AIM:To determine whether ultrasound is useful in detecting cervical rib. Ultrasound was used to diagnose cervical rib in five patients with neck pain and the findings were compared to those from plain radiography.MATERIALS AND METHODS:Ultrasound was used in 34 patients with pain and stiffness in the neck region. The area concerned was scanned sonographically in both longitudinal and transverse planes. In the sitting position, plain radiographs were obtained after ultrasound examination for comparison and verification. The contralateral side of the neck was used as control.RESULTS:Sonography revealed abnormalities in five patients. Sonography and X-ray confirmed the diagnosis of cervical rib in six patients, whereas one patient had a lipoma of the neck.CONCLUSION:Sonography is an additional and easily available diagnostic modality for the detection of cervical rib in cases of pain and stiffness in the neck region.

Background: Musculoskeletal ultrasonography (U.S.) is an important imaging technique in the diagnosis of olecranon bursitis, especially for early manifestation. It allows sensitive detection of small fluid collections as well as for differentiation between soft tissue and bone lesions. U.S. examination allows detection of effusions, synovial proliferation, calcifications, loose bodies, rheumatoid nodules, gout tophi and septic processes.Aim: To assess the role of ultrasonography in the diagnosis and management of patients with olecranon bursitis.Methods: Ultrasound was used in 34 patients with swelling above the olecranon. The opposite asymptomatic side served as a control group.Results: 20 patients demonstrated increased fluid collection in the olecranon bursa. 5 had synovial proliferation, 2 cases showed loose body, 5 patients revealed markedly increased blood flow consistent with inflammation, 2 patients had triceps tendonitis with calcifications.Conclusions: Sonography is an extremely effective tool for the diagnosis of soft tissue lesions in the olecranon area.

Ziel der Studie: Evaluation der Wertigkeit einer Ultraschalluntersuchung (US) zur Diagnostik bei Knieschmerzen. Methodik: 110 konsekutive Patienten zwischen 35 und 68 Jahren mit generalisiertem Knieschmerz wurden klinisch, nativradiologisch und im US untersucht. Ausgeschlossen wurden postoperative, verletzte und febrile Patienten, sowie solche mit Infektverdacht. Als Kontrolle dienten 52 gesunde Freiwillige, die Gruppen waren vergleichbar bezüglich Alter und Geschlecht. Verwendet wurde ein real time US, 5-13 MHz linear transducer. Ergebnisse: Unter den symptomatischen Patienten zeigten 30 pathologische Veränderungen im US, davon 12 auch in der Röntgenuntersuchung. In der asymptomatischen Gruppe zeigten 9 Probanden pathologische Veränderungen im US. US erwies sich als besonders hilfreich zur Beurteilung von Gelenkergüssen, Veränderungen der Synovia und des Knochens, Meniskuspathologie und Knorpelschäden bei normalem Nativröntgenbefund.

Bei Sportlern mit persistierender Metatarsalgie sollte an das Vorliegen eines Morbus Freiberg (Synonym: aseptische Nekrose der Mittelfußköpfchen Freiberg-Köhler II) gedacht und die entsprechende bildgebende Diagnostik veranlasst werden. Es wird eine Kasuistik mit verzögerter Diagnosestellung und operativer Behandlung geschildert. Obwohl die Ätiologie des Krankheitsbildes bisher unklar ist, ergibt eine frühzeitige Diagnose mit entsprechender Behandlung bessere Resultate als spätere Rückzugsoperationen.

BACKGROUND:Previously reported results of total hip arthroplasty in patients under the age of 30 indicate a high complication rate and questionable durability.OBJECTIVES:To estimate the results of THA in extremely young patients.METHODS:We report the results of 69 THA procedures in 56 patients who were under the age of 30 at the time of surgery (mean age 23.23 +/- 4.31 years) and were followed postoperatively for 2-23 years (mean 7.4 +/- 3.79 years).RESULTS:Loosening of the cup (11/69) and early traumatic dislocation (5/69) accounted for the majority of complications.CONCLUSION:The final average Harris hip scores of 90.59 +/- 9.36 in these patients indicated that THA is a successful and durable treatment modality for young patients with disabling diseases affecting the hip joint. However, due to the likelihood of complications it should be used with caution in this patient group. Efforts should be made to diminish the complication rate.

Of 2776 intracapsular fractures of the proximal femur, 18% of the patients were treated nonoperatively. Included in the group of patients who were treated conservatively were children, patients with cardiac problems or mental problems, stroke, renal failure, multiple disseminated malignancies, and patients who chose nonoperative treatment. The medical treatment protocol can be divided into two stages: Initially, (1) nursing of a bedridden patient with emphasis on the prevention of complications; and (2) once partial bone union has occurred, the attempted rehabilitation to independent ambulation. Paramedical services provide a major contribution during inpatient therapy and during the preparation for returning the patient to the community. A multidisciplinary medical team evaluates and assesses the patient's needs and rehabilitation potential and in cooperation with the patient and the family, an operative plan then is established.

