Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 1992
Comparative StudyMRI of the knee joint with a 3-D gradient echo sequence. Equivalent to diagnostic arthroscopy?
Three-dimensional (3-D) gradient echo sequences offer the advantage of volume imaging within a few minutes scanning time and creating thin contiguous slices. An optimized sequence (FISP 3D 40) was evaluated for its potential to detect lesions of the menisci, cruciate ligaments, and articular cartilage in 80 patients compared to arthroscopy as the standard. Magnetic resonance imaging showed a sensitivity of 97.9%, a specificity of 97.3%, and an accuracy of 97.5% for meniscal lesions, and a sensitivity of 100%, a specificity of 97.1%, and an accuracy of 97.5% for lesions of the cruciate ligaments. ⋯ Measurement of mean signal intensity (95% confidence intervals) was more useful to discriminate normal from abnormal cartilage (grades 1-3). This method promises the capability to detect early stages of oestoarthritis in future. The present results show MRI of the knee joint with a 3-D fast imaging technique to be a noninvasive alternative to diagnostic arthroscopy.
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The cases of 80 patients with necrosis of the femoral head who underwent operative treatment in the period April 1980 to April 1988 are reported. Altogether, 102 operative procedures were carried out: 48 intertrochanteric osteotomies, 50 arthroplasties, 3 subchrondral bone graftings, and in one case drilling of the necrotic focus. Joint-preserving methods in advanced-stage disease seem to be of doubtful use when judged by clinical and socio-economic criteria over a mean follow-up time of 4.5 years. Since no conservative treatment exists, an improvement in therapeutic results can only be achieved by early diagnosis using magnetic resonance imaging and operating when the disease is still at an early stage.
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Arch Orthop Trauma Surg · Jan 1992
Aneurysmal bone cyst. A review of 52 primary and 16 secondary cases.
Authors report on the results of treatment of 52 primary and 16 secondary aneurysmal bone cysts (ABC). ABC grow rapidly; 84% of them have already destroyed more than the half of the bone width at recognition. En bloc resection is preferred when the ABC is growing superficially and eccentrically and more than half of the bone width is intact. ⋯ The 16 cases of secondary ABC were observed mostly in association with osteoblastomas, giant-cell tumors, and osteosarcomas. The incidence of the secondary ABC was 23% in the whole ABC group but not more than 2-4% among the osteosarcomas and giant-cell tumors. Secondary ABC may confuse the histological and clinical diagnoses and that, especially in cases of osteosarcoma, may have fatal consequences.
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Arch Orthop Trauma Surg · Jan 1992
Case ReportsIdiopathic acro-osteolysis in an elderly woman. A 10-year follow-up.
We report a case of idiopathic acro-osteolysis in an 80-year-old, otherwise normal woman. The patient first presented at the age of 70 years with a 3-year history of progressive shortening of the left toes. ⋯ Angiography was normal. During follow-up over 10 years the osteolysis gradually progressed and spread to affect the right toes.
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Arch Orthop Trauma Surg · Jan 1992
No physiologic age-related increase of circulating somatomedin-C during early stage of Perthes' disease: a longitudinal study in 21 boys.
Perthes' disease was originally viewed as a local ischaemic necrosis of the femoral head. Several authors, however, have presented data suggesting that children with this disease also suffer from a general disorder of skeletal maturation. Hormonal changes in the hypothalamus-pituitary-growth plate axis have been discussed as a possible underlying cause and contradictory results reported on the role of the somatomedins in this process. ⋯ The physiologic increase with age of plasma Sm-C levels in the control group was either absent or diminished in children with early-stage Perthes' disease (P less than 10(-6), signs test). The Sm-C values in affected children were low. Our data correlate well with reports from others of retarded skeletal maturation in children with Perthes' disease and support the hypothesis of an accompanying disorder of the synthesis or release of Sm-C/IGF-I or its binding proteins.