MRI for paediatric flatfoot: Is it necessary?

2021 ◽  
Author(s):  
Caroline Bagley ◽  
Sean McIlhone ◽  
Nehal Singla ◽  
Rupert Berkeley ◽  
Paul O’Donnell ◽  
...  
Keyword(s):  
Radiology Information System ◽  
Weight Bearing ◽  
Diagnostic Information ◽  
Radiographic Findings ◽  
Specific Diagnosis ◽  
Valuable Adjunct ◽  
Accessory Navicular ◽  
Paediatric Orthopaedic ◽  
Musculoskeletal Radiologist ◽  
Specific Abnormality

Objective: To determine the additional benefit of MRI for children with flatfoot deformity assessed with weight-bearing radiographs in a specialist paediatric orthopaedic unit. Methods and materials: Patient cohort was obtained by searching the Radiology Information System for children referred for investigation of flatfoot. All patients with flatfoot on weight bearing radiographs who had undergone MRI were included. Radiographs were classified by a consultant musculoskeletal radiologist as showing no underlying abnormality, talo-calcaneal coalition, calcaneo-navicular coalition, accessory navicular or other abnormality. MRI studies were classified similarly by a different consultant musculoskeletal radiologist blinded to the radiographic findings. Results: 33 males and 24 females were included (mean age 12.5 years; range 3–18 years). Twenty-four had bilateral abnormality, so 81 feet were assessed. Radiographs showed no specific abnormality (n = 51), talo-calcaneal coalition (n = 6), calcaneo-navicular coalition (n = 3), os naviculare (n = 12) or other abnormality (n = 9). MRI showed no specific abnormality (n = 40), talo-calcaneal coalition (n = 10), calcaneo-navicular coalition (n = 5), os naviculare (n = 12) or other abnormality (n = 14). Assuming MRI as the diagnostic gold standard, additional relevant diagnostic information was identified in 19 (23.5%) cases, while in the 51 cases for which radiographs provided no specific diagnosis MRI confirmed no underlying abnormality in 31 (60.8%). Conclusion: MRI is a valuable adjunct to weight bearing radiography for investigating paediatric flatfoot deformity. Advances in knowledge: MRI is of value in the assessment of paediatric flatfoot, additional diagnostic information to radiography being identified in 23.5% cases, while in 60.8% of cases for which radiographs provided no specific diagnosis MRI confirmed no underlying abnormality.

scholarly journals The intra-articular administration of triamcinolone hexacetonide in the treatment of osteoarthritis. Its effects in a naturally occurring canine osteoarthritis model

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245553
Author(s):  
João C. Alves ◽  
Ana Santos ◽  
Patrícia Jorge ◽  
Catarina Lavrador ◽  
L. Miguel Carreira
Keyword(s):  
Weight Distribution ◽  
Repeated Measures ◽  
Weight Bearing ◽  
Interleukin 1 ◽  
Response To Treatment ◽  
Control Group ◽  
Radiographic Findings ◽  
Triamcinolone Hexacetonide ◽  
Paired Samples ◽  
Kaplan Meier

Objective To evaluate the effect of an intra-articular (IA) administration of triamcinolone hexacetonide, compared with saline. Patients and methods Forty (N = 40) hip joints were randomly assigned to a treatment group (THG, n = 20, receiving IA triamcinolone hexacetonide) and a control group (CG, n = 20, receiving IA saline). On treatment day (T0), and at 8, 15, 30, 90 and 180 days post-treatment, weight distribution, joint range of motion, thigh girth, digital thermography, radiographic signs, synovial fluid interleukin-1 and C-reactive protein levels were evaluated. Data from four Clinical Metrology Instruments was also gathered. Results were compared Repeated Measures ANOVA, with a Huynh-Feldt correction, Paired Samples T-Test or Wilcoxon Signed Ranks Test. A Kaplan-Meier test was performed to compare both groups, with p<0.05. Results Joints were graded as mild (65%), moderate (20%) and severe (15%). Patients of both sexes, with a mean age of 6.5±2.4 years and bodyweight of 26.7±5.2kg, were included. No differences were found between groups at T0. Comparing THG to CG, weight distribution showed significant improvements in THG from 8 (p = 0.05) up to 90 days (p = 0.01). THG showed lower values during thermographic evaluation in the Lt view (p<0.01). Pain and function scores also improved from 30 to 180 days. Increasing body weight, age, and presence of caudolateral curvilinear osteophyte corresponded to worse response to treatment. Results of the Kaplan Meier test showed significant differences between groups, with THG performing better considering several evaluations and scores. Conclusion THG recorded significant improvements in weight-bearing and in with the considered CMIs, particularly pain scores. Lower thermographic values were registered in THG up to the last evaluation day. Age, sex, and radiographic findings did significantly influenced response to treatment.

