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Background: The purpose of this study was to develop a reproducible upper limb swelling model and quantify the efficacy of changing elevation posture in swelling reduction using this model. Methods: A manual sphygmomanometer was applied to healthy volunteers’ upper arms while in a dependent position for 25 minutes to create venous congestion and swelling. Seven different levels of pressure (250, 120, 100, 80, 50, 40 and 30 mmHg) were tested. Every 5 minutes, the level of swelling was measured using the volumetric method. Any complications were recorded. We then compared the swelling reduction potential among 3 limb postures (arm on head, elevation brace, and simple sling). The significance level was set at p < .05. Results: Thirty to forty milliliters of swelling was created for all pressure levels except the 250 and 30 mmHg. All complications including transient nerve palsy, pain and petechiae were severe at 250 and 120 mmHg, less severe at 100 mmHg, mild at 80 mmHg, and absent below 40 mmHg. Both the on head and elevated brace limb postures markedly and significantly decreased swelling greater than the simple sling posture. Conclusions: We found that 20 ml or greater swelling can be reliably created with a blood pressure cuff inflated to 40 mmHg on the upper limb. The on head and elevated brace postures demonstrated a greater degree of swelling reduction than the simple sling posture.

We retrospectively analyzed 83 metal-on-metal total hip arthroplasties in 74 patients. Ultrasonography and magnetic resonance imaging (MRI) of each hip were performed to detect abnormal patterns and pseudotumors. We examined the reliability of ultrasonography for detecting pseudotumors in comparison with MRI. We also compared the acetabular component inclination between patients with and without pseudotumors. The mean positive and negative predictive values for pseudotumor detection by ultrasonography were 65% and 91%, respectively. The mean positive and negative likelihood ratios were 5.78 and 0.32, respectively. There was no clear association between pseudotumor presence and acetabular component inclination. We concluded that ultrasonography is a suitable technique to screen for the presence of pseudotumors. We also need to distinguish between bearing-related and taper junction corrosion-related complications.

Background:The safety of posterior ankle arthroscopy is still the subject of debate. The purpose of this study was to evaluate the anatomical relationship between the posterior portals and the neurovascular structures using magnetic resonance imaging (MRI) to determine the safety of posterior portals in posterior ankle arthroscopy.Methods:Forty ankles from 38 patients who had undergone MRI scanning for ankle disorders were assessed (18 males, 20 females). For each ankle, the angles of the presumed position of the portals to the posterior neurovascular structures and the malleoli were measured on 4-mm proximal slices from the anterior tip of the fibula. The shortest distance from the sural nerve and the tibialis posterior neurovascular bundle to the position of the posterior portals was measured.Results:The average distance between the posteromedial portal and the tibialis posterior neurovascular bundle was 18 ± 3 mm, whereas the average distance between the posterolateral portal and the sural nerve was 15 ± 3 mm. In 100% of ankles, there were no neurovascular structures lying within the region between the anterior tip of fibula and the posteromedial portal or between the posterior tip of fibula and the posteromedial portal. In 32 ankles (80%), the medial neurovascular structures were present on the medial side of the line running between the anterior tip of medial malleolus and the posteromedial portal.Conclusion:The posterior neurovascular structures were not in immediate proximity to where we estimated the posteromedial and posterolateral portals to be located.Clinical Relevance:The findings of the present MRI-based study suggest that arthroscopic instruments oriented toward the fibula may be safely introduced into the posterior ankle without injuring the neurovascular structures.