Concepts in glenoid tracking and treatment strategies of glenoid bone loss are well established. Initial observations in our practice in Singapore showed few patients with major bone loss requiring glenoid reconstructions. This led us to investigate the incidence of and the extent of bone loss in our patients with shoulder instability. Our study revealed
The aim of this study was to determine the position of the glenoid’s “Bare Spot” in a large number of cadaver specimens. The “Bare Spot” area of the glenoid has been used to determine the presence and size of a
Aim: The aim of the present study was to evaluate the functional results of the Latarjet procedure. Moreover we analysed the prevalence of glenohumeral OA after this intervention. Patients and Methods: Forty patients were included in the study. All the patients were clinically evaluated according to the system of Rowe, Duplay and Constant. X-ray evaluation was useful to detect
Purpose of the study: Depending on the series, fractures of the anteroinferior glenoid labrum have been reported in 3% to 90% of patients with anterior shoulder instability. These fractures disrupt the physiological glenoid concavity and shorten the effective length of the glenoid arch. Indications for treatment depend on the size of the fragment and range from osteosynthesis to resection or suture. We hypothesized that these lesions could be treated arthroscopically (Bankart procedure with fragment suture). The purpose of this work was to analyze clinical and radiological outcome observed in nine patients with anterior instability associated with significant glenoid fracture. Material and methods: This was a monocentric study of a continuous series of nine glenoid fractures associated with anteromedial dislocation in nine patients (three women and six men), mean age 35.5 years (range 17–75 years). Preoperatively, all of the fractures were considered to involve more than 25% of the glenoid surface. After detaching the capsulolabral lesion with the bony fragment and avivement of the anterior border, the Bankart procedure was performed with anchors and resorbable sutures. The shoulder was strapped for six weeks with passive rehabilitation (pendulum movements) initiated early. Results: Mean follow-up was 27 months (range 12–48 months). There were no cases of recurrent instability. Seven patients were very satisfied and two were satisfied. Eight patients were able to resume their sports activities at the same level. Apprehension developed in all patients. At last follow-up, joint motion was normal for eight of the nine patients, the Duplay score was 100 for eight patients and 45 for one. All
Aim: Traumatic shoulder dislocation in patients older than 50 years is an unusual injury with specific anatomic lesions and different treatment considerations than these encountered in younger patients. We present our experience in treating such kind of injuries. Patients-methods: Between January December 2002 9 patients-4 males, 5 females – with ages ranging between 50–72 years (mean age 64 y.), have been treated in our department suffering from first traumatic shoulder dislocation. Rehabilitation program and overall recovery progress was observed in an outpatient basis while postoperative outcome was evaluated using ASES and UCLA rating scores. Results: In 4 patients rotator cuff tear was found and reconstructed by suturing the lesion. One (1) of these patients, who had a coexisted
Purpose of the study: The purpose of this retrospective study was to analyze clinical datao n pigmented villon-odular synovitis (PVSN) of the knee as well as outcome after treatment in order to define the diagnostic stages, the surgical treatment, and follow-up modalities for this rare benign proliferative disease of the synovial which predominantly affects the knee joint. Material and methods: Between 1996 and 2004, 28 patients were managed in our department, 13 men and 15 women, diffuse PVNS in 20 and localized PVNS in 8. IN the localized forms, symptoms were similar to those observed in knees with intra-articular foreign bodies or a meniscal lesion (75%) was present for 14 months on average at the first consultation. Mean age at onset of therapeutic management was 40 years (range 20–62). Localized arthroscopic or open resection was performed. For the diffuse forms, symptoms had been present for 15 months on average at the first consultation. Patients sought medical care because of spontaneous hemarthrosis or diffuse knee pain with no specific signs. Mean age at onset of therapeutic management was 38 years (range 15–59).
