Florid reactive periostitis of the digit with cortical erosion: a case report and review of the literature.
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Adult↗
Biomedical subjects
L A Gilula
Publications and source records attributed to L A Gilula.
Repair of calvarial defects with flap tissue: role of bone morphogenetic proteins and competent responding tissues.
Bone morphogenetic proteins 2 through 8 have the ability to induce the in vivo transformation of extraskeletal mesenchymal tissue into bone. The aims of this investigation were to determine the optimal responding tissue and the specificity of the inductive effect of bone morphogenetic protein 3. The optimal responding tissue was found to be skeletal muscle. The specificity of this response to bone morphogenetic protein 3 was compared with that of recombinant human basic fibroblast growth factor, recombinant platelet-derived growth factor, and recombinant insulin-like growth factor. Bone morphogenetic protein 3 was the only factor that induced de novo bone formation. This ability to transform muscle into bone was tested in 7 x 7 mm irradiated skull defects in the rat. After 1500 rads of exposure, these defects showed no significant signs of healing by 8 months. When these defects were treated with the microvascular transfer of a nonirradiated muscle flap, they had 8 percent healing at 4 months and 37 percent healing by 8 months. Defects treated with 30 micrograms bone morphogenetic protein 3 (without the muscle flap) achieved 50 percent healing by 4 months and 64 percent healing by 8 months. When the defects were treated with both the muscle flap and bone morphogenetic protein 3, there was 96 percent healing by 4 months and 100 percent healing by 8 months (p < 0.015, compared with bone morphogenetic protein 3 alone at both time points). At 8 months, the transplanted muscle was entirely transformed into bone and healed the skull defect with newly generated bone indistinguishable from the surrounding calvarial tissue. These findings suggest a potential clinical utility of bone morphogenetic protein 3-induced bone formation in skeletal reconstructions. Furthermore, they also show that there is a collaborative requirement for both the osteoinductive factor bone morphogenetic protein 3 and the presence of competent responsive cells in the well-perfused muscle.
Animals↗
Imaging of pelvic insufficiency fractures.
Insufficiency fractures of the pelvis are being increasingly recognized as a major cause of low back pain in elderly women with osteoporosis. Fractures in the sacrum are difficult to diagnose, as plain radiographic findings are either unhelpful or misleading. Bone scintigraphy is very sensitive for the detection of fractures in the sacrum, with demonstration of the H-shaped (or butterfly) sacral pattern or the combination of concomitant sacral and parasymphyseal uptake being considered as characteristic of insufficiency fractures. Computed tomography (CT) is helpful for confirming the presence of fractures in cases with atypical scintigraphic patterns, particularly in those with a known primary malignant neoplasm. CT is especially useful in the further evaluation of parasymphyseal and pubic rami lesions. The majority of patients respond well to periods of enforced bed rest and administration of analgesics. Recognition of the spectrum of imaging findings for this entity should lead to its correct identification and the institution of appropriate treatment.
Aged↗
Surgeons' decision making in patients with chronic wrist pain: role of bilateral three-compartment wrist arthrography--prospective study.
PURPOSE: To determine if wrist arthrography changes surgeons' diagnoses and treatment plans for patients with chronic wrist pain. MATERIALS AND METHODS: Bilateral, three-compartment wrist arthrography was performed in 64 patients. Prospective questionnaires evaluated surgeons' diagnoses and management plans at three stages: before arthrography, after arthrography of the symptomatic wrist, and after arthrography of the asymptomatic wrist. RESULTS: Surgeons tended to plan more conservative management after receiving the results of arthrography. The number of patients for whom the reported treatment plan included surgery dropped from 28 of 64 patients (44%) to 19 of 64 patients (30%) after review of the arthrography results (P = .05). The number of patients for whom the treatment plan included treatment of any kind dropped from 55 of 64 patients (86%) to 49 of 64 patients (77%) after review of the arthrography results (P = .09). An overall change in treatment plan occurred in 29 of 64 patients (45%). CONCLUSION: Wrist arthrography influences surgeons' decision making. After reviewing the results of arthrography, surgeons tended to change treatment plans toward more conservative, less invasive treatment.
