Publications by authors named "Antti Mustonen"

18 Publications

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Withdrawal from Long-Term Use of Unusually High-Dose Oxazepam.

Case Rep Psychiatry 2021 5;2021:2140723. Epub 2021 Nov 5.

Department of Psychiatry, Central Hospital of Southern Ostrobothnia, Hanneksenrinne 7, FI-60220 Seinäjoki, Finland.

Benzodiazepine (BZD) misuse is a worldwide problem that healthcare professionals encounter in daily practice. High-dose BZD withdrawal is usually a long process that may require referral to an inpatient rehabilitation unit. Relapses after withdrawal are common. BZD withdrawal can cause complications including seizures, suicidal behavior, anxiety, and depression. Guidelines describe tapering protocols for modest doses; however, protocols for exceptionally high-dose BZD withdrawal are not well described. Herein, we describe a BZD tapering protocol for a patient with daily use of high-dose (1800 mg) oxazepam (OXP). The BZD tapering was administered in an inpatient psychiatric hospital, and the outcome was evaluated monthly after discharge for three months. This report describes a unique case of high-dose OXP withdrawal and also outlines an optional protocol to apply when clinicians encounter these unusual cases.
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http://dx.doi.org/10.1155/2021/2140723DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8589494PMC
November 2021

Withdrawal from Long-Term Use of Unusually High-Dose Oxazepam.

Case Rep Psychiatry 2021 5;2021:2140723. Epub 2021 Nov 5.

Department of Psychiatry, Central Hospital of Southern Ostrobothnia, Hanneksenrinne 7, FI-60220 Seinäjoki, Finland.

Benzodiazepine (BZD) misuse is a worldwide problem that healthcare professionals encounter in daily practice. High-dose BZD withdrawal is usually a long process that may require referral to an inpatient rehabilitation unit. Relapses after withdrawal are common. BZD withdrawal can cause complications including seizures, suicidal behavior, anxiety, and depression. Guidelines describe tapering protocols for modest doses; however, protocols for exceptionally high-dose BZD withdrawal are not well described. Herein, we describe a BZD tapering protocol for a patient with daily use of high-dose (1800 mg) oxazepam (OXP). The BZD tapering was administered in an inpatient psychiatric hospital, and the outcome was evaluated monthly after discharge for three months. This report describes a unique case of high-dose OXP withdrawal and also outlines an optional protocol to apply when clinicians encounter these unusual cases.
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http://dx.doi.org/10.1155/2021/2140723DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8589494PMC
November 2021

Age of first alcohol intoxication and psychiatric disorders in young adulthood - A prospective birth cohort study.

Addict Behav 2021 07 11;118:106910. Epub 2021 Mar 11.

Department of Psychiatry, University of Turku, Turku, Finland; Addiction Psychiatry Unit, Department of Psychiatry, Turku University Hospital, Turku, Finland.

Objective: Early onset of alcohol use is associated with an increased risk of substance use disorders (SUD), but few studies have examined associations with other psychiatric disorders. Our aim was to study the association between the age of first alcohol intoxication (AFI) and the risk of psychiatric disorders in a Finnish general population sample.

Methods: We utilized a prospective, general population-based study, the Northern Finland Birth Cohort 1986. In all, 6,290 15-16-year old adolescents answered questions on AFI and were followed up until the age of 33 years for psychiatric disorders (any psychiatric disorder, psychosis, SUD, mood disorders and anxiety disorders) by using nationwide register linkage data. Cox-regression analysis with Hazard Ratios (HR, with 95% confidence intervals (CI)) was used to assess the risk of psychiatric disorders associated with AFI.

Results: Statistically significant associations were observed between AFI and any psychiatric disorder, psychosis, SUDs, and mood disorders. After adjustments for other substance use, family structure, sex and parental psychiatric disorders, AFIs of 13-14 years and ≤12 years were associated with SUD (HR = 5.30; 95%CI 2.38-11.82 and HR = 6.49; 95%CI 2.51-16.80, respectively), while AFI ≤ 12 years was associated with any psychiatric disorder (HR = 1.59; 95%CI 1.26-2.02) and mood disorders (HR = 1.81; 95%CI 1.22-2.68). After further adjustments for Youth Self Report total scores, AFI ≤ 14 was associated with an increased risk of SUD and AFI ≤ 12 with an increased risk of any psychiatric disorder.

