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Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_11 | Pages 225 - 225
1 Jul 2014
MRI T2∗ MAPPING TO ASSESS EARLY DEGENERATION OF THE INTERVERTEBRAL DISC IN A LARGE ANIMAL MODEL
Detiger S Holewijn R Hoogendoorn R Helder M Berger F Kuijer J Smit T
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Summary Statement

Conventional imaging techniques lack the ability to objectively assess early stages of intervertebral disc degeneration, characterised by glycosaminoglycan loss. This study shows that MRI T2∗ mapping correlates positively with GAG content and that it provides continuous measurements for disc degeneration.

Introduction

Early degenerative changes arise in the nucleus pulposus (NP) and are characterised by a loss of glycosaminoglycans (GAG). Early disc degeneration (DD) could possibly be treated with upcoming regenerative therapies (e.g. with stem cells and/or growth factors). In order to evaluate degeneration and treatments, a sensitive diagnostic tool is needed. While conventional magnetic resonance imaging (MRI) and x-ray techniques can detect late stages of DD, these techniques lack the ability to detect early degenerative changes. Recently, T2∗ mapping has been proposed as a new technique to evaluate early IVD degeneration, yet the correlation with GAG content and histological features has not been previously investigated. The objective of this study was to determine the value of T2∗ mapping in diagnosing DD by correlating this technique with the biochemical composition of IVDs.

Orthopaedic Proceedings
Vol. 87-B, Issue SUPP_II | Pages 111 - 111
1 Apr 2005
INCIDENCE OF COVER FLAPS FOR SOFT TISSUE LOSS AFTER HIGH-ENERGY LEG FRACTURE: 26 CASES
Bauer B Boyer P Berger F Fabre A Lambert F Levadoux M Rigal S
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Purpose: Prognosis of open leg fractures is better when cover flaps are used early to cover tissue loss. Beyond eight days after high-energy trauma (Byrd stage III and IV), the therapeutic strategy requires discussion. The purpose of this study was to analyse the influence of flap covers on these complex fractures.

Material and methods: We conducted a retrospective analysis of 26 patients operated on from 1996 to 201. The therapeutic sequence was debridement, external fixation, and flap cover. High-energy trauma predominated (n=21). We used homolateral leg flaps (n=24, ten muscle flaps and 14 fasciocutaneous flaps) and free latissimus dorsi flaps (n=2). Flap cover was performed on day 8 (n=13), between day 8 and day 45 (n=11), or after day 45 (n=2).

Results: Cover flaps failed in eight cases requiring revision surgery. Time to cover or type of flap was not statistically related with initial severity of the injury. Time to cover influenced the type of flap chosen by the surgeons: 8/13 muscle flaps performed before day 8 versus 10/13 fasciocutaneous flaps after day 8 (p< 0.05). Complementary bone grafts were used for 18 patients before the third month leading to bone healing before ten months. Serious infection occurred in 16.6% of patients in the group treated before day 8 and in 36.66% of patients in the group treated after day 8. The severity of the initial injury and time to cover were not predictive of functional outcome.

Discussion: Proper management of high-energy leg fractures (Byrd stage III and IV) remains controversial. Most authors prefer external fixation to achieve skeletal stability. The growing interest for plastic surgery techniques for the leg segment has led to using locoregional homolateral leg flaps even after day 8. At this phase, we prefer muscle flaps. This attitude has demonstrated its usefulness in terms of healing time and its limitations due to the high risk of infection. Complementary bone grafting is performed before three months if signs of correct bone healing are absent on the control x-rays.