Use of quantitative ultrasound scans of the calcaneus to diagnose osteoporosis in patients with rheumatoid arthritis

Background: Patients with rheumatoid arthritis are recognized as being at risk for osteoporosis as a result of the disease process as well as the medication used to treat it. This study was conducted to consider the use of calcaneal scanning with quantitative ultrasound—contact ultrasound bone analysis (CUBA)—to diagnose osteoporosis in patients with rheumatoid arthritis.Methods: Forty-six patients (11 men and 35 women) with established rheumatoid arthritis underwent dual-energy x-ray absorptiometry (DEXA) of the nondominant wrist andCUBA of the nondominant heel. Sensitivity, specificity, and positive and negative predictive values were used to determine the correlation between osteoporosis as diagnosedby the CUBA heel scan compared with the DEXA wrist scan given that DEXA is widely seen as the gold standard for the diagnosis of osteoporosis.Results: The CUBA heel scan revealed a sensitivity of 90% and a specificity of 44% for a diagnosis of osteoporosis compared with DEXA. The positive predictive value of theCUBA scan was 31%, and the negative predictive value was 94%. Therefore, if normal bone density is found using CUBA, there is 94% certainty this is correct. However, if osteoporosis is diagnosed using CUBA, there is only 31% certainty this is correct. In such instances a secondary scan using a different method (eg, DEXA) would be required. Future work should consider the effect of minor alterations to the equipment or scanning protocol, because this may improve diagnosis.Conclusions: The CUBA unit could be used as a primary screening device. Given the cost and accessibility issues associated with DEXA, quantitative ultrasound may have arole in screening for osteoporosis in the primary-care setting to determine the most appropriate routes of referral for patients requiring further investigations. <br/

Ameloblastoma : Management and outcome

Introduction Ameloblastoma is a locally destructive tumor with a propensity for recurrence if not entirely excised. Management of ameloblastoma poses a challenge for all involved in the field of head and neck surgery because successful treatment requires not only adequate resection but also a functional and aesthetically acceptable reconstruction of the residual defect. Methods Patients who had histologically proven ameloblastoma between 1991 and 2009 were identified from the database of Aga Khan University Hospital. A review of all medical records, radiological images, operative reports and pathology reports was undertaken. Results A total of 15 patients with histologically confirmed ameloblastoma were identified. Out of 15 patients nine were males and six were females with age range from 20 to 60 years (mean age 43 years). The most common symptom found in our patient group was painless facial swelling. In 13 patients the origin of tumor was mandible and in the remaining two the tumor originated from maxilla. Eleven out of 15 patients underwent segmental mandibulectomy, two had maxillectomy and two had enucleation. All patients who underwent segmental mandibulectomy required reconstruction. Reconstruction was done with microsurgical free tissue transfer in eight patients, non-vascularized iliac crest bone graft was used in one patient and two had plating only. All free flaps survived with no evidence of flap loss. The mean follow-up was eight years. There was no evidence of graft failure which was used in one patient. Complication was seen in only one of our patients in the form of plate exposure. Recurrence was seen in two of our cases who primarily underwent enucleation. All patients had satisfactory speech, cosmesis and mastication. Conclusion The management of ameloblastoma still poses a big challenge in spite of being the most common odontogenic tumor. In our study we have found that segmental mandibulectomy with disease-free margin of around 1 cm and immediate reconstruction with free tissue transfer have shown good results

Ankle arthrodesis using Ilizarov ring fixator: A primary or salvage procedure?: An analysis of twenty cases

Introduction: Ankle arthrodesis using the Ilizarov technique provides high union rate with the added benefits of early weight-bearing, and the unique advantage of its ability to promote regeneration of soft tissue around the bone, including skin, muscle and neuro-vascular structures, and its versatility to allow correction of the position of the foot by adjusting the frame post-operatively as needed. We describe our experience with this technique and the functional outcomes in our patients. Materials and Methods: This retrospective study was conducted in 20 ankle fusion cases using the Ilizarov method between the years 2007 and 2017. We defined success in treatment by loss of preoperative symptoms and radiological union on plain radiographs of the ankle. Results: Fusion was achieved in all patients (100%). Immediate post-operative ambulation was with full weight bearing (FWB) in 16 (83%) of the participants and non-weight bearing (NWB) in 3 patients (17%). Post-procedure 11 patients (67%) of the participants who were full weight bearing required some form of support for walking for 2-3 weeks. Post-operatively three patients had pin tract infection requiring intravenous antibiotics. Radiological union took range of 6-12 weeks, mean union time was 8 weeks. Only one patient required bone grafting due to bone loss. Average follow-up period was 10-45 months. Conclusion:The Ilizarov technique has a high union rate and leads to general favourable clinical outcome and may be considered for any ankle arthrodesis but is especially useful in complex cases such as for revisions, soft-tissue compromise, infection and in patients with risk for non-union. Early weight bearing is an extra benefit

MRI identifies plantar plate pathology in the forefoot of patients with rheumatoid arthritis