Sonographic examination of the knee has been proposed by several authors in the past as a simple and reliable method to diagnose Osgood-Schlatter disease (OSD). Ultrasound was used to compare the knees of 25 boys and 10 girls with typical OSD with 35 symptom-free knees of an aged-matched group of children. Based on recorded data, patients were categorized (one affected knee in each individual) according to the classification system proposed by De Flaviis et al. in 1989. The results included the following pathological findings: pretibial swelling, fragmentation of the ossification center, insertional thickening of the patellar tendon, and excessive fluid collection in the infrapatellar bursa. Of our patients, 26% fell into the type 1 category, 43% were type 2, 20% type 3, and 11% type 4. This distribution of cases was found to be statistically similar to the initial findings reported by De Flaviis and colleagues. This study therefore supports the validity and reproducibility of their classification method for the ultrasonographic evaluation of children with OSD. This is only the first step, and further assessment of this classification is still required to elucidate its clinical as well as its prognostic value.

Twenty-one cases of clavicular fractures in newborn babies were examined. Ten by radiographic and ultrasonic evaluation and 11 had only ultrasound examination. Clavicle fracture can be diagnosed by ultrasound.

BACKGROUNDWhen encountering complaints of pain in the area of the Achilles tendon, the clinician seldom reaches a correct and precise diagnosis based solely on the grounds of physical examination and standard X-rays.OBJECTIVESTo assess the usefulness of ultrasound in diagnosing pathologies of the Achilles tendon.METHODSWe conducted a retrospective review of patients presenting at our orthopedic clinics.RESULTSSonography was used to evaluate 41 patients with achillodynia. This modality enabled the diagnoses of 19 abnormal tendons (46%), peritendinous and other lesions; a complete rupture in two patients (5%); a partial rupture of the Achilles tendon in 3 (7%); various degrees of calcification of the tendon in 7 (17%); and peritendinous lesions discerned by the tendon's hypoechoic regions with disorganized arrangement of collagen fibrils in 4 patients (10%). Other lesions included tendonitis (3 patients, 7%), retrocalcaneal bursitis (3 patients, 7%), lipoma (1 patient, 2%), and foreign bodies (2 patients, 5%). The mean diameter of the pathological tendons was 10.4 +/- 2.7 mm, while normal tendons measured 5.2 +/- 0.8 mm (P < 0.001).CONCLUSIONAs in many other soft tissue lesions, ultrasonography is a useful tool in the evaluation of the underlying pathology in patients presenting with achillodynia.

BACKGROUND:Foreign bodies are sometimes overlooked in the initial evaluation of soft tissue wounds in the emergency room setting. The physical examination identifies foreign bodies that are superficial enough to be seen or palpated, while radiographs reveal those that are radio-opaque. If these two criteria are not met, however, the foreign body may remain undetected. These patients present later with long-standing pain in the area of penetration sometimes associated with localized tenderness.OBJECTIVES:To assess the role of ultrasonography in the diagnosis and management of patients with a suspected retained foreign body.METHODS:Ultrasound was used in 21 patients with suspected retained foreign bodies and the diagnosis was positive in 19. Fifteen underwent a surgical exploration in which the ultrasound was used as an adjunctive modality either pre- or intraoperatively to assist in the localization of the foreign body.RESULTS:All procedures were successful. No postoperative complications were recorded at an average follow-up of 2 years. Three patients gradually became asymptomatic and were left untreated. One patient was lost to follow-up.CONCLUSION:Sonography is an extremely effective tool for the late diagnosis of retained foreign bodies in the soft tissues. We suggest that its availability in the emergency room may decrease the rate of misdiagnosis and avoid these unfortunate cases, although this remains to be proven.

A consecutive series of 16 patients with classical Haemophilia underwent 21 total knee replacements between 1989 and 1997 for haemophilic arthropathy. The patients received Factor VIII replacement therapy via continuous infusion, and fibrin glue was used to facilitate haemostasis. Three different types of prostheses were used. A follow-up evaluation was undertaken between 2 and 10 years after the operation (mean 5.6 years) and two patients with infection were excluded. Knee scores averaged 77.5 (pre-operative 24. 1) and functional scores averaged 84.4 (preoperative 23.2). There were no cases with aseptic loosening of the prosthesis. Complications included one early deep infection controlled by conversion of the TKR into an arthrodesis, one case of late septic loosening that had to be re-operated upon, one case of patellar dislocation, two cases of stiff knee (fibro-arthrosis) that required manipulation under anaesthesia, one postoperative hepatitis, one superficial infection treated by incision and drainage and four febrile patients with no clear source of infection, who responded to antibiotics alone. In conclusion, TKR offers haemophilic patients a long-lasting improvement of their quality of life and we therefore advocate its use with the appropriate indications.

