Plain Film Evaluation Research Articles

Arthroscopic Treatment of Labral Tears in Patients with Borderline Developmental Dysplasia of the Hip: A Retrospective Study with Mean 5.8 Years Follow-Up.

ObjectiveTo retrospectively assess the mid‐term clinical and radiological results of hip arthroscopic treatment of labral tears in patients with borderline developmental dysplasia of the hip (BDDH).MethodsFrom January 2010 and December 2019, data were retrospectively reviewed for all patients who underwent arthroscopic surgery of the hip for the treatment of intra‐articular abnormalities. Only the Patients who had borderline developmental dysplasia (BDDH) were included. All operations were performed by two senior surgeons, the arthroscopic treatment including labral repair, labral debridement, minimal acetabuloplasty, femoroplasty and capsular closure. The evaluation consisted of pain evaluation (visual analog scale [VAS]), the modified Harris hip score (MHHS), range of motion, the radiological evaluation of plain film and MRI analysis of the hip joint. The plain film evaluation included anteroposterior views of the pelvis to assess lateral center‐edge angle (LCEA) and acetabular inclination (AI), frog‐leg lateral views of the hip to assess α angle.ResultsThere were 34 patients (36 hips) ultimately enrolled in this study. The follow‐up duration of the patients were minimal 2 years (average, 69.2 months) postoperatively. The patient group included seven men and 27 women, the mean age at the time of surgery was 30.9 years. The mean BMI was 22.3 kg/m2. From the pre‐operative status to the final follow‐up visit, mean mHHS score increased from 64.5 to 92.7, mean VAS score decreased from 6.8 to 1.3. All scores exhibited statistically significant differences (P < 0.001). The mean LCEA decreased from 22.9° to 22.7°, the mean AI decreased from 7.7° to 7.6°. Which all showed no significant differences compared with the final follow‐up to the pre‐operative status (P > 0.05). However, the mean α angle was significantly decreased from 48.3° to 40.1° (P < 0.001). We encountered no significant complications such as infection, deep venous thrombosis, fluid extravasation, or permanent nerve injury. One patient (2.94%) underwent revision periacetabular osteotomies (PAO) because of subluxation of the hip joint with permanent pain after 6 months failed conservative treatment.ConclusionArthroscopic treatment of labral tears in patients with BDDH may provide safe and durable favorable results at midterm follow‐up. The best outcome could be expected in patients with labral repair and closure of the capsule with strict patient selection criteria.

ILEO-COLIC INTUSSUSCEPTION;

Objective: To evaluate the success rate of hydrostatic reduction of intussusceptionand incidence of complications in late presenting cases. Study Design: prospective study.Place and duration of study: Study was carried out in Armed Forces Institute of Radiologyand Imaging Rawalpindi and different Combine Military Hospitals during last 5 years. Materialsand Methods: All the children up to 2 years age with diagnosis of ileo-colic intussusceptionand 3 days or less history of onset of symptoms were included in the study. Patients with signsof perforation, suspicion of lead point or long intussusceptum protruding through rectum wereexcluded. After plain film evaluation, thin barium was instilled through Foleys catheter underfluoroscopic guidance. Rule of 3 was followed and reduction was considered successful whencontrast refluxed into terminal ileal segment. Follow up plain x-ray and ultrasound was doneafter 48 hours to rule out recurrence. Results: Hydrostatic reduction was successful in 18 outof 21 patients collected during last five years. Reduction was incomplete in one case whileperforation was observed in 2 cases. These complications were observed in the largest group(52%) of patients reporting on 3rd day of onset of symptoms. A significant number (38%) ofpatients reached the hospital within 48 hours. Only 2 (10%) patients presented in first 24 hrsbut uneventful reduction was possible in later two groups. Conclusions: Careful hydrostaticreduction in cases of ileo-colic intussusception reporting within 72 hrs will reduce hospital stayand patient morbidity in most of the cases.

