Transient synovitis is a common cause of hip pain in children that presents with limping and limited range of motion. Ultrasound is useful for detecting joint effusion but cannot determine if the effusion is caused by infection, bleeding, or transudate. A diagnostic joint aspiration provides quick pain relief and determines if antibiotics are necessary to treat potential septic arthritis. Imaging plays an important role in evaluating developmental dysplasia of the hip and determining treatment for complex hip disorders in children.
This document discusses principles of surgical approaches to central nervous system (CNS) lesions. It covers brain and spine lesions and various surgical techniques. For the brain, it describes common lesion types and goals of surgery. It then explains different surgical approaches like craniotomy, craniectomy, endoscopy, and stereotactic procedures. For the spine, it outlines common lesion locations and types of tumors. It also discusses posterior and anterior surgical approaches to access different spinal regions. The document provides examples of various patients who underwent these procedures.
Primary bone tumors of the spine are rare, accounting for only 4.2% of spinal tumors. This study summarizes the experience of treating 18 cases of primary bone tumors of the spine over 10 years at two hospitals in Bangladesh. The most common tumors were malignant (61%), with the dorsal and lumbar spine being most commonly involved. Pain was the primary presenting symptom in most cases. Surgical treatment with the aim of complete resection when possible combined with preservation of neurological function and spinal stabilization was performed. Adjuvant chemotherapy and radiation were also used. Outcomes were improved pain and function, though malignant tumors often had poorer outcomes and higher mortality. Early diagnosis and multidisciplinary treatment were concluded to be important for managing these rare tumors
The document evaluates stabilization failure in the thoracolumbar spine. It analyzes 93 patients who underwent spinal stabilization surgery. 9 patients (8.37%) experienced implant failure, mostly screw breakage. Failure was likely due to inadequate bone grafting, poor surgical technique, use of undersized screws, low-quality implants, and inadequate rest after surgery. To prevent failure, the study recommends limiting stabilization to appropriate cases, improving surgical methods, using adequate bone grafts, proper implant selection, and considering spinal biomechanics.
Sonography of the neonatal brain is an important diagnostic tool, but the posterior fossa is often poorly visualized due to its location. This study evaluated adding images through the posterolateral fontanelle to the standard anterior fontanelle approach. Of 1292 neonatal sonograms reviewed, 24 showed posterior fossa abnormalities. Posterolateral fontanelle images better displayed abnormalities in 23 cases and increased diagnostic confidence in 18 cases. In 11 cases, it was the only view revealing abnormalities. Follow-up confirmed most findings, though 4 cases of suspected vermian defects were false positives. Adding posterolateral fontanelle imaging significantly improved posterior fossa evaluation.
This document provides information on parotidectomy surgery and the Fundamentals of Laparoscopic Surgery (FLS) program.
It describes the technique for parotidectomy surgery, including identifying and dissecting around the facial nerve. It notes that most parotid tumors are benign and complications are usually temporary facial nerve paralysis.
It then discusses the development of the FLS program to standardize laparoscopic surgery training. The program includes cognitive training and manual skills assessment. Many residency programs and hospitals now require surgeons to complete the FLS. A large grant will help make the program more accessible to residency programs.
This document discusses pediatric radiology and focuses on proper techniques and positioning for imaging the chest and abdomen in children. Key points include:
- Obtaining chest x-rays requires proper inspiration, positioning without rotation, and ensuring adequate exposure. Positioning the child comfortably can help reduce movement.
- Abdominal exams should include supine, prone, and erect views to visualize the maximum amount of bowel by moving gas into different loops.
- Children are more vulnerable to radiation due to faster cell growth and their longer remaining lifespan after exposure. Proper techniques help minimize unnecessary radiation dose.
1) Arthroscopic stabilization of anterior shoulder instability has advantages over open surgery such as better cosmesis, less morbidity, and possibly less loss of external rotation. However, past studies reporting on arthroscopic stabilization have been limited by small sample sizes and variable surgical techniques and patient characteristics.
2) Several arthroscopic techniques have been developed and studied, including stapling, transglenoid suturing, suture anchors, and biodegradable tacks. Recurrence rates vary significantly between studies and depend on patient factors like age and activity level. Improper patient selection and surgical technique also contribute to failed stabilization.
3) Recent studies directly comparing suture anchor and transglenoid fixation techniques found lower recurrence
This document discusses principles of surgical approaches to central nervous system (CNS) lesions. It covers brain and spine lesions and various surgical techniques. For the brain, it describes common lesion types and goals of surgery. It then explains different surgical approaches like craniotomy, craniectomy, endoscopy, and stereotactic procedures. For the spine, it outlines common lesion locations and types of tumors. It also discusses posterior and anterior surgical approaches to access different spinal regions. The document provides examples of various patients who underwent these procedures.
Primary bone tumors of the spine are rare, accounting for only 4.2% of spinal tumors. This study summarizes the experience of treating 18 cases of primary bone tumors of the spine over 10 years at two hospitals in Bangladesh. The most common tumors were malignant (61%), with the dorsal and lumbar spine being most commonly involved. Pain was the primary presenting symptom in most cases. Surgical treatment with the aim of complete resection when possible combined with preservation of neurological function and spinal stabilization was performed. Adjuvant chemotherapy and radiation were also used. Outcomes were improved pain and function, though malignant tumors often had poorer outcomes and higher mortality. Early diagnosis and multidisciplinary treatment were concluded to be important for managing these rare tumors
The document evaluates stabilization failure in the thoracolumbar spine. It analyzes 93 patients who underwent spinal stabilization surgery. 9 patients (8.37%) experienced implant failure, mostly screw breakage. Failure was likely due to inadequate bone grafting, poor surgical technique, use of undersized screws, low-quality implants, and inadequate rest after surgery. To prevent failure, the study recommends limiting stabilization to appropriate cases, improving surgical methods, using adequate bone grafts, proper implant selection, and considering spinal biomechanics.
Sonography of the neonatal brain is an important diagnostic tool, but the posterior fossa is often poorly visualized due to its location. This study evaluated adding images through the posterolateral fontanelle to the standard anterior fontanelle approach. Of 1292 neonatal sonograms reviewed, 24 showed posterior fossa abnormalities. Posterolateral fontanelle images better displayed abnormalities in 23 cases and increased diagnostic confidence in 18 cases. In 11 cases, it was the only view revealing abnormalities. Follow-up confirmed most findings, though 4 cases of suspected vermian defects were false positives. Adding posterolateral fontanelle imaging significantly improved posterior fossa evaluation.
This document provides information on parotidectomy surgery and the Fundamentals of Laparoscopic Surgery (FLS) program.
It describes the technique for parotidectomy surgery, including identifying and dissecting around the facial nerve. It notes that most parotid tumors are benign and complications are usually temporary facial nerve paralysis.
It then discusses the development of the FLS program to standardize laparoscopic surgery training. The program includes cognitive training and manual skills assessment. Many residency programs and hospitals now require surgeons to complete the FLS. A large grant will help make the program more accessible to residency programs.
This document discusses pediatric radiology and focuses on proper techniques and positioning for imaging the chest and abdomen in children. Key points include:
- Obtaining chest x-rays requires proper inspiration, positioning without rotation, and ensuring adequate exposure. Positioning the child comfortably can help reduce movement.
- Abdominal exams should include supine, prone, and erect views to visualize the maximum amount of bowel by moving gas into different loops.
- Children are more vulnerable to radiation due to faster cell growth and their longer remaining lifespan after exposure. Proper techniques help minimize unnecessary radiation dose.
1) Arthroscopic stabilization of anterior shoulder instability has advantages over open surgery such as better cosmesis, less morbidity, and possibly less loss of external rotation. However, past studies reporting on arthroscopic stabilization have been limited by small sample sizes and variable surgical techniques and patient characteristics.
2) Several arthroscopic techniques have been developed and studied, including stapling, transglenoid suturing, suture anchors, and biodegradable tacks. Recurrence rates vary significantly between studies and depend on patient factors like age and activity level. Improper patient selection and surgical technique also contribute to failed stabilization.
3) Recent studies directly comparing suture anchor and transglenoid fixation techniques found lower recurrence
This study retrospectively analyzed 127 cases of tuberculosis of the spine treated surgically between 2007-2017. Most patients were young adults between 11-30 years old and more were male. Surgical decompression without stabilization was performed in 72 patients for pain or symptoms but no neurological deficit. Surgical decompression with stabilization using implants was performed in 55 patients with neurological deficit, paraplegia, or bone destruction. Histopathology confirmed the diagnosis. Complications were rare. The study concludes early diagnosis and treatment, whether medical or surgical, improves prognosis for spinal tuberculosis.