scholarly journals Suture anchor stabilization of symptomatic accessory navicular in adolescents: Clinical and radiographic outcomes

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902091894
Author(s):  
Masataka Kakihana ◽  
Yuki Tochigi ◽  
Takayuki Yamazaki ◽  
Masanori Ohashi ◽  
Satoru Ozeki
Keyword(s):  
Tilt Angle ◽  
Suture Anchor ◽  
Weight Bearing ◽  
Bone Union ◽  
First Metatarsal ◽  
Radiographic Outcomes ◽  
Metatarsal Angle ◽  
Radiographic Measurements ◽  
Accessory Navicular ◽  
Stabilization Technique

Background: Screw fixation used in modified Kidner procedures to treat persistent symptomatic accessory navicular in adult cases is often challenging in adolescent cases with a small accessory fragment. The present study aimed to document the clinical effect of a suture anchor stabilization technique applicable to such cases where osteosynthesis is considered an ideal outcome. Methods: Consecutive clinical cases who received this surgical treatment from 2009 to 2016 were retrospectively reviewed. The focus of interest included radiographic union of the accessory bone, changes in symptoms evaluated using a validated clinical outcome scale introduced by the Japanese Society for Surgery of the Foot, and changes in the medial arch bony alignment measured in lateral weight-bearing plain radiographs. Results: Twenty-two feet in 15 individuals (11 females and 4 males, age at surgery 10–16 years) were identified. In 14 feet (64%), radiographic bone union was confirmed within 8 weeks postoperatively. At the final follow-up ranging 12–51 months postoperation, the clinical scores have significantly improved ( p < 0.001) to 96 ± 5.71 (mean ± standard deviation, range 87–100), from 54 preoperatively. Radiographic measurements revealed significant postoperative increase of the sagittal talar tilt angle ( p < 0.001, increment 4 ± 3°, range 0–11) and the talo-first metatarsal angle ( p < 0.001, increment 5 ± 4°, range 0–12). No significant changes were identified in the calcaneal pitch angle, first metatarsal tilt angle, calcaneo-navicular angle, and the navicular height. Conclusion: Despite the modest bone union rate, the clinical outcomes suggest distinct symptom-relieving effect, at least in the short- to midterm, while the radiographic measurements suggest positive biomechanical effects. The present suture-anchor stabilization concept appears to be a promising treatment option for persistent symptomatic accessory navicular in adolescent cases.

scholarly journals Relationship between osteophyte and arthroscopic findings in osteoarthritis of ankle

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0027
Author(s):  
Munekazu Kanemitsu ◽  
Tomoyuki Nakasa ◽  
Mikiya Sawa ◽  
Masahiro Yoshikawa ◽  
Yusuke Tsuyuguchi ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Weight Bearing ◽  
Arthroscopic Surgery ◽  
Joint Space ◽  
Cartilage Injury ◽  
Radiographic Findings ◽  
Tibiotalar Joint ◽  
Arthroscopic Findings ◽  
Articular Cartilage Injury ◽  
Mortise View

