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Richard H Daffner

Publications and source records attributed to Richard H Daffner.

13 recordsLinked to original sources
PubMed2006

Detection of cervical spine injuries in alert, asymptomatic geriatric blunt trauma patients: who benefits from radiologic imaging?

There are differing recommendations in the literature regarding cervical spine imaging in alert, asymptomatic geriatric patients. Previous studies also have not used computed tomography routinely. Given that cervical radiographs may miss up to 60 per cent of fractures, the incidence of cervical spine injuries in this population and its implications for clinical management are unclear. We conducted a retrospective study of blunt trauma patients 65 years and older who were alert, asymptomatic, hemodynamically stable, and had normal neurologic examinations. For inclusion, patients were required to have undergone computed tomography and plain radiographs. The presence and anatomic location of potentially distracting injuries or pain were recorded. Two hundred seventy-four patients were included, with a mean age of 76 +/- 10 years. The main mechanisms of injury were falls (51%) and motor vehicle crashes (41%). Nine of 274 (3%) patients had cervical spine injuries. The presence of potentially distracting injuries above the clavicles was associated with cervical injury when compared with patients with distracting injuries in other anatomic locations or no distracting injuries (8/115 vs 1/159, P = 0.03). There was no association of cervical spine injury with age greater or less than 75 years or with mechanism of injury. The overall incidence of cervical spine injury in the alert, asymptomatic geriatric population is low. The risk is increased with a potentially distracting injury above the clavicles. Patients with distracting injuries in other anatomic locations or no distracting injuries may not need routine cervical imaging.

Accidental Falls↗
PubMed2005

POEMS syndrome: radiographic appearance with MRI correlation.

POEMS syndrome is a rare disorder in which patients present with the hallmark signs of polyneuropathy, organomegaly, endocrinopathy, M protein and skin changes. Many other clinical findings are also often present, most notably osseous lesions. The MRI appearance of the bony lesions in POEMS syndrome has been described in five cases, four of which are in the non-English literature. We report the MRI appearance of the osseous lesions in a patient with POEMS syndrome who presented with sciatic neuropathy.

Adult↗
PubMed2005

Controversies in cervical spine imaging in trauma patients.

The subject of cervical spine imaging for trauma patients has generated significant controversy over the past decade and a half. This review considers three aspects of this controversy. The first examines the indications for cervical imaging, focusing on the factors that determine whether trauma patients are at high or low risk for cervical injury. The second discusses the uses of radiography and computed tomography as the main screening diagnostic examination. In addition to the roles of each modality in this evaluation process, other factors such as efficacy of diagnosis, time requirements for study, and cost will be discussed. The final section explores the methods currently used to "clear" the cervical spine in comatose patients.

Cervical Vertebrae↗
PubMed2005

Electrochemical corrosion of metal implants.

OBJECTIVE: The objective of our study was to show the radiographic changes that result from electrochemical corrosion of implanted metal in the body. CONCLUSION: Corrosion of metal implants is not rare. Radiologists should become familiar with the changes this process produces.

Adult↗
PubMed2004

Controversies in cervical spine imaging in trauma patients.

No area of emergency radiology has generated as much discussion in recent years as the subject of cervical spine imaging for trauma patients. This review will be in three parts. The first will examine the indications for cervical imaging and will focus on those factors that make patients at high risk or low risk for cervical injury. The second part will discuss the merits of radiography and computed tomography as the main screening diagnostic examination. In addition to the roles of each modality in the evaluation process, such factors as efficacy of diagnosis, time (duration) of study, and cost will be discussed. Finally, the third part will explore the methods currently employed to "clear" the cervical spine in comatose patients.

Cervical Vertebrae↗
PubMed2004

Fatigue fracture of the sacrum in an adolescent.

There are relatively few reports of sacral stress fractures in children. In adolescents, sacral stress fractures have been reported in patients involved in vigorous athletic activity. Recognition of these fractures is important to avoid unnecessary biopsy if the findings are confused with tumor or infection. We report a sacral fatigue fracture in a 15-year-old without a history of athletic participation or trauma.

