SPECT vs. MRI in the evaluation of Acute Spondylolysis (Pediatric and Adolescent)
With modern imaging technologies, MRI is superior to SPECT in the evaluation of acute stress reaction of the pars and spondylolysis.
Authors have argued that a stress reaction around the defect is the most important factor for osseous union. It would then make sense that the earlier the spondylolytic defect is identified, the higher the likelihood for union, especially with nonoperative treatment such as rest, activity restriction, and bracing. For this reason, early radiographic identification is important. While historical SPECT was considered the most sensitive imaging modality, recently many have argued that an MRI is a better study.
In my practice I like to avoid radiation exposure to my patients and would prefer using an MRI rather than CT or SPECT, although MRI is not adequate for evaluating bony anatomy, it will identify bone edema and this is usually enough for first line treatment. If surgery is planned, I would get a CT scan in addition to the MRI.
Dupuytren's Open Fasciectomy
This surgical video demonstrates an open fasciectomy for Dupuytren's disease with intraoperative identification of pathologic structures.
J Hand Surg Am. 2011 Jan;36(1):170-82.
Which of the following statements is true regarding zone II flexor tendon injuries?
At this level, FDS and FDP are located within separate tendon sheaths
FDS repair has not been shown to improve outcomes
Improved gliding is seen with repair of 1 slip of FDS compared to repairing both slips
Repairing FDS does not affect post-operative digit strength
FDP repair has not been shown to improve outcomes
On iPad, you can't hit the arrow to transition between the pictures. You have to click off the picture and enter the next picture separately. This is universal through the new website format.
Cubital Tunnel Syndrome
Please I would like to know the association between cubital tunnel syndrome and primary elbow osteoarthritis, Is there any exact percentage of association? Any articles on this relationship specifically ?Thanks in advance
In Froment's sign, the thumb flexes at the IP joint to grasp a piece of a paper. The lack of function of the adductor pollicis brevis allows the flexor pollicis longus to become more dominant. In Jeanne's sign the IP flexion is accompanied by MP hyperextension. This can be seen as the ulnar function worsens and may be accentuated by weakness in the dually innervated flexor pollicis brevis.
AIN Compressive Neuropathy
Agreed that strict immobilization would cause stiffness in 8-12 weeks; however, the authors do not advocate strict immobilization here. More importantly, a take away from management of AIN syndrome is that the majority of patients diagnosed with this compressive neuropathy do get better with conservative management, but it may take up to 1 year. The article below nicely reviews management of AIN and Pronator syndromes. Without a doubt, conservative management is an important mainstay in treatment, and surgery is indicated only in persistent disease or worsening neurological deterioration (rare here).Pronator syndrome and anterior interosseous nerve syndrome.Rodner CM, Tinsley BA, O'Malley MPJ Am Acad Orthop Surg. 2013 May. pii: 21/5/268. doi: 10.5435/JAAOS-21-05-268. 21. (5). :268-75PMID: 23637145 (Link to Abstract)
wouldn't splinting the elbow at 90 for 8-12 weeks as suggested lead to significant elbow stiffness?
plz answer this what is the difference between 15° scaphoid humpback deformity and intrascaphoid angle of > 35°?
nice diagram of gilulas arc
which clinical situations could be evaluated by gilula arcs?
Radial Head Fracture ORIF with screws and bone graft
ORIF of Radial Head Fracture with Kocher approach, scews, Bio-suture Tak anchor, and bone graft.Dr Thomas TrumbleUniversity of Washingtonwww.uwhand.comIkeda M, Sugiyama K, Kang C, Takagaki T, Oka Y. Comminuted fractures of the radial head: comparison of resection and internal fixation. Surgical technique. J Bone Joint Surg Am. 2006 Mar;88 Suppl 1 Pt 1:11-23. Review. PubMed PMID: . Level of Evidence: 2. [PMID]16510796[/PMID]
Very nice description. Thanks very much
A 50-year-old woman is diagnosed with carpal tunnel syndrome. She is prescribed a cock-up wrist splint at 30 degrees of extension to wear at night. This splint has what effect on the carpal tunnel?
Decreases carpal tunnel pressure
Increases carpal tunnel pressure
No effect on carpal tunnel pressure
Enlarges the carpal tunnel volume
Improves nerve conduction studies
Dr. Mostafa - what area are you seeing alphabetical errors? Do you mean spelling errors? There aren't any images associated with this question.
A 42-year-old male sustains the injury seen in Figure A. Which of the following is true regarding management of this injury?
Replantation at this level has a worse functional outcome when compared to above the elbow amputations
The veins should be reconstructed prior to the arteries
Bony stabilization should occur at the end of the procedure
Vein grafting should not be used at this level of amputation
A warm ischemia time of 8 hours is a relative contraindication to replantation
I had previously been taught that veins are reconstructed before arteries, as restoring inflow without outflow can lead to acidosis. Is this not the case?
Pyogenic Flexor Tendon Irrigation and Debridement
Percutaneous irrigation technique
Yes you made a movie.
Please I cannt save some good pictures after the new version,, also sometimes threr is alphabetical errors in the text comment like this question
J Am Acad Orthop Surg. 2015 Jan;23(1):47-57. doi: 10.5435/JAAOS-23-01-47.