Pseudoparalysis From a Massive Rotator Cuff Tear Is Reliably Reversed With an Arthroscopic Rotator Cuff Repair in Patients Without Preoperative Glenohumeral Arthritis

Background: Pseudoparalysis is defined as active forward flexion less than 90° with full passive motion. There is controversy about the ideal surgical management of a massive rotator cuff tear with pseudoparalysis. Purpose/Hypothesis: The purpose of this study was to prospectively analyze the ability to reverse pseudoparalysis with an arthroscopic rotator cuff repair (ARCR). The hypothesis was that in the absence of substantial glenohumeral arthritis, preoperative fatty infiltration of grade 3 or higher and an acromiohumeral interval (AHI) of less than 7 mm would not prevent reversal of pseudoparalysis with an ARCR. Study Design: Case series; Level of evidence, 4. Methods: A prospective multicenter study of ARCR performed for preoperative pseudoparalysis was conducted. The minimum follow-up was 1 year. The mean patient age was 63 years, and pseudoparalysis was present for a mean of 4.2 months preoperatively. Preoperative radiographic evaluation included plain film evaluation of the AHI and Hamada classification and MRI evaluation of fatty degeneration and rotator cuff retraction. Functional outcome was determined by the Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES) Shoulder Score, visual analog scale (VAS), and subjective shoulder value (SSV). Results: Of the 58 patients enrolled, 56 had at least 1 year of follow-up. Mean active forward flexion improved from 47° preoperatively to 159° postoperatively (P < .001). Statistically significant improvements were seen in the SST (from 2.8 preoperatively to 10.1 postoperatively), SSV (from 28 to 83), ASES Shoulder Score (from 37 to 88), and VAS (from 5.7 to 1.1) (P < .001). Pseudoparalysis was reversed in 53 of 56 patients (95%). There was no difference in the rate of reversal of pseudoparalysis between those patients with an AHI of less than 7 mm (88.2%) and those with an AHI of 7 mm or more (96.9%) (P =.289). Pseudoparalysis was reversed in all 8 of the patients with fatty degeneration of grade 3 or higher in 1 or more of the rotator cuff muscles. Conclusion: ARCR can lead to reversal of preoperative pseudoparalysis in patients with minimal preoperative glenohumeral arthritis. ARCR is a viable first line of treatment for patients with pseudoparalysis in the absence of advanced glenohumeral arthritis.

Femoro-acetabular impingement: what the general radiologist should know

Femoro-acetabular impingement (FAI) is a common condition in young active subjects, which can lead to the development of early osteoarthritis if not correctly diagnosed. Imaging evaluation of FAI, mainly based on plain film and magnetic resonance evaluation, must be performed according to precise guidelines and is fundamental for reaching a final diagnosis. The purpose of this paper is to provide a clinical and radiological overview of FAI by describing the most common clinical tests, the imaging techniques used in the diagnosis, and the main radiological signs that may be encountered.

Acquired os odontoideum: a case report and literature review

Os odontoideum has been defined as an independent ossicle, with smooth margins, separated with the base of the odontoid or the axis vertebrae [7, 15–17]. Since Giacomini first described os odontoideum in 1886 [10], its etiology has remained controversial. Supporters of a congenital etiology have considered os odontoideum as a segmental anomaly resulting from fusion failure between the odontoid and the axis vertebrae [2, 3, 8]. Moreover, several case reports of familial os odontoideum have been reported in support of their theory [1, 14, 18, 24]. Recently, we reported a threegeneration family with three members who presented os odontoideum [30]. In contrast, proponents of an acquired etiology state that the ossicle results from an unrecognized fracture or a cartilaginous injury of the odontoid followed by alar ligament contraction and interruption of the blood supply [7, 11, 29]. In support of the acquired theory, Verska et al reported one identical twin with an os odontoideum after documented trauma and the other twin with a normal odontoid and no traumatic history [27]. In the literature, proponents of the acquired etiology also reported 11 patients who had radiographic documentation of a normal odontoid and subsequently developed an os odontoideum after trauma [6, 7, 9, 12, 20, 22, 26]. The previously reported cases are summarized in Table 1. Most of these os odontoideum cases with a pretraumatic normal radiograph were present before CT scans were available. Obviously, solely based on plainfilm evaluation, the possibility of congenital deficits cannot be totally excluded. To our knowledge, the present case is the 12th case reported of posttraumatic os odontoideum who had radiographic documentation of a previous normal odontoid process in the English literature. This case report demonstrates a posttraumatic os odontoideum using reconstructive CT imaging, which has yet to be reported. The family was informed that data concerning the case would be submitted for publication, and consent was obtained.

Progressive Dysphagia in an Elderly Male

Dysphagia can result from a variety of causes, including central nervous and peripheral nervous system, myogenic, and structural disorders. A 76-year-old man underwent anterior cervical disketomy and fusion 10 years ago, with progressive dysphagia noted 2 years ago. Endoscopy showed an oropharyngeal tumor, and lateral plain film evaluation of the neck revealed a cervical plate extrusion. Removal of the instrumentation and tumor with primary closure of the pharyngeal perforation was performed, and dysphagia was resolved postoperatively. We report the case of an unusual presentation in the pharynx. We should not neglect this rare diagnosis, because it can progress to a life-threatening outcome.

