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Davey MS, Hurley ET, Liu K, White-Gibson A, Molony DC, Moran CJ, Delaney RA, Mullett H. The clinical utility of immediate post-operative PACU plain film radiographs following uncomplicated open Latarjet procedure - An institutional series of consecutive patients. J Orthop 2023; 46:178-181. [PMID: 38037554 PMCID: PMC10685133 DOI: 10.1016/j.jor.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/03/2023] [Indexed: 12/02/2023] Open
Abstract
Background Immediate post-operative plain film radiograph x-rays in PACU following open Latarjet procedure are often ordered as routine. However, such radiographs utilize institutional cost and time, whilst potentially exposing patients to often-unnecessary additional radiation. This study sought to evaluate whether routine immediate post-operative radiographs following uncomplicated open Latarjet procedures impacted clinical decision-making in our institution. Methods From 2017 to 2020, patients who underwent open Latarjet procedure by one of four fellowship-trained upper limb surgeons at a single institution were included in this study. Post-operative radiographs taken immediately in PACU were reviewed to determine if any reported radiographic findings impacted on clinical decision-making in the immediate post-operative setting. SPSS was used for descriptive statistics. Results A total of 337 patients underwent an X-ray in PACU immediate after uncomplicated open Latarjet procedure. Overall, 98.5% were male (n = 332), the mean patient age of included patients was 22.9 ± 4.2 years. No patient had an abnormal finding on their post-operative x-ray. Two patients returned to the operating room in the immediate post-operative period, both requiring washout and debridement due to haemtoma or superficial wound infection. Conclusion The findings of this study suggest that the use of post-operative plain films in PACU following open Latarjet procedure remains a costly use of resources, with little ultimate impact on clinical decision making in the short-term post-operatively. Level of Evidence IV - Institutional Case Series of Consecutive Patients.
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Affiliation(s)
| | | | - Kathy Liu
- Sports Surgery Clinic, Dublin, Ireland
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Hjorth MH, Mechlenburg I, Soballe K, Rømer L, Jakobsen SS, Stilling M. The anatomical location of cystic pseudotumors and muscle atrophy in metal-on-metal resurfacing hip arthroplasty is related to the surgical approach used for implantation. A subgroup analyses of a randomized controlled trial. Arch Orthop Trauma Surg 2023; 143:5967-5976. [PMID: 36802238 DOI: 10.1007/s00402-023-04788-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/22/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Pseudotumors and muscle atrophy have been associated with metal-on-metal (MoM) resurfacing hip arthroplasty (RHA). We aimed to investigate the influence of the anterolateral (AntLat) and the posterior (Post) surgical approach on the location, grade and prevalence of pseudotumors and muscle atrophy in MoM RHA. PATIENTS AND METHODS Forty-nine patients were randomized to MoM RHA by the AntLat (n = 25) or the Post (n = 24) approach at Aarhus University Hospital. Patients underwent metal artifact reduction sequence (MARS) magnetic resonance imaging (MRI) scans for investigation of location, grade and prevalence of pseudotumors and muscle atrophy. Plain radiographs, metal-ions concentrations and clinical outcome scores were evaluated to compare outcomes of the surgical approaches. RESULTS MRI-detected pseudotumors were seen in 7 of 18 patients (39%) in the AntLat group and in 12 of 22 patients (55%) in the Post group (p = 0.33). Pseudotumors were mainly located anterolaterally to the hip joint in the AntLat group and postero-lateral to the hip joint in the Post group. Higher grades of muscle atrophy of the caudal part of the gluteus medius and minimus (p < 0.004) were seen in the AntLat group, and higher grades of muscle atrophy of the small external rotators were seen in the Post group (p < 0.001). The AntLat group had higher anteversion angles of mean 15.3° (range 6.1-7.5) versus mean 11.5° (range 4.9-22.5) in the Post group (p = 0.02). Metal-ion concentrations and clinical outcome scores were similar between groups (p > 0.08). CONCLUSION Muscle atrophy and pseudotumor location after MoM RHA follow the surgical approach used for implantation. This knowledge may help differentiate between "normal postoperative appearance" and "MoM disease."