Adolescent↗
PubMed2003

Correlation of joint fluid and internal derangement on knee MRI.

OBJECTIVE: To test the hypothesis that in symptomatic patients, knees in which MRI examinations demonstrate no significant effusion will also be free of internal derangement. DESIGN AND PATIENTS: One hundred and fifteen knee MRI examinations performed between March 2002 and June 2002 at our institution were retrospectively reviewed, evaluating for both the presence of knee effusions and concurrent internal derangement. The amount of joint fluid was measured quantitatively by obtaining anteroposterior measurements in the midline and lateral aspects of the suprapatellar pouch using sagittal MR images. These measurements were then correlated with presence or absence of MRI-demonstrated internal derangement and statistical analysis was performed. RESULTS: Of the 115 knee MRI examinations evaluated, 47 (41%) were negative for internal derangement and 68 (59%) were positive for internal derangement. Thirty-six of 115 (31%) examinations showed joint fluid with anteroposterior measurement of 10 mm or less in the lateral aspect of the suprapatellar pouch. Of these, 31 (86%) showed no concurrent internal derangement. Statistical analysis was also performed using other lateral suprapatellar pouch cutoff values. CONCLUSION: While knees in which MRI examinations demonstrate no significant effusion are most often free of internal derangement, there remain a significant number which will exhibit internal derangement. An anteroposterior measurement of 10 mm or less in the lateral aspect of the suprapatellar pouch is a reasonable threshold value for distinguishing a physiologic from a pathologic amount of joint fluid.

Adolescent↗
PubMed2003

MRI of tibialis anterior tendon rupture.

Ruptures of the tibialis anterior tendon are rare. We present the clinical histories and MRI findings of three recent male patients with tibialis anterior tendon rupture aged 58-67 years, all of whom presented with pain over the dorsum of the ankle. Two of the three patients presented with complete rupture showing discontinuity of the tendon, thickening of the retracted portion of the tendon, and excess fluid in the tendon sheath. One patient demonstrated a partial tear showing an attenuated tendon with increased surrounding fluid. Although rupture of the tibialis anterior tendon is a rarely reported entity, MRI is a useful modality in the definitive detection and characterization of tibialis anterior tendon ruptures.

Aged↗
PubMed2002

Vertebral injuries: detection and implications.

Vertebral injuries occur in a predictable and reproducible manner that is dependent upon the mechanism of injury. Each mechanism of injury leaves distinct imaging 'fingerprints' regardless of the location in the spine. This chapter will discuss four areas: the mechanisms of injury and their imaging 'fingerprints'; abnormalities of alignment and anatomy, bony integrity, cartilage or joint space, and soft tissues-the ABCS of injury; the imaging features that will indicate stability of the spine following injury; and the classification of spine injuries into two categories-'major' or 'minor'. The imaging features described in this chapter apply to both radiography as well as to computed tomography (CT). Although helical CT is being used more commonly for the evaluation of suspected cervical injuries, radiography of the entire spine remains the standard.

Cartilage, Articular↗
PubMed2002

Computed tomography diagnosis of facet dislocations: the "hamburger bun" and "reverse hamburger bun" signs.

Unilateral or bilateral facet dislocations are difficult to diagnose. Computed tomography (CT) is being used more extensively to screen patients with suspected cervical vertebral injury. We describe two new signs, the "hamburger bun" sign of normal facet joints and the "reverse hamburger bun" sign that should be useful in establishing a diagnosis of facet dislocation. Normal facet joints are oriented on a CT examination so that they resemble the sides of a hamburger bun. Facet dislocations upset this relationship and reverse the orientation of the "bun" halves to each other.

Biomechanical Phenomena↗
PubMed2001

Fibroblastic osteosarcoma of the mandible.

Osteosarcoma of the mandible is a rare lesion. We report the case of a 16-year-old male who developed a fibroblastic osteosarcoma at the site of a wisdom tooth extraction. The lesion followed an aggressive course of recurrence and diffuse disseminated osteosarcomatosis. We speculate on the causal factors that resulted in this rapid course.

Adolescent↗