Biomedical subjects
Publications and source records attributed to J J Poggi.
A 40-year-old man with a history of previous cheilectomy and two steroid injections for first metatarsophalangeal degenerative joint disease sustained an acute rupture of the extensor hallucis longus tendon. He was treated successfully with delayed primary repair of the tendon.
Fourteen patients with traumatic hip dislocation had serial magnetic resonance imaging and routine radiographic studies from the time of injury through 24 months after injury. One experienced radiologist interpreted all images prospectively for abnormalities suggesting osteonecrosis of the femoral head and posttraumatic arthritis. Eight hips demonstrated abnormal marrow signals on T1 and T2 weighted images within 6 weeks of injury. These changes progressed in 3 hips, and osteonecrosis was confirmed subsequently by plain radiography. The abnormal marrow signals in the remaining 5 hips proved to be transient, resolving on magnetic resonance images within 3 months in 4 of the 5 patients. Magnetic resonance imaging can be used with confidence for the early detection of osteonecrosis of the femoral head after traumatic hip dislocation or fracture-dislocation. The presence of acetabular or femoral shaft hardware did not preclude magnetic resonance imaging assessment of these patients when coronal, sagittal, and axial images were obtained. Magnetic resonance imaging was not reliable for assessing marrow changes within the first week after injury, nor was it helpful in predicting which patients were at risk for posttraumatic arthritis to develop. An algorithm is proposed for using magnetic resonance imaging in the early diagnosis of osteonecrosis of the femoral head after traumatic hip dislocation.
The term cervical spondylolysis describes a long-standing, perhaps congenital defect of the pars interarticularis of a cervical vertebra. We report 10 new cases of cervical spondylolysis and review the literature. All patients in this report were treated nonoperatively with subsequent symptomatic improvement. Cervical spondylolysis must be differentiated from its traumatic counterparts radiographically. Characteristic radiographic findings include well-corticated margins at the defect, a characteristic "bow tie" deformity, and ipsilateral dysplastic facets. Compensatory hypertrophic changes of the adjacent articular processes, spina bifida, and spondylolisthesis are frequently, but not always, seen in conjunction with cervical spondylolysis. The vast majority of patients with radiographically proven cervical spondylolysis can be treated confidently with conservative measures. Surgical intervention should be reserved for those who fail nonoperative management or who exhibit neurologic compromise referable to an unstable spondylolytic defect.