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Fishman FG, January AM. Increasing Severity of Radial Longitudinal Deficiency Correlates With the Degree of Proximal Ulnar Hypoplasia. J Hand Surg Am 2024:S0363-5023(24)00206-5. [PMID: 38970602 DOI: 10.1016/j.jhsa.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 03/31/2024] [Accepted: 04/17/2024] [Indexed: 07/08/2024]
Abstract
PURPOSE Classification systems and treatment for children with radial longitudinal deficiency are classically focused on the hand and wrist. However, the elbow can affect the function of these patients secondary to stiffness or instability. The objective of this study was to determine if a correlation exists between severity of radial longitudinal deficiency (RLD) and degree of proximal ulnar hypoplasia. METHODS A single-institution retrospective review was performed at a pediatric hospital. One hundred elbows were identified in 72 patients who met the inclusion criteria. Measurements such as the coronoid height, olecranon coronoid angle (OCA), and the anterior coverage index were obtained from lateral radiographs of children with RLD. Ten elbows had posterior subluxation of the ulnohumeral joint radiographically. Eleven patients had thrombocytopenia absent radius (TAR) syndrome. RESULTS There was a significant mean difference for OCA between RLD types. Type 4 RLD (mean [M] = 17.9; standard deviation [SD] = 11.3) had a significantly lower OCA than type 0 (M = 26.4; SD = 5.9) and type 1 (M = 31.0; SD = 5.0). A subanalysis of the 58 elbows with type 4 RLD demonstrated that those with TAR (n = 11) had significantly higher anterior coverage index total scores (M = 1.7; SD = 0.3) than those with type 4 without TAR (M = 1.5; SD = 0.2). CONCLUSIONS The degree of proximal ulnar hypoplasia is correlated with increasing severity of RLD, with significantly lower OCA and coronoid height observed in the elbow radiographs of patients with type 4 RLD compared with type 0 and type 1. Children with TAR have less proximal ulnar dysplasia and higher anterior coverage index than children with type 4 RLD without associated TAR. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Felicity G Fishman
- Shriners Children's Chicago, Chicago, IL; Department of Orthopaedic Surgery and Rehabilitation, Loyola Stritch School of Medicine, Maywood, IL.
| | - Alicia M January
- Shriners Children's Chicago, Chicago, IL; Department of Psychology, Purdue University Northwest, Hammond, IN
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Joshi MA, Bains NJJ, Stone AJM, Wells LJ, Phadnis JS. Considerable variation in current coronoid height and fracture measurement techniques: a systematic review. J Shoulder Elbow Surg 2024; 33:1425-1434. [PMID: 38521484 DOI: 10.1016/j.jse.2024.01.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/19/2024] [Accepted: 01/30/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Coronoid fractures usually occur in the presence of a significant osseoligamentous injury to the elbow. Fracture size and location correlate with degree of instability and many authors have attempted to analyze the effect of fracture variation on decision making and outcome. There remains no standardized technique for measuring coronoid height or fracture size. The aim of this study was to appraise the literature regarding techniques for coronoid height measurement in order to understand variation. METHODS Preferred Reporting Items of Systematic Reviews and Meta-Analyses guidelines were followed. A search was performed to identify studies with either a description of coronoid height, fracture size, or bone loss using the terms (Coronoid) AND (Measurement) OR (Size) OR (Height). Articles were shortlisted by screening for topic relevance based on title, abstract and, if required, full-text review. Exclusion criteria were non-English articles, those on nonhuman species or parts other than the ulna coronoid process, and studies that included patients with pre-existing elbow pathology. Shortlisted articles were grouped based on study type, imaging modality, measurement technique, and measurement parameter as well as its location along the coronoid. RESULTS Thirty out of the initially identified 494 articles met the inclusion criteria. Twenty-one articles were clinical studies, 8 were cadaveric studies, and 1 combined patients as well as cadavers. A variety of imaging modalities (plain radiographs, 2-dimensional computed tomography [CT], 3-dimensional CT, magnetic resonance imaging or a combination of these) were used with CT scan (either 2-dimensional images or 3-dimensional reconstructions or both) being the most common modality used by 21 studies. Measurement technique also varied from uniplanar linear measurements in 15 studies to multiplanar area and volumetric measurements in 6 studies to techniques describing various angles and indices as an indirect measure of coronoid height in 8 studies. Across the 30 shortlisted studies, 19 different measurement techniques were identified. Fifteen studies measured normal coronoid height while the other 15 measured intact coronoid and/or fracture fragment height. The location of this measurement was also variable between studies with measurements at the apex of the coronoid in 24/30 (80%) of studies. Measurement accuracy was assessed by only 1 study. A total of 12/30 (40%) studies reported on the interobserver and intraobserver reliability of their measurement technique. CONCLUSION The systemic review demonstrated considerable variability between studies that report coronoid height or fracture size measurements. This variability makes comparison of coronoid height or fracture measurements and recommendations based on these between studies unreliable. There is need for development of a consistent, easy to use, and reproducible technique for coronoid height and bone loss.
