Soft-tissue masses caused by long-standing foreign bodies in the extremities: MR imaging findings.
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Biomedical subjects
Publications and source records attributed to S P Bohrer.
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STUDY OBJECTIVES: To reappraise Boehler's angle and evaluate factors, including centering of the central beam, sex of subjects, and side of the body, that may affect angle measurement. DESIGN: Retrospective clinical review. SETTING: Emergency department, Level I trauma center. TYPE OF PARTICIPANTS: 120 consecutive patients radiographed for ankle injury who had normal bones on the ankle and/or foot radiographs. MEASUREMENTS AND MAIN RESULTS: The mean and SD of Boehler's angle were 30 degrees C +/- 6 degrees (range, 14 degrees to 50 degrees). There was no difference in Boehler's angle between male and female subjects (P greater than .05) or between left and right feet (P greater than .05). Slight variations in central beam location for ankle and foot radiographs had no significant effect on Boehler's angle. CONCLUSION: If 28 degrees is taken as the lower limit of normal for Boehler's angle, 37 cases (31%) would be false-positive "abnormal." The use of 20 degrees as the lower limit may decrease the number of false-positive to three cases (2.5%); using 18 degrees (mean -2 SD) reduces the false-positive rate to less than 1% (one case).
Thirty-six patients with calcification or ossification at or around the coracoclavicular and coracoacromial regions were analyzed with regard to type, location, and configuration of the deposits and related clinical history. Calcification or ossification in the coracoclavicular region resulted largely from trauma (36%) or renal failure (28%). Trauma patients may develop punctate calcification or ossification but do not develop the tumoral type of calcification. About 5% of the renal failure patients had coracoclavicular ligament calcifications, one-half of which were of the tumoral type. Renal failure patients may have punctate or tumoral calcifications but do not develop ossification.
Lateral projection flexion and extension radiographs of the cervical spine are stress views. They are necessary to evaluate unstable ligamentous injury, which may not be apparent on neutral unstressed films. As there is very little literature on the proper evaluation of these radiographic views, we reviewed 150 consecutive cases from our Emergency Department to define patterns of flexion. Four significantly different patterns emerged. No flexion at any level was seen in 24.7% of patients. A single flexion angle was seen in 24.7% Two flexion angles, usually at consecutive levels, were present in 29.3% of patients, and 21.3% had three or more flexion angles. Correlation with clinical data suggests that attempted flexion with no significant angle or a single angle is abnormal and may indicate soft tissue (ligament or muscle) injury. Three or more flexion angles are thought to represent a normal pattern. The most common pattern, two flexion angles at consecutive levels, has not been previously described. We believe this pattern indicates less than full flexion and can be seen in individuals without significant injury and in those limited by mild soft-tissue injury.
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Thirty-eight annulus vacuums in 27 patients were analyzed with regard to location, configuration, and associated vertebral abnormalities such as degenerative changes, absent and compressed anterosuperior vertebral body corners, and annulus calcification. It is concluded that most annulus vacuums are a degenerative phenomenon at the attachment of the annulus to bone. These vacuums may be associated with other degenerative changes such as osteophytes and annulus calcification. Vacuums have a strong association with compressed anterosuperior corners. These deformed corners are thought to be early osteophytes and may be related to previous trauma, a vertebra with an absent corner, and/or normal motion. Small annulus vacuums adjacent to vertebral corners with a normal appearance are more likely to result from acute trauma.
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An annulus vacuum sign at the anterosuperior or anteroinferior margin of a cervical interspace in extension may be due to an acute hyperextension injury with tearing of Sharpey fibers allowing the annulus fibrosus to separate from the adjacent bone. The sign is not pathognomonic of this injury as has been implied in the literature. It can be due to an old hyperextension injury and is seen in degenerative disease of the annulus without any acute trauma. In addition, a pseudovacuum sign may be very difficult to distinguish from a true vacuum sign.