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Bending and torsion strain are calculated in biomechanical analysis. They allow to be used as reliable standard whether or not a definite kind of osteosynthesis is stable or will have to be denied as unstable.
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Magnetic resonance imaging (MRI) permits noninvasive evaluation of the cartilage of the growth plate and epiphysis. This paper reports three cases where MRI was used to supplement conventional radiography in the assessment of acute physeal injuries. In the first patient, MRI was used for postoperative assessment of a radial neck fracture, avoiding further surgical exploration. In the second case, MRI was compared with ultrasonography in the diagnosis of proximal humeral epiphyseal separation in a neonate. In the third case MRI and computed tomography were compared in evaluation of a Salter-Harris type 4 distal femur fracture. In all cases MRI was diagnostic. MRI is the investigation of choice in acute complex physeal injuries, and is particularly appropriate for use prior to the appearance of the secondary ossification center.
Shoulder instability is a common clinical feature leading to recurrent pain and limited range of motion within the glenohumeral joint. Instability can be due a single traumatic event, general joint laxity or repeated episodes of microtrauma. Differentiation between traumatic and atraumatic forms of shoulder instability requires careful history and a systemic clinical examination. Shoulder laxity has to be differentiated from true instability followed by the clinical assessment of direction and degree of glenohumeral translation. Conventional radiography and CT are used for the diagnosis of bony lesions. MR imaging and MR arthrography help in the detection of soft tissue affection, especially of the glenoid labrum and the capsuloligamentous complex. The most common lesion involving the labrum is the anterior labral tear, associated with capsuloperiostal stripping (Bankart lesion). A number of variants of the Bankart lesion have been described, such as ALPSA, SLAP or HAGL lesions. The purpose of this review is to highlight different forms of shoulder instability and its associated radiological findings with a focus on MR imaging.
In cases of injuries to the shoulder region, ultrasonography is an ideal supplement to clinical and radiologic examination, including dynamic functional evaluation. The advantages of the method in children and adults are mainly the reduction of conventional radiographs and thus a minimum exposure to radiation. Despite the growing experience of clinicians and the development of high-resolution sonographic technology, primary conventional radiology cannot be dispensed with. Moreover, sonographic examination is rather time-consuming. Evaluation of the subacromial space and the glenohumeral joint itself is impossible in adults, and diagnosis of lesions to the labrum and the articular capsule requires a great deal of experience on the part of the clinician. Ultrasonography has gained increasing importance in the evaluation and follow-up of shoulder trauma in adults and children.
The most frequent localization of fractures in elderly patients are the metaphysis of the distal radius, the metaphysis of the proximal humerus and the metaphysis of the proximal femur. Displaced fractures of the distal radius should be reduced anatomically with a broad indication for surgery. A unilateral frame is the method of choice in multi-fragmentary and articular fractures although this procedure carries some disadvantages. Displaced proximal fractures of the head of the humerus should be reduced and fixed operatively. Minimal invasive procedures like tension band fixation lead to better results than fixation with plates. Non-reducible four-part fractures require primary prosthetic replacement. If standard procedures in the treatment of distal fractures of the humerus fail because of severe osteoporosis, tension band fixation may allow functional post-operative treatment. Fractures of the trochanteric region of the femur can be stabilized by several dynamic standard implants that permit early weight bearing. If fixations should fail, corrective osteotomies or changing of implants--in rare cases combined with bone cement--may be necessary. Each case requires an individualized procedure in order to ensure optimal restoration of function and mobility in elderly patients.
This case presents the imaging features of a posterior shoulder dislocation complicated by a rare but surgically relevant lesion of the posterior labrum. Due to the attachment of the posterior capsule to the posterior portion of the labrum, which in itself is attached to the posterior scapular periosteum, stripping of the labrum by the posterior capsule resulted in a posterior labrocapsular periosteal sleeve avulsion.