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Affiliation(s)
- Mithun A Joshi
- Trauma and Orthopaedics Department, Brighton and Sussex University Hospitals, Brighton, UK.
| | | | - Andrew J M Stone
- Trauma and Orthopaedics Department, East Surrey Hospital, Redhill, UK
| | - Lucy J Wells
- Sussex Health Knowledge and Libraries, Brighton and Sussex University Hospitals, Brighton, UK
| | - Joideep S Phadnis
- Trauma and Orthopaedics Department, Brighton and Sussex University Hospitals, Brighton and Sussex Medical School, Brighton, UK
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Monteleone V, Vismara V, Cassin S, Luceri F, Zaolino C, Kulkarni C, Randelli PS, Arrigoni P. A 70° Arthroscope Provides Better Visualization of the Medial Side of the Elbow Than a 30° Arthroscope. Arthrosc Sports Med Rehabil 2024; 6:100865. [PMID: 38328531 PMCID: PMC10844937 DOI: 10.1016/j.asmr.2023.100865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 12/14/2023] [Indexed: 02/09/2024] Open
Abstract
Purpose To assess and quantify the improvement in visualization of humeral insertion of the medial collateral ligament (MCL) using a 70° scope compared with a 30° scope during elbow arthroscopy. Methods Twenty patients undergoing elbow arthroscopy for different pathologic conditions were enrolled in this single-center study. Visualization of the medial gutter of the elbow was evaluated by using both the 70° and the 30°scope. During the procedure, a needle was inserted at 45° with respect to the axis of the forearm, directed toward the intra-articular humeral emergence of the MCL. Four areas were established: the body (Z1), the lanceolate part (Z2), the tip of the needle (Z3), and the medial portion of the trochlea (Z4). The visible areas during arthroscopy using 2 different scopes were collected. Results The 70° scope allowed the detection of the first 3 areas in all patients (Z1, Z2, and Z3) and the visualization of the last area (Z4) in 19 patients (95%). On the other hand, the 30° scope allowed the detection of Z1 in 85% of patients, Z2 in 60% of patients, and Z3 in only 5% of patients. The medial portion of the trochlea was never visualized with the 30° scope. These findings were statistically significant. Conclusions The 70° scope improves visualization of the medial elbow compartment during elbow arthroscopy compared to the 30° scope, enhancing the extent of joint visualization and potentially permitting the detection of otherwise missed injuries in the difficult-to-reach areas of the joint. Level of Evidence Level II, diagnostic, prospective, cohort study.