This document discusses the use of surgical navigation in craniomaxillofacial surgery and classifies different indications for its use. It analyzes cases where surgical navigation was used or considered at a clinic from 2003-2009. Four typical clinical situations are presented: 1) difficult secondary reconstruction of a zygomatic bone fracture where navigation provided high accuracy, 2) acute orbital floor fractures where navigation aided in identifying bony edges, 3) removal of lingual displaced root fragments where navigation helped locate structures near bony areas, and 4) bilateral midface fractures where navigation was not deemed necessary. The document concludes by classifying indications for surgical navigation as Class I (clear), Class II (limited), or Class III (no indication).
The document discusses prediction rules for identifying pediatric patients at low risk for intra-abdominal injuries after blunt abdominal trauma. It summarizes the PECARN prediction rule, which identifies variables from history and physical exam that predict whether a child needs intervention. The rule achieved high sensitivity and specificity. The document also discusses the UF-Jax algorithm for managing pediatric blunt abdominal trauma, which incorporates physical exam findings, labs, ultrasound, and CT imaging to determine need for observation, admission, or intervention. The goal is identifying injuries requiring treatment while avoiding unnecessary radiation exposure.
The document discusses a prospective study that compares the incidence of incisional hernia in 134 patients undergoing gastric bypass surgery who received either primary fascial closure or closure with a prophylactic biological mesh. The results showed a significantly lower incidence of incisional hernia in patients who received the biological mesh (2.3% vs 17.7%), though these patients experienced a higher rate of seroma formation. After adjusting for risk factors, prophylactic mesh placement was found to be protective against hernia development while smoking increased hernia risk. The study provides evidence that prophylactic biological mesh may reduce incisional hernia rates in high-risk patients.
The document discusses a retrospective study of 17 patients with spontaneous pyogenic spondylodiscitis who underwent surgical treatment in Bangladesh. The study found the highest incidence was in the 4th-6th decades of life, with more cases in males. The lumbar region was most commonly affected. Surgical techniques included laminectomy with drainage of pus or laminectomy with fixation. The study concludes spontaneous pyogenic spondylodiscitis has relatively high incidence in Bangladesh, affects mostly older males, and surgical treatment has good outcomes when tailored to individual cases.
This study evaluated the use of real-time ultrasound in diagnosing congenital hip dislocation and dysplasia in infants. The researchers examined 131 hips in 104 patients, finding real-time ultrasound to be reliable and accurate with few false positives or negatives. Ultrasound clearly images cartilaginous structures in the infant hip joint that are poorly visualized on radiographs. The advantages of ultrasound are that it is non-invasive, portable, and does not use radiation. The researchers conclude that ultrasound is a useful adjunct to radiography in diagnosing instability and abnormalities in the infant hip.
A 1-month-old girl presented with a large congenital lesion on her face. A biopsy revealed it to be a giant congenital juvenile xanthogranuloma (JXG), which is a rare non-Langerhans cell histiocytosis characterized by yellow-brown nodules larger than 20 mm. Systemic exams found no other involvement. Giant JXG usually spontaneously regresses within years without treatment.
In this presentation, several aspects about imaging, sentinel node and treatment of the N0 neck in head and neck cancer are discussed with emphasis on oral cancer. 2015
This document discusses the treatment of a 6-year-old male patient who presented with disocclusion of teeth and a deformed mandible for 15 days following a road traffic accident. Diagnostic studies including CBCT were performed. A treatment plan was developed to fabricate a cap splint using alginate impressions and stone casts. The splint was used for audiovisual distraction and tying of an arch bar for realignment and stabilization of the mandible during healing. Conservative treatment is emphasized for pediatric mandibular fractures to allow for facial growth and development.
Arthroscopic Management of Anterior, Posterior, and Multidirectional Shoulder...Peter Millett MD
Arthroscopic treatment of the unstable shoulder has evolved rapidly and significantly in recent years. Better understanding of the pathoanatomy, advancements in technology, and improved surgical techniques have led to dramatic improvements in outcome. An arthroscopic approach includes significant advantages. Arthroscopy provides better identification of concomitant pathology, lower morbidity, less soft tissue dissection, maximal preservation of motion, shorter surgical time, and improved cosmesis. There is less pain, and many patients have an easier functional recovery, with greater returns in motion compared with traditional open techniques. Finally, some of the inherent risks of open procedures, such as postoperative subscapularis rupture, are virtually eliminated. Surgeons can now routinely expect results that are at least comparable, if not better than, those achieved with open techniques. For more shoulder surgery and instability studies, visit Dr. Millett, Orthopedic Surgeon, Vail Colorado http://drmillett.com/shoulder-studies
1) The study analyzed outcomes of 728 soft tissue sarcoma patients, 281 of whom underwent unplanned excisions prior to referral to specialty centers.
2) Patients who had unplanned excisions were found to have smaller and more superficial tumors on average.
3) After adjusting for factors like tumor grade and size, unplanned excisions were not found to provide any survival benefit compared to planned surgery, and resulted in more complex subsequent procedures.
4) The study concludes that while unplanned excisions do not seem to directly harm prognosis, they should still be avoided due to increased treatment complexity.
Laparoscopic Inguinal Hernia Repair Eminence-based or Evidence-based?George S. Ferzli
The document summarizes evidence from studies on various aspects of inguinal hernia repair. It reviews evidence on diagnostic modalities, indications for surgical treatment, risk factors, techniques for laparoscopic repair, recommendations for female patients, and recommendations for young men. It also reviews evidence that found insufficient evidence to recommend routine antibiotic or thromboembolic prophylaxis for laparoscopic hernia surgery.
Vitamin E capsules can effectively be used as fiducial markers for image-guided neurosurgery, providing accurate registration while significantly reducing costs compared to proprietary fiducials. The use of Vitamin E capsules for registration resulted in a mean overall accuracy of 1.84 mm, compared to 2.41 mm for regular fiducials. Image guidance improves the safety, accuracy, and visualization for trans-sphenoidal pituitary surgeries compared to fluoroscopy alone.
Spinal Cord Injury Without Radiology Abnormality (SCIWORA)Ade Wijaya
Spinal cord injury without radiographic abnormality (SCIWORA) is a rare myelopathy without vertebral fracture or malalignment on imaging. It mainly affects the cervical spine. MRI is the gold standard for diagnosis. Treatment involves nonsurgical options like steroids initially, while surgical decompression 3-7 days after injury can improve outcomes. The prognosis depends on the initial neurological severity and type of spinal cord injury seen on MRI.
Primary hydatidosis of the tibia is a rare disease. In an endemic area, it should be considered in the differential diagnosis of a
hypolucent osteolytic lesion on x-ray. If not properly managed, anaphylactic shock may occur intraoperatively, as well as increased recurrence of the disease. This is a case report of a primary tibial hydatid cyst, treated fi rst with curettage and phenolizaton, and then after recurrence, with total knee arthroplasty. We will review the literature of the diagnosis and the treatment of a tibial hydatid cyst.
Placement of dental_implants_in_irradiated_bone_the_case_for_using_hyperbaric...Dr syed sohaib Gilani
This document discusses the use of hyperbaric oxygen therapy (HBO) prior to placing dental implants in patients who have received radiation therapy for cancer treatment. It begins by asking if there is a reason to use the osseointegrated implant (OI) concept in irradiated patients, and answers that implants can improve function and quality of life. However, placement of implants in irradiated bone can pose risks. The document then discusses factors related to radiation therapy and the patient that may affect implant outcomes, such as radiation dose, time since radiation, and bone quality. It concludes that HBO can help prevent potential complications in high-risk patients undergoing implant placement after radiation.
This document discusses the management of duodenal injuries. It notes that while duodenal injuries are uncommon, accounting for about 4% of abdominal injuries, they can have high morbidity and mortality rates of 65% and 20% respectively due to difficulties in diagnosis and management. It outlines the history of treatment for duodenal injuries and factors that influence incidence rates. It then discusses techniques for diagnosis, including physical exam, imaging studies, and exploratory laparotomy. Finally, it reviews surgical management strategies and repairs that can be used to treat duodenal injuries.
Este documento presenta los resultados del tratamiento endoscópico con Deflux para el reflujo vesicoureteral primario en 25 pacientes (38 uréteres). El 73,6% de los casos tuvieron éxito con una sola inyección de Deflux, resolviéndose completamente el reflujo. Los mejores resultados se obtuvieron en grados bajos de reflujo y en casos unilaterales o de sistema único, alcanzando un 100% de éxito. El peor resultado fue en casos de sistema doble, resolviéndose solo 1 de 6
The document summarizes a study examining the association between late gadolinium enhancement seen on cardiac magnetic resonance imaging and clinical outcomes in patients with hypertrophic cardiomyopathy. The study found that the presence and amount of late gadolinium enhancement was independently associated with increased risks of major cardiovascular events, heart failure hospitalization, and arrhythmic events. While the presence of late gadolinium enhancement classified over 60% of patients as high risk, quantitative parameters such as the percentage of late gadolinium enhancement showed even stronger associations with outcomes and may better stratify patient risk. Larger prospective studies are still needed to determine if late gadolinium enhancement can be used as a primary risk stratification tool.