Conclusions: We found significant associations between the early age of first alcohol intoxication, later SUD and any psychiatric disorder in a general population sample. This further supports the need for preventive efforts to postpone the first instances of adolescent alcohol intoxication.
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http://dx.doi.org/10.1016/j.addbeh.2021.106910DOI Listing
July 2021

Frequent Alcohol Intoxication and High Alcohol Tolerance During Adolescence as Predictors of Mortality: A Birth Cohort Study.

J Adolesc Health 2020 11 29;67(5):692-699. Epub 2020 Aug 29.

Department of Psychiatry, University of Turku, Turku, Finland; Addiction Psychiatry Unit, Department of Psychiatry, Turku University Hospital, Turku, Finland.

Purpose: Long-term prospective studies evaluating the health burden that is consequent to adolescent drinking are needed. The aim of this study was to examine the predictive associations between self-reported alcohol tolerance and frequent intoxication at age 15-16 years and the risk of death by age 33 years.

Methods: A sample (n = 6,615; 49.3% males) of the Northern Finland Birth Cohort Study 1986 was studied. Self-reported alcohol tolerance (drinks needed to feel intoxicated) and frequency of alcohol intoxication at age 15-16 years were analyzed along with background variables and data regarding subsequent psychiatric diagnoses. Categories were formed for both predictive variables from self-reported tolerance and frequency of intoxication in mid-adolescence. Cox regression was used to calculate hazard ratios (HRs) with 95% confidence interval (95% CI) for death by age 30 years.

Results: By the age of 33 years, of all 6,615 participants, 53 (.8%) were deceased. The HR for death by age 33 years was 3.08 (95% CI 1.17-8.07) among adolescents with high alcohol tolerance compared with adolescents without alcohol use or intoxication. The frequency of alcohol intoxication was also associated with mortality; HR 2.05 (95% CI 1.01-4.16) for those who had been intoxicated one to two times and HR 3.02 (95% CI 1.21-7.54) for those who had been intoxicated three or more times in the past 30 days compared with adolescents without intoxication.

Conclusions: High self-reported alcohol tolerance and frequent alcohol intoxication during mid-adolescence significantly predicted death by age 33 years. These behaviors carry long-term repercussions with respect to premature loss of life. Substantial efforts should be made to diminish this mortality risk.
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http://dx.doi.org/10.1016/j.jadohealth.2020.07.034DOI Listing
November 2020

Association of age at first drink and first alcohol intoxication as predictors of mortality: a birth cohort study.

Eur J Public Health 2020 12;30(6):1189-1193

Department of Psychiatry, University of Turku, Turku, Finland.

Background: More information on the health-related repercussions of age at onset of adolescent drinking is needed. The aim of this study was to examine the associations between self-reported age at first drink and age at first alcohol intoxication with the risk of death by age 30.

Methods: The sample (n = 6564; 49.1% males) included all participants of the Northern Finland Birth Cohort Study 1986 (NFBC1986) for whom the two measures of adolescent drinking were available. Self-reported age at onset of first drink and first alcohol intoxication were analyzed along with background variables and data regarding subsequent psychiatric diagnoses. Adolescents were dichotomized into those reporting age at first drink and age at first intoxication before or after age 14. Cox regression was used to calculate hazard ratios (HRs) with 95% confidence interval (95% CI) for death by age 30.

Results: By the age of 30, 0.7% (n = 47) of all 6564 participants were deceased. In the multivariable models, male gender and a history of illicit substance use in adolescence were associated with both all-cause mortality and mortality due to accidents or suicide. After controlling for confounding variables, age at first alcohol intoxication was associated with all-cause mortality (HR 2.33; 95% CI 1.04-5.20) as well as death due to accidents or suicide (HR 2.99; 95% CI 1.11-8.05).

Conclusions: Earlier age at first intoxication carries long-term repercussions with respect to premature loss of life. Efforts should be made targeting the prolongation of initiating binge drinking in adolescence to diminish this mortality risk.
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http://dx.doi.org/10.1093/eurpub/ckaa134DOI Listing
December 2020

Author's reply.

Br J Psychiatry 2020 08;217(2):458

Center for Life Course Health Research, University of Oulu; and Medical Research Center Oulu, Oulu University HospitalFinland.

