Magnetic resonance imaging (MRI) has rapidly become an effective technique for the diagnosis and localization of most musculoskeletal diseases. Because MRI lacks ionizing radiation and has superior soft tissue contrast as compared with computed tomography without the need for intravenous contrast material, MRI is emerging as the study of choice for soft tissue masses. This report describes the use of MRI in the evaluation of an unusual axillary soft tissue mass in an adult, a cystic lymphangioma.

Axilla↗

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Talectomy in the treatment of the myelomeningocele patient.

This paper is an analysis of a series of 11 pediatric myelomeningocele patients in whom 20 talectomies were performed for correction of rigid equinovarus of paralytic vertical talus deformities. In most of the patients talectomy achieved a satisfactory correction of the foot deformity with maintenance of the correction for up to 5 years of follow-up in this study. Failure of the procedure related to two factors: (1) severe external rotational contracture of the hips in patients with high spinal lesions; (2) incomplete removal of the talus because of extensive scarring and fibrosis due to prior infection or surgery. Correction of the external rotational deformity of the hip or a derotational supramalleolar osteotomy of the tibia can prevent the first cause of failure. An intra-operative X-ray of the foot can prevent the latter.

Arthrogryposis↗

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Vitamin D prophylaxis and the lowered incidence of fractures in anticonvulsant rickets and osteomalacia.

Small doses of vitamin D can probably prevent catastrophic skeletal demineralization in patients taking antiseizure medication. Moderate doses of vitamin D can reverse this degree of demineralization once it has occurred. Prophylactic vitamin D therapy was associated with a lowered incidence of seizure patients in the overall fracture census and a decrease in the number of in-hospital days for treatment of seizure patients with fractures. Vitamin D therapy should probably be used as a routine dietary supplement in all seizure patients at dosage levels of approximately 400 units daily. Much larger doses (50,000 units once or twice weekly) should be as necessary when these patients sustain fractures or other injuries.

Adult↗

PubMedDate not supplied

Congenital os odontoideum with Klippel-Feil anomaly and fatal atlanto-axial instability. Report of a case.

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Aged↗

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Facial malformations and spinal anomalies. A predictable relationship.

Facial malformations have generally been associated with spinal anomalies, but this report reviews patients with specific facial abnormalities and attempts to document accompanying spinal anomalies. The results indicate that the most common types of facial malformations vary predictably in their influence on spinal or other musculoskeletal abnormalities. Apert and Goldenhaar syndromes are associated with significant spinal anomalies.

Acrocephalosyndactylia↗

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Injuries in the sport of luge. Epidemiology and analysis.

We undertook this study to determine the types and frequency of injuries sustained in the sport of luge. Before this study, no data were available in the medical literature on luge injuries. We performed a retrospective analysis between the years 1985 and 1992 using data obtained from the athlete injury and illness report forms at the US Training Center Sports Medicine Clinic in Lake Placid, New York. During the 7 years examined, 1043 athletes took 57,244 track runs and sustained 407 injuries. The risk of sustaining an injury was 0.39 per person per year, and the risk of an injury causing the loss of more than 1 day of practice was 0.04 per person per year. Contusions were the major injury (51%), followed by strains (27%). Strains of the neck muscles and contusions of extremities, especially the hands, were characteristic injuries sustained by athletes. The most serious injuries were concussions (2%) and fractures (3%). Crashes were responsible for 64% of injuries. Luge appears to be a relatively safe sport with injury rates comparable with recreational alpine skiing.

Adolescent↗

PubMedDate not supplied

Ground reaction forces on the plantar surface of the foot after talectomy in the myelomeningocele.

Results of talectomies in 19 patients with severe foot deformities secondary to myelomeningocele were evaluated with an average follow-up of 12 years, 7 months. Although an apparently plantigrade foot was usually obtained, talectomy rarely succeeded in distributing weightbearing forces uniformly over the plantar surface. Photoelastic force-plate analysis incorporating three-dimensional contour mapping clearly identified areas of high ground-foot reaction forces (GFRs) and high-pressure gradients. We suggest that such high-pressure areas predispose these patients to neurotrophic ulceration.

Adolescent↗

PubMedDate not supplied

Hip fractures: condylocephalic rod versus compression screw.

In a series of 70 consecutive patients with nonpathologic intertrochanteric or subtrochanteric hip fractures, the first 35 were treated by a single semi-flexible condylocephalic nail. The second 35 patients were treated by a sliding compression screw and side-plate. The groups were comparable regarding age and intercurrent medical illness. The average anesthesia time and blood loss were nearly the same in each group. The incidence of failure of fracture fixation was high in the group treated by the condylocephalic nail, statistically significant at p less than .001. None of the patients treated by the sliding compression screw and side-plate lost fracture fixation. In this series, condylocephalic nails did not provide good fixation of this type of fracture and did not lessen surgical morbidity.

Aged↗

PubMedDate not supplied

Indications for orthopedic surgery in the mentally retarded patient.

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Achilles Tendon↗

PubMedDate not supplied

Multiple dislocations of the cervical spine in a patient with juvenile rheumatoid arthritis and Down's syndrome.

Both Down's syndrome and juvenile rheumatoid arthritis can cause instability of the cervical spine. Patients with Down's syndrome usually have instability of the atlantoaxial joint. With juvenile rheumatoid arthritis, cervical instability is a manifestation of a more generalized process involving ligamentous laxity, posterior facet ankylosis, and growth disturbances of the vertebral bodies. When the two syndromes occur in the same patient, the potential exists for serious cervical instability. In the 14-year-old girl reported here, the two conditions coexisted, and more severe cervical spine involvement occurred than was originally anticipated. Prior awareness of the combined effects of Down's syndrome and juvenile rheumatoid arthritis on the stability of the cervical spine should be useful in the management of future cases.

Adolescent↗