We reports the accuracy of direct Magnetic Resonance Arthrography (MRA) in detecting Triangular Fibrocartilage Complex (TFCC), Scapho-Lunate Ligament (SLL) and Luno-Triquetral Ligament (LTL) tears using wrist arthroscopy as the gold standard. We reviewed the records of all patients who underwent direct wrist MRA and subsequent arthroscopy over a 4-year period between June 2007 and March 2011. Demographic details, MRA findings, arthroscopy findings and the time interval between MRA and arthroscopy were recorded. The scans were performed using a 1.5T scanner and a high resolution wrist coil. All scans were reported by a musculoskeletal radiologist. Sensitivity, specificity, positive and negative predictive values (PPV & NPV) were calculated.Introduction
Methods
The number of patients undergoing total hip replacement surgery is rising and thus the number of periprosthetic fractures is set to increase. The risk factors for periprosthetic fractures include osteolysis, rheumatoid arthritis, osteoporosis and use of certain types of implants. Evidence from literature suggests that the mortality rate within one year is similar to that following treatment for hip fractures thus as surgeons it is important for us to understand the various management strategies of these fractures. Acetabular periprosthetic fractures are uncommon and classified into Type I, in which the acetabular component is radiographically stable and Type II, in which the acetabular component is unstable. It is better to prevent than to treat these fractures. Femoral periprosthetic fractures have several classifications the most commonly used is the Vancouver classification (fig 1). Type-A fractures are proximal and can involve the greater or lesser trochanter. These are often related to osteolytic wear debris and therefore revision of the bearing surface with bone grafting is recommended. AG involves the greater trochanter and AL involves the lesser, and these can usually be stabilised by cerclage wires supplemented by screws or plates if required (fig 2). Management of type B fractures is more controversial and will be discussed in depth with reference to all recent papers at the meeting and data from the Swedish Joint Registry. In summary the management is shown in fig 3. In type-C fractures, one should ensure the fixation device bypasses the femoral stem by at least 2 diaphyseal diameters. Management is as shown in fig 4.INTRODUCTION
MANAGEMENT
