Procedural Dictations in Image-Guided Intervention, 2016
This section provides a comprehensive procedural report for intra-articular facet joint injection... more This section provides a comprehensive procedural report for intra-articular facet joint injection procedure with up-to-date explanatory notes, synopsis of the indications and contraindications and potential complications in an organized and practical format.
Background Distal tibia fractures are among the most common bony injuries, with a significant rat... more Background Distal tibia fractures are among the most common bony injuries, with a significant rate of nonunion and delayed union. There are multiple methods for the management of distal tibia fractures. Among the plating methods, there are bridge plating and compression plating techniques. There is still a lack of evidence about whether one method has a higher rate of union than the other. The present study aimed to assess the union rate of extra-articular distal tibia fractures using biological fixation with bridge plating and rigid fixation with compression plating. Methods This retrospective analysis was performed on 41 adult patients with distal tibia fractures. The subjects were divided into two groups based on the fixation method, namely bridge plating and compression plating. Baseline characteristics, fracture characteristics, and union status were analyzed and compared in this study. Results Baseline and fracture characteristics were similar between the groups. Only higher t...
Purpose The optimal treatment for late-presenting developmental dysplasia of the hip (DDH) is con... more Purpose The optimal treatment for late-presenting developmental dysplasia of the hip (DDH) is controversial. High tension forces after hip reduction increase the pressure on the femoral head, potentially causing avascular necrosis. Femoral shortening (FS) is commonly used as a means to decrease the pressure on the femoral head. We examined the effect of FS on the outcomes of patients with late-presenting DDH. Methods A total of 645 hips of a late-presenting DDH cohort treated with open reduction and iliac osteotomies were retrospectively reviewed; 328 hips had a FS performed (FS+) and 317 (FS-) had not. The mean age was 3.9 years (sd 1.55). We classified the hips with the Tönnis and International Hip Dysplasia Institute (IHDI) methods; and the Pediatric Outcomes Data Collection Instrument (PODCI), Iowa Hip Score (IHS) and Severin classification as outcome measurements. Results The FS- group had higher scores in PODCI (median 95 points; interquartile range (IQR) 78 to 91) and IHS (me...
This section provides a comprehensive procedural report for sacroiliac joint injection procedure ... more This section provides a comprehensive procedural report for sacroiliac joint injection procedure with up-to-date explanatory notes, synopsis of the indications and contraindications and potential complications in an organized and practical format.
The management of idiopathic clubfoot has transformed over the past several decades as the Ponset... more The management of idiopathic clubfoot has transformed over the past several decades as the Ponseti method for the correction of this deformity became the standard of care, and surgical release has almost all but been abandoned. The Ponseti method has shown very high initial success rate and excellent long-term functional results. Relapse of the deformity, however, continues to be a major problem, occurring in up to 40% of patient, and there is no consensus on the definition and management of the relapsed clubfoot. This review discusses the available management options for the treatment of a relapsed clubfoot deformity following initial treatment with the Ponseti method [including repeat casting, tendo-Achilles lengthening, plantar fascia release, and tibialis anterior tendon transfer (TATT)] as well as following initial surgical treatment with posteromedial release (including casting, hemiepiphysiodesis, revised posteromedial release, osteotomies, fusion, and the use of gradual dist...
BACKGROUND Lung cancer is one of the most commonly diagnosed cancers and is the leading cause of ... more BACKGROUND Lung cancer is one of the most commonly diagnosed cancers and is the leading cause of cancer-related deaths. Metastatic bone disease occurs in 20% to 40% of patients with lung cancer, and these patients often present with pain or skeletal-related events (SREs) that are associated with decreased survival. Bone-modifying agents such as denosumab or bisphosphonates are routinely used; however, to our knowledge, there has been no quantitative synthesis of randomized controlled trial data to determine the most effective pharmacologic treatment of metastatic bone disease because of lung cancer. QUESTIONS/PURPOSES We aimed to perform a network meta-analysis of randomized trials to identify the bone-modifying agent that is associated with the (1) highest overall survival, (2) longest time to SRE, (3) lowest SRE incidence, and (4) greatest likelihood of pain resolution. METHODS We conducted our study according to the Preferred Reporting Items for Systematic Reviews and Meta-Analys...
This section provides a comprehensive procedural report for soft tissue biopsy procedure with up-... more This section provides a comprehensive procedural report for soft tissue biopsy procedure with up-to-date explanatory notes, synopsis of the indications and contraindications, and potential complications in an organized and practical format.
