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Biomedical subjects

L A Gilula

Publications and source records attributed to L A Gilula.

At least 37 records · Page 2Linked to original sources
PubMed1998

Microcirculation of the distal humeral epiphyseal cartilage: implications for post-traumatic growth deformities.

The purpose of this study was to determine if there is an anatomic basis for development of the avascular necrosis infrequently seen after elbow trauma. The microcirculation to the distal humeral epiphyseal cartilage was studied in 38 elbow joints from 19 skeletally immature individuals. The findings of this study were as follows: (1) Vascularity is centripetal within the epiphyseal cartilages of the capitellum, trochlea, and medial and lateral epicondyles. Because of this vascularity pattern, it is not easy for avascular necrosis to develop after trauma within these epiphyses. (2) Vascularity is longitudinal in the epiphyseal cartilage between the capitellum and trochlea. The longitudinal vessels appear susceptible to fractures around the elbow in childhood. (3) A rich vascular network exists in the olecranon fat pad, and a vascular arch forms from the vascular network adjacent to the distal humeral epiphyseal cartilage. The vascular arch sends several large branches into the epiphyseal cartilage in a vertical fashion. Disruption of either the longitudinal intraosseous vasculature (vertical extraosseous blood supply) or the vascular arch in more than 2 places may lead to selective avascular necrosis of the epiphyseal cartilage between the capitellum and trochlea. These findings suggest vascular compromise as a possible explanation for "fish-tail" deformities seen as sequellae of different fracture patterns.

Female↗
PubMed1998

Assessment of dorsal or ventral intercalated segmental instability configurations of the wrist: reliability of sagittal MR images.

PURPOSE: To determine whether a dorsal intercalated segmental instability (DISI) or ventral intercalated segmental instability configuration can be mimicked on sagittal magnetic resonance (MR) images in asymptomatic subjects with unremarkable lateral radiographs. MATERIALS AND METHODS: In 10 asymptomatic adult volunteers, capitolunate, scapholunate, and radiolunate angles were measured on lateral radiographs and compared with those measured on T1-weighted spin-echo MR images obtained in neutrally positioned wrists with subtle variations in the sagittal imaging plane. MR measurements also were obtained in 15 degrees radially and 15 degrees ulnarly deviated wrists. RESULTS: In neutrally positioned wrists, the mean capitolunate, scapholunate, and radiolunate MR angles were 13.6 degrees-14.5 degrees, 4.0 degrees-9.9 degrees, and 18.0 degrees-20.3 degrees larger, respectively, than those on lateral radiographs. In 15 degrees radially deviated wrists, the mean MR angles were similar to those on lateral radiographs. In 15 degrees ulnarly deviated wrists, the mean MR angles were 32.3 degrees, 16.6 degrees, and 37.1 degrees larger than those on lateral radiographs. At MR imaging, a DISI configuration would have been diagnosed in four subjects with neutrally positioned wrists and in eight subjects with ulnarly deviated wrists. CONCLUSION: The lunate appears more dorsally tilted on sagittal MR images than on lateral radiographs, and a DISI configuration can be mimicked. Subtle errors in the selection of the imaging plane do not substantially influence measurements; however, wrist positioning is crucial.

Adult↗
PubMed1997

Imaging of the hand and wrist.

This article reviews many of the most commonly used modalities for imaging the hand and wrist. Particular attention is paid to proper radiographic positioning, with emphasis on the four-view wrist series. Standard wrist measurements are detailed, and wrist arthrography is also discussed. Techniques for cross-sectional imaging, computed tomography, and MR imaging are reviewed, and several examples are presented as to where MR imaging is diagnostically valuable.

Anthropometry↗
PubMed1997

Radiographic evaluation of osseous displacement following intra-articular fractures of the distal radius: reliability of plain radiography versus computed tomography.

