Orthopaedic and trauma surgeons not infrequently encounter the hallucal interphalangeal joint sesamoid (HIPJS) in irreducible traumatic dislocations. However, patients with the classic triad of plantar keratoma beneath a hyperextended interphalangeal (IP) joint associated with stiffness of the first metatarsophalangeal joint tend to present to podiatrists rather than orthopaedic surgeons. We present our experience with the HIPJS following first metatarsophalangeal joint (MTP1) arthrodesis in 18 feet of 16 women, aged 42 to 70 years old. Where CT scan was available, volume of the HIPJS was determined using Vitrea Software.Introduction
Methods
This study analyzes position of the peroneal tendons and status of the superior peroneal retinaculum (SPR) whenever a lateral malleolar bony flake fracture occurs. Twenty-four patients had a lateral malleolar bony fleck on anteroposterior ankle radiographs, either in isolation or associated with other hindfoot injuries. We studied size of the bony flecks, presence or absence of peroneal tendon dislocation and pathoanatomy on CT scans.Background
Methods
Although dislocation of the peroneal tendons (PT's) in association with calcaneal fractures has been described over 25 years ago, it frequently passes unrecognised by radiologists and orthopaedic surgeons. This retrospective study aims to determine the prevalence of PT dislocation in association with calcaneal fractures at a single institution and describe systematic steps to avoid missed diagnosis at each stage of management. CT scans of all patients with calcaneal fractures from the Picture Archiving and Communications System (PACS) from 2010 were systematically reviewed. The senior author and a Musculoskeletal Radiologist analysed the images for concomitant dislocation or subluxation of the PT's, utilizing criteria as defined by Ho et al. Further to this we included patients who sustained calcaneal fractures with associated PT dislocation prior to June 2010 and were referred either for primary open reduction or later with post-traumatic osteoarthrosis of the subtalar joint.Introduction:
Methods:
Percutaneous fluoroscopically asseisted iliosacral screw insertion has become one of the most popular methods of stabilisation of the posterior aspect of the vertically unstable pelvis. Screw malpositioning rates range from 0 to 10%. Screw misplacement can cause injury to the iliac and gluteal vessels, L4 to s1 nerve roots and sympathetic chain. We performed two radiographic studies on dry human bones to seek safe radiographic landmarks for insertion of iliosacral screws.
Percutaneous fluoroscopically assisted iliosacral screw insertion has become one of the most popular methods of stabilisation of the posterior aspect of the vertically unstable pelvis. Screw malpositioning rates range from 0 to 10 per cent. Screw malplacement can cause injury to the iliac and gluteal vessels, L4 to S1 nerve roots and sympathetic chain. We performed two radiographic studies on dry human bones to seek safe radiographic landmarks for insertion of iliosacral screws. Part 1. Two parallel linear densities are always present on lateral plain radiographs of the lumbosacral spine and pelvis. Using wire markers on pelvic bones, we accurately define the origin of these pelvic lines. Steel wires of different lengths were placed along the iliopectineal and arcuate lines of the pelvis. The shorter wire stopped at the anterior limit of the sacro-iliac joint. The longer wire extended further along the entire course of the medial border of the ilium to the iliac crest posteriorly. We demonstrate that each ‘ pelvic line ‘ represents the sharp bony ridge that forms the anterosuperior limit for insertion of iliosacral screws. Part 2. In a second experimenton dry pelvis, we inserted balloons filled with radio-opaque contrast medium into the spinal canal of the sacrum and exiting through the anterior and posterior sacral foramina on either side. Plain lateral radiographs and CT scan with reformatted images were obtained. We present a previously undescribed radiological sign on plain lateral radiographs of the lumbosacral spine. The inferior and posterior boundaries of the acorn sign are delineated.
A Salter innominate osteotomy is used to treat acetabular dysplasia, but reports of its effects on the position of the femoral head are few and conflicting. Lateral shift would increase the resultant forces acting on the joint and be detrimental. We studied 15 Salter innominate osteotomies and demonstrated that a correctly performed osteotomy does not significantly alter the distance from the centre of the femoral head to the midline of the body. Stereophotogrammetry was used in three patients to delineate the axis of rotation of the distal acetabular fragment and determine the locus of movement of the centre of the femoral head about it. Our results explain why the Salter osteotomy does not lateralise the femoral head.