The management of
Background. Revision surgery for a failed metal on metal (MoM) hip arthroplasty is often unpredictable and challenging due to associated massive soft tissue and
Heterotopic ossification (HO) is the formation of bone at extra-skeletal sites. Genetic diseases, traumatic injuries, or severe burns can induce this pathological condition and can lead to severe immobility. While the mechanisms by which the
Because of
Purpose. The hip region is the second most common site for tuberculosis following the spine in children. The aim is to describe the variable radiological patterns of presentation and their resemblance to pyogenic infection, tumours and other benign conditions of bone in children. Methods. The clinical and radiological records of 29 children aged 10 months–13 years with confirmed tuberculosis of the hip region seen between 1990 and 2011 were reviewed retrospectively. Clinical features were pain, limp and flexion, adduction contractures. Abscesses and sinuses were seen in 4 children. The ESR ranged between 7–110 mm/hr. Mantoux was positive in 20 children. All cases were histologically confirmed. Treatment involved biopsy, currettage of bone defects, limited synovectomy and adductor tenotomy. Patients were immobilised for 4 weeks on a spica cast or traction. Antituberculous treatment was administered for 9–12 months. Results. Radiologically 9 lesions were extra-articular and 20 involved the joint synovium and articular surface. Extra-articular lesions were seen in the pubis, greater and lesser trochanter, ilium, proximal femur and peri-acetabular regions. Intra-articular lesions were seen in the femoral head, neck and acetabulum. Dislocations and subluxations occurred in 8 patients; various lesions mimicked pyogenic arthritis, idiopathic chondrolysis, chondrobastoma, Perthes disease, eosinophilic granuloma and osteoid osteoma. Follow up ranged between 8 months and 5 years. Good range of movement was seen in 20 children. Nine children had flexion adduction contractures, four of these had ankylosed hips and five required abduction extension osteotomies. Other changes seen were coxa vara (2) coxa magna (1) and avascular necrosis (3). Conclusion. The variable radiological picture of tuberculosis of the hip region can mimic various osteoarticular conditions in children. Biopsy is essential and should be taken from the
MRI arthography (MRA) is commonly used in the investigation of shoulder instability. However many surgeons are now using CT arthography (CTA) as their primary radiological investigative modality. They argue that CTA is cheaper, and give satisfactory soft tissue images in the “soft tissue window” mode. They believe that CTA give superior images when looking at bone loss and bony defects, and as such is more useful in deciding whether a patient requires an open procedure or not. In this study we aimed to compare the results of MRA and CTA in the investigation of shoulder instability. We reviewed the operative and arthographic findings in all patients who had surgery for shoulder instability in our unit over a 4 year period. We compared the results of the arthograms with the definitive findings found at the time of surgery. All arthograms were performed by standard techniques and were reported by musculoskeletal radiology consultants. All surgery was performed by experienced consultant shoulder surgeons. In total 48 CTAs and 50 MRAs were performed. We found that there was no significant difference between the two wrt sensitivity (p=0.1) and specificity (p=0.4) when looking at labral pathology. However CTA was more sensitive at picking up
Background. Bone lesions in Ewing's sarcoma (ES/PNET) have been traditionally diagnosed with bone Scan. PET-scan is emerging as a promising investigative modality for detection of metastatic lesions. In this prospective study, we compare the utility of both to detect the metastatic sites. Methods. One hundred and seventy five histologically proven cases of ESPNET from 2004-2009 were prospectively staged with bone scan and PET-scan with Breath- hold CT scan- thorax. The diagnostic value of PET-scan to pick up metastatic lesions was compared with bone scan. Results. The site of primary disease was axial in 62(35.4 %) patients, appendicular in 94(53.7 %) patients, and extraskeletal in 19 (10.8 %) patients. 24(13.7 %) patients were metastatic at presentation, while 151(86.2 %) patients had localized disease. In all patients with localized disease, bone scan did not detect any lesion other than that detected on PET-scan. In metastatic patients, PET-scan detected 12 patients with lymph node involvement which were not detected by bone scan, 10 patients were found to have lung metastasis by PET scan with breath-hold CT thorax, bony metastases were seen in two patients where the number and site of lesions were same in both PET and bone scan. In 19 patients with extraskeletal PNET, PET scan detected primary lesion in all while the bone scan was non-avid in any of these. Conclusion. PET- Scan was able to detect all the
