The sliding compression screw-sideplate combination is currently the most widely employed device ... more The sliding compression screw-sideplate combination is currently the most widely employed device for internal fixation of stable and unstable intertrochanteric fractures of the femur. The normal and abnormal radiographic appearances of this device in the immediate post-operative period are discussed. Potential long-term complications including mal-or non-union, intra-articular penetration, metal failure, rotation of the proximal fracture fragment, disengagement, trochanteric bursitis, leg length discrepancy, delayed cervical stress fracture, and ischemic necrosis are reviewed.
We reviewed 845 cases of benign and 356 cases of malignant cartilaginous tumors from a total of 3... more We reviewed 845 cases of benign and 356 cases of malignant cartilaginous tumors from a total of 3067 primary bone tumors in our database. Benign cartilaginous lesions are unique because the epiphyseal plate has been implicated in the etiology of osteochondroma, enchondroma (single or multiple), periosteal chondromas and chondroblastoma. In the first part of this paper, we will review important clinical, radiologic and histologic features of intramedullary cartilaginous lesions in an attempt to support theories related to anatomic considerations and pathogenesis.
The bones, soft tissue contents, and boundaries of the tarsal tunnel can be imaged with sufficien... more The bones, soft tissue contents, and boundaries of the tarsal tunnel can be imaged with sufficient detail to show all the major structures within it. Pathological conditions affecting these structures can also be identified. The purpose of this paper was to determine the ability of magnetic resonance imaging to help in the evaluation of tarsal tunnel syndrome. Thirty-three patients with 40 feet were used for this study. All patients presented with complaints of pain along the course of the posterior tibial nerve or its branches and a positive Tinel's sign. Nerve conduction studies were obtained on 29 feet. All feet were evaluated with a magnetic resonance imaging study of the tarsal tunnel. Twenty-one feet eventually required surgery. Magnetic resonance imaging revealed an inflammatory or mass lesion in the tarsal tunnel in the majority of cases. The magnetic resonance imaging findings were confirmed at surgery in 19 patients. The information provided by magnetic resonance imagi...
Cadaveric specimens and patient radiographs were examined in order to establish the pattern and t... more Cadaveric specimens and patient radiographs were examined in order to establish the pattern and the distribution of degenerative alterations of the glenohumeral joint. Characteristic osseous changes occur in response to afterations in the articular cartilage and rotator cuff. The extent of these changes is underestimated by plain-film radiography. A strong association was found between the changes of osteoarthritis (OA) and those related to deterioration of the rotator cuff. Idiopathic OA of the glenohumeral joint was discovered in 10 (20%) of 50 symptomatic patients age 60 years and over. Theories regarding the pathomechanics and interrelations between glenohumeral joint OA and rotator cuff deterioration are discussed. Degenerative alterations in the glenohumeraljoint are relatively uncommon when compared to those in weight-bearing joints, such as the hip and knee. However, the incidence of osteoarthritis (OA) in the glenohumeral joint increases with age [1, 2], and the disease may be an occasional source of significant pain and disability [3]. The precise pathogenesis of glenohumeral joint OA is not clear, although hereditary and systemic factors as well as functional stress have all been implicated in its development [4]. In addition, a strong association between glenohumeral joint OA and tear or atrophy of the rotator cuff has been suggested by several investigators [5-8]. Using both patient and cadaveric material, we investigated OA ofthe glenohumeraljoint in order to establish its pattem, distribution, and correlation with other degenerative alterations of the shoulder.
Total quality management is basically about continuous organizational success through the employm... more Total quality management is basically about continuous organizational success through the employment of customer satisfaction and by basing it on the contribution of all the employees constantly working to enhance processes, services and products. The competitiveness concept has been defined in multitude of ways; in the individual firm's context, industries context and nation's context. The aim of the study is to identify the relationship between total quality management practices and contractors competitiveness. In order to achieve the study objective in the present study, a survey conducted. Questionnaires distributed to the contractor's managers in Saudi Arabia. The findings of the study turn out to be true; the study will contribute to both theory and practice. Through the present study, the researcher expects the findings to shed light on the research conducted hierarchical regression to analyse the relationships amongst different total quality management practices and practices of competitiveness.
