Background:The triangular fibrocartilage complex (TFCC) is a key fibrocartilaginous and ligamentous structure located on the ulnar side of the wrist. It plays a crucial role in separating the ulnocarpal joint from the distal radioulnar joint (DRUJ) and is essential for stabilizing the DRUJ. In addition to maintaining joint stability, the TFCC also functions as a shock absorber, distributing axial loads transmitted through the ulnar aspect of the wrist. Objective:To evaluate the diagnostic utility of high resolution ultrasound and strain elastography in detecting TFCC injuries, focusing primarily on the articular disc, in comparison to MRI using sensitive sequences. Patients and Methods:This study is cross sectional study conducted at the US Radiology Unit; Radiology Department, Ain Shams University Hospitals (ASUH), and the magnetic resonance imaging (MRI) Radiology Unit; Radiology Department, ASUH on 26 patients included in this study. Patients who came to the orthopaedic hand clinic presented with ulnar side wrist pain. Results:The results of the study demonstrated a strong correlation between strain elastography (SE) and MRI in the detection of TFCC injuries. Quantitative Sonoelastography (SEL) measurements showed consistent patterns of altered tissue stiffness in patients with confirmed TFCC pathology on MRI, suggesting that SEL can reliably reflect the biomechanical changes associated with TFCC damage. Statistical analysis revealed a significant positive correlation between SEL findings and MRI-detected abnormalities, supporting the potential of SEL as a complementary diagnostic modality. Conclusion:These findings indicate that SEL may represent a promising adjunctive imaging modality for the early assessment of TFCC injuries, particularly in settings where MRI availability is limited. So incorporating SEL in the diagnostic workflow could help stratify patients, identifying those who may benefit from more advanced imaging modalities such as magnetic resonance arthrography (MRA) or diagnostic arthroscopy for further evaluation and confirmation. This approach may enhance diagnostic accuracy while minimizing unnecessary invasive procedures.
Abstract:The medico-legal assessment of sports injuries in professional athletes continues to rely on tools designed for an entirely different context. Permanent impairment tables measure the reduction in overall individual function, but not the loss of competitive performance, the reduction in expected athletic lifespan, or the impact on contracts and earnings. In this Editorial we argue that closing this gap does not require new, ad hoc composite indices, but a more rigorous and systematic integration of approaches already validated in the sports medicine and rehabilitation literature: objective quantification of the return-to-sport (RTS) deficit, obtained by comparing validated sport-specific functional and performance outcome measures recorded before and after injury; structured documentation of the rehabilitation pathway, including objective RTS criteria, time-to-RTS, and the psychological readiness to compete; and an evidence-based estimate of the economic and contractual impact, grounded in objective performance-analytics data rather than presumptive percentages. The integration of these indices with clinical-orthopaedic assessment may allow a more accurate definition of "functional-professional" damage in athletes, with significant implications for insurance, legal, and medico-legal practice. The aim is to promote a new multidisciplinary assessment model capable of bridging the traditional distinction between biological damage and economic loss, providing a more realistic and equitable measure of the consequences of sports trauma on athletes' careers.
Objective:To describe the origin, morphology, and branching patterns of the prostatic artery in Vietnamese men with symptomatic benign prostatic hyperplasia and to identify anatomical features relevant to planning and safety of prostatic artery embolization (PAE). Methods:This prospective study enrolled 120 patients who underwent pelvic digital subtraction angiography before planned PAE at Bach Mai Hospital, Hanoi, Vietnam between September 2022 and December 2024. For each hemipelvis, the number and origin of prostatic arteries were classified using the Yamaki and Moreira de Assis systems. Arterial diameter, length, tortuosity, atherosclerotic changes, and anastomotic connections with adjacent pelvic vessels were documented. Side-to-side differences were analyzed using paired tests, and correlations between arterial measurements and clinical variables were assessed. Results:A total of 240 hemipelves were evaluated. Yamaki type A was the predominant internal iliac artery branching pattern (77.9%). The most common prostatic artery origin was Moreira de Assis type I (46.7%), followed by types IV and III. A single prostatic artery was identified in 91.3% of hemipelves. Mean arterial diameter and length were 1.90 ± 0.43 mm and 180.53 ± 68.60 mm. Tortuosity was present in 70.4% of arteries, atherosclerosis in 38.3%, and anastomoses in 49.2%. No significant side-to-side differences were found in arterial diameter or tortuosity, whereas atherosclerosis differed (p = 0.040). Prostate volume showed a weak positive correlation with arterial diameter (r = 0.27; p < 0.05). Conclusions:Variability in prostatic artery anatomy highlights the importance of detailed vascular assessment for safe PAE.