The Latarjet procedure utilises the coracoid as a vascularised bone autograft to augment the glenoid in patients with shoulder dislocation, especially where there is a
Hemangioendothelioma is a rare vascular tumor that is infrequently recognized in bone. It can be multicentric and often painful with an indolent course. The treatments of choice include curettage, resection, radiation, systemic medications or a combination of these modalities. O.G. 5 years old girl, presented with left ankle pain and limping, without response to non steroidal anti-inflammatory drugs for few months. Radiological investigation (MRI) showed a lytic vascular lesion in the methadiaphysis, invading the epiphysis of the distal left tibia and lateral cartilage of the ankle, with atrophy of the left lower limb. Bone scan showed high uptake in this area. Histology showed fragments of bone, infiltrated by a vascular lesion with nodular pattern, well differentiated vascular spaces and endothelial cells with few mitotic figures. Immunostains were positive for CD31 and F8. The pathology report confirmed hemangioendothelioma. As the lesion invaded the growth plate of the distal tibia, surgical or radiation therapy at this age could cause a permanent damage. We therefore successfully treated the child with Interferon α–2β 0.5 million IU three times a week for 18 months. She was pain free after the first few months of therapy with full recovery of daily function and activity. Radiological evaluation showed improvement on X-ray and MRI, and shrinkage of the lesion to the epiphysis area only. Unfortunately, 3 years later the pain and limping reappeared. MRI showed a lytic lesion in the diamethaphysis of the left tibia. Re-biopsy supported the diagnosis of recurrent hemangioendothelioma. She was retreated with Interferon α–2β using the same protocol with considerable improvement of the pain and limping. We present here a non invasive option for therapy with Interferon α–2β for
Shoulder Instability impacts on the ability of military personnel to fulfil their operational role and maintain sporting competence. Magnetic Resonance Imaging (MRI) and Arthrogram (MRA) are increasingly available as diagnostic adjuncts. We analysed MR reports from personnel undergoing stabilisation, correlating clinical diagnosis with operative findings and reviewed the literature in order to recommend improvements. We report a retrospective, consecutive case note analysis of 106 personnel undergoing open anterior capsulolabral reconstruction (ACLR) by a single surgeon. Seventy patients had MR (48 MRA, 22 MRI). Commonly reported pathology included Hill Sachs Lesions (41%), Soft tissue (59%) and
The management of
Aims: Lateral ligament complex injuries are a common cause of chronic ankle instability. It has been found that functional and mechanical instability of the ankle joint can respond to arthroscopic debridement of the ankle alone and that not all structurally unstable joints require stabilisation. The aim of this study was to find out the role of EUA &
Arthroscopy in the management of these problems. Methods: We retrospectively studied 43 patients with chronic lateral ankle instability who had failed to respond to a functional rehabilitation programme. All patients underwent an examination under anaesthesia with stress views to determine instability proceeded by arthroscopic examination of the ankle. Results: Intra-articular
Shoulder Instability impacts on the ability of military personnel to fulfil their operational role and maintain sporting competence. Magnetic Resonance Imaging (MRI) and Arthrogram (MRA) are increasingly available as diagnostic adjuncts. We analysed MR reports from personnel undergoing stabilisation, correlating clinical diagnosis with operative findings and reviewed the literature in order to recommend improvements. This was a retrospective, consecutive case note analysis of 106 personnel undergoing open anterior capsulolabral reconstruction (ACLR) by a single surgeon. 70 patients had MR (48 MRA, 22 MRI). Commonly reported pathology included Hill Sachs Lesions (41%), Soft tissue (59%) and
Aims Lateral ligament complex injuries are a common cause of chronic ankle instability. It has been found that functional and mechanical instability of the ankle joint can respond to arthroscopic debridement of the ankle alone and that not all structurally unstable joints require stabilisation. The aim of this study was to find out the role of examination under anaesthesia (EUA) and arthroscopy in the management of these problems. Method We retrospectively studied 43 patients with chronic lateral ankle instability who had failed to respond to a functional rehabilitation programme. All patients underwent an EUA with stress views to determine instability, proceeded by arthroscopic examination of the ankle. Results Intra-articular