Previous cadaveric studies have suggested that forefoot deformities at the metatarsophalangeal (MTP) joints in patients with rheumatoid arthritis (RA) might result from the failure of the ligamentous system and displacement of the plantar plates. This study aimed to examine the relationship between plantar plate pathology and the rheumatoid arthritis magnetic resonance imaging score (RAMRIS) of the lesser (second to fifth) MTP joints in patients with RA using high-resolution 3 T magnetic resonance imaging (MRI). In 24 patients with RA, the forefoot was imaged using 3 T MRI. Proton density fat-suppressed, T2-weighted fat-suppressed and T1-weighted post gadolinium sequences were acquired through 96 lesser MTP joints. Images were scored for synovitis, bone marrow oedema and bone erosion using the RAMRIS system and the plantar plates were assessed for pathology. Seventeen females and 7 males with a mean age of 55.5 years (range 37–71) and disease duration of 10.6 years (range 0.6–36) took part in the study. Plantar plate pathology was most frequently demonstrated on MRI at the fifth MTP joint. An association was demonstrated between plantar plate pathology and RAMRIS-reported synovitis, bone marrow oedema and bone erosion at the fourth and fifth MTP joints. In patients with RA, 3 T MRI demonstrates that plantar plate pathology at the lesser MTP joints is associated with features of disease severity. Plantar plate pathology is more common at the fourth and fifth MTP joints in subjects with RA in contrast to the predilection for the second MTP reported previously in subjects without RA

Artrodesis tibiotalocalcanea con placa Philos. Experiencia en Hospital Militar Central

Diferentes tipos de fijación han sido utilizados para la realización de artrodesis tibiotalocalcanea, el propósito de nuestro estudio fue realizar un análisis de nuestra experiencia utilizando la placa bloqueada de 3,5mm de humero proximal philos para este fin. Estudio descriptivo observacional, retrospectivo tipo serie de casos, realizado entre enero de 2007 y diciembre de 2009 en el Hospital Militar Central. Fueron tratados 21 pacientes (5 mujeres, 16 hombres) con edad promedio de 33 años, artrosis de la articulación tibio talar y subtalar de etiología diversa, 14 (66%) postraumáticas, la mayoría de ellas secundarias a mina antipersonal, neuropáticas 5 (24%) principalmente por artropatía diabética, metabólicas en un caso (5%) y congénitas en un caso (5%) por hemimelia de peroné. Se realizó seguimiento mínimo de 6 meses. Se evaluó la función pre operatoria y post operatoria por medio de la escala AOFAS (0 a 100), el dolor mediante la escala visual análoga (0 a 10), el tiempo de consolidación con controles radiográficos, el tipo de injerto utilizado y las complicaciones asociadas. Se encontraron como complicación 2 pacientes con infección superficial, que requirieron manejo con antibiótico endovenoso, y 2 pacientes con retardo en la consolidación que fueron llevados a cirugía de revisión. Los resultados obtenidos con seguimiento a 6 meses muestran que la artrodesis tibiotalocalcanea con placa philos es un excelente método de fijación (90,4% consolidación) en pacientes con artrosis del tobillo y sub talar con mala calidad ósea por lo cual la consideramos una técnica apropiada y reproducible para pacientes con ésta patologí

Primary signet ring cell adenocarcinoma of the uterine cervix — A rare neoplasm that raises the question of metastasis to the cervix

AbstractPrimary signet ring cell adenocarcinoma is extremely rare. Signet ring cell carcinoma is more commonly primary in the stomach or breast, and the more likely metastatic disease to the cervix needs to be ruled out. We present a case of primary signet ring cell carcinoma of the cervix and review the literature

Kei Apple Plant Thorn Synovitis

Plant thorn synovitis is well described but may be overlooked in the differential diagnosis of monoarticular inflammatory disease. It can present as a diagnostic difficulty because of its insidious onset after an apparently trivial injury, which may not be reported. Historically, thorn synovitis has been considered aseptic and treated with removal of the intra-articular foreign body and the affected synovial ring. We present a child with Kei apple thorn that had penetrated into the right knee joint and lodged in the medial compartment.Keywords: Kei Apple, Plant Thorn, Foreign Body Synovitis

Giant cell tumour in the diaphysis of radius – a report

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Mechanical characteristics of three staples commonly used in foot surgery

<p>Abstract</p> <p>Background</p> <p>Bone staples are an accepted method of fixation in foot surgery. They reduce operating time and trauma in surgical procedures. A variety of memory staples are available but their properties compared to standard staples are not known. We carried out a study comparing two popular types of memory staples and a standard stainless steel staple.</p> <p>Methods</p> <p>Standardized bone models of metatarsals made from Tufnol tubes were osteotomized and stabilised using one of three types of bone staples, two types of memory staple (Memory staple and heat-activated Memoclip) or a standard stainless steel staple (Richards). Constructs were loaded in bending and torsion on a material testing machine. The moment and torque to achieve 10 degree of bending or torsion and permanent angulation of the osteotomized bones were assessed.</p> <p>Results</p> <p>The Richards staple was found to provide a four times larger resistance to bending and torsion than the two memory staples. However, it was permanently deformed after bending. The Memory and Memoclip staples were equal in their stiffness. In addition, angulation of bones fixed with the Memoclip was elastic, preventing any permanent deformation.</p> <p>Conclusion</p> <p>The Richards staple was stiffer, although the permanent deformation of this staple is a disadvantage. Memoclip staples exhibit lower but adequate stiffnesss when compared to the standard Richards staple and are not permanently deformed after bending. The Memoclip staples were easier to handle. The results will enable surgeons to determine the optimal staple for foot and ankle procedures.</p