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Affiliation(s)
- Mette Holm Hjorth
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark.
| | - Inger Mechlenburg
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
| | - Kjeld Soballe
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
| | - Lone Rømer
- Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Stig Storgaard Jakobsen
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
| | - Maiken Stilling
- Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
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Yin P, Zhong J, Liu Y, Liu T, Sun C, Liu X, Cui J, Chen L, Hong N. Clinical-radiomics models based on plain X-rays for prediction of lung metastasis in patients with osteosarcoma. BMC Med Imaging 2023; 23:40. [PMID: 36959569 PMCID: PMC10037898 DOI: 10.1186/s12880-023-00991-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/06/2023] [Indexed: 03/25/2023] Open
Abstract
OBJECTIVES Osteosarcoma (OS) is the most common primary malignant bone tumor in adolescents. Lung metastasis (LM) occurs in more than half of patients at different stages of the disease course, which is one of the important factors affecting the long-term survival of OS. To develop and validate machine learning radiomics model based on radiographic and clinical features that could predict LM in OS within 3 years. METHODS 486 patients (LM = 200, non-LM = 286) with histologically proven OS were retrospectively analyzed and divided into a training set (n = 389) and a validation set (n = 97). Radiographic features and risk factors (sex, age, tumor location, etc.) associated with LM of patients were evaluated. We built eight clinical-radiomics models (k-nearest neighbor [KNN], logistic regression [LR], support vector machine [SVM], random forest [RF], Decision Tree [DT], Gradient Boosting Decision Tree [GBDT], AdaBoost, and extreme gradient boosting [XGBoost]) and compared their performance. The area under the receiver operating characteristic curve (AUC) and accuracy (ACC) were used to evaluate different models. RESULTS The radscore, ALP, and tumor size had significant differences between the LM and non-LM groups (tradscore = -5.829, χ2ALP = 97.137, tsize = -3.437, P < 0.01). Multivariable LR analyses showed that ALP was an important indicator for predicting LM of OS (odds ratio [OR] = 7.272, P < 0.001). Among the eight models, the SVM-based clinical-radiomics model had the best performance in the validation set (AUC = 0.807, ACC = 0.784). CONCLUSION The clinical-radiomics model had good performance in predicting LM in OS, which would be helpful in clinical decision-making.
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Affiliation(s)
- Ping Yin
- Department of Radiology, Peking University People's Hospital, 11 Xizhimen Nandajie, Xicheng District, Beijing, 100044, P. R. China
| | - Junwen Zhong
- Department of Radiology, Peking University People's Hospital, 11 Xizhimen Nandajie, Xicheng District, Beijing, 100044, P. R. China
| | - Ying Liu
- Department of Radiology, Peking University People's Hospital, 11 Xizhimen Nandajie, Xicheng District, Beijing, 100044, P. R. China
| | - Tao Liu
- Department of Radiology, Peking University People's Hospital, 11 Xizhimen Nandajie, Xicheng District, Beijing, 100044, P. R. China
| | - Chao Sun
- Department of Radiology, Peking University People's Hospital, 11 Xizhimen Nandajie, Xicheng District, Beijing, 100044, P. R. China
| | - Xiaoming Liu
- Department of Research and Development, United Imaging Intelligence (Beijing) Co.,Ltd, Yongteng North Road, Haidian District, Beijing, 100089, China
| | - Jingjing Cui
- Department of Research and Development, United Imaging Intelligence (Beijing) Co.,Ltd, Yongteng North Road, Haidian District, Beijing, 100089, China
| | - Lei Chen
- Department of Radiology, Peking University People's Hospital, 11 Xizhimen Nandajie, Xicheng District, Beijing, 100044, P. R. China
| | - Nan Hong
- Department of Radiology, Peking University People's Hospital, 11 Xizhimen Nandajie, Xicheng District, Beijing, 100044, P. R. China.
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Li W, Feng J, Zhu D, Xiao Z, Liu J, Fang Y, Yao L, Qian B, Li S. Nomogram model based on radiomics signatures and age to assist in the diagnosis of knee osteoarthritis. Exp Gerontol 2023; 171:112031. [PMID: 36402414 DOI: 10.1016/j.exger.2022.112031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/03/2022] [Accepted: 11/12/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Knee osteoarthritis (KOA) is a common disease in the elderly. An effective method for accurate diagnosis could affect the management and prognosis of patients. OBJECTIVES To develop a nomogram model based on X-ray imaging data and age, and to evaluate its effectiveness in the diagnosis of KOA. METHODS A total of 4403 knee X-rays from 1174 patients (July 2017 to November 2018) were retrospectively analyzed. Radiomics features were extracted and selected from the X-ray image data to quantify the phenotypic characteristics of the lesion region. Feature selection was performed in three steps to enable the derivation of robust and effective radiomics signatures. Then, logistic regression (LR), support vector machine (SVM) AdaBoost, gradient boosting decision tree (GBDT), and multi-layer perceptron (MLP) was adopted to verify the performance of radiomics signatures. In addition, a nomogram model combining age with radiomics signatures was constructed. At last, receiver operating characteristic (ROC) curve, calibration and decision curves were used to evaluate the discriminative performance. RESULTS The LR model has the best classification performance among the four radiomics models in testing cohort (LR AUC vs. SVM AUC: 0.843 vs. 0.818, DeLong test P = 0.0024; LR AUC vs. GBDT AUC: 0.843 vs. 0.821, P = 0.0028; LR AUC vs. MLP AUC: 0.843 vs. 0.822, P = 0.0019). The nomogram model achieved better predictive efficacy than the radiomics model in testing cohort compared to radiomics models although the statistical difference was not significant (Nomogram AUC vs. Radiomics AUC: 0.847 vs. 0.843, P = 0.06). The decision curve analysis revealed that the constructed nomogram had clinical usefulness. CONCLUSION The nomogram model combining radiomics signatures with age has good performance for the accurate diagnosis of KOA and may help to improve clinical decision-making.