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http://dx.doi.org/10.1192/bjp.2020.28DOI Listing
August 2020

Frequent intoxication and alcohol tolerance in adolescence: associations with psychiatric disorders in young adulthood.

Addiction 2020 05 17;115(5):888-900. Epub 2020 Jan 17.

Department of Psychiatry, University of Turku, Turku, Finland.

Aims: To assess the associations of intoxication frequency and number of drinks needed to become intoxicated in mid-adolescence with onset of psychiatric disorders in early adulthood.

Design, Setting And Participants: Prospective cohort study in Northern Finland, with people from the Northern Finland Birth Cohort 1986 who self-reported adolescent alcohol use: 6548 subjects (69.4% of the original sample). Data on alcohol use were collected using questionnaires at ages 15-16 years.

Measurements: Outcomes were any non-organic psychosis, mood disorder, anxiety disorder, any substance use disorder (SUD) and all the studied psychiatric disorders in early adulthood gathered from nation-wide health care, pension and insurance registers. Number of drinks needed to become intoxicated was categorized into three classes: (1) no alcohol use or intoxication, and (2) low and (3) high alcohol tolerance (more than seven/nine drinks for females/males) groups. Similarly, intoxication frequency was divided into three classes: (1) never, (2) one to two times and (3) three or more times during the past 30 days. Information regarding gender, family type, other drug use, psychopathology using Youth Self-Report (YSR) total score and parental psychiatric disorders were used as covariates.

Findings: In the multivariable analyses, both low [odds ratio (OR) = 3.0, 95% confidence interval (CI) = 1.3-6.7, P-value = 0.009] and high (OR = 4.4, 95% CI = 1.8-11.1, P-value = 0.001) alcohol tolerance were associated with increased risk of SUD. More frequent intoxication was associated with increased frequency of SUD (OR = 3.9, 95% CI = 2.0-7.3, P-value < 0.001) and mood disorder (OR = 1.6, 95% CI = 1.1-2.3, P-value = 0.008). The latter was attenuated after adjusting with concurrent psychopathology (YSR) and other drug use.

Conclusions: Both higher alcohol tolerance and frequent intoxication in adolescence appear to be associated with increased risk of future substance use disorder.
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http://dx.doi.org/10.1111/add.14889DOI Listing
May 2020

Fibular head avulsion fractures accompanying operative treated medial tibial plateau fractures.

Skeletal Radiol 2019 Sep 5;48(9):1411-1416. Epub 2019 Mar 5.

Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden.

Objective: The aims of this work are to determine how frequently medial tibial plateau fractures are accompanied by fibular head avulsion fractures and evaluate the sensitivity of radiographs detecting them, and also to assess if the presence of fibular fracture is correlated with long-term functional outcome and peroneal nerve damage.

Materials And Methods: A retrospective chart review of operated patients with medial tibial plateau fractures at level I trauma center during 2002-2008 was performed. From 63 patients imaged preoperatively, 59 had CT and radiographs, three had only CT, and one only radiograph. The presence and fragment size of fibular fracture were retrospectively evaluated. Body mass index (BMI) and functional outcome measurements (the Modified Lysholm knee score and WOMAC) were available for 46 patients.

Results: Fourteen out of 63 patients (22.2%) had fibular fractures. Of the 59 patients with both CT and radiographs, 12 had fibular fractures, and of these, nine were seen with both modalities and three only in CT. Functional scores were available for ten patients with fibular fracture. Patients with fibular fracture seen on radiographs had a significantly higher score on WOMAC function (26 vs. 7; p = 0.027). The patients with fibular fractures had also higher BMI (p = 0.035). Of the six patients with peroneal nerve damage, 50% had fibular fracture.

Conclusions: In patients with operatively treated medial tibial plateau fracture, the fibular fractures are relatively common. Detecting it is important, as it may be associated with worse functional scores and peroneal nerve paresis. Some fibular fractures may remain undetected on radiographs, hence preoperative CT is recommended.
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http://dx.doi.org/10.1007/s00256-019-03191-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6647171PMC
September 2019

Evidence of a Causal Relationship Between Smoking Tobacco and Schizophrenia Spectrum Disorders.

Front Psychiatry 2018 20;9:607. Epub 2018 Nov 20.

Center for Life Course Health Research, University of Oulu, Oulu, Finland.

