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- [Limits of palmar locking-plate osteosynthesis of unstable distal radius fractures]. [Comparative Study, English Abstract, Journal Article]
- Handchir Mikrochir Plast Chir 2007 Feb; 39(1):34-41.
The use of locking plate systems in the treatment of distal radius fractures has increased during the last years. In the presented study our experience and results after palmar plating of dorsal dislocated distal radius fractures are analysed and presented. Besides the functional and radiological results, the potential surgical risks and the observed complications are discussed.Over a mean 15-month period, 112 consecutive patients (24 men, 88 women) with an average age of 57 years who were treated for an unstable dorsal dislocated distal radius fracture using the palmar locking-plate system could be assessed. The functional results were compared with the uninjured contralateral side. The subjective pain level was assessed using the visual analogue scale (VAS) and the subjective results were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) Score. Radiographic assessment included palmar tilt, radial inclination, and ulnar variance. The objective and subjective functional results were evaluated using the modified Mayo-Wrist Score.Functional results: extension slashed circle 53.1 degrees (84 % as compared with the uninjured side); flexion slashed circle 45.8 degrees (81 % as compared with the uninjured side); pronation slashed circle 78.7 degrees (95 % as compared with the uninjured side); supination 81.9 degrees (95 % as compared with the uninjured side); grip strength slashed circle 56 Kp (73 % as compared with the uninjured side). Radiological results: postoperative reduction/mean postoperative loss of reduction: radial inclination: slashed circle 20.4 degrees /slashed circle 0.2 degrees ; palmar tilt: slashed circle 0.2 degrees /slashed circle 3.1 degrees ; ulnar variance: 0.08 mm/slashed circle 0.42 mm. Pain values: slashed circle 2.7 points; DASH score: slashed circle 14.8 points; complications: breakage of plates 1 %, screw loosening 3 %, intraarticular screw position 2 %, delayed bone union 4 %, rupture M. extensor pollicis longus 2 %/M. flexor pollicis longus 3 %, peritendinitis extensor tendons 5 %, synovialitis flexor tendons 8 %, CTS 3 %, complex regional pain syndrome 6 %.Favourable indications for palmar locking plate osteosynthesis are A2, A3, C1 and C2 fractures with big distal fracture fragments. In these cases, additional bone grafting is not needed. In very distal fractures, multidirectional plate-systems are advantageous. Multifragmental C3 fractures show a high complication rate. Additional bone grafting for the metaphyseal defect should be considered.
- MRI and US of gluteal tendinopathy in greater trochanteric pain syndrome. [Journal Article]
- Eur Radiol 2007 Jul; 17(7):1772-83.
Greater trochanteric pain syndrome is commonly due to gluteus minimus or medius injury rather than trochanteric bursitis. Gluteal tendinopathy most frequently occurs in late-middle aged females. In this pictorial review the pertinent MRI and US anatomy of the gluteal tendon insertions on the greater trochanter and the adjacent bursae are reviewed. The direct (peritendinitis, tendinosis, partial and complete tear) and indirect (bursal fluid, bony changes and fatty atrophy) MRI signs of gluteal tendon injury are illustrated. The key sonographic findings of gluteal tendinopathy are also discussed.
- [Extended field-of-view sonography in Achilles tendon disease: a comparison with MR imaging]. [Comparative Study, English Abstract, Journal Article]
- Rofo 2004 May; 176(5):704-8.
