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Chen YP, Chan WP, Zhang HW, Tsai ZR, Peng HC, Huang SW, Jang YC, Kuo YJ. Automated osteoporosis classification and T-score prediction using hip radiographs via deep learning algorithm. Ther Adv Musculoskelet Dis 2024; 16:1759720X241237872. [PMID: 38665415 PMCID: PMC11044771 DOI: 10.1177/1759720x241237872] [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] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 02/09/2024] [Indexed: 04/28/2024] Open
Abstract
Background Despite being the gold standard for diagnosing osteoporosis, dual-energy X-ray absorptiometry (DXA) is an underutilized screening tool for osteoporosis. Objectives This study proposed and validated a controllable feature layer of a convolutional neural network (CNN) model with a preprocessing image algorithm to classify osteoporosis and predict T-score on the proximal hip region via simple hip radiographs. Design This was a single-center, retrospective study. Methods An image dataset of 3460 unilateral hip images from 1730 patients (age ⩾50 years) was retrospectively collected with matched DXA assessment for T-score for the targeted proximal hip regions to train (2473 unilateral hip images from 1430 patients) and test (497 unilateral hip images from 300 patients) the proposed CNN model. All images were processed with a fully automated CNN model, X1AI-Osteo. Results The proposed screening tool illustrated a better performance (sensitivity: 97.2%; specificity: 95.6%; positive predictive value: 95.7%; negative predictive value: 97.1%; area under the curve: 0.96) than the open-sourced CNN models in predicting osteoporosis. Moreover, when combining variables, including age, body mass index, and sex as features in the training metric, there was high consistency in the T-score on the targeted hip regions between the proposed CNN model and the DXA (r = 0.996, p < 0.001). Conclusion The proposed CNN model may identify osteoporosis and predict T-scores on the targeted hip regions from simple hip radiographs with high accuracy, highlighting the future application for population-based opportunistic osteoporosis screening with low cost and high adaptability for a broader population at risk. Trial registration TMU-JIRB N201909036.
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Affiliation(s)
- Yu-Pin Chen
- Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Wing P. Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Han-Wei Zhang
- Biomedica Corporation, New Taipei City, Taiwan
- Program for Aging, China Medical University, Taichung City, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
- Department of Electrical and Computer Engineering, Institute of Electrical Control Engineering, National Yang Ming Chiao Tung University, Hsinchu City, Hsinchu County, Taiwan
| | - Zhi-Ren Tsai
- Department of Computer Science and Information Engineering, Asia University, Taichung City, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung City, Taiwan
- Center for Precision Medicine Research, Asia University, Taichung City, Taiwann
| | | | - Shu-Wei Huang
- Department of Applied Science, National Taitung University, Taitung City, Taitung County, Taiwan
| | - Yeu-Chai Jang
- Department of Obstetrics and Gynecology, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan
| | - Yi-Jie Kuo
- Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, No. 111, Sec. 3, Xinglong Road, Wenshan, Taipei 11696, Taiwan (R.O.C.)
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Junaid Tahir M, Aymen U, Mehmood Q, Sohaib Asghar M, Kumari U, Hassan Z, Naz N, Rafiq N, Tayyeb M, Ullah I, Abbasher Hussien Mohamed Ahmed K, Alwalid O. Digital eye strain and its associated factors among radiology physicians in Pakistan: a cross-sectional survey using logistic regression analysis. Ann Med Surg (Lond) 2024; 86:1933-1941. [PMID: 38576948 PMCID: PMC10990352 DOI: 10.1097/ms9.0000000000001882] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 02/20/2024] [Indexed: 04/06/2024] Open
Abstract
Background and aims Increased use of digital devices in the modern era has led to the development of digital eye strain (DES) or computer vision syndrome in their users. This can result in the development of various ocular and visual symptoms among them. In this study, the authors aimed to view the prevalence of digital eye strain among radiology physicians in Pakistan and their associated risk factors. Materials and methods A cross-sectional study was conducted to evaluate occupational DES among radiology physicians in Pakistan. The data collection was done using the convenience sampling technique, and the data were analyzed using IBM SPSS for Windows, Version 25.0. Results Out of the 247 respondents, 33.6% were males and 66.4% were females. 41.7% of them were between 30 and 40 years of age and 51.8% of them were radiology residents. 52.2% of the participants had a refractive error and were using a corrective lens. The majority of the radiologists in our study (84.2%) preferred picture archiving and communication system (PACS) over films and 82.2% of them reported having breaks of less than 15 min. Major symptoms reported by the participants were tired or heavy eyes (69.6%) and headache (69.3%). The proportion of developing DES was higher in females [P=0.001, adjusted odds ratio (aOR)=2.94], radiology residents (P=0.031, aOR=3.29), and working hours of more than 4 h per day (P<0.001, aOR=0.04). Conclusion With recent advances in the field of radiology in Pakistan, the frequency of developing DES among radiologists is increasing. Being a female, having long working hours, and having noticeable flickers on the digital screens were among the significant factors in developing DES among radiologists.
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Affiliation(s)
| | | | | | | | | | | | | | - Nida Rafiq
- Dow University of Health Sciences, Karachi
| | | | - Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar
| | | | - Osamah Alwalid
- Department of Diagnostic Imaging, Sidra Medicine, Doha, Qatar
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Roels J, Genevois JP, Fostier-Humbert M, Porsmoguer C, Blondel M, Chanoit G, Fau D, Cachon T. Prevalence of elbow dysplasia in 13 dog breeds in France: a retrospective radiographic study (2002-2022). Am J Vet Res 2024:1-8. [PMID: 38518402 DOI: 10.2460/ajvr.23.12.0290] [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: 12/22/2023] [Accepted: 03/05/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE To describe the prevalence of elbow dysplasia (ED) in 13 dog breeds in France. ANIMALS A total of 18,870 elbow radiographs taken from 2002 to 2022 were evaluated by 2 independent examiners. METHODS For each breed, the incidence of each of the 4 International Elbow Working Group scoring classes was extracted from the database. Breeds were excluded if fewer than 150 radiographs had been read for that breed. RESULTS This study included 17,861 records for 13 dog breeds: American Akita, Alaskan Malamute, Old German Shepherd (Altdeutscher Schäferhund), American Staffordshire Terrier, Australian Shepherd, Belgian Shepherd, White Swiss Shepherd, Bernese Mountain Dog, Cane Corso, Czechoslovakian Wolfdog, Rhodesian Ridgeback, Rottweiler, and Dogue de Bordeaux. The overall prevalence of ED was 11.4%, ranging from 1.1% in the Czechoslovakian Wolfdog to 32.2% in the Dogue de Bordeaux. The Dogue de Bordeaux, Rottweiler, Bernese Mountain Dog, and Cane Corso breeds were most commonly affected by ED. The prevalence of ED was significantly higher in male dogs than in female dogs (17.5% vs 10.5%, P < .05). Joint incongruity and fragmented coronoid process were the 2 most common primary ED lesions identified. The prevalence of ED among the dogs evaluated decreased over the timeframe of the study. CLINICAL RELEVANCE The results of this study help to clarify the prevalence of ED in different breeds in France. These data should be interpreted with caution as this study included a small percentage of the total number of dogs born for each breed in France over the study period.
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Affiliation(s)
- Joséphine Roels
- Surgery Unit, Lyon Veterinary Teaching Hospital, University of Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France
- Research Unit ICE, UPSP 2016-A104, University of Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France
| | - Jean-Pierre Genevois
- Surgery Unit, Lyon Veterinary Teaching Hospital, University of Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France
- Research Unit ICE, UPSP 2016-A104, University of Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France
| | - Mathilde Fostier-Humbert
- Surgery Unit, Lyon Veterinary Teaching Hospital, University of Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France
- Research Unit ICE, UPSP 2016-A104, University of Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France
| | - Charles Porsmoguer
- Surgery Unit, Lyon Veterinary Teaching Hospital, University of Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France
- Research Unit ICE, UPSP 2016-A104, University of Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France
| | - Margaux Blondel
- Surgery Unit, Lyon Veterinary Teaching Hospital, University of Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France
- Research Unit ICE, UPSP 2016-A104, University of Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France
| | - Guillaume Chanoit
- Surgery Unit, Lyon Veterinary Teaching Hospital, University of Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France
- Research Unit ICE, UPSP 2016-A104, University of Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France
| | - Didier Fau
- Surgery Unit, Lyon Veterinary Teaching Hospital, University of Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France
- Research Unit ICE, UPSP 2016-A104, University of Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France
| | - Thibaut Cachon
- Surgery Unit, Lyon Veterinary Teaching Hospital, University of Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France
- Research Unit ICE, UPSP 2016-A104, University of Lyon, Veterinary Campus of VetAgro Sup, Marcy l'Etoile, France
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Kamiński P, Nurzynska K, Kwiecień J, Obuchowicz R, Piórkowski A, Pociask E, Stępień A, Kociołek M, Strzelecki M, Augustyniak P. Sex Differentiation of Trabecular Bone Structure Based on Textural Analysis of Pelvic Radiographs. J Clin Med 2024; 13:1904. [PMID: 38610669 PMCID: PMC11012966 DOI: 10.3390/jcm13071904] [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: 01/31/2024] [Revised: 03/14/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Objectives: The purpose of this paper is to assess the determination of male and female sex from trabecular bone structures in the pelvic region. The study involved analyzing digital radiographs for 343 patients and identifying fourteen areas of interest based on their medical significance, with seven regions on each side of the body for symmetry. Methods: Textural parameters for each region were obtained using various methods, and a thorough investigation of data normalization was conducted. Feature selection approaches were then evaluated to determine a small set of the most representative features, which were input into several classification machine learning models. Results: The findings revealed a sex-dependent correlation in the bone structure observed in X-ray images, with the degree of dependency varying based on the anatomical location. Notably, the femoral neck and ischium regions exhibited distinctive characteristics between sexes. Conclusions: This insight is crucial for medical professionals seeking to estimate sex dependencies from such image data. For these four specific areas, the balanced accuracy exceeded 70%. The results demonstrated symmetry, confirming the genuine dependencies in the trabecular bone structures.