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Affiliation(s)
- Wei Li
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Department of Radiology, Sun Yat-sen University, 52 East Meihua Rd, New Xiangzhou, Zhuhai, Guangdong Province, China
| | - Jiaxin Feng
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Department of Radiology, Sun Yat-sen University, 52 East Meihua Rd, New Xiangzhou, Zhuhai, Guangdong Province, China
| | - Dantian Zhu
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Department of Radiology, Sun Yat-sen University, 52 East Meihua Rd, New Xiangzhou, Zhuhai, Guangdong Province, China
| | - Zhongli Xiao
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Department of Radiology, Sun Yat-sen University, 52 East Meihua Rd, New Xiangzhou, Zhuhai, Guangdong Province, China
| | - Jin Liu
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Department of Radiology, Sun Yat-sen University, 52 East Meihua Rd, New Xiangzhou, Zhuhai, Guangdong Province, China
| | - Yijie Fang
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Department of Radiology, Sun Yat-sen University, 52 East Meihua Rd, New Xiangzhou, Zhuhai, Guangdong Province, China
| | - Lin Yao
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Department of Radiology, Sun Yat-sen University, 52 East Meihua Rd, New Xiangzhou, Zhuhai, Guangdong Province, China
| | - Baoxin Qian
- Huiying Medical Technology (Beijing), Huiying Medical Technology Co., Ltd, Room A206, B2, Dongsheng Science and Technology Park, HaiDian District, Beijing City 100192, China
| | - Shaolin Li
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Department of Radiology, Sun Yat-sen University, 52 East Meihua Rd, New Xiangzhou, Zhuhai, Guangdong Province, China.
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Becker J, Luria S, Huang S, Petchprapa C, Wollstein R. Wrist angle measurements in predicting the presence of a displaced scaphoid fracture. Eur J Orthop Surg Traumatol 2022:10.1007/s00590-022-03418-5. [PMID: 36303041 DOI: 10.1007/s00590-022-03418-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE Early diagnosis and treatment of scaphoid fractures is critical to achieve union and prevent wrist degenerative arthritis. Plain radiographic measurements can guide the early approach to suspected fractures. Specifically, the ability to predict fracture or fracture stability from plain radiographs may allow the traumatologist to expand initial referral to three-dimensional imaging. We evaluated the ability of four measured angles to predict presence of a scaphoid fracture and stability. METHODS Fifty patients with a scaphoid fracture and 50 patients without fracture were evaluated for the cortical ring sign, scapho-lunate gapping, lateral scapholunate (SL), radio-scaphoid (RS), radio-lunate (RL), and radio-capitate (RC) angles by two-blinded observers. RESULTS Measurement of an increased SL interval was associated with the presence of a scaphoid fracture as diagnosed on three-dimensional imaging [odds ratio (OR) 3.0, confidence interval (CI) 1.53-5.87, p = < 0.01]. The measured RL angle was associated with fracture displacement (OR 1.13, 95% CI 1.02-1.25, p = 0.02). CONCLUSIONS Scapholunate gapping on plain radiographs in the context of a clinically suspected scaphoid fracture should increase suspicion for a fracture and may prompt earlier 3-dimensional imaging, while the presence of an abnormal radiolunate angle should increase wariness for instability and can be used in preoperative planning.
