Aims. The aim of this study was to investigate the agreement in interpretation of the quality of the paediatric hip
Aims. The aim of this study was to establish a reliable method for producing 3D reconstruction of sonographic callus. Methods. A cohort of ten closed tibial shaft fractures managed with intramedullary nailing underwent
Aims. Given the possible radiation damage and inaccuracy of radiological investigations, particularly in children,
Objectives. The aim of this study was to review the current evidence and future application for the role of diagnostic and therapeutic
In-situ assessment of collateral ligaments strain could be key to improving total knee arthroplasty outcomes by improving the ability of surgeons to properly balance the knee intraoperatively.
Aims. The objective of this double-blind randomised controlled trial
was to assess whether
Aims. The aims of this study were to assess the pre- and postoperative incidence of deep vein thrombosis (DVT) using routine duplex Doppler
Aims. This 501-patient, multi-centre, randomised controlled trial sought
to establish the effect of low-intensity, pulsed,
Aims. The aim of this double-blind prospective randomised controlled
trial was to assess whether low intensity pulsed
Background. Although there are predictive equations that estimate the total fat mass obtained from multiple-site
This study evaluates the position of the long
head of biceps tendon using
Aims. To analyze whether the addition of risk-based criteria to clinical examination-based selective
We test the clinical validity and financial implications of the proposed Choosing Wisely statement: “Using
Abstract. Objectives.
The primary aim was to assess the reliability of
Introduction
In recent years, there has been a growing interest to incorporate
Aims. Studies of infant hip development to date have been limited by considering only the changes in appearance of a single
Aims. We investigated the prevalence of late developmental dysplasia of the hip (DDH), abduction bracing treatment, and surgical procedures performed following the implementation of universal
In cartilage tissue engineering (TE),new solutions are needed to effectively drive chondrogenic differentiation of mesenchymal stromal cells in both normal and inflammatory milieu.
The opposable thumb is one of the defining characteristics of human anatomy and is involved in most activities of daily life. Lack of optimal thumb motion results in pain, weakness, and decrease in quality of life. First carpometacarpal (CMC1) osteoarthritis (OA) is one of the most common sites of OA. Current clinical diagnosis and monitoring of CMC1 OA disease are primarily aided by X-ray radiography; however, many studies have reported discrepancies between radiographic evidence of CMC1 OA and patient-related outcomes of pain and disability. Radiographs lack soft-tissue contrast and are insufficient for the detection of early characteristics of OA such as synovitis, which play a key role in CMC OA disease progression. Magnetic resonance imaging (MRI) and two-dimensional
16 to 34% of the population suffer from shoulder pain, the most common cause being rotator cuff tears. NICE guidance recommends using
Aims. To evaluate if union of clavicle fractures can be predicted at six weeks post-injury by the presence of bridging callus on
Abstract. Objectives. To compare the effectiveness of phonophoresis (PH) and conventional therapeutic
Introduction. Articular cartilage injuries have a limited potential to heal and, over time, may lead to osteoarthritis, an inflammatory and degenerative joint disease associated with activity-related pain, swelling, and impaired mobility. Regeneration and restoration of the joint tissue functionality remain unmet challenges. Stem cell-based tissue engineering is a promising paradigm to treat cartilage degeneration. In this context, hydrogels have emerged as promising biomaterials, due to their biocompatibility, ability to mimic the tissue extracellular matrix and excellent permeability. Different stimulation strategies have been investigated to guarantee proper conditions for mesenchymal stem cell differentiation into chondrocytes, including growth factors, cell-cell interactions, and biomaterials. An interesting tool to facilitate chondrogenesis is external
Aims. Although low-intensity pulsed
Introduction. At present, orthopaedic surgeons utilize either CT, MRI or X-ray for imaging a joint. Unfortunately, CT and MRI are quite expensive, non weight-bearing and the orthopaedic surgeon does not receive revenue for these procedures. Although x-rays are cheaper, similar to CT scans, patients incur radiation. Also, all three of these imaging modalities are static. More recently, a new
Staphylococcus aureus is responsible for 60–70% infections of surgical implants and prostheses in Orthopaedic surgery, with cumulative treatment costs for all prosthetic joint infections estimated to be ∼ $1 billion per annum (UK and North America). Its ability to develop resistance or tolerance to a diverse range of antimicrobial compounds, threatens to halt routine elective implant surgery. One strategy to overcome this problem is to look beyond traditional antimicrobial drug therapies and investigate other treatment modalities. Biophysical modalities, such as