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Affiliation(s)
- Paweł Kamiński
- Clinic of Locomotor Disorders, Andrzej Frycz Modrzewski Krakow University, 30-705 Krakow, Poland;
- Małopolska Orthopedic and Rehabilitation Hospital, Modrzewiowa 22, 30-224 Krakow, Poland
| | - Karolina Nurzynska
- Department of Algorithmics and Software, Silesian University of Technology, 44-100 Gliwice, Poland
| | - Joanna Kwiecień
- Department of Automatic Control and Robotics, AGH University of Krakow, 30-059 Krakow, Poland;
| | - Rafał Obuchowicz
- Department of Diagnostic Imaging, Jagiellonian University Medical College, Kopernika 19, 31–501 Krakow, Poland;
| | - Adam Piórkowski
- Department of Biocybernetics and Biomedical Engineering, AGH University of Krakow, 30-059 Krakow, Poland (E.P.); (P.A.)
| | - Elżbieta Pociask
- Department of Biocybernetics and Biomedical Engineering, AGH University of Krakow, 30-059 Krakow, Poland (E.P.); (P.A.)
| | | | - Marcin Kociołek
- Institute of Electronics, Lodz University of Technology, 93-590 Lodz, Poland; (M.K.); (M.S.)
| | - Michał Strzelecki
- Institute of Electronics, Lodz University of Technology, 93-590 Lodz, Poland; (M.K.); (M.S.)
| | - Piotr Augustyniak
- Department of Biocybernetics and Biomedical Engineering, AGH University of Krakow, 30-059 Krakow, Poland (E.P.); (P.A.)
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Wan HTS, Wong DLL, To CHS, Meng N, Zhang T, Cheung JPY. 3D prediction of curve progression in adolescent idiopathic scoliosis based on biplanar radiological reconstruction. Bone Jt Open 2024; 5:243-251. [PMID: 38522456 PMCID: PMC10961174 DOI: 10.1302/2633-1462.53.bjo-2023-0176.r1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
Aims This systematic review aims to identify 3D predictors derived from biplanar reconstruction, and to describe current methods for improving curve prediction in patients with mild adolescent idiopathic scoliosis. Methods A comprehensive search was conducted by three independent investigators on MEDLINE, PubMed, Web of Science, and Cochrane Library. Search terms included "adolescent idiopathic scoliosis","3D", and "progression". The inclusion and exclusion criteria were carefully defined to include clinical studies. Risk of bias was assessed with the Quality in Prognostic Studies tool (QUIPS) and Appraisal tool for Cross-Sectional Studies (AXIS), and level of evidence for each predictor was rated with the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. In all, 915 publications were identified, with 377 articles subjected to full-text screening; overall, 31 articles were included. Results Torsion index (TI) and apical vertebral rotation (AVR) were identified as accurate predictors of curve progression in early visits. Initial TI > 3.7° and AVR > 5.8° were predictive of curve progression. Thoracic hypokyphosis was inconsistently observed in progressive curves with weak evidence. While sagittal wedging was observed in mild curves, there is insufficient evidence for its correlation with curve progression. In curves with initial Cobb angle < 25°, Cobb angle was a poor predictor for future curve progression. Prediction accuracy was improved by incorporating serial reconstructions in stepwise layers. However, a lack of post-hoc analysis was identified in studies involving geometrical models. Conclusion For patients with mild curves, TI and AVR were identified as predictors of curve progression, with TI > 3.7° and AVR > 5.8° found to be important thresholds. Cobb angle acts as a poor predictor in mild curves, and more investigations are required to assess thoracic kyphosis and wedging as predictors. Cumulative reconstruction of radiographs improves prediction accuracy. Comprehensive analysis between progressive and non-progressive curves is recommended to extract meaningful thresholds for clinical prognostication.
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Affiliation(s)
- Hiu-Tung S. Wan
- Department of Orthopaedics & Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Darren L. L. Wong
- Department of Orthopaedics & Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Ching-Hang S. To
- Department of Orthopaedics & Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Nan Meng
- Department of Orthopaedics & Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Teng Zhang
- Department of Orthopaedics & Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Jason P. Y. Cheung
- Department of Orthopaedics & Traumatology, The University of Hong Kong, Hong Kong SAR, China
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Adams BJ, Butler E, Fuehr SM, Olivares-Pérez F, Tamayo AS. Radiographic age estimation based on degenerative changes of vertebrae. J Forensic Sci 2024; 69:391-399. [PMID: 37924233 DOI: 10.1111/1556-4029.15422] [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] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 11/06/2023]
Abstract
Age estimation is an important component of decedent identification. When assessing adult remains, anthropologists frequently use gross examination of skeletal elements, such as clavicles, ribs, and pubic symphyses. For fleshed bodies, this requires the removal of these elements and maceration prior to analysis. A new method was developed using radiographic imaging to estimate age from degenerative changes of the lower thoracic and upper lumbar vertebrae. This technique will complement anthropological age estimation methods in young and middle-aged adults and may serve as a stand-alone method for older individuals. Digital radiographs from 240 medical examiner cases were evaluated. The sample included 120 females and 120 males between the ages of 18 and 101 years. A 3-phased scoring system was used for the target vertebrae. Transition analysis was conducted on binned average scores and a Bayesian approach was used to assign age intervals. At the 90% credible interval, individuals in Bin 1 were under 36 years of age while those in Bin 3 were over 47 years of age. Individuals in Bin 2 showed too much age variation to be informative. No significant differences were found between males and females. These findings will be especially useful in the age estimation of older adults and may eliminate the need for skeletal sampling in medicolegal cases where advanced degenerative changes are radiographically observed in the lower thoracic and/or upper lumbar vertebrae. This method was developed for use on fleshed individuals but may also be applicable to skeletonized remains.
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Affiliation(s)
- Bradley J Adams
- New York City Office of Chief Medical Examiner, New York, New York, USA
| | - Erin Butler
- New York City Office of Chief Medical Examiner, New York, New York, USA
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Jackson NJ, Root KT, Nichols JA, Reb CW. Image Rotation Alters Apparent Fibula Length: An Evaluation of Talocrural Angle, Shenton Line, and Dime Sign. Foot Ankle Int 2024; 45:236-242. [PMID: 38240153 DOI: 10.1177/10711007231221991] [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] [Indexed: 03/24/2024]
Abstract
BACKGROUND Fibula shortening can compromise ankle stability and force transmission, thereby impacting clinical outcomes. Because radiographs depict 3-dimensional anatomy in 2 dimensions, accurate radiographic assessment of fibula length is a commonly encountered clinical challenge. The talocrural angle (TCA), Shenton line, and dime sign are useful parameters of fibula length. Yet, the impact of 3-dimensional limb positioning on these radiographic parameters is not established. METHODS Bone models were constructed from CT scans of 30 lower limbs. Fibula length was computationally manipulated, and digitally reconstructed radiographs were generated reflecting 1-degree increments of sagittal and axial plane rotation of each limb for each fibula length condition. The TCA was computationally measured on each image. The presence of an aligned mortise view, intact Shenton line, and intact dime sign was assessed by 2 observers. RESULTS The mean TCA, which was 78.0 (95% CI ± 1.6) degrees for a true mortise projection with anatomic fibula length, changed by approximately 1 degree per millimeter of fibula length change. On average, 14.7 degrees of caudal rotation obscured 2 mm of fibular shortening by virtue of producing the same TCA as a true mortise view with anatomic fibula length, designated a false positive view. Axial rotation had a comparatively small effect. Observers 1 and 2 were, respectively, 91% and 88% less likely to accurately judge the image alignment of the false positive images compared to true mortise images. Moreover, intraobserver agreement was poor to moderate (mean 0.47, range 0.13-0.59) and interobserver agreement was uniformly poor (mean 0.08, range 0.01-0.20). CONCLUSION In our study using digitally reconstructed radiographs from CT scans of 30 limbs, we found that sagittal plane rotation impacts the radiographic appearance of fibula length as measured by the TCA. Limb axial rotation had a comparatively small effect. Further study of human perception of Shenton line and dime sign is needed before the effect of rotation on these parameters can be fully understood. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Nicholas J Jackson
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Kevin T Root
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jennifer A Nichols
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL, USA
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Archer H, Reine S, Ramachandran S, Koay J, Liu G, Wukich DK, Chhabra A. Correlation Between Traditional Anteroposterior Radiographic Measurements With Lateral Radiographic Measurements Following Triplanar Correction of Hallux Valgus and With Patient-Reported Outcomes From a Prospective Multicenter Trial. J Foot Ankle Surg 2024; 63:226-232. [PMID: 37984694 DOI: 10.1053/j.jfas.2023.11.005] [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: 06/06/2023] [Revised: 11/03/2023] [Accepted: 11/11/2023] [Indexed: 11/22/2023]
Abstract
Hallux valgus (HV) is a common condition in which the first ray is deformed, leading to pain and altered joint mechanics. A variety of radiographic measurements are used to evaluate HV. Little is known about measurements used in the assessment of HV on lateral radiographs compared to anteroposterior (AP) radiographs. The primary aim of this study was to correlate lateral measurements with AP measurements pre and postoperatively. The secondary aim was to correlate lateral measurements with patient-reported outcome measures (PROMs) pre and postoperatively. One hundred eighty-three patients were initially enrolled in the study. Two fellowship-trained musculoskeletal radiologists independently performed all measurements. On AP radiographs, hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured. On lateral radiographs, sagittal IMA, Meary's angle, and sagittal first ray length were measured. Measurements were recorded at baseline and 6, 12, and 24 months postoperatively. Intraclass correlation coefficients (ICCs) were used for inter-reader analysis. ICCs were moderate to very strong among readers. There were significant but weak correlations between lateral measurements and AP measurements. For at least 1 timepoint, IMA correlated with sagittal IMA, sagittal first ray length, and Meary's angle. HVA only correlated with sagittal first ray length. These correlations were all weak in magnitude. There were a few significant but weak correlations between the measurements in the study and PROMs. This study showed that sagittal IMA, sagittal first ray length, and Meary's angle are not predictive of AP measurements or patient outcomes and are not useful in preoperative assessment of HV.