Skull fracture vs. accessory sutures: how can we tell the difference?

Plain film radiography remains the most cost effective method in evaluating skull fractures and can easily differentiate major sutures and common vascular grooves from fractures. However, in children this can be complicated due to the presence of numerous synchondroses and unusual accessory sutures. Plain film evaluation is especially challenging not only because of various artifacts that can degrade the study but also the inability to visualize intracranial processes, such as contusions and hemorrhage, that can substantiate a calvarial finding. Minimal soft tissue swelling can be difficult to see even with oblique views. Superimposition of normal suture lines like the metopic suture can mimic a fracture if one is not careful to obtain additional views [1]. During the past decade, the increasing use of spiral and multidetector CT have lead to the ability of workstations to generate three-dimensional (3D) reconstructions of the skull. Therefore if cranial CT is deemed clinically necessary in trauma patients, questionable fractures can be confidently differentiated from unusual accessory sutures using these additional workstation capabilities.

Can radiographic plain film be used to determine the depth of the tumour bed in the absence of surgical clips for breast boost planning?

PurposeA number of studies have demonstrated the importance of using surgical clips to define the tumour bed in breast boost radiotherapy. In the absence of such clips, other techniques suggested to improve boost location have included CT and ultrasound (US). Determination of the depth of the tumour bed is important in the selection of electron energy. This study was conducted to prospectively compare the depth of the lumpectomy cavity as defined by ultrasound to radiographic plain film evaluation of the anterior border of the pectoralis muscle.Materials and MethodsForty-one breast-cancer patients treated at the Division of Therapeutic Radiology and Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University between December 2004 and December 2006 were prospectively identified as having no surgical clips within the lumpectomy cavity. All patients underwent both US evaluation of the depth of tumour bed (D1) and radiographic evaluation of the depth of the anterior border of the pectoralis muscle (D2). These depth dimensions (D1 and D2) were compared using a paired t-test. The correlation of both methods was analyzed by Pearson correlation test.ResultsDepth dimensions by US were shorter than the radiographic film method in 85% of patients. The absolute mean difference of the depth (radiographic films minus US) was 0.129 cm. A paired t-test demonstrated that the difference between these two methods to be not statistically significant (p= 0.27). The absolute difference of depth between the two methods ranged from 0 to 0.5 cm. A significant correlation was found between US and radiographic film measurements (p<0.01).ConclusionPlane radiographic film evaluation of the anterior border of the pectoralis muscle can be used to define the depth of the tumour bed in patients who have no surgical clips. However, the plane radiographic film method determines only the depth, not the transverse and longitudinal dimensions of the tumour bed. Additional information from US is needed to delineate the target volume for the tumour bed boost. In the absence of surgical clips, the authors recommend integration of both methods in breast boost planning process.

Are Plain Radiographs of the Spine Necessary during Evaluation after Blunt Trauma? Accuracy of Screening Torso Computed Tomography in Thoracic/Lumbar Spine Fracture Diagnosis

Fracture of the thoracolumbar (TL) spine is reported in 8 to 15% of victims of blunt trauma. Current screening of these patients is done with conventional radiography. This may require repeated sets of films and take hours to days. It is imperative that these patients get timely, accurate evaluation to allow for treatment planning and early mobilization; alternatives to plain films would aid in this. The objective of this study is to determine whether the data obtained from admission chest/abdomen/pelvis (CAP) computed tomography (CT) scans after blunt trauma has utility in thoracolumbar spine evaluation. The records of all patients admitted to a Level I trauma center over a 2-month period who underwent CAP CT were reviewed for the presence of TL spine fracture, time to completion of plain film evaluation, and clinical course. Admission CT scans were reviewed by an attending radiologist who was blinded to any previously diagnosed spine fractures. The two tests were compared for diagnostic accuracy and their discriminatory ability was compared using receiver operating characteristic (ROC) curves. Significance was defined as p < 0.05. In all, 103 patients were admitted from January 1, 2003 to February 28, 2003 and underwent CAP CT scan as part of their initial trauma evaluation. Of these, 26 (25%) had thoracolumbar fractures. Seven (27%) thoracolumbar fractures were not seen on plain radiographs taken during the trauma evaluation. Average time until plain film completion in this group was 8 hours (range, 44 minutes to 38 hours). All 26 (100%) patients with fractures, however, were diagnosed on CT scan performed shortly after admission. Of the remaining 77 patients, two (2.6%) were falsely read as positive for fracture on CT. Sensitivity and specificity of CT scan for thoracolumbar fracture were excellent at 100% and 97%, respectively, with a negative predictive value of 100%. Plain radiographs were 73% sensitive, 100% specific, and had a negative predictive value of 92%. Area under the ROC curve for CT was 0.98, but for plain film was 0.86 (p < 0.02). Admission CAP CT obtained as part of the routine trauma evaluation in these high-risk patients is more sensitive than plain radiographs for evaluation of the TL spine after blunt trauma. In addition, CAP CT can be performed faster. Omission of plain radiographs will expedite accurate evaluation allowing earlier treatment and mobilization.