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Affiliation(s)
- Valerio Monteleone
- Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Valeria Vismara
- Scuola Di Specializzazione in Ortopedia e Traumatologia Università Degli Studi Di Milano, Milan, Italy
| | - Simone Cassin
- Scuola Di Specializzazione in Ortopedia e Traumatologia Università Degli Studi Di Milano, Milan, Italy
| | - Francesco Luceri
- Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Carlo Zaolino
- Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Chandan Kulkarni
- Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Pietro Simone Randelli
- Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Milan, Italy
- Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Milan, Italy
| | - Paolo Arrigoni
- Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
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Arrigoni P, Archinà M, Luceri F, Radici M, Zaolino C, Folco G, Foschini C, Regazzoni S, Miano PM, Zagarella A, Colozza A, Randelli P. Humeral trochlear morphology does not influence coronoid fractures in elbow dislocation. J Exp Orthop 2023; 10:25. [PMID: 36918478 PMCID: PMC10014637 DOI: 10.1186/s40634-023-00571-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/11/2023] [Indexed: 03/16/2023] Open
Abstract
PURPOSE Traumatic elbow dislocation is the second most frequent joint dislocation, even though the elbow is a congruent and stable joint. Individual variability in anatomical congruence of the elbow and how it relates to simple or complex instability has rarely been studied in the literature; we hypothesized that a greater articular coverage by the humeral trochlea would be more likely to result in complex dislocation. The aim of this study is to analyze trochlear morphology in simple (SED) and complex elbow dislocation (CED), to assess whether the degree of humeroulnar joint congruence influences the incidence of coronoid fractures in elbow dislocation. The secondary goal is to evaluate the association between trochlear morphology and coronoid fracture pattern. METHODS All the elbow CT scans of the hospital server were retrospectively analyzed. 62 patients were enrolled and so divided in 2 groups: SED and CED with isolated coronoid fracture. Patients who were skeletally immature, presented with other concomitant elbow fractures, or who previously underwent elbow surgery were excluded. The CT scans were performed after closed reduction and prior to further treatment. Coronoid fracture pattern was classified on CT scan according to Regan-Morrey and O'Driscoll classifications; "grade 0" was assigned to SED. Trochlear coverage was measured and expressed as three angles (anterior, posterior, and distal) and their width/depth ratios. Measurements were taken by four different readers and the assessment was repeated after 15 days. RESULTS No statistically significant difference was found between humeral trochlear morphology of SED and CED patients. There was no association between morphometric measurements and coronoid fracture pattern. The results are strengthened by a good intra- and inter-reader reproducibility of the CT analysis protocol. CONCLUSIONS Our study is the first to evaluate the impact of trochlear morphology on elbow instability. Considering the results, other variables may have a greater impact on coronoid bone damage, such as trauma energy or ligamentous hyperlaxity: in particular, we believe that the capsuloligamentous structures of the elbow might contribute in a preponderant way to articular stability. The CT analysis protocol gave excellent results: reproducible, accurate and easy to perform. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Paolo Arrigoni
- U.O.C. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio-Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Via Bignami 1, 20126, Milan, Italy
| | - Martina Archinà
- U.O.C. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio-Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Via Bignami 1, 20126, Milan, Italy. .,Residency Program, Università Degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.
| | - Francesco Luceri
- U.O.C. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio-Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Via Bignami 1, 20126, Milan, Italy
| | - Mattia Radici
- U.O.C. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio-Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Via Bignami 1, 20126, Milan, Italy
| | - Carlo Zaolino
- U.O.C. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio-Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Via Bignami 1, 20126, Milan, Italy
| | - Gianluca Folco
- Residency Program, Università Degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.,S.S. Radiodiagnostica CTO, Azienda Socio-Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Via Bignami 1, 20126, Milan, Italy
| | - Chiara Foschini
- Residency Program, Università Degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.,S.S. Radiodiagnostica CTO, Azienda Socio-Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Via Bignami 1, 20126, Milan, Italy
| | - Simona Regazzoni
- U.O.C. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio-Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Via Bignami 1, 20126, Milan, Italy
| | - Paul Muriithi Miano
- Department of Orthopaedic and Trauma Surgery, PCEA Kikuyu Hospital, Nairobi, Kenya
| | - Andrea Zagarella
- S.S. Radiodiagnostica CTO, Azienda Socio-Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Via Bignami 1, 20126, Milan, Italy