To evaluate the role of real-time extended field-of-view sonography (EFOVS) in symptomatic Achilles tendon disease in comparison with MR imaging (MRI).Twenty-three symptomatic tendons were examined by conventional grayscale sonography, EFOVS and MRI, which served as the gold standard.The median tendon thickness in MRI was 7.8 mm (IQR 3.1) and correlated significantly to the results of EFOVS (7.0 mm, IQR 2; r = 0.74, P < 0.01). In total, MRI detected 24 lesions in 18 tendons and EFOVS 21 hypoechoic lesions in 15 tendons, corresponding to a sensitivity of 87.5 % and specificity of 100 %. The additional usage of conventional grayscale sonography improved sensitivity to 95.8 %. The median distance of the largest lesion to the calcaneal tuberosity was 10.4 mm (IQR 3.4) in MRI and 8.5 mm (IQR 5.1) in EFOVS (r = 0.64; P < 0.05). The sensitivity and specificity of EFOVS for the detection of a peritendinitis were 63.6 % and 66.7 %, respectively. Corresponding values for the detection of a bursitis were 68.8 % and 28.6 %. The additional usage of conventional grayscale sonography improved the specificity to 85.7 %.The combination of EFOVS and grayscale sonography has the potential to challenge MRI as the preferred imaging method in diagnosing symptomatic Achilles tendon disease, especially with respect to saving time and cost and the absence of any contraindications.
- [Achillodynia: diagnosis and treatment]. [English Abstract, Journal Article]
- Rev Med Suisse Romande 2003 Jun; 123(6):365-7.
Chronic achillodynia are mostly due to ether an injury of the tendon itself (tendinosis) or to an inflammatory process occurring inside the surrounding tissues (bursitis or peritendinitis); these lesions are often seen simultaneously. The Achilles tendon plays an important role during gate (mainly during the propulsion phase), which explains its high incidence in runners, particularly those who are used to train and compete on steep slopes. The diagnosis of the condition is essentially based on medical history and examination: search for trigger factors and events, precise location of the complaints; management includes treatment of the cause, not only the consequences (pain, tissue injuries).
- MRI features of intersection syndrome of the forearm. [Journal Article]
- AJR Am J Roentgenol 2003 Nov; 181(5):1245-9.
The purpose of this original report is to describe the MRI findings in patients with intersection syndrome of the forearm.Intersection syndrome is an overuse disorder of the dorsal distal forearm, presenting with particular symptoms and signs that may be clinically misdiagnosed. MRI can perform an important role in establishing the diagnosis. Peritendinous edema (peritendinitis) around the first and second extensor compartment tendons, extending proximally from the crossover point, is the most characteristic finding that should suggest a diagnosis of intersection syndrome. Chronic cases may be subtle and not show substantial MRI findings likely reflecting the development of a stenosing tenosynovitis.
- Acute flexor calcific peritendinitis of the wrist after trauma. [Case Reports, Journal Article]
- Injury 2003 Jul; 34(7):533-4.
- Operative treatment of chronic Achilles tendinopathy. [Journal Article]
- Int Orthop 2003; 27(5):307-10.
Seventy-six patients with Achilles tendinopathies (n=86) operated between 1980 and 1995 were retrospectively evaluated at an average follow-up of 13 (5-21) years. Total or gross partial ruptures were excluded. Patients' average age at surgery was 38 (18-58) years. The majority of patients were active in competitive or recreational sports. Tendinopathies were classified in peritendinitis, tendinosis, insertional tendinopathies, and mixed forms. The surgical technique depended entirely on the pathology encountered. For 32 cases of peritendinitis, results were excellent in 26, good in four, and poor in two. For eight cases of tendinosis, results were excellent in four and good in four. For 34 cases of insertional tendinopathy, results were excellent in 22, good in four, fair in four, and poor in four. For 12 cases of mixed tendinopathies, results were excellent in ten and good in two. Forty-nine patients (52 cases) were able to return to sport at the desired level.
- Ultrasound, magnetic resonance imaging, and posterior tibialis dysfunction. [Comparative Study, Journal Article]
- Clin Orthop Relat Res 2003 Mar; (408):225-31.
The authors studied posterior tibialis tendons in 31 subjects with posterior tibialis tendon pain to compare clinical findings with those of magnetic resonance imaging and ultrasound images. All subjects received clinical, ultrasound, and magnetic resonance imaging examinations using T1-weighted, T2-weighted, and enhanced magnetic resonance imaging, and high resolution ultrasound using power Doppler. Forty-four tendons in 25 women and six men with a mean age 43.3 years (range, 20-73 years) were studied. Magnetic resonance imaging tendon and peritendon enhancement are associated statistically with increasing pain intensity on resistance to testing. Ultrasound tendon and peritendon flow were associated with increasing pain intensity on resistance to testing. There is no statistically significant association between magnetic resonance imaging inhomogeneity and pain intensity on resistance to testing. Clinical and ultrasound examinations positively identify peritendinitis and tendonitis but not inhomogeneity (partial tear) of the posterior tibialis tendon. The magnetic resonance imaging is a more sensitive test for posterior tibialis tendon tear than either clinical or ultrasound evaluation.
