Ravitch Procedure

Ravitch

 

Some contend that Ravitch is indicated when a Nuss has failed or is contraindicated.

The Ravitch procedure involves an incision across the chest and the removal of the cartilage that causes the defect. The sternum is then placed in the normal position. If treated for pectus excavatum, a small bar is then inserted under the sternum to hold it in the desired position.

The cartilage will regenerate over the next 4-6 weeks, causing the sternum to be in a fixed position. A small drain may be placed at the site of the operation to prevent a fluid collection.

Triplane fracture

Triplane or triplanar fractures are of the distal tibia only occurring in adolescents. As the physiological closure of the physeal plate begins medially, the lateral (open) physis is prone to this type of fracture. The name is due to the fact of the fracture expanding both in frontal and lateral as well as transverse planes. Most authors regard it as a type IV Salter-Harris fracture.

  • a vertical fracture through the epiphysis
  • a horizontal fracture through the physis
  • an oblique fracture through the metaphysis

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Shoulder Meniscoid Plica?

I have seen this many times in the past but it is usually not accompanied by static subluxation of the GH joint.  There is a large fibrous meniscoid lesion in the anterior shoulder that appears to be capsular or synovial based on signal characteristics.

 

shoulder meniscoid axial

Ax PD FatSat: These images are slowed down on the slices of interest.

 

Gallery – I apologize for the seizure inducing poly-animation.  Click on a sequence to view individually.

Shoulder plicae are alluded to in some articles:  Superior plica of the shoulder joint: Case reports

 

 

Lytic Distal Femur Lesion (GCT)

Good case of an uncommon solitary lytic bone lesion.

 

This has the 4 hallmarks elaborated in Brandt and Helms:

  1. occurs only with a closed growth plate
  2. abuts articular surface: 84-99% come within 1 cm of the articular surface 1
  3. well defined with non-sclerotic margin (though < 5% may show some sclerosis 8)
  4. eccentric

 

As with most bone tumors, this is not a slam dunk as there are always mimics ranging from fibrous dysplasia to metastatic disease.

 

CSF Leak After Diastematomyelia Operation

I’ll be frank, I don’t have all the details on this but the findings are clear on this animated gif.  If you watch carefully, you can see the pulsation artifact at the site of leak.  There is a rent in the dura and pseudomeningocele in the dorsal soft tissues.

 

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I’m guessing this was a laminectomy for a bony septum producing symptoms.  I have seen these on myelography where the dye pours out as soon as it’s injected.