Aims. There is no consensus regarding optimum timing and frequency of
Aims. To evaluate whether low-intensity pulsed
In the native articular cartilage microenvironment, chondrocytes are constantly subjected to dynamic physical stimuli that maintains tissue homeostasis. They produce extra cellular matrix (ECM) components such as collagens (type II mainly, 50-75%), proteoglycans (10-30%) and other type of proteins. 1. . While collagen offers a large resistance in tension, proteoglycans are the responsible of the viscoelastic response under compression due to the negative charge they confer to the ECM allowing it to entrap a large amount of interstitial fluid. In pathologic states (e.g. osteoarthritis), this ECM is degenerated and the negative charge becomes unbalanced, losing the chondroprotective properties and resulting on an overloaded chondrocytes that further degenerate the matrix. Low-Intensity Pulsed
Pressure ulcers are a common occurrence in individuals with spinal cord injuries, and are attributed to prolonged sitting and limited mobility. This therefore creates the need to better understand soft tissue composition, in the attempt to prevent and treat pressure ulcers. In this study, novel approaches to imaging the soft tissue of the buttocks were investigated in the loaded and unloaded position using
Abstract. Objectives. Three-dimensional visualisation of sonographic callus has the potential to improve the accuracy and accessibility of
Introduction and Objective. Nonunion is incomplete healing of fracture and fracture that lacks potential to heal without further intervention. Nonunion commonly presents with persistent pain, swelling, or instability. Those symptoms affect patient quality of life. It is known that using low intensity pulsed
Sonographic callus may enable assessment of fracture healing. The aim of this study was to establish a reliable method for three-dimensional reconstruction of sonographic callus. Patients that underwent non-operative management of displaced midshaft clavicle fractures and intramedullary nailing of tibia fractures were prospectively recruited and followed to union.
The prevalence of pseudotumours in patients with large-head metal-on-metal (MOM) THA has been the subject of implant recalls and warnings from various regulatory agencies. To date, there is no consensus on whether
Background: Screening modalities in early detection of DDH remain controversial worldwide despite of universal accessibility to
Hip fractures are associated with poor outcomes and high mortality rates of 30%. The current gold standard to measure bone fragility is a Dual-Energy X-ray Absorptiometry (DEXA) scan measuring bone mineral density. Yet DEXA under-diagnoses bone fragility by 50% (1). To combat the burden of bone fragility, this experimental study combined
When compared to magnetic resonance imaging (MRI),
Purpose.
Introduction. The objective of this study is to assess the use of
Introduction. Failure rates of Metal-on-Metal (MoM) ASR XL hip implants have been unacceptably high compared with other bearing surfaces, so patients must be monitored over the time checking for disorders in clinical condition, blood tests or in diagnostic imaging. Objectives. We have carried out a continuing prospective investigation to evaluate the relationship between blood metal ions measurements and
Quantitative
The treatment of extremity ballistic injury is challenging in that the zone of injury can be extensive and determining the surgical exposure can be difficult. We describe a method of pre-operative evaluation of the zone of injury in conjunction with the regional anesthesiologist utilizing
We have examined the accuracy of 143 consecutive
Aims. The purpose of this study was to analyze the incidence of the different
Aims. The objective of this study is to assess the use of
This study was designed to test the hypothesis
that the sensory innervation of bone might play an important role
in sensing and responding to low-intensity pulsed
The prevalence of pseudotumours in patients with large-head metal-on-metal (MOM) THA has been the subject of implant recalls and warnings from various regulatory agencies. To date, there is no consensus on whether
Introduction:. Instability and synovitis of the lesser metatarsalphalangeal (MTP) joints is a significant cause of forefoot pain. Plantar plate imaging traditionally has been through MRI and fluoroscopic arthrography. We have described
Percutaneous fixation of scaphoid fractures has become popular in recent years, mainly due to its reduced complexity compared to open surgical approaches. Fluoroscopy is currently used as guidance for this percutaneous approach, however, as a projective imaging modality, it provides only a 2D view of the complex 3D anatomy of the wrist during surgery, and exposes both patient and physician to harmful X-ray radiation. To avoid these drawbacks, 3D
We have evaluated in vitro the accuracy of percutaneous and
Improving the accuracy of measuring 6 degree of freedom tibiofemoral kinematics is a crucial step in gait analysis, but skin-marker estimated kinematics are subject to soft tissue artefacts. Fluoroscopic systems have been reported to achieve high accurate kinematics, but their induced irradiation, limited field of view, and high cost hampers routine usage on large patient cohorts. The aim of this study is to assess the feasibility of measuring tibiofemoral kinematics using multi-channel A-mode