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Affiliation(s)
- Holden Archer
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Seth Reine
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | - George Liu
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Dane K Wukich
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Avneesh Chhabra
- University of Texas Southwestern Medical Center, Dallas, TX.
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Holzbauer M, Raher W, Kobler E, Froschauer SM. Periprosthetic radiolucency in total wrist arthroplasty: a radiographic study. J Hand Surg Eur Vol 2024:17531934241232059. [PMID: 38366378 DOI: 10.1177/17531934241232059] [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] [Indexed: 02/18/2024]
Abstract
This retrospective study investigates the incidences of periprosthetic radiolucency and the position of the prosthesis in patients who underwent total wrist arthroplasty. A total of 50 patients with a mean age of 58 years (SD 11) were included. The available dorsopalmar and lateral radiographs were categorized into the following groups: immediately postoperative and 1, 2, 3, 5 and beyond 6 years postoperatively. The findings of this study indicate that periprosthetic radiolucency is a progressive phenomenon that originates at the bone adjacent to the joint line, possibly due to stress shielding. The size of the periprosthetic radiolucency showed no correlation with any clinical parameter, nor can its size be predicted by intraoperative implant positioning. However, a significant correlation was observed between a reduced implant-middle finger carpometacarpal distance and higher postoperative pain levels as well as patient dissatisfaction. Revision surgery after total wrist arthroplasty should not be solely guided by radiological signs of periprosthetic radiolucency. Instead, this study suggests that consideration for revision surgery should be reserved for symptomatic patients experiencing persistent pain and swelling accompanied by radiographic evidence of carpal implant subsidence.Level of evidence: IV.
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Affiliation(s)
- Matthias Holzbauer
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Austria
- Johannes Kepler University Linz, Medical Faculty, Linz, Austria
| | - Wolfgang Raher
- Johannes Kepler University Linz, Medical Faculty, Linz, Austria
| | - Erich Kobler
- Department of Neuroradiology, University Medical Center Bonn, Bonn, Germany
| | - Stefan M Froschauer
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Austria
- Johannes Kepler University Linz, Medical Faculty, Linz, Austria
- Diakonissen Clinic Linz, Linz, Austria
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Plant CE, Ooms A, Cook JA, Costa ML. Radiological outcomes following surgical fixation with wires versus moulded cast for patients with a dorsally displaced fracture of the distal radius: a radiographic analysis from the DRAFFT2 trial. Bone Jt Open 2024; 5:132-138. [PMID: 38346449 PMCID: PMC10861272 DOI: 10.1302/2633-1462.52.bjo-2023-0149] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Aims The primary aim of this study was to report the radiological outcomes of patients with a dorsally displaced distal radius fracture who were randomized to a moulded cast or surgical fixation with wires following manipulation and closed reduction of their fracture. The secondary aim was to correlate radiological outcomes with patient-reported outcome measures (PROMs) in the year following injury. Methods Participants were recruited as part of DRAFFT2, a UK multicentre clinical trial. Participants were aged 16 years or over with a dorsally displaced distal radius fracture, and were eligible for the trial if they needed a manipulation of their fracture, as recommended by their treating surgeon. Participants were randomly allocated on a 1:1 ratio to moulded cast or Kirschner wires after manipulation of the fracture in the operating theatre. Standard posteroanterior and lateral radiographs were performed in the radiology department of participating centres at the time of the patient's initial assessment in the emergency department and six weeks postoperatively. Intraoperative fluoroscopic images taken at the time of fracture reduction were also assessed. Results Patients treated with surgical fixation with wires had less dorsal angulation of the radius versus those treated in a moulded cast at six weeks after manipulation of the fracture; the mean difference of -4.13° was statistically significant (95% confidence interval 5.82 to -2.45). There was no evidence of a difference in radial shortening. However, there was no correlation between these radiological measurements and PROMs at any timepoint in the 12 months post-injury. Conclusion For patients with a dorsally displaced distal radius fracture treated with a closed manipulation, surgical fixation with wires leads to less dorsal angulation on radiographs at six weeks compared with patients treated in a moulded plaster cast alone. However, the difference in dorsal angulation was small and did not correlate with patient-reported pain and function.
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Affiliation(s)
- Caroline E. Plant
- Oxford Trauma and Emergency Care, NDORMS, University of Oxford, Oxford, UK
- Trauma and Orthopaedic Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Alexander Ooms
- Oxford Clinical Trials, Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Jonathan A. Cook
- Oxford Clinical Trials, Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Matthew L. Costa
- Oxford Trauma and Emergency Care, NDORMS, University of Oxford, Oxford, UK
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11
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Jang SJ, Kunze KN, Casey JC, Steele JR, Mayman DJ, Jerabek SA, Sculco PK, Vigdorchik JM. Variability of the femoral mechanical-anatomical axis angle and its implications in primary and revision total knee arthroplasty. Bone Jt Open 2024; 5:101-108. [PMID: 38316146 PMCID: PMC10843864 DOI: 10.1302/2633-1462.52.bjo-2023-0056.r1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
Aims Distal femoral resection in conventional total knee arthroplasty (TKA) utilizes an intramedullary guide to determine coronal alignment, commonly planned for 5° of valgus. However, a standard 5° resection angle may contribute to malalignment in patients with variability in the femoral anatomical and mechanical axis angle. The purpose of the study was to leverage deep learning (DL) to measure the femoral mechanical-anatomical axis angle (FMAA) in a heterogeneous cohort. Methods Patients with full-limb radiographs from the Osteoarthritis Initiative were included. A DL workflow was created to measure the FMAA and validated against human measurements. To reflect potential intramedullary guide placement during manual TKA, two different FMAAs were calculated either using a line approximating the entire diaphyseal shaft, and a line connecting the apex of the femoral intercondylar sulcus to the centre of the diaphysis. The proportion of FMAAs outside a range of 5.0° (SD 2.0°) was calculated for both definitions, and FMAA was compared using univariate analyses across sex, BMI, knee alignment, and femur length. Results The algorithm measured 1,078 radiographs at a rate of 12.6 s/image (2,156 unique measurements in 3.8 hours). There was no significant difference or bias between reader and algorithm measurements for the FMAA (p = 0.130 to 0.563). The FMAA was 6.3° (SD 1.0°; 25% outside range of 5.0° (SD 2.0°)) using definition one and 4.6° (SD 1.3°; 13% outside range of 5.0° (SD 2.0°)) using definition two. Differences between males and females were observed using definition two (males more valgus; p < 0.001). Conclusion We developed a rapid and accurate DL tool to quantify the FMAA. Considerable variation with different measurement approaches for the FMAA supports that patient-specific anatomy and surgeon-dependent technique must be accounted for when correcting for the FMAA using an intramedullary guide. The angle between the mechanical and anatomical axes of the femur fell outside the range of 5.0° (SD 2.0°) for nearly a quarter of patients.
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Affiliation(s)
- Seong J. Jang
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Kyle N. Kunze
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
| | - Jack C. Casey
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
- Warren Alpert Medical School of Brown University, Providence, USA
| | - Jack R. Steele
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
| | - David J. Mayman
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
| | - Seth A. Jerabek
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
| | - Peter K. Sculco
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
| | - Jonathan M. Vigdorchik
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
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12
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Alamoudi RA. The Role of an Endodontist in Victim Identification: A Narrative Review on Forensic Endodontics. Cureus 2024; 16:e53391. [PMID: 38435194 PMCID: PMC10908307 DOI: 10.7759/cureus.53391] [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] [Accepted: 02/01/2024] [Indexed: 03/05/2024] Open
Abstract
This narrative review highlights the role of endodontists and the significance of various dental tools in forensic dentistry. An online search was conducted in peer-reviewed journals, including MEDLINE (Ovid), PubMed, Web of Science, Scopus, and Google Scholar databases, to retrieve studies regarding "the role of an endodontist in victim identification using different tools". The searches used controlled vocabulary and free-text terms. Articles written in English and published from 1923 to 2023 were selected. An essential stage in forensic dentistry is dental identification of the dead person and is regarded as an initial step for both judicial and humanitarian purposes if fingerprint records are missing or the remains have undergone significant changes. Endodontists should be aware of all available dental tools that aid in identification. The four fundamental tools for identification are dental radiographs, hard and soft dental structures, and dental materials. Dental radiographs provide a substantial nondestructive record for estimating age and sex. Moreover, maxillofacial hard and soft structures provide important tools for individual identification as they are considered the strongest structures in the human body and can withstand severe chemical and temperature changes. In addition, endodontic and restorative materials can be identified under different conditions and serve as excellent forensic identification measures.
