A supplemental view of the distal radius combined with AP and lateral views significantly improves the ability of all evaluators, regardless of specialty or training level, to correctly assess placement of fixation screws. The greatest improvements are seen for resident trainees.

Objective: Autologous fat-grafting for the purpose of breast augmentation has gained widespread acceptance as a viable and safe alternative to classical breast implant procedures and has recently been successfully applied to buttock augmentation. Due to the numerous patient re-positionings and widely variable OR time, these procedures present unique challenges for anesthesiologists. Our goal is to discuss the current surgical methods, anesthetic methods, risks and benefits of this procedure. Methods: This is a retrospective cohort study in the setting of the operating room. Twenty-nine consecutive cases of mega-volume fat transplantation, defined as >300 cc to an individual site, performed by one surgeon, were reviewed. Age, Body Mass Index, total fat injected, total operating room time, maximum intraoperative temperature, minimum intraoperative and temperature were measured. RESULTS: Our procedure has enjoyed a 100% patient satisfaction rate. Analysis reveals high variability in age (21-57), total fat injected (200 cc-1990 cc), patient Body Mass Index (18.8-42.2) and total operating room time (1:23:00-6:14:00) for our procedures. There were no instances of major complications in this cohort. Conclusions: Autologous fat transplantation for the purposes of breast and buttock augmentation is an emerging technique that shows great promise and high patient satisfaction, but providing unique challenges for anesthesiologists and surgeons.

Spina bifida is a common birth defect affecting the central nervous system and represents a group of neural tube defects caused by congenital dysraphic malformations of the vertebral column and/or spinal cord. The anatomy in these patients is challenging and includes structural and vascular abnormalities including arteriovenous malformation or fistulae, and fatty substitution of paravertebral tissues. A magnetic resonance image (MRI) is needed for management of patients with lumbar radiculopathy and clinical features suspicious of occult spinal dysraphism. Risks and benefits of lumbar epidural steroids should be discussed comprehensively with those patients and in the best case scenario be avoided. Occult spinal dysraphism poses a clinical dilemma for interventional pain specialists managing those patients with lumbar radiculopathy. We report a case of occult spinal dysraphism discovered following the development of post-traumatic radicular symptoms. Key words: Occult spinal dysraphism, spina bifida, lumbar radiculopathy, pain, pain management, physical findings