Radiohamate impingement after proximal row carpectomy

Radiocarpal impingement after PRC is a well-known complication due to impingement of the radial styloid against the radial carpal bones. A less common impingement syndrome is that of the pisiforme. We describe a radiohamate impingement and its diagnosis and treatment. Based on a case we saw at our practice. Diagnosis is bases on standard radiographs and SPECT-CT. The treatment is initially conservative. Surgery is necessary when conservative treatment fails and consists of resectie of the proximal pole of the hamate

Pyoderma gangrenosum following trauma of the knee: a case of pathergy and review of orthopaedic cases

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Lateral collateral ligament injuries of the elbow : chronic posterolateral rotatory instability (PLRI)

Chronic posterolateral rotatory instability (PLRI) is the most common form of chronic elbow instability. PLRI usually occurs from a fall on the outstretched hand. On impact, the radial head and ulna rotate externally coupled with valgus displacement of the forearm. This leads to posterior displacement of the radial head relative to the capitellum, thus causing disruption of some or all of the lateral-sided stabilisers. PLRI is mainly a clinical diagnosis with a history of instability, clicking and lateral-sided pain, with a positive clinical examination including the pivot-shift test, push-up, chair and tabletop test. MRI can often help guide diagnosis but more commonly assists in surgical planning. Surgery is indicated in patients with persistent, symptomatic instability of the elbow causing pain or functional deficit. There are several surgical techniques to treat PLRI, often leading to good to excellent results. An open or arthroscopic technique has been successfully used in patients with symptomatic PLRI following one or more episodes of dislocation or subluxation. At the pre-operative examination under general anaesthesia, all of our patients had a positive pivot-shift test but not a frank dislocation. We prefer to perform a lateral collateral ligament (LCL) reconstruction with an allograft tendon. The outcomes after repair are good to excellent in the majority of patients. Results of acute repair are generally better compared with reconstruction. This is due to the fact that predictive factors for a poor outcome include the number of previous surgeries and the prevalence of degenerative changes at the elbow. Recurrent instability is not uncommon following repair or reconstruction and has been reported in up to 25% of patients after medium- to longer-term follow-up. Cite this article: EFORT Open Rev 2016;1:461-468. DOI: 10.1302/2058-5241.16003

Can a ratio between medial and lateral meniscal volumes be calculated to determine critical meniscal volume in view of post-meniscectomy symptoms?

Partial meniscectomy is a frequently performed treatment strategy for non-suturable meniscal tears. However, the meniscal volume which can be resected without compromising the load-bearing, shock-absorbing function of the meniscus remains a topic of ongoing research. The aim of this study was to calculate the medio-lateral meniscal volume ratio to estimate this volume. In 90 patients (98 pairs of menisci) without meniscal injury, medial and lateral menisci were segmented on MRI imaging and 3D surface models were created to calculate volume. The mean medial meniscal volume was 1928,9mm3 and the mean lateral meniscal volume was 1681,7mm3. A fixed ratio of the medial over the lateral meniscal volume was calculated to be 1,16. The standard deviation of the prediction errors based on this ratio equals 217mm³. This ratio seems a useful parameter in follow-up research to determine whether there is a critical volume which can be resected without post-operative pain and osteoarthritis.status: accepte

Evaluation of clinical tests for partial distal biceps tendon ruptures and tendinitis

Background: The clinical diagnosis of partial distal biceps tendon ruptures or tendinosis can be challenging. Three clinical tests have been described to aid in an accurate and timely diagnosis: biceps provocation test, tilt sign, and resisted hook test. However, not much is known about the sensitivity, specificity, and inter-rater reliability as the available evaluations are based on small groups or are case based. Furthermore, these tests have not been compared together in the same patient group. Methods: Two dedicated elbow surgeons each included 20 consecutive patients in whom distal biceps tendon pathology was suspected. Patients with a complete distal biceps tendon tear were excluded. As a control, the same number of consecutive patients with various elbow pathologies other than distal biceps tendon problems was included. All 3 tests were performed both in control patients and in patients with suspected biceps tendon pathology. Magnetic resonance imaging (MRI) in the flexion-abduction-supination view and/or surgical exploration was performed in both groups. The findings of the clinical tests were determined before the results of MRI and other technical investigations were analyzed. The values of sensitivity, specificity, and accuracy were calculated. Results: The combined sensitivity, specificity, and accuracy values for the biceps provocation test were 95%, 97%, and 96%, respectively. For the resisted hook test, the combined values were 78%, 76%, and 77%, respectively. The combined values for the tilt sign were 58%, 55%, and 56%, respectively. When the biceps provocation test and the resisted hook test were combined in a parallel testing setup, the sensitivity increased to 98% whereas the specificity was 73%. The sensitivity and specificity of the biceps provocation test and the tilt sign in a parallel testing setup were 97% and 53%, respectively. Finally, the sensitivity and specificity of the tilt sign and the resisted hook test in a parallel testing setup were 90% and 41%, respectively. Conclusions: The biceps provocation test yielded higher accuracy than the resisted hook test and the tilt sign. When the biceps provocation test and the resisted hook test were combined, the sensitivity increased to 98%. We advise integration of these tests in daily practice to minimize delays in the diagnosis of partial distal biceps tendon ruptures, distal biceps tendon bursitis, or tendinosis. MRI in the flexion-abduction-supination view is still advised to distinguish between a partial biceps tendon rupture and tendinosis or bursitis at the distal biceps tendon insertion as this may influence further treatment