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Essex-Lopresti injuries are rare and present a clinical challenge. Incomplete diagnosis and treatment can lead to long-term instability, pain and functional impairment. We report on a clinical case of proximal radioulnar joint (PRUJ) and distal radioulnar joint (DRUJ) dislocation with unusual distal radial displacement and associated radial head shear fracture. The case was managed with closed reduction of the PRUJ and DRUJ followed by open reduction and fixation of the radial head. A high index of suspicion with thorough examination of the elbow, forearm and wrist and comprehensive imaging was important in reaching a complete diagnosis for appropriate treatment. Anatomical reduction of the PRUJ and DRUJ is essential to achieve optimal functional outcomes. Six months following the injury the patient made a satisfactory recovery with full range of movement; however, she continued to have mild to moderate general and moderate work-related disability. [ABSTRACT FROM AUTHOR]

Background: To guarantee equal chances for different age groups, age-related tournaments for male and female players have been established in soccer. However, on registration at birth is not compulsory in some countries, other methods of age determination are needed to prevent participation in the incorrect age group. Objectives: To evaluate the age of soccer players of international U-17 competitions from the degree of fusion of the distal radius and to compare the findings with on age-related normative population. Methods: MRI scans of the wrist of o representative sample of 189 players from four U-17 competitions (FIFA U-17 World Cups 2003 and 2005, and Asian (AFC) U-17 championships 2004 and 2006) were analysed using a previously published grading system. Results: Because of different regulations, all players in the AFC U-17 championships were younger than 17 years, whereas 71% of the players in the FIFA U-17 World Cup competitions were 17 years old. The distal radius of 15% of players from the AFC U-17 tournaments and 27% of the players from the FIFA U-17 tournaments were graded as completely fused on the MRI scans, which is a substantially higher percentage than in the respective age groups of a previously published normative population of soccer players. Furthermore, in contrast with the normative population, no significant correlation between the age category and the fusion grading (r = 0.13) was observed in U-17 players. Conclusion: From the MRI results, U-17 soccer players seem to be mare mature than a normative population of the same age category. However, the lack of correlation between age category and degree of fusion in U-17 players supports the suspicion that the age stated in the official documents of the U-17 players examined might not be correct in all cases. [ABSTRACT FROM AUTHOR]

Objectives: To explore the relative merits of clinical and radiological examination in defining hand osteoarthritis (OA) for epidemiological purposes.Methods: A total of 976 women aged 45-64 years were selected from the general population and underwent a structured interview, clinical examination of the hand joints and radiography of the hands and knees. The inter-relationship of the clinical and radiological findings was examined, and also the association of each with hand symptoms and the presence of knee OA.Results: Clinical and radiographic signs of hand OA generally correlated with each other, and each was associated with hand symptoms to a similar degree. When analysed in combination, they were only marginally better at predicting symptoms than when tested individually. However, when they were examined in relation to radiographic features of knee OA, there was a significantly stronger association with radiographic features of hand OA than with clinical features.Conclusions: Hand radiology provides a better overall assessment of osteoarthritis than physical examination of the interphalangeal joints or carpo-metacarpal joint; in situations where radiology is not available clinical examination is a viable substitute. [ABSTRACT FROM AUTHOR]

Objective: To determine whether the number of patients required in a therapeutic trial that uses progression of radiological abnormalities as the outcome measure would be similar for multiple centres.Methods: The progression of radiological damage to the fingers and wrists of patients with rheumatoid arthritis in five centres, three in North America and two in Europe, was examined. The reproducibility of repeated readings by the same and multiple observers was examined. The number of patients required in a two group trial was calculated for several combinations of power and significance.Results: Scoring progression of radiological abnormalities in sequential films taken between 0.5 and 2.1 years was found to be highly reproducible. When the scores of a single reader were used the rate of change of radiological scores was similar in all centres. Based on the mean progression rate for all centres it was estimated that 153 patients in each group would be required to assure 90% power for detecting a 50% slowing of radiological progression at a significance of 0.05. Review of the experience in three trials showed a large variability in the radiological progression rates.Conclusion: The progression of scores for radiological damage in rheumatoid arthritis is relatively uniform in North America and Europe and thus the number of patients required in a trial would be similar. Experience in three trials showed that patient selection is of paramount importance in setting up a successful study. [ABSTRACT FROM AUTHOR]

Objective: Heberden's nodes are often used as a marker for osteoarthritis (OA). This study examined how often Heberden's nodes and radiological distal interphalangeal (DIP) osteophytes coexist in the same digit and the sensitivity, specificity, and positive predicative value of each for OA at different sites or generalised disease.Methods: This was a population-based study of 660 middle ages women taking part in a twin study of OA. Distal interphalangeal osteophytes were defined radiologically and graded on a four point scale (0-3) using a published atlas of individual features. Heberden's nodes were defined by standardised clinical examination. OA in other joint (knees, proximal interphalangeal (PIP) joints and carpometacarpal (CMC) joints) was defined radiologically using a published atlas.Results: Poor agreement was observed between a Heberden's node (HN) and a radiological distal interphalangeal osteophyte in the same finger of the same hand (K statistic (95% CI) = 0.36 (0.33, 0.39)). Although HN and radiological DIP osteophytes had similar sensitivity, the specificity and positive predicative value of DIP osteophytes was considerably higher for detecting knee, CMC, PID OA, and OA in more than two groups of joint (knee, CMC, and DIP joints).Conclusion: HN are not synonymous with DIP osteophytes. Radiological DIP osteophytes are a better marker of knee and multiple joint OA than HN. HN may still be an imperfect surrogate for hand OA when radiology is impractical, but are not an accurate marker of generalised disease. [ABSTRACT FROM AUTHOR]

A quiz related to medical topics including a case study of an elderly woman with postprandial abdominal pain, a photograph to identify carpal bones on a lateral plain radiograph of the wrist, and method of baseline observation for weight management programmes is presented.