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Biomedical subjects

L A Gilula

Publications and source records attributed to L A Gilula.

At least 127 records · Page 7Linked to original sources
PubMed1992

Radiographic evaluation of the wrist: what does the hand surgeon want to know?

Congenital, developmental, and acquired wrist deformities predispose patients to characteristic conditions and their associated debilities. The accurate recognition and quantitation of these conditions represent guideposts to treatment and prognosis. The authors present mensuration methods and normal ranges for the important morphologic features of carpal height, ulnar variance, radial inclination, radial length, palmar tilt, and radial shift. These measurements assume importance in the description and quantitation of many conditions. The authors review the radiographic features and diagnosis of dissociated and nondissociated carpal instability, scapholunate advanced collapse, ulnar translocation, ulnocarpal impaction, and ulnoradial impingement.

Female↗
PubMed1992

Imaging rounds #111. VATER association.

The following case describes the roentgenographic and clinical findings of a condition of interest to the orthopaedic surgeon. Initial history, physical findings, and roentgenographic examinations are found on this page. The next page presents the final clinical differential diagnosis.

Abnormalities, Multiple↗
PubMed1992

A 35-year-old man with right wrist pain.

The following is presented to illustrate the roentgenographic and clinical findings of a condition of interest to the orthopaedic surgeon. The initial history, physical findings, and roentgenographic examinations are found on this page. The final clinical and roentgenographic differential diagnoses are presented on the following pages.

Carpal Bones↗
PubMed1992

Intracortical small cell osteosarcoma.

A case of intracortical osteosarcoma, a rare form of osteosarcoma that may radiologically simulate a variety of benign and malignant bone lesions, is described. To date, all cases have arisen in the diaphysis of either the tibia or femur, and histologically have been of osteoblastic type. In contrast, the current tumor was a small cell osteosarcoma, another uncommon variety of osteosarcoma. A summary of the reported cases of intracortical osteosarcoma is given, and the literature on small cell osteosarcoma is briefly reviewed.

Adolescent↗
PubMed1992

Basic principles and clinical uses of screws and bolts.

The orthopaedic surgeon uses screws for interfragmentary fixation, fastening soft tissue to bone, or holding plates or nails to bone. The most common function of screws is to fix bone to bone. This article reviews the design parameters and types of screws used in orthopaedic surgery.

Bone Screws↗
PubMed1992

Imaging rounds. Bilateral condensing osteitis of the clavicles.

The following case illustrates the roentgenographic and clinical findings of a condition of interest to the orthopaedic surgeon. The initial history, physical findings, and roentgenographic examinations are found on the first two pages. The following pages present the final clinical and roentgenographic differential diagnosis.

Aged↗
PubMed1991

Calcaneal and pelvic fractures: diagnostic evaluation by three-dimensional computed tomography scans.

A major application of three-dimensional (3D) computed tomography (CT) is in the imaging of the skeleton. 3D CT has a potentially important role in determining the presence, type, and extent of fractures, especially of the calcaneus and pelvis. The objective of this study was to compare the diagnostic sensitivity and specificity of 3D CT, CT slices, and plain radiography in the detection and characterization of calcaneal and pelvic fractures. 3D CT reconstructions were obtained by two methods, surface reconstruction and volumetric techniques. Twenty-eight patients were imaged with CT, 3D CT, and plain radiography. The opinion of a musculoskeletal radiologist with access to all images plus clinical history, surgical findings, and follow-up findings was taken as truth. Four additional musculoskeletal radiologists read these cases in a blinded fashion and ranked the modalities with regard to perceived utility. Receiver operating characteristic analysis was used to determine the relative value of each modality in terms of diagnostic quality. All imaging modalities performed comparably in the diagnosis of fractures. CT slices and plain-films were the most useful for more difficult diagnostic tasks such as fracture stability, and the presence of comminution and estimation of the number of fragments. The results suggest that for skeletal areas with complicated anatomy (such as the pelvis and calcaneus), the diagnostic value of 3D CT is often equivalent to that of conventional methods.

