Document Detail


Variability of joint communications in the foot and ankle demonstrated by contrast-enhanced diagnostic injections.
MedLine Citation:
PMID:  19439145     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The history and physical examination will usually direct a surgeon to the correct site of joint pathology. Imaging with plain radiographs and diagnostic injections help localize joint pathology more precisely. The presence of accessory communications between adjacent joints may reduce the sensitivity of these investigations. MATERIAL AND METHODS: We report on the findings of 389 arthrograms of the midfoot, hindfoot and ankle that were performed by a single radiologist over a 7-year period. Fluoroscopic guidance with radioopaque dye was used to confirm needle position before local anesthetic was injected. Images were closely studied to identify any communication between adjacent joints. RESULTS: The passage of contrast into adjacent joints confirmed the presence of an additional communication. In 13.9% of cases there was a communication between the ankle and subtalar joint. A communication between the talonavicular and the calcaneocuboid joint was observed in 42.3% of local injections. We identified previously unreported communications between the anterior subtalar and the naviculocunieform joints (8%), the anterior subtalar and the calcaneocuboid joints (9%) and the naviculocunieform and tarsometatarsal joints (1.1%). CONCLUSION: This study reinforces the typical incidence of known joint communications, describes previously unreported communications and highlights the importance of these communications particularly with the small joints of the midfoot. The possible presence of accessory communications must always be considered when performing isolated midfoot fusions relying upon diagnostic local anesthetic injections.
Authors:
Michael R Carmont; James E Tomlinson; Chris Blundell; Mark B Davies; David J Moore
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Foot & ankle international / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society     Volume:  30     ISSN:  1071-1007     ISO Abbreviation:  Foot Ankle Int     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-05-14     Completed Date:  2009-07-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9433869     Medline TA:  Foot Ankle Int     Country:  United States    
Other Details:
Languages:  eng     Pagination:  439-42     Citation Subset:  IM    
Affiliation:
Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.
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MeSH Terms
Descriptor/Qualifier:
Anesthetics, Local / administration & dosage
Cohort Studies
Contrast Media / diagnostic use*
Extravasation of Diagnostic and Therapeutic Materials / radiography*
Fluoroscopy
Foot Joints*
Humans
Injections, Intra-Articular
Iopamidol / diagnostic use*
Joint Diseases / radiography*,  therapy
Predictive Value of Tests
Retrospective Studies
Triiodobenzoic Acids / diagnostic use*
Chemical
Reg. No./Substance:
0/Anesthetics, Local; 0/Contrast Media; 0/Triiodobenzoic Acids; 62883-00-5/Iopamidol; 79770-24-4/iotrolan

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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