This study evaluated 83 patients with acute pancreatitis using initial CT scans and clinical assessments. CT scans were classified into 5 grades (A-E) based on pancreatic abnormalities and surrounding tissue involvement. Higher grades (D-E) were associated with more complications like abscesses. 21.6% of patients developed abscesses, most commonly those with grade E pancreatitis. Pleural effusions were also more common in grade E. Grades A-B had no abscesses and no deaths. Abscesses were seen in 80% of those with many prognostic signs, but only 12.5% of those with few signs. Combining initial CT grade and prognostic signs improved prognosis prediction in acute pancreatitis.
This study retrospectively analyzed 127 cases of tuberculosis of the spine treated surgically between 2007-2017. Most patients were young adults between 11-30 years old and more were male. Surgical decompression without stabilization was performed in 72 patients for pain or symptoms but no neurological deficit. Surgical decompression with stabilization using implants was performed in 55 patients with neurological deficit, paraplegia, or bone destruction. Histopathology confirmed the diagnosis. Complications were rare. The study concludes early diagnosis and treatment, whether medical or surgical, improves prognosis for spinal tuberculosis.
This document discusses the use of surgical navigation in craniomaxillofacial surgery and classifies different indications for its use. It analyzes cases where surgical navigation was used or considered at a clinic from 2003-2009. Four typical clinical situations are presented: 1) difficult secondary reconstruction of a zygomatic bone fracture where navigation provided high accuracy, 2) acute orbital floor fractures where navigation aided in identifying bony edges, 3) removal of lingual displaced root fragments where navigation helped locate structures near bony areas, and 4) bilateral midface fractures where navigation was not deemed necessary. The document concludes by classifying indications for surgical navigation as Class I (clear), Class II (limited), or Class III (no indication).
The document discusses prediction rules for identifying pediatric patients at low risk for intra-abdominal injuries after blunt abdominal trauma. It summarizes the PECARN prediction rule, which identifies variables from history and physical exam that predict whether a child needs intervention. The rule achieved high sensitivity and specificity. The document also discusses the UF-Jax algorithm for managing pediatric blunt abdominal trauma, which incorporates physical exam findings, labs, ultrasound, and CT imaging to determine need for observation, admission, or intervention. The goal is identifying injuries requiring treatment while avoiding unnecessary radiation exposure.
The document discusses a prospective study that compares the incidence of incisional hernia in 134 patients undergoing gastric bypass surgery who received either primary fascial closure or closure with a prophylactic biological mesh. The results showed a significantly lower incidence of incisional hernia in patients who received the biological mesh (2.3% vs 17.7%), though these patients experienced a higher rate of seroma formation. After adjusting for risk factors, prophylactic mesh placement was found to be protective against hernia development while smoking increased hernia risk. The study provides evidence that prophylactic biological mesh may reduce incisional hernia rates in high-risk patients.
The document discusses a retrospective study of 17 patients with spontaneous pyogenic spondylodiscitis who underwent surgical treatment in Bangladesh. The study found the highest incidence was in the 4th-6th decades of life, with more cases in males. The lumbar region was most commonly affected. Surgical techniques included laminectomy with drainage of pus or laminectomy with fixation. The study concludes spontaneous pyogenic spondylodiscitis has relatively high incidence in Bangladesh, affects mostly older males, and surgical treatment has good outcomes when tailored to individual cases.
This study evaluated the use of real-time ultrasound in diagnosing congenital hip dislocation and dysplasia in infants. The researchers examined 131 hips in 104 patients, finding real-time ultrasound to be reliable and accurate with few false positives or negatives. Ultrasound clearly images cartilaginous structures in the infant hip joint that are poorly visualized on radiographs. The advantages of ultrasound are that it is non-invasive, portable, and does not use radiation. The researchers conclude that ultrasound is a useful adjunct to radiography in diagnosing instability and abnormalities in the infant hip.
A 1-month-old girl presented with a large congenital lesion on her face. A biopsy revealed it to be a giant congenital juvenile xanthogranuloma (JXG), which is a rare non-Langerhans cell histiocytosis characterized by yellow-brown nodules larger than 20 mm. Systemic exams found no other involvement. Giant JXG usually spontaneously regresses within years without treatment.
In this presentation, several aspects about imaging, sentinel node and treatment of the N0 neck in head and neck cancer are discussed with emphasis on oral cancer. 2015
This document discusses the treatment of a 6-year-old male patient who presented with disocclusion of teeth and a deformed mandible for 15 days following a road traffic accident. Diagnostic studies including CBCT were performed. A treatment plan was developed to fabricate a cap splint using alginate impressions and stone casts. The splint was used for audiovisual distraction and tying of an arch bar for realignment and stabilization of the mandible during healing. Conservative treatment is emphasized for pediatric mandibular fractures to allow for facial growth and development.
Arthroscopic Management of Anterior, Posterior, and Multidirectional Shoulder...Peter Millett MD
Arthroscopic treatment of the unstable shoulder has evolved rapidly and significantly in recent years. Better understanding of the pathoanatomy, advancements in technology, and improved surgical techniques have led to dramatic improvements in outcome. An arthroscopic approach includes significant advantages. Arthroscopy provides better identification of concomitant pathology, lower morbidity, less soft tissue dissection, maximal preservation of motion, shorter surgical time, and improved cosmesis. There is less pain, and many patients have an easier functional recovery, with greater returns in motion compared with traditional open techniques. Finally, some of the inherent risks of open procedures, such as postoperative subscapularis rupture, are virtually eliminated. Surgeons can now routinely expect results that are at least comparable, if not better than, those achieved with open techniques. For more shoulder surgery and instability studies, visit Dr. Millett, Orthopedic Surgeon, Vail Colorado http://drmillett.com/shoulder-studies
1) The study analyzed outcomes of 728 soft tissue sarcoma patients, 281 of whom underwent unplanned excisions prior to referral to specialty centers.
2) Patients who had unplanned excisions were found to have smaller and more superficial tumors on average.
3) After adjusting for factors like tumor grade and size, unplanned excisions were not found to provide any survival benefit compared to planned surgery, and resulted in more complex subsequent procedures.
4) The study concludes that while unplanned excisions do not seem to directly harm prognosis, they should still be avoided due to increased treatment complexity.
Laparoscopic Inguinal Hernia Repair Eminence-based or Evidence-based?George S. Ferzli
The document summarizes evidence from studies on various aspects of inguinal hernia repair. It reviews evidence on diagnostic modalities, indications for surgical treatment, risk factors, techniques for laparoscopic repair, recommendations for female patients, and recommendations for young men. It also reviews evidence that found insufficient evidence to recommend routine antibiotic or thromboembolic prophylaxis for laparoscopic hernia surgery.
Vitamin E capsules can effectively be used as fiducial markers for image-guided neurosurgery, providing accurate registration while significantly reducing costs compared to proprietary fiducials. The use of Vitamin E capsules for registration resulted in a mean overall accuracy of 1.84 mm, compared to 2.41 mm for regular fiducials. Image guidance improves the safety, accuracy, and visualization for trans-sphenoidal pituitary surgeries compared to fluoroscopy alone.
Spinal Cord Injury Without Radiology Abnormality (SCIWORA)Ade Wijaya
Spinal cord injury without radiographic abnormality (SCIWORA) is a rare myelopathy without vertebral fracture or malalignment on imaging. It mainly affects the cervical spine. MRI is the gold standard for diagnosis. Treatment involves nonsurgical options like steroids initially, while surgical decompression 3-7 days after injury can improve outcomes. The prognosis depends on the initial neurological severity and type of spinal cord injury seen on MRI.
Primary hydatidosis of the tibia is a rare disease. In an endemic area, it should be considered in the differential diagnosis of a
hypolucent osteolytic lesion on x-ray. If not properly managed, anaphylactic shock may occur intraoperatively, as well as increased recurrence of the disease. This is a case report of a primary tibial hydatid cyst, treated fi rst with curettage and phenolizaton, and then after recurrence, with total knee arthroplasty. We will review the literature of the diagnosis and the treatment of a tibial hydatid cyst.
Placement of dental_implants_in_irradiated_bone_the_case_for_using_hyperbaric...Dr syed sohaib Gilani
This document discusses the use of hyperbaric oxygen therapy (HBO) prior to placing dental implants in patients who have received radiation therapy for cancer treatment. It begins by asking if there is a reason to use the osseointegrated implant (OI) concept in irradiated patients, and answers that implants can improve function and quality of life. However, placement of implants in irradiated bone can pose risks. The document then discusses factors related to radiation therapy and the patient that may affect implant outcomes, such as radiation dose, time since radiation, and bone quality. It concludes that HBO can help prevent potential complications in high-risk patients undergoing implant placement after radiation.