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Affiliation(s)
- Ruaa A Alamoudi
- Endodontics Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
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13
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Elsawaf AE, Deri AYA, Armanious PS, Khasawneh AM, AlKhaja AM, Yasin AR, Al-Rawi NH, Kawas SA, Shetty SR. Efficiency of Near-Infrared Technology in the Clinical Detection of Carious Lesions: A Systematic Review. Eur J Dent 2024; 18:14-25. [PMID: 36870328 PMCID: PMC10959616 DOI: 10.1055/s-0043-1761187] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/06/2023] Open
Abstract
The field of dentistry has seen various technological advances regarding caries detection, some lesions still prove to be difficult to detect. A reasonably new detection method, near-infrared (NIR), has shown good results in caries detection. This systematic review aims to compare NIR with conventional methods in terms of caries detection. Online databases (PubMed, Scopus, ScienceDirect, EBSCO, and ProQuest) were used for the literature search. The search was performed from January 2015 till December-2020. A total of 770 articles were selected, of that 17 articles qualified for the final analysis as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The articles were assessed according to a modified Critical Appraisal Skills Programme checklist, and then synthesis of the review started. The inclusion criteria were clinical trials done in vivo on teeth with active caries of vital or nonvital teeth. This review excluded nonpeer reviewed articles, case reports, case series, opinions, abstracts, non-English written articles, studies of subjects with arrested caries, or teeth with developmental defects of tooth structure and teeth having environmental defects of tooth structure, as well as in-vitro studies. The review compared near-infrared technology with radiography, visual inspection, and laser fluorescence in terms of caries detection, sensitivity, specificity, and accuracy. The sensitivity of NIR ranged from 99.1 to 29.1%. Studies showed that NIR exhibited higher sensitivity for occlusal enamel and dentin caries. The specificity of NIR ranged from 94.1 to 20.0%. In enamel and dentinal occlusal caries, NIR demonstrated lower specificity than that of radiograph. The specificity of NIR in early proximal caries was low. Accuracy was determined in 5 out of 17 studies where the values ranged from 97.1 to 29.1%. The accuracy of NIR was the highest for dentinal occlusal caries. NIR shows promising evidence as an adjunct in caries examination due to its high sensitivity and specificity; however, more studies are required to determine its full potential in different situations.
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Affiliation(s)
- Ahmed Essam Elsawaf
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | | | | | | | | | - Ahmad Ribhi Yasin
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | | | - Sausan Al Kawas
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Shishir Ram Shetty
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
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14
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Lee JK, Kim DH, Hyun SJ, Yang SH, Kim KJ. Radiographic outcomes following surgical correction for lumbar degenerative kyphosis: the impact of supine pelvic tilt. J Neurosurg Spine 2024; 40:132-142. [PMID: 38000072 DOI: 10.3171/2023.9.spine23155] [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] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/15/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVE Lumbar degenerative kyphosis (LDK), a flexible deformity, is a common form of sagittal imbalance in Asian countries. Assessing a patient's spine prior to surgery by using positional radiographs is becoming more crucial in determining surgical planning to achieve favorable clinical and radiographic outcomes, especially in patients with flexible deformities. This study aims to identify radiographic characteristics of supine pelvic tilt (sPT) and its relation to mechanical failure (MF) following LDK correction. METHODS A single-center, single-surgeon retrospective analysis was performed in patients who underwent LDK correction with sacropelvic fixation between January 2014 and May 2019. Patients were grouped into pelvic match and mismatch groups according to the difference between postoperative pelvic tilt (PT) and sPT. Demographic, surgical, and radiographic parameters were compared. Chronological change of PT was assessed by comparing preoperative, supine, immediate postoperative, and final PT. RESULTS Baseline demographics and sagittal alignments were similar between PT match (n = 25) and mismatch (n = 42) groups (p > 0.05). There was a significant difference in the rate of MF between PT match and mismatch groups (4% vs 31%, p = 0.021). Multivariable analysis demonstrated that after including control variables, PT mismatch was independently associated with the likelihood of MF development (OR 33.42, p = 0.04). CONCLUSIONS sPT reflects postoperative PT changes; therefore, supine imaging may represent a tool that could be used for preoperative decision-making in patients with LDK or possibly those with flexible adult spinal deformity. PT mismatch > 10° or < 0° is a significant risk factor for MF following correction of LDK. Measurement of sPT would aid surgeons in optimal preoperative planning and in minimizing catastrophic MF following deformity correction surgery.
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Affiliation(s)
- Jae-Koo Lee
- 1Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam
| | - Do-Hyoung Kim
- 2Department of Neurosurgery, Spine Center, Yonsei Okay Hospital, Uijeongbu-si, Gyeonggi-do; and
| | - Seung-Jae Hyun
- 1Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam
| | - Seung Heon Yang
- 3Department of Neurosurgery, Spine Center, Seoul Barun Hospital, Seoul, Republic of Korea
| | - Ki-Jeong Kim
- 1Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam
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15
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Alm CE, Karlsten A, Madsen JE, Nordsletten L, Brattgjerd JE, Pripp AH, Frihagen F, Röhrl SM. No benefit of the trochanteric stabilizing plate on loss of fracture reduction in AO/OTA 31-A2 trochanteric fractures. Bone Jt Open 2024; 5:37-45. [PMID: 38240179 PMCID: PMC10797560 DOI: 10.1302/2633-1462.51.bjo-2023-0082.r1] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2024] Open
Abstract
Aims Despite limited clinical scientific backing, an additional trochanteric stabilizing plate (TSP) has been advocated when treating unstable trochanteric fractures with a sliding hip screw (SHS). We aimed to explore whether the TSP would result in less post operative fracture motion, compared to SHS alone. Methods Overall, 31 patients with AO/OTA 31-A2 trochanteric fractures were randomized to either a SHS alone or a SHS with an additional TSP. To compare postoperative fracture motion, radiostereometric analysis (RSA) was performed before and after weightbearing, and then at four, eight, 12, 26, and 52 weeks. With the "after weightbearing" images as baseline, we calculated translations and rotations, including shortening and medialization of the femoral shaft. Results Similar migration profiles were observed in all directions during the course of healing. At one year, eight patients in the SHS group and 12 patients in the TSP group were available for analysis, finding a clinically non-relevant, and statistically non-significant, difference in total translation of 1 mm (95% confidence interval -4.7 to 2.9) in favour of the TSP group. In line with the migration data, no significant differences in clinical outcomes were found. Conclusion The TSP did not influence the course of healing or postoperative fracture motion compared to SHS alone. Based on our results, routine use of the TSP in AO/OTA 31-A2 trochanteric fractures cannot be recommended. The TSP has been shown, in biomechanical studies, to increase stability in sliding hip screw constructs in both unstable and intermediate stable trochanteric fractures, but the clinical evidence is limited. This study showed no advantage of the TSP in unstable (AO 31-A2) fractures in elderly patients when fracture movement was evaluated with radiostereometric analysis.
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Affiliation(s)
- Carl E. Alm
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Jan E. Madsen
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lars Nordsletten
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jan E. Brattgjerd
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Are H. Pripp
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo, Norway
| | - Frede Frihagen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Orthopaedic Surgery, Østfold Hospital Trust, Grålum, Norway
| | - Stephan M. Röhrl
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Çoban Büyükbayraktar Z, Eninanç İ. Assessment of mandibular trabecular structure and cervical vertebral maturation using fractal analysis. Technol Health Care 2024; 32:1211-1221. [PMID: 38043029 DOI: 10.3233/thc-231100] [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] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
BACKGROUND Changes in bone trabeculae occur during skeletal maturation. Fractal analysis is a technique for assessing changes in the internal structure of the bone. OBJECTIVE The aim of this study was to investigate correlation of bone trabeculation measured on panoramic and lateral cephalometric radiographs with cervical vertebral maturation stages (CVMS). METHODS CVMS was evaluated on lateral cephalometric radiographs of 120 individuals aged 6 to 18 years. The subjects were divided into 6 groups (n= 20 each) according to CVMS. On panoramic and lateral cephalometric radiographs, fractal dimension (FD) analyses were performed in mandibular corpus, gonial and condylar regions and cervical vertebral bodies (C2, C3, C4). RESULTS FD measurements from the mandibular corpus region bilaterally and C2-C4 vertebral bodies showed significant positive correlations with CVMS (r= 0.418, r= 0.412, r= 0.324, r= 0.304, r= 0.263, respectively). Significant differences were found in the FD values of the right/left mandibular corpus and C2 and C3 vertebrae compared to CVMS (P< 0.001, P< 0.001, P= 0.005, P= 0.019, respectively). CONCLUSION Significant positive moderate correlations between the FD values of the right and left mandibular corpus and CVMS suggest that fractal analysis may be useful in determining skeletal maturity stage. The significant FD values obtained from the right/left mandibular corpus, and C2 and C3 vertebra indicate that the complexity of the internal trabecular structure increases with maturation.
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Affiliation(s)
| | - İlknur Eninanç
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Sivas Cumhuriyet University, Sivas, Turkey
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17
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Zhao Y, Zhu Y, Lu Y, Li F, Jiang C. Does age affect patient outcomes after humeral head replacement in the treatment of acute proximal humeral fractures? A comparative cohort study with a minimum 10 years long-term follow-up. J Shoulder Elbow Surg 2024; 33:46-54. [PMID: 37331501 DOI: 10.1016/j.jse.2023.05.017] [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: 12/08/2022] [Revised: 04/25/2023] [Accepted: 05/06/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Humeral head replacement (HHR) is now rarely recommended for complex proximal humeral fractures (PHFs) in older patients. However, in relatively young and active patients with unreconstructable complex PHFs, controversy still exists regarding the treatment options of reverse shoulder arthroplasty and HHR. The goal of this study was to compare the survival, functional, and radiographic outcomes of HHR in patients aged <70 years and those aged ≥70 years after a minimum 10 years follow-up. METHODS Eighty-seven out of 135 patients undergoing primary HHR were enrolled and then divided into 2 groups based on age: <70 years and ≥70 years. Clinical and radiographic evaluations were performed with a minimum follow-up of 10 years. RESULTS There were 64 patients (mean, 54.9 years) in the younger group and 23 patients (mean, 73.5 years) in the older group. The younger and older groups had comparable 10-year implant survivorship (98.4% vs. 91.3%). Patients aged ≥70 years had worse American Shoulder and Elbow Surgeons scores (74.2 vs. 81.0, P = .042) and lower satisfaction rates (12% vs. 64%, P < .001) than younger patients. At the final follow-up, older patients had worse forward flexion (117° vs. 129°, P = .047) and internal rotation (17 vs. 15, P = .036). More greater tuberosity complications (39% vs. 16%, P = .019), glenoid erosion (100% vs. 59%, P = .077), and humeral head superior migration (80% vs. 31%, P = .037) were also identified in patients aged ≥70 years. CONCLUSIONS Unlike the increased risk for revision and functional deterioration over time after reverse shoulder arthroplasty for PHFs in younger patients, a high implant survival rate with lasting pain relief and stable functional outcomes could be observed in younger patients after HHR during long-term follow-up. Patients aged ≥70 years had worse clinical outcomes, lower patient satisfaction, more greater tuberosity complications, and more glenoid erosion and humeral head superior migration than those aged <70 years. HHR should not be recommended for the treatment of unreconstructable complex acute PHFs in older patient populations.
