Introduction: Up to 20% of Lisfranc injuries can go unrecognised with resultant long-term morbidity. Spontaneous relocation may mask the injury. Standard AP, lateral and oblique views of the foot are the primary radiological views. Weight bearing views may not be possible acutely and stress views may require anaesthesia. The standard AP view does not show the tarso-metatarsal joint clearly with alignment of the medial border of the second metatarsal to the medial border of the intermediate cuneiform all important. Materials and methods: We used a tangential AP view of the tarso-metatarsal joint taken by tilting the x-ray beam cephalad. The degree of tilt was dictated by the declination angle of the first metatarsal seen on the lateral view of the foot (20–25 degrees for most people). Sixteen patients had standard AP, lateral and oblique views of their foot at the time of injury and were not diagnosed to have a Lisfranc injury. They remained symptomatic for an average period of 5 weeks (range, 2 to 15 weeks) before they had the tangential view of the Lisfranc joint. Results: In all 16 patients the first and second tarso-metatarsal joint and the first inter-metatarsal space were more clearly visible. Thirteen patients had abnormal findings to confirm the diagnosis of Lisfranc injury and for 2 surgical treatment would have been appropriate if identified earlier than 14 and 15 weeks respectively. Discussion and conclusion: This view confirmed the diagnosis in 13 patients who would have otherwise been discharged as a minor soft tissue injury. We have also used this view successfully for injecting local anaesthetic in the tarso-metatarsal joints to elucidate the exact source of pain. We recommend this simple view should be routinely used in addition to the standard AP, lateral and oblique views of the foot for mid foot injuries

Aims

To evaluate how fore- and midfoot coronal plane alignment differs in feet with hallux valgus (HV), using 3DCT when measured in standard weightbearing (SWB) versus sesamoid view (SV) position, and to determine whether first metatarsophalangeal (MTP) dorsiflexion affects the relationship between the first metatarsal (M1) head and the sesamoid bones.

Open reduction and internal fixation of comminuted, displaced intra-articular or potentially unstable fractures of the distal radius with plate and screws has increasingly become a favoured treatment. Intra-operative assessment of fixation with the help of an image intensifier has always been difficult because of the anatomy of the distal radius which has an average ulnar inclination of 22 degrees and an average volar tilt of 14 degrees. These inclination and tilt produce superimposition of images and imaging of the implants placed as distal as possible to achieve satisfactory fixation often shows the screws to be penetrating the joint. We describe two new radiographic views of the distal radius, which we used intra-operatively in ten patients undergoing open reduction and internal fixation of distal radius fractures. These are the tangential views of the articular surface of the distal radius taken by elevating the wrist so that the forearm makes an angle to the operating table to negate the effects of natural inclination and tilt in antero-posterior and lateral views. The images were compared with the images of standard antero-posterior and standard lateral views. Screws were thought to have been penetrating the joint in the standard lateral views of all of them and in the standard antero-posterior views of eight of them. However, no screw was seen penetrating the joint in these new views. The tangential views showed correct relation of the screws with the articular surface and a more distal placement of the plate was possible. This enabled the screws to engage the sub-chondral bone and obtain bi-cortical purchase in presence of dorsal comminution. We recommend use of these views in open reduction and internal fixation of distal radius fractures

Extensor tendon ruptures have been reported in up to 8.8% of patients after volar plating and long screws have been implicated. The dihedral dorsal surface of the distal radius hinders accurate screw length determination using standard radiographic views (lateral; pronation and supination). A ‘dorsal tangential’ view has recently been described, but has not been validated. To validate this view, we mounted a plate-instrumented sawbone onto a jig. Radiographs at different angles were reviewed independently by 11 individuals. Skyline views clearly demonstrated all screw tips, whereas only 69% of screw tips were identifiable on standard views. With screws 2mm proud of the dorsal surface, skyline views detected 67% of long screws (sensitivity). The best of the standard views achieved only 11% sensitivity. At 4mm long, skyline sensitivity was 85%, compared with 25% for standard views. At 6mm long, 100% of long screws were detected on skylines, but only 50% of 8mm long screws were detected by standard views. Inter and intra-observer variability was 0.97 (p=0.005). For dorsal screw length determination of the distal radius, the skyline view is superior to standard views. It is simple to perform and its introduction should reduce the incidence of volar plate-related extensor tendon rupture

Aims: Degradation of articular cartilage in gonarthritis seems to be modiþable pharmacologically. For these to be helpful, early diagnosis is essential. Weight bearing radiograms obtained at various degrees of ßexion, have shown to provide more information about joint space narrowing (JSN). Methods: Between March and November 2001, 28 consecutive patients whom have been admitted to hospital for knee surgery due to knee osteoarthritis, enrolled for study. Their mean age was 57.5 years (in range of 35–78). Extension weight bearing A/P, lateral and tangential views were made on standard examinations. 30û Flexion standing P/A, and at 45û ßexion standing P/A knee xÐrays were made with the consent of patient. Surgical þndings of the cartilage (Outerbridge classiþcation) were compared with radiological þndings. Results: The statistical evaluations revealed that there is no signiþcant correlation between JSN and observed clinical osteoarthritis level at MFC, LFC, and LTP. A signiþcant correlation was found between the degree of JSN measured at weight-bearing A/P, 30û ßexion P/A and 45û ßexion P/A radiographs and the degree of cartilage degradation at MTP (p< 0.05). The semifelxion radiograms were found to demonstrate Conclusions: Radiograms taken at weight-bearing semißexed positions are more effective than standing A/P knee x-rays, in demonstrating the JSN, and JSN þnding is associated only with the medial compartment gon-arthritis. We concluded that the degree of ßexion (30û–45û) during radiographic examination is not an important factor and for the evaluation of the lateral compartment new positions should be deþned

Introduction: Osteolysis is a silent disease with few clinical symptoms until significant bone loss has occurred. Advanced osteolysis, with associated bone loss, can make revision surgery more difficult and compromise the ultimate outcome. In order to delineate the natural history of screw osteolysis in the AMK (Anatomic Modular Knee, Depuy) TKA, a cohort of patient were followed prospectively to determine the incidence and progression of osteolysis. Methods: Between October 1987 and November 1992, 370 patients had 450 uncemented AMK TKA performed at a single institution. Attempts were made to contact all patients in 1993 and 228 patients (280 TKA) agreed to participate in the study. Flouroscopically guided tangential views of the tibial tray were performed and any osteolysis was catalogued by location and graded based on the classification of Lewis et al. Eighty-seven knees had osteolysis for an incidence of 31%, with 52 line, 23 cyst, and 12 cavity. The patients with osteolysis were reassessed 3 years later. No progression was noted in patients with line osteolysis, but two patients with cyst and two patients with cavity had progressive osteolysis. Five knees had been revised for symptomatic osteolysis. This cohort was reassessed by chart and radiograph review in 2000. All patients who initially had cavitary osteolysis had been revised. In addition, 13 patients with cyst osteolysis progressed to cavity and ten knees had been revised. Of the 52 knees that had line osteolysis, 21 progressed to cyst or cavity and 15 knees were revised. Furthermore, 57 additional knees had developed osteolysis with 24 knees being revised. Osteolysis in the AMK is a silent and progressive disorder. We were unable to identify any risk factors that would classify certain patients as at risk for osteolysis. Consequently, we recommend regular periodic follow up in order to recognize osteolysis early