The clinical case: validity, values and strategies to approach its writing. / El caso clínico: vigencia, valores y estrategias para abordar su escritura.

The case report is used to communicate the experience acquired by its authors with a patient. Although its relevance has been doubted, the case report deserves to be vindicated and contextualized. We review the case report's historical tradition, recent evolution and current formats. We describe its utility as a scientific tool, a continuing education resource and an aid to diagnosis. We reflect on the teaching potential its writing entails. Finally, we provide strategies to address the writing of a radiological case report.

Autonomy, consent and responsability. Part 1: limitations of the principle of autonomy as a foundation of informed consent. / Autonomía, consentimiento y responsabilidad. Parte 1: limitaciones del principio de autonomía como fundamento del consentimiento informado.

Legal recognition of patient's rights aspired to change clinical relationship and medical lex artis. However, its implementation has been hampered by the scarcity of resources and the abundance of regulations. For several years, autonomy, consent, and responsibility have formed one of the backbones of the medical profession. However, they have sparked controversy and professional discomfort. In the first part of this article, we examine the conceptual and regulatory limitations of the principle of autonomy as the basis of informed consent. We approach the subject from philosophical, historical, legal, bioethical, deontological, and professional standpoints. In the second part, we cover the viability of informed consent in health care and its relationship with legal responsibility.

Autonomy, consent and responsibility. Part II. Informed consent in medical care and in the law. / Autonomía, consentimiento y responsabilidad. Parte II. El consentimiento informado en la medicina asistencial y en la jurisprudencia.

Legal recognition of patient's rights aspired to change clinical relationship and medical lex artis. However, its implementation has been hampered by the scarcity of resources and the abundance of regulations. For several years, autonomy, consent, and responsibility have formed one of the backbones of the medical profession. However, they have sparked controversy and professional discomfort. In the first part of this article, we examine the conceptual and regulatory limitations of the principle of autonomy as the basis of informed consent. We approach the subject from philosophical, historical, legal, bioethical, deontological, and professional standpoints. In the second part, we cover the viability of informed consent in health care and its relationship with legal responsibility.

Cam-type deformities: Concepts, criteria, and multidetector CT features.

Interpreting imaging studies of a painful hip requires detailed knowledge of the regional anatomy. Some variants of the proximal femur, such as cam-type deformities, can course asymptomatically or cause femoroacetabular impingement. The principal numerical criterion for defining cam-type deformities, the alpha angle, has some limitations. In this article, we review the anatomic variants of the anterior aspect of the proximal femur, focusing on cam-type deformities. Using diagrams and multidetector CT images, we describe the parameters that are useful for characterizing these deformities in different imaging techniques. We also discuss the potential correspondence of imaging findings of cam-type deformities with the terms coined by anatomists and anthropologists to describe these phenomena.

[The postsurgical rotator cuff: surgical techniques, clinical outcome, and MRI evaluation]. / El manguito rotador intervenido: técnicas quirúrgicas, resultados clínicos y evaluación con resonancia magnética.

Surgical treatment of rotator cuff tears significantly reduces painful symptoms and improves functional capacity in many patients. However, despite recent advances, up to 25% of patients remain symptomatic after surgery. This has led to research into the reasons for these poor outcomes, including how to identify them with imaging methods and how to avoid them through new therapeutic approaches. Based on our clinical experience, we review the available treatment alternatives for rotator cuff tears, analyzing the main areas of controversy and the possible causes of unsatisfactory outcome after surgery. Furthermore, we review the expectations, difficulties, and requirements of diagnostic imaging in the follow-up of surgically treated rotator cuffs, with special emphasis on the MRI findings and their clinical impact.

El manguito rotador intervenido: técnicas quirúrgicas, resultados clínicos y evaluación con resonancia magnética / The postsurgical rotator cuff: surgical techniques, clinical outcome, and MRI evaluation

El tratamiento quirúrgico de las roturas del manguito rotador mejora significativamente la sintomatología dolorosa y la capacidad funcional de muchos pacientes. A pesar de los avances recientes, hasta un 25% de los enfermos permanecen sintomáticos después de la cirugía. Esto ha llevado a investigar las causas de los malos resultados, su identificación por métodos de imagen y su evitación con nuevos esquemas terapéuticos. Basándonos en nuestra experiencia clínica revisamos las alternativas disponibles en el tratamiento de las roturas del manguito rotador, analizando los principales motivos de controversia y las posibles causas del fracaso quirúrgico. Además, repasamos las expectativas, dificultades y requisitos del diagnóstico por la imagen durante el seguimiento del manguito rotador intervenido, haciendo especial énfasis en los hallazgos y aportaciones clínicas de la resonancia magnética (AU)

Surgical treatment of rotator cuff tears significantly reduces painful symptoms and improves functional capacity in many patients. However, despite recent advances, up to 25% of patients remain symptomatic after surgery. This has led to research into the reasons for these poor outcomes, including how to identify them with imaging methods and how to avoid them through new therapeutic approaches. Based on our clinical experience, we review the available treatment alternatives for rotator cuff tears, analyzing the main areas of controversy and the possible causes of unsatisfactory outcome after surgery. Furthermore, we review the expectations, difficulties, and requirements of diagnostic imaging in the follow-up of surgically treated rotator cuffs, with special emphasis on the MRI findings and their clinical impact (AU)

MR assessment of the repaired rotator cuff: prevalence, size, location, and clinical relevance of tendon rerupture.

