J Bone Joint Surg Br
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J Bone Joint Surg Br · May 1986
Comparative StudyMagnetic resonance imaging and discography in the diagnosis of disc degeneration. A comparative study of 50 discs.
The lumbar spines of 22 patients were examined for disc degeneration by magnetic resonance imaging (MRI) and by discography. The results from 50 intervertebral discs visualised by both techniques were independently assessed and graded on a five-point scale from normality to gross degeneration and then compared. ⋯ MRI was shown to be more accurate than discography in the diagnosis of disc degeneration. It has several major advantages, which should make it the investigation of choice.
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J Bone Joint Surg Br · May 1986
Exposure of the hip by anterior osteotomy of the greater trochanter. A modified anterolateral approach.
Exposure of the hip by osteotomy of the anterior part of the greater trochanter is described. This maintains the continuity of the tendinous junction between the anterior half of gluteus medius and the vastus lateralis and preserves intact the insertion of gluteus minimus into the anterior surface of the trochanter. ⋯ The approach can be extracapsular or intracapsular. Reattachment of the osteotomised fragment is simple, and upward displacement after operation, as sometimes seen after complete osteotomy of the greater trochanter, cannot occur.
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Twelve cases of sternal injury associated with spinal fractures have been reviewed. The sternum is regularly buckled or fractured in patients with high thoracic spinal fractures. ⋯ A displaced fracture of the thoracic spine, with or without an associated sternal fracture, can produce significant widening of the mediastinal shadow on a chest radiograph. This is caused by a paravertebral haematoma, and can be difficult to differentiate from widening due to an aortic rupture.
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Forty-six children with Monteggia fracture-dislocations have been studied. The circumstances of the accident could rarely be recalled so that the mechanism of injury remains unclear. ⋯ Our review also supports the classification into three basic types of Monteggia lesion according to the direction of displacement of the dislocated radial head. For simplicity, all other types, variations or equivalents can be regarded as belonging to these basic patterns; in particular we include those controversial cases in which the radiohumeral dislocation is combined with a fractured olecranon.
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Fourteen patients with ankylosing spondylitis had an extension osteotomy for severe flexion deformity of the spine. The Smith-Petersen technique was modified by using a compression device which allows a slow, finely controlled closure of the osteotomy, and provides rigid internal fixation. There were no serious neurological complications. All the patients were able to see straight ahead after operation, and all had solid fusion at nine months, having maintained good correction.