A surgical approach for an avulsion fracture of the ischial tuberosity: a case report.

We report a case of an avulsion fracture of the ischial tuberosity treated with a new surgical approach early after injury. Although surgical treatment of this fracture is usually avoided because of the difficulty of the procedure and the risk of sciatic nerve complication, we believe our subgluteal approach is simple and safe. We therefore recommend it for treating avulsion fractures of the ischial tuberosity, especially when the fragment is displaced by >2 cm and the sciatic nerve is not involved. If there is clinical evidence of sciatic nerve disturbance, it is likewise an indication for surgery. However, the incision needs to be deepened to approach the nerve, along the lines of the incisions advocated by both Miller and Spinner.

Magnetic resonance delineation of the anterior cruciate ligament of the knee: flexed knee position within a surface coil.

The purpose of this study was to evaluate the effect of the knee position at three different flexion angles in magnetic resonance (MR) delineation of the anterior cruciate ligament (ACL) in the knee and to determine the optimal knee position. Thirteen knees of normal volunteers were examined at 15 degrees, 30 degrees, and 45 degrees of flexion with a surface coil, and three sets of obtained oblique sagittal MR images were evaluated by four observers. MR images at 30 degrees of knee flexion most clearly delineate compared with those at 15 degrees and 45 degrees of knee flexion. We recommended examining the knee in 30 degrees of flexion.

Lumbar multilevel degenerative spondylolisthesis: radiological evaluation and factors related to anterolisthesis and retrolisthesis.

Radiographs of 3,259 outpatients with low back disorders were examined for age, gender, level, direction, degree of slip, lumbar lordosis, pedicle-facet (P-F) angle, facet shape, and disc height. Degenerative lumbar spondylolisthesis was found in 284 (8.7%) of the patients, of which 83 were excluded. Single-level spondylolisthesis was present in 132 of the 201 patients studied, including 93 cases of anterolisthesis and 39 of retrolisthesis, the former being predominant at L4 and in women and the latter at L2 and equal between the genders. Multilevel spondylolisthesis in 69 patients included 65 (94%) of two-segment slip, 21 anterior, 25 posterior, and 19 combined, and 4 cases of three-segment retrolisthesis. Factors related to anterolisthesis were increased P-F angle and W-shaped facet joint; statistically, however, no factors were found statistically related to retrolisthesis. Multilevel anterolisthesis was considered to occur from factors similar to those previously reported for single-level anterolisthesis, and the pathomechanism of retrolisthesis is different from that of anterolisthesis.