FDP Flexor Tendon Re-rupture (C2522)
23 / M - Dec 6th, 2015 - Deep laceration to palm of hand (zone III/IV). Ruptured all 8 flexor tendons (except for thumb), severed median and ulnar nerves.
Dec 15th, 2015 - Six-hour long repair; nerve grafting. Immobilized post-op for one week, then transitioned to a splint + passive-active motion.
January 5th, 2016 - Sutures removed, active motion allowed.
February 18th, 2016 - Decent range of motion, a lot of scarring in the palm present. The middle finger is doing best, able to touch the palm. Very good range of motion at all DIP joints. (Please see the attached video).
February 19th, 2016 - At 8 weeks and 2 days post-repair, sudden loss of middle finger tip flexion (DIP). Most likely re-rupture. The range of motion at PIP joint worsens as well. Previous best finger now becomes the worst with the least ROM.
March 1st, 2016 - At about 10 weeks post-repair, able to bend the tip of middle finger if and only if the PIP joint is held down. (Again, video attached). Most likely it was possible all along, just haven't tried/put enough force into it.
What is the possible cause of this new onset middle-finger DIP stiffness?
Dr Sanaullah,Lumbrical plus would not occur at this laceration zone, would need to be a laceration, avulsion or lengthening distal to lumbrical origin, most likely zone ii.I agree with Dr Evans that FDP to the middle appear intact to the middle finger in the last two videos.He appears to be failing to be able to flex the middle finger while keeping other digits extended, concerning for FDS to middle finger rupture. (second half of second video, and item F on patient's notes) http://upload.orthobullets.com/topic/6008/images/fds.jpgDoes not appear to show much intrinsic recovery yet from either ulnar or median motor.
Scaphoid Nonunion Advanced Collapse (C2654)
52 / M - no memory of wrist injury, last 2 years progressive wrist pain, decreased grip strength, decreased active flexion of thumb IP joint
What procedure would you suggest for this patient?
Radio-lunate joint is good. you con get two option in order ti resolve the problem.Four corner Arthrodesis: to maintain the level of the carpus, so it done better flexor and extensor tendons function. but you have to use graft an the time of the arthrodesis consolidation is mat be more than 2 monthHemicarpectomy: Doesn't use graft so you don't have a morbidity of a donor site, easier than four corner as a technique, the patient at 30 days of the surgery usually is pain free, at motivated to begin to do her o her activities.Carpal height and postoperative strength after proximal row carpectomy or four-corner arthrodesis: Clinical, anatomical and biomechanical study.Carpal height and postoperative strength after proximal row carpectomy or four-corner arthrodesis: Clinical, anatomical and biomechanical study.Laronde P, Christiaens N, Aumar A, Chantelot C, Fontaine CLaronde P, Christiaens N, Aumar A, Chantelot C, Fontaine CHand Surg Rehabil. 2016 Apr. pii: S2468-1229(16)00034-7. doi: 10.1016/j.hansur.2016.01.003. 35. (2). :100-6Hand Surg Rehabil. 2016 Apr. pii: S2468-1229(16)00034-7. doi: 10.1016/j.hansur.2016.01.003. 35. (2). :100-6PMID: 27117123 (Link to Abstract)Carpal height and postoperative strength after proximal row carpectomy or four-corner arthrodesis: Clinical, anatomical and biomechanical study.Carpal height and postoperative strength after proximal row carpectomy or four-corner arthrodesis: Clinical, anatomical and biomechanical study.Laronde P, Christiaens N, Aumar A, Chantelot C, Fontaine CLaronde P, Christiaens N, Aumar A, Chantelot C, Fontaine CHand Surg Rehabil. 2016 Apr. pii: S2468-1229(16)00034-7. doi: 10.1016/j.hansur.2016.01.003. 35. (2). :100-6Hand Surg Rehabil. 2016 Apr. pii: S2468-1229(16)00034-7. doi: 10.1016/j.hansur.2016.01.003. 35. (2). :100-6PMID: 27117123 (Link to Abstract)Functional outcomes of proximal row carpectomy: 2-year follow-up.Mandarano-Filho LG, Campioto DS, Bezuti MT, Mazzer N, Barbieri CHActa Ortop Bras. 2015 Nov-Dec. doi: 10.1590/1413-785220152306150054. 23. (6). :311-4PMID: 27057144 (Link to Abstract)
Creation of a Stener lesion, as found in Gamekeeper's thumb, requires combined tears of the proper and accessory ulnar collateral ligaments in order for the ligament to be displaced by the adductor aponeurosis. Which of the following most accurately describes the role these ulnar collateral ligaments (PCL/ACL) play in thumb MCP joint stability?
PCL is primary restraint to radial deviation with MCPJ in flexion, ACL provides restraint to radial deviation with MCPJ in extension
PCL is primary restraint to radial deviation with MCPJ in extension, ACL provides restraint to radial deviation with MCPJ in extension
ACL is primary restraint to ulnar deviation with MCPJ in flexion, PCL provides restraint to ulnar deviation with MCPJ in extension
ACL is primary restraint to radial deviation with MCPJ in flexion, PCL provides restraint to radial deviation with MCPJ in extension
PCL is primary restraint to ulnar deviation with MCPJ in flexion, ACL provides restraint to radial deviation with MCPJ in extension
I think, 'Ulnar stress' in explanation is not correct, it should be radial stress. Please correct me if I am wrong.