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The effect of lossy discrete cosine transform compression on subtle bone fractures.

Extensive research efforts have been devoted to the feasibility of picture archiving and communication systems (PACS) in recent years. The advantages of PACS are numerous but mainly include reduced cost and improvement in the operational efficiency of a PACS-based radiology department. In digital radiography, images are viewed either in hard-copy or soft-copy format. Usually, these images are subsequently compressed and archived for future evaluation. There are various methods used in image compression. In this study, computed radiography images showing subtle pediatric bone fractures were compressed with the lossy method of image compression after they had been initially evaluated on workstation monitors. These studies were subsequently evaluated by observers, who were unaware of the interpretations of these images before compression, to determine if they could detect similar abnormalities. Our conclusion is that there is no difference in the interpretation of soft-copy computed radiographic images before or after lossy 10:1 compression in studies of subtle pediatric bone fractures. This is a US government work. There are no restrictions on its use.

Analysis of Variance↗

[Injuries and response to overload stress in running as a sport].

Running is rarely associated with acute injuries (muscle injuries, ankle sprain, ruptures of the Achilles tendon). More than 80% of the complaints are due to overuse injuries, mainly concerning knee, foot and Achilles tendon. Risk factors are high-performance sports, high training quantity, rapid increase of training intensity, previous injuries, and skeletal axis malalignment. Running is not suitable for severely overweight people and those with significant skeletal malalignment, dysplastic hips, spondylolisthesis, or cartilage damage.

Ankle Injuries↗

Magnetic resonance imaging in the evaluation of ligament injuries.

Magnetic resonance imaging has had a dramatic effect on the means by which we diagnose ligament injuries. Tears resulting from either acute trauma or overuse can be detected noninvasively, directing appropriate therapy be it conservative or surgical. For the elite athlete, earlier diagnosis leads to earlier intervention, or alternatively, a normal MRI examination can result in an earlier return to play. While MRI is accepted for the diagnosis of certain injuries such as complete tears of the cruciate ligaments of the knee, other injuries, such as partial cruciate ligament tears or tears of the intercarpal ligaments of the wrist, remain controversial.

Arm Injuries↗

Seronegative spondyloarthropathy initiated by physical trauma.

We undertook this study to demonstrate the pattern of onset and the course of arthritis on the traumatised joint in spondyloarthropathy (SpA) initiated by physical trauma. Among 288 patients with SpA, 12 (4.2%) whose arthropathies were associated with trauma were reviewed retrospectively. There were seven patients with ankylosing spondylitis (AS), three with juvenile onset AS and two undifferentiated SpA. The type of trauma was direct injury to the joint and injuries at other sites, except in spinal surgery, for example. In eight cases the initial evidence of disease was peripheral arthritis. The disease first occurred in traumatised joints in five cases. Only three cases showed recurrent inflammatory episodes in the traumatised joints throughout the disease course. SpA initiated by trauma initially manifested as peripheral arthritis at the traumatised joints in about half of the cases. Inflammatory episodes preferentially involved other joints apart from the traumatised joints throughout the whole course of the disease.

Adolescent↗

Lower limb salvage using an extended free radial forearm flap.

A case is reported of an unusual double injury, in which a lower limb salvage procedure employed a free radial forearm flap from an amputated upper limb. The use of amputated parts for salvage procedures is well documented but none has previously involved a free forearm flap. This clinical case shows that the entire forearm and hand skin can be adequately perfused on the radial artery along with the superficial palmar arch.

Adolescent↗

One-staged coverage and revascularisation of traumatised limbs by a flow-through radial mid-forearm free flap.

The concept of flow-through circulation in free flaps is an interesting and useful one. Its importance is paramount in the clinical field, if one applies it as a one-staged technique for cover and revascularisation in major trauma of the extremities. This paper describes the practical use of this concept in two clinical cases (hand and foot), in which an uninterrupted arterial and venous flow was established through the radial mid-forearm fasciocutaneous flap, allowing revascularisation of the ischaemic extremity.