There has been emerging evidence of an association between tobacco smoking and schizophrenia spectrum disorders (SSD). Two meta-analyses have reported that people who smoke tobacco have an ~2-fold increased risk of incident schizophrenia or psychosis, even after adjusting for confounding factors. This study aimed to critically appraise the research which has examined the association between tobacco smoking and SSD against the Bradford Hill criteria for causality, to determine the strength of the evidence for a causal relationship. Eight longitudinal studies (seven cohort studies and one case control study) were identified which examined tobacco smoking as an exposure and psychosis as an outcome. All seven cohort studies were assessed as being of high quality using the Newcastle-Ottawa Scale. Six of the eight studies found a statistically significant positive association between tobacco smoking and onset of SSD. These studies reported a consistent association with a moderate to large effect size and a dose response relationship. The studies adjusted for multiple potential confounders including age, sex, socioeconomic status, shared genetic risk, prodromal symptoms, and comorbid cannabis and other substance use. The studies did not adjust for exposure to childhood trauma or prenatal tobacco. There was substantial though inconclusive evidence supporting a causal relationship between tobacco smoking and increased risk of SSD. If a causal relationship does exist, nicotine is most likely responsible for this association. This raises serious public health concerns about the increasing use of e-cigarettes and other products, particularly by adolescents whose nicotine use may increase their risk of SSD. Research is urgently needed to examine the association between e-cigarette use and incident psychosis, particularly in adolescents and young adults.
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http://dx.doi.org/10.3389/fpsyt.2018.00607DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6255982PMC
November 2018

Adolescent inhalant use and psychosis risk - a prospective longitudinal study.

Schizophr Res 2018 11 27;201:360-366. Epub 2018 Jun 27.

Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland, Australia; Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia; Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.

Background: Cross-sectional studies have suggested inhalant use is associated with psychosis. This association was examined in a longitudinal study accounting for other substance use and potential confounders.

Methods: We used a prospective sample (N = 6542) from the Northern Finland Birth Cohort 1986. Self-report questionnaires on substance use and psychotic experiences were completed when the cohort members were 15-16 years old. Inhalant use was categorized into four groups (never, once, 2-4 times, 5 times or more). Subsequent psychosis diagnoses (ICD-10) until age 30 years were obtained from national registers. Cox regression analysis was used to examine the association between adolescent inhalant use and risk of psychosis.

Results: During the observation period 124 individuals were diagnosed with incident psychosis. Overall, there were 225 (3.4%) subjects with any inhalant use, 18 (8.0%) of whom were diagnosed with psychosis during the follow up. Of non-inhalant users (n = 6317) 106 (1.7%) were diagnosed with psychosis. Compared to non-users, those using inhalants had increased risk of incident psychosis with most frequent inhalant use associated with the greatest risk (unadjusted HR = 9.46; 3.86-23.20). After adjusting for baseline psychotic experiences, other substance use, comorbid mental disorder and parental substance abuse, the increased risk of psychosis persisted (HR = 3.06; 1.05-8.95). Furthermore, a dose-response effect between inhalant use and risk of psychosis was identified (OR = 2.34; 1.83-2.99).

Conclusions: Inhalant use in adolescence was independently associated with incident psychosis. The adverse health outcomes associated with adolescent inhalant use provide compelling reasons for implementation of policies to reduce the use of volatile substances in adolescents.
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http://dx.doi.org/10.1016/j.schres.2018.05.013DOI Listing
November 2018

Adolescent cannabis use, baseline prodromal symptoms and the risk of psychosis.

Br J Psychiatry 2018 04;212(4):227-233

Center for Life Course Health Research,University of Oulu, Oulu, Finland and Medical Research Center Oulu, Oulu University Hospital and University of Oulu,Oulu,Finland.

Background: The association between cannabis use and the risk of psychosis has been studied extensively but the temporal order still remains controversial. Aims To examine the association between cannabis use in adolescence and the risk of psychosis after adjustment for prodromal symptoms and other potential confounders.

Method: The sample (n = 6534) was composed of the prospective general population-based Northern Finland Birth Cohort of 1986. Information on prodromal symptoms of psychosis and cannabis use was collected using questionnaires at age 15-16 years. Participants were followed up for ICD-10 psychotic disorders until age 30 years using nationwide registers.