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Affiliation(s)
- Yang Zhao
- Department of Sports Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Yiming Zhu
- Department of Sports Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Yi Lu
- Department of Sports Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Fenglong Li
- Department of Sports Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Chunyan Jiang
- Department of Sports Medicine, Beijing Jishuitan Hospital, Beijing, China.
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Seidler S, Siedenburg J, Rhode M, Volk HA, Harms O. Dogs with Bilateral Medial Coronoid Disease Can Be Clinically Sound after Unilateral Arthroscopic Fragment Removal-Preliminary Study. Animals (Basel) 2023; 13:3803. [PMID: 38136840 PMCID: PMC10741036 DOI: 10.3390/ani13243803] [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: 09/05/2023] [Revised: 11/10/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
The purpose of this study was to assess the outcome of dogs with bilateral medial coronoid disease (MCD) treated with arthroscopic intervention for the clinically more severely affected side and conservative management for the contralateral side. The medical records of dogs with bilateral medial coronoid disease diagnosed using computed tomography (CT) and treated using arthroscopic intervention on one elbow and conservative management on the other elbow were retrospectively reviewed. The outcome evaluation included clinical re-examination; follow-up radiographic-visible osteophytic lesions; as well as sclerotic changes and Liverpool osteoarthritis in a dogs questionnaire. Data from 48 clinically affected elbow joints (24 dogs) with bilateral MCD diagnosed using CT were included. Every dog underwent arthroscopic intervention on the elbow joint, which was clinically more severely affected, and the other side was treated with conservative management. A fragment of the medial coronoid was diagnosed using CT in all elbows, whereas 19 elbows (39.4%) showed a dislocation of the fragment and the other 29 elbows (60.4%) did not. There are no findings regarding the radioulnar Incongruence. Initially, 86% of all radiographs had the same degree of osteophytes. At the time of follow-up, the arthroscopic-treated limbs had more severe radiological changes in comparison to the conservatively treated limbs. Lameness improved after arthroscopic therapy in walking. The conservative group showed a largely unchanged gait pattern. Radiological changes do not necessarily reflect the severity of clinical signs. Arthroscopic intervention showed an improvement of the clinical gait pattern, even though the radiographic changes worsened.
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Affiliation(s)
- Sophia Seidler
- Clinic for Small Animals, University of Veterinary Medicine Hannover Foundation, 30559 Hannover, Germany
- Clinic for Small Animals, 71640 Ludwigsburg, Germany
| | - Johannes Siedenburg
- Clinic for Small Animals, University of Veterinary Medicine Hannover Foundation, 30559 Hannover, Germany
| | - Michaela Rhode
- Tierarztpraxis für Kleintierchirurgie, 58809 Neuenrade, Germany
| | - Holger A. Volk
- Clinic for Small Animals, University of Veterinary Medicine Hannover Foundation, 30559 Hannover, Germany
| | - Oliver Harms
- Clinic for Small Animals, University of Veterinary Medicine Hannover Foundation, 30559 Hannover, Germany
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Chevalier JM, Pugliese BR, Mitchell KJ, Thompson MS, Hackett ES. Acute neck injury in a six-year-old Thoroughbred mare. J Am Vet Med Assoc 2023; 261:1903-1905. [PMID: 37562782 DOI: 10.2460/javma.23.05.0256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/18/2023] [Indexed: 08/12/2023]
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Elsenosy AM, Mansy IH, Hassan E, Muthian S. Comparison of Two Different Methods to Evaluate Ankle Syndesmosis on Lateral Ankle Radiographs. Cureus 2023; 15:e51070. [PMID: 38146335 PMCID: PMC10749521 DOI: 10.7759/cureus.51070] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2023] [Indexed: 12/27/2023] Open
Abstract
Background Ankle sprains and fractures rank among the most commonly occurring musculoskeletal injuries and hold significant relevance in current medical practice. Accurate information regarding these injuries is crucial for their effective treatment. This study aimed to explore the viability of utilizing ankle lateral radiographs to evaluate syndesmosis in both emergency settings and operating theatres. Methods This randomized retrospective clinical study involved the analysis of 150 ankle lateral radiographs (54 males and 96 females) from patients who presented at our emergency department with suspected ankle injuries. Two authors jointly examined these radiographs and reached a consensus. The anterior tibiofibular (ATF) ratio and anterior-posterior tibiofibular (APTF) ratio were computed. Patients requiring syndesmotic fixation were classified as having experienced a genuine syndesmotic injury. Participants were randomly divided into two equal groups: Group I (normal group) without fractures and Group II (abnormal group) with fractures. Comprehensive patient data, including medical history and clinical examinations, were recorded. Results Gender distribution within the studied population consisted of 54.67% males (n=41) and 45.33% females (n=34) in the abnormal group, while the normal group comprised 37.33% males (n=28) and 62.67% females (n=47). Both APTFR and ATFR methods were found to be inconclusive and unreliable for syndesmosis assessment in ankles. The sensitivity of APTFR stood at 21.33%, with a specificity of 86.67%, a positive predictive value (PPV) of 61.5%, and a negative predictive value (NPV) of 52.4%. Meanwhile, the sensitivity of ATFR was 32%, with a specificity of 80%, a PPV of 61.5%, and an NPV of 54.1%. Conclusions Both techniques demonstrated low sensitivity when ankle fractures were present, indicating their unsuitability for routine clinical diagnosis of syndesmotic disruption via lateral ankle radiographs.
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Affiliation(s)
| | - Islam H Mansy
- General Surgery and Surgical Oncology, Maadi Armed Forces Medical Complex, Cairo, EGY
| | - Eslam Hassan
- Trauma and Orthopaedics, Poole General Hospital, Poole, GBR
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Abdullah Bahamid A, Yousef Alsaif S, Mohamed Almansouri AS, Mefawez Alshammari S, Abdullah Alshahrani F, Ali Alhusayni H. Mental Foramen Position, Shape, Continuity, and Symmetry Among Malocclusion Patients: A Radiographic Study. Cureus 2023; 15:e51056. [PMID: 38269222 PMCID: PMC10806384 DOI: 10.7759/cureus.51056] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/23/2023] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION Many dental treatments need exact knowledge of the anatomical location of the mental foramen (MF). This retrospective research uses orthopantomograph (OPG) to assess the MF of orthodontic patients in Saudi Arabia and their position, symmetry, shape, and connectivity. MATERIALS AND METHOD One hundred and eighty panoramic radiographs of patients having orthodontic treatment were analyzed for the location, form, symmetry, as well as bilateral preservation of the MF. The patients were of varied ages, genders, and degrees of malocclusion and were divided into three classes: Class I (60), Class II (60), and Class III (60). Chi-squared tests and other descriptive statistics were employed to examine the data for statistical significance. RESULT When looking at the right side of the mouth, the most frequent location for MF was position 3 (between the apexes of the first and second premolars; 50.6%), whereas on the left side, it was location 4 (near the apical of the second premolar; 47.2%). The most typical form of MF has an irregular shape. MF location on the left side and continuity types differed significantly across malocclusion groups (p<0.05). CONCLUSION OPGs of Saudi orthodontic patients demonstrated a significant variability of position and continuity of the MF across different classes of malocclusion. The third most frequent position was between the first and second premolars, while the shape of MF showed variation across the age of the patients. Hence, this precise comprehension of the anatomical and morphological diversity of the MF is of utmost significance for dental professionals.
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Affiliation(s)
- Ahmed Abdullah Bahamid
- Department of Preventive Dentistry, College of Medicine and Dentistry, Riyadh Elm University, Riyadh, SAU
| | - Sarah Yousef Alsaif
- College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | | | | | | - Hibah Ali Alhusayni
- College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
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Renfree SP, Zhang N, Renfree KJ. Establishing Confidence Intervals for Normal Radiographic Intracarpal Alignment Throughout the Arc of Wrist Motion: A Cadaveric Pilot Study. Hand (N Y) 2023:15589447231213382. [PMID: 38014530 DOI: 10.1177/15589447231213382] [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] [Indexed: 11/29/2023]
Abstract
BACKGROUND High-quality lateral radiographs with the wrist in neutral (0°) or near neutral (less than 15° flexion or extension) are felt to be important for diagnosing carpal instability using intracarpal angular measurements, but may be unavailable. In addition, radiolunate (RLA) and capitolunate (CLA) measurement angles for defining carpal instability have poor validation. We sought to establish 95% confidence intervals (CIs) for predicted RLA and CLA throughout the arc of wrist motion in normal cadaveric wrists. METHODS Fresh frozen cadaveric upper extremities were secured in a limb positioner. Scaphopisocapitate lateral radiographs were obtained throughout the arc of motion and RLA and CLA, and wrist flexion or extension angles (WA) were measured by a board-certified hand surgeon. Scatter plots of variables were constructed, and correlation coefficients calculated for areas under the curves. Regression equations for predicted RLA and CLA based on WA were developed. RESULTS Both RLA and CLA correlated strongly with WA for each measurement in both flexion and extension (r = 0.7-0.8). Linear regression modeling demonstrated a good relationship between RLA (R2 = 84%) and CLA (R2 = 80%) with WA. Regression equations were constructed to give predicted values for RLA and CLA based on WA and 95% prediction CI. CONCLUSIONS If RLA and CLA exceed 20° with neutral (0°) wrist alignment, it likely represents pathologic carpal alignment. Presented tables demonstrate 95% CI of RLA and CLA throughout the arc of wrist flexion/extension. Values outside of the 95% CI are also likely to indicate pathologic carpal alignment.