This document discusses the management of duodenal injuries. It notes that while duodenal injuries are uncommon, accounting for about 4% of abdominal injuries, they can have high morbidity and mortality rates of 65% and 20% respectively due to difficulties in diagnosis and management. It outlines the history of treatment for duodenal injuries and factors that influence incidence rates. It then discusses techniques for diagnosis, including physical exam, imaging studies, and exploratory laparotomy. Finally, it reviews surgical management strategies and repairs that can be used to treat duodenal injuries.
Este documento presenta los resultados del tratamiento endoscópico con Deflux para el reflujo vesicoureteral primario en 25 pacientes (38 uréteres). El 73,6% de los casos tuvieron éxito con una sola inyección de Deflux, resolviéndose completamente el reflujo. Los mejores resultados se obtuvieron en grados bajos de reflujo y en casos unilaterales o de sistema único, alcanzando un 100% de éxito. El peor resultado fue en casos de sistema doble, resolviéndose solo 1 de 6
The document summarizes a study examining the association between late gadolinium enhancement seen on cardiac magnetic resonance imaging and clinical outcomes in patients with hypertrophic cardiomyopathy. The study found that the presence and amount of late gadolinium enhancement was independently associated with increased risks of major cardiovascular events, heart failure hospitalization, and arrhythmic events. While the presence of late gadolinium enhancement classified over 60% of patients as high risk, quantitative parameters such as the percentage of late gadolinium enhancement showed even stronger associations with outcomes and may better stratify patient risk. Larger prospective studies are still needed to determine if late gadolinium enhancement can be used as a primary risk stratification tool.
This study evaluated 83 patients with acute pancreatitis using initial CT scans and clinical assessments. CT scans were classified into 5 grades (A-E) based on pancreatic abnormalities and surrounding tissue involvement. Higher grades (D-E) were associated with more complications like abscesses. 21.6% of patients developed abscesses, most commonly those with grade E pancreatitis. Pleural effusions were also more common in grade E. Grades A-B had no abscesses and no deaths. Abscesses were seen in 80% of those with many prognostic signs, but only 12.5% of those with few signs. Combining initial CT grade and prognostic signs improved prognosis prediction in acute pancreatitis.
This document discusses the use of cardiac magnetic resonance (CMR) in evaluating hypertrophic cardiomyopathy (HCM). CMR provides high resolution imaging of the heart and can identify fibrosis using late gadolinium enhancement, providing useful information beyond echocardiography. CMR is now routinely performed in new HCM patients to aid diagnosis and risk stratification, and help guide treatment planning. The incremental data from CMR improves understanding of HCM's phenotypic heterogeneity and prognostic implications.
Transient synovitis is a common cause of hip pain in children that presents with limping and limited range of motion. Ultrasound is useful for detecting joint effusion but cannot determine if the effusion is caused by infection, bleeding, or transudate. A diagnostic joint aspiration provides quick pain relief and determines if antibiotics are necessary to treat potential septic arthritis. Imaging plays an important role in evaluating developmental dysplasia of the hip and determining treatment for complex hip disorders in children.
La pancreatitis aguda puede ser leve o grave. La TC muestra en la leve un aumento del tamaño y densidad del páncreas con contornos mal definidos. La grave presenta colecciones líquidas, necrosis pancreática e infección. La extensión de la necrosis se correlaciona con la morbilidad y mortalidad. La RMN es comparable a la TC y útil para identificar material necrótico.
Este estudio evaluó los resultados del tratamiento endoscópico con Deflux para el reflujo vesicoureteral primario en 25 pacientes (38 uréteres). La tasa de éxito general fue del 73,6% después de una inyección. Los mejores resultados se obtuvieron en los grados bajos de reflujo (100% en grados 1 y 2) y en casos unilaterales simples (100% en casos simples y unilaterales). El peor resultado se obtuvo en casos de sistemas dobles, donde solo 1 de 6 uréteres se
La hemorragia digestiva baja (HDB) es un sangrado gastrointestinal distal al ligamento de Treitz. El manejo incluye estabilización, colonoscopia para identificar la causa, y angiografía para diagnóstico y posible embolización si el sangrado es masivo o persistente. La embolización con microcoils u otros agentes es efectiva para controlar el sangrado pero existe riesgo de isquemia intestinal.
Este documento describe la pancreatitis aguda, incluyendo su etiología, manifestaciones clínicas, diagnóstico e imágenes radiológicas. Las principales causas de pancreatitis aguda son la litiasis biliar, el alcoholismo y factores metabólicos. Los síntomas incluyen dolor abdominal severo, náuseas y vómitos. La tomografía computarizada y la escala de Balthazar son útiles para la evaluación y pronóstico, clasificando la gravedad de la inflamación y necrosis pancreática. La colangiopancreat
This document discusses developmental dysplasia of the hip (DDH), including:
- DDH is a common disorder of newborns and infants that affects hip development. It can be present at birth or develop later.
- Reported incidences of DDH vary significantly between populations and studies due to differences in study methods and diagnostic techniques.
- Clinical examination, ultrasound, x-ray and other imaging methods are used to diagnose and monitor DDH at different infant ages. Treatment options also vary depending on the infant's age and severity of the condition.
Dr. Balakrishna Shetty is a pediatric radiologist who discusses several acute abdominal conditions that present similarly in children and adults, such as appendicitis. He notes that some findings differ in children, such as appendicitis sometimes presenting without fecalith. Transient intussusception is more common in children and often associated with mesenteric adenitis. Pneumonia can also mimic acute abdominal conditions. Overall, many pediatric abdominal issues are non-surgical and can be managed conservatively with careful evaluation to rule out serious conditions requiring surgery.
This document summarizes a study examining risk factors associated with late presentation of developmental dysplasia of the hip (DDH) in children. The study assessed 370 children ages 3-7 months referred for DDH. Key findings included:
1) Female sex, being first-born, family history of DDH, and breech presentation were confirmed as risk factors. Bilateral DDH was more common than unilateral.
2) Abnormal groin skin folds and limited hip abduction were the most common clinical findings.
3) Vaginal delivery carried higher risk than caesarean for breech babies, while caesarean reduced risk in non-breech babies. Multiple births and
Intussusception in adult population is quite uncommon. It is usually seen in the pediatric age group. A wide range of causes can predispose to intussusception in adults. Majority of them are benign especially in cases of small bowel intussusception. However malignancy is quite often encountered in cases of colonic intussusception. Diagnosis in adults is difficult due to vague symptoms and intermittent nature. Computerized tomography is diagnostic. However majority of cases in adults are diagnosed at laparotomy. Surgical resection assuming the lesion to be malignant is the treatment of choice.
Study of current pattern of Cervical Spondylotic Myelopathy and to evaluate t...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This document provides an overview of the diagnosis and treatment of complex regional pain syndrome (CRPS) in pediatric patients. While historically thought to be intrinsically different in children, there appear to be relatively few differences from adults. Treatment focuses primarily on physical therapy, with additional sympathetic blocks, medications, or other modalities used to facilitate rehabilitation. Outcomes generally seem positive, though some children experience long-term pain and disability despite aggressive treatment.
This document discusses the imaging assessment and localization of head and neck infections. It notes that cervical lymphadenitis is common in children while dental or odontogenic infections are more common causes in adults. Imaging can help localize drainable collections and assess for complications. Specific infections discussed include orbital infections, acute otitis media, mastoiditis, retropharyngeal abscesses, and submandibular space infections. The role of imaging is to identify the location and extent of infection and detect any complications.
This document summarizes a study on using ultrasound to assess cystic neck lesions prior to treatment. The study examined 120 patients with neck masses and found cystic lesions in 7.5% of cases, including branchial cysts and lymphangiomas. Ultrasound was able to differentiate cystic from solid lesions and characterize features like contents, borders, and location. The study concluded ultrasound is a useful non-invasive tool for evaluating cystic neck lesions before treatment due to its low cost, lack of radiation, and ability to detect diagnostic imaging characteristics of various cyst types.
Endometriosis is a disease restricted usually to the female genital tract. Involvement of the bowel by this disease can lead to a diagnostic dilemma due to the great variation in the symptomatology. Awareness of the pathophysiology, clinical features and diagnostic modalities is of utmost importance to decide the modality of treatment. Hormonal manipulation and surgical resection are the two modalities of treatment. The choice depends upon critical analysis of clinical and radiological findings and the desire to have pregnancy in cases associated with infertility.
Guidelines for Diagnostic Imaging During Pregnancy and Lactation.pdfFernanda
Ultrasonography and magnetic resonance imaging (MRI) are not associated with risk during pregnancy and are the preferred imaging techniques. While radiation exposure from other techniques like radiography and computed tomography is typically lower than levels linked to fetal harm, they should not be withheld if needed. The use of gadolinium contrast with MRI should be limited to situations where benefits outweigh risks, and breastfeeding need not be interrupted after gadolinium administration.