Results: The risk of psychosis was elevated in individuals who had tried cannabis five times or more (hazard ratio, (HR) = 6.5, 95% CI 3.0-13.9). The association remained statistically significant even when adjusted for prodromal symptoms, other substance use and parental psychosis (HR = 3.0, 95% CI 1.1-8.0).

Conclusions: Adolescent cannabis use is associated with increased risk of psychosis even after adjustment for baseline prodromal symptoms, parental psychosis and other substance use. Declaration of interest None.
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http://dx.doi.org/10.1192/bjp.2017.52DOI Listing
April 2018

Predictors of osteoarthritis following operative treatment of medial tibial plateau fractures.

Injury 2018 Feb 14;49(2):370-375. Epub 2017 Nov 14.

Department of Orthopaedics and Traumatology, Helsinki University Hospital, Topeliuksenkatu 5, 00260 Helsinki, Finland.

Purpose: To determine factors influencing the development of posttraumatic osteoarthritis (OA) following medial tibial plateau fractures and to evaluate concomitant injuries associated with these fractures.

Materials And Methods: A chart review of patients with operatively treated medial tibial plateau fractures admitted to our Level I trauma centre from 2002 to 2008 was performed. Of 63 patients, 41 participated in a clinical and radiographic examination. The mean age was 47 years (range 16-78) and the mean follow-up time was 7.6 (range 4.7-11.7) years. All patients had preoperative computed tomography (CT) scans and postoperative radiographs. At the end of follow-up, standing radiographs, mechanical axis, and CT scans were evaluated.

Results: Of the 41 patients, 24 had no or mild (Kellgren-Lawrence grade 0-2) OA and 17 had severe (grade 3-4) OA. Initial articular depression measured from preoperative CT scans was a significant predictor of OA (median 1.8mm vs 4.5mm, p=0.009). Fracture line extension to the lateral plateau (p=0.68) or fracture comminution (p=0.21) had no effect on the development of posttraumatic OA, nor did articular depression at the end of follow-up (p=0.68) measured from CT scans. Mechanical axis >4° of varus and ≥2mm articular depression or step-off were associated with worse WOMAC pain scores, but did not affect other functional outcome scores. Six patients (10%) had permanent peroneal nerve dysfunction. Ten patients (16%) required LCL reconstruction and nine (14%) ACL avulsions were treated at the time of fracture stabilisation.

Conclusions: The amount of articular depression measured from preoperative CT scans seems to predict the development of posttraumatic OA, probably reflecting the severity of chondral injury at the time of fracture. Restoration of mechanical axis and articular congruence are important in achieving a good clinical outcome.
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http://dx.doi.org/10.1016/j.injury.2017.11.014DOI Listing
February 2018

Treatment of compound tibial fracture with free osteomuscular latissimus dorsi scapula flap.

J Reconstr Microsurg 2015 Mar 6;31(3):217-24. Epub 2015 Feb 6.

Department of Plastic and Reconstructive Surgery, Helsinki University Central Hospital, Helsinki, Finland.

Background: Compound tibial fractures with extensive comminution and soft tissue defects are limb-threatening reconstructive challenges. The purpose of this study was to assess the long-term outcomes and the reliability of the latissimus dorsi scapula flap for this indication.

Methods: The hospital records of 26 compound tibial fracture patients treated with the latissimus dorsi scapula flap were reviewed. An overall assessment was performed in several steps based on a preinformation and two function-related questionnaires together with radiographs, clinical overviews, and functional tests.

Results: In 85% of the cases, the fractures had resulted from high-energy trauma and had extensive zone of injury. The mean follow-up time was 6.2 years. Nine patients required reconstruction because of prolonged sequelae after infection, nonunion, or tissue deficiency. One flap loss occurred leading to amputation. Six patients required an additional operation to enhance bony union. Full weight-bearing was allowed in 3 months and the mean time to bony union was 10 months. Overall, 90% returned to their pretrauma occupation. Overall 11 patients were lost to follow-up. A total of 14 patients answered the questionnaires whereas 12 outpatients attended the clinical assessment. The main finding after evaluating the results of the functional tests and reviewing the questionnaires was the limitation in ankle movement while the donor site performed well.

