Abstract:Objective: This study is analyzing the role and significance of the three diagnostic methods (clinical diagnosis, magnetic resonance imaging (MRI) and arthroscopy), in establishing accurate diagnosis in knee injuries. The goal is to determine the diagnostic accuracy of each diagnostic method, using arthroscopy as gold standard.Material and Methods: We examined 70 patients with knee injuries. Clinical diagnosis was established using patient's history and positive clinical tests for meniscal lesions, ACL injury and articular cartilage lesions. All patients underwent MRI on a 1.5 T magnet for MRI diagnosis. This was followed by arthroscopy for making the final diagnosis.Results: We analyzed the results of clinical tests for meniscal, ligamentous and articular cartilage injuries of the patients in both groups. Validity of the clinical tests was compared to the results got from MRI and arthroscopy. Accuracy of clinical diagnosis versus MRI diagnosis for medial(69.6% vs. 68.5%) and lateral (84% vs. 82.6%) meniscal lesions was almost identical. Accuracy of clinical diagnosis compared with the accuracy of MRI diagnosis for ACL injuries was higher (91.3% vs. 81.4%). Accuracy (85.5% vs. 72.8%) of clinical diagnosis versus MRI diagnosis for articular cartilage lesions was better.Conclusion: Affirmation of clinical diagnosis in this study is a result of usage of standard clinical signs and tests which are fundamental in establishing clinical diagnosis of knee injuries. MRI is a diagnostic method which enriches the diagnostic process. Arthroscopy is defined as superior diagnostic method, also a gold standard for comparison of the other two diagnostic methods.
The patient T. K, 7 years old, had sustained a supracondylar fracture of the left elbow after the fall on the left hand with elbow extended. She was admitted in local hospital where the clinical examination and X ray were made and they confirmed the diagnosis of supracondylar fracture of the left elbow (Gartland Type III). She was treated with closed reduction (without anaesthesia) and cast immobilization for four weeks. With poor to no function of the left hand she was send to physical therapy for duration of 10 days, but she did not gain her functions of the left hand, almost all active movements of the left hand were impossible and the muscles of the left underarm were hypotonic. Due to loss of left hand function, EMG was made and the EMG result showed acute lesion of the nerves of left forearm caused by possible nerve compression (n. medianus, n. radialis and n. ulnaris). After four months she was admitted in University Clinic for Orthopaedic Surgery in Skopje were we perform operation of the left elbow, with removing callus formation in which we find entrapped median and ulnar nerves. We also have done osteotomy of the humerus for correction of the angular deformity and fixation with K wire. The patient was put in cast immobilisation after the surgery for four weeks. After the removal of the cast and K wire she was sent to intensive rehabilitation. One year after surgery she regains almost all of hand and elbow functions with satisfying range of motion. She is now able to fulfil every day function without any help or support.
Dzo le va-To lev ska Ro za, Po po ska Ana sta si ka, Sa mard zi ski Mi lan, Ge or gi e va Da ni e la Uni ver sity Cli nic for Or t ho pa e dic Sur gery, Sko pje, R. Ma c e do nia Pri mljen/Re ce i ved 31. 03. 2014. god. Pri hva }en/Ac cep ted 06. 05. 2014. god. Ab stract:We pre s ent a ca se of a 38-year-old woman with a soft tis sue mass on the right knee in me dial in fra pa tel lar area. The fle xi on of the knee ap pe a red to be li m i ted and a pain was pre s ent at ma x i mal fle xi on. Ul tra so no graphy, stan dard X-ray and CT scan we re per for med for di ag no sis of this soft tis sue tu mo ur. MRI was not do ne due to tec h ni cal pro b lems. Any how the MRI co uld pro vi de us with mo re pre sump ti ons of the type of the tu mo ur, but it will not af fect the sur geon's de ci sion for op e r a tion. Any way the fi nal di ag no sis will co me out of the hi sto pa to lo gi cal fin d ings.Ar thro sco p ic ex a m i na ti on was per for med in or der to eli m i na te pos si ble pro b lems in to the jo int fol lo wed by open wi de ex ci si on. A soft tis sue tu mo ur with dimen si ons of 5 x 4 x 1.5 cm was ex ci sed. Hi sto pat ho logi cal di ag no sis was syno vial ha e man gi o ma lo ca ted in the in fra pa tel lar fat pad. The pa ti ent was asymp to m a tic po st o p e r a ti vely.Ha e man gi o mas lo ca ted in in fra pa tel lar fat pad are ra re. Or t ho pa e dic sur ge ons can of ten be con fu sed by mo re com mon en ti ti es li ke chon dro mal la tia of pa tel la, syno vi tis of the knee, Hof fa's di s e a se, ot her soft tis sue tu mo urs, even le sion of me ni s cus. So, ac cu ra te di ag nosis is very im por tant for dif fe r en ti a tion. Op e r a ti ve exci si on, ar thro sco p ic or open wi de, is de fi n i ti ve tre atment for this be nign tu mo ur.
Introduction: Hallux valgus represents a complex progressive deformity of the front part of the foot, with the most distinguished malformation as lateral deviation of the toe. Radiography is extremely important in the decision of the surgical procedure for the best correction of this deformity. Aim: The aim of this work is to show the significance of radiographic examinations in operated patients with Hallux Valgus deformityaccording to Mitchell and Keller techniques. Material and methods: The study included 70 patients having hallux valgus deformity of the foot, and they were divided to two groups. The patients were grouped according their sex, age, the degree of deformity (moderate or severe degree of deformity) and according to radiographic findings. The first group (Group 1) was composed of 35 patients who were treated by osteotomy of the I metatarsal bone according to Mitchell, while the second group (Group 2) was also composed of 35 patients who were treated by resectional arthroplasty according to Keller. Radiographic examinations (Method of Hardy and Clapham, Piggott classification, presence and absence of the secondary arthritic and reactive changes of the first metatarsophalangeal joint) were analyzed comparatively during the evaluation. The analyses of the radiographic results were performed pre-operatively and post-operatively for the two groups. Results: According to their sex, the patients were 5 men and 65 women. The average age of the patients in group 1 was 42 years, while for group 2 it was 56 years. There is no significant difference (p > 0.05) in the patients of the two groups concerning the pre-operative mean dimension values of the I metatarsophalangeal angle and I intermetatarsal angle. However, the radiographic analysis of the same angles in both groups , one year post-operatively, showed a high statistically significant difference (p < 0.001). The patients operated by Mitchell's technique, according to Piggott classification, have deviation significantly more often on the I metatarsophalangeal joint of 51.43% as a result of their hallux valgus deformity. Significantly more often, there is a subluxation of 77.14% on the I metatarsophalangeal joint in the patients treated by Keller's technique. The radiographic analysis of the I metatarsophalangeal joint (presence and absence of the secondary arthritic and reactive changes) in both groups, pre-operatively (p < 0.01) and one year post-operatively (p < 0.001), showed a high statistically significant difference. Conclusion: Radiographic analyses were of enormous benefit as in the choice of the decision on the type of the operative procedure and also for the evaluation of the postoperative results.
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