Sonographic imaging of abdominal and extraabdominal desmoids.

PURPOSE: To describe the sonographic imaging characteristics of abdominal and extraabdominal desmoids. MATERIALS AND METHODS: We retrospectively investigated 12 histologically and pathologically proven abdominal and extraabdominal desmoids. Two radiologists with musculoskeletal sonography experience reviewed sonographic images for lesion location, size, echotexture, and vascularity with agreement by consensus. RESULTS: Desmoids were seen in 9 females and 3 males. They manifested as slowly growing masses. Nine lesions were intramuscular and 3 were found within the subcutaneous adipose tissue. A typical sonographic feature of all intramuscular desmoids was the spindle-shaped margin at the tumor ends when scanned along the long axis of the affected muscle. The desmoids arising from the fascia had an irregular shape. Tumor vascularity was rich in 6 cases and poor in 6 cases. A fibrillar pattern within the tumor was found in 75% of the cases. CONCLUSION: A spindle-shaped appearance is common in intramuscular desmoids. Hyperechoic areas and a fibrillar pattern within desmoids are also common sonographic features.

[Minimally invasive total hip arthroplasty. Anterior approach]. / Minimal-invasive Hüftendoprothetik : Der vordere Zugang.

Minimally invasive surgery aims at reducing soft tissue trauma to reduce blood loss and postoperative pain, to shorten the necessary stay in hospital, to accelerate the rehabilitation and to improve the cosmesis of the scar. The article describes the technique of minimally invasive total hip arthroplasty via an anterior approach utilizing the interval between the tensor fasciae latae, gluteus medius et minimus muscle laterally and the sartorius and rectus femoris muscle medially. The proposed method is a safe procedure, which allows correct placement of cup and stem. It may be performed within a reasonable time and blood loss is low. The procedure leads to cosmetically pleasing scars. As the patients usually do not suffer from considerable postoperative pain and experience accelerated rehabilitation, they agree to early discharge.

[Minimally invasive total hip arthroplasty via direct anterior approach]. / Minimal-invasive Hüftendoprothetik über einen direkten vorderen Zugang.

BACKGROUND: Minimally invasive total hip arthroplasty (THA) aims at reduction of tissue damage to accelerate recovery. The anterior approach promises optimal soft tissue preservation. PATIENTS AND METHOD: Safety and feasibility of minimally invasive THA via an anterior approach without the use of an orthopedic table was tested in a prospective cohort study on 100 consecutive patients. There were no exclusion criteria, and cementless and cemented techniques were employed. RESULTS: No second incision was needed and neither nerve palsy nor dislocation was observed. The inclination angle of the cup was a median of 44.1 degrees and the position of the stem a median of 0 degrees varus/valgus. Short, satisfactory scars, little blood loss and postoperative pain, accelerated rehabilitation, and early discharge were noted. There were six cases of a permanent lesion of the lateral femoral cutaneous nerve. CONCLUSION: The proposed technique is safe and allows correct positioning of the cup and stem. It can be performed in a reasonable amount of time and blood loss is little.

Reducing the risk of dislocation after total hip arthroplasty: the effect of orientation of the acetabular component.

Malposition of the acetabular component is a risk factor for post-operative dislocation after total hip replacement (THR). We have investigated the influence of the orientation of the acetabular component on the probability of dislocation. Radiological anteversion and abduction of the component of 127 hips which dislocated post-operatively were measured by Einzel-Bild-Röentgen-Analysis and compared with those in a control group of 342 patients. In the control group, the mean value of anteversion was 15 degrees and of abduction 44 degrees. Patients with anterior dislocation after primary THR showed significant differences in the mean angle of anteversion (17 degrees), and abduction (48 degrees) as did patients with posterior dislocation (anteversion 11 degrees, abduction 42 degrees). After revision patients with posterior dislocation showed significant differences in anteversion (12 degrees) and abduction (40 degrees). Our results demonstrate the importance of accurate positioning of the acetabular component in order to reduce the frequency of subsequent dislocations. Radiological anteversion of 15 degrees and abduction of 45 degrees are the lowest at-risk values for dislocation.

Heat distribution and heat transport in bone during radiofrequency catheter ablation.

BACKGROUND: To assess the feasibility of percutaneous radiofrequency ablation in large bone tumours, the heat distribution in cortical bone and marrow around inserted electrodes was measured. METHODS: Fresh bovine cadaver tibial bones were locally heated through drill holes for a maximum of half an hour using water-cooled single radiofrequency electrodes (Radionics Instruments Inc) by pulsed energy. Temperatures were measured in the marrow canal as well as in cortical bone by thermocouples at various distances from the inserted probes. RESULTS: Perpendicular to the probe, hyperthermia of more than 50 degrees C could be created in bone marrow in a sphere of approximately 3 cm, and of approximately 1 cm in cortical bone. CONCLUSION: As irreversible cellular damage can be expected when increasing the temperature to 50 degrees C for a duration of 6 min, this method may be effective for the minimal invasive ablation of neoplasms within human bone in cigar-shaped regions of approximately 3-cm diameter.

Multiple previous surgeries, infection, and preoperative radiation: a cause for arterial rupture in closed reduction?

We report a patient who underwent revision hip arthroplasty with preoperative radiation after a septic loosening of the primary hip prosthesis. Subsequently the patient presented with a dislocation of the hip. During the closed reduction with general anesthesia, a rupture of the arteria profunda femoris occurred. The patient was treated by angiographic obliteration of the arteria profunda femoris followed by an open reduction and augmentation of the acetabular component.

Radiographic abnormalities in the thoracolumbar spine of young elite skiers.