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Affiliation(s)
- Jacob Becker
- School of Medicine, New York University, 1999 Marcus Ave., New Hyde Park, NY, 11042, USA
| | - Shai Luria
- Hadassah Medical Center, Jerusalem, Israel
| | - Shengnan Huang
- School of Medicine, New York University, 1999 Marcus Ave., New Hyde Park, NY, 11042, USA
| | - Catherine Petchprapa
- School of Medicine, New York University, 1999 Marcus Ave., New Hyde Park, NY, 11042, USA
| | - Ronit Wollstein
- School of Medicine, New York University, 1999 Marcus Ave., New Hyde Park, NY, 11042, USA.
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Tahir M, Mehta D, Sandhu C, Jones M, Gardner A, Mehta JS. A comparison of the post-fusion outcome of patients with early-onset scoliosis treated with traditional and magnetically controlled growing rods. Bone Joint J 2022; 104-B:257-264. [PMID: 35094579 DOI: 10.1302/0301-620x.104b2.bjj-2021-1198.r1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to compare the clinical and radiological outcomes of patients with early-onset scoliosis (EOS), who had undergone spinal fusion after distraction-based spinal growth modulation using either traditional growing rods (TGRs) or magnetically controlled growing rods (MCGRs). METHODS We undertook a retrospective review of skeletally mature patients who had undergone fusion for an EOS, which had been previously treated using either TGRs or MCGRs. Measured outcomes included sequential coronal T1 to S1 height and major curve (Cobb) angle on plain radiographs and any complications requiring unplanned surgery before final fusion. RESULTS We reviewed 43 patients (63% female) with a mean age of 6.4 years (SD 2.6) at the index procedure, and 12.2 years (SD 2.2) at final fusion. Their mean follow-up was 8.1 years (SD 3.4). A total of 16 patients were treated with MCGRs and 27 with TGRs. The mean number of distractions was 7.5 in the MCGR group and ten in the TGR group (p = 0.471). The mean interval between distractions was 3.4 months in the MCGR group and 8.6 months in the TGR group (p < 0.001). The mean Cobb angle had improved by 25.1° in the MCGR group and 23.2° in TGR group (p = 0.664) at final follow-up. The mean coronal T1 to S1 height had increased by 16% in the MCGR group and 32.9% in TGR group (p = 0.001), although the mean T1 to S1 height achieved at final follow-up was similar in both. Unplanned operations were needed in 43.8% of the MCGR group and 51.2% of TGR group (p = 0.422). CONCLUSION In this retrospective, single-centre review, there were no significant differences in major curve correction or gain in spinal height at fusion. Although the number of planned procedures were fewer in patients with MCGRs, the rates of implant-related complications needing unplanned revision surgery were similar in the two groups. Cite this article: Bone Joint J 2022;104-B(2):257-264.
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Affiliation(s)
- Muaaz Tahir
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | | | | | - Morgan Jones
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Adrian Gardner
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK.,University of Birmingham, Birmingham, UK
| | - Jwalant S Mehta
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
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Horberg JV, Bailey JR, Mikesell TA, Graham RD, Allan DG. Assessing the Weight-Bearing Surface in Dysplastic Acetabulae: The Sourcil Index. Arthroplast Today 2021; 11:56-61. [PMID: 34466639 PMCID: PMC8383000 DOI: 10.1016/j.artd.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/24/2021] [Accepted: 07/16/2021] [Indexed: 11/29/2022] Open
Abstract
Background Although a variety of standardized measurements have been described to evaluate acetabular dysplasia, no single measurement is without limitations. We describe the Sourcil Index (SI), a novel measure of the weight-bearing surface of the acetabulum on anteroposterior pelvis films. The SI is the angle formed by the medial and lateral margins of the sourcil and the center of rotation of the femoral head. Methods Anteroposterior pelvis radiographs of skeletally mature patients from 2015 were reviewed. Studies with fractures or implants were excluded. Films were read by 2 orthopedic surgeons and a radiologist 3 times each, 8 weeks apart. The SI, Sharp's Angle (SA), and lateral center edge angle (LCEA) were recorded. Pearson intraclass correlation coefficients with 95% confidence intervals were calculated. The SI was then compared to the SA and LCEA to preliminarily assess diagnostic accuracy. Results Five hundred thirty-five hips in 292 patients met inclusion. Intraobserver reliability is as follows: SI = 0.95 (0.93-0.98), LCEA = 0.89 (0.82 -0.96), and SA = 0.90 (0.85-0.96). Interobserver reliability is as follows: SI = 0.90 (0.84-0.94), SA = 0.78 (0.64-0.86), and LCEA = 0.73 (0.56-0.82). There were 51 dysplastic hips within this cohort. Conclusion The SI is a reproducible measurement on plain radiographs. The SI is a two-dimensional representation of the size of the weight-bearing surface of the acetabulum and could provide an estimation of joint contact pressures. Used with existing measures, the SI may provide a more nuanced understanding of acetabular morphology.