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Taban M, Fatemi A, Soleimani M, Sajedi SM, Sabzevari B. Risk factors associated with implant sites prepared by orthodontic treatment: a systematic review. Eur J Transl Myol 2023; 33:11727. [PMID: 37990970 PMCID: PMC10811641 DOI: 10.4081/ejtm.2023.11727] [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: 09/08/2023] [Accepted: 10/04/2023] [Indexed: 11/23/2023] Open
Abstract
The patient's health and quality of life would probably be improved with dental implant. This study aimed to evaluate the risk factors associated with dental implants place by orthodontic treatment. In this study, information on risk factors associated with implants of sites prepared, radiology stereotypes and hospitalized were obtined from databases such as Scopus, Google scholar and PubMed, and 58 articles were included for this purpose. After analyzing the articles, 24 articles were not accepted and 34 articles were accepted, then, 16 articles were miscarriage and 18 articles were scientific sources. The results showed that orthodontic treatment has a significant effect on a person's sense of beauty and would possibly increase self-confidence and quality of life. The stability of the implant in the healing phase depends on the quality and quantity of the bone. Also, the width of the bone is one of the important issues in creating a successful treatment. When an implant fails, problems and symptoms of failure usually occur within the first year after surgery. After one year, there is only about a 1% chance of failure, and on average only 1% of all implants fail each year.
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Affiliation(s)
- Mohsen Taban
- Department of Periodontics, Borujerd Branch, Islamic Azad University, Borujerd.
| | | | - Milad Soleimani
- Department of Orthodontics, School of Dentistry, Alborz University of Medical Sciences, Karaj.
| | - Seyed Masoud Sajedi
- Department of Oral and Maxillofacial Medicine, Faculty of Dentistry, Shahed University, Tehran.
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Bökeler U, Liener U, Vogeley N, Mayer B, Horsch C, Tröster F, Eschbach D, Ruchholtz S, Knauf T. Value of Proximal Femur Geometry in Predicting Occult Hip Fracture. Medicina (Kaunas) 2023; 59:1987. [PMID: 38004036 PMCID: PMC10673107 DOI: 10.3390/medicina59111987] [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] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/02/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: Patients with occult hip fractures are a difficult subgroup to treat. MRI is the gold standard for diagnosing occult proximal femur fractures but is costly and may not be readily available in an emergency setting. The purpose of this study was to determine whether changes in the proximal femur geometry can predict the likelihood of an occult hip fracture in patients presenting with hip pain following a ground-level fall. Material and Methods: Patients admitted to the hospital with a clinical suspicion of a hip fracture but initial negative radiographs over a seven-year period were included. All patients were additionally investigated with an MRI scan, and retrospectively, six radiologic parameters were obtained on plain radiographs: The cortical thickness index (CTI), the canal to calcar ratio (CCR), the canal flare index (CFI), the morphological cortical index (MCI), the canal bone ratio (CBR) and the canal bone aria ratio (CBAR). Subsequently the result of the plain radiographic indices of the patients with a negative MRI (Group A, no occult fracture) were compared to those with a positive MRI (Group B, occult fracture). Results: A total of 78 patients (59 female, 19 male) could be included in the study. The mean age was 82 years. The univariate analyses revealed a poor predictive ability of all radiological parameters with AUC values ranging from 0.515 (CBR) to 0.626 (CTI), whereas a multivariate prognostic model demonstrated improved prognosis (AUC = 0.761) for the CTI (p = 0.024), CBAR (p = 0.074) and CRR (p = 0.081) as the most promising predictive radiological parameters. Conclusions: Single radiologic indices obtained from conventional X-rays of the proximal femur have a weak predictive value in detecting occult fractures of the hip and cannot be used as clinical decision-making factors.
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Affiliation(s)
- Ulf Bökeler
- Department for Orthopaedics and Trauma Surgery, Marienhospital Stuttgart, Böheimstrasse 37, 70199 Stuttgart, Germany
| | - Ulrich Liener
- Department for Orthopaedics and Trauma Surgery, Marienhospital Stuttgart, Böheimstrasse 37, 70199 Stuttgart, Germany
| | - Nils Vogeley
- Department for Orthopaedics and Trauma Surgery, Marienhospital Stuttgart, Böheimstrasse 37, 70199 Stuttgart, Germany
| | - Benjamin Mayer
- Department for Epidemiology and Medical Biometry, University of UIm, 89081 Ulm, Germany; (B.M.); (C.H.)
| | - Cornelia Horsch
- Department for Epidemiology and Medical Biometry, University of UIm, 89081 Ulm, Germany; (B.M.); (C.H.)
| | - Fridolin Tröster
- Department for Diagnostic and Interventional Radiology, Marienhospital Stuttgart, 70199 Stuttgart, Germany
| | - Daphne Eschbach
- MVZ Hessisch Lichtenau e.v., Kaufungen, 34123 Kassel, Germany
| | - Steffen Ruchholtz
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, 35043 Marburg, Germany
| | - Tom Knauf
- Orthopaedische Klinik Hessisch Lichtenau, 37235 Hessisch Lichtenau, Germany;
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Callary SA, Sharma DK, D’Apollonio TM, Campbell DG. Large articulations do not increase wear rates of thin second-generation highly cross-linked polyethylene liners at ten years. Bone Jt Open 2023; 4:839-845. [PMID: 37926113 PMCID: PMC10625862 DOI: 10.1302/2633-1462.411.bjo-2023-0124.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Aims Radiostereometric analysis (RSA) is the most accurate radiological method to measure in vivo wear of highly cross-linked polyethylene (XLPE) acetabular components. We have previously reported very low wear rates for a sequentially irradiated and annealed X3 XLPE liner (Stryker Orthopaedics, USA) when used in conjunction with a 32 mm femoral heads at ten-year follow-up. Only two studies have reported the long-term wear rate of X3 liners used in conjunction with larger heads using plain radiographs which have poor sensitivity. The aim of this study was to measure the ten-year wear of thin X3 XLPE liners against larger 36 or 40 mm articulations with RSA. Methods We prospectively reviewed 19 patients who underwent primary cementless THA with the XLPE acetabular liner (X3) and a 36 or 40 mm femoral head with a resultant liner thickness of at least 5.8 mm. RSA radiographs at one week, six months, and one, two, five, and ten years postoperatively and femoral head penetration within the acetabular component were measured with UmRSA software. Of the initial 19 patients, 12 were available at the ten-year time point. Results The median proximal, 2D, and 3D wear rates calculated between one and ten years were all less than 0.005 mm/year, with no patient recording a proximal wear rate of more than 0.021 mm/year. Importantly, there was no increase in the wear rate between five and ten years. Conclusion The very low wear rate of X3 XLPE liners with larger articulations remains encouraging for the future clinical performance of this material.
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Affiliation(s)
- Stuart A. Callary
- Centre for Orthopaedic and Trauma Research, The University of Adelaide and Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia
| | - Deepti K. Sharma
- Centre for Orthopaedic and Trauma Research, The University of Adelaide and Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia
| | - Taisha M. D’Apollonio
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia
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Brenneis M, Thewes N, Holder J, Stief F, Braun S. Validation of central peak height method for final adult height predictions on long leg radiographs. Bone Jt Open 2023; 4:750-757. [PMID: 37813396 PMCID: PMC10562078 DOI: 10.1302/2633-1462.410.bjo-2023-0105.r1] [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] [Indexed: 10/11/2023] Open
Abstract
Aims Accurate skeletal age and final adult height prediction methods in paediatric orthopaedics are crucial for determining optimal timing of growth-guiding interventions and minimizing complications in treatments of various conditions. This study aimed to evaluate the accuracy of final adult height predictions using the central peak height (CPH) method with long leg X-rays and four different multiplier tables. Methods This study included 31 patients who underwent temporary hemiepiphysiodesis for varus or valgus deformity of the leg between 2014 and 2020. The skeletal age at surgical intervention was evaluated using the CPH method with long leg radiographs. The true final adult height (FHTRUE) was determined when the growth plates were closed. The final height prediction accuracy of four different multiplier tables (1. Bayley and Pinneau; 2. Paley et al; 3. Sanders - Greulich and Pyle (SGP); and 4. Sanders - peak height velocity (PHV)) was then compared using either skeletal age or chronological age. Results All final adult height predictions overestimated the FHTRUE, with the SGP multiplier table having the lowest overestimation and lowest absolute deviation when using both chronological age and skeletal age. There were no significant differences in final height prediction accuracy between using skeletal age and chronological age with PHV (p = 0.652) or SGP multiplier tables (p = 0.969). Adult height predictions with chronological age and SGP (r = 0.769; p ≤ 0.001), as well as chronological age and PHV (r = 0.822; p ≤ 0.001), showed higher correlations with FHTRUE than predictions with skeletal age and SGP (r = 0.657; p ≤ 0.001) or skeletal age and PHV (r = 0.707; p ≤ 0.001). Conclusion There was no significant improvement in adult height prediction accuracy when using the CPH method compared to chronological age alone. The study concludes that there is no advantage in routinely using the CPH method for skeletal age determination over the simple use of chronological age. The findings highlight the need for more accurate methods to predict final adult height in contemporary patient populations.