Acetabulum↗
PubMed1991

Unidirectional joint communications in wrist arthrography: an evaluation of 250 cases.

Although arthrographically demonstrable communications between various compartments of the wrist occur in older persons without symptoms, similar communications in younger persons may indicate clinically significant posttraumatic ligament tears and other pathologic processes. However, detection of communications varies depending on the arthrographic technique used. It has been claimed that if triple-compartment arthrography is not used in all patients, clinically significant unidirectional ligament tears may be overlooked. We determined the frequency and distribution of unidirectional intercompartmental communications, using a modification of techniques described in the literature. Separate injections of contrast material were made in sequence into the midcarpal, distal radioulnar, and radiocarpal joints of 250 consecutive patients. We found 38 unidirectional communications (17 lunotriquetral, nine scapholunate, three radial capsular, one ulnar capsular, six combined sites, and two indeterminate sites) between the midcarpal and radiocarpal joints. Nine unidirectional communications between the radiocarpal and distal radioulnar joints were found. Comparison of these results with the frequency and direction of unidirectional communications reported by others suggests that demonstration of communications depends on specific technical factors, such as which joint is injected first, the amount of contrast material used, and the delay between injections. This dependence on technical factors raises questions about the value of routine three-compartment wrist arthrography.

Adult↗
PubMed1991

Imaging rounds #109. Intraosseous ganglia of the scaphoid.

An intraosseous ganglion is a relatively uncommon, benign, cyst-like lesion that occurs in middle-aged adults, and has a predilection for the tibia. Roentgenographically, it commonly appears as well a well-defined osteolytic lesion with a surrounding area of sclerosis.

Adult↗
PubMed1990

Coincident rupture of the scapholunate and lunotriquetral ligaments without perilunate dislocation: pathomechanics and management.

Wrist injuries causing coincident disruptions of the scapholunate and lunotriquetral ligaments commonly result in perilunate dislocations. This article (1) describes our management of eight patients with wrist pain after coincident scapholunate and lunotriquetral ligament disruptions in the absence of perilunate dislocation; and (2) reports the results of biomechanical testing of some of the extrinsic and intrinsic wrist ligament and interprets these data to explain the injury seen clinically. The diagnosis of ligament failure was made on the basis of history, physical examination, arthrography and surgical exploration. Surgical treatment of seven patients consisted of concomitant scapho-trapezio-trapezoid fusion and lunotriquetral fusion. Three of seven patients were free of pain, two had pain only at the extremes of motion, and two required additional surgery. Biomechanical analysis of the scapholunate and lunotriquetral ligaments and two extrinsic wrist ligaments, the radiolunotriquetral and the radioscaphocapitate, confirmed the clinical suspicion that the intrinsic ligaments could be completely disrupted while the extrinsics are only partially injured. Such a scenario could account for the residual stability that prevents the development of perilunate dislocations. Coincident disruption of the scapholunate and lunotriquetral ligaments in the absence of perilunate dislocation is an unusual injury. Treatment with lunotriquetral fusion and scapho-trapezio-trapezoid fusion restored functional use in five of seven wrists while maintaining wrist motion.

Adult↗
PubMed1990

Dorsal lunate tilt (DISI configuration): sign of scaphoid fracture displacement.

Excessive dorsiflexion (dorsal tilting) of the lunate on a lateral wrist radiograph can be an important sign of carpal injury. Lunate dorsiflexion is a well-recognized sign of an intercarpal ligamentous injury pattern known as dorsal intercalated segment instability (DISI). It is less well recognized that excessive dorsal tilting of the lunate (DISI configuration) can also be produced by displacement of a scaphoid waist fracture. Since the management and prognosis of displaced scaphoid fractures may be quite different from those for nondisplaced fractures, radiologists can make an important contribution by recognizing dorsal tilting of the lunate and appreciating that it may be an important, indirect sign of scaphoid fracture displacement, which may not be directly visualized with standard wrist radiography. In this setting, computed tomography or complex motion tomography may be helpful for further evaluation of the scaphoid fracture.

Aged↗