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Affiliation(s)
- John V Horberg
- Division of Orthopaedic Surgery, Southern Illinois University School of Medicine, Springfield, IL
| | - J Ross Bailey
- Division of Orthopaedic Surgery, Southern Illinois University School of Medicine, Springfield, IL
| | - Tim A Mikesell
- Department of Radiology, Southern Illinois University School of Medicine, Springfield, IL
| | - R David Graham
- Division of Orthopaedic Surgery, Southern Illinois University School of Medicine, Springfield, IL
| | - D Gordon Allan
- Division of Orthopaedic Surgery, Southern Illinois University School of Medicine, Springfield, IL.,Orthopaedic Center of Illinois, Springfield, IL
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Abstract
Aims The aim of this study was to present the first retrieval analysis findings of PRECICE STRYDE intermedullary nails removed from patients, providing useful information in the post-market surveillance of these recently introduced devices. Methods We collected ten nails removed from six patients, together with patient clinical data and plain radiograph imaging. We performed macro- and microscopic analysis of all surfaces and graded the presence of corrosion using validated semiquantitative scoring methods. We determined the elemental composition of surface debris using energy dispersive x-ray spectroscopy (EDS) and used metrology analysis to characterize the surface adjacent to the extendable junctions. Results All nails were removed at the end of treatment, having achieved their intended lengthening (20 mm to 65 mm) and after regenerate consolidation. All nails had evidence of corrosion localized to the screw holes and the extendable junctions; corrosion was graded as moderate at the junction of one nail and severe at the junctions of five nails. EDS analysis showed surface deposits to be chromium rich. Plain radiographs showed cortical thickening and osteolysis around the junction of six nails, corresponding to the same nails with moderate – severe junction corrosion. Conclusion We found, in fully united bones, evidence of cortical thickening and osteolysis that appeared to be associated with corrosion at the extendable junction; when corrosion was present, cortical thickening was adjacent to this junction. Further work, with greater numbers of retrievals, is required to fully understand this association between corrosion and bony changes, and the influencing surgeon, implant, and patient factors involved. Cite this article: Bone Jt Open 2021;2(8):599–610.
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Affiliation(s)
- Harry Hothi
- The Royal National Orthopaedic Hospital, London, UK
| | | | | | | | | | - Jonathan Wright
- The Royal National Orthopaedic Hospital, London, UK.,The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - John Skinner
- The Royal National Orthopaedic Hospital, London, UK
| | - Peter Calder
- The Royal National Orthopaedic Hospital, London, UK
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Kim JY, Moon JW, Ryu BY. Considerations When Diagnosing and Treating an Extra-Articular Fracture of Distal Radius Based on Plain Radiographs. J Hand Surg Asian Pac Vol 2020; 25:489-494. [PMID: 33115351 DOI: 10.1142/s2424835520500551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: The aim of this study was to investigate what should be considered when diagnosing and treating displaced extra-articular fractures based on plain radiographs. Methods: We included 181 extra-articular distal radius fractures with marked displacement requiring surgery, which were diagnosed with posteroanterior (PA) + lateral (Lat) + oblique views (obl). We compared the plain radiographs with CT scans to determine whether the diagnosis was properly made. We described the types of articular involvement incidentally found on CT scans and how the articular involvement was treated. We tested the inter-observer and intra-observer reliability with three orthopedic surgeons. Results: Forty-two (32%) out of 181 displaced extra-articular fractures diagnosed by plain radiographs had intra-articular involvement on CT scans. Dorso-ulnar intra-articular fragment was most commonly found. Thirty-three (78.6%) out of 42 intra-articular involvements required additional reduction and a dorsal approach was used in eight patients. Inter-observer and intra-observer reliability ranged from "substantial" to "almost perfect". Conclusions: When treating displaced extra-articular fractures requiring surgery, CT scans might be necessary to find intra-articular involvement and at least, an oblique view showing the dorso-ulnar corner of the articular surface should be added. Surgeons should consider that extra-articular fractures with marked displacement, which are diagnosed by plain radiographs alone, might have intra-articular involvement requiring additional reduction or fixation via a different incision.
