MRI enables morphological and structural changes of CMI to be monitored over time. Follow-up can be extended beyond 2 years, until the CMI has stabilised and subchondral bone marrow oedema has completely resolved. In the single case with a poor CMI outcome, no related direct or indirect signs were identified.

Osteoarthritis (OA) leads to significant pain and disability. For pain relief, a tailored approach using non-pharmacological and pharmacological therapies is recommended. If adequate symptom relief is not achieved with acetaminophen, other pharmacological options include non-steroidal anti-inflammatory drugs (NSAIDs), topical analgesics, intra-articular corticosteroids and intra-articular hyaluronic acid (HA) viscosupplementation. Most of these therapies generally do not improve functional ability or quality of life or are associated with tolerability concerns. In OA patients, concentration and molecular weight (MW) of HA are reduced, diminishing elastoviscosity of the synovial fluid, joint lubrication and shock absorbancy, and possibly anti-inflammatory, analgesic and chondroprotective effects. In knee OA, viscosupplementation with 3-5 weekly intra-articular HA injections diminishes pain and improves disability, generally within 1 week and for up to 3-6 months and is well tolerated. HAs have comparable efficacy as NSAIDs, with less gastrointestinal adverse events, and compared with intra-articular corticosteroids, benefits last generally longer. High MW hylans provide comparable benefits versus HA, albeit with an increased risk of immunogenic adverse events. In mild-to-moderate hip OA, intra-articular injection of HA moderately improved pain and function, generally for up to 3 months with no serious adverse events. Efficacy in other joints is being evaluated. Viscosupplementation with intra-articular Sinovial(®) (other trade names: Yaral(®), Intragel(®)) injections (an HA of low-medium MW) relieves pain and improves function in OA of the knee, and other joints including the carpometacarpal joint of the thumb and the shoulder. HA viscosupplementation, including use of Sinovial(®), is a valuable treatment approach for OA patients, if other therapies are contraindicated or have failed.

Foreign bodies (FBs) retained in the soft tissues are a common reason for medical consultation, and usually consist of wooden or metal splinters or glass shards. Failure to remove foreign bodies is likely to give rise to acute or late complications, such as allergies, inflammation or infection, that may be severe. The surgical removal of an FB is invasive, costly and technically challenging. The procedure may fail in some cases and carries the risk of complications. Our study describes a technique for the ultrasound-guided removal of an FB, devised from our experience, and demonstrates its advantages over the standard surgical procedure. Sixty-two patients (43 males and 19 females aged from 9 to 65 years, median age 31 years) presented at our institution between October 2005 and June 2008 with suspected foreign bodies retained in the soft tissues of various body districts. Radiographic and/or ultrasound diagnosis was established by a radiologist expert in musculoskeletal sonography. The same radiologist helped by a nurse subsequently undertook the ultrasound-guided removal in the outpatient's clinic according to the technique described in the paper. ATL 5000 and PHILIPS iu22 ultrasound systems were used with high-frequency linear-array probes, sterile material, local anaesthetic (lidocaine 2%), scapels and surgical forceps. Antibiotic prophylaxis with amoxicillin and clavulanic acid were prescribed to all patients for 7 days after the procedure. Ninety-five FBs (39 glass, 35 metal, 17 vegetable, 2 plastic, 2 stone) were successfully removed under ultrasound guidance in all patients and the procedure took between 15 and 30 min. No complications arose either during or after the procedure. Seventy-five skin incisions were made and the wounds closed with Steri-Strips in 73/75 cases, whereas skin sutures were used in 2/75 cases. No complications arose either during or after the procedure. Ultrasound-guided removal of an FB retained in the soft tissues is a good alternative to surgery as is its relatively straightforward, inexpensive, repeatable and carries a low risk of complications. In addition, failure to remove an FB does not preclude traditional surgical removal. The advantages of this real-time procedure and the use of small instruments minimize bleeding time and avoid injury to surrounding structures. Patient compliance is enhanced by the fact that the procedure has little or no aesthetic impact. These encouraging results suggest ultrasound-guided removal as a first-choice procedure for the extraction of foreign bodies.

Magnetic resonance arthrography improved the evaluation of implants and facilitated the characterisation of MACI integration with contiguous tissues. The follow-up showed significant changes in MACI, even at 60 months, allowing for useful long-term MR evaluations.

Transphyseal elbow fracture is a rare entity in newborns, and in the last century, only case reports or small case series have been published; however, precise epidemiological data lack. Such fractures occur more often in emergency Caesarian section or vaginal delivery. The differential diagnosis with elbow dislocation can be challenging. Radiography, arthrography, magnetic resonance, ultrasound or a combination of these have already been described to make diagnosis, but guidelines for the management of this injury in the neonate are not well established. A review of the literature of the last century about distal transphyseal fracture of the humerus in newborns was performed. A bibliographic search was conducted accessing usual medical databases. The work-up methods, treatments, results at follow-up and the rate of complications were collected. Twenty case reports or small retrospective case series reporting a total of 33 cases were included. A posteromedial displacement of the radioulnar complex was found in 21 elbows (64 %). Four patients (12 %) underwent surgical treatment, whilst 29 (88 %) were managed without surgery. An attempt of reduction was reported in 23 cases (69 %). At follow-up, 88 % recovered completely the carrying angle and 80 % range of motion. A relationship between the type of treatment (conservative or surgical, with attempt of reduction or not) and results at follow-up could not be demonstrated. The most common complication was cubitus varus. Transphyseal elbow fractures are rare among newborns. Regardless of the treatment choice, such lesions are in most cases associated with a good prognosis.