| | - Alessandra Colozza
- Unità Operativa Ortopedia e Traumatologia, Ospedale Civile di Faenza, Faenza, Italy
| | - Pietro Randelli
- U.O.C. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio-Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Via Bignami 1, 20126, Milan, Italy.,Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.,Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.,U.O.C. 1° Clinica Ortopedica, Azienda Socio-Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
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Lyra da Silva CC, Cardoso JR, Rodrigues da Silva WP, Pinheiro LA, Ferreira LR, Nunes GO, Borges NC. Morphological and radiological study of the shoulder and elbow joints of the giant anteater (Myrmecophaga tridactyla). J Morphol 2023; 284:e21526. [PMID: 36271893 DOI: 10.1002/jmor.21526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 10/04/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
The giant anteater (Myrmecophaga tridactyla) has specialized thoracic limbs to forage by breaking the walls of anthills and termite mounds. They also play critical roles in defense posture and locomotion. This study aimed to provide a morphological and radiographic description of the shoulder joint and elbow joint of the giant anteater. Both joints of 13 tamanduas were assessed by morphological dissections and histological evaluation and radiographies without and with positive contrast. The radiographic projections selected to this study were the mediolateral and craniocaudal projections. The radiographic and anatomical findings were compared with the following results: the shoulder joint had a continuous joint capsule with the tendon sheaths of the short head and long head of the biceps brachii muscle, which could be visualized with an injection of 3 ml of intra-articular contrast. The shoulder joint arthrography was performed with the needle positioned cranially to the joint for contrast injection. The elbow joint presented three articular compartments, and the insertion of the joint capsule was proximal to the radial fossa and distal to the radial tuberosity in the radial notch of the ulna, which were possible to identify with 2 ml of intra-articular contrast. The elbow joint arthrography was performed with the needle positioned laterally to the joint for contrast injection. Moreover, the joint capsule presented a caudomedial distention and fat pads. The powerful muscles of the forelimb play a fundamental role in maintaining the shoulder joint and elbow joint stability due to bony adaptations and the absence of usual ligaments. The morphological and radiological study provided relevant information on the soft-tissue characteristics of shoulder and elbow joints, which may aid clinical-surgical and diagnostic imaging procedures.
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Affiliation(s)
- Carolina Castro Lyra da Silva
- Department of Veterinary Medicine, School of Veterinary and Animal Science, Federal University of Goiás, Goiânia, Brazil
| | - Júlio Roquete Cardoso
- Department of Morphology, Institute of Biological Sciences, Federal University of Goiás, Goiânia, Brazil
| | | | - Lizandra Araújo Pinheiro
- Department of Veterinary Medicine, School of Veterinary and Animal Science, Federal University of Goiás, Goiânia, Brazil
| | - Lucas Rodrigues Ferreira
- Department of Veterinary Medicine, School of Veterinary and Animal Science, Federal University of Goiás, Goiânia, Brazil
| | - Gabriel Oliveira Nunes
- Department of Veterinary Medicine, Federal Institute of Education, Science and Technology of Goiás, Urutaí, Brazil
| | - Naida Cristina Borges
- Department of Veterinary Medicine, School of Veterinary and Animal Science, Federal University of Goiás, Goiânia, Brazil
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Clinical Presentation and Characteristics of the Upper Extremity in Patients with Musculocontractural Ehlers–Danlos Syndrome. Genes (Basel) 2022; 13:genes13111978. [DOI: 10.3390/genes13111978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022] Open
Abstract
Musculocontractural Ehlers–Danlos syndrome (mcEDS) is a subtype of EDS caused by defective dermatan sulfate biosynthesis, characterized by multiple malformations (craniofacial features, ocular and visceral malformations) and progressive cutaneous, skeletal, vascular, and visceral fragility-related manifestations. Repeated dislocations and deformities of the joints due to joint relaxation are observed, causing serious damage to the musculoskeletal system of the whole body; however, the motor function of the upper limbs and the morphology of the bone joints have not been systematically investigated. In this study, we present a detailed and comprehensive report on upper limb lesions of 13 patients with a mean age at the first visit of 21 years. Twelve patients (92.3%) had a history of dislocation. Eleven patients (84.6%) had shoulder dislocations, and two patients (15.4%) had elbow dislocations. Four patients (30.8%) had elbow osteoarthritis, and three patients (23.1%) had distal radioulnar joint (DRUJ) osteoarthritis. The phalanges and metacarpals are thin, and the ratio of medullary cavity of the metacarpal bone decreases with age. As bone and joint deformity progresses, patients with mcEDS should be recommended to receive regular follow-up, including radiology. The present findings suggest an important role for dermatan sulfate in the maintenance of the skeletal system.