The objectives of this study were to use magnetic resonance (MR) imaging to evaluate the prevalence, size, location, and clinical relevance of tendon rerupture following complete repair of full-thickness rotator cuff tear (RCT). A total of 78 surgically proven full-thickness rotator cuff tears in 74 patients were retrospectively included in the study. Clinical assessment was performed using the University of California at Los Angeles score. Postoperative MR imaging was evaluated to determine prevalence, size, and location of tendon rerupture. At a mean 48.4 months' follow-up, 62 shoulders (79.5%) had favorable outcomes and 45 shoulders (57.6%) showed rerupture on MR imaging studies. Reruptures were significantly more prevalent among patients with intermediate-to-bad outcomes (81.3%), with surgically demonstrated two-tendon tears (78.9%) or three-tendon tears (100%), and with preoperative fatty degeneration of the supraspinatus muscle greater than 1 (91.6%). Reruptures were also significantly larger in those subgroups. Complete repair of RCT of all sizes may have favorable outcomes in a significant proportion of patients in spite of a high prevalence of reruptures. Preoperative tear size and degree of muscle fatty degeneration influence the prevalence and rerupture size. After repair of supraspinatus tears, reruptures tend to invade the posterior aspect of the tendon.

Surgically repaired massive rotator cuff tears: MRI of tendon integrity, muscle fatty degeneration, and muscle atrophy correlated with intraoperative and clinical findings.

OBJECTIVE: Our goal in this study was to evaluate by means of MRI the clinical significance of tendon integrity, muscle fatty degeneration, and muscle atrophy in surgically repaired massive rotator cuff tears and to correlate these and other prognostic factors with intraoperative and clinical findings. MATERIALS AND METHODS: Twenty-eight surgically proven massive rotator cuff tears were retrospectively included in the study. Twenty-two patients underwent complete repair, and six patients underwent partial repair. Preoperative and postoperative clinical assessment was performed by using the University of California at Los Angeles score. Preoperative and postoperative MRI studies were evaluated for the presence and extent of rotator cuff tear and for the degree of fatty degeneration and atrophy of the rotator cuff muscles. RESULTS: At a mean 44.4 months' follow-up, 20 patients (71.4%) had a favorable result. A total of 25 patients (89.2%) showed postoperative full-thickness rotator cuff tear, 19 of which were reruptures. A sagittal preoperative rotator cuff tear of less than or equal to 34 mm showed a specificity of 100% for predicting a favorable outcome. A coronal postoperative rotator cuff tear of less than or equal to 34 mm showed a specificity of 85.7% and a positive predictive value of 92.9% for predicting a favorable outcome. A postoperative fatty degeneration of infraspinatus muscle less than or equal to 2 had a specificity of 87.5% and a positive predictive value of 90.9% for predicting a favorable outcome. CONCLUSION: Open repair of massive rotator cuff tears may reach a favorable outcome in a significant proportion of patients, despite a high rate of recurrent or residual tears. Oblique coronal sizes of the recurrent or residual tear of less than or equal to 34 mm and postoperative fatty degenerations of infraspinatus muscle of less than or equal to 2 may allow a favorable outcome.

Cementoma of the fibula: imaging findings with histopathologic correlation and review of the literature.

Bone tumors containing fibrous tissue and cementum-like spherules are typically found in the maxilla and mandible. However, such lesions are extremely infrequent in the long bones. We report the complete radiologic assessment of a cementoma of the fibula in a 42-year-old man. We also correlate the findings with data provided by histopathologic analysis, and review the English-language literature on tumors of long bones that may contain cementum-like material.

Early intrathoracic migration of Kirschner wires used for percutaneous osteosynthesis of a two-part humeral neck fracture: a case report.

We present an unusual case of early migration of three Kirschner wires used for percutaneous osteosynthesis of a two-part humeral neck fracture, causing hemothorax. An 85-year-old woman was admitted to the emergency room after casual accident. She was found to have suffered a two-part fracture of the surgical neck of the right humerus. The humeral fracture was treated by closed reduction and percutaneous osteosynthesis with three threaded Kirschner wires, which were bent subcutaneously. Ten days after the accident the patient presented with dyspnea and laterocervical pain. Plain X-rays and complementary CT demonstrated intrathoracic migration of the three Kirschner wires with hemothorax. Two of the wires were seen under the right clavicle and adjacent to the C7 vertebra. The third wire reached the lateral chest wall. Immediate surgery was performed, with withdrawal of the wires and placement of a drainage tube. The patient had an uneventful recovery after surgery. The humeral fracture resulted in a nonunion, which was well tolerated by the patient and was left untreated. The use of Kirschner wires for osteosynthesis of proximal humeral fractures may cause significant thoracic morbidity, even if various prophylactic measures, including the use of threaded wires, subcutaneous bending, and close radiographic follow-up, are adopted. The use of Kirschner wires should anyway be restricted to carefully selected cases, in order to avoid major complications.