This study evaluated the reliability of plain radiography versus computed tomography (CT) for the measurement of small (< 5 mm) intra-articular displacements of distal radius fracture fragments. The plain radiographs and CT scans of 19 acute intra-articular distal radius fractures were used by 5 independent observers, using 2 standardized techniques, to quantify incongruity of the articular surface in a blinded and randomized fashion. Repeat measurements were performed by the same observers 2-4 weeks later, allowing determination of intraclass correlation coefficients (ICC) as a measure of intraobserver and interobserver agreement. The average maximum gap displacement on plain radiographs was 2.1 mm (range, 0.0-15.0 mm, lateral view) and on CT images was 4.9 mm (range, 0.7-17.3 mm, axial view). The average maximum step displacement on plain radiographs was 0.9 mm (range, 0.0-6.4 mm, lateral view) and on CT images was 1.2 mm (range, 0.0-6.0 mm, sagittal view). More reproducible values determining step and gap displacement were obtained when the arc method of measurement was used on CT scans (ICC values, .69-.97) as compared to the longitudinal axis method for plain radiographs (ICC values, .30-.50). For measured displacements of 2 mm or more, our data demonstrated poor correlation between measurements made on CT images and those made on plain radiographs (gap or step displacement > 2 mm, K = 0.21; step displacement > 2 mm, K = 0.21). Thirty percent of measurements from plain radiographs significantly underestimated or overestimated displacement compared to CT scan measurements. From these data, we conclude that CT scanning data, using the arc method of measurement, are more reliable for quantifying articular surface incongruities of the distal radius than are plain radiography measurements.

Fracture Healing↗
PubMed1997

Radiographically occult scaphoid fractures: value of MR imaging in detection.

PURPOSE: To evaluate the diagnostic value of magnetic resonance (MR) imaging in patients with clinical suspicion of scaphoid fractures and normal initial plain radiographs. MATERIALS AND METHODS: MR imaging was performed within 7 days after trauma in 42 patients with clinical suspicion of scaphoid fractures and normal plain radiographs. T1-weighted spin-echo, T2*-weighted gradient-echo, and short inversion time inversion-recovery (STIR) sequences were performed. MR images were evaluated independently by two radiologists. Six-week follow-up radiographs were used as a standard to diagnose fractures. RESULTS: MR imaging depicted occult fractures of the scaphoid bone in 14 patients (33%), the capitate bone in four (10%), the trapezium in one (2%), and the distal radius in two (5%). All wrist fractures were detected with a combination of STIR and T1-weighted spin-echo sequences. The sensitivity and specificity for detection of radiographically occult fractures of the wrist were 100% each for the first and 95% and 100%, respectively, for the second radiologist with an almost perfect interobserver agreement (K = 0.953). CONCLUSION: MR imaging has a high sensitivity for detection of fractures of the scaphoid bone and wrist not evident on plain radiographs and may enable early diagnosis and treatment.

Adolescent↗
PubMed1997

Scaphopisocapitate alignment: criterion to establish a neutral lateral view of the wrist.

PURPOSE: To determine whether a "true" neutral lateral view of the wrist is necessary for accurate capitolunate angle measurement, to compare two standards of diagnostic adequacy for neutral lateral wrist views (distal radioulnar overlap [RUO] and scaphopisocapitate [SPC] relationship), and to confirm positional reproducibility and measurement precision of the SPC criterion. MATERIALS AND METHODS: Capitolunate angles were measured on neutral lateral and supine pisotriquetral views of 10 normal wrists. Two hundred neutral lateral wrist views were classified by each standard (RUO and SPC) as excellent, acceptable, or unacceptable. In two subgroups, capitolunate angles were measured on the lateral views to determine SPC practicality and sensitivity. RESULTS: Compared with neutral lateral positioning, supinated off-lateral views showed an apparent increase in lunate dorsiflexion of up to 30 degrees. Diagnostically unacceptable, excellent, and acceptable pronosupination was present on 118, 22, and 60 of 200 views by using the RUO criterion and on 40, 79, and 81 of 200 views by using the SPC criterion, respectively. The capitolunate angle did not show a significant difference between each of the two subgroups (P > .05). CONCLUSION: A true neutral lateral view of the wrist is necessary for accurate measurement of the capitolunate angle on the basis of a comparison with off-lateral views. SPC relationship provides a diagnostically reproducible standard for a neutral lateral wrist view and should reduce the need for repeat lateral radiographs.