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Affiliation(s)
- Jin Young Kim
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Ji Won Moon
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Byung Young Ryu
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyang, Korea
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Wollstein R, Kramer A, Babb J, Petchprapa C. Translation of 2-Dimensional Wrist Radiographic Measurements to 3-Dimensional CT Scans. J Hand Surg Asian Pac Vol 2020; 25:315-319. [PMID: 32723043 DOI: 10.1142/s2424835520500344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Anatomical structure affects function. The morphology of articulations dictates the way forces will travel through the joint. A better understanding of the structure and function of the wrist will enhance our ability to diagnose and treat wrist conditions. Two wrist types have been described based on the morphology of the midcarpal joint. Biomechanically it is important to see if these 2-dimensional (2D) observations reflect articular contact areas. Our purpose was to assess the correlation between measurements performed on wrist radiographs (2D) to measurements performed on 3-dimensional (3D) computed tomography (CT). Methods: Retrospective review of a database of normal wrist radiographs and corresponding normal CT scans. Only imaging pairs with normal carpal alignment and technically optimal imaging were included. Evaluations included lunate, capitate and wrist type, capitate circumference, percent capitate circumference and volume that articulates with the lunate, scapholunate ligament, scaphoid, hamate, trapezoid, base of the index and middle and ring metacarpal bones. Results: Midcarpal joint radiographic measurements were positively correlated with measurements on CT scans. Correlations were 0.51 for capitate type and 0.71 for lunate type with both p < 0.001. Percent contact of the lunate with the hamate: r was 0.74 p < 0.001. Using logistic regression analysis, percent lunate-hamate contact on CT was a significant predictor of radiographic lunate type 2 p < 0.001. Percent contact area between lunate and hamate > 7.8% on CT scan achieved a sensitivity of 100% and specificity 79.4% for a type 2 lunate. Conclusions: 1) Good correlations found between CT and plain radiographs in lunate type, capitate type, and midcarpal joint contact support the use of plain radiographs to describe contact between the carpal bones in the clinical setting. 2) The retrospective nature of this study limited the technical quality of the measurements. Volumetric analysis may aid in a more exact evaluation of surface contact area.
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Affiliation(s)
- Ronit Wollstein
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Aviv Kramer
- Department of Plastic Surgery, Israel Institute of Technology School of Medicine, Haifa, Israel
| | - James Babb
- Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - Catherine Petchprapa
- Department of Radiology, New York University School of Medicine, New York, NY, USA
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Kosy JD, Mandalia VI. Plain radiographs can be used for routine assessment of ACL reconstruction tunnel position with three-dimensional imaging reserved for research and revision surgery. Knee Surg Sports Traumatol Arthrosc 2018; 26:534-549. [PMID: 28224200 DOI: 10.1007/s00167-017-4462-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 01/30/2017] [Indexed: 01/14/2023]
Abstract
PURPOSE The position of the osseous tunnels and graft during anterior cruciate ligament (ACL) reconstruction has been the subject of multiple studies aiming for either anatomical placement or an alternative. The assessment of these positions, using post-operative imaging, is therefore of interest to the surgeon in both the evaluation of surgical performance and surveillance of potential complications. The purpose of this review is to identify the optimal use of imaging in both the surveillance of clinical practice and in planning revision surgery. METHODS A comprehensive systematic review was performed using Medline and Pubmed searches to identify radiological methods used to assess ACL reconstruction tunnel position. Commonly used methods were identified with correlation to either native anatomy or clinical results. RESULTS The findings suggest that plain radiographs can be used to assess tunnel position and identify grafts that are positioned non-anatomically and may be at increased risk of complications. Computer tomography (CT) offers additional information about the tunnel aperture shape and size that is of importance for revision surgery and research projects whilst magnetic resonance imaging (MRI) provides further assessment of both graft integrity and associated soft tissue damage. CONCLUSION In the surveillance of routine clinical practice, plain radiographs are sufficient to define tunnel position. The additional information provided by three-dimensional imaging is only required in revision surgery or research studies. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jonathan David Kosy
- ST8 Registrar in Trauma and Orthopaedics, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, UK.