Assessing the appropriateness of CT scans among pediatric ortho patientsImage gently
The article discusses assessing the appropriate use of CT scans among pediatric orthopedic patients to minimize radiation exposure. It notes that while CT scans can be necessary, other imaging options should be considered whenever possible. The authors conducted a review of studies on radiation doses from various imaging technologies used for pediatric orthopedic injuries. Their findings suggest current practices need reexamination based on nationally accepted best practices to balance imaging needs with minimizing radiation exposure.
This document summarizes a study that evaluated the efficacy of ultrasonography and computed tomography in diagnosing palpable neck masses. 40 patients with neck masses were examined clinically and underwent ultrasound and CT scans. The results found that ultrasound was useful for characterizing masses as solid or cystic and identifying features like margins, calcifications and necrosis. CT provided additional information on tissue attenuation, extent of lesions, and involvement of surrounding structures or distant spread. The study concluded that ultrasound combined with CT provides valuable information to accurately diagnose neck masses and guide their management.
Medical Management of Chronic Pelvic Pain: The Evidence.Alex Swanton
Chronic pelvic pain (CPP) is a significant problem for both general practitioners in the primary care setting and gynaecologists alike. The incidence of CPP has often been overlooked due, partially, to an inappropriate referral pattern, but also due to the inherent difficulty in correctly diagnosing the condition.
Adrenal Mass in Pregnancy: Diagnostic Approach and DilemmasApollo Hospitals
An adrenal incidentaloma is a mass lesion greater than 1 cm in diameter, incidentally found during radiologic examination for other reasons.
1. Such “adrenal incidentalomas” are increasingly recognised in clinical practice.
2. This is attributed to routine use of sophisticated and sensitive imaging techniques, with a reported prevalence of 4.4%.
3. Incidental findings of such masses pose dilemmas in evaluation and management, as current recommendations based on expert opinion.
4. Are open to debate in terms of cost and clinical
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complicating second trimester of pregnancy. This case
outlines the huge decisional dilemmas, both for the patient
and healthcare provider.
This document provides an overview of the internal educational program (IEP) of the Vanderbilt University Division of Trauma, Emergency Surgery and Surgical Critical Care. The goal of the IEP is to explore topics related to trauma care from pre-hospital care to injury prevention. The program will outline the full continuum of care provided to trauma patients. It then introduces the trauma team members and multidisciplinary liaisons that will be involved in the educational sessions. The overall goal is to continuously improve trauma patient care and reduce injuries in the local region.
classification and managenement of paediatric craniocervical junction injuriesDieu Merci KABULO
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This document reviews appendicitis in children. It discusses the demographics, natural history, diagnosis, medical and surgical management of both acute and perforated appendicitis. Key points include that appendicitis is most common in adolescents, is caused by luminal obstruction, and diagnosis involves clinical exam and imaging studies like ultrasound or CT scan. Treatment involves antibiotics for uncomplicated cases or appendectomy for acute or perforated cases, which can be performed laparoscopically or openly. Outcomes of laparoscopic appendectomy are generally better with less complications compared to open surgery.
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𝐄𝐱𝐩𝐥𝐚𝐢𝐧 𝐭𝐡𝐞 𝐍𝐚𝐭𝐮𝐫𝐞 𝐚𝐧𝐝 𝐒𝐜𝐨𝐩𝐞 𝐨𝐟 𝐚𝐧 𝐄𝐧𝐭𝐫𝐞𝐩𝐫𝐞𝐧𝐞𝐮𝐫:
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The recent surge in pro-Palestine student activism has prompted significant responses from universities, ranging from negotiations and divestment commitments to increased transparency about investments in companies supporting the war on Gaza. This activism has led to the cessation of student encampments but also highlighted the substantial sacrifices made by students, including academic disruptions and personal risks. The primary drivers of these protests are poor university administration, lack of transparency, and inadequate communication between officials and students. This study examines the profound emotional, psychological, and professional impacts on students engaged in pro-Palestine protests, focusing on Generation Z's (Gen-Z) activism dynamics. This paper explores the significant sacrifices made by these students and even the professors supporting the pro-Palestine movement, with a focus on recent global movements. Through an in-depth analysis of printed and electronic media, the study examines the impacts of these sacrifices on the academic and personal lives of those involved. The paper highlights examples from various universities, demonstrating student activism's long-term and short-term effects, including disciplinary actions, social backlash, and career implications. The researchers also explore the broader implications of student sacrifices. The findings reveal that these sacrifices are driven by a profound commitment to justice and human rights, and are influenced by the increasing availability of information, peer interactions, and personal convictions. The study also discusses the broader implications of this activism, comparing it to historical precedents and assessing its potential to influence policy and public opinion. The emotional and psychological toll on student activists is significant, but their sense of purpose and community support mitigates some of these challenges. However, the researchers call for acknowledging the broader Impact of these sacrifices on the future global movement of FreePalestine.
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Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
1. Imaging, 14 (2002), 179–187 E 2002 The British Institute of Radiology
Imaging of children’s hips
1
D WILSON, MBBS, BSc, FRCP, FRCR and 2G ALLEN, BM DCH, MRCGP, MRCP, FRCR
1
Nuffield Orthopaedic Centre, Oxford and 2Royal Orthopaedic Hospital, Birmingham, UK
Children may present with hip disease in a
variety of ways. In the newborn it may be detected Summary
by routine clinical examination. In the older child
pain, stiffness and limping are the primary
symptoms. In the toddler ‘‘going of their feet’’
N Ultrasound is an important tool in thedysplasia
and management of developmental
detection
may be the presenting event. of the hip.
Most children who complain of pain in the hip
have genuine pathology. It is an unusual location N Universal screening for developmental
for a child to make up or exaggerate complaints. dysplasia of the hip by ultrasound may be wise
Imaging has a pivotal role in the management of but there is currently insufficient evidence to
these patients who may have disease that requires clearly recommend this a national policy.
urgent medical or surgical treatment.
In most cases a child or infant complaining of a
N A painful hip in childhood is a clinical
emergency.
painful hip should be examined and investigated
as a matter or urgency. Hospitals should provide N Ultrasound is the definitive method for
on-call imaging and general practitioners should detecting joint effusion.
be fully aware of local facilities and management
protocols.
N Ultrasound cannot determine whether a joint
effusion is due to infection, haemorrhage or
transudate.
Developmental dysplasia
N Imaging has a role in determining the cause of
Between 1 and 3 newborns per 1000 live births snapping hips.
will be diagnosed as suffering from developmental
dysplasia of the hip (DDH), formerly known as
congenital dislocation of the hip, with a female vehement advocates. In reality, local outcome
preponderance of 9:1. This hides the much larger measures must be the standard by which these
incidence of premature osteoarthritis that devel- techniques are judged. The best method applied
ops in young adults who have a shallow and badly or administered ineffectively will be of less
mechanically disadvantaged hip that is not bad use than a less technically demanding method that
enough to have presented in infancy. Many who is used rigorously with top quality clerical and
undergo hip replacement in their middle years are management support.
undiagnosed cases of DDH. The true incidence of
DDH is therefore much higher, although there are
no clear figures in the literature (Figures 1 and 2).
There is good evidence that early treatment of
DDH with splint therapy improves prognosis [1].
This is only effective in the first 6 months of
life when remodelling is very active. Therefore if
diagnosis is made early enough, overall popula-
tion morbidity may be reduced. It was this rationale
that led to the now universal clinical screening
protocols using Barlow and Ortolani manoeuvres
to detect subtle subluxation and instability of the
hip. Unfortunately clinical examination, even in
the best of hands, will overlook a substantial
proportion of cases that would benefit from early
treatment. Ultrasound introduces an additional
Figure 1. Plain radiograph of a 28-year-old who has
method of screening that considerably improves early osteoarthritis secondary to developmental dys-
detection [2–7]. A number of methods have been plasia that was asymptomatic as a child and young
developed and each has strong and sometimes adult.
Imaging, Volume 14 (2002) Number 3 179
2. D Wilson and G Allen
Figure 2. Plain radiograph of a pseudarthrosis result-
ing from unrecognized dislocation of the hip.
Most techniques stem from that developed by
Professor Graf, an Austrian orthopaedic surgeon.