Objectives:To evaluate the clinical outcomes of our index needle revision with subconjunctival 5-fluorouracil (5-FU) injection for failed non-penetrating deep sclerectomy (NPDS) in Vietnamese patients. Methods:This prospective study included eyes with failed NPDS that underwent 5-FU-augmented needle revision between 2023 and 2025. Complete and qualified success rates were evaluated at 6 and 12 months postoperatively. Factors potentially associated with procedure success were analyzed. Results:A total of 41 eyes of 33 patients with failed NPDS underwent first needle revision augmented with 5-fluorouracil. The mean patient age was 46.09 ± 16.7 years. Mean pre-needling intraocular pressure (IOP) was 27.66 ± 6.84 mmHg, which was reduced to 14.05 ± 3.22 mmHg, 14.56 ± 5.35 mmHg, and 14.10 ± 3.72 mmHg at 3, 6, and 12 months, respectively (p < 0.001). Best-corrected visual acuity showed a minimal change from 0.67 ± 0.76 preoperatively to 0.65 ± 0.77 at 12 months. Complete and qualified success rates were 78.1% at 6 months, and 68.3% and 70.7%, respectively, at 12 months. Postoperative complications included subconjunctival hemorrhage in 33 eyes (80.5%), hyphema in 4 eyes (9.8%), shallow or flat anterior chamber in 10 eyes (24.4%), corneal epithelial toxicity in 6 eyes (14.6%), iris incarceration in 2 eyes (4.8 %), and hypotony in 4 eyes (9.8%), all occurring in eyes with prior mitomycin C exposure. No cases of endophthalmitis were observed. No significant associations were found between surgical success and patient age, history of previous needle revision, or prior laser goniopuncture, or the interval between the first needle revision and surgery. Conclusion:First-time needle revision augmented with 5-fluorouracil demonstrated satisfactory effectiveness in restoring bleb function in failed NPDS, with an acceptable and predictable safety profile. Most complications were self-limited. Particular caution is recommended when revising thin, avascular blebs, which may be more susceptible to postoperative hypotony.
Background:Temporomandibular joint (TMJ) internal derangement is a common cause of orofacial pain and functional limitation. Clinical symptoms such as joint pain, clicking sounds, and limited mouth opening are frequently used in the initial assessment of temporomandibular disorders (TMD). However, the diagnostic accuracy of these clinical signs in predicting disc displacement remains uncertain. Magnetic resonance imaging (MRI) is considered the gold standard for evaluating TMJ disc position and morphology. This study aimed to assess the diagnostic value of common clinical symptoms for detecting TMJ disc displacement using MRI as the reference standard. Methods:A cross-sectional study was conducted between August 2023 and August 2024. A total of 178 patients, contributing 267 temporomandibular joints, were included. Clinical symptoms including joint pain, joint clicking, and limited mouth opening were recorded during standardized clinical examination. All participants underwent MRI evaluation of the temporomandibular joints. Disc displacement identified on MRI served as the reference standard. Because both joints of a patient could be included, observations were clustered within patients; diagnostic performance (sensitivity, specificity, PPV, NPV, accuracy, likelihood ratios, and diagnostic odds ratios with 95% confidence intervals) and multivariable generalized estimating equation models accounted for this clustering. Results:Disc displacement was present in 206 of 265 analyzed joints (77.7%). Joint pain showed the highest sensitivity (92.7%, 95% CI 88.3-95.5) but low specificity (33.9%), together with the most useful negative likelihood ratio (0.21) and the strongest discrimination (diagnostic odds ratio 6.53, 95% CI 3.08-13.86). Limited mouth opening had the highest specificity (69.5%), whereas joint clicking did not discriminate displaced from normally positioned discs (diagnostic odds ratio 1.34, 95% CI 0.74-2.42). In multivariable analysis, joint pain (adjusted odds ratio 4.06, 95% CI 1.83-9.03) and younger age were the only independent clinical predictors of disc displacement; joint effusion and condylar abnormality were additionally associated when MRI findings were included. Conclusion:Clinical symptoms provide useful preliminary information in the evaluation of TMJ disorders. However, clinical examination alone has limited diagnostic accuracy for identifying disc displacement. MRI remains the most reliable imaging modality for confirming TMJ internal derangement and should be considered when clinical findings are inconclusive.