| | - Vipul I Mandalia
- Consultant Orthopaedic Surgeon with Specialist Interest in Knee Surgery, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, EX2 5DW, UK
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Wheeler DL, Fredericks DC, Dryer RF, Bae HW. Allogeneic mesenchymal precursor cells (MPCs) combined with an osteoconductive scaffold to promote lumbar interbody spine fusion in an ovine model. Spine J 2016; 16:389-99. [PMID: 26291397 DOI: 10.1016/j.spinee.2015.08.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 06/22/2015] [Accepted: 08/11/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Advances in immunomagnetic cell sorting have enabled isolation and purification of pleuripotent stem cells from marrow aspirates and have expanded stem cell therapies to include allogeneic sources. PURPOSE This study aimed to determine the safety and efficacy of allogeneic mesenchymal precursor cells (MPCs) combined with an osteoconductive scaffold in lumbar interbody spinal fusion using an ovine model. STUDY DESIGN Thirty-two skeletally mature ewes underwent a single-level interbody fusion procedure using a Polyetheretherketone fusion cage supplemented with either iliac crest autograft (AG) or an osteconductive scaffold (Mastergraft Matrix, Medtronic, Memphis, TN, USA) with 2.5×10(6) MPCs, 6.25×10(6) MPCs, or 12.5×10(6) MPCs. METHODS Plain radiographs and computed tomography scans were scored for bridging bone at multiple points during healing and at necropsy. The biomechanical competency of fusion was scored by manual palpation and quantified using functional radiographs at necropsy. Postnecropsy histopathology and histomorphometric analysis assessed the local response to MPC treatment and quantified the volume and connectivity of newly formed bridging bone. Safety was assessed by serum biochemistry, hematology, and organ histopathology. RESULTS Mesenchymal precursor cell treatment caused no adverse systemic or local tissue responses. All analyses indicated MPCs combined with an osteoconductive scaffold achieved similar or better fusion success as AG treatment after 16 weeks, and increasing the MPC dose did not enhance fusion. Manual palpation of the fusion site indicated more than 75% of MPC-treated and 65% of AG-treated animals achieved rigid fusion, which was corroborated with functional radiography. Computed tomography fusion scores indicated all animals in the MPC- and AG-treatment groups were fused at 16 weeks, yet X-ray scores indicated only 67% of the AG-treated animals were fused. Histomorphometry analyses showed equivalent outcomes for fusion connectivity and bony fusion area for MPC- and AG-treated groups. Approximately 6% residual graft material remained in the MPC-treated fusion sites at 16 weeks. CONCLUSIONS Adult allogeneic MPCs delivered using an osteoconductive scaffold were both safe and efficacious in this ovine spine interbody fusion model. These results support the use ofallogeneic MPCs as an alternative to AG for lumbar interbody spinal fusion procedures.
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Tyler PA, Mohaghegh P, Foley J, Isaac A, Zavareh A, Thorning C, Kirwadi A, Pressney I, Amary F, Rajeswaran G. Tibial cortical lesions: a multimodality pictorial review. Eur J Radiol 2014; 84:123-141. [PMID: 25445894 DOI: 10.1016/j.ejrad.2014.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 07/01/2014] [Accepted: 09/09/2014] [Indexed: 11/29/2022]
Abstract
Shin pain is a common complaint, particularly in young and active patients, with a wide range of potential diagnoses and resulting implications. We review the natural history and multimodality imaging findings of the more common causes of cortically-based tibial lesions, as well as the rarer pathologies less frequently encountered in a general radiology department.
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Affiliation(s)
- P A Tyler
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP, UK.
| | - P Mohaghegh
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP, UK.
| | - J Foley
- Department of Radiology, Glasgow Royal Infirmary, 16 Alexandra Parade, Glasgow G31 2ES, UK.
| | - A Isaac
- Department of Radiology, King's College Hospital, Denmark Hill, London SE5 9RS, UK.
| | - A Zavareh
- Department of Radiology, North Bristol NHS Trust, Frenchay, Bristol BS16 1LE, UK.
| | - C Thorning
- Department of Radiology, East Surrey Hospital, Canada Avenue, Redhill, Surrey RH1 5RH, UK.
| | - A Kirwadi
- Department of Radiology, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK.
| | - I Pressney
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP, UK.
| | - F Amary
- Department of Histopathology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP, UK.
| | - G Rajeswaran
- Department of Radiology, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.
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MacKay JW, Godley KC, Toms AP, Donell ST. Trochlear boss height measurement: a comparison of radiographs and MRI. Knee 2014; 21:1052-7. [PMID: 25115655 DOI: 10.1016/j.knee.2014.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 07/01/2014] [Accepted: 07/16/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND A key anatomical consideration and determinant of surgical approach in trochlear dysplasia is the trochlear boss height (TBH), traditionally defined by measurements on plain X-rays (XR). Magnetic resonance (MR) imaging is increasingly used for pre-operative planning and follow-up. However, it is unclear whether measurement of TBH on XR is applicable to MR. The aim of this study was to establish the reliability of TBH measurement on MR compared to XR. METHODS This study used lateral knee radiographs and MR scans of 14 knees of patients with trochlear dysplasia, six knees of non-dysplastic patients with anterior knee pain (AKP), and five knees of non-dysplastic controls with no AKP. Correlation between XR and MR measurements was assessed using Pearson correlation coefficients. Agreement between methods and observers was assessed using Bland-Altman plots with 95% limits of agreement. Intra- and inter-observer reliability was assessed using intraclass correlation coefficients (ICC). RESULTS Bland-Altman charts showed a total width of 95% limits of agreement of 4.78 mm for XR and MR subchondral bone (SB) TBH measurements, and 6.73 mm for XR and MR cartilage TBH measurements. Inter-observer ICCs were 0.86 for XR, 0.62 for MR SB, and 0.53 for MR cartilage. The widths of the Bland-Altman 95% limits of agreement between observers were 4.79 mm (XR), 5.04 mm (MR SB) and 4.74 mm (MR cartilage). CONCLUSION Measurement of TBH on MR is not directly interchangeable with XR. Adjustments need to be made to treatment thresholds based on XR measurement if MR is used instead.
