Pain and disability following wrist trauma are highly prevalent, however the mechanisms underlying painare highly unknown. Recent studies in the knee have demonstrated that altered joint contact may induce changes to the subchondral bone density and associated pain following trauma, due to the vascularity of the subchondral bone. In order to examine these changes, a depth-specific imaging technique using quantitative computed tomography (QCT) has been used. We've demonstrated the utility of QCT in measuring vBMD according to static jointcontact and found differences invBMD between healthy and previously injured wrists. However, analyzing a static joint in a neutral position is not necessarily indicative of higher or lower vBMD. Therefore, the purposeof this study is to explore the relationship between subchondral vBMDand kinematic joint contact using the same imaging technique. To demonstrate the relationship between kinematic joint contact and subchondral vBMDusing QCT, we analyzed the wrists of n = 10 participants (n = 5 healthy and n = 5 with previous wrist trauma). Participantsunderwent 4DCT scans while performing flexion to extension to estimate radiocarpal (specifically the radiolunate (RL) and radioscaphoid (RS)) joint contact area (JCa) between the articulating surfaces. The participantsalso underwent a static CT scan accompanied by a calibration phantom with known material densities that was used to estimate subchondral vBMDof the distal radius. Joint contact is measured by calculatinginter-bone distances (mm2) using a previously validated algorithm. Subchondral vBMD is presented using mean vBMD (mg/K2HPO4) at three normalized depths from the subchondral surface (0 to 2.5, 2.5 to 5 and 5 to 7.5 mm) of the distal radius. The participants in the healthy cohort demonstrated a larger JCa in the RS joint during both extension and flexion, while the trauma cohort demonstrated a larger JCa in the RL during extension and flexion. With regards to vBMD, the healthy cohort demonstrated a higher vBMD for all three normalized depths from the subchondral surface when compared to the trauma cohort. Results from our preliminary analysis demonstrate that in the RL joint specifically, a larger JCa throughout flexion and extension was associated with an overall lower vBMD across all three normalized layers. Potential reasoning behind this association could be that following wrist trauma, altered joint contact mechanics due to pathological changes (for example, musculoskeletal trauma), has led to overloading in the RL region. The overloading on this specific region may have led to a decrease in the underlying vBMD when compared to a healthy wrist. However, we are unable to conclude if this is a momentary decrease in vBMD that could be associated with the acute healing phase following trauma given that our analysis is cross-sectional. Therefore, future work should aim to analyze kinematic JCa and vBMD longitudinally to better understand how changes in kinematic JCa over time, and how the healing process following wrist trauma, impacts the underlying subchondral bone in the acute and longitudinal phases of recovery.
We wished to review the indications for surgical intervention and the outcomes in this group with emphasis on safety, rate of rehabilitation, function, and pain levels.
Questionnaires were returned by 29 of 34 patients at a mean of 3 years post-injury. All of these had returned to work or usual level of activity at 14.3 weeks (4–36 wks). Pain was experienced never or occasionally by 18 (62%), in relation to activity by 9 (31%), and on most days by 2 (7%). The average visual analog pain score was 2.1/10. No patient required regular or opioid analgesia.
Since 1989 the Ganz periacetabular osteotomy has been performed in Christchurch for pain arising from hip dysplasia in selected patients. This review was performed to assess symptoms, function and radiographic appearances at a medium term follow up. The results of 14 peri-acetabular osteotomies performed in 13 patients was evaluated. The mean age of the patients at the time of surgery was 23 years (range 17–44). The mean duration of follow up was 5 years (3 months to 13 years). The follow up examination included clinical evaluation, chart review and radiographic analysis. Of the 13 patients evaluated, improvement in pain was achieved in 12. One required a hip replacement and intermittent discomfort was noted in 3 resulting in restriction in activites. Complications included sciatic nerve palsy (1), leg length discrepancy (2), superficial wound infection (1), scar tenderness (2), numbness in lateral femoral cutaneous nerve distribution (5) and pain from prominent metalware (1). Improvement in femoral head coverage was seen in all patients on follow up x-ray with minimal progression of arthritic changes. Improvement in symptoms ranging from complete relief of pain and participation in high intensity sporting events to intermittent discomfort was achieved. One failure occurred requiring arthroplasty. Significant complications occurred but have largely resolved. The osteotomy was successful in obtaining good relief of symptoms and has prevented the requirement for total hip replacement in this young active group.
INTRODUCTION: The optimal treatment for acute thoracolumbar burst fractures remains controversial, particularly in the patient with minimal or no neurologic deficit. While this group could be treated conservatively, at Burwood we prefer to utilise short segment instrumented stabilisation. We wished to review the indications for surgical intervention and the outcomes in this group with emphasis on safety, rate of rehabilitation, function, and pain levels. METHODS: The clinical notes and X-rays were reviewed for 34 consecutive patients with thoracolumbar burst fractures with minimal or no neurologic deficit, and treated by Dick fixator between August 1995 and September 2001. A questionnaire was mailed to all patients. RESULTS: At presentation this group had a mean age of 30.7 years (range 16–59), mean kyphotic deformity (Cobb method) of 16.1°, decrease in vertebral body anterior height of 40.9%, and decrease in canal area of 41.2%. Operative fixation was successful in greatly improving both height and kyphosis. No major complication such as metalware breakage, thromboembolism, deep infection, or neurologic deterioration was encountered. Average operating time was 71 minutes, time to discharge was 8.4 days, except where an associated injury limited mobility (17.1 days). Questionnaires were returned by 29 of 34 patients at a mean of three years post-injury. All of these had returned to work or usual level of activity at 14.3 weeks (4–36 weeks). Pain was experienced never or occasionally by 18 (62%), in relation to activity by 9 (31%), and on most days by 2 (7%). The average visual analog pain score was 2.1/10. No patient required regular or opioid analgesia. DISCUSSION: This form of operative fixation appeared to benefit this group of patients by allowing rapid rehabilitation with early mobilisation, discharge, and return to work. Pain frequency and severity were both low at medium term follow-up and no major complication was encountered.
