The ability to detect and categorize SLAP (Superior Labrum Anterior to Posterior) lesions of the scapular labrum is of practical importance to the orthopedic surgeon and the radiologist. The aim of this study, performed on cadaveric shoulders, was to determine whether CT arthrography or MR arthrography is able to show normal anatomical variation of the glenoid labrum and detect labral abnormalities. CT arthrography, MR arthrography followed by anatomical dissection were performed on twenty three fresh frozen cadaveric shoulders and analysed by a radiologist and two orthopaedic surgeons. As Gadolinium intra-articular injection is not allowed in France, we used an iodinated contrast media for both MR arthrography and CT arthrography. In this study, the sensitivity of MR arthrography seemed higher than CT arthrography (respectively 4 and 3 labral lesions diagnosed out of five), although no significant statistical conclusions can be made due to the small number of cases. In conclusion, under such specific conditions, MR arthrography seems to be the method of choice for the detection and classification of labral lesions.
With more than 20 years follow-up for the older cases, the concept of the biological fixation of an implant by bony ingrowth using surface treatment seems to be very reliable.The experience of this long term study argues for the thickness of polyethylene to be at least 10 mm for all metal back acetabular component and the future of this kind of implant seems to lie in modularisation made possible by the morse cone which would allow the replacement of the bearing surfaces.
We reviewed 47 type 3 femoral fractures (below the femoral stem according to the Johansson classification). There were 36 women and 11 men. The average age was 73,4 years, at the time of the fracture.These patients had had a total arthroplasty in 32 cases, a hemi arthroplasty in 10 cases and a bipolar arthroplasty in 5 cases.Of these 47 patients:- 6 underwent an orthopedic treatment (2 trans-tibial traction, and 4 plaster of Paris immobilisations) for a period averaging 60 days. Two (33%) developed pseudoarthritis and 2 (33%) developed bed-sores and decubitus complications.- The remaining, 41 patients underwent a surgical procedure:- 34 osteosynthesis using plates or screw plates brought about : - 4 fractures under the plate; - 4 pseudo-arthrosis; - 4 infections; - 4 plate breakages; - 1 femoral stem loose-ring;- 6 femoral stems were replaced with longer stems going through and extending past the fractures, without any material breakage or local complications (one patient died however, following other complications).- One patient had an Olerud procedure and unfortunately died after 3 months.At last follow up : - 4 patients had died; - consolidation occured in 41 cases over an average period of 130 days (45 to 590); - fractures treated by using osteosynthesis plates, showed a 50% incidence of complication; - on the other hand, when using stem replacement, no mechanical or local complications occured.
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