Imaging of acute appendicitis: US as the primary imaging modality

The investigation of the acute abdomen in infants and children has evolved during the last two decades, placing imagers at the forefront of the evaluation and diagnosis of acute right lower quadrant abdominal problems. US and CT have recently been shown to be equally accurate in the diagnosis of acute appendicitis, but not everyone agrees. To demonstrate the efficacy of triaging patients with acute abdominal problems that suggest appendicitis with US as the primary imaging modality. We retrospectively reviewed the prospective imaging diagnoses in 622 children who presented to our emergency room (ER) and clinics with acute abdominal symptoms suggestive of appendicitis. We documented whether US or CT was performed and noted the diagnoses made. All of the patients had plain films. In addition, all patients undergoing surgical appendectomy during this time were also documented so as not to miss any cases of appendicitis. None was missed. There were 622 consecutive patients in our study. Three patients, diagnosed as normal, were eventually excluded because of lack of follow-up. In all, 152 patients were evaluated clinically and with plain films only. They were not subject to surgical exploration or further imaging. None returned with appendicitis. Eighty-one patients were directly subject to laparotomy after clinical and plain film evaluation. Of these patients, 20% had a normal appendix. Of the remaining 389 patients, 386 had US and three had CT alone. Four patients had both CT and US because of an inconclusive US examination. Three patients had CT alone because of their size. In total, 137 patients were diagnosed with appendicitis with US and/or CT. Four of these patients (3%) had normal appendices. Forty-two patients (less three lost to follow-up) were diagnosed as normal, and none returned with findings of appendicitis. Nine others had conditions other than acute appendicitis. Three had surgically proven, nonrelated conditions, and of the other six, one had pancreatitis and five nonsurgical adnexal problems. In all, 201 patients were diagnosed (with US) with mesenteric adenitis-enteritis, and none returned with findings of appendicitis. We attained a high degree of diagnostic accuracy in patients presenting with findings suggestive of appendicitis using US as the primary imaging modality. Our false-positive appendectomy rate was 3%. Therefore, triage of the acute abdomen with US supported by CT when required has considerable merit, especially when considering that US is noninvasive and does not use ionizing radiation.

Cervical plain films should be eliminated in the high risk patient: Results from decision analysis using an institutional cost perspective

Abstract Introduction: In the evaluation of the cervical spine, Helical CT scan has higher sensitivity and specificity than plain radiographs in the high-risk trauma population but is more costly. We hypothesized that institutional indemnity payments associated with missed injuries make helical CT scan the least-costly approach. Methods: A decision analytic model was created for helical CT scan vs. radiographic evaluation of the c-spine. Model variables obtained from the literature: probability of c-spine fracture (11–11.5%), probability of paralysis after missed injury (1.0–10.5%), sensitivity of plain films (44–84%), specificity of plain films (72–89%), sensitivity of CT scan (95–97%), specificity of CT scan (93–100%). Costs from Level 1 trauma center: helical CT scan ($329), plain radiography ($120), missed injuries resulting in paralysis ($500k-$1M). Sensitivity analysis tested model strength, accounted for parameter variability, and determined threshold values for individual parameters. Results: Evaluation of c-spine with helical CT scan has expected cost of $444 compared to $1155 for plain films. CT scan is the least costly alternative if threshold values exceed: $113,616 for indemnity payments, 2.6 % for probability of c-spine fracture, and 1.1% for probability of paralysis. Plain films are a cost-effective alternative if institutional costs of CT scan exceed $1040 or the sensitivity of plain films is greater than 90%. Conclusions: Decision analysis from an institutional perspective shows an economic advantage for helical CT scan. This combined with CT scan’s enhanced sensitivity and specificity suggests that plain film evaluation of the c-spine should be eliminated in the high risk trauma patient.

