The etiology of TBMOS is not known yet.Possibly, TBMES and osteonecrosis may not be completely separate and distinct conditions. We performed a prospective study in 32 patients, among 1150 with knee pain that were examined, who fullfilled the following criteria: no history of trauma, inconclusive radiographs and MR images demonstrating a bone marrow edema pattern.The mean age of the patients was 45 years (35 to 56).Patients were followed up for three years clinical examination, laboratory examination, xrays, MRI and in most cases T99 scanning and CT scanning. The disease proved to be transient in 8 patients.In three of them edema extended to subchondral bone as in osteonecrosis with an illdefined bandlike signal.The mean width of the signal was 3 mm.In two other cases the type of manifestation has never been reported. We concluded that TBMES can extend to subchondral bone, as osteonecrosis does, through illdefined low signal band like lesions parallel to the articular surface and then resolve completely.It may also have various types of manifestation.We believe that TBME is a common status of different conditions including early avascular necrosis that the bone repair process managed to overcome.
In many cases, treatment of intercondylar T- or Y- fractures of numerous is complex, technically difficult and consideration to many factors is needed. The purpose of this study was to review the results of treatment in 20 isolated fractures in 20 patients that were operated between 1991 and 2001. All patients were operated as soon as possible after the laboratory studies were completed. In no case there was a delay beyond the 5th fracture day. The mean age of the patients was 48.4 years and men to women ratio was 6/1. The fractures were closed, type III according to Riseborough and Radin classification. In 8 cases the fracture was fixed with one 3.5 compression plate with lag screws. In 12 cases two 3.5 compression plates oriented in two planes at 90° angles to each other were needed for fixation. The posterior approach included chevron osteotomy of the olecranon and exposure of the ulnar nerve. Minimum follow up period was 9 months. The time needed for the sound union of the fracture, range of motion and elbow axis were some of the factors that were examined. Five of the eight fractures that were fixed with one plate achieved union in the expected period of time. In two cases delayed union and malalignment was noticed without the need for surgical intervention. In one case grafts were needed to help the union of the osteotomy site. We had one case of myossitis ossificans. All fractures that were fixed with two plates achieved union without any complications. In one case there was a 30° extension lag of the elbow. The rest of the patients, in both groups had a satisfactory range of motion with an extension lag less than 10°.