Of the 34 723 infants born between 1 June 1992 and 31 May 2002, the hips of 2578 with clinical instability or at-risk factors for developmental dysplasia of the hip were imaged by
The use of
Non-operative management of displaced olecranon fractures in elderly low demand patients is reported to result in a satisfactory outcome despite routinely producing a nonunion. The aim of this study was to assess whether there is evidence of dynamic movement of the fracture fragment during the elbow arc of movement. Five consecutive patients (≥70 years of age) with a displaced olecranon fracture (Mayo 2A) that were managed with non-operative intervention were recruited. All underwent
Shoulder pain or loss of normal range of motion is a frequent complaint in the outpatient clinic. Of these presentations, rotator cuff injury is a common cause. This can range from mild, transient inflammation of the tendons, to partial tears of tendons, or even full thickness tears. Disruption of the tendons can occur from forceful forward throwing actions undertaken in some sports, for example baseball pitching, more commonly in the UK however, chronic impingement can lead eventually to a tendon tear-usually seen in an older population. Current methods of investigation of such injuries after clinical history and examination, includes plain film radiography, ultrasonography, magnetic resonance imaging and arthrography. We decided to look at how
Reduction therapy in developmental dysplasia of the hip (DDH) is initialized in the newborn period. Harness treatment is continued until normal ultrasound-values are reached. Above the age of one year the assessment of DDH relies mainly on interpretation of plain radiographs of the pelvis. In order to rule out residual dysplasia after
Aim. The present study aimed to assess the accuracy of preoperative departmental
X-ray is the standard method for monitoring fracture healing however it is not ideal; signs of healing are not normally visible on X-ray until around 6–8 weeks post fracture. Ultrasonography allows the detection of both the initial haematoma, usually formed immediately after fracture, and the small calcium deposits laid down between broken bone ends in the first stages of fracture healing. It has been reported that these early indicators of the healing process are visible as early as 1–2 weeks after fracture. We use Freehand 3D
Purpose: The aim of the study was to assess the usefulness of
The use of shoulder
Introduction: Acoustic microscopy for medicine and biology has been developed for more than twenty years at Tohoku University [. 1. –. 8. ]. Application of acoustic microscopy in medicine and biology has three major features and objectives. First, it is useful for intra-operative pathological examination because staining is not required. Second, it provides basic acoustic properties to assess the origin of lower frequency ultrasonic images. Third, it provides information on biomechanical properties at a microscopic level because
If the lower re-rupture in operative treated patients was an effect of tendon-end apposition, then patients in whom that could be demonstrated in equinus by
Introduction: The quality of newborn hip screening is usually measured as the number of late detected cases of hip dysplasia. There is no consensus concernig the use of ultrasonography in hip joint screening in newborns. At our hospital the number of late detected cases was around 2/1000 births using clinical screening. In a prospective, randomised study we compared universal
Early detection and management of developmental dysplasia of the hip (DDH) yields simpler and more effective the treatment. Diagnosis by
Postero-lateral rotator instability (PLRI) is the most common pattern of recurrent elbow instability. Unfortunately, current imaging to aid PLRI diagnosis is limited. We have developed an
Imaging of the musculoskeletal system is vital for delivering optimum treatment particularly in the assessment of fracture healing. X-ray and CT are adequate imaging methods for bone but, soft tissue needs other modalities such as MRI and
The hips of 1000 newborn babies were examined clinically and by ultrasonography. The
Aim: To audit the impact of emergency hip
Purpose of the study: Prenatal screening and search for risk factors has lead to early diagnosis of congenital hip dysplasia. The percent of excentration of the dysplastic hip can be quantified with ultrasonography. The purpose of this study was to evaluate the usefulness of
Introduction. In this work, we present the first real-time fully automatic system for reconstruction of patient-specific 3D knee bones models using
A challenging problem in
This study of collegiate basketball players evaluated change over time (COT) in
Aims: Clinical methods do not provide direct quantitative information about cartilage functional properties. We have developed a novel handheld
This study evaluates high power low frequency
Introduction and Objectives: This study reviews the results of osteoarticular
Background.