Cervical spine trauma in children under 5 years: productivity of CT.

The aim of the study was to determine the value of CT in the evaluation of cervical spine trauma in children under 5 years in the Emergency Department. A retrospective review of 606 patients undergoing cervical spine examination in the emergency room was undertaken. The age and sex of the patients were documented, and in addition presence or absence of fracture-dislocation was noted on each of the plain film and CT studies. Of the 606 patients studied, 459 (75.7%) were cleared by a combination of clinical and plain film radiographic findings. The other 147 (24.3%) went on to CT imaging for clearing of the cervical spine. Of the 147 patients evaluated with CT, 143 (97.3%) had exams that were negative for fracture, dislocation, and instability. Only four (2.7%) demonstrated positive findings for fracture, dislocation, or instability. All of these patients had positive, diagnostic findings on initial plain film evaluation. Another five patients demonstrated new findings which were unrelated to trauma and of no clinical consequence. The yield of positive, clinically significant findings on CT of cervical spine injuries in children less than 5 years was low and showed significant findings only in patients where the same findings were seen on initial plain radiographs.

Spine imaging.

Imaging of the vertebral column and spinal cord has evolved from plain film evaluation to computed tomography (CT), CT in conjunction with myelography, and most recently magnetic resonance imaging (MRI). Currently, MRI has essentially replaced other imaging modalities in evaluation of the spine because of its superiority in demonstrating anatomic detail and multiplanar capability. The following is a review of the various imaging modalities available and their application in the evaluation of common spinal disorders.

Pelvic Lines and Landmarks

In the plain film evaluation of the pelvis, multiple bony landmarks and lines have been identified, and alteration of these landmarks often indicates underlying pathology. This article reviews many previously described bony landmarks and uses cross-sectional imaging to display and explain the underl

Plain film evaluation of degenerative disk disease at the lumbosacral junction.

Diagnosing degenerative disk disease (DDD) at the lumbosacral junction (LSJ) on plain films is often difficult, compared with other disk levels. The purpose of this study was to determine whether criteria for diagnosis of DDD at the LSJ can be established for plain films. We retrospectively reviewed 100 lumbar MRI scans of patients who also had lumbar plain films. Using MRI as the reference standard, the LSJ was classified as normal (n=35) or exhibiting mild (n=45) or severe (n=20) DDD by two radiologists using accepted criteria. Measurements were performed on the plain films by two other radiologists and the average measurements were tabulated according to the three categories of DDD defined by MRI. Plain film measurements included the anterior and posterior disk heights (ADH, PDH), Farfan's ratio, determined by adding ADH to PDH and dividing that number by the measured anteroposterior (AP) length of the inferior end plate of L5 [(ADH+PDH)/AP length of L5], and lumbosacral angle (LSA). Subsequently, five additional radiologists interpreted the radiographs by visual inspection only, for DDD at the LSJ, both before and, several weeks later, after being provided with the quantitative data for normal versus DDD. There was a statistically significant difference between normal disk and increasing severity of DDD on radiographs using the parameters of PDH and Farfan's ratio. There was no statistically significant difference regarding ADH or LSA. Diagnostic accuracy by visual inspection was not significantly altered using the quantitative data for interpretation of DDD (68% correct before, 69.5% correct after). Analysis of results indicates that PDH is the most reliable and easily used criterion for detection of DDD at the LSJ. A PDH < or =5.4 mm on plain lateral film indicates DDD; PDH > or =7.7 mm indicates the absence of DDD on plain film.

The Utility of Motor-Evoked Potential Monitoring During Intramedullary Surgery

The Utility of Motor-Evoked Potential Monitoring During Intramedullary Surgery

Acute fracture of the distal tibial physis: role of gradient-echo MR imaging versus plain film examination.