Conclusion: This study confirms that osteomuscular latissimus dorsi scapula flap reconstruction is a suitable alternative for compound and comminuted tibia fractures especially in the case of extensive soft tissue injury with bony loss or significant comminution and with high probability of amputation.
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http://dx.doi.org/10.1055/s-0034-1395995DOI Listing
March 2015

Segond fracture combined with tibial plateau fracture.

AJR Am J Roentgenol 2011 Dec;197(6):W1101-4

Department of Radiology, Helsinki Medical Imaging Center, Helsinki University Hospital, Finland.

Objective: The objective of our study was to examine the coexistence of Segond fracture in tibial plateau fractures and to assess the prevalence of anterior cruciate ligament (ACL) rupture and meniscal tear when those fractures coexist.

Materials And Methods: This retrospective study was conducted at a level 1 trauma center. A total of 1203 emergency department knee trauma MDCT examinations were evaluated. Surgical findings served as the reference standard for intraarticular injuries.

Results: A total of 33 patients with a Segond fracture were found. Of these patients, 10 had isolated Segond fractures (surgery, n = 7) and 23 patients (surgery, n = 20) had a Segond fracture associated with a tibial plateau fracture. Patients with both fractures had significantly fewer anterior cruciate ligament (ACL) ruptures (20% vs 71%, p = 0.023) and more avulsion fractures of the ACL (50% vs 0%, p = 0.026) than patients with isolated Segond fractures. For meniscal injuries, the corresponding numbers were 25% and 57% (p = 0.175), respectively. In approximately one of every 32 tibial plateau fractures, a Segond fracture also coexists.

Conclusion: Patients with a Segond fracture combined with a tibial plateau fracture have a high risk of avulsion fracture of the ACL.
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http://dx.doi.org/10.2214/AJR.10.6095DOI Listing
December 2011

Postoperative MDCT of tibial plateau fractures.

AJR Am J Roentgenol 2009 Nov;193(5):1354-60

Department of Radiology, Helsinki Medical Imaging Center, Helsinki University Central Hospital, Töölö Trauma Center, Topeliuksenkatu 5, FIN-00029 Helsinki, Finland.

Objective: The purposes of this retrospective study were to elaborate our experience in postoperative MDCT of tibial plateau fractures, to establish the frequency of these fractures and the indications for MDCT, and to assess the common findings and their clinical importance.

Materials And Methods: A total of 782 knee injuries were imaged with MDCT at a level 1 trauma center over 86 months. A total of 592 knees had a tibial plateau fracture; 381 of these fractures were managed surgically, and postoperative MDCT was performed on 36 of these knees (9%). At postoperative image analysis, an orthopedic surgeon evaluated reduction as good or suboptimal using the first postoperative radiographs. Fracture healing was determined as complete ossification, partial ossification, or nonunion on MDCT images acquired later in follow-up. The MDCT findings were compared with the radiographic findings to assess the usefulness and clinical importance of MDCT.

Results: The main indications for MDCT were assessment and follow-up of the joint articular surface and evaluation of fracture healing. Orthopedic hardware caused no diagnostic problems at MDCT. Postoperative MDCT revealed additional clinically important information on 29 patients (81%), and 14 patients (39%) underwent reoperation.

Conclusion: Postoperative MDCT of tibial plateau fractures is performed infrequently, even in a large trauma center. When it is performed, however, because of suspicion of increasing articular step-off or fracture nonunion, postoperative MDCT reveals clinically significant information in most cases.
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http://dx.doi.org/10.2214/AJR.08.2260DOI Listing
November 2009

MRI of acute meniscal injury associated with tibial plateau fractures: prevalence, type, and location.

AJR Am J Roentgenol 2008 Oct;191(4):1002-9

Department of Radiology, Helsinki Medical Imaging Center, Helsinki University Central Hospital, Toolo Trauma Center, Topeliuksenkatu 5, FIN-00029, Helsinki, Finland.

Objective: The purpose of this study was to evaluate the prevalence, type, and location of meniscal injuries, particularly to assess the prevalence of unstable meniscal tears in acute knee trauma with tibial plateau fractures.

Materials And Methods: A total of 78 menisci were evaluated in 39 patients who had undergone knee MDCT and MRI. Meniscal tears were classified as horizontal, vertical (subdivided into longitudinal and radial), flap, bucket-handle, or complex. The presence of meniscal contusion was documented. The anterior horn, body, and posterior horn were assessed separately for both menisci. Knee arthroscopy was performed on 28 patients.