Adult↗
PubMed1997

Quantification of the radial torsion angle with computerized tomography in cadaver specimens.

Torsion of a long bone is the twist along its longitudinal axis; torsion of the radius is defined by the angle between the proximal and distal metaphyses in the transverse plane. Measurement of the radial torsion angle provides a means of detection and quantification of malrotation after a fracture. The purpose of the current study was to develop and standardize a technique for the measurement of torsion of the radius. Axial computerized tomographic images of thirty-nine pairs of dry cadaver specimens of normal radii, and an additional four pairs of radii with a unilateral deformity of the distal metaphysis that was consistent with a previous fracture, were studied and a measurement protocol was established. The radial torsion angle was measured by three independent observers on two separate occasions. Reproducibility of the technique was determined with use of the intraclass correlation coefficient to express both interobserver and intraobserver reliability. Consistency of measurements between observers and by the same observer was high, with intraclass correlation coefficients ranging from 0.87 to 0.94. The mean torsion angle for the eighty-two normal radii in the study was 32.6 degrees (95 per cent confidence interval of the mean, 30.3 to 34.9 degrees; range, 1.4 to 58.8 degrees). There were small variations in torsion angle between the two radii of each normal pair (mean side-to-side difference, 4.9 degrees; 95 per cent confidence interval of the mean, 3.5 to 6.3 degrees). The mean torsion angle of the four radii with a malunited fracture was 10.4 degrees (95 per cent confidence interval of the mean, 5.7 to 15.1 degrees), and the mean side-to-side difference in the pairs containing these radii was 24.1 degrees (95 per cent confidence interval of the mean, 8.5 to 39.6 degrees; p < 0.0001 compared with the normal radii).

Aged↗
PubMed1997

Displaced intra-articular fractures of the distal aspect of the radius. Long-term results in young adults after open reduction and internal fixation.

The purpose of this retrospective study was to determine the long-term functional and radiographic outcomes in a series of young adults (less than forty-five years old) in whom an acute displaced intra-articular fracture of the distal aspect of the radius had been treated with operative reduction and stabilization. Twenty-six fractures in twenty-six patients met the initial inclusion criteria for the study. Twenty-one patients returned for a physical examination, imaging (plain radiographs and computerized tomography scans), and completion of a validated musculoskeletal function assessment questionnaire at a minimum of 5.5 years. The physical examinations were performed by the same observer, who was not involved in the initial care of the patients. The plain radiographs and computerized tomography scans were assessed in a blinded fashion by two independent observers who measured the radiographic parameters with standardized methods. At an average of 7.1 years, osteoarthrosis of the radiocarpal joint was evident on the plain radiographs and computerized tomography scans of sixteen (76 per cent) of the twenty-one wrists. A strong association was found between the development of osteoarthrosis of the radiocarpal joint and residual displacement of articular fragments at the time of osseous union (p < 0.01). However, the functional status at the time of the most recent follow-up, as determined by physical examination and on the basis of the responses on the questionnaire, did not correlate with the magnitude of the residual step and gap displacement at the time of fracture-healing. All patients had a good or excellent functional outcome irrespective of radiographic evidence of osteoarthrosis of the radiocarpal or the distal radio-ulnar joint or non-union of the ulnar styloid process. It appears prudent therefore to base the indications for salvage operative procedures on the presence of severe symptoms or a loss of function rather than on radiographic evidence of osteoarthrosis of the radiocarpal joint.

Adolescent↗
PubMed1997

A 63-year-old woman with right small finger pain.