Recent reports indicate that, compared with MR imaging, plain film radiography often underestimates the extent of injury in children with physeal fracture-separation. Such underestimation may have significant therapeutic and prognostic outcomes. We performed this study to assess the benefit of MR imaging compared with plain film radiography in the diagnosis and immediate treatment of acute fractures of the distal tibial physis. Twenty-nine patients with acute fractures, including 15 Salter-Harris II, four Salter-Harris III, four Salter-Harris IV, and six triplane fractures, were prospectively examined by MR imaging with gradient-echo sequences. The MR images were compared with plain film radiographs. All cases were reviewed in a blind fashion by two experienced radiologists to determine the Salter-Harris classification on the basis of first plain film radiographs and then MR images. Two experienced pediatric surgeons were asked to propose treatment on the basis of first plain film radiographs and then MR images. Both the radiologists and the surgeons were asked to rate the two techniques in terms of degree of confidence and overall diagnostic effectiveness. Only 1 or 29 fractures (3%) was misclassified by plain film radiography. MR imaging never caused the treatment plan to be modified. However, the position of fracture fragments in Salter-Harris IV and triplane fractures was always better appreciated on MR images, facilitating more accurate surgical treatment. Except for those in the misclassified fracture, all other fracture lines were seen on both plain film radiographs and MR images but were more easily seen on MR images. Gradient-echo MR imaging allowed easier assessment of fracture lines than did plain film radiography, but the latter technique remains the primary means of evaluating epiphyseal injuries. For acute fractures of the lower extremity of the tibia, gradient-echo MR imaging should be limited to complex fractures and to cases in which the classification of a fracture on the basis of plain film evaluation is uncertain.

Frequency and significance of fractures of the upper cervical spine detected by CT in patients with severe neck trauma.

Radiographic evaluation of the upper cervical spine in patients who have suffered severe trauma is often problematic because of the difficulty of obtaining adequate open-mouth views of the odontoid in these critically ill patients. This study was undertaken to determine the frequency and clinical significance of upper cervical spine fractures detected by CT in this patient population. The study group consisted of 100 consecutive patients brought to the emergency department after severe trauma who had CT of the craniocervical junction done instead of an open-mouth view. Plain film evaluation consisted of a cross-table lateral view, an anteroposterior view, and, if necessary, a swimmer's view. The radiographic studies were reviewed retrospectively by a musculoskeletal radiologist and a neuroradiologist, respectively. Hospital records were reviewed to ascertain the patients' clinical signs and symptoms on admittance and to determine how identification of the fractures changed the treatment plan. Eight fractures in seven patients were identified with CT of the craniocervical junction. Three of the fractures were of the occipital condyle, and five were at the C1-C2 level. None of the fractures were seen directly on plain radiographs, although secondary signs of injury such as prevertebral soft-tissue swelling were seen in two of the seven cases. CT of the craniocervical junction revealed an 8% frequency of fractures of the occipital condyle and C1-C2 that were undetected on the cross-table lateral cervical spine radiographs. Fractures occurred in greater numbers than expected, and all surviving patients were stabilized with a halo. This experience shows that CT is an efficient method of evaluating patients in whom the standard open-mouth radiograph of the odontoid cannot be done.

Plain film evaluation of bone grafting for nonunited scaphoid fractures.

To determine how the appearance of fracture line bridging and graft incorporation changed on sequential plain films obtained during the healing of successful grafts for scaphoid nonunion. We identified 50 patients who had healed Russe bone grafts for nonunited scaphoid fractures. These patients had 214 sets of wrist radiographs obtained 1-36 months after surgery. Each set of radiographs was reviewed in random order by two observers who were blinded as to the patient's name and the time interval since surgery. Closure of the fracture line and the presence of a linear lucency in each of six zones surrounding the graft were assessed using a three-point grading scale. Forty-six men and four women were included in the study. Their mean age was 30 years with a range from 21-43 years. With increasing time after surgery, there was progressive fracture line closing and disappearance of linear lucencies at the interfaces between the scaphoid and the graft. However, a 20% of the patients had a well-defined lucency in at least one of the six zones around the graft on their last film. Even 1 year after surgery, the fracture line showed no bridging on the radial side in 22% of patients and on the ulnar side in 11%. We conclude that after grafting, most scaphoid nonunions show progressive fracture line closure and graft incorporation. However, the fracture line may not completely close and lucencies may persist in several zones around the graft for more than 1 year. These radiographic appearances should be recognized as part of the normal spectrum of healing.

Magnetic resonance imaging evaluation of acute spine trauma

A comparison study of magnetic resonance imaging (MR), computed tomography (CT), and plain film evaluation of 113 consecutive spine trauma cases was conducted. The rate of true-positive findings (sensitivity) on MR was shown to be significantly higher than for CT or plain films in the evaluation of soft tissue or ligamentous injury (P<0.001). MR had a significantly lower rate of positive findings for fracture than CT (P<0.001) and was also shown to be significantly less sensitive for fracture than plain films (P<0.001). Spinal cord contusion, epidural hematoma, high-grade stenosis, and ligamentous or soft tissue injury were best evaluated with MR.