Results: Of the 39 patients in the study, 24 had detectable abnormal menisci, for a total of 33 abnormal menisci (42%). Among the 33 meniscal abnormalities were 11 longitudinal tears (33%), 17 contusions (52%), four flap tears (12%), six horizontal tears (18%), and six radial tears (18%). Among the 16 patients with meniscal tears (41% of the 39), 14 patients had an unstable tear. No significant correlation was found between degree of articular depression and site or morphologic features of the meniscal injury. Correspondingly, no statistical correlation was evident between normal menisci and degree of articular depression, nor was a significant correlation found between differing fracture groups and meniscal findings.

Conclusion: A high percentage of patients (36%) with a tibial plateau fracture had an unstable meniscal tear. If a meniscal tear is detected preoperatively, meniscal surgery can be combined with fracture fixation, and reoperation can be avoided. A large number of meniscal contusions were found. Awareness of this abnormality can help radiologists increase specificity by avoiding false-positive findings of meniscal tear.
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http://dx.doi.org/10.2214/AJR.07.3811DOI Listing
October 2008

MRI of menisci repaired with bioabsorbable arrows.

Skeletal Radiol 2006 Jul 18;35(7):515-21. Epub 2006 Mar 18.

Helsinki University Hospital-Radiology, Topeliuksenkatu 5, Helsinki, 00260, Finland.

Objective: To analyze with conventional magnetic resonance imaging (MRI) the signal appearance of menisci repaired with bioabsorbable arrows.

Design And Patients: Forty-four patients with 47 meniscal tears treated with bioabsorbable arrows underwent follow-up conventional MRI examination. The time interval between the surgery and MRI varied from 5 to 67 months (mean 26 months). Twenty-six patients also had concurrent repair of torn anterior cruciate ligament. The following grades were used to classify meniscal signal intensity: (a) G0; low signal intensity on all sequences and regular configuration in every plane, (b) G1; increased signal intensity within the meniscus, not extending to the meniscal surface, (c) G2; increased signal intensity linear in shape, which may or may not communicate with the capsular margin of the meniscus, without extending to the meniscal surface, and (d) G3; increased signal intensity extending to the meniscal surface.

Results: Thirteen menisci (27.5%) had normal signal intensity, 13 menisci (27.5%) Grade 1 signal intensity, 9 menisci (19%) Grade 2 signal intensity and 12 menisci (26%) Grade 3 signal intensity. The time difference between operation and MRI was statistically significant between the G0 (36 months) and G3 groups (14 months; P = 0.0288). There was no statistical significance in different grades between medial and lateral meniscus or between patients with operated or intact ACL. On physical examination sixteen patients reported slight symptoms, seen evenly in each group.

Conclusion: No difference was seen in different grades between patients with operated or intact ACL. The highest incidence of menisci with a Grade 3 signal was seen in patients where surgery was within the last 18 months.
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http://dx.doi.org/10.1007/s00256-006-0080-xDOI Listing
July 2006

Radicular lower extremity pain as the first symptom of primary hyperparathyroidism.

Skeletal Radiol 2004 Aug 19;33(8):467-72. Epub 2004 Jun 19.

Toolo Trauma Center, Helsinki University Central Hospital, Topeliuksenkatu 5, 00029, Helsinki, Finland.

Clinical symptoms of hyperparathyroidism are generally nausea, vomiting, fatigue, constipation, and hypotonicity of the muscles and ligaments; bone pain and tenderness are also seen but are more common in secondary hyperparathyroidism. We report a histologically confirmed case of a 28-year-old man whose sole symptom of primary hyperparathyroidism was lower extremity radicular pain due to a vertebral brown tumor. Magnetic resonance imaging demonstrated brown tumor to be hyperintense on T2-weighted and slightly hypointense on T1-weighted sequences; it showed intense contrast enhancement with gadolinium. Because brown tumors usually contain hemosiderin a short T2 should have been expected, but this was not seen in our case. Healing resulted in decreasing contrast enhancement on T1-weighted sequences and increasingly short T2. To our knowledge, this is the first report of a lumbar vertebral brown tumor associated with primary hyperparathyroidism.
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http://dx.doi.org/10.1007/s00256-004-0803-9DOI Listing
August 2004
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