Neonatal MRI

The neurological examination often falls short as a definitive test of central nervous system (CNS) integrity in newborn infants. In addition, neonatal brain injury often eludes diagnosis, especially in preterm infants, because obvious signs are not apparent or may be attributed to immaturity. However, the likelihood of CNS compromise increases dramatically with signs of perinatal distress such as low umbilical cord blood pH, low Apgar score, and seizures. The importance of early diagnosis becomes apparent in studies showing the efficacy of treating brain injury with pharmacologic and head- or body cooling therapies. These treatments may support the maturing brain in its early self-repair mechanisms and rescue neurons after the initial perinatal insult. The treatment’s success, however, hinges on early diagnosis. Magnetic resonance imaging (MRI) techniques are far superior to ultrasonography (US) or computed tomography (CT) in detecting early perinatal brain injury. MRI provides more specific anatomical localisation and more often reveals the underlying cause and timing of the initial insult. In addition, MRI is the only technique that can distinguish the presence or absence of myelin. Information such as the timing of the insult, its location, and myelination are crucial for assessing neurodevelopmental outcome. This paper reviews the basic principles of MRI as well as the benefits of imaging the neonatal brain. It also examines two pathological patterns of neonatal brain injury on MRI: intraventricular haemorrhage (IVH) and hypoxic-ischaemic encephalopathy (HIE).</p

The Role of Surgery and Adjuvants to Survival in Pagetic Osteosarcoma

Osteosarcoma is a rare complication of Paget's disease with a very poor prognosis. Treatment is controversial: the older age of the patients affected by Paget's disease may limit the use of chemotherapy and axial involvement may limit the practicality of surgery. Questions/purposes: The purposes of this study are (1) to report the survival in patients treated for osteosarcoma in Paget's disease; (2) to identify correlations between type of treatment and survival comparing our data with those in the literature; (3) to determine if the extent of Paget's disease and risk of malignant transformation are associated; (4) to assess if prognosis is related with site; and (5) to identify the variations of histologic subtypes of these osteosarcomas. Methods: We retrospectively reviewed the medical records of 26 patients treated between 1961 and 2006 who had bone sarcoma arising from a site of Paget's disease. Twenty two of the 26 patients had surgery. In six surgery only was performed; three had surgery, adjuvant chemotherapy, and radiotherapy; one surgery and radiotherapy; 12 underwent surgery and chemotherapy, adjuvant in 10 patients and neoadjuvant in two; two had only radiotherapy and two had only chemotherapy. We performed survival analyses between various combinations of treatment. Results: At last followup four patients had no evidence of disease (NED) at a minimum followup of 42.6 months (mean, 139 months; range, 42.6-257.4 months) and 22 died with disease (DWD) at a minimum time of 1 month (mean, 20.2 months; range, 1-84 months). One of the six patients (11%) treated with surgery only had NED at 10 years; the other five died from disease at a mean of 30 months. Three of 12 patients (25%) treated with surgery and chemotherapy are NED at a mean followup of 12 years; nine died of disease at a mean of 24 months. All patients treated without surgery died at a mean of 7.5 months (range, 1-13.7 months). Conclusions: Despite improvements in surgery and medical treatments the prognosis remains poor in patients with Paget's sarcoma. \ua9 2010 The Association of Bone and Joint Surgeons\uae

Clinical Characteristics and Multisystem Imaging Findings of COVID-19: An Overview for Orthopedic Surgeons

The COVID-19 pandemic holds widespread implications for global public health, economies, societies, and the practice of orthopedic surgery. As our knowledge of the transmissibility of SARS-CoV-2 and the symptomatology and management of COVID-19 expands, orthopedic surgeons must remain up to date on the latest medical evidence and surgical perspectives. While COVID-19 primarily manifests with pulmonary symptoms, cardiovascular, neurologic, and other major organ systems may also be affected and present with hallmark imaging findings. This article reviews initial and emerging literature on clinical characteristics and imaging findings of COVID-19

Magnetic resonance imaging of the failed superior capsular reconstruction

Superior capsular reconstruction (SCR) of the shoulder is an increasingly common procedure in the treatment of patients with massive, irreparable rotator cuff tears lacking significant osteoarthritis. Post-operatively, the appearance of failed grafts has only been described in isolated case reports and review articles. From January 2016 through December 2017, surgical records at a single tertiary-care facility were queried to identify all patients undergoing SCR. Patient records were reviewed for patient demographic information, reason for post-operative MRI, and post-operative surgeon assessment. 74 patients underwent SCR, of whom 12 received a follow-up MRI post-operatively. One patient was excluded due to missing records; the remaining 11 patients comprise the study cohort. Post-operative MRIs were obtained at mean six months after surgery. On review of post-operative MRIs, three distinct locations of failure were identified. Four patients (40%) had midsubstance failure of the allograft with all glenoid and humeral head fixation remaining intact. One patient (10%) had complete detachment of the allograft from both glenoid and humeral head fixation. Five patients (50%) had detachment of the allograft from the glenoid. In this series of ten failed SCRs, the most common mode of failure was loss of fixation on the glenoid, followed closely by midsubstance rupture. We found no instances of isolated fixation failure on the humeral head. This series illustrates the need for careful imaging in patients whose post-operative course suggests clinical failure. These findings suggest that strengthening glenoid fixation may provide better clinical outcomes as this procedure becomes more common. Level of evidence: III - Retrospective study. •Failure of the SCR was evident on imaging in 10 of 11 of the symptomatic subjects.•There was an overall SCR graft failure rate of 14% over the study period.•Three distinct modes of failure were identified on MRI:(1)midsubstance rupture of the graft;(2)loss of both humeral and glenoid fixation; and(3)loss of glenoid fixation with intact graft