Determining scaphoid waist fracture union by conventional radiographic examination: an analysis of reliability and validity.

INTRODUCTION: Conventional radiographic imaging is the first imaging tool of choice in scaphoid fractures. The majority of undisplaced scaphoid waist fractures unite after 6 weeks of cast immobilization. We hypothesized that conventional radiographic imaging at 6 weeks after injury can both accurately and reliably predict union in undisplaced scaphoid waist fractures. MATERIALS AND METHODS: Fleiss' kappa statistics were used concerning the opinions of four observers reviewing 47 sets of good-quality scaphoid radiographs of undisplaced scaphoid waist fractures. As reference standard for union, radiographs were taken at a minimum of 6 months after injury to determine validity. RESULTS: Overall agreement was defined as moderate. (κ = 0.583) "No consolidation" (κ = 0.816), "full consolidation" (κ = 0.517) and "partial consolidation" (κ = 0.390) were defined as good, moderate and fair agreement, respectively. The average sensitivity and specificity of diagnosing scaphoid waist fracture union on standard scaphoid radiographs were 0.65 and 0.67, respectively. The positive predictive value for diagnosing union was 0.93 and the negative predictive value was 0.22. CONCLUSIONS: Conventional radiographic imaging is accurate and moderately reliable in diagnosing union, and reliable but inaccurate in diagnosing nonunion of scaphoid waist fractures at 6 weeks follow-up.

Diagnostic value of radiological breast imaging in a non-screening population.

The aim of this study was to assess the diagnostic performance of breast imaging in the diagnosis of breast cancer in a non-screening population. In a consecutive set of patients referred for mammography in one year, the results of palpation and radiological breast imaging were scored on a 5-point grading scale and linked to pathology as gold standard after a follow up period of one year. The diagnostic performance was studied by logistic regression analysis and ROC-curves. There were 1,944 breast examinations in 1,890 patients and 3,816 breasts. Pathology results reported 118 malignancies in 115 women. With a cut-off point between benign and uncertain benign a sensitivity of 89% and a specificity of 98% was found for radiological imaging. ROC-curves showed a significant increase in diagnostic performance when radiology was added to results of palpation and age (p = 0.007). Radiological imaging tests have a large diagnostic value in the detection of breast cancer in addition to palpation and age. A sensitivity close to 100% could be reached.

Osteoporosis and intellectual disability: is there any relation?

One of the causes of osteoporosis is immobility. The present study examined osteoporosis in 23 bedridden adults with intellectual disability. It was found that the bone mineral density of the subjects was low, even though their calcium intake was more than adequate. Vertebral and other fractures were concentrated mainly in the elderly subjects (> 50 years). Very low vitamin D levels were also found in the subjects despite good nutritional levels. It is concluded that people with intellectual disability and mobility disorders are at risk of metabolic bone disease.

Lethal hypophosphatasia, spur type: case report and fetopathological study.

Lethal hypophosphatasia, spur type: case report and fetopathological study: Hypophosphatasia (HP) is characterised by severe undermineralisation of the skeleton owing to deficiency of tissue nonspecific alkaline phosphatase. Clinically a perinatal, infantile, childhood and adult type is distinguished. Clinical signs in the perinatal type of HP show considerable overlap with other skeletal dysplasias such as osteogenesis imperfecta type IIA and type IIC, and achondrogenesis type IA. If present, "spurs" of the limbs are diagnostic for HP. We present a prenatally diagnosed case of HP and discuss the differential diagnosis based on clinical, radiological and pathological findings. Our findings indicate that two types of spurs can be distinguished in hypophosphatasia: midshaft type and joint type.

Functional and radiological outcome after intra-articular tibial plateau fractures.

A follow-up study was performed to assess the functional and radiological outcome after operative treatment of tibial plateau fractures. Of 62 patients operated upon from 1985 to 1993, 46 patients were traced and re-examined. Follow-up averaged 60 months. Three functional scores were applied: the HSS knee score, the Lysholm score and the Tegner score. Radiographs obtained at follow-up were rated for deformity and signs of arthrosis, using a score described by Reswick and Niwayama. Patients reported most functional complaints during the first 3 years and after 6 years. Patients seen between 3 and 6 years after injury showed better functional scores. Arthritic changes were seen from 5 years after the fracture. Patients over 60 years of age seemed to suffer less functional loss than younger patients, indicating that operative treatment should not be withheld on grounds of age alone.

Delayed intraosseous venous blood flow does not correlate with patellar cartilage changes in anterior knee pain.

In 67 patients with longstanding anterior knee pain intra-osseous phlebography of the patella and arthroscopy of the knee were performed. No statistical correlation could be demonstrated between the delayed drainage of the contrast medium from the patellar veins and the degree of damage to the patellar cartilage.

The value of computed tomography in the diagnosis of grating scapula.

Snapping or grating scapula is a condition of the shoulder girdle in which the patient complains of pain and an audible snapping sound which may be associated with pain. We evaluated the diagnostic value of the computed tomography (CT) scans using the clinical diagnosis of a grating scapula as the gold standard. This retrospective study reports the sensitivity, specificity, likelihood ratio and receiver operator characteristic curve for the CT scans and the kappa value as a measure of the interobserver agreement. None of the parameters validated the examination. We therefore concluded that CT scans are inappropriate for differentiation between a grating scapula and a normally functioning shoulder except in cases where bony abnormalities are present.