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The use of reverse total shoulder arthroplasty has increased for the management of cuff-deficient glenohumeral joint arthritis and fractures. With bone preservation being a major target in reverse shoulder arthroplasty, metaphyseal humeral components without a stem were developed. The aim of this study is to present the survivorship, functional and radiological outcomes of a novel short metaphyseal prosthesis without a diaphyseal stem from an independent centre. Clinical function and radiological features of patients undergoing stemless reverse shoulder arthroplasty were prospectively recorded. Patients’ demographics, indications for surgery, complications, functional and radiological assessment at the final follow-up as well as survivorship with the end point of revision for any reason were recorded. Between 2009 and 2016, 36 patients received 37 reverse shoulder arthroplasties with the stemless Verso prosthesis. Mean age of the patients was 76.9 years. The most common indication for surgery was cuff tear arthropathy. Mean follow-up was 3 years (range 1–7 years). Oxford shoulder score improved from an average of 11 pre-operatively (range 2–19) to 44 post-operatively (range 29–48) (p

Introduction: The purpose of this national study was to audit the weight-bearing practice of orthopaedic services in the National Health Service (NHS) in the treatment of operatively and non-operatively treated ankle fractures. Methods: A multicentre prospective two-week audit of all adult ankle fractures was conducted between July 3rd 2017 and July 17th 2017. Fractures were classified using the AO/OTA classification. Fractures fixed with syndesmosis screws or unstable fractures (>1 malleolus fractured or talar shift present) treated conservatively were excluded. No outcome data were collected. In line with NICE (The National Institute for Health and Care Excellence) criteria, “early” weight-bearing was defined as unrestricted weight-bearing on the affected leg within 3 weeks of injury or surgery and “delayed” weight-bearing as unrestricted weight-bearing permitted after 3 weeks. Results: 251 collaborators from 81 NHS hospitals collected data: 531 patients were managed non-operatively and 276 operatively. The mean age was 52.6 years and 50.5 respectively. 81% of non-operatively managed patients were instructed for early weight-bearing as recommended by NICE. In contrast, only 21% of operatively managed patients were instructed for early weight-bearing. Discussion: The majority of patients with uni-malleolar ankle fractures which are managed non-operatively are treated in accordance with NICE guidance. There is notable variability amongst and within NHS hospitals in the weight-bearing instructions given to patients with operatively managed ankle fractures. Conclusion: This study demonstrates community equipoise and suggests that the randomized study to determine the most effective strategy for postoperative weight-bearing in ankle fractures described in the NICE research recommendation is feasible.

Dislocation following primary and revision arthroplasty is a well-recognised complication with an estimated incidence rate of 0.2-10%. We present a rare case of simultaneous bilateral total hip replacement dislocation, complicated by unilateral foot drop following closed reduction, with no improvement in neurological function at 6-month follow-up.

Visual illusions are distortions, alterations, or alternatives in the appearance of reality that result primarily from the sensory and perceptual processing mechanisms of the human visual system. These illusions are common phenomena in radiology, and it is important to understand them because they can create the illusion of disease, leading to incorrect image interpretation. Visual illusions in radiology can be organized according to the point in the visual system at which they emerge. Illusions of sensation, including Mach bands and background effect, are "lower-order" visual phenomena that occur as the eye and brain translate light into neural activity. Illusions of perception, such as ambiguous figures and distortion, occur in "higher-order" brain structures that are responsible for coalescing sensory input into a mental image interpreted by the mind. Illusions of image formation (eg, parallax), as the name implies, result from the way images are generated. Some visual illusions occur with all modalities, whereas others tend to be modality specific. The authors discuss a variety of visual illusions, describing their underlying psychologic and neuroscientific basis and demonstrating their relevance to radiology. A thorough understanding of visual illusions in radiology enhances diagnostic accuracy by minimizing the risk of mistaking illusions for disease.

Acute dizziness (including vertigo) is a common reason to visit the emergency room, and imaging with head CT is often performed initially to exclude a central cause. In this study, consecutive patients presenting with dizziness and undergoing head CT were retrospectively reviewed to determine diagnostic yield. Four hundred forty-eight consecutive head CTs in a representative sample of dizzy emergency room (ER) patients, including patients with other neurological symptoms, were reviewed to identify an acute or subacute cause for acute dizziness along with the frequency and modalities used in follow-up imaging. The diagnostic yield for head CT ordered in the ER for acute dizziness is low (2.2 %; 1.6 % for emergent findings), but MRI changes the diagnosis up to 16 % of the time, acutely in 8 % of cases. Consistent with the American College of Radiology appropriateness criteria and the literature, this study suggests a low diagnostic yield for CT in the evaluation of acute dizziness but an important role for MRI in appropriately selected cases.

BACKGROUND AND PURPOSE: IRIS occurs in a small percentage of patients with AIDS following the initiation of HAART. Because PML lesions have a characteristic DWI/ADC appearance, our purpose was to determine if DWI/ADC measurements of PML lesions can be used to follow HAART treatment response and/or identify patients at risk for IRIS. MATERIALS AND METHODS: Six patients with AIDS and PML who had recently started HAART were retrospectively identified. On the basis of clinical history, patients were classified as having slow (non-IRIS) or rapid (IRIS) progression. Images were obtained at pre-HAART (time point 1) and post-HAART (time point 2). ADC parameters were measured and compared by using the 2-tailed t test. RESULTS: Seven lesions (4 rapidly progressing, 3 slowly progressing) were identified. Lesions from patients with rapid clinical progression had higher maximal ADC ratios at time point 1. There were also significant correlations between ADC parameters, time to clinical deterioration, and JCV titers. CONCLUSIONS: The ADC parameters of PML lesions were different for patients with rapid-versus-slow clinical progression. In our preliminary experience, ADC was helpful in diagnosing rapid clinical progression and IRIS. ADC values may correlate with the pathologic changes in PML lesions following HAART therapy.

The purpose of this study is to determine whether blood inflow impacts the temporal behavior of BOLD-contrast fMRI signal changes in a typical event-related paradigm. The inflow contributions in the hemodynamic response to repeated single trials of short visual stimulation were assessed with a gradient-echo EPI sequence by altering the flip angle (FA) from 30 degrees to 90 degrees at a repetition time of 1 s. For each FA condition (30 degrees, 60 degrees, and 90 degrees), 30 trials were performed on 15 healthy volunteers on a 3T MRI scanner. Comparing the percent BOLD contrast, prominent inflow effects were found with statistical significance between the 90 degrees- and 30 degrees-FA conditions (0.73 +/- 0.15 versus 0.67 +/- 0.12%, p=0.028). BOLD responses with FA=30 degrees exhibited latencies significantly slower than those with FA=90 degrees (3.69 +/- 0.39 s versus 3.37 +/- 0.28 s, p=0.001). The falling time of the 30 degrees-FA responses was earlier but not statistically different from that of the 90 degrees-FA (8.17 +/- 1.04 s versus 8.03 +/- 1.15 s, p=0.3). Using a voxelwise analysis, the latency variations of the activated visual areas were determined at several contrast-to-noise ratio (CNR) levels (controlled by averaging different numbers of randomly selected trials). The latency variations from the 90 degrees-FA responses were greater at lower CNR but similar at higher CNR levels when comparing to the 30 degrees-FA ones. This study suggests that inflow effects contribute to the BOLD signal, resulting in hemodynamic response with shorter latency.