Hypothesis: If the lower re-rupture in operative treated patients was an effect of tendon-end apposition, then patients in whom that could be demonstrated in equinus by
INTRODUCTION:. Previous modalities such as static x-rays, MRI scans, CT scans and fluoroscopy have been used to diagnosis both soft-tissue clinical conditions and bone abnormalities. Each of these diagnostic tools has definite strengths, but each has significant weaknesses. The objective of this study is to introduce two new diagnostic, ultrasound and sound/vibration sensing, techniques that could be utilized by orthopaedic surgeons to diagnose injuries, defects and other clinical conditions that may not be detected using the previous mentioned modalities. METHODS:. A new technique has been developed using
Lateral Epicondylitis is a common condition caused by angiofibroblastic hyperplasia of the tendinous insertion. Its treatment is varied and includes rest, physiotherapy, corticosteroid injection and surgical release. Of late, the role of Platelet Rich Plasma (PRP) injections have been explored, with positive results. We prospectively assessed the outcomes of lateral epicondylitis treated with PRP injections and compared the outcomes of
Purpose. There are concerns of soft-tissue reactions such as metal hypersensitivity or pseudotumors for metal-on-metal (MoM) bearings in hip arthroplasty, however, such reactions around ceramic or polyethylene bearings are incompletely understood. The present study was conducted to examine the capabilities of
Ruptures of the patellar and/or quadriceps tendon are rare injuries requiring immediate repair to re-establish knee extensor continuity and to allow early motion.
The aim of this study was to evaluate whether universal (all neonates) or selective (neonates belonging to the risk groups)
A less invasive surgical treatment of clubfoot is increasingly considered, it aims to limit extensive exposure, to improve the functional and cosmetic outcome and to lower the risk of stiffness and recurrence of the deformity. The Ponseti method consists in an original casting technique followed, only in the most resistant clubfeet, by a percutaneous Achilles tenotomy. Critical decision is the selection of the clubfeet which needs tenotomy. Purpose of this study was to determine if
Introduction: Lesser metatarsophalangeal joint (MTPJ) instability is a common cause of forefoot pain. Instability is probably caused by tears of the plantar plate and collateral ligaments. We prospectively compared MRI and
Eighty-two consecutive patients with forefoot pain and clinical signs strongly suggesting a neuroma all underwent
The “Toddler Fracture” is an un-displaced oblique distal tibia fracture seen in children 9–36months of age presenting with refusal to walk, often after an unwitnessed or minor injury. Diagnosis is often made clinically, because initial x-rays are negative in up to 50% of patients, and then confirmed by the presence of periosteal reaction on follow up x-ray 7–10 days later. Point of Care
This paper reports a prospective study of the value of ultrasonography in detecting lesions of the lumbar spine in patients with compressive sciatica. The measurements of the diameter of the spinal canal obtained by using
Background. We searched -in transverse
Aims: Low-intensity pulsed
We compared the results of primary ultrasonographic examination of 163 children with 224 suspected fractures with the subsequent radiological findings. The aim was to assess the value of
INTRODUCTION. A detailed clinical examination and investigations are required to evaluate the cause of persisting groin pain following a metal on metal (MoM) hip replacement. Adverse reaction to metallic debris (ARMD) is an emerging problem with MoM hip replacements. It is an umbrella term encompassing metallosis, pseudo-tumors and aseptic lymphocytic vasculitis associated lesions (ALVAL). The role of imaging in the diagnosis of this complex problem is still unclear. A study was undertaken to evaluate the efficacy of
BACKGROUND: With the improvement of the
Introduction (Statement of purpose): Majority of the hips that are borderline on
Congenital Talipes Equinovarus (CTEV) is one
of the most common congenital limb deformities. We reviewed the records
of infants who had received treatment for structural CTEV between
1 January 2007 and 30 November 2012. This was cross-referenced with
the prenatal scans of mothers over a corresponding period of time.
We investigated the sensitivity, specificity, and positive and negative
predictive values of the fetal anomaly scan for the detection of CTEV
and explored whether the publication of Fetal Anomaly Screening
Programme guidelines in 2010 affected the rate of detection. During the study period there were 95 532 prenatal scans and
34 373 live births at our hospital. A total of 37 fetuses with findings
suggestive of CTEV were included in the study, of whom 30 were found
to have structural CTEV at birth. The sensitivity of screening for
CTEV was 71.4% and the positive predictive value was 81.1%. The negative
predictive value and specificity were more than 99.5%. There was
no significant difference between the rates of detection before
and after publication of the guidelines (p = 0.5). We conclude that a prenatal fetal anomaly
Background: DDH represents a spectrum of anatomical abnormalities in which the femoral head and the acetabulum are either in improper alignment or grow abnormally. Although screening leads to earlier identification, 60–80% of abnormal hips of newborns identified by physical examination resolve spontaneously by 2–8 weeks and 90% of the hips of newborns with mild dysplasia identified by
Introduction. Plantar fasciopathy is a common cause of heel pain, and is usually treated in primary practice with conservative measures. Intractable cases can prove very difficult to treat. Currently plantar fasciopathy is not routinely imaged and treatment is empirical. At the Royal Surrey County Hospital patients with intractable plantar fasciopathy are managed in a unique ‘one-stop’ Heel Pain clinic. Here they undergo clinical assessment,
Aim: To evaluate the accuracy of