Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 1990
New aspects of lumbar disc disease. MR imaging and histological findings.
Magnetic resonance imaging (MRI) and plain X-ray and CT studies were performed in patients with a history of lumbar back pain due to spinal disc disease. Spin-echo pulse sequences (SE), phase-contrast techniques (partial saturation sequences with delayed readout, PS), and fat-suppressing inversion recovery sequences (STIR) were employed. In 74 of 325 patients, PS and STIR images displayed vertebral marrow changes adjacent to the end-plates of the affected segments. ⋯ In six patients histological diagnosis showed substitution of hematopoietic marrow by fatty tissue, cartilaginous particles, degeneration of fat cells, and an increase in extracellular fluid with different components. The etiology is still unclear, but a correlation with lumbar disc disease is demonstrated. These vertebral marrow changes were best displayed with STIR and phase-contrast MR sequences, both providing contrast changes superior to T2-weighted SE techniques.
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Twenty cases of aneurysmal bone cyst were reviewed, with an average follow-up of 10.3 years. Twelve patients still had open growth plates at diagnosis, but all of them were fully grown at follow-up. The treatments performed were: resection of the cyst or of the whole affected bone, curettage, and curettage and bone grafting. ⋯ Two patients relapsed, one that had been treated by curettage alone and one by curettage and bone grafting. Five patients showed skeletal deformities at follow-up. Two had lesions of the growth plate, most likely caused by radiation therapy, whereas in the other three growth had probably been impaired by surgical trauma.
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The present authors analyzed the pathological alterations of 1966 tendons examined in the National Institute of Traumatology, Budapest, during the past 18 years. The majority of cases proved to be tendinopathies (hypoxic-degenerative tendinopathy or calcific tendinitis, tendolipomatosis and mucoid degeneration) leading to tendon rupture. The incidence of tendon tumors, foreign bodies, infectious tendon diseases, and other pathological conditions was clearly lower. ⋯ In degenerative tendinopathies and alterations due to hereditary disease, electron microscopy was necessary. Polarization microscopy had a key role in examination of collagen structure and architecture, and identification of foreign bodies in the tendons. Enzyme histochemical and immunohistochemical examination were reliable but not absolutely necessary in the diagnosis of tendon pathology.
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Arch Orthop Trauma Surg · Jan 1990
Case ReportsTransient palsy of hip abductors after a fall on the buttocks.
A fall on the buttocks caused monolateral transient palsy of the hip abductors in two patients. Palsy could be ascribed to acute entrapment of the superior gluteal nerve between the piriformis muscle and the incisura ischiadica major.
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Arch Orthop Trauma Surg · Jan 1990
Case ReportsSimultaneous dislocation of both interphalangeal joints in a finger.
Unlike dislocations of the distal or proximal interphalangeal joints, the simultaneous dislocation in a single finger of both seems to be a rare occurrence. Reduction and checking of the collateral ligament, extensor tendon, and volar plate, followed by 3 weeks of splinting in the intrinsic plus position seems to be the treatment of choice.