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Affiliation(s)
- Marco Brenneis
- Department of Orthopedics (Friedrichsheim), University Hospital, Goethe University Frankfurt, Frankfurt, Germany
| | - Niklas Thewes
- Department of Orthopedics (Friedrichsheim), University Hospital, Goethe University Frankfurt, Frankfurt, Germany
| | - Jana Holder
- Department of Orthopedics (Friedrichsheim), University Hospital, Goethe University Frankfurt, Frankfurt, Germany
- Department of Sport and Exercise Science, University of Salzburg, Salzburg, Austria
| | - Felix Stief
- Department of Orthopedics (Friedrichsheim), University Hospital, Goethe University Frankfurt, Frankfurt, Germany
- Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, Department of Orthopedics (Friedrichsheim), University Hospital, Goethe University Frankfurt, Frankfurt, Germany
| | - Sebastian Braun
- Department of Orthopedics (Friedrichsheim), University Hospital, Goethe University Frankfurt, Frankfurt, Germany
- Center for Musculoskeletal Surgery, Charité - University Hospital Berlin, Berlin, Germany
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27
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Nguyen TP, Chae DS, Choi SH, Jeong K, Yoon J. Enhancement of Hip X-ray with Convolutional Autoencoder for Increasing Prediction Accuracy of Bone Mineral Density. Bioengineering (Basel) 2023; 10:1169. [PMID: 37892899 PMCID: PMC10604653 DOI: 10.3390/bioengineering10101169] [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: 08/31/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023] Open
Abstract
It is very important to keep track of decreases in the bone mineral density (BMD) of elderly people since it can be correlated with the risk of incidence of major osteoporotic fractures leading to fatal injuries. Even though dual-energy X-ray absorptiometry (DXA) is the one of the most precise measuring techniques used to quantify BMD, most patients have restricted access to this machine due to high cost of DXA equipment, which is also rarely distributed to local clinics. Meanwhile, the conventional X-rays, which are commonly used for visualizing conditions and injuries due to their low cost, combine the absorption of both soft and bone tissues, consequently limiting its ability to measure BMD. Therefore, we have proposed a specialized automated smart system to quantitatively predict BMD based on a conventional X-ray image only by reducing the soft tissue effect supported by the implementation of a convolutional autoencoder, which is trained using proposed synthesized data to generate grayscale values of bone tissue alone. From the enhanced image, multiple features are calculated from the hip X-ray to predict the BMD values. The performance of the proposed method has been validated through comparison with the DXA value, which shows high consistency with correlation coefficient of 0.81 and mean absolute error of 0.069 g/cm2.
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Affiliation(s)
- Thong Phi Nguyen
- Department of Mechanical Design Engineering, Hanyang University, Seoul 04763, Republic of Korea; (T.P.N.); (K.J.)
- BK21 FOUR ERICA-ACE Center, Hanyang University, Ansan 15588, Republic of Korea
| | - Dong-Sik Chae
- Department of Orthopedic Surgery, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon 22711, Republic of Korea;
| | - Sung Hoon Choi
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul 04763, Republic of Korea;
| | - Kyucheol Jeong
- Department of Mechanical Design Engineering, Hanyang University, Seoul 04763, Republic of Korea; (T.P.N.); (K.J.)
- BK21 FOUR ERICA-ACE Center, Hanyang University, Ansan 15588, Republic of Korea
| | - Jonghun Yoon
- BK21 FOUR ERICA-ACE Center, Hanyang University, Ansan 15588, Republic of Korea
- Department of Mechanical Engineering, Hanyang University, Ansan 15588, Republic of Korea
- AIDICOME Inc., Ansan 15588, Republic of Korea
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28
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Kubberød JO, Torgersen GR, Gjermo P, Baelum V, Preus HR. Five-year radiological findings from a randomized controlled trial of four periodontitis treatment strategies. Eur J Oral Sci 2023; 131:e12949. [PMID: 37593975 DOI: 10.1111/eos.12949] [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] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/30/2023] [Indexed: 08/19/2023]
Abstract
Radiographic findings from long-term studies of periodontitis treatment have rarely been reported. Although bone destruction is a prominent feature of periodontitis, the long-term effect on alveolar bone levels of different treatment strategies, with or without adjunctive metronidazole (MTZ), has not been reported. We investigated the 5-year radiographic outcome of therapy in patient groups treated with conventional scaling and root planing (SRP) or same-day full-mouth disinfection (FDIS), with or without adjunctive MTZ. Following a 3-month oral hygiene phase, 184 periodontitis patients were randomly allocated to one of four treatment regimens: (i) FDIS+MTZ; (ii) FDIS+placebo; (iii) SRP+MTZ; or (iv) SRP+placebo. Following active treatment, patients received biannual maintenance. In total, 161 patients (87.5%) completed the 5-year follow-up examination, at which the radiographic bone level (RBL), clinical attachment level, probing pocket depth, presence of plaque, and bleeding were recorded again. At the 5-year follow up examination, minor radiological bone loss was observed in the intervention groups FDIS+placebo, SRP+MTZ, and SRP+placebo; by contrast, the FDIS+MTZ group did not show any change in RBL. Full-mouth disinfection did not generally perform better than conventional SRP performed over a period of 2 to 4 weeks.
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Affiliation(s)
- Jon Olav Kubberød
- Department of Periodontology, Faculty of Dentistry, Institute of Clinical Odontology, University of Oslo, Oslo, Norway
| | - Gerald Ruiner Torgersen
- Department of Maxillofacial Radiology, Institute of Clinical Odontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Per Gjermo
- Department of Periodontology, Faculty of Dentistry, Institute of Clinical Odontology, University of Oslo, Oslo, Norway
| | - Vibeke Baelum
- Department of Odontology and Oral Health, Aarhus University, Aarhus, Denmark
| | - Hans R Preus
- Department of Periodontology, Faculty of Dentistry, Institute of Clinical Odontology, University of Oslo, Oslo, Norway
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Linn TY, Salamanca E, Aung LM, Huang TK, Wu YF, Chang WJ. Accuracy of implant site preparation in robotic navigated dental implant surgery. Clin Implant Dent Relat Res 2023; 25:881-891. [PMID: 37199055 DOI: 10.1111/cid.13224] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Modern technological advancements have led to increase in the development of surgical robots in dentistry, resulting in excellent clinical treatment outcomes. PURPOSE This study aimed to determine the accuracy of automatic robotic implant site preparation for different implant sizes by correlating planned and posttreatment positions, and to compare the performance of robotic and human freehand drilling. METHOD Seventy-six drilling sites on partially edentulous models were used, with three different implant sizes (Ø = 3.5 × 10 mm, 4.0 × 10 mm, 5.0 × 10 mm). The robotic procedure was performed using software for calibration and step-by-step drilling processes. After robotic drilling, deviations in the implant position from the planned position were determined. The angulation, depth, and coronal and apical diameters on the sagittal plane of sockets created by human and robotic drilling were measured. RESULTS The deviation of the robotic system was 3.78° ± 1.97° (angulation), 0.58 ± 0.36 mm (entry point), and 0.99 ± 0.56 mm (apical point). Comparison of implant groups showed the largest deviation from the planned position for 5 mm implants. On the sagittal plane, there were no significant differences between robotic and human surgery except for the 5-mm implant angulation, indicating similar quality between human and robotic drilling. Based on standard implant measurements, robotic drilling exhibited comparable performance to freehand human drilling. CONCLUSIONS A robotic surgical system can provide the greatest accuracy and reliability regarding the preoperative plan for small implant diameters. In addition, the accuracy of robotic drilling for anterior implant surgery can also be comparable to that of human drilling.
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Affiliation(s)
- Thu Ya Linn
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Eisner Salamanca
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Lwin Moe Aung
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ta-Ko Huang
- School of Dentistry, Kaohsiung Medical University, Kaohsiung, Taiwan
- EPED Incorporation, Kaohsiung, Taiwan
| | - Yi-Fan Wu
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wei-Jen Chang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
- Dental Department, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
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Driban JB, Vo N, Duryea J, Schaefer LF, Haugen IK, Eaton CB, Roberts MB, Lu B, McAlindon T. Hand joints without radiographic osteoarthritis maintain their joint space width over 4 years despite what's happening elsewhere in the hand. Rheumatology (Oxford) 2023:kead480. [PMID: 37695305 DOI: 10.1093/rheumatology/kead480] [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: 03/11/2023] [Revised: 07/28/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023] Open
Abstract
OBJECTIVES We aimed to determine if hand osteoarthritis is characterized by systemic cartilage loss by assessing if radiographically normal joints had greater joint space width (JSW) loss during four years in hands with incident or prevalent osteoarthritis elsewhere in the hand compared with hands without osteoarthritis. METHODS We used semi-automated software to measure JSW in the distal and proximal interphalangeal joints of 3,368 participants in the Osteoarthritis Initiative who had baseline and 48-month hand radiographs. A reader scored 16 hand joints (including the thumb-base) for Kellgren-Lawrence (KL) Grade. A joint had osteoarthritis if scored as KL ≥ 2. We identified three groups based on longitudinal hand osteoarthritis status: 1) no hand osteoarthritis (KL < 2 in all 16 joints) at the baseline and 48-month visits, 2) incident hand osteoarthritis (KL < 2in all 16 joints at baseline and then ≥1 joint with KL ≥ 2 at 48-months), and 3) prevalent hand osteoarthritis (≥1 joint with KL ≥ 2 at baseline and 48-months). We then assessed if JSW in radiographically normal joints (KL = 0) differed across these three groups. We calculated unpooled effect sizes to help interpret the differences between groups. RESULTS We observed small differences in JSW loss that are unlikely to be clinically important between radiographically normal joints between those without hand osteoarthritis (n = 1054) and those with incident (n = 102) or prevalent hand osteoarthritis (n = 2212) (effect size range: -0.01 to 0.24). These findings were robust when examining JSW loss dichotomized based on meaningful change and in other secondary analyses. CONCLUSIONS Hand osteoarthritis is not a systemic disease of cartilage.