Ankle fractures in the elderly are extremely common (up to 184 fractures per 100,000 persons per year, and of these approximately 20%-30% occur in the elderly). The medical literature contains no research that has investigated ankle fractures in the elderly. A prospective, randomised study was conducted of 84 patients with displaced ankle fractures, who were over the age of 65 years and were assigned to operative or conservative treatment after closed reduction. The results of treatment assessed according to the American Orthopedic Foot and Ankle Society (AOFAS) Score showed a mean of 91.37 +/- 8.96 in the non-operated group compared with 75.2 +/- 14.38 (P = 0.001) in the operated group. The costs of treatment were accordingly higher. These results call for consideration of a non-operative approach to the treatment of well-reduced ankle fractures in the elderly. Increased efforts should be invested in the prevention of these common fractures.

A 52-year-old, trans-femoral amputee with haemophilia was hospitalized because of ambulatory problems arising from the osteo-arthropathic involvement of other major articulations. Reduced function in the upper limbs, caused by the effects of recurrent haemarthroses, resulted in additional problems concerning the usage of auxiliary ambulatory aids. The advantages and disadvantages of traditional and experimental crutches highlight the functional problems of ambulation in persons with concomitant upper limb pathologies.

First-ray metatarsalgia is commonly attributed to pathologies of the 1st metatarso-phalangeal joint or the sesamoids. A case of a 50-year-old male patient with 1st ray metatarsalgia caused by a rare benign tumour is presented – a soft tissue chondroma located in the subcutaneous tissue plantar to the head of the 1st metatarsus. The tumour was removed with no evidence of recurrence and the patient is symptom-free ever since. A review of the literature regarding this unusual type of tumour is further presented and discussed.

Disuse atrophy has been the subject of research studies of an animal model in which single-limb immobilization induces atrophic changes in the immobilized limb. These reveal systemic changes in the experimental animals that go far beyond the local response expected in that situation and are not fully understood as yet. We therefore performed a biochemical study on the effect of hind-limb immobilization on the serum and tissues of rats. The experiment was carried out on 70 young Sprague-Dawley male rats. In one group of 35 rats, the left hind-limb was immobilized for 3 weeks. Another group of 35 rats served as controls. Serum total protein, albumin, urea, creatinine, and calcium were found to be reduced during immobilization. Serum cholesterol levels, on the other hand, increased to a considerable extent. No changes were recorded with phosphate, bilirubin, and magnesium. Serum alanine aminotransferase (ALT) and alkaline phosphatase (ALP) were both reduced in activity. The activity of muscle aspartate aminotransferase (AST) and bone alkaline phosphatase (ALP) was also decreased. Lactate dehydrogenase (LDH) remained unchanged in both serum and muscle. We discuss our findings in the light of previous knowledge regarding the atrophic process.

BACKGROUND:Bone banking and the clinical use of banked tissue are the most common forms of allopreservation and transplantation in modern medicine.OBJECTIVES:This article reviews 25 years (1973-98) of experience in bone banking in Israel.METHODS:A nationwide survey on the clinical application of the banked musculoskeletal tissues during 1996 was conducted by means of a written questionnaire sent to all orthopedic departments in Israel.RESULTS:The response rate to the questionnaire was 84%. A total of 257 cases were allocated bone allografts: the majority comprised 225 spongy bones, 26 were massive bone allografts and 6 were soft tissue allografts.CONCLUSION:Improvement of quality control and quality assurance of the banked tissues, together with development of skills in the use of osteoinductive and osteoconductive materials, cast the future of musculoskeletal tissue banking.

Disuse atrophy has been the subject of research studies that make the use of an animal model in which single-limb immobilization induces atrophic changes in the immobilized limb. The effect upon the nonimmobilized contralateral limb is, however, still unclear, and findings in the literature are inconclusive. We therefore performed a multidisciplinary study to clear this issue. The experimental population was 70 young male Sprague-Dawley rats. In one group of 35 rats, the left hind limb was immobilized for 3 weeks. Another group of 35 rats served as controls. limb and tibial bone weights (both "dry" and "ash") were found to be reduced in both hind limbs. Bone alkaline phosphatase (ALP) activity was likewise reduced in both limbs. We conclude that the contralateral hind limb in the rat is clearly subjected to atrophic changes that are similar in magnitude or severity to those experienced by the immobilized limb. We further discuss these findings in view of previous knowledge regarding the atrophic process.