Forearm fractures in children are among the most common long bone injuries, which occur in about ... more Forearm fractures in children are among the most common long bone injuries, which occur in about 1% of children annually, with a peak incidence in the early adolescent age group. Though most of these fractures can be treated with casting, with or without closed reduction, the orthopedic surgeon may indicate a patient for operative fixation with flexible intramedullary nailing in the setting of unacceptable malalignment, an unstable fracture, refracture, neurovascular compromise, or an open fracture. This type of fixation provides a three-point bending moment, which results in angular and longitudinal stability, particularly with mid-shaft fractures. When compared to plating, flexible intramedullary nailing results in similar reduction and union rates, functional outcomes, and with reduced operative time and blood loss, as well as increased ease of hardware removal. It is not without complications, however, which include skin irritation, extensor tendon injury, nerve injury, delayed ...
Extraskeletal Ewing sarcoma (EES) is a relatively uncommon primary tumor of the soft tissues, whi... more Extraskeletal Ewing sarcoma (EES) is a relatively uncommon primary tumor of the soft tissues, which accounts for 20-30% of all reported cases of ES. Being uncommon, all members of the ES family tumors are treated following the same general protocol of sarcoma tumors. The present review summarizes the diagnosis, management and prognosis of EES, focusing on the differences between the subtypes of ESS. The clinical features and imaging of EES are also discussed. Magnetic resonance imaging is the modality of choice for diagnostic imaging and local staging, while core-needle biopsy with pathological testing is used to obtain a definitive diagnosis. Although several oncology groups endorse that ES family of tumors should be treated with similar algorithm and protocols, some studies have demonstrated that surgery and radiotherapy may be used as a form of local control. However, further studies are required to conclude the optimum treatment option for EES.
Three cases of extraskeletal myxoid chondrosarcoma (EMC) in patients who presented with pulmonary... more Three cases of extraskeletal myxoid chondrosarcoma (EMC) in patients who presented with pulmonary metastases and were managed with long-term close observation without systemic intervention are presented. Follow-up imaging showed slow progression of their disease over several years, and the patients remained asymptomatic from their pulmonary metastases. This clinical experience provides insight into the natural history of the disease and suggests that some patients may experience long-term survival and remain asymptomatic even without systemic intervention, thereby improving their quality of life by avoiding potentially debilitating treatments.
Procedural Dictations in Image-Guided Intervention, 2016
This section provides a comprehensive procedural report for intra-articular facet joint injection... more This section provides a comprehensive procedural report for intra-articular facet joint injection procedure with up-to-date explanatory notes, synopsis of the indications and contraindications and potential complications in an organized and practical format.
Background Distal tibia fractures are among the most common bony injuries, with a significant rat... more Background Distal tibia fractures are among the most common bony injuries, with a significant rate of nonunion and delayed union. There are multiple methods for the management of distal tibia fractures. Among the plating methods, there are bridge plating and compression plating techniques. There is still a lack of evidence about whether one method has a higher rate of union than the other. The present study aimed to assess the union rate of extra-articular distal tibia fractures using biological fixation with bridge plating and rigid fixation with compression plating. Methods This retrospective analysis was performed on 41 adult patients with distal tibia fractures. The subjects were divided into two groups based on the fixation method, namely bridge plating and compression plating. Baseline characteristics, fracture characteristics, and union status were analyzed and compared in this study. Results Baseline and fracture characteristics were similar between the groups. Only higher t...
Purpose The optimal treatment for late-presenting developmental dysplasia of the hip (DDH) is con... more Purpose The optimal treatment for late-presenting developmental dysplasia of the hip (DDH) is controversial. High tension forces after hip reduction increase the pressure on the femoral head, potentially causing avascular necrosis. Femoral shortening (FS) is commonly used as a means to decrease the pressure on the femoral head. We examined the effect of FS on the outcomes of patients with late-presenting DDH. Methods A total of 645 hips of a late-presenting DDH cohort treated with open reduction and iliac osteotomies were retrospectively reviewed; 328 hips had a FS performed (FS+) and 317 (FS-) had not. The mean age was 3.9 years (sd 1.55). We classified the hips with the Tönnis and International Hip Dysplasia Institute (IHDI) methods; and the Pediatric Outcomes Data Collection Instrument (PODCI), Iowa Hip Score (IHS) and Severin classification as outcome measurements. Results The FS- group had higher scores in PODCI (median 95 points; interquartile range (IQR) 78 to 91) and IHS (me...
