Alteration in the Cross-sectional Area (CSA) Ratio of the Paraspinal Muscles following Vertebral Insufficiency Fractures

Background  Vertebral insufficiency fractures in the elderly are associated with increased morbidity and mortality. Early diagnosis is essential to direct patient-specific rehabilitation. Aims  We hypothesize that in patients with vertebral insufficiency fractures, there is atrophy of the psoas and paraspinal muscles with alteration in the cross-sectional area (CSA) of the muscles. Materials and Methods  Magnetic resonance imaging (MRI) studies for 100 consecutive patients, older than 60 years presenting with lower back pain, were included in the study. For each MRI study, the CSA of the psoas and paraspinal muscles (multifidus) at the level of L4/5-disc space was measured to calculate the cross-sectional area ratio (CSAR) by two readers. One reader repeated the measurements after an interval of 2 weeks. We divided the patients ( n  = 100) into various groups based on the number of vertebral fractures. Results  In total, 77 patients with vertebral body fractures (48 with one, 16 with two and 13 with more than two fractures) were identified with a mean age of 73 (range 60-92) years. The ratio of multifidus CSA to psoas CSA was calculated with mean values of each group (1-4) as 2.56, 1.89, 2.09 and 2.16, respectively. There was statistically significance difference of the CSAR between the cohorts ( p -value = 0.0115). Conclusion  Vertebral insufficiency fractures in the elderly are associated not only with atrophy of psoas and the multifidus group of muscles as evident by the CSA values, but they also affect the CSAR depending on the number of fractures. This finding may help to direct targeted patient-specific physiotherapy rehabilitation and interventions to prevent further such fractures

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Accessory Tibionavicular Muscle: An Unusual Cause of Medial Ankle Pain

Accessory or anomalous muscles around the ankle are not uncommon and are usually asymptomatic. They are traditionally encountered during imaging undertaken for evaluation of ankle pain. We reported the first case of a new accessory muscle in the anteromedial part of the ankle with associated partial thickness tear in an 18-year-old football player presenting as symptomatic pathology. In this article, we described the role of cross-sectional imaging in its diagnosis including successful management of the condition with ultrasound-guided platelet-rich plasma therapy and review-associated literature

Ischiofemoral impingement caused by an intrapelvic lipoma of the sciatic nerve - A rare case presentation

Introduction: Sciatica referring to radicular pain that travels along the path of the sciatic nerve in the affected lower limb is a common complaint and traditionally due to lumbar spine nerve impingement. There can be multitude of entities responsible for its aetiology and may mimic other pathologies. Ischiofemoral impingement (IFI) due abnormal contact between the lesser trochanter of the femur and the ischium leading to compression of nearby soft-tissue structures such as Quadratus Femoris muscle may imitate sciatica. Case report: We report a rare cause of Ischiofemoral impingement (IFI) due to a lipoma causing impingement of the sciatic nerve presenting as sciatica, left lower limb radiculopathy posing a diagnostic dilemma. Conclusion: This case-report highlights the importance of a thorough clinical evaluation, a high index of suspicion and critical role of cross-sectional imaging in reaching a conclusive diagnosis and effective patient management

Bilateral Cubonavicular and Synchronous Talocalcaneal Tarsal Coalition with Stress Response-Case Report and Review of Literature.

Tarsal coalition occurs in 1% of the population and represents a congenital failure of segmentation in two or more tarsal bones. It most commonly occurs at the talocalcaneal and calcaneonavicular joint. Although commonly asymptomatic, it may present with pain, rigidity, and pes planus. Cubonavicular, multiple synchronous, and bilateral coalitions are rare but an awareness is required to ensure accurate diagnosis and management. In this article, we presented the first reported case (to the best of our knowledge) of bilateral cubonavicular coalition with synchronous talocalcaneal coalition and stress response within the intermediate cuneiform