Introduction. There is a challenge to detect partial tear of the ACL, the number of bundle injured and the proportion of fibers torn. The MRI was shown efficient to individualize the two anteromedial (AM) and posterolateral (PL) bundles of the ACL. The purpose of this study was to assess the ability of the MRI to detect partial tears of the ACL on axial views to display the AM and PL bundles. Materials and methods. This retrospective study included 48 patients (19 partial tears of the ACL, 16 complete rupture of the ACL and 13 normal knee) who underwent both arthroscopy and MRI examinations of the knee. The conventional MRI protocol included one sagittal T1- weighted sequence and 3 proton-density fat sat. The images from MRI were analysis by a radiologist specialized in musculoskeletal imaging who was blinding to the arthroscopic findings. The criteria for the analysis of MRI were divided into primary (those involving the ACL himself) and secondary signs (associated abnormalities). The primary signs included the horizontalisation of the ACL (ACL axis), the global ACL signal intensity and the signal intensity of each AM and PL bundle. The secondary signs included bone bruise, osteochondral impaction, popliteus muscle injury, medial collateral ligament injury and joint effusion. The ACL was classified as normal, partially or totally torn. The rupture of the AM and PL bundle was specified. Results. In our study, MRI was found to have a 75% sensitivity and a 73% specificity for the diagnosis of partial tears of the ACL. The sensitivity to detect AM bundle lesion was 88% but the specificity was 50%. The lack of horizontalisation of the ACL was a very good sign, for partial tears of the ACL, with a sensitivity of 84% and a specificity of 81% (p<0.05). Regarding the secondary signs, there was no significant difference to distinguish partial and complete tear. However, we found that there was a greater probability to find a partial tear of the ACL with the lack of joint effusion, bone bruise and medial collateral ligament injury. Quantifying the proportion of injured fibers was unsuccessful and was found as a failure of the MRI. Conclusions. MRI exhibited lower sensitivity and specificity for partial tear than for complete rupture of the ACL. However 3 important arguments can guide us: the lack of horizontalisation of the ACL, a continuous ACL signal, the display of one of two bundles on the axial view

We have compared the results at a mean follow-up of 13 years (11 to 14) of two groups of supination-external rotation type-4 fractures of the ankle, in one of which there was a fracture of the medial malleolus and in the other the medial deltoid ligament had been partially or completely ruptured. Of 66 patients treated operatively between 1993 and 1997, 36 were available for follow-up. Arthroscopy had been performed in all patients pre-operatively to assess the extent of the intra-articular lesions. The American Orthopaedic Foot and Ankle Society hind-foot score was used for clinical evaluation and showed a significant difference in both the total and the functional scores (p < 0.05), but not in those for pain or alignment, in favour of the group with a damaged deltoid ligament (p < 0.05). The only significant difference between the groups on the short-form 36 quality-of-life score was for bodily pain, again in favour of the group with a damaged deltoid ligament. There was no significant difference between the groups in the subjective visual analogue scores or in the modified Kannus radiological score. Arthroscopically, there was a significant difference with an increased risk of loose bodies in the group with an intact deltoid ligament (p < 0.005), although there was no significant increased risk of deep cartilage lesions in the two groups. At a mean follow-up of 13 years after operative treatment of a supination-external rotation type-4 ankle fracture patients with partial or complete rupture of the medial deltoid ligament tended to have a better result than those with a medial malleolar fracture

