Compartmental anatomy: relevance to staging and biopsy of musculoskeletal tumors

A thorough understanding of compartmental anatomy is essential for accurate staging of a suspected musculoskeletal tumor with MR imaging and for avoiding potentially devastating biopsy-related complications. Imaging-guided, percutaneous needle biopsy is a safe and cost-effective technique but requires careful planning in conjunction with the surgeon who will perform the definitive surgery because it constitutes the final step in the staging process and the first step in surgical therapy.     

MRI findings following laparoscopic sacrocolpopexy

Sacrocolpopexy is a surgical procedure that provides effective treatment for pelvic prolapse. The surgical technique and complications of laproscopic sacrocolpopexy are described. This review presents experience of MRI for postoperative assessment and illustrates normal and abnormal findings.     

CT-guided hookwire placement: a technical innovation for preoperative localization of nonpalpable cervical lymph nodes

The aim is to describe the technique of preoperative CT-guided hookwire localization of small, but suspicious, cervical lymph nodes. We present 3 patients who underwent the procedure for nonpalpable cervical nodes detected on PET/CT prior to complete surgical resection of the nodes. The details of the radiological procedure, surgical outcomes, and pathologic results are described. The mean intervention time for preoperative hookwire localization was 9 minutes (range 7-14 minutes). There were no complications. All surgeons felt that the lengths of the surgical skin incision and operative times were reduced because of localization. The pathologic diagnoses were 2 benign nodes and 1 case of metastatic ovarian carcinoma. In conclusion, preoperative CT-guided hookwire localization is a useful technique for guiding surgical excision, especially when cervical nodes are small and deep in location.     

Distal Biceps Tendon Repair: Suture Anchor Technique

In active patients, acute ruptures of the distal biceps tendon are best treated by primary repair due to a loss of strength with conservative management. Various techniques have been reported with good clinical outcomes. The single-incision suture anchor repair technique demonstrates clinical results comparable with other fixation methods and low complication rates. The surgical technique is described in detail in this chapter.     

Percutaneous gastrostomy and transgastric jejunostomy.

Gastrostomy for feeding or decompression of the stomach or small intestine can be performed by using surgical or percutaneous, nonsurgical techniques. Although use of the surgical technique is well established, recent interest has focused on the nonsurgical methods because of their lower rates of morbidity. Percutaneous gastrostomy by either the endoscopic or the fluoroscopically guided Seldinger technique was introduced in the early 1980s. A number of technical modifications have been described, and sufficient clinical data have been accumulated and published to validate the safety of the percutaneous approach. Several published studies compare surgical with nonsurgical gastrostomy, but none compare the two percutaneous techniques. The purpose of this article is to review the current status of the fluoroscopically guided technique, its indications, and its results and to examine the relative merits of the surgical and nonsurgical techniques.     

Meniscus bucket-handle fixation with an absorbable biofix tack: development of a new technique

The authors present a new method for fixation of meniscus bucket-handle lesions. This technique is based on the development of a Biofix self-reinforced polylactic acid tack and an application system. The main goal of this technique has been to eliminate or at least reduce the risk of neurovascular injury during meniscus fixation and to simplify the fixation procedure. Additional skin incisions and exposure of the knee joint capsule are superfluous. The steps in the development of this technique are outlined and the surgical technique and preliminary results described.     

Tibial antivarus closing wedge osteotomy

Antivarus lateral closing wedge osteotomy of the proximal tibia is a time-tested surgical technique. Redistribution ofweight-bearing forces within the knee joint decreases the medial compartment load and the varus knee moment. Young or middle-aged patients as well as athletes with medial unicompartmental arthritis, posterolateral instability and varus thrust, or chronic anterior cruciate ligament deficiency and varus malalignment may be candidates. The indications have expanded recently to include patients with a varus mechanical axis who are undergoing periosteal resurfacing, autogenous chondrocyte implantation, meniscal transplantation, osteochondral grafting, or multiple subchondral bone microfractures. The osteotomy is performed between the knee joint and the tibial tubercle by removing a laterally based bone wedge. The construct is stable because of osteoclasis of the medial tibial cortex, an intact periosteal hinge, and excellent apposition of broad cancellous bone surfaces. Early knee motion is possible and bone healing is expeditious. Complications can be averted by careful patient selection, precise preoperative planning, and meticulous surgical technique. The weight-bearing line method uses a full-length standing radiograph to determine the desired correction angle. The osteotomy is performed with fluoroscopic guidance through a limited exposure. Low-profile step staples provide satisfactory fixation, and no bone grafting is required. Tibial Antvarus lateral closing wedge osteotomy is a useful and reliable surgical technique.     

Distal biceps brachii tendon repair: Suture anchor technique

Rupture of the biceps brachii tendon has been associated with significant loss of flexion and supination strength.Several techniques have been described with reports of clinical success. The single incision suture anchor repair technique produces clinical results comparable with other methods of fixation with low complication rates. The procedure can be performed through a limited 3-cm transverse incision with minimal dissection. The surgical technique and postoperative rehabilitation are described.     

A stepless needle-dilator for expedient percutaneous catheterization: Technical note

A new stepless needle-dilator is described which allows arterial puncture and dilation in a single step using a single wall puncture technique. The new needle-dilator causes significantly less arterial damage than a conventional dilator (p<0.05). Additionally, time and cost savings are realized by clinical users.     