Figure 4. Ultrasound of a shallow acetabulum that
Graf uses coronal plane ultrasound to produce a would be treated by a splint or harness.
standard section equivalent in orientation to a
frontal radiograph of the hip. Lines drawn on the More contentious is deciding upon the popula-
image are used to measure the angular depth of tion to be screened. Infants with family history of
the acetabulum and the cover of the femoral head. hip dysplasia, those born by breech delivery and
Strict adherence to the technique is essential as those with other congenital anomalies are at much
small variations in measurement will alter classi- higher risk of developing DDH. Screening of
fication and affect management protocols. Others those at high risk in addition to those who are
have introduced less demanding methods of mea- suspected as being abnormal on routine clinical
surement, although still requiring discipline in examination is the most common practice in the
image acquisition (Figures 3–5). It has been UK. Others argue that this policy will fail to
argued that a static image alone is less sensitive provide the most accurate and sensitive detection
than a morphological measure plus a dynamic of all who might benefit from early treatment and
stress test, and there is evidence that this improves suggest universal screening [11]. In Austria and
detection [8]. In most practices a combination of Germany, child benefit entitlement is linked to
static and dynamic imaging is employed [9, 10]. attending for screening. One counter to this
Figure 3. Ultrasound of a borderline depth acetabu- Figure 5. Ultrasound of a dislocated hip that required
lum with measurement using the Morin method. surgical reduction.
180 Imaging, Volume 14 (2002) Number 3
3. Imaging of children’s hips
argument is that required resources are not cost to immediate pain relief [25, 26]. There are no
effective, although this is a difficult line to take in organisms present on Gram stain and culture will
what is an emotionally charged topic. Indeed be negative.
there is evidence that the overall saving in Pain may be treated with analgesia, however,
resources is conquerable in all screening strategies this is not very effective. Some advocate skin
[12, 13]. More telling is the point that standards of traction and bed rest but this requires hospital
detection are likely to drop in any universal admission. A diagnostic aspirate of the joint is a
screening project and that there is currently no more effective method of analgesia as there is
evidence that overall population outcome is better instant pain relief and restoration of function.
in those centres where it is practiced. Further Local anaesthetic jelly and ultrasound guidance
epidemiological research is required before firm allow a safe and rapid joint puncture and prevent
recommendations can be made, and current hospital admission in many cases.
advice in the UK is to perform ultrasound
screening in infants in the high risk category only.
Septic arthritis
In complex congenital hip disorders a combina-
tion of ultrasound, plain radiography and MRI Pyogenic organisms may infect the hip via a
are indicated, especially for planning surgery [14, blood borne route. Staphylococcus aureus and
15]. For example, in deficiency of the proximal haemophylus influenzae are the most common
femur either ultrasound or MRI may be used to organisms. If infection is untreated the joint will
detect whether there is a cartilage fragment in the be rapidly destroyed. Consequent septicaemia
gap and to determine the integrity of the hip joint may be life threatening. The only effective therapy
[16]. is a combination of arthotomy with joint lavage
Following surgery or splint therapy, MRI is and intravenous antibiotics. Clinical presentation
useful to assess the degree and efficacy of reduc- is often indistinguishable from transient synovitis.
tion [17]. In managing pelvic and femoral Fever and serological signs of inflammation are
osteotomies the information from cross-sectional often absent. The degree of irritability does not
imaging is important [18, 19]. predict diagnosis and ultrasound appearances of
septic arthritis are no different from transient
synovitis [27]. The only effective means of diag-
Irritable hip
nosis is aspiration, Gram stain and culture.
Children between the ages of 3 years and 12 Fortunately the condition is rare and those who
years commonly suffer from acute episodes of hip rely on ineffective methods of diagnosis will only
pain. The vast majority are suffering from rarely cause permanent damage.
transient synovitis, which is a benign and self-
limiting condition. Unfortunately, a small but
Perthes disease
important minority have a more serious com-
plaint such as septic arthritis and need urgent Osteochondrosis of the hip, Legg–Calve– ´
surgical management to minimize long-term Perthes disease, is an uncommon disease of
disability [20]. The challenges are detecting and unknown cause. The most convincing theory is
treating this small subset whilst treating the pain that it is the result of trauma in an immature
and discomfort of the majority in a timely and joint. Again, presentation is with pain and
safe manner. limitation of movement. The child may be older
(7–14 years) and there is sometimes a history of
previous episodes of pain. Plain radiography is
Transient synovitis
diagnostic showing fragmentation, roughening,
The cause of transient synovitis is not known. flattening and distortion of the femoral capital
There are postulates that it is traumatic or epiphysis (Figures 6–8). In the early phase the
infective in origin, but neither is proven. The plain radiograph shows widening of the hip joint
condition presents with a short history of pain owing to cartilage overgrowth. Long-term dis-
and limping, which typically resolves within 3–4 ability may result owing to alteration in shape and
days. Although MRI, CT and ultrasound will all mechanical stress. Treatment is based around
detect effusions [21], ultrasound is the established surgery designed to confine the femoral head
method of choice as it is readily available, easy to within the joint, and often includes pelvic and
perform and extremely accurate [22–24]. Ultrasound femoral osteotomies. Ultrasound examination in
examination shows a joint effusion with capsular the early stages of the condition will show joint
distension and a varied amount of synovial thicken- effusion [5, 28–30] and the fragmented epiphysis
ing. A difference of 2 mm or more between the may be visible, but this method should not be
hips is significant. Joint aspirate will be clear and relied upon. For older children with an irritable
straw coloured and depressurizing the joint leads hip a plain radiograph is mandatory to exclude
Imaging, Volume 14 (2002) Number 3 181
4. D Wilson and G Allen
predicting osteonecrosis by assessing vascular
supply to the epiphysis [38]. MRI also has
important roles in surgical planning and in
detecting occult disease in the opposite hip. It is
also valuable in assessing the late sequelae of
Perthes disease [39, 40].
Slipped epiphysis
Older children (8–14 years) may suffer from
slipped upper femoral capital epiphysis (SUFE).
This typically occurs in boys heavier than average
and is thought to be the result of mechanical
stress on the immature growth plate. Presentation
is also with pain and limping of short duration.
Figure 6. A frog lateral view of a child with sus-
pected slipped upper femoral capital epiphysis;
The only effective treatment is surgical fixation,
appearances are normal. most commonly achieved by inserting pins into
the epiphyses via the femoral neck. If treatment is
delayed the slip will worsen with considerably
increased risk of osteonecrosis in the displaced
epiphysis and severe long-term consequences [41,
42]. Detection and treatment are therefore urgent.
Whilst ultrasound will show an effusion in 75% of
cases, and may show the step in the contour of the
femoral head [43–45], it is not as safe and
effective as plain radiograph examination using a
frog lateral projection. SUFE represents a Salter–
Harris 1 type lesion of the proximal femoral
epiphysis. The slip most often occurs in a postero-
medial direction and may be difficult to see on
anteroposterior (AP) radiography [46]. A frog
lateral is mandatory. It is reasonable to omit the
conventional AP film to reduce radiation dose to
Figure 7. The same child as in Figure 6, 1 month the patient. MRI is useful to asses direction and
later, showing contour changes and sclerosis of severity of the slip, especially in planning surgery
Perthes disease.
[47]. It is particularly useful in detecting occult or
subtle slip in the opposite asymptomatic hip,
which may occur in up to 60% of cases. This
examination should be performed prior to surgery
on the affected hip as prophylactic pinning under
the same anaesthetic is possible [48] (Figures 9–11).
Investigation of irritable hip
From the above it should be apparent that a
child with an irritable hip should be seen as an
emergency. The clinician should take a history
and confirm the hip as the origin of pain by
clinical examination. Ultrasound examination
Figure 8. Established Perthes disease with frag-
should be arranged as an emergency [49, 50]. If
mentation and flattening of the right femoral capital there is no joint effusion plain radiography should
epiphysis. be undertaken [44, 45]. If this is normal then other
causes of pain should be considered, e.g. retro-
slipped epiphysis and Perthes disease [31]. Children caecal appendicitis, muscle strain and referred
with recurrent irritable hip should be examined by back pain.
MRI as this technique may detect the condition If ultrasound examination shows fluid, a
when plain radiograph changes have not yet therapeutic and diagnostic aspiration should be
occurred [32–37] (Figure 3). Gadolinium (Gd) performed. Fluid should be sent for urgent Gram
DTPA enhancement may prove to be useful in stain and culture (Figures 12 and 13).
182 Imaging, Volume 14 (2002) Number 3
5. Imaging of children’s hips
Figure 9. Early slipped epiphysis missed as the subtle
changes were not noticed and a lateral view was not
performed.
Figure 11. MRI of advanced slipped epiphysis.
Figure 10. 6 weeks after the image in Figure 9, the
slip was recognized. There is now significant change,
the epiphysis being rendered avascular with a poor
outcome. Figure 12. Ultrasound of a normal hip without an
effusion.
In older children (over 8 years) plain radiog-
raphy in a frog lateral should be performed. Presentation varies greatly from an acutely
In complex or recurrent cases, MRI should be painful region, immobility and systemic toxicity
considered as an additional investigation [51, 52]. through to a completely occult disease with minimal
If MRI is not available there is a role for isotope local symptoms and just s general sense of ill
bone scintigraphy to detect occult bone lesions health.