- Biomechanical models for the pathogenesis of specific distal upper extremity disorders. [Journal Article, Research Support, U.S. Gov't, Non-P.H.S.]
- Am J Ind Med 2002 May; 41(5):353-69.
Knowledge of the pathogenesis of most disorders that occur in the distal upper extremity is generally lacking. The individual roles of postulated etiologic factors, such as biomechanical or psychosocial exposures, are poorly understood and their potential interactions even less so. This article proposes biomechanical or physiological models of pathogenesis for specific distal upper extremity disorders.Tendon entrapment of the dorsal wrist compartments (tenosynovitis), peritendinitis, lateral epicondylitis, and carpal tunnel syndrome are common specific neuromusculoskeletal disorders of the upper extremities observed among workers. The normal anatomy and function of the targeted structures is considered the initial state; their pathology is considered the final state. Using biomechanical or physiological principles combined with clinical observations and experimental studies, pathways leading from the initial state to the final state are proposed. Each model defined a critical biomechanical or physiological attribute that was considered to best characterize 'dose.' Two temporal patterns of exposure (duration vs. repetition) were used to characterize 'dosage.' The roles of long-term exposure vs. unaccustomed work were mentioned, but not incorporated into the models.Compressive force transmitted to the extensor retinaculum was considered the critical factor in the model for tendon entrapment at the dorsal wrist compartments. Two models were proposed for lateral epicondylitis. One emphasized the role of eccentric exertions; the other emphasized contact pressure from the radial head. The model for peritendinitis relied on localized muscle fatigue. Seven plausible models were presented for carpal tunnel syndrome.It is possible to propose biologically plausible models of pathogenesis that are both coherent with current knowledge of tissue responses and consistent with clinical observations; however, more than one model was plausible for some conditions. Additional research is needed to determine which, if any, of the proposed models might be correct. Such models may be useful to health care providers and ergonomists in the context of primary, secondary, or tertiary prevention.
- Endoscopic surgery in chronic achilles tendinopathies: A preliminary report. [Case Reports, Clinical Trial, Journal Article]
- Arthroscopy 2002 Mar; 18(3):298-303.
The objective of this prospective study was to evaluate preliminary results of an endoscopic-assisted surgical technique for patients suffering from chronic Achilles tendinopathies.Case series.Endoscopic operations were performed on 7 consecutive patients involved in recreational sports suffering from chronic Achilles tendon (AT) lesions in whom conservative treatment had failed. Diagnoses included 2 patients with pure peritendinitis, 4 with peritendinitis and degenerative tendinosis, and 1 with a chronic partial tear. Patients were preoperatively and postoperatively evaluated at a mean follow-up period of 16 months (range, 6 to 27 months) with a 0-100 points rating system. All patients were studied preoperatively with magnetic resonance imaging (MRI) and 6 were re-evaluated with the same procedure after surgery. All surgical interventions were performed on an ambulatory basis and 5 under local anesthesia. The surgical endoscopic technique consisted of peritenon release and debridement in cases with pure peritendinitis. In addition, 2 longitudinal tenotomies were performed in cases with degenerative tendinosis or partial tears.According to the scoring system used, all 7 patients had improved final outcome after surgery from a mean of 39 points preoperatively to 88 points postoperatively. The patient with an AT partial tear achieved the lowest score. The only complications were a minor hematoma and edema that resolved spontaneously. Postoperative MRI in patients with tendinosis failed to show evidence of degenerative areas.Endoscopic surgery may be a valid alternative to treat Achilles tendinopathies unresponsive to conservative treatment because of potential lower morbidity.