Adult↗
Kashin-Beck disease: radiographic appearance in the hands and wrists.
PURPOSE: To review the radiographic changes of Kashin-Beck disease (KBD) in the hands and wrists and provide a method for the diagnosis, staging, and evaluation of the effectiveness of prevention and treatment of this disease. To perform radiographic-histologic correlation to facilitate an early diagnosis of KBD. MATERIALS AND METHODS: Hand and wrist radiographs in 300 children and five autopsy cases with KBD from an endemic area of China were analyzed for radiographic changes in the epiphyseal plates, bone ends, epiphyses, and carpal bones. Histopathologic sections of the hand and wrist from five autopsies were studied for comparison with corresponding radiographs. RESULTS: The chief histopathologic changes in KBD included chondronecrosis, secondary repair, and remodeling processes. These histopathologic stages occurred in isolation or simultaneously in a patient. The radiographic and histopathologic changes within cartilage were related specifically to the different sites of cartilage. CONCLUSION: Radiographic changes in the hands and wrists in patients with KBD result from atrophy and necrosis of chondrocytes and their subsequent repair processes in the deep layer of growing cartilage.
Carpal Bones↗
Evaluation of selective wrist arthrography of contralateral asymptomatic wrists for symmetric ligamentous defects.
OBJECTIVE: The objective of this investigation was to study the role of selective wrist arthrography of the asymptomatic wrists of patients with unilateral wrist pain and the efficacy of three-compartment and selective-compartment injections of contrast medium into the asymptomatic wrist in demonstrating symmetric and asymmetric intercarpal ligament and triangular fibrocartilage communicating defects. SUBJECTS AND METHODS: Wrist arthrography with bilateral three-compartment injections was performed for 62 patients with unilateral wrist pain. The numbers of bilateral intercarpal ligament and triangular fibrocartilage communicating defects were recorded. The results obtained with three-compartment injections in each wrist of these patients were compared with those obtained with single-compartment injections. RESULTS: Bilateral three-compartment injections identified 110 communicating defects (59 in the symptomatic and 51 in the asymptomatic wrists). Midcarpal injections showed all 36 scapholunate and lunatotriquetral ligament defects that were also shown by three-compartment injections in asymptomatic wrists. However, only 26 (72%) of these 36 ligament defects were shown by radiocarpal injections. No single-compartment injection showed all triangular fibrocartilage defects that were shown by three-compartment injections. Ten bilateral symmetric triangular fibrocartilage communicating defects were shown by three-compartment injections. All 10 triangular fibrocartilage communicating defects in asymptomatic wrists were shown by radiocarpal injections. However, only five of the 10 triangular fibrocartilage communicating defects in asymptomatic wrists were shown by injection of the distal radioulnar joints. CONCLUSION: Selective midcarpal injection of an asymptomatic wrist showed all matching defects in that wrist when only intercarpal ligament defects were found in the symptomatic wrist. Similarly, selective radiocarpal injection of an asymptomatic wrist showed all matching defects of the triangular fibrocartilage in that wrist. In either situation, routine injection of all three compartments of the asymptomatic wrist should not be necessary.
Adolescent↗
A simple restraint system for floating radiography tables.
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Humans↗
Multiple loose bodies: formation, revascularization, and resorption. A 29-year followup study.
A 45-year-old patient sustained a traumatic dislocation of 1 hip. During a 29-year period, 10 to 13 multiple calcified loose bodies developed slowly in the hip. These first grew in size and became very radiodense, but later showed progressively less radiodensity. Progressive osteoarthritis of the hip was the indication for hip arthrotomy. The loose bodies had become reattached to the synovial surface of the hip joint and were revascularized, having converted from calcified cartilage to bone. This case dramatically shows the body's mechanism for attempting to remove loose bodies from joints.
