Anatomic restoration of displaced fracture-dislocation of the tarsometatarsal junction of the foot is essential, as even "minor" disruptions of this joint complex leads to poor clinical results. In order to determine a "key" element associated with good or poor functional outcomes, 11 patients with excellent radiographic results following surgical treatment of unilateral closed Lisfranc fracture-dislocation of the tarsometatarsal joint of the foot were evaluated at an average of 41.2 (range, 14 to 53) months following their injury and surgery. Their average age was 40.6 (range, 21 to 58) years. AOFAS midfoot scores averaged 71.0 (range, 30 to 95). Radiographic analysis at follow-up revealed anatomic reduction in 10 of 11. Eight of 11 had evidence of arthritis of the tarsometatarsal joints. Clinical alignment was normal in all subjects, with nine of 11 clinically exhibiting decreased relative range of motion. Gait analysis was performed with the F-Scan (Tekscan, Boston, MA) in-shoe pressure-monitoring system. Vertical ground reaction force was recorded under the hallux, first metatarsal head, lateral metatarsals, and heel. Stance phase duration, rate of loading, rate of unloading, peak loading, and total loading were recorded at each of the named regions. There was no statistical difference in the parameters measured between the injured and normal control feet. The results of this study reveal that when anatomic reduction is accomplished in tarsometatarsal fracture dislocation of the foot, objective measures of gait analysis are returned to normal. In spite of excellent radiographic results and return to normal dynamic walking patterns, subjective patient outcomes were less than satisfactory. It is presently well accepted that fracture-dislocations of the tarsometatarsal junction of the foot are best treated with anatomic restoration by closed, percutaneous or open methods. Many individuals achieve poor functional results. It is well accepted that patients are likely to develop late joint deformity at the tarsometatarsal junction, joint separation, and radiographic and clinical evidence of post-traumatic arthritis when anatomic reduction is not obtained. (1-7) The goal of this study was to determine if clinical results and subjective patient outcomes are assured with anatomic reduction. It appears that the major function of the tarsometatarsal joint complex is the regulation and redirecting of loading forces during weightbearing. There is very limited motion of the tarsometatarsal joint during walking. (8) This knowledge has prompted support for anatomic restoration following injury. Even with seemingly anatomic restoration of normal alignment, many patients fare poorly. The goal of this study was to objectively analyze the components of vertical ground reaction force during walking in patients who had evidence of excellent surgical reduction measured on follow-up weightbearing radiographs following isolated injury to the tarsometatarsal joint complex. We hoped to detect some key element of gait altered by the inj...

We have developed a reliable radiographic scoring instrument for assessing radiographic OA of the LS spine. It appears that painless LS disc OA is one factor that influences spinal motion.

The influenza vaccine is increasingly available to the general public and mandated by many employers in the United States. The prevalence of post-vaccination complications is likely on the rise. Complications are well known to general clinicians, but are under-reported in the imaging literature. We present four cases of post-vaccination shoulder pain with magnetic resonance imaging (MRI) findings. An intrasubstance fluid-like signal in deep muscular and/or tendinous structures was the most common finding on MRI of these four cases. Focal bone marrow signal within the humeral head and inflammatory changes in the subacromial/subdeltoid bursa were also observed. The most likely reason for a humeral intraosseous edema-like signal was presumed injection of vaccine substance directly into osseous structures that might lead to focal osteitis. In the published literature, there is little emphasis on the imaging of local injection site complications accompanying influenza vaccination. We intended to increase familiarity of MRI findings in the setting of prolonged or severe clinical symptoms following influenza vaccination through the imaging findings of these four cases.

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DentaScan is an accurate method of preoperative evaluation for mandibular invasion in patients with SCC of the oral cavity.