[53]. Acute infection is typified by bone oedema and
subperiosteal reaction. The latter may be seen on
plain radiography but both are readily apparent
on MRI. The oedema extends beyond the area
Osteomyelitis that is histologically identifiable as active inflam-
Bone infection may be primary due to blood matory response but it is difficult, if not impossible,
borne organisms or secondary due to implantation, to distinguish this margin using imaging. It has
surgery or other forms of trauma. Occasionally been suggested that areas of true infection would
infection spreads to bone from septic arthritis. enhance with intravenous Gd DTPA injection on
Imaging, Volume 14 (2002) Number 3 183
6. D Wilson and G Allen
Juvenile arthritis
Juvenile arthropathy may present in the hip,
although other joints such as the wrist or knees
are more common presenting locations. It should
be considered as a possible diagnosis in recurrent
or complicated cases where diagnosis of transient
synovitis is in doubt. Synovial reaction will be
visible on ultrasound as thickening and irregular-
ity of the capsule. MRI may be more difficult to
interpret as the high signal from fluid in the joint
seen on T2 weighted or short tau inversion recovery
(STIR) images will be the same signal as exhibited
by thickened and oedematous synovium [56]
(Figure 14). Intravenous Gd DTPA enhancement
would resolve this issue but ultrasound is cheaper,
faster and more acceptable to the patient. Ultrasound
is the imaging method of choice for detecting
Figure 13. Ultrasound of a hip with a substantial effusion and pannus [57] and it has a very useful
effusion. Aspirate was sterile. The appearances of role in follow-up studies [58].
septic arthritis may be identical.
Trauma
MRI, however, this is not a reliable test and in Fractures and dislocations around the hip
practice it is rare for contrast enhancement to are rare in children [59, 60]. They tend to be
assist in management. Subperiosteal reaction may associated with high energy injuries. Fractures
be detected using ultrasound. A positive finding should be apparent on plain radiography but
on ultrasound is very specific but a negative study minimally displaced fractures and stress lesions
does not exclude acute osteomyelitis. may not. MRI is the definitive test and will show
Chronic infection and acute infection after all fractures as low signal lines on T1 weighted
antibiotic therapy are best studied by a combina- images surrounded by high signal material on T2
tion of plain radiographs to detect bony destruc- weighted or STIR sequences. MRI also has a role
tion and sclerosis, with MRI to show the extent of in complex fractures of the acetabulum when CT is
diseased bone, abscess within and outside bone not conclusive [61]. Non-accidental injury should
and the extent and nature of soft tissue involve-
ment [54]. Ultrasound is useful in excluding or
defining soft tissue abscesses [55]. CT is sometimes
useful in defining the shape and extent of sclerotic
sequestered fragments. The response to drug
treatment and planning of surgical debridement
depends very much on follow up studies. Serial
MRI studies are invaluable in deciding timing and
extent of surgery. Again, contrast enhancement
rarely alters clinical decisions.
Tumours may mimic infection and vice versa.
In most cases biopsy is indicated and MRI will be
important in deciding where to biopsy and via
which route. Infection in bone is notorious for the
difficulty in identifying the organisms. Even in
proven and definite osteomyelitis only 30% of
biopsy specimens will grow organisms. For this
reason it is important to send biopsy material for
histological examination as this is more often the
means by which infection is established. Image
guided needle biopsy is valuable. However, in
children an open biopsy under general anaesthesia
is not only kinder but may also treat symptoms
as the marrow oedema may be depressurized, Figure 14. T2 weighted coronal MRI of a joint effu-
relieving some of the pain. sion and synovitis in juvenile arthritis.
184 Imaging, Volume 14 (2002) Number 3
7. Imaging of children’s hips
always be considered in younger age groups. 5. Terjesen T. Ultrasonography in the primary evalua-
Ultrasound can also pick up fractures in the tion of patients with Perthes disease. J Pediatr
Orthop 1993;13:437–43.
younger patient. 6. Terjesen T. Ultrasound as the primary imaging
Acute chondral injuries due to sheering forces method in the diagnosis of hip dysplasia in children
may cause an acute arthropathy. If there is a aged ,2 years. J Pediatr Orthop B 1996;5:123–8.
resulting defect in the articular surface, symptoms 7. Poul J, Bajerova J, et al. Selective treatment
may persist and fail to resolve. Conventional MRI program for developmental dysplasia of the hip in
an epidemiologic prospective study. J Pediatr
may show the lesion especially on T2 weighted fast
Orthop B 1998;7:135–7.
spin echo images, although it may be necessary to 8. Finnbogason T, Jorulf H. Dynamic ultrasono-
perform MR arthrography to be sure. CT arthrog- graphy of the infant hip with suspected instability.
raphy is also effective but is less suitable in A new technique. Acta Radiol 1987;38:206–9.
children as the radiation burden is large. 9. Joseph KN, Meyer S. Discrepancies in ultrasono-
Muscle strains and tears may mimic irritable graphy of the infant hip. J Pediatr Orthop B
1996;5:273–8.
hip. They may be invisible on all imaging but 10. Poul J, Garvie D, et al. Ultrasound examination of
significant tears will be well seen on ultrasound as neonate’s hip joints. J Pediatr Orthop B 1998;7:59–
defect in the myofibrillar structure, oedema and 61.
scar tissue. Dynamic stress ultrasound will show 11. Marks D, Clegg J, et al. Routine ultrasound
muscle tears by the retraction of muscle and screening neonatal hip instability. Can it abolish
late-presenting congenital dislocation of the hip.
bulging of the margins of the tear. In the acute J Bone Joint Surg 1994;76:534–8.
phase, MRI of the affected area may be the most 12. Davids JR, Benson LJ, et al. Ultrasonography and
sensitive test. developmental dysplasia of the hip: a cost-benefit
Growth plate injuries are a particular problem analysis of three delivery systems. J Pediatr Orthop
in children. Their management depends on the 1995;15:325–9.
13. Clegg J, Bache CE, et al. Financial justification for
extent and the skeletal age of the child. MRI is
routine ultrasound screening of the neonatal hip. J
the best method of studying the nature of the Bone Joint Surg Br 1999;81:852–7.
injury [62]. 14. Exner GU, Frey E. [Hip dysplasia in infancy.
Proton spin tomography and computerized tomo-
graphy]. Orthopade 1997;26:59–66. (In German.)
15. Tegnander A, Terjesen T. Reliability of ultrasono-
Snapping hip graphy in the follow-up of hip dysplasia in children
above 2 years of age. Acta Radiol 1999;40:619–24.
A variety of clicks and snaps may occur around 16. Court C, Carlioz H. Radiological study of severe
the hip. These are most common in teenage girls. proximal femoral focal deficiency. J Pediatr Orthop
They include iliopsoas snaps, iliotibial tract 1997;17:520–4.
snapping, greater trochanteric bursitis and glenoid 17. Kashiwagi N, Suzuki S, et al. Prediction of
labral injuries. Static ultrasound will demonstrate reduction in developmental dysplasia of the hip
by magnetic resonance imaging. J Pediatr Orthop
inflamed bursae and thickening whilst dynamic 1996;16:254–8.
ultrasound is much more useful as it will show the 18. Lin CJ, Romanus B, et al. Three-dimensional char-
clicking or snapping tendon [63–65]. Local anaes- acteristics of cartilaginous and bony components
thetic blocks of the snapping tendon guided by of dysplastic hips in children: three-dimensional
imaging are useful in confirming diagnosis when computed tomography quantitative analysis. J Pediatr
Orthop 1997;17:152–7.
more invasive forms of treatment are being 19. MacDonald J, Barrow S, et al. Imaging strategies in
considered. Labral tears will only be visible on the first 12 months after reduction of developmental
MRI or CT arthrography [66–69]. They are more dislocation of the hip. J Pediatr Orthop B
common anteriorly than superiorly and imaging 1995;4:95–9.
should include axial sections following the joint 20. Champoux A, Bockers T, et al. Septic arthritis
versus transient synovitis of the hip: the value of
injection.
screening laboratory tests. Ann Emerg Med
1992;21:1418–22.
21. Ranner G, Ebner F, et al. Magnetic resonance
imaging in children with acute hip pain. Pediatr
References Radiol 1989;20:67–71.
1. Teo EL. Clinics in diagnostic imaging (69). Bilateral 22. Wilson D, Green D, et al. Arthrosonography of the
developmental dysplasia of the hip. Singapore Med painful hip. Clin Radiol 1984;35:17–9.
J 2002;43:49–52. 23. Egund N, Wingstrand H, et al. Computed tomo-
2. Berman L, Klenerman L. Ultrasound screening for graphy and ultrasonography for diagnosis of hip
hip abnormalities. Preliminary findings in 1001 joint effusion in children. Acta Orthop Scand
neonates. BMJ 1986;293:719–22. 1986;57:211–5.