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Affiliation(s)
- Jeffrey B Driban
- Division of Rheumatology, Allergy, & Immunology; Tufts Medical Center; Boston, MA; USA
| | - Nhung Vo
- Division of Rheumatology, Allergy, & Immunology; Tufts Medical Center; Boston, MA; USA
| | - Jeff Duryea
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Lena F Schaefer
- Department of Radiology, South Nuremberg Hospital, Nuremberg, Germany
| | - Ida K Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Charles B Eaton
- Alpert Medical School of Brown University, Providence, RI, USA. Center for Primary Care and Prevention, Pawtucket, RI, USA. Brown University School of Public Health, Providence, RI, USA
| | - Mary B Roberts
- Center for Primary Care and Prevention, Pawtucket, RI, USA
| | - Bing Lu
- Department of Public Health Sciences, University of Connecticut Health Center, Farmington CT, USA
| | - Timothy McAlindon
- Division of Rheumatology, Allergy, & Immunology; Tufts Medical Center; Boston, MA; USA
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Wagler JB, Muir JM, Foley KA, Paprosky WG. Radiographic measurement of leg-length change in the nonoperative leg during total hip arthroplasty: a potential indicator of imaging error? Hip Int 2023; 33:858-863. [PMID: 36642781 DOI: 10.1177/11207000221150783] [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] [Indexed: 01/17/2023]
Abstract
BACKGROUND Anteroposterior (AP) pelvic radiographs are subject to errors that may cause measurement inaccuracy in total hip arthroplasty (THA). Such errors may be detected by measuring pre- to postoperative leg-length changes in the nonoperative leg, which experiences no physical changes during THA. METHODS From AP pelvic radiographs, we measured pre- to postoperative leg-length changes (LLC) in the nonoperative legs of 67 patients who underwent primary THA using the trans-ischial line method. RESULTS An LLC of 0 mm was observed in the nonoperative leg in only 14 cases (21%). A LLC ⩾ 2 mm was observed in 27% (18/67) of cases, including 13% (9/67) with LLC ⩾ 3 mm and 6% (4/67) with LLC ⩾ 4 mm. A post-hoc analysis used a validated method to measure change in pelvic tilt between pre- and postoperative images and found that changes in pelvic tilt ⩾ 4° in the anterior and posterior directions created apparent lengthening (2.0 ± 1.4 mm, p < 0.001 vs. 0-3° of tilt) and shortening (-2.1 ± 1.6 mm, p < 0.001 vs. 0-3° of tilt) of the nonoperative leg, respectively. CONCLUSIONS The current study provides evidence of measurement errors in leg length using AP pelvic radiographs following THA. Changes in pelvic tilt may be in part responsible for these errors, with the direction of change in pelvic tilt influencing the apparent lengthening or shortening of the lower limb. Ultimately, these findings may influence the radiographic measurement and interpretation of leg-length changes following THA.
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Affiliation(s)
- Justin B Wagler
- Department of Kinesiology and Health Sciences, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Nasser AAHH, Osman K, Chauhan GS, Prakash R, Handford C, Nandra RS, Mahmood A. Characteristics and risk factors of UCS fracture subtypes in periprosthetic fractures around the hip. Bone Jt Open 2023; 4:659-667. [PMID: 37654129 PMCID: PMC10471444 DOI: 10.1302/2633-1462.49.bjo-2023-0065.r1] [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] [Indexed: 09/02/2023] Open
Abstract
Aims Periprosthetic fractures (PPFs) following hip arthroplasty are complex injuries. This study evaluates patient demographic characteristics, management, outcomes, and risk factors associated with PPF subtypes over a decade. Methods Using a multicentre collaborative study design, independent of registry data, we identified adults from 29 centres with PPFs around the hip between January 2010 and December 2019. Radiographs were assessed for the Unified Classification System (UCS) grade. Patient and injury characteristics, management, and outcomes were compared between UCS grades. A multinomial logistic regression was performed to estimate relative risk ratios (RRR) of variables on UCS grade. Results A total of 1,104 patients were included. The majority were female (57.9%; n = 639), ethnically white (88.5%; n = 977), used mobility aids (67%; n = 743), and had a median age of 82 years (interquartile range (IQR) 74 to 87). A total of 77 (7%) had pain prior to the PPF. The most common UCS grade was B2 (33%; n = 368). UCS type D fractures had the longest length of stay (median 19 days (IQR 11 to 26)), highest readmission to hospital (21%; n = 9), and highest rate of discharge to step-down care (52%; n = 23). Multinomial regression suggests that uncemented femoral stems are associated with a reduced risk of UCS C (RRR 0.36 (95% confidence interval (CI) 0.2 to 0.7); p = 0.002) and increased risk of UCS A (RRR 3.3 (95% CI 1.9 to 5.7); p < 0.001), compared to UCS B fracture. Conclusion The most common PPF type in elderly frail patients is UCS B2. Uncemented stems have a lower risk of UCS C fractures compared to cemented stems. A national PPF database is needed to further identify correlation between implants and fracture subtypes.
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Affiliation(s)
- Ahmed A. H. H. Nasser
- The Birmingham Orthopaedic Training Program, The Royal Orthopaedic Hospital, Birmingham, UK
- The Birmingham Orthopaedic Network, Birmingham, UK
| | - Khabab Osman
- The Birmingham Orthopaedic Training Program, The Royal Orthopaedic Hospital, Birmingham, UK
- The Birmingham Orthopaedic Network, Birmingham, UK
| | - Govind S. Chauhan
- The Birmingham Orthopaedic Training Program, The Royal Orthopaedic Hospital, Birmingham, UK
- The Birmingham Orthopaedic Network, Birmingham, UK
| | - Rohan Prakash
- The Birmingham Orthopaedic Training Program, The Royal Orthopaedic Hospital, Birmingham, UK
- The Birmingham Orthopaedic Network, Birmingham, UK
| | - Charles Handford
- The Birmingham Orthopaedic Training Program, The Royal Orthopaedic Hospital, Birmingham, UK
- The Birmingham Orthopaedic Network, Birmingham, UK
| | | | - Ansar Mahmood
- Trauma and Orthopaedic Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - The PPF Study Collaborative
- The Birmingham Orthopaedic Training Program, The Royal Orthopaedic Hospital, Birmingham, UK
- The Birmingham Orthopaedic Network, Birmingham, UK
- Trauma and Orthopaedic Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK
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Anderson PM, Heinz T, Rak D, Arnholdt J, Holzapfel BM, Dorsch S, Weißenberger M, von Eisenhart-Rothe R, Jaenisch M, Ertl M, Wagner M, Windhagen H, Rudert M, Jakuscheit A. Accuracy of Positioning and Risk Factors for Malpositioning Custom-Made Femoral Stems in Total Hip Arthroplasty-A Retrospective Multicenter Analysis. J Pers Med 2023; 13:1285. [PMID: 37763052 PMCID: PMC10532930 DOI: 10.3390/jpm13091285] [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: 07/31/2023] [Revised: 08/17/2023] [Accepted: 08/20/2023] [Indexed: 09/29/2023] Open
Abstract
Total hip arthroplasty (THA) is commonly performed using off-the-shelf implants. In the case of a severe mismatch between the anatomy of the proximal femur and the geometry of the stem, the use of custom-made stems might become necessary. The goal of this study was to investigate the precision of the implantation of custom-made stems of one manufacturer (CTX stem, AQ Implants) and to determine risk factors for malpositioning. All patients receiving a custom-made CTX stem between 2014 and 2020 at six high-volume academic centers were retrospectively recruited. The achieved position of the stem, as determined by stem version, stem coronal angle, and implantation depth on radiographs, was compared to the plan. The influence of radiographic and demographic parameters on the position was investigated. The results revealed a high variability of the achieved implant position in relation to the preoperative plan. While the stem coronal angle only differed slightly from the intended position, the stem version and the implantation depth showed a high frequency and amount of deviation. Right stems showed significantly higher positions than planned. Surgeons must be aware of this potential problem when implanting custom-made stems.
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Affiliation(s)
- Philip Mark Anderson
- Department of Orthopedics, König-Ludwig-Haus, University of Würzburg, Brettreichstraße 11, 97070 Wuerzburg, Germany
| | - Tizian Heinz
- Department of Orthopedics, König-Ludwig-Haus, University of Würzburg, Brettreichstraße 11, 97070 Wuerzburg, Germany
| | - Dominik Rak
- Department of Orthopedics, König-Ludwig-Haus, University of Würzburg, Brettreichstraße 11, 97070 Wuerzburg, Germany
| | - Jörg Arnholdt
- Department of Orthopedic Surgery, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Boris Michael Holzapfel
- Department of Orthopedic Surgery, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Silke Dorsch
- Department of Orthopedics, König-Ludwig-Haus, University of Würzburg, Brettreichstraße 11, 97070 Wuerzburg, Germany
| | - Manuel Weißenberger
- Department of Orthopedics, König-Ludwig-Haus, University of Würzburg, Brettreichstraße 11, 97070 Wuerzburg, Germany
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
| | - Max Jaenisch
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Max Ertl
- Department of Orthopaedic Surgery, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany;
| | - Michael Wagner
- Department of Orthopaedics and Trauma Surgery, Klinikum Nürnberg Campus Süd, Paracelsus Medical University, Breslauer Straