Triplane fractures of the distal tibia.
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Biomedical subjects
Publications and source records attributed to W P Butt.
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Chondromyxoid fibroma is a rare benign cartilaginous tumour seen most frequently around the knee in children and young adults. Up to 17% occur in the foot, where more aggressive appearances have been reported. Four cases of chondromyxoid fibroma in the forefoot are presented, demonstrating the wide range of radiological appearances of this primary tumour. Three of the four tumours recurred, one at 19 years after the surgery. These cases illustrate the need for thorough preoperative assessment to ensure complete surgical resection in an attempt to reduce the incidence of local recurrence.
Bilateral three-compartment wrist arthrography was performed in 30 patients with unilateral posttraumatic wrist pain to assess the incidence of bilateral findings. The mean age of patients was 30 (range 18-55) years. Thirty-three percent of patients were normal bilaterally, 30% had unilateral communication in the symptomatic wrist, 30% had communications in both the symptomatic and asymptomatic wrists and 7% had communication in the asymptomatic wrist only. Unilateral three-compartment wrist arthrography is not recommended in the assessment of unilateral post-traumatic wrist pain; no advantage of three-compartment injection over radiocarpal injection alone was shown.
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A retrospective study was performed to determine whether bone blood supply can be assessed on gadolinium-enhanced magnetic resonance imaging. Lumbar spine magnetic resonance imaging (MRI) examinations of 49 patients attending for post-laminectomy examination were reviewed (30 male, 19 female, mean age 46.4 years, age range 23-84 years). Each study included sagittal T1-weighted spin echo sequences before and after gadolinium administration. Regions of interest were drawn within the L3 vertebral body from a parasagittal slice from each sequence. Signal intensity (SI) values were ascertained and the percentage increase in SI was calculated. For each patient, changes in receiver gain for pre- and post-gadolinium images were corrected by an image scaling factor. In all cases, a measurable increase in SI was found (mean 15.3%, range 4.4-55.7) due to bone vascularity. The results give no indication of the quantity or timing of blood supply but provide a basis for further work.
Five cases of septic sacroiliitis diagnosed by magnetic resonance imaging (MRI) are presented. Imaging was performed between 2 and 14 days after onset of symptoms and consisted of varying combinations of coronal short tau inversion recovery (STIR), axial T2-weighted spin echo (SE), and coronal and axial pre- and postcontrast T1-weighted SE scans. Abnormalities included demonstration of sacroiliac joint effusions, bone oedema and adjacent inflammation as high signal on STIR and T2-weighted SE scans, and identification of abscesses in two cases as rim-enhancing lesions anterior to the joint on gadolinium-enhanced T1-weighted SE scans. The role of MRI and other forms of imaging in septic sacroiliitis is discussed.
Longitudinal stress fractures of the tibia are a recognized but unusual finding in long distance runners. Two cases are presented in which the diagnosis on plain films and scintigraphy (in one case) was not evident. Both patients were referred for MRI. Coronal short tau inversion recovery (STIR) sequences demonstrated extensive hyperintense longitudinal intramedullary signal changes in the tibia. T1-weighted spin-echo scans showed corresponding but less extensive regions of reduced signal intensity. In one case, enhancement of this area was seen following i.v. dimeglumine-gadopentetate (Gd-DTPA). Adjacent soft-tissue abnormality and periosteal reaction was seen in one case but in neither patient was a fracture line identified. Thin section CT with sagittal reformats demonstrated an irregular intracortical longitudinal lucent fracture line which was distinct from the nutrient foramen, establishing the diagnosis.
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Primary or secondary psoas abscess is infrequently seen but should not be forgotten. We report on two patients with RA who presented predominantly with back pain and who subsequently developed pyrexia. The correct diagnosis of psoas abscess was not immediately apparent. These cases and the discussion and comments which follow illustrate the difficulties that may be encountered and remind readers of this inperspicuous diagnosis.
Computed tomographic arthrography (CTA) of the shoulder is currently the best investigation of the unstable shoulder. 47 patients had CTA in the prone oblique position to assess its ability to demonstrate both anterior and posterior capsular mechanisms simultaneously. The first five patients were also scanned supine oblique to allow direct comparison with the prone oblique position. All studies were reviewed retrospectively by three musculoskeletal radiologists with regard to how well the relevant structures were demonstrated. In the prone oblique position, the anterior capsule was well shown in 98%, anterior labrum 98%, posterior capsule 91%, posterior labrum 89%, subscapularis tendon 98%, biceps tendon 100% and biceps tendon proximal insertion 78%. In 86% of cases both anterior and posterior structures were well seen simultaneously. In the five cases that also had supine imaging the prone oblique images were superior. The cause of poor demonstration of structures was invariably insufficient intraarticular air. It is concluded that the prone oblique is an excellent technique for CTA of the shoulder and should become the standard position for assessing shoulder instability.
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