PurposeThe purpose of this study was to investigate the impact of varying knee flexion and quadriceps activity on patellofemoral indices measured on magnetic resonance imaging (MRI).Materials and MethodsMRI of the knee was performed in 20 patients for indications other than patellar or patellofemoral pathology. Axial and sagittal sequences were performed in full extension of the knee with the quadriceps relaxed, full extension of the knee with the quadriceps contracted, 30° flexion of the knee with the quadriceps relaxed, and 30° flexion with the quadriceps contracted. Bisect offset, patella tilt angle, Insall-Salvati ratio and Caton-Deschamps index were measured.ResultsWith the knee flexed to 30° and quadriceps relaxed, the mean values of patellar tilt angle, bisect offset, Insall-Salvati ratio and Caton-Deschamps index were all within normal limits. With the knee extended and quadriceps contracted, the mean patellar tilt angle (normal value, <15°) was 14.6° and the bisect offset (normal value, <65%) was 65%, while the Caton-Deschamps index was 1.34 (normal range, 0.6 to 1.3). With the knee extended and quadriceps relaxed, the mean Caton-Deschamps index was 1.31.ConclusionsMRI scanning of the knee in extension with the quadriceps contracted leads to elevated patellofemoral indices. MRI taken with the knee in 30° of flexion allows more reliable assessment of the patellofemoral joint and minimises the confounding effect of quadriceps contraction.

There are numerous reports of anatomical variants of the muscles of the forearm, particularly the extensors of the wrist and hand. The abnormal deep and short radial wrist flexor (flexor carpi radialis) is rare. There are only two previously reported cases. We present the case of an anomalous ‘flexor carpi radialis brevis’, muscle found intra-operatively during a volar approach to the distal radius and discuss the strategies needed for further exposure in order to complete the procedure.

Conclusion:A megaprosthesis is a viable option in complex fractures around the knee.Crown

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Fractures of the radial head and neck are common injuries that largely result from a fall onto an outstretched hand. They can range from simple injuries amenable to conservative management, to complex injuries requiring operative intervention. Undisplaced and minimally displaced fractures can usually be managed nonoperatively with satisfactory results. Open reduction and internal fixation (ORIF) is generally indicated for significantly displaced or complex fractures, with radial head replacement reserved for cases refractory to ORIF. However, there remains debate regarding optimal treatment of complex radial head fractures and further evidence is required before definitive management guidelines can be produced.