Three-dimensional computerized imaging is a new modality of radiological imaging. This new technique transforms the two-dimensional slices of bi-plane CT into a three-dimensional picture by a computer’s monitor adjusted to the system. This system enables the physician to rotate the angle of viewing of the desired region to any desired angle. Moreover, this system can delete certain features of different densities from the picture, such as silicone implants, thus improving visualization. Our preliminary results using this technique are presented. The advantages, pitfalls, and suggested future applications of this new technique in hand surgery are discussed.
Open reduction and internal fixation are the current trends of treatment for comminuted calcaneal fractures. Assessing treatment results is often difficult due to discrepancy between objective parameters such as range of movement, and subjective results such as pain.To test the reliability of footprint analysis as an adjuvant method of postoperative assessment of patients who sustained calcaneal fractures.Dynamic and static footprint analysis was used as an adjuvant additional method to objectively assess operative results. This method is simple and is independent of the patient's initiatives. This modality was used in 22 patients followed-up 9-90 months postoperatively.We found a good correlation between footprint analysis and objective and subjective parameters of results expressed by American Orthopedic Foot and Ankle Society hind foot score. In certain cases, this method can be used to distinguish between uncorrelated parameter results, such as malingering, and workmens' compensation claims.We recommend the use of this simple, non-invasive objective test as an additional method to assess the results of ankle and foot surgery treatment.
Introduction: To follow fracture healing, radiography is commonly used, but it is not sensitive to the early stages of this healing process when nonossified callus is formed. Hence, radiography can lag behind the physiological events of bone healing by some weeks. Although the use of ultrasound for fracture diagnosis has been reported previously, mainly in children, the clinical use of ultrasound to follow fracture healing has rarely been commented on. The goal of the current study was to test the efficiency and efficacy of ultrasound as an alternative method for follow-up of fracture healing. Material and Methods: During a one-year period, 12 patients—six with proximal fibula fracture and six with proximal metatarsal fractures—were followed by ultrasonographic examination in parallel with the routine radiographs. Results: The ultrasound examinations revealed callus formation after one month, with the early signs of healing after ten days. Early callus was first seen on radiographs after a month. Conclusion: Ultrasound was found to be a good modality to follow up fracture healing in long bones. This modality can reduce the amount of radiation received by the patients in the follow-up of fractures, and may shorten the immobility period and hence the recovery time of returning to normal function.
Objective: Surgical site infection (SSI) after hip fracture surgery is a well-known complication with serious consequences for both the patient and the medical system. Silver ion treatment is considered an effective antibacterial agent, however, the use of silver dressing (SD) in the primary prevention of SSIs is controversial. The aims of this study were to compare SD with regular dressing (RD) in the prevention of SSI in elderly patients undergoing surgery for hip fractures, and to compare costs. Method: A matched group of 55 patients with hip fractures undergoing surgery with dynamic hip screw, cephalomedullary nail or hemiarthroplasty were randomised to either SD or RD groups. The dressings were applied in the operating theatre, and the patients were followed for one week for clinical signs of infection (discharge, erythema and fever). The RDs were replaced daily. The SDs were not removed for 5–7 days and kept moist. Skin swabs were taken from the wound surface on postoperative day 5–7 for bacterial skin colonisation. Results: The SD (n=31) and RD (n=24) groups were similar in age, sex and comorbidities. Infection signs were seen in two (2/31, 6.4%) of the SD patients compared with 2 (2/24, 8.3%) RD patients (p=1.0). Skin colonisation by bacteria at postoperative day 5–7 was tested in 27 patients: it was higher in the SD group (positive skin swab, 12/19, 63.2%) compared to the RD group (4/8, 50%, p=0.67). The use of SD added ~US$5 (UK ~£3.19) per patient. Conclusion: The use of SD was associated with higher costs than RD, but not superior in preventing SSIs in elderly patients undergoing hemiarthroplasty or fixation of hip fractures. SD was also not effective in reducing bacterial skin colonisation following hip fracture and surgery.
Elastofibroma is a rare type of lesion consisting of elastic fibers within a stroma of collagen and fatty tissue. It is usually located on the lower scapular region attached firmly to the thoracic cage, often causing debilitating pain. Its clinical presentation mimics a soft tissue tumor.To evaluate the diagnosis and treatment results of elastofibroma.Clinical and radiographic evaluations were performed in 11 patients with thoracic wall mass. In five of them a biopsy was taken before surgery. All patients were operated and the diagnosis of elastofibroma was confirmed by histology.Two patients had a postoperative seroma that resolved spontaneously within a few days. All patients reesumed their preoperative activities, including sports.Considering the slow-growing nature of this tumor and its typical presentation, we believe that when this diagnosis is suspected, investigation does not necessitate staging (as in sarcomas). Also, marginal surgical excision is sufficient. Observation is an acceptable alternative to surgery.
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