Etude radiologique chez un enfant. Apres une chute de velo, il developpe des signes neurologiques... more Etude radiologique chez un enfant. Apres une chute de velo, il developpe des signes neurologiques, avec troubles de la marche, en rapport avec un granulome du corps de la 5eme vertebre thoracique. Les aspects radiologiques (cliche thoracique standard, scanner et RMN) sont presentes
In patients with hemophilia, hemarthrosis often occurs in one or several joints and may progress ... more In patients with hemophilia, hemarthrosis often occurs in one or several joints and may progress to a destructive, disabling arthropathy. Treatment includes continuous or on-demand clotting factor replacement and radionuclide or open synovectomy. The radiographic findings of hemophilic arthropathy depend on the stage of disease, the age of the patient at onset, and the joint involved. These findings include joint effusion, soft tissue swelling, epiphyseal overgrowth, subchondral cysts, osseous erosion, and secondary degenerative changes. Magnetic resonance imaging (MRI) is the most accurate imaging modality for assessing hemophilic arthropathy and may have a significant impact on patient management. MRI is anticipated to be useful in documenting early joint changes when treatment may be most effective. Hemophilic pseudotumor is a chronic, encapsulated, hemorrhagic fluid collection that usually destroys bone and may become quite large. Both computed tomography and MRI are useful in determining the extent of this lesion.
Journal of the American Academy of Orthopaedic Surgeons, 2001
M AGNETIC RESONANCE imaging (MRI) of the foot or ankle is most commonly performed in patients wit... more M AGNETIC RESONANCE imaging (MRI) of the foot or ankle is most commonly performed in patients with chronic pain that has not responded to conservative treatment. It may be performed after an acute injury in competitive athletes, wherein the extent of injury and need for surgery must be determined. A variety of posttraumatic disorders account for most cases of foot or ankle pain. Degenerative, developmental, neoplastic, and synovial disorders are less common causes of symptoms. Bone and soft-tissue infection are important causes of foot and ankle problems in diabetic patients. Because of the complex anatomy of the foot and ankle, the source of pain may be difficult to diagnose clinically. MRI is useful in distinguishing between the many potential causes of symptoms in this region and has been shown to have a substantial effect on clinical decision-making. In a recent study, MRI of the ankle and hindfoot established a diagnosis not achieved clinically in 47% of patients and prompted a change in treatment in 34% of patientsJ This article describes the disorders of the foot and ankle that are most commonly encountered with MRI, grouped according to the region affected. IMAGING TECHNIQUE The ankle and hindfoot are imaged with an extremity surface coil with the patient supine and the ankle in neutral position or mild plantar flexion. Imaging is generally performed in three orthogonal planes, but in some patients, it may be tailored to a specific region or structure by using an axial oblique or coronal oblique plane or placing the ankle in dorsiflexion or plantar flexion. Standard technique includes a 12-to 16-cm field of view, 3to 4-mm section thickness, Tl-weighted and fast spin-echo fat-saturated T2-weighted or inversion recovery images. Imaging of the forefoot is usually
A destructive spondyloarthropathy is reported in four patients undergoing maintenance hemodialysi... more A destructive spondyloarthropathy is reported in four patients undergoing maintenance hemodialysis for chronic renal disease. In a separate investigation a controlled, prospective radiographic study of the cervical spine revealed this spondyloarthropathy in 4 (15%) of 26 long-term dialysis patients. A single disc level was involved in three patients, and two disc levels were involved in one patient. This spondyloarthropathy correlated with the duration of dialysis but not with the radiographic evidence of renal osteodystrophy or severity of laboratory abnormalities associated with hyperparathyroidism. Three of these four patients also had discovertebral erosions or destruction involving the lumbar spine. Cervical spine flexion views revealed evidence of ligamentous laxity or instability in three (12%) dialysis patients, all with vertebral resorption and disc space narrowing. It is postulated that this instability may contribute to the development of cervical discovertebral lesions or be a secondary manifestation of disc destruction.