Category: Ankle Introduction/Purpose: Mortise view weight-bearing radiograph is widely used for the diagnosis of osteoarthritis of ankle. Thickness of the articular cartilage cannot be accurately evaluated in the evaluation of joint space from weight-bearing radiograph, because lateral tibiotalar joint space is maintained in valgus type osteoarthritis in some cases. There are few reports on the relation between osteophyte and the articular cartilage injury. We considered that it might be possible to estimate the cartilage injury more accurately by examining osteophytes. The purpose of this study is to analyze the relationship between the location and grade of osteophytes in weight-bearing radiograph and cartilage injury in arthroscopic findings was analyzed. Methods: Twenty-one anklets of 21 patients consisted of 10 males and 10 females, with mean age of 61.4 years (31-79 years), who underwent arthroscopic surgery for osteoarthritis in our department were included. Weight-bearing radiograph were taken before surgery. Location and grade of osteophytes were evaluated using Ankle and Hindfoot Radiographic Osteoarthritis Scoring reported by Kraus et al. Arthroscopic findings were evaluated with International Cartilage Repair Society (ICRS) Grade at a total of 20 sites (9 areas of tibia and talar in tibiotalar joint, medial malleolus and lateral malleolus). The correlation between radiographic findings and arthroscopic findings were analyzed. Results: In Mortise view, strong correlations were found between lateral tibial osteophyte grade and ICRS grade of the center (talus R = 0.69, tibia R = 0.76), the central lateral (tibia R = 0.79), the posterior center (talus R = 0.72, tibia R = 0.74) and the posterior lateral of the tibiotalar joint (talus R = 0.63, tibia R = 0.76). There are moderate correlations between distal fibular osteophyte grade and ICRS grade of the medial inner (tibia R = 0.74) and the posterior medial of the tibiotalar joint (talus R = 0.61, tibia = 0.63). In lateral view, there are moderate correlations between posterior talar osteophyte grade and ICRS grade at the center of the tibiotalar joint (talus R = 0.61, tibia R = 0.60). Conclusion: From this study, there was a strong correlation between location and grade osteophyte and the articular cartilage injury. Osteoarthritis progression is caused by degeneration of the cartilage because of the joint instability, and osteophytes were formed by traction force or impaction. This study showed that local cartilage injury is thought to be related to osteophytes. By evaluating the location and size of osteophytes, the articular cartilage injury might be predicted accurately before arthroscopic surgery.

scholarly journals Haemosiderotic Synovitis Secondary to Anticoagulant Use: An Unusual Mechanism of Failure of a Unicompartmental Knee Replacement

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Jonathan Bartlett ◽  
Surjit S. Lidder ◽  
Andrew T. Bucknill
Keyword(s):  
Knee Replacement ◽  
Knee Prosthesis ◽  
Weight Bearing ◽  
Rare Condition ◽  
Left Knee ◽  
Unicompartmental Knee Replacement ◽  
Tissue Samples ◽  
Radiographic Findings ◽  
Unicompartmental Knee ◽  
Mechanism Of Failure

Haemosiderotic synovitis is a rare condition caused by recurrent or chronic haemarthroses. This may lead to intra-articular destruction, a painful joint, and, if untreated, ankylosis of the joint. We highlight a case of an elderly lady who presented to an orthopaedic clinic with left knee pain, following recurrent left knee atraumatic haemarthroses secondary to oral anticoagulant use. At her presentation, she had a left medial unicompartmental knee prosthesis in situ. Weight bearing radiographs of the left knee showed marked loss of lateral joint space with valgus alignment. These radiographic findings were not present on the radiographs taken at her first presentation with haemarthrosis nine months previously. A left revision total knee arthroplasty was performed, and a diagnosis of haemosiderotic synovitis was made following histological analysis of intraoperative tissue samples. This case highlights an unusual mechanism of failure of a unicompartmental knee replacement. Though haemosiderotic synovitis is an exceedingly rare condition, it must be considered following recurrent haemarthrosis as, due to its destructive nature, prompt recognition and treatment is paramount.

scholarly journals PREOPERATIVE ANALYSIS OF RADIOGRAPHIC FINDINGS IN 516 PATIENTS WITH HALLUX VALGUS DEFORMITY

2019 ◽  
Vol 27 (1) ◽  
pp. 16-19
Author(s):  
Marco Götze ◽  
Sandra Elisabeth Hasmann ◽  
Ulf Krister Hofmann ◽  
Christian Walter ◽  
Falk Mittag
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Young Patients ◽  
Case Series ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Osteotomy ◽  
First Metatarsophalangeal Joint ◽  
Radiographic Findings ◽  
Plain Radiographs ◽  
Operative Correction

ABSTRACT Objective: This is a descriptive study to report our method of operative correction for patients with hallux valgus deformities. Methods: From 2006 to 2012, 516 consecutive patients (601 feet) with hallux valgus deformities were treated surgically in our department after conservative treatments were exhausted. The hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, and degree of osteoarthritis in the first metatarsophalangeal joint were measured on preoperative plain radiographs of the weight-bearing forefoot. Results: Young patients with severe intermetatarsal deviation received a combined proximal and distal osteotomy of the first metatarsal (n = 21). Patients with low intermetatarsal deviation received a distal metatarsal chevron osteotomy (n = 196), whereas patients with severe intermetatarsal deviation and less flexible deformities without osteoarthritis received a basal metatarsal osteotomy with a distal soft tissue procedure (n = 173). Elderly active patients with osteoarthritis in the first metatarsophalangeal joint received an arthrodesis (n = 100) or resection arthroplasty (n = 58). Conclusion: Determining a few simple angles on plain radiographs of the weight-bearing forefoot in combination with the age and level of activity of patients can help simplify the operative correction method by using the schema we developed. Level of evidence IV, case series.

The Association of Hallux Limitus with the Accessory Navicular

2002 ◽  
Vol 92 (6) ◽  
pp. 359-365 ◽  
Author(s):  
R. D. Lee Evans ◽  
Ryan Averett ◽  
Stephanie Sanders
Keyword(s):  
Surgical Treatment ◽  
Causal Relationship ◽  
Metatarsophalangeal Joint ◽  
Pes Planus ◽  
First Metatarsophalangeal Joint ◽  
Radiographic Findings ◽  
Hallux Limitus ◽  
Accessory Navicular ◽  
Clinical Cases

Hallux limitus is one of the most prevalent, debilitating disorders of the first metatarsophalangeal joint, and it has many proposed etiologies. This article reviews these etiologies, focusing primarily on the pes planus foot. The pes planus foot type is often associated with symptomatic hallux limitus and the accessory navicular. This article discusses this correlation, although a causal relationship has not been proven. The prevalence and classification of the accessory navicular are also discussed. Clinical cases involving symptomatic hallux limitus occurring concomitantly with an accessory navicular are reviewed, including radiographic findings, symptoms, and surgical treatment. (J Am Podiatr Med Assoc 92(6): 359-365, 2002)

scholarly journals Experience with free fibula transfer with screw fixation as a primary modality of treatment for congenital pseudarthosis of tibia in children - Series of 26 cases

2012 ◽  
Vol 45 (03) ◽  
pp. 468-477 ◽  
Author(s):  
Guru Dayal Singh Kalra ◽  
Amit Agarwal
Keyword(s):  
Weight Bearing ◽  
Treatment Options ◽  
Bony Union ◽  
Non Union ◽  
Fibula Graft ◽  
Congenital Pseudarthrosis ◽  
Free Fibula ◽  
Paediatric Orthopaedic ◽  
Primary Modality