An increased frequency of radiologic abnormalities in the thoracolumbar spine has been reported among young athletes in various sports, but there are no data concerning ski sports. To evaluate the incidence of these abnormalities in young elite skiers, we compared 120 skiers younger than 17 years old (alpine skiers, ski jumpers, and Nordic cross-country skiers) with a random sample of 39 control subjects of the same age who had no history of high-performance sports participation. Standardized anteroposterior and lateral radiographs of the entire lumbar spine, the lower thoracic spine, and the upper part of the sacrum were obtained from each athlete and each control subject. Radiographs were evaluated by two independent observers for the presence and size of anterior and posterior endplate lesions and Schmorl's nodes. The elite alpine skiers and ski jumpers demonstrated a significantly higher rate of anterior endplate lesions than did the control subjects. This finding might be attributable to excessive loading and repetitive trauma of the immature spine under high velocity, especially in the forward bent posture.

Motion in lumbar functional spine units during side bending and axial rotation moments depending on the degree of degeneration.

STUDY DESIGN: Human lumbar spine specimens were tested in axial rotation and side bending. Motion was related to the grade of degeneration. OBJECTIVES: To determine the degree to which degeneration with fissure formation in the disc affects axial rotation of the lumbar functional spine unit. SUMMARY OF BACKGROUND DATA: There is controversy in the literature regarding the influence of severe degeneration and fissures of the disc on the range of axial rotation. METHODS: Thirty-six lumbar spine specimens were tested in axial rotation and side bending, by applying pure moments in an unconstrained setting. The motion in 6 df was recorded by dial gauges. The grade of degeneration was established by the grading schemes of Nachemson, Thompson, Adams, and Mimura. RESULTS: A significant increase of axial rotation and lateral translation under torque was found. This increase mainly took place between Grade 3 according to the schemes of Nachemson, Thompson, and Adams (no fissure formation) and the higher grades of degeneration (defined by fissure formation). Reduced disc height was always associated with fissures. CONCLUSIONS: A reduced lumbar disc height in radiographs seems to be associated with fissure formation in the disc. In this case, the range axial rotation after torque is increased in comparison with cases with less degeneration.

Glenohumeral osteoarthrosis after the Eden-Hybbinette procedure.

Thirty-six patients (36 shoulders) who underwent the Eden-Hybbinette procedure for recurrent anterior dislocation of the shoulder with an average followup of 15 years were evaluated. Evaluation consisted of radiographic assessment in a true anteroposterior view and an axillary lateral view of both shoulders, physical examination, and a questionnaire. Mild glenohumeral osteoarthrosis was present in 1/3 of the patients, and moderate and severe osteoarthrosis was evident in 1/2. There were no signs of osteoarthrosis in four shoulders. Function, as assessed by the Rowe score as modified by Young and Rockwood, was excellent or good in 27 shoulders and fair or poor in nine shoulders. The extent of osteoarthrosis was related to restriction of external rotation, length of followup, and function.

Surgical treatment of neuropathic scoliosis: morphologic and functional outcome.

We evaluated the morphologic and functional outcome as well as the extent of satisfaction following surgical treatment in 41 patients with progressive neuropathic scoliosis. The mean follow-up time was 5.6 years (range 2.5-20 years), and follow-up rate was 97.6%. Posterior spine fusion was performed with new instrumentation techniques (Luque/Luque-Galveston, CD, ISOLA) in 29 patients, with extension onto the sacrum in 16 patients, and Harrington instrumentation in 12. In 20 patients we did an additional intervertebral disc excision and fusion. Mean correction of the thoracic spine deformity, as assessed by comparing the Cobb angles on pre- and postoperative X-rays, was 53%, and of the lumbar spine 55.2%, in patients classified as Lonstein I. Scolioses classified as Lonstein II evidenced an average correction of 46.2%. Functional improvement according to the Rancho-Los Amigos scheme could be demonstrated in 20 patients. Seventeen patients remained unchanged, whereas 4 patients showed deterioration. Cosmetic results were rated as excellent by 25 patients, good by 7, and poor by 1. For 8 patients the appearance was unimportant. Pain relief was experienced in all cases (n = 4) of the preoperative low-back or abdominal pain. The major complications were deep wound infection in 3 patients which led to revision surgery, and removal of instrumentation in 1 patient.

Suprascapular nerve entrapment at the spinoglenoid notch caused by a ganglion cyst.

A 34-year-old man had right infraspinatus muscle palsy and posterior aching of the shoulder caused by electromyographically confirmed suprascapular nerve entrapment. Sonography and magnetic resonance imaging revealed a cystic lesion at the spinoglenoid notch; this lesion was diagnosed as a ganglion. Operative removal led to immediate pain relief and incomplete recovery of the compressed branches of the suprascapular nerve.

Acetabular development following early treatment of hip dysplasia by Pavlik harness.

One hundred sixty-two neonates with sonographically diagnosed developmental dysplasia of the hip (200 hips) according to the method of Graf were treated with a Pavlik harness until sonographic maturation was reached. Eight patients (12 hips) treated with closed reduction and retention in a bilateral hip spica cast were included. When the children started to walk their acetabular indices were assessed and demonstrated low-grade dysplasia in 26% and high-grade dysplasia in 6% according to the criteria of Tönnis and Brunken. We discuss the current sonographic criteria defining treatment-induced normalization and the adequacy of the length of treatment. We conclude that despite normal values at the end of treatment dysplasia may develop, which necessitates further radiological monitoring of all hips initially rated at risk on sonography. When to end monitoring, however, remains to be determined.