Long-standing Morel-Lavallée lesions of the trochanteric region and proximal thigh: MRI features in five patients.

OBJECTIVE: The purpose of this study was to review and describe the MRI features of long-standing Morel-Lavallée lesions of the trochanteric region and proximal thigh in five patients with a history of trauma. CONCLUSION: Long-standing Morel-Lavallée lesions of the trochanteric region and proximal thigh may present various MRI patterns that reflect their variable composition and stage of development. MRI may prove especially useful for characterizing these lesions when the trauma is remote and progressive growth or pain is present.

Open bicondylar Hoffa fracture associated with extensor mechanism injury.

Two cases of open bicondylar Hoffa fracture of the knee associated with extensor mechanism injury are described in two active young patients with multiple fractures. The level of the fracture was determined by the proximal insertion of the posterior cruciate ligament and anterior cruciate ligament in the medial and lateral condyle. The level of the extensor mechanism injury was determined by the degree of flexion of the knee at the moment of impact. No ligament or meniscal tears were found. Open reduction and internal fixation with four lag screws and bone-to-tendon repair of the patellar and quadriceps tendon gave excellent results after more than 2 years of follow-up. The mechanism of injury and the therapeutic implications are discussed, and the literature is reviewed.

Magnetic resonance imaging of anterior cruciate ligament tears: reevaluation of quantitative parameters and imaging findings including a simplified method for measuring the anterior cruciate ligament angle.

We evaluated the diagnostic utility of magnetic resonance imaging (MRI) for predicting anterior cruciate ligament (ACL) tears using both quantitative parameters and nonquantitative imaging findings. MRI examinations were retrospectively evaluated in a group of patients with arthroscopically confirmed complete ACL tear and in a control group with arthroscopically confirmed intact ACL. We evaluated multiple MRI features to compare their sensitivity and specificity for detecting ACL tears. Particular emphasis is put on the evaluation of three different quantitative parameters, including a simplified method for measuring the ACL angle. With a threshold value of 45 degrees the ACL angle reached a sensitivity and specificity of 100% for detecting ACL tears. With a threshold value of 0 degrees the Blumensaat angle had a sensitivity of 90% and a specificity of 98%. Finally, a threshold value of 115 degrees gave the posterior cruciate ligament angle a sensitivity of 70% and a specificity of 82%. Discontinuity was found to be the most useful of the ACL abnormalities. Of the secondary findings anterior tibial displacement was the best predictor of ligamentous injury. However, ACL abnormalities and secondary findings, alone or combined, failed to surpass the diagnostic value of the ACL angle for predicting ACL tears. Quantitative parameters are thus good predictors of ACL tears and may increase the overall sensitivity and specificity of MRI. The ACL angle may be confidently measured in a single MRI section and can be considered to be the most reliable quantitative parameter for detecting ACL tears.

Clinically significant skeletal variations of the shoulder and the wrist: role of MR imaging.

Several skeletal variations of the upper extremity may cause painful conditions or precipitate early degenerative changes, either spontaneously or in response to overuse and trauma. Magnetic resonance imaging has proved particularly useful for accurate interpretation of many of these clinically significant skeletal variations; however, the widespread use of MR imaging may have contributed to over-emphasizing their clinical importance, which is still controversial in many cases. We review, illustrate, and discuss clinically significant skeletal variations of the upper extremity as seen on MR images, particularly those involving the shoulder and the wrist. In the shoulder region, we evaluate variations of acromial and coracoid processes as well as variations and minor dysplastic deformities of the glenoid fossa. We also review different skeletal variations of the carpal region, including ulnar variance, ulnar styloid, lunate morphology, carpal coalition, and carpal accessory ossicles. The role of MR imaging in assessing the clinical importance of such conditions, whether potential, controversial, or well established, is emphasized in this review.

Accessory ossicles and sesamoid bones of the ankle and foot: imaging findings, clinical significance and differential diagnosis.

Accessory ossicles and sesamoid bones are frequent findings in routine radiographs of the ankle and foot. They are commonly considered fortuitous and unrelated to the patient's complaint; however, they may eventually cause painful syndromes or degenerative changes in response to overuse and trauma. They may also suffer or simulate fractures. Our aim was to review, illustrate and discuss the imaging findings of some of the more frequent accessory ossicles and sesamoid bones of the ankle and foot region, with particular emphasis on those that may be of clinical significance or simulate fractures.

Accessory ossicles and sesamoid bones of the ankle and foot: imaging findings, clinical significance and differential diagnosis.

Accessory ossicles and sesamoid bones are frequent findings in routine radiographs of the ankle and foot. They are commonly considered fortuitous and unrelated to the patient's complaint; however, they may eventually cause painful syndromes or degenerative changes in response to overuse and trauma. They may also suffer or simulate fractures. Our aim was to review, illustrate and discuss the imaging findings of some of the more frequent accessory ossicles and sesamoid bones of the ankle and foot region, with particular emphasis on those that may be of clinical significance or simulate fractures.