ABSTRACTBackground: Congenital pseudarthrosis is one of the greatest challenges of paediatric orthopaedic practice. Treatment options and literature addressing this condition are numerous, reflecting the difficulty in management. We aimed to study the effectiveness of free fibula transfer as a primary modality of treatment in children with this condition in terms of achieving length, union, and normal axis of the involved leg. Materials and Methods: During the period of 2001 to 2010, 26 children with congenital pseudarthrosis of tibia between age group of 2-8 years were evaluated and were reconstructed using contra-lateral free fibula graft, and then patients were followed up for 5 years subsequently. Patients were examined and time of bony union, weight bearing ability and walking without support were noted. Any complication directly or indirectly related to surgery with any complication seen in the due course of follow up of 5 years was also taken care of. Results: In our experience with treatment of congenital pseudarthrosis over a span of 10 years with free fibula transfer, the results have been gratifying with no flap loss. All our patients had UNEVENTFUL post-op recovery. Only 2 patients out of 26 had non-union, for which cancellous bone grafting was done (7.6%). Most of the patients were ambulatory with support by 3-6 months and continued to walk without support after a span of 18-24 months. The incidence of stress fracture in our study over the follow-up period was 4 out of 26 pts (15.3%). None of them had any deformity in the donor leg. Conclusion: When compared to other surgical modalities of treatment of the problem in question, vascularised free fibula transfer has emerged as a real saviour with good patient compliance and less complication rate in our study. It achieves the desired target with no residual deformities and near normal to normal gait with no stigma of bone removal from other leg.

scholarly journals THU0587 TB OR NOT TB? THIS IS THE QUESTION. CASE REPORT OF AN EXTRAPULMONARY TUBERCULOUS ARTHRITIS.

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 535.2-536
Author(s):  
N. Abaza
Keyword(s):  
Case Report ◽  
Clinical Medicine ◽  
Case Reports ◽  
Weight Bearing ◽  
Fluid Collection ◽  
Biologic Treatment ◽  
Cystic Fluid ◽  
Radiographic Findings ◽  
Tuberculous Arthritis ◽  
Active Synovitis

Background:Tuberculous (TB) arthritis consists of 1-3% of all TB cases, whereas TB tenosynovitis & bursitis account for 1%. Primarily it involves large joints but occasionally smaller non-weight-bearing joints. Diagnosis is usually delayed due to lack of awareness, radiographic findings & constitutional or pulmonary involvement.Objectives:We aim to increase rheumatologists awareness to detect possible TB etiology for arthritis & tenosynovitis.Methods:Our case is a 32 years old male complaining of polyarthritis of wrists, MCPs, ankle joints 4 months prior to presentation. Patient was referred as diagnosed rheumatoid patient resistant to treatment based on clinical presentation & laboratory investigation. His lab. was as follows; ESR 76 mm/hr, CRP 56.6 mg/L, RF 181.8 IU/ml, Serum creat 0.8 mg/dL, SGOT 20 SGPT 22, FBS 94, Uric acid 5.4, Hepatitis & HIV negative. CBC showing Hb 14.1 g/dL, TLC 7030/ml & platelets 289000/ml. There was no history of genitourinary, gastrointestinal manifestations, oral/genital ulcers, ophthalmological, mucocutaneous, cardiac, pulmonary, hepatic nor renal manifestations. The treatment at time of presentation was Methotrexare 25mg/week IM injection, Leflunamide 20mg/d & low dose steroids, prednisolone 5mg/d. Patient was referred to our department to assess activity, perform musculoskeletal ultrasound to the various involved joints. Hence, expected by referring physician to shift from DMARDs to biologic treatment.Results:MSUS study following eular guidlines showed active synovitis in both radiocarpal & midcarpal joints bilaterally grade II by doppler signal (figure 1). Other active synovitis in multiple MCPs as well as tenosynovitis of Peroneus longus and brevis bilaterally was detected (figure 1). The swelling aound the ankle was alarming though the other swollen joints seemed to be consistent with a case of RA in activity. This swelling revealed a well-defined hypoechoic heterogeneous cystic fluid collection with posterior through-transmission (figure 2) & hyperechoic hyperemic wall on PD imaging opposite medial malleolous of right fibula. The laboratory investigations prior to shifting patient had to included TB tests, tuberculin test and PCR following the positive result that we found in the skin test. Aspiration was performed from the cystic swelling and sent for clinical pathology analysis. Thick yellowish fluid aspirate on cytology revealed moderately cellular mainly of PMN cells, neutrophils, nuclear debris in proteinaceous background no atypical or malignant cells were found. As regards bacteriology no pus with no growth (both aerobic & anerobic). These results warranted us to perform a culture for atypical bacteria and revealed growth of mycobacterium tuberculosis. AntiTB therapy was started for 9 months in the form of 2 months of isoniazid (INH) and rifampicin (RIF), pyrazinamide (PZA) and ethambutol (EMB) followed by 7 months of INH and RIF. Excision of the synovial cyst was done on the spot.Figure 1.Figure 2.Conclusion:Extrapulmonary TB is usually diagnosed late due to a reduced diagnostic suspicion. A variant of 8 - 60% of TB cases are +ve for RF & 7–39% +ve for ACPA. Musculoskeletal manifestations occur in approximately 1-3% of TB cases. Of these, spondylitis and arthritis are the most frequent, whereas bursitis and tenosynovitis are exceptional. Extraarticular cystic masses occur in tuberculous arthritis. Mixture of septic tuberculous arthritis and Poncet’s disease is rare but documented.References:[1]Varshney et al. Isolated tuberculosis of Achilles tendon. Joint Bone Spine, 74 (2007): 103-106.[2]Lee et al.Tuberculous Tenosynovitis and Ulnar Bursitis of the Wrist.Ann Rehabil Med. 2013 Aug; 37(4): 572–576.[3]Rekha et al. Tuberculous Olecranon Bursitis. Case Reports in Clinical Medicine, 2014, 3, 281-285.[4]Kim et al. Tuberculosis of the trochanteric bursa: a case report. Journal of Orthopaedic Surgery 2014;22(1):126-9.Disclosure of Interests:None declared

