RESUMO
Varus stress radiographs are reported as an effective and cost-beneficial diagnostic and decision-making tool for lateral knee injuries, both in the acute and chronic settings. The opening of the lateral compartment is reported to vary according to the number of structures injured, helping to differentiate isolated fibular collateral ligament injury from grade-III posterolateral corner injury. The conventional technique requires the physician or another healthcare provider to apply manual varus stress while obtaining the radiograph on one knee at a time. The present study aimed to describe, in detail, the preferred method of the authors to assess the opening of the lateral compartment in both knees simultaneously, which also avoids the need for the examiner to be present in the imaging room.
RESUMO
Abstract Varus stress radiographs are reported as an effective and cost-beneficial diagnostic and decision-making tool for lateral knee injuries, both in the acute and chronic settings. The opening of the lateral compartment is reported to vary according to the number of structures injured, helping to differentiate isolated fibular collateral ligament injury from grade-III posterolateral corner injury. The conventional technique requires the physician or another healthcare provider to applymanual varus stresswhile obtaining the radiograph on one knee at a time. The present study aimed to describe, in detail, the preferred method of the authors to assess the opening of the lateral compartment in both knees simultaneously, which also avoids the need for the examiner to be present in the imaging room.
Resumo As radiografias de estresse em varo são descritas como uma técnica efetiva e econômica de diagnóstico e tomada de decisão em lesões laterais do joelho, tanto no contexto agudo quanto crônico. A abertura do compartimento lateral varia de acordo com o número de estruturas danificadas, ajudando a diferenciar lesões isoladas do ligamento colateral fibular das lesões do canto posterolateral de grau III. A técnica convencional exige que o médico ou outro profissional de saúde aplique estresse em varo manual ao obter a radiografia em um joelho de cada vez. O presente estudo teve como objetivo descrever, em detalhes, o método preferido dos autores para avaliar a abertura do compartimento lateral em ambos os joelhos simultaneamente, o que também evita a necessidade da presença do examinador na sala de imagem.
Assuntos
Fraturas de Estresse , Joelho , Traumatismos do JoelhoRESUMO
The medial collateral ligament is the most commonly injured knee ligament. Valgus stress radiographs are reported to be an effective way to quantify the medial compartment opening. However, most of the techniques require the presence of a physician in the radiograph room to apply a manual valgus stress force, and can only be performed in 1 knee at a time. These techniques, although extremely effective, increase radiation exposure to physicians, are time consuming, and require additional radiographs to compare the side-to-side difference. The purpose of this Technical Note is to describe our preferred valgus stress radiographic technique to evaluate medial side laxity, which offers several advantages compared with conventional manual techniques.
RESUMO
Posterolateral corner injuries are a severe and often unrecognized pathology. Injuries to these structures are difficult to identify using magnetic resonance images. Physical examination tests including the dial test, frog-leg test, and varus stress test can be difficult to perform. In addition it is difficult to correctly evaluate the results in a multiligament injury setting. The correct diagnosis of this pathology is essential to determine the proper treatment and improve outcomes. Furthermore, failure to recognize this pathology is associated with a high risk of failure following isolated anterior cruciate ligament reconstructions. The purpose of this Technical Note is to present an alternative method for the evaluation of posterolateral corner injuries using radiographic images.
RESUMO
The use of ankle stress radiographs is common to evaluate ankle instability. However, the majority of the studies report the use of a manual method to apply the stress, increasing radiation exposure to the physician. Furthermore, as reported in other studies, the force applied during the stress may vary between examiners according the strength and experience. In this Technical Note, we describe our preferred method to evaluate ankle instability, either using an inversion or eversion stress, avoiding the necessity of a physician in the radiographic room.
RESUMO
Six male children, aged 8-28 months, were studied for three consecutive periods of 1 week each. They were given diets that provided 1.7g protein/kg per d and supplements of minerals and vitamins, with a metabolizable energy intake during the 1st, 2nd and 3rd week of 419, 293 and 335 kJ (100, 70 and 80 kcal)/kg per d, diets 1, 2 and 3 respectively. All the food offered was consumed. Each child was weighed at the same time each day on an electronic balance. On the 6th and 7th day of each study period urine and stool were collected for 24h to assess nitrogen balance. Using linear regression analysis it was shown that all children gained weight on diet 1, 2.3(SD 1.3)g/kg per d, and five of six children gained weight on diet 3, the mean for the whole group being 2.7(SD 2.3)g/kg per d, not significantly different. On diet 2 all children lost weight, -5.4(SD 1.3)g/kg per d, highly significantly different from each of the other dietary periods. Using asymptotic regression analysis it could be shown that the rate of weight loss during the first part of the week on diet 2, -11g/kg per d, was greater than at the end of the week, -2g/kg per d, with a tendency towards a steady weight by day 7. Apparent N retention (mg/kg per d) was positive at the end of each of the three dietary periods: diet 1, 112(SD 25); diet 2, 54(SD 34); diet 3, 82(SD20). In five of the six children there was a marked reduction in stool frequency on diet 2 compared with diet 1, that was maintained to the period on diet 3. The findings suggest that during the period on diet 2 there was a saving of energy of the order of 105 kJ(25 kcal)/kg per d, which lasted through into the period on diet 3