Mason''s vertical banded gastroplasty for morbid obesity. Surgical procedure and radiographic evaluation

Mason's vertical banded gastroplasty is performed to treat morbidly obese patients. The surgical procedure and the subsequent technique used to carry out a radiological evaluation are described. Radiographic features of the normal and abnormal postoperative stomach are detailed.     

A new surgical procedure for the treatment of patella infera

A new method for the treatment of patella infera is presented. This technique is based on the previously described procedure for treatment of old ruptures of the patellar ligament. The main advantage of this technique is the achievement of a normal patellar position without the adverse effects on the knee extensor mechanism found with other techniques, such as patellectomy or elevation of the tibial tubercle. The main surgical steps of this technique are outlined and the preliminary results reported.     

Preoperative localization of low-density foreign bodies under CT guidance

A simple technique for the localization of foreign bodies using a spring hook wire under computed tomographic (CT) guidance is described. The advantages of CT in detecting foreign bodies of near water density and in planning a surgical approach which avoids important anatomical structures are emphasized.     

Percutaneous lumbar diskectomy using a new aspiration probe: porcine and cadaver model

A method of percutaneous aspiration of the nucleus pulposus of lumbar disks is described as performed in four pigs and three cadavers. Through a lateral oblique percutaneous approach, 80-100% of the nucleus pulposus was removed in each of the pigs; approximately 30% of the cadaver disk was removed. A unique aspiration probe and the introducing set as well as the technique are described. The implications for clinical use in patients are discussed. We believe this technique may be an alternative to both surgical diskectomies and chymopapain injection in the treatment of herniated disk disease of the lumbar spine.     

Percutaneous vertebral biopsy: A review of 135 cases

The technique and advantages of undertaking percutaneous biopsy of vertebral lesions as a radiological procedure are described and illustrated with a series of 135 biopsies. An overall accuracy of 88.9% was achieved. The technique has a low morbidity and offers considerable advantages to the patient compared with open surgical biopsy.     

Surgery of the parotid gland. Indications. Review of the anatomy

The surgical division of the parotid gland in three parts or "lobes" in relation to facial nerve is a practical custom. After revising the surgical anatomy, the indications and operative technique of total parotidectomy with preservation of the facial nerve (TPP) are described. The discussion is open for pleomorphic adenomas of the superficial lobe, between some authors in favour of a superficial parotidectomy and others who perform a systematic TPP. Other surgical operations are total parotidectomy (TP) without preservation of the facial nerve, TP associated with a neck dissection, at lastly extensive or partial parotidectomies. Trans-parotid surgery uses the parotid region as an approach to neighbouring structures or regions.     

Percutaneous peritoneal dialysis catheter placement for the management of end-stage renal disease: technique and comparison with the surgical approach

As the incidence of end-stage renal disease is increasing, so is the pressure on the health care system to promote less expensive and burdensome management solutions. Peritoneal dialysis (PD) has been increasingly used and is especially suited for patients who, in exchange for meticulous care and technique, enjoy more independence and fewer clinic visits than their counterparts on hemodialysis. Both the efficiency and the complication profile of the percutaneously placed PD catheters are comparable to that of surgically implanted ones. Percutaneous procedures have the added advantage of being less expensive and requiring shorter hospitalization. Radiologists are in an advantageous position to provide fluoroscopic placement of PD catheters promptly and safely. We describe this technique step by step and compare its complication profile to that of the surgical approach as reported in the literature.     

Over-the-top double-bundle revision ACL reconstruction

Revision ACL presents many technical issues that are not seen in the primary ACL reconstruction. A variety of surgical techniques for revising ACL reconstruction have been described in the literature to address these concerns. The purpose of this article is to present a novel technique consisting in a non-anatomic double-bundle ACL revision reconstruction, using a fresh-frozen Achilles tendon allograft with soft tissue fixation. This technique is a valid treatment option when faced with a complex scenario such as ACL revision surgery.     

Tibial inlay procedure for PCL reconstruction: One tunnel and two tunnel

Many operative techniques have been described for reconstructing the posterior cruciate ligament (PCL). Nocurrent surgical procedure has been able to consistently correct abnormal posterior laxity or provide consistent functional results. This may be because of the nonanatomic placement of the tibial portion of the PCL graft with the tibial tunnel technique. With this method, the graft must make a greater than 90° turn toward the medial femoral condyle. It is believed that this “killer turn” may degrade the graft with time. The tibial inlay technique avoids this by securing the graft with a bone block anatomically within the PCL footprint on the posterior tibia. By using this technique, both a decrease in posterior translation and less graft degradation can be found when compared with the standard tunnel technique of PCL reconstruction. A double-bundle reconstruction may also be performed with the inlay technique. In this article, we present the operative indications, surgical technique, and postoperative rehabilitation protocol for the tibial inlay technique of PCL reconstruction.     

Osteotomy for the early varus arthritic knee

High tibial osteotomy is a well-established procedure for the management of medial compartment arthritis that is currently experiencing a resurgence in popularity. A number of techniques have been described, with the ultimate goal of obtaining appropriate alignment to provide pain relief and functional improvement over a long-term period. Appropriate patient selection and careful surgical technique is necessary to achieve these goals with a minimal risk of complication. Newer technology such as computer navigation promises to improve the overall accuracy of the procedure. The need for alignment correction in combination with ligament reconstruction and chondral resurfacing surgery will increase the indications for this procedure. This article discusses the techniques available for high tibial osteotomy, the results and relative advantages of each, and the appropriate surgical technique to achieve optimal results while minimizing complications.