3. Novick G. Sonography in paediatric hip disorders. 24. Harcke H, Grissom L. Pediatric hip sonography.
Radiol Clin North Am 1988;26:29–53. Diagnosis and differential diagnosis. Radiol Clin
4. Castelein R, Sauter A, et al. Natural history of North Am 1999;37:787–96.
ultrasound hip abnormalities in clinically normal 25. Berman L, Fink A, et al. Technical note: identifying
newborns. J Pediatr Orthop 1992;12:423–7. and aspirating hip effusions. BJR 1995;68:306–10.
Imaging, Volume 14 (2002) Number 3 185
8. D Wilson and G Allen
26. Fink A, Berman L, et al. The irritable hip: 44. Castriota-Scanderbeg A, Orsi E, et al.
immediate ultrasound guided aspiration and pre- [Ultrasonography in the diagnosis and follow-up
vention of hospital admission. Arch Dis Child of hip pain in children]. Radiol Med (Torino)
1995;72:110–3. 1993;86:808–14. (In Italian.)
27. Zawin JK, Hoffer FA, et al. Joint effusion in 45. Castriota-Scanderbeg A, Orsi E. Slipped capital
children with an irritable hip: US diagnosis and femoral epiphysis: ultrasonographic findings.
aspiration. Radiology 1993;187:459–63. Skeletal Radiol 1993;22:191–3.
28. Wirth T, LeQuesne G, et al. Ultrasonography in 46. Shanker VS, Hashemi-Nejad A, et al. Slipped
Legg-Calve-Perthes disease. Pediatr Radiol 1992; capital femoral epiphysis: is the displacement
22:498–504. always posterior? J Pediatr Orthop B 2000;9:119–
29. Bosch R, Niedermeier C, et al. [Value of ultrasound 21.
in differential diagnosis of pediatric hip joint 47. Umans H, Liebling M, et al. Slipped capital femoral
effusion (Perthes disease, C. fugax, epiphysiolysis epiphysis: aphyseal lesion diagnosed by MRI, with
coapitis femoris]. Z Orthop Ihre Grenzgeb 1998; radiographic and CT correlation. Skeletal Radiol
136:412–9. 1998;27:139–44.
30. Eggl H, Drekonja T, et al. Ultrasonography in the 48. Futami T, Suzuki S, et al. Sequential magnetic
diagnosis of transient synovitis of the hip and Legg- resonance imaging in slipped capital femoral
Calve-Perthes disease. J Pediatr Orthop 1999;8:177– epiphysis: assessment of preslip in the contralateral
80. hip. J Pediatr Orthop B 2001;10:298–303.
31. Robben SG, Meradji M, et al. US of the painful hip 49. Konermann W, Gruber G, et al. [Standardized
in childhood: diagnostic value of cartilage thicken- sonographic examination of the hip joint].
ing and muscle atrophy in the detection of Perthes Ultraschall Med 2000;21:137–41. (In German.)
disease. Radiology 1998;208:35–42. 50. Marchal GJ, Van Holsbeeck MT, et al. Transient
32. Toby EB, Koman LA, et al. Magnetic resonance synovitis of the hip in children: role of US.
imaging of pediatric hip disease. J Pediatr Orthop Radiology 1987;162:825–8.
1985;5:665–71. 51. de Pellegrin M, Fracassetti D, et al. [Coxitis fugax.
33. de Sanctis N, Rega AN, et al. Prognostic evaluation The role of diagnostic imaging]. Orthopade
of Legg-Calve-Perthes disease by MRI. Part I: the 1997;26:858–67. (In German.)
role of physeal involvement. J Pediatr Orthop 52. Thomas S, Tytherleigh-Strong G, et al. Adductor
2000;20:455–62. myositis as a cause of childhood hip pain. J Pediatr
34. Hosokawa M, Kim WC, et al. Preliminary report Orthop B 2002;11:117–20.
on usefulness of magnetic resonance imaging for 53. Alexander JE, Seibert JJ, et al. A protocol of plain
outcome prediction in early-stage Legg-Calve- radiographs, hip ultrasound, and triple phase bone
Perthes disease. J Pediatr Orthop B 1999;8:161–4. scans in the evaluation of the painful pediatric hip.
35. Minio Paluello GB, De Pellegrin M, et al. Clin Pediatr (Phila) 1988;27:175–81.
[Persistent coxalgia in the child. The value of magnetic 54. Kearney SE, Carty H. Pelvic musculoskeletal
resonance]. Radiol Med (Torino) 1997;89:402–8.(In infection in infants—diagnostic difficulties and
Italian.) radiological features. Clin Radiol 1997;52:782–6.
36. Ranner G. [Osteochondrosis deformans coxae 55. Tran-Minh VA, Pracros JP, et al. Sonography of
juvenilis (Legg-Calve-Perthes disease) in the MR the hip and soft tissues of the thigh in children.
tomogram: diagnosis and follow-up assessment Radiol Med (Torino) 1993;85(5 Suppl. 1):247–51.
correlated with x-rays and skeletal scintigraphy]. 56. Lamer S, Sebag GH. MRI and ultrasound in
Rofo Fortschr Geb Rontgenstr Neuen Bildgeb children with juvenile chronic arthritis. Eur J Radiol
Verfahr 1990;153:124–30. (In German.) 2000;33:85–93.
37. Schittich I, Gradinger R, et al. [Legg-Calve-Perthes 57. Eich GF, Halle F, et al. Juvenile chronic arthritis:
disease in the MRI: possibilities and limits]. Z Orthop imaging of the knees and hips before and after
Ihre Grenzgeb 1990;128:404–10. (In German.) intraarticular steroid injection. Pediatr Radiol
38. Sebag G, Ducou Le Pointe H, et al. Dynamic 1994;24:558–63.
gadolinium-enhanced subtraction MR imaging—a 58. Friedman S, Gruber MA. Ultrasonography of the
simple technique for the early diagnosis of Legg- hip in the evaluation of children with seronegative
Calve-Perthes disease: preliminary results. Pediatr juvenile rheumatoid arthritis. J Rheumatol
Radiol 1997;27:216–20. 2002;29:629–32.
39. Lahdes-Vasama TT, Lamminen AE, et al. MRI in 59. Gennari JM, Merrot T, et al. X-ray transparency
late sequelae of Perthes’ disease: imaging findings interpositions after reduction of traumatic disloca-
and symptomatology in ten hips. Pediatr Radiol tions of the hip in children. Eur J Pediatr Surg
1996;26:640–5. 1996;6:288–93.
40. Mastantuono M, Milella PP, et al. [Role of 60. Macnicol MF. The Scottish incidence of traumatic
magnetic resonance in the evaluation of the normal dislocation of the hip in childhood. J Pediatr
and osteochondrosis hip in early and late child- Orthop B 2000;9:122–4.
hood]. Radiol Med (Torino) 1997;94:571–8. (In 61. Rubel IF, Kloen P, et al. MRI assessment of the
Italian.) posterior acetabular wall fracture in traumatic
41. Cowell H. The significance of early diagnosis dislocation of the hip in children. Pediatr Radiol
and treatment of slipping of the capital femoral 2002;32:435–9.
epiphyses. Clin Orthop 1966;48:89–94. 62. Futami T, Foster BK, et al. Magnetic resonance
42. Boles C, el-Khoury G. Slipped capital femoral imaging of growth plate injuries: the efficacy and
epiphysis. Radiographics 1997;17:809–23. indications for surgical procedures. Arch Orthop
43. Kallio P, LeQuesne G, et al. Ultrasonography in Trauma Surg 2000;120:390–6.
slipped capital femoral epiphysis. J Bone Joint Surg 63. Pelsser V, Cardinal E, et al. Extraarticular snapping
1991;73:884–9. hip: sonographic findings. AJR 2001;176:67–73.
186 Imaging, Volume 14 (2002) Number 3
9. Imaging of children’s hips
64. Wunderbaldinger P, Bremer C, et al. Efficient 67. Grainger AJ, Elliott JM, et al. Direct MR
radiological assessment of the internal snapping arthrography: a review of current use. Clin Radiol
hip syndrome. Eur Radiol 2001;11:1743–7. 2000;55:163–76.
65. Choi YS, Lee SM, et al. Dynamic sonography of 68. Erb RE. Current concepts in imaging the adult hip.
external snapping hip syndrome. J Ultrasound Med Clin Sport Med 2001;20:661–96.
2002;21:753–8. 69. Petersilge CA. MR arthrography for evaluation of
66. Ghebontni L, Roger B, et al. MR arthrography the acetabular labrum. Skeletal Radiol 2001;30:423–
of the hip: normal intra-articular structures and 30.
common disorders. Eur Radiol 2000;10:83–8.
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