Precise nail tip positioning after tibial intramedullary nailing prevents anterior knee pain

Purpose

Anterior knee pain (AKP) is a common complication following intramedullary nailing of tibial shaft fractures. Our aim was, by analysing the postoperative lateral knee X-rays and clinical status (VAS score), to find the best intramedullary tip position of a non protruded nail that will provide the best postoperative outcome avoiding AKP.

Methods

We evaluated the postoperative outcome of 221 patients, from the last four years, with healed fractures initially treated with intramedullary reamed nails with two or three interlocking screws proximally and distally through a medial paratendinous incision for nail entry portal. Our aim was to analyse a possible relationship between AKP according to the VAS scale, and nail position marked as a distance from tip of nail to tibial plateau (NP) and to tibial tuberosity (NT), measured postoperatively on lateral knee X-rays.

Results

Two groups of patients were formed on the basis of presence of pain related to AKP (the level of pain was neglected): group A were patients with pain and group B without pain. The difference between the two groups concerning NP and NT measurements appeared to be statistically significant concerning NT measurement (p < 0.05), with high accuracy according to the classification tree.

Conclusions

We presume that the position of the proximal tip of the nail and its negative influence on the innervation pattern of the area dorsal to patellar tendon could be the key factor of AKP. We conclude that the symptoms of AKP will not appear if the tip of the nail position is more than 5.5 mm from the tibial plateau (NP) and more than 2.5 mm from the tibial tuberosity (NT).     

The Value of Ultrasound in Acute Ankle Injury: Comparison With MR

Abstract Objective:   To assess the value of the ultrasound (US) in different grades of acute trauma by comparing with MR. Methods:   We analyzed 30 patients, of average age 33, with acute ankle trauma, without fracture on standard radiograms. One week after injury all patients were sent for US. We used linear probe 8–15 MHz. Ten days later, the patients were examined on MR. Results:   Anterior talofibular ligament was normal in 20.6% by US and in 20.3% by MR. Ligament lesion were found by ultrasound in 40%, proven in only 20.6% by MR. Ultrasound diagnosed 33,3% ruptured ligament, MR found 50% rupture of anterior talofibular ligament. In 80.3% cases the calcaneofibular ligament appeared to be intact with both methods. Ultrasound found stretch ligament in 10.6% cases and MR proved that in 10% cases. In other 6.6% cases, MR found complete rupture. Intraarticular effusion was found in 80.3% patients by US and in 86.6% by MR. Lesion of tendon of long peroneal muscle was found in 40.6% patients by both methods. Lesion of tendon of short peroneal muscle was found in 33.3% lesions and proved by MR in only 20.3% cases. In other patients findings were normal. US found 10% lesions of the tendon of anterior tibial muscle and MR found 10.3% lesions. US found 10.6% lesions of tendon of long halucis flexor and MR found 20%. Our results were statistically analyzed by cross-tabs, the Stuart-Maxwell test, Npar tests and the McNemar test. Conclusion:   US proved to be a good and reliable method for diagnosing Grade I and II of ankle sprain, but for proper evaluation of Grade III, MR is recommended.     

Image quality of mammography in Croatian nationwide screening program: comparison between various types of facilities

Purpose

The study was aimed to provide objective evidence about the mammographic image quality in Croatia, to compare it between different types of MG facilities and to identify the most common deficiencies and possible reasons as well as the steps needed to improve image quality.

Materials and methods

A total of 420 mammographic examinations collected from 84 mammographic units participating in the Croatian nationwide breast cancer screening program were reviewed in terms of four image quality categories: identification of patient and examination, breast positioning and compression, exposure and contrast, and artifacts. Those were rated using image evaluating system based on American College of Radiology and European Commission proposals. The results were compared among different types of mammographic units, and common image quality deficiencies were identified.

Results

Total image quality scores of 12.8, 16.1, 13.0 and 13.7 were found for general hospitals, university hospitals, private clinics and public healthcare centres, respectively. Average score for all mammographic units was 13.5 (out of 25 points). University hospitals were significantly better than all other mammography units in overall image quality, which was mostly contributed by better breast positioning practices. Private clinics showed the worst results in identification, exposure, contrast and artifacts.

Conclusions

Serious deficiencies in identification and breast positioning, which might compromise breast cancer screening outcome, were detected in our material. They occur mainly due to subjective reasons and could be corrected through additional staff training and improvement of working discipline.     

Time trends of incidence rates of thyroid cancer in Israel: what might explain the sharp increase.

Background: Worldwide changes in the incidence, histological type, and prognosis of thyroid cancer (TC) have been observed. Regional differences in the spectrum of TC may be related to genetic factors, ionizing radiation, lifestyle, and nutritional iodine, as well as to the availability of medical services. Methods: Analysis of records of 5864 TC patients (diagnosed between 1982 and 2001), retrieved from the Israel National Cancer Registry. Results: The age-standardized incidence rate (ASR per 100,000 persons) of TC among Jewish women in 2001 was 12.45 (higher than generally reported in the world) and 3.68 among Jewish men. There was a significant increase in the ASR for TC between 1982 and 2001 in the Jewish population (by 101% among women and by 25% among men, p < 0.01 for both), mainly due to papillary carcinoma. TC incidence increased in the non-Jewish population from 2.33 to 6.02 in women (p < 0.05) and from 1.13 to 2.49 in men (p > 0.05). TC incidence was similar among immigrants from Europe and America arriving in Israel before 1990 or after 1990 for both genders. An improved 5-year survival was noted in patients diagnosed between 1992 and 1996 in comparison to patients diagnosed earlier: 1982-1986 (86% versus 78%, p < 0.01). Conclusions: A marked increase in TC incidence over the last two decades (mainly due to papillary carcinoma) has been noted in different Israeli subpopulations, being the highest in Jewish women. The increase trends were similar regardless of gender or ethnicity. The reasons for this rise in TC incidence and improvement in the survival are probably multifactorial and may relate partly to increased diagnostic vigilance and changes in clinical practice.     

The grading model for the assessment of the total amount of epidural fibrosis in postoperative lumbar spine

Purpose

To present a new model derived from Ross’s model for the assessment of the total amount of epidural fibrosis and to present inter- and intravariability study.

Methods

Two readers blinded to each other and blinded to their first and second reading retrospectively evaluated the magnetic resonance examinations in 32 postoperative spine surgery patients using this model.

Results

Paired and unpaired two-sided t tests showed no significant difference between the first and second reading, and interclass correlation coefficient revealed good interobserver reliability.

Conclusion

The proposed model enables estimation of the amount of epidural fibrosis in postoperative lumbar spine and does not require any additional software or hardware. It is designed for multi-centered clinical studies where it is necessary to compare the values of epidural fibrosis between the tested and control group. The use of the proposed model is fast and practical and helps to avoid complications arising from image format, calibration and software, which are often encountered in multi-centered studies.