The following case is presented to illustrate the clinical findings and imaging modalities of a condition of interest to the orthopedic/hand surgeon. The initial history, physical examination, and imaging examinations are found on this page. The final clinical and roentgenographic differential diagnosis and discussion can be found on the following pages.

Female↗
PubMed1997

A 3-month-old baby with multiple fractures.

This case is presented to illustrate the radiographic and clinical findings of a condition of interest to orthopedic surgeons. The initial findings are noted on this page. The clinical and radiographic diagnoses are presented on the following pages.

Calcium↗
PubMed1996

Detection of occult wrist fractures by magnetic resonance imaging.

The early detection and management of wrist fractures may avert potential complications and patient morbidity. Five cases are described in which radiographically-occult fractures were clearly demonstrated by magnetic resonance imaging (MRI). These fractures were seen on MRI as a low signal linear band on T1- and T2-weighted images, with surrounding increased signal intensity from bone marrow oedema on T2-weighted images. In one case, intense oedema obscured the fracture line on the initial MR scan. MRI is useful in confirming the presence of a fracture, delineating its exact shape and location, and in the follow-up of these injuries during and after treatment.

Adult↗
PubMed1996

Midcarpal instability: is capitolunate instability pattern a clinical condition?

Five cases are presented with clinical findings of capito-lunate instability pattern of the wrist. All painful areas and tender points were dorsal, but variable in location and intensity. All plain radiographs and fluoroscopic instability series were normal. None of the cases had an explanation for the dorsal wrist pain other than a positive dorsal capitate-displacement test. Four out of five cases were treated in a cast for 4 weeks and two had subsequent splint immobilization. Although at short-term follow-up two of these five patients became pain-free, none was completely pain-free at long-term follow-up. Three patients treated with a cast had long-term follow-up. Only one could perform his original work. These findings support a clinical condition of midcarpal instability producing dorsal wrist pain reproduced with a simple stress test. Conservative, non-operative treatment will not usually produce long-term pain relief.

Adult↗
PubMed1996

Normal disruption of carpal arcs.

The hypotheses that carpal arcs normally break in radial and ulnar deviation and that they remain intact in the neutral position were tested. Wrist instability series of 100 asymptomatic wrists were reviewed. Three carpal arcs were drawn on posteroanterior (prone) and anteroposterior (supine) x-ray films in neutral and radial- and ulnar-deviated positions, and any proximal-distal arc step-off was measured. On posteroanterior radial deviation at the lunatriquetral joint, arc I was disrupted in 80 and arc II disrupted in 78 cases, while at the scapholunate joint, arc II was disrupted in 10 cases. Similar findings were detected on anteroposterior views. In ulnar deviation, arc II was disrupted at the scapholunate joint in 30 posteroanterior and 12 anteroposterior cases, respectively. With 4 exceptions, arcs I and II were normal in neutral anteroposterior and posteroanterior positions. Six of 20 wrists with a type II lunate had arc II disruption. Arc III was intact in all positions. As radiographic carpal arcs normally disrupt with radial and ulnar deviation, caution in interpretation of arcs I and II and scapholunate joint width should be exercised when the wrist is not strictly neutral in position.

Adolescent↗
PubMed1996

Bicompartmentalization of the radiocarpal joint.

Seven wrists are presented with a septum connecting the lunotriquetral interosseous ligament and triangular fibrocartilage, resulting in bicompartmentalization of the radiocarpal joint. In all of the 7 wrists, having no history of trauma, the septums were suspected to be of congenital origin. The histopathology of the septum in 1 cadaver wrist showed a fibrocartilaginous structure. Two types of radiocarpal joint bicompartmentalization were identified by arthrography. Type 1 (2 wrists) had a septum with normal (intact) lunotriquetral interosseous ligament, and type 2 (5 wrists) had a septum with a communicating defect of the lunotriquetral interosseous ligament. The septum is most likely a congenital malformation caused by a disturbance of the vacuolization of the mesenchymal mass between the forearm and carpus.

Adult↗