In a prospective study 104 patients >or=65 years with distal radius fractures (DRF; n=52) and proximal forearm fractures (PHF; n=52) were followed up for a period of 4 months after injury. As an inception- cohort study, influence on treatment pattern was not part of the examination. A total of 53% of the DRF and 74% of the PHF patients underwent surgery. There were no significant changes in the ability of daily living management (IADL) with either fracture form. Functional outcome was better in PHF than DRF patients. PHF patients showed a high incidence in "fear of falling" throughout the whole study, whereas fear of falling rose significantly in DRF patients. 4% of DRF and 9.6% of PHF patients died during the observation period, while 6% of DRF and even 17% of PHF patients had to give up their own housekeeping. One third of both patient groups did not receive physiotherapy. In only 12% of DRF and 6% of PHF patients was osteoporosis treated. In both groups of patients there was a significant worsening in the ability of walking after injury, leading to two or more new falls in 24% of DRF and 28% of PHF patients.
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Intrathoracic displacement of the humeral head occurred in a man in association with fracture of the surgical neck of the humerus. This report describes the mechanism of the injury and a method of operative exposure.
The authors describe arthroscopic reduction and percutaneous fixation of greater tuberosity fractures of the humerus with displacement of more than 0.5 cm. Arthroscopy for reduction and fixation of this fracture presents the same difficulties and advantages as arthroscopic repair of rotator cuff tears.
Competitive athletics in school-aged children has become the norm rather than the exception. The increased repetitive stresses placed on the upper extremity in a wide variety of sports result in a host of injuries unique to the skeletally immature athlete. This article focuses on a discussion of the more common upper extremity injuries encountered in the child athlete and the role of radiography and MRI in diagnosis and management.
Although it is much less common than injuries in the lower extremities, an upper extremity stress injury can have a significant impact on an athlete. If an accurate and timely diagnosis is to be made, the clinician must have a high index of suspicion of a stress fracture in any athlete who is involved in a throwing, weightlifting, or upper extremity weight-bearing sport and presents with chronic pain in the upper extremity. Imaging should play an integral role in the work-up of these patients; if initial radiographs are unrevealing, further cross-sectional imaging should be strongly considered. Although a three-phase bone scan is highly sensitive in this regard, MRI has become the study of choice at most centers.
MRI provides excellent soft tissue contrast and allows for multiplanar imaging in anatomic planes. Because of these advantages MRI has become the study of choice for imaging of shoulder pathology. Some structures, such as the rotator cuff, humeral head contour, and glenoid shape, are evaluated well with conventional MRI. When more sensitive evaluation of the labrum, capsule, articular cartilage, and glenohumeral ligaments is required or when a partial-thickness rotator cuff tear is suspected,magnetic resonance arthrography with intra-articular contrast can be performed. For MR arthrography contrast is injected directly into the glenohumeral joint. This article reviews the appearances of normal anatomic structures in MRI of the shoulder and disorders involving the rotator cuff and glenoid labrum.
This self-directed learning module highlights new advances in this topic area. It is part of the chapter on rehabilitation in joint and connective tissue diseases in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article discusses the following: differential features, diagnostic strategy, and rehabilitation management of hip, knee, foot, and shoulder pain; indications, contraindications, and postsurgical management for joint arthroplasty; management of gout and chondrocalcinosis; and rehabilitation issues related to hip and shoulder fracture.
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When a total shoulder arthroplasty is performed, restoration of the anatomy to near normal is important in order to achieve a stable implant. So as not to sacrifice stability, it is not uncommon for soft tissues to be either over tightened or insufficiently released. This article analyzes the various factors to consider in order to obtain appropriate soft-tissue balancing for a successful total shoulder arthroplasty.
To further minimize complications in the currently available arthroplasties and to improve results, the surgeon must understand all aspects of gleno-humeral joint replacement. Many of the important variables for successful results are under the surgeon's control and are discussed in this article.