11/16. Successful autogenous corticocancellous grafting of a radial defect complicating acute hematogenous osteomyelitis in an infant.Recurrent osteomyelitis of the radius during infancy after initial hematogenous onset is rare. When encountered, this lesion may result in a segmental defect associated with limitation of forearm motion and progressive deformity. A 10-month-old girl developed distal radial osteomyelitis following bilateral otitis media. A radial defect developed and was treated successfully with autogenous tibial corticocancellous grafting. The surgical management of radial shaft defects is reviewed.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
12/16. Spiral CT with multiplanar reconstruction in the diagnosis of sternoclavicular osteomyelitis.OBJECTIVE. The purpose of this study was to determine whether contrast-enhanced spiral ct scanning supplemented by multiplanar reconstruction is of value in the evaluation of suspected infection of the sternoclavicular joints. MATERIALS AND methods. Seven patients with suspected infection of the sternoclavicular joints were evaluated with spiral CT using narrow collimation (4 mm) and close interscan reconstruction (2-4 mm). All patients were scanned immediately following the injection of 120 ml Omnipaque-300 at a rate of 3 ml/s. Spiral CT scans were of 24 or 32 s duration and done as single-breath-hold studies. All images were then filmed at soft tissue and bone settings (window width 2300, window center 270). In selected cases, coronal, sagittal, and/or oblique reconstruction of data was done for review. RESULTS. All studies were successfully completed without any interscan or intrascan motion. In six cases, infections of the sternoclavicular joint was found, including five cases of osteomyelitis of the clavicular head. The scans obtained during the phase of high contrast enhancement allowed definition of the extension into the soft tissue and muscle. Bone windows demonstrated subtle cortical and periosteal abnormalities. CONCLUSION. Imaging of the sternoclavicular joints with standard CT can be difficult due to interscan motion and the inability to get good data sets for reconstruction. Spiral CT with 24- to 32-s acquisition allows high quality images enabling detection of disease and definition of extent of disease, thus helping to guide patient management.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
13/16. Primary chronic sclerosing osteomyelitis.The case of a ten-year-old white male with longstanding, painful swelling and severe limitation of left elbow motion is reported. The lack of symptoms and signs characteristic of infection and the pseudosarcomatous radiological findings coupled with the pathological findings of chronic osteomyelitis outline the diagnosis of primary chronic sclerosing osteomyelitis. A detailed description is given of the clinical course to illustrate the diagnostic difficulties encountered in a case of this nature. The outcome was favorable.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
14/16. tuberculosis of the ankle in childhood: clinical, roentgenographic and computed tomography findings.We report on three Italian children who presented with unilateral ankle tuberculosis (TB) consecutively during a short time period and in the same geographical area. A 6-year-old-girl with a family history of TB had limited mobility of the right leg at age 9 months; Mantoux test and radiographs at that age yielded normal findings. When severe right tibiotarsal swelling, reddening, pain and restriction of motion became apparent at age 4.6 years, the typical lesions of TB were evident on radiographs and computed tomographic (CT) scans. Mantoux test and synovial biopsy confirmed TB. A three-drug regimen of treatment proved useless: articular cartilage destruction and diffuse osteosclerosis ensued. Only a four-drug prolonged regimen of treatment proved to be somewhat effective. A 5-year-old girl had a 6-month history of painless swelling and limited mobility of the ankle; radiographs and CT showed osteopenia with marginal erosion of cartilages. A 14-month-old boy presented with a 2-week history of painless swelling ankle. Radiographs showed decreased bone density of talocalcanear bones. Mantoux test and synovial biopsy confirmed TB in both patients; treatment with a three-drug regimen greatly reduced symptoms. A careful suspicion of the diagnosis of tuberculosis is paramount in children with chronic or subacute monoarticular arthritis, even in absence of a positive tuberculin test or abnormalities on chest radiograph. When negative early on, the tuberculin test should be repeated after 6 weeks of arthritis, and a needle biopsy of the synovium is required in those children with monoarticular arthritis and a positive tuberculin test. Careful therapy is necessary to avoid sequelae that may lead to severe osteoarticular damage.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
15/16. Pyogenic infections of the sacro-iliac joint.In 3 cases of pyogenic infection of the sacro-iliac joint, the diagnosis was difficult. Limp, buttock pain and upper sciatica were the most common presenting symptoms. Differential limitation of hip motion, positive straight leg raising, a positive Gaenslen test and pain on pelvic compression were frequent fingings. Increased E.S.R., W.B.C. count and fever were seen in 2/3 cases. Plain and tomographic x-rays are often helpful but bone scan has been helpful in localizing early lesions. Treatment after early diagnosis may consist of antibiotics and immobilization alone while in the more chronic cases surgical drainage and debridement may be necessary.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
16/16. Vascularized partial first metatarsal transfer for the treatment of phalangeal osteomyelitis.The author reports the salvage of the index finger in a patient with extensive osteomyelitis of the proximal phalanx. Salvage was achieved by a staged reconstruction, using external fixation combined with aggressive debridement, and an antibiotic/methylmethacrylate spacer, followed by a vascularized bone flap from the first metatarsal. Union was achieved with an excellent functional outcome of 205 degrees of total active motion. The literature addressing the management of osteomyelitis in this particular location is incomplete. This author believes that loss of a large portion of the diaphysis is difficult to treat by conventional bone grafting because of the poorly vascularized bed following extensive infection. The case reported is unique because of the choice of donor site. Vascularized bone grafting is suggested as offering the best chance for success, and the donor-site material can be easily tailored to fit the phalangeal defects.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
| <- Previous | |