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 ultrasound (US) and magnetic resonance imaging (MRI).

Twenty-six able-bodied participants (n=26, 13 males and 13 females) were recruited for this study and 1 male with a spinal cord injury. Two visits using US were required, as well as one MRI visit to evaluate soft tissue thickness and composition. US Imaging for the loaded conditions was performed using an innovative chair which allowed image acquisition in the seated upright position and MRI was done in the lateral decubitus position and loading was applied to the buttocks using a newly developed MRI compatible loader. The unloaded condition was a lateral decubitus position. Soft tissue was measured between the peak of the ischial tuberosity (IT) and the proximal femur and skin.

Tissue thickness reliability for US was excellent, ICC=0.934–0.981 with no significant differences between the scan days. US and MRI measures of tissue thickness were significantly correlated (r=0.68–0.91). US underestimated unloaded tissue thicknesses with a mean bias of 0.39 – 0.56 for total tissue and muscle + tendon thickness. When the buttocks were loaded, total tissue thickness was reduced by 64.2±9.1%.

US assessment of soft tissue thicknesses was reliable in both positions. The unloaded measurements using US were validated with MRI with acceptable limits of agreement, albeit tended to underestimate tissue thickness. Tissue thickness, but not fatty infiltration of muscle played a role in how the soft tissue of the buttocks responded to loading.

Thomas WJ, Jenkins EF, Owen JM, Sangster MJ, Kirubanandan R, Beynon C, Woods DA. Treatment of frozen shoulder by manipulation under anaesthetic and injection: does the timing of treatment affect the outcome? J Bone Joint Surg [Br] 2011;93-B:1377-81. doi: 10.1302/0301-620X.93B10.27224.

Koh Y-G, Moon H-K, Kim Y-C, Park Y-S, Jo S-B, Kwon S-K. Comparison of medial and lateral meniscal transplantation with regard to extrusion of the allograft, and its correlation with clinical outcome.

K. A. Jung, C. Restrepo, M. Hellman, H. AbdelSalam, W. Morrison, J. Parvizi. The prevalence of cam-type femoroacetabular deformity in asymptomatic adults. J Bone Joint Surg Br 2011 93-B: 1303-1307.

J. E. Lang, S. Mannava, A. J. Floyd, M. S. Goddard, B. P. Smith, A. Mofidi , T. M. Seyler, R. H. Jinnah. Robotic systems in orthopaedic surgery. J Bone Joint Surg Br 2011 93-B: 1296-1299.

P. Bollars, J.-P. Luyckx, B. Innocenti, L. Labey, J. Victor, J. Bellemans.Femoral component loosening in high-flexion total knee replacement: An in vitro comparison of high-flexion versus conventional designs. J Bone Joint Surg Br 2011 93-B: 1355-1361.

J. Vanbiervliet, J. Bellemans, C. Verlinden, J.-P. Luyckx, L. Labey, B. Innocenti, H. Vandenneucker. The influence of malrotation and femoral component material on patellofemoral wear during gait. J Bone Joint Surg Br 2011 93-B: 1348-1354.

M. Soubeyrand, G. Ciais, V. Wassermann, I. Kalouche, D. Biau, C. Dumontier, O. Gagey.The intra-operative radius joystick test to diagnose complete disruption of the interosseous membrane. J Bone Joint Surg Br 2011 93-B: 1389-1394.

C.-S. Lee, S- S. Chung, S.-K. Shin, S.-J. Park, H.-I. Lee, K.-C. Kang. Differences in post-operative functional disability and patient satisfaction between patients with long (three levels or more) and short (less than three) lumbar fusions. J Bone Joint Surg Br 2011 93-B: 1400-1404.

A. R. Nguyen, J. Ling, B. Gomes, G. Antoniou, L. M. Sutherland, P. J. Cundy. Slipped capital femoral epiphysis: rising rates with obesity and aboriginality in South Australia. J Bone Joint Surg Br 2011 93-B: 1416-1423.

D. Regis, A. Sandri, I. Bonetti, M. Braggion, P. Bartolozzi. Femoral revision with the Wagner tapered stem: A ten- to 15-year follow-up study. J Bone Joint Surg Br 2011 93-B: 1320-1326.

S. S. Jameson, D. Dowen, P. James, I. Serrano-Pedraza, M. R. Reed, D. J. Deehan. The burden of arthroscopy of the knee: A contemporary analysis of data from the English NHS. J Bone Joint Surg Br 2011 93-B: 1327-1333.

M. L. Costa, X. L. Griffin, N. Pendleton, M. Pearson, N. Parsons. Does cementing the femoral component increase the risk of peri-operative mortality for patients having replacement surgery for a fracture of the neck of femur?: Data from the National Hip Fracture Database. J Bone Joint Surg Br 2011 93-B: 1405-1410.

A. P. Monk, H. A. Doll, C. L. M. H. Gibbons, S. Ostlere, D. J. Beard, H. S. Gill, D. W. Murray. The patho-anatomy of patellofemoral subluxation. J Bone Joint Surg Br 2011 93-B: 1341-1347.

J. E. Lang, S. Mannava, A. J. Floyd, M. S. Goddard, B. P. Smith, A. Mofidi , T. M. Seyler, R. H. Jinnah. Robotic systems in orthopaedic surgery. J Bone Joint Surg Br 2011 93-B: 1296-1299.