Adult↗

Foot reconstruction using vascularised fibula.

Vascularised fibula has been used to treat three patients with skin-bone defects of the foot following severe trauma. Similarity between fibula and metatarsal bone is obvious and makes fibula an ideal choice in the replacement of defects in the first metatarsal. Depending on the size of soft tissue defects, different combinations of fibula-skin transfer were used.

Adolescent↗

Auger injuries.

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Accident Prevention↗

Vinylpyridine: an unusual cause of a chemical burn.

A case of a chemical burn following cutaneous exposure to vinylpyridine is presented. This unusual injury was distinguished by the delay in onset of pain and erythema, followed by gradual resolution leaving patchy skin discolouration. The properties of vinylpyridine are outlined. This case illustrates the dangers of long-term chemical storage and the importance of proper disposal.

Adult↗

Dedicated MR system and acute trauma of the musculo-skeletal system.

MRI diffusion in the osteoarticular field is limited by the high costs of whole-body systems. Recent technological advances have allowed the development of cost-effective and easy-to-install dedicated MRI systems. One such system, which can only be employed for the study of limbs, is based on a 0.2-T permanent magnet. Acute trauma of the musculo-skeletal system represents an important area of application. Over a period of 2 years, 1258 patients with acute trauma of the joints (64%) and the periarticular bones (36%) have been studied. Satisfactory results, comparable to those from whole-body scanners operating at higher magnetic fields, were obtained. Acute painful syndromes did not represent an obstacle to the performance of the examination. Only in 2% of patients was it not possible to carry out the examination due to oversized limbs or complete articular blocks. On the basis of these considerations, it may be predicted that in the near future dedicated MR systems will find increasingly wide application in the field of musculo-skeletal traumatology.

Acute Disease↗

Limb deficiency and prosthetic management. 3. Complex limb deficiency.

UNLABELLED: This self-directed learning module highlights rehabilitation and prosthetic issues associated with complex limb deficiencies. It is part of the chapter on acquired limb deficiencies in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article discusses rehabilitation and prosthetic management of patients with amputations for complex limb deficiencies secondary to trauma. Mechanisms of injury, prosthetic issues, prosthetic components, and potential problems in prosthetic fitting will be discussed. OVERALL ARTICLE OBJECTIVE: To evaluate common problems associated with complex limb deficiency.

Adult↗

More degrees of freedom by using chimeric concept in the applications of anterolateral thigh flap.

For obliterating a dead space, especially deep and slender, it is more challenging for a reconstructive surgeon to design a musculocutaneous flap by conventional technique. Tethering at the midway of a musculocutaneous flap while inset is not unusual, and trimming of excess muscle may jeopardize the perfusion of the skin. Based on the lateral femoral circumflex system (LFCS), introducing a chimeric concept into the reconstruction of these difficult wounds will simplify the flap design and give more degrees of freedom to inset the flap. Technique of intramuscular dissection of perforators is frequently demanded. Vastus lateralis muscle based on the distal runoff of the LFCS can be included with sharp dissection. Using chimeric concept in the application of anterolateral thigh flap, the muscle and skin can be considered as individual units although they base on a single pedicle. The dimension of skin and the volume of muscle can be tailored as adequate as desired. While insetting the flap, the lengthy pedicles distal to the bifurcation enhance a three-dimensional reconstruction without difficulty. Chimeric concept of anterolateral thigh flap affords more degrees of freedom for difficult reconstructions.

Adolescent↗

Management of high voltage electrical injury in children.

High voltage electrical injuries in children are rare. They produce severe internal damage to limbs resulting in a high incidence of amputation. Early, aggressive serial debridement ensures adequate removal of dead tissue. Flap coverage to defects is necessary. Secondary surgery is common, and delayed sequelae such as tendon rupture should be expected.

Abdomen↗