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Affiliation(s)
- J W MacKay
- Department of Radiology, Norfolk & Norwich University Hospital, United Kingdom
| | - K C Godley
- Department of Radiology, Norfolk & Norwich University Hospital, United Kingdom
| | - A P Toms
- Department of Radiology, Norfolk & Norwich University Hospital, United Kingdom
| | - S T Donell
- Department of Trauma & Orthopaedics, Norfolk & Norwich University Hospital, United Kingdom
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Schöneberg C, Schweiger B, Lendemans S, Waydhas C. Special considerations in the interpretation of plain radiographs of the cervical spine in children. A review of the literature. Eur J Trauma Emerg Surg 2013; 39:647-52. [PMID: 26815550 DOI: 10.1007/s00068-013-0305-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 05/19/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION This review provides an overview of the special considerations with regard to correct diagnosis of plain radiographs of the pediatric cervical spine. Injuries to the cervical spine are rare in children. The leading trauma mechanism is motor vehicle injury. Plain radiographs are a common tool in the search for a diagnosis. Taking the growth process into account there are many differences to be found compared to the adult c-spine. Knowledge of these differences is important when working towards the correct interpretation of plain radiographs of the pediatric c-spine. METHODS To create this review, a literature search of the electronic databases Cochrane, PubMed/MEDLINE and Embase was conducted. RESULTS Special considerations of plain radiographs of the pediatric c-spine are presented. Biomechanical and embryology specifics have been a focus of this review. They are explained relating on the development of the c-spine. The known auxiliary lines used in the interpreting of the pediatric c-spine are reported. A selection of these auxiliary lines is shown. CONCLUSION Knowledge of the c-spines characteristics is of major importance for every physician involved in pediatric trauma care. This could lead to not only avoiding misdiagnosis but could also lead to avoiding the overuse of computed tomography of the pediatric c-spine.
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Lee CH, Kim JH, Lee MR. Postoperative pneumoperitoneum: guilty or not guilty? J Korean Surg Soc 2012; 82:227-31. [PMID: 22493763 PMCID: PMC3319776 DOI: 10.4174/jkss.2012.82.4.227] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 01/14/2012] [Accepted: 02/02/2012] [Indexed: 11/30/2022]
Abstract
Purpose The aim of this study was to determine the incidence and duration of postoperative pneumoperitoneum on plain radiographs and to identify the radiologic findings associated with anastomotic leakage. Methods A retrospective analysis was conducted on plain radiographs of 384 patients who underwent intra-abdominal anastomoses between March 2005 and December 2008. Results Of the 384 patients, 93 patients (24.2%) had postoperative pneumoperitoneums. Of the 93 patients, 86 patients (92.5%) had physiologic pneumoperitoneums and 7 patients (7.5%) had pneumoperitoneums associated with anastomotic leakage. The initial air height was significantly greater in the leakage group than the physiologic air group (12.16 ± 7.65 mm vs. 7.71 ± 5.08 mm, P = 0.04). The area under the receiver operating characteristic curve of the initial height of free air for anastomotic leakage was 0.69 (95% confidence interval, 0.59 to 0.78). The best cut-off point was 11.7 mm. The height of the pneumoperitoneum increased with time in the leakage group. Ileus was significantly more prevalent in the leakage group than the physiologic air group (P < 0.01). Conclusion Postoperative pneumoperitoneum is a common phenomenon after abdominal surgery. An initial air height >11.7 mm, increasing air height over time, and the presence of ileus on plain radiographs suggest a high likelihood of anastomotic leakage.
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Affiliation(s)
- Chang Ho Lee
- Department of Surgery, Chonbuk National University Medical School, Jeonju, Korea
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