Background. Acquired flatfoot deformity goes ahead with a partial or complete rupture and thus insufficiency of the tibialis posterior tendon. We present the results of flexor digitorum longus transfer and medial displacement calcaneal osteotomy to reconstruct the acquired deformity. Material & Methods. Twenty two patients (24 feet) with an average age of 58 (36–75) years were operated on for acquired flexible flatfoot deformity. Two patients had a bilateral procedure. Patients were seen pre-and postoperatively in order to evaluate following parameters: AOFAS hindfoot score, visual analogue scale for pain (0–10), the tarsometatarsal angle on lateral and ap standing x-rays, the cuneiform heights and talocalcaneal angle on lateral standing x-rays and subjective postoperative satisfaction score (1-worst to 5-best). Average time of follow-up was 24.7 months (12–48). Results. The AOFAS hindfoot score could be increased from 46.4 to 89.5 points, the visual analogue scale for pain decreased from 6.6 to 1.1. The average satisfaction score was 4.5 points with one patient scoring 2 and another one scoring 3. All the other patients scored either 4 or 5. All radiological parameters could be improved. Following complications were seen: one recurrence, two patients with irritation of the sural nerve, one patient with hypesthesia of the big toe. The calcaneal screws had to be removed in 3 patients. Conclusion. Flexor digitorum longus transfer together with medial displacement calcaneal osteotomy gave satisfactory results for the treatment of acquired flatfoot deformity. All radiologic parameters were improved

The Essex-Lopresti injury (ELI) of the forearm is a rare and serious condition which is often overlooked, leading to a poor outcome.

The purpose of this retrospective case study was to establish whether early surgery can give good medium-term results.

From a group of 295 patients with a fracture of the radial head, 12 patients were diagnosed with ELI on MRI which confirmed injury to the interosseous membrane (IOM) and ligament (IOL). They were treated by reduction and temporary Kirschner (K)-wire stabilisation of the distal radioulnar joint (DRUJ). In addition, eight patients had a radial head replacement, and two a radial head reconstruction.

All patients were examined clinically and radiologically 59 months (25 to 90) after surgery when the mean Mayo Modified Wrist Score (MMWS) was 88.4 (78 to 94), the mean Mayo Elbow Performance Scores (MEPS) 86.7 (77 to 95) and the mean disabilities of arm, shoulder and hand (DASH) score 20.5 (16 to 31): all of these indicate a good outcome.

In case of a high index of suspicion for ELI in patients with a radial head fracture, we recommend the following: confirmation of IOM and IOL injury with an early MRI scan; early surgery with reduction and temporary K-wire stabilisation of the DRUJ; preservation of the radial head if at all possible or replacement if not, and functional bracing in supination. This will increase the prospect of a good result, and avoid the complications of a missed diagnosis and the difficulties of late treatment.

Cite this article: Bone Joint J 2014;96-B:1385–91.

We describe the routine imaging practices of Level 1 trauma centres for patients with severe pelvic ring fractures, and the interobserver reliability of the classification systems of these fractures using plain radiographs and three-dimensional (3D) CT reconstructions. Clinical and imaging data for 187 adult patients (139 men and 48 women, mean age 43 years (15 to 101)) with a severe pelvic ring fracture managed at two Level 1 trauma centres between July 2007 and June 2010 were extracted. Three experienced orthopaedic surgeons classified the plain radiographs and 3D CT reconstruction images of 100 patients using the Tile/AO and Young–Burgess systems. Reliability was compared using kappa statistics. A total of 115 patients (62%) had plain radiographs as well as two-dimensional (2D) CT and 3D CT reconstructions, 52 patients (28%) had plain films only, 12 (6.4%) had 2D and 3D CT reconstructions images only, and eight patients (4.3%) had no available images. The plain radiograph was limited to an anteroposterior pelvic view. Patients without imaging, or only plain films, were more severely injured. A total of 72 patients (39%) were imaged with a pelvic binder in situ.

Interobserver reliability for the Tile/AO (Kappa 0.10 to 0.17) and Young–Burgess (Kappa 0.09 to 0.21) was low, and insufficient for clinical and research purposes.

Severe pelvic ring fractures are difficult to classify due to their complexity, the increasing use of early treatment such as with pelvic binders, and the absence of imaging altogether in important patient sub-groups, such as those who die early of their injuries.

Cite this article: Bone Joint J 2013;95-B:1396–1401.