Bone Resorption↗
A 40-year-old man with "stabbing" right-side chest pain.
The following case is presented to illustrate the roentgenographic and clinical findings of a condition of interest to orthopedic surgeons. The initial history, physical findings, and roentgenographic examination are found on the first page. The final clinical and roentgenographic diagnosis is presented on the following pages.
Adult↗
A 68-year-old man with gradual onset of low-back pain.
The following case is presented to illustrate the roentgenographic and clinical findings of a condition of interest to orthopedic surgeons. The initial history, physical findings, and roentgenographic examinations are noted on this page. The clinical and roentgenographic diagnoses are presented on the following pages.
Aged↗
A 24-year-old woman with dorsal wrist swelling.
The following case is presented to illustrate the roentgenographic and clinical findings of a condition of interest to orthopedic surgeons. The initial history, physical findings, and roentgenographic examinations are noted on this page. The clinical and roentgenographic diagnoses are presented on page 455.
Adult↗
Update on imaging techniques of the wrist and hand.
Several imaging techniques are available and necessary for evaluation and treatment of hand and wrist pathology. Conventional radiography is still the imaging technique of first choice for evaluation of abnormalities of the wrist and hand. Bone scintigraphy is an important diagnostic tool with a high sensitivity but low specificity. Arthrography should be performed if abnormality of ligamentous or triangular fibrocartilaginous pathology is suspected; however, using arthrography, all three major compartments and both wrists should be examined arthrographically. In selected cases, such as occult fractures, fracture healing, and early detection of avascular necrosis, advanced imaging techniques, such as magnetic resonance imaging and computed tomography, may be necessary and are helpful to achieve correct diagnosis.
Arthrography↗
Imaging of the wrist and hand.
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Arthrography↗
Pictorial review: magnetic resonance imaging of benign soft tissue masses of the hand and wrist.
Magnetic resonance imaging (MRI) is the imaging method of choice for evaluating the presence and extent of soft tissue masses. It is particularly useful for assessing masses in the wrist and hand, where benign lesions predominate. A specific diagnosis may be made, or strongly suspected, from the characteristic MRI features found in certain conditions like ganglion, haemangioma, arteriovenous malformation, giant cell tumour of the tendon sheath and lipoma.
Arteriovenous Malformations↗
Dorsal intercalated segment instability (DISI) and scapho-trapezio-trapezoid (STT) osteoarthritis.
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Carpal Bones↗
Analysis of carpal instability: I. Description of the scheme.
There is a lack of a generally agreed analysis of carpal instability that can assist in the diagnosis, give guidelines for treatment, and ensure unity when reporting results of treatment. Based on the literature and using six categories describing chronicity, constancy, etiology, location, direction, and pattern of the instability, we present a proposal for a standardized analysis. Using this analysis, an instability should be presented with information in all six categories. The analysis may be expanded and developed according to future needs.
Acute Disease↗
Analysis of carpal instability: II. Clinical applications.
An analytic scheme for carpal instability patterns has been described to help standardize reporting of these conditions. Six categories to be recognized in each case are chronicity, constancy, etiology, location, direction, and pattern. Examples are presented to illustrate the use of this scheme.
Acute Disease↗
Post-traumatic irreducible nondissociative carpal instability: a case report.
We present a case that is unusual in two respects. To our knowledge, it is the first clearly documented instance in the literature of a post-traumatic, irreducible nondissociative volar intercalated carpal instability to result from a known wrist flexion force and a known dorsal capsuloligamentous tear. Second, the same wrist revealed a coalition at both intraosseous levels of the proximal carpal row: a synfibrosis at the scapholunate joint and a synostosis at the lunotriquetral joint. Treatment by open removal of an interposed capsuloligamentous flap from the radiocarpal joint, followed by alignment of carpal elements, temporary internal fixation, and repair of the damaged dorsal capsule and ligaments gave an excellent result.
Accidental Falls↗