The sliding compression screw-sideplate combination is currently the most widely employed device ... more The sliding compression screw-sideplate combination is currently the most widely employed device for internal fixation of stable and unstable intertrochanteric fractures of the femur. The normal and abnormal radiographic appearances of this device in the immediate post-operative period are discussed. Potential long-term complications including mal-or non-union, intra-articular penetration, metal failure, rotation of the proximal fracture fragment, disengagement, trochanteric bursitis, leg length discrepancy, delayed cervical stress fracture, and ischemic necrosis are reviewed.
We reviewed 845 cases of benign and 356 cases of malignant cartilaginous tumors from a total of 3... more We reviewed 845 cases of benign and 356 cases of malignant cartilaginous tumors from a total of 3067 primary bone tumors in our database. Benign cartilaginous lesions are unique because the epiphyseal plate has been implicated in the etiology of osteochondroma, enchondroma (single or multiple), periosteal chondromas and chondroblastoma. In the first part of this paper, we will review important clinical, radiologic and histologic features of intramedullary cartilaginous lesions in an attempt to support theories related to anatomic considerations and pathogenesis.
The bones, soft tissue contents, and boundaries of the tarsal tunnel can be imaged with sufficien... more The bones, soft tissue contents, and boundaries of the tarsal tunnel can be imaged with sufficient detail to show all the major structures within it. Pathological conditions affecting these structures can also be identified. The purpose of this paper was to determine the ability of magnetic resonance imaging to help in the evaluation of tarsal tunnel syndrome. Thirty-three patients with 40 feet were used for this study. All patients presented with complaints of pain along the course of the posterior tibial nerve or its branches and a positive Tinel's sign. Nerve conduction studies were obtained on 29 feet. All feet were evaluated with a magnetic resonance imaging study of the tarsal tunnel. Twenty-one feet eventually required surgery. Magnetic resonance imaging revealed an inflammatory or mass lesion in the tarsal tunnel in the majority of cases. The magnetic resonance imaging findings were confirmed at surgery in 19 patients. The information provided by magnetic resonance imagi...
Cadaveric specimens and patient radiographs were examined in order to establish the pattern and t... more Cadaveric specimens and patient radiographs were examined in order to establish the pattern and the distribution of degenerative alterations of the glenohumeral joint. Characteristic osseous changes occur in response to afterations in the articular cartilage and rotator cuff. The extent of these changes is underestimated by plain-film radiography. A strong association was found between the changes of osteoarthritis (OA) and those related to deterioration of the rotator cuff. Idiopathic OA of the glenohumeral joint was discovered in 10 (20%) of 50 symptomatic patients age 60 years and over. Theories regarding the pathomechanics and interrelations between glenohumeral joint OA and rotator cuff deterioration are discussed. Degenerative alterations in the glenohumeraljoint are relatively uncommon when compared to those in weight-bearing joints, such as the hip and knee. However, the incidence of osteoarthritis (OA) in the glenohumeral joint increases with age [1, 2], and the disease may be an occasional source of significant pain and disability [3]. The precise pathogenesis of glenohumeral joint OA is not clear, although hereditary and systemic factors as well as functional stress have all been implicated in its development [4]. In addition, a strong association between glenohumeral joint OA and tear or atrophy of the rotator cuff has been suggested by several investigators [5-8]. Using both patient and cadaveric material, we investigated OA ofthe glenohumeraljoint in order to establish its pattem, distribution, and correlation with other degenerative alterations of the shoulder.
Total quality management is basically about continuous organizational success through the employm... more Total quality management is basically about continuous organizational success through the employment of customer satisfaction and by basing it on the contribution of all the employees constantly working to enhance processes, services and products. The competitiveness concept has been defined in multitude of ways; in the individual firm's context, industries context and nation's context. The aim of the study is to identify the relationship between total quality management practices and contractors competitiveness. In order to achieve the study objective in the present study, a survey conducted. Questionnaires distributed to the contractor's managers in Saudi Arabia. The findings of the study turn out to be true; the study will contribute to both theory and practice. Through the present study, the researcher expects the findings to shed light on the research conducted hierarchical regression to analyse the relationships amongst different total quality management practices and practices of competitiveness.