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Luceri F, Cucchi D, Rosagrata E, Zaolino CE, Menon A, Radici M, Zagarella A, Catapano M, Gallazzi MB, Arrigoni PA, Randelli PS. Novel Radiographic Indexes for Elbow Stability Assessment: Part B-Preliminary Clinical Study. Indian J Orthop 2021; 55:347-358. [PMID: 34306547 PMCID: PMC8275714 DOI: 10.1007/s43465-021-00399-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/23/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The coronoid process plays a key-role in preserving elbow stability. Currently, there are no radiographic indexes conceived to assess the intrinsic elbow stability and the joint congruency. The aim of this study is to present new radiological parameters, which will help assess the intrinsic stability of the ulnohumeral joint and to define normal values of these indexes in a normal, healthy population. METHODS Four independent observers (two orthopaedic surgeons and two radiologists) selected lateral view X-rays of subjects with no history of upper limb disease or surgery. The following radiographic indexes were defined: trochlear depth index (TDI); anterior coverage index (ACI); posterior coverage index (PCI); olecranon-coronoid angle (OCA); radiographic coverage angle (RCA). Inter-observer and intra-observer reproducibility were assessed for each index. RESULTS 126 subjects were included. Standardized lateral elbow radiographs (62 left and 64 right elbows) were obtained and analysed. The mean TDI was 0.46 ± 0.06 (0.3-1.6), the mean ACI was 2.0 ± 0.2 (1.6-3.1) and the mean PCI was 1.3 ± 0.1 (1.0-1.9). The mean RCA was 179.6 ± 8.3° (normalized RCA: 49.9 ± 2.3%) and the mean OCA was 24.6 ± 3.7°. The indexes had a high-grade of inter-observer and intra-observer reliability for each of the four observers. Significantly higher values were found for males for TDI, ACI, PCI and RCA. CONCLUSION The novel radiological parameters described are simple, reliable and easily reproducible. These features make them a promising tool for radiographic evaluation both for orthopaedic surgeons and for radiologists in the emergency department setting or during outpatient services. LEVEL OF EVIDENCE Basic Science Study (Case Series). CLINICAL RELEVANCE The novel radiological parameters described are reliable, easily reproducible and become handy for orthopaedic surgeons as well as radiologists in daily clinical practice.
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Affiliation(s)
- Francesco Luceri
- U.O.C. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Venurberg-Campus 1, 53127 Bonn, Germany
| | - Enrico Rosagrata
- U.O.C. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
- Residency Program, University of Milan, Via Mangiagalli 31, 20133 Milan, Italy
| | - Carlo Eugenio Zaolino
- U.O.C. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Alessandra Menon
- U.O.C. 1° Clinica Ortopedica, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli 31, 20133 Milan, Italy
| | - Mattia Radici
- U.O.C. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
- Residency Program, University of Milan, Via Mangiagalli 31, 20133 Milan, Italy
| | - Andrea Zagarella
- Servizio di Radiologia, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Michele Catapano
- Servizio di Radiologia, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Mauro Battista Gallazzi
- Servizio di Radiologia, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Paolo Angelo Arrigoni
- U.O.C. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli 31, 20133 Milan, Italy
| | - Pietro Simone Randelli
- U.O.C. 1° Clinica Ortopedica, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli 31, 20133 Milan, Italy
- REsearch Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, University of Milan, Via Mangiagalli 31, 20133 Milan, Italy
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