injury at the L4/5 area, where the interspinous ligament provides a high resistance to flexion. METHODS: A 29-year-old international rugby football player injured his low back during a match. Plain radiography and magnetic resonance imaging did not reveal the injury. Single photon emission computerized tomography and computerized tomography showed the lesion. RESULTS: Initial conservative therapy failed to control the symptoms, and, therefore, late excision was performed with pain-free return to contact sports at 3 months. CONCLUSIONS: Few cases of interspinous process avulsions have been described, and, to our knowledge, this is the first reported case of rugby football player who had a successful outcome with late surgical excision.