This section provides a comprehensive procedural report for sacroiliac joint injection procedure ... more This section provides a comprehensive procedural report for sacroiliac joint injection procedure with up-to-date explanatory notes, synopsis of the indications and contraindications and potential complications in an organized and practical format.
The management of idiopathic clubfoot has transformed over the past several decades as the Ponset... more The management of idiopathic clubfoot has transformed over the past several decades as the Ponseti method for the correction of this deformity became the standard of care, and surgical release has almost all but been abandoned. The Ponseti method has shown very high initial success rate and excellent long-term functional results. Relapse of the deformity, however, continues to be a major problem, occurring in up to 40% of patient, and there is no consensus on the definition and management of the relapsed clubfoot. This review discusses the available management options for the treatment of a relapsed clubfoot deformity following initial treatment with the Ponseti method [including repeat casting, tendo-Achilles lengthening, plantar fascia release, and tibialis anterior tendon transfer (TATT)] as well as following initial surgical treatment with posteromedial release (including casting, hemiepiphysiodesis, revised posteromedial release, osteotomies, fusion, and the use of gradual dist...
BACKGROUND Lung cancer is one of the most commonly diagnosed cancers and is the leading cause of ... more BACKGROUND Lung cancer is one of the most commonly diagnosed cancers and is the leading cause of cancer-related deaths. Metastatic bone disease occurs in 20% to 40% of patients with lung cancer, and these patients often present with pain or skeletal-related events (SREs) that are associated with decreased survival. Bone-modifying agents such as denosumab or bisphosphonates are routinely used; however, to our knowledge, there has been no quantitative synthesis of randomized controlled trial data to determine the most effective pharmacologic treatment of metastatic bone disease because of lung cancer. QUESTIONS/PURPOSES We aimed to perform a network meta-analysis of randomized trials to identify the bone-modifying agent that is associated with the (1) highest overall survival, (2) longest time to SRE, (3) lowest SRE incidence, and (4) greatest likelihood of pain resolution. METHODS We conducted our study according to the Preferred Reporting Items for Systematic Reviews and Meta-Analys...
This section provides a comprehensive procedural report for soft tissue biopsy procedure with up-... more This section provides a comprehensive procedural report for soft tissue biopsy procedure with up-to-date explanatory notes, synopsis of the indications and contraindications, and potential complications in an organized and practical format.
Forearm fractures in children are among the most common long bone injuries, which occur in about ... more Forearm fractures in children are among the most common long bone injuries, which occur in about 1% of children annually, with a peak incidence in the early adolescent age group. Though most of these fractures can be treated with casting, with or without closed reduction, the orthopedic surgeon may indicate a patient for operative fixation with flexible intramedullary nailing in the setting of unacceptable malalignment, an unstable fracture, refracture, neurovascular compromise, or an open fracture. This type of fixation provides a three-point bending moment, which results in angular and longitudinal stability, particularly with mid-shaft fractures. When compared to plating, flexible intramedullary nailing results in similar reduction and union rates, functional outcomes, and with reduced operative time and blood loss, as well as increased ease of hardware removal. It is not without complications, however, which include skin irritation, extensor tendon injury, nerve injury, delayed ...
Extraskeletal Ewing sarcoma (EES) is a relatively uncommon primary tumor of the soft tissues, whi... more Extraskeletal Ewing sarcoma (EES) is a relatively uncommon primary tumor of the soft tissues, which accounts for 20-30% of all reported cases of ES. Being uncommon, all members of the ES family tumors are treated following the same general protocol of sarcoma tumors. The present review summarizes the diagnosis, management and prognosis of EES, focusing on the differences between the subtypes of ESS. The clinical features and imaging of EES are also discussed. Magnetic resonance imaging is the modality of choice for diagnostic imaging and local staging, while core-needle biopsy with pathological testing is used to obtain a definitive diagnosis. Although several oncology groups endorse that ES family of tumors should be treated with similar algorithm and protocols, some studies have demonstrated that surgery and radiotherapy may be used as a form of local control. However, further studies are required to conclude the optimum treatment option for EES.
Three cases of extraskeletal myxoid chondrosarcoma (EMC) in patients who presented with pulmonary... more Three cases of extraskeletal myxoid chondrosarcoma (EMC) in patients who presented with pulmonary metastases and were managed with long-term close observation without systemic intervention are presented. Follow-up imaging showed slow progression of their disease over several years, and the patients remained asymptomatic from their pulmonary metastases. This clinical experience provides insight into the natural history of the disease and suggests that some patients may experience long-term survival and remain asymptomatic even without systemic intervention, thereby improving their quality of life by avoiding potentially debilitating treatments.
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