Physeal injury in a skeletally immature male athlete

2021 ◽  
Vol 14 (7) ◽  
pp. e243044
Author(s):  
Bradley Richey ◽  
Cassidy M Foley Davelaar
Keyword(s):  
Knee Pain ◽  
Weight Bearing ◽  
Skeletally Immature ◽  
Radiographic Findings ◽  
Male Athlete ◽  
Immature Male ◽  
Chronic Knee Pain ◽  
Active Rehabilitation ◽  
High Index Of Suspicion ◽  
Acute Knee

A 12-year-old skeletally immature male athlete presented for evaluation with acute bilateral knee pain. Initial radiographs revealed subtle lucency of the medial proximal tibial physis and MRI was recommended. On MRI, broad-based intravasation of the physis into the proximal femoral and tibial physes was observed. This represented physeal widening, a phenomenon that has been observed in skeletally immature athletes presenting for acute knee pain. While such changes to the physis may be quite prominent on MRI, conventional radiographic findings may be much more subtle. As many causes of chronic knee pain in this population are managed with active rehabilitation, a high index of suspicion for this diagnosis in the presence of physeal abnormalities may warrant evaluation with MRI. The literature suggests this pathology will resolve with rest, but, if weight-bearing activities are continued, there is a risk for significant growth abnormalities.

Unusual Case of a Fractured Anconeal Process in a Boxer

1997 ◽  
Vol 10 (04) ◽  
pp. 192-193 ◽  
Author(s):  
G. Kehnscherper ◽  
T. Flegel
Keyword(s):  
Growth Plate ◽  
Unusual Case ◽  
Weight Bearing ◽  
Radiographic Findings ◽  
One Year ◽  
Left Front

SummaryAn acute weight-bearing lameness in the left front limb following a slight trauma happened in a male, one-year-old Boxer. Clinical and radiographic findings suggested a fractured anconeal process.Such a fracture after mild trauma is uncommon and indicates the possibility of a disorder in the area of the growth plate between anconeal process and ulna. Therefore this case could be related to the complex of the ununited anconeal process, too.A one-year-old Boxer sustained a fracture of the anconeal process following a mild trauma. This case might be related to the complex of the ununited anconeal process.

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