Etude radiologique chez un enfant. Apres une chute de velo, il developpe des signes neurologiques... more Etude radiologique chez un enfant. Apres une chute de velo, il developpe des signes neurologiques, avec troubles de la marche, en rapport avec un granulome du corps de la 5eme vertebre thoracique. Les aspects radiologiques (cliche thoracique standard, scanner et RMN) sont presentes
In patients with hemophilia, hemarthrosis often occurs in one or several joints and may progress ... more In patients with hemophilia, hemarthrosis often occurs in one or several joints and may progress to a destructive, disabling arthropathy. Treatment includes continuous or on-demand clotting factor replacement and radionuclide or open synovectomy. The radiographic findings of hemophilic arthropathy depend on the stage of disease, the age of the patient at onset, and the joint involved. These findings include joint effusion, soft tissue swelling, epiphyseal overgrowth, subchondral cysts, osseous erosion, and secondary degenerative changes. Magnetic resonance imaging (MRI) is the most accurate imaging modality for assessing hemophilic arthropathy and may have a significant impact on patient management. MRI is anticipated to be useful in documenting early joint changes when treatment may be most effective. Hemophilic pseudotumor is a chronic, encapsulated, hemorrhagic fluid collection that usually destroys bone and may become quite large. Both computed tomography and MRI are useful in determining the extent of this lesion.
Journal of the American Academy of Orthopaedic Surgeons, 2001
M AGNETIC RESONANCE imaging (MRI) of the foot or ankle is most commonly performed in patients wit... more M AGNETIC RESONANCE imaging (MRI) of the foot or ankle is most commonly performed in patients with chronic pain that has not responded to conservative treatment. It may be performed after an acute injury in competitive athletes, wherein the extent of injury and need for surgery must be determined. A variety of posttraumatic disorders account for most cases of foot or ankle pain. Degenerative, developmental, neoplastic, and synovial disorders are less common causes of symptoms. Bone and soft-tissue infection are important causes of foot and ankle problems in diabetic patients. Because of the complex anatomy of the foot and ankle, the source of pain may be difficult to diagnose clinically. MRI is useful in distinguishing between the many potential causes of symptoms in this region and has been shown to have a substantial effect on clinical decision-making. In a recent study, MRI of the ankle and hindfoot established a diagnosis not achieved clinically in 47% of patients and prompted a change in treatment in 34% of patientsJ This article describes the disorders of the foot and ankle that are most commonly encountered with MRI, grouped according to the region affected. IMAGING TECHNIQUE The ankle and hindfoot are imaged with an extremity surface coil with the patient supine and the ankle in neutral position or mild plantar flexion. Imaging is generally performed in three orthogonal planes, but in some patients, it may be tailored to a specific region or structure by using an axial oblique or coronal oblique plane or placing the ankle in dorsiflexion or plantar flexion. Standard technique includes a 12-to 16-cm field of view, 3to 4-mm section thickness, Tl-weighted and fast spin-echo fat-saturated T2-weighted or inversion recovery images. Imaging of the forefoot is usually
A destructive spondyloarthropathy is reported in four patients undergoing maintenance hemodialysi... more A destructive spondyloarthropathy is reported in four patients undergoing maintenance hemodialysis for chronic renal disease. In a separate investigation a controlled, prospective radiographic study of the cervical spine revealed this spondyloarthropathy in 4 (15%) of 26 long-term dialysis patients. A single disc level was involved in three patients, and two disc levels were involved in one patient. This spondyloarthropathy correlated with the duration of dialysis but not with the radiographic evidence of renal osteodystrophy or severity of laboratory abnormalities associated with hyperparathyroidism. Three of these four patients also had discovertebral erosions or destruction involving the lumbar spine. Cervical spine flexion views revealed evidence of ligamentous laxity or instability in three (12%) dialysis patients, all with vertebral resorption and disc space narrowing. It is postulated that this instability may contribute to the development of cervical discovertebral lesions or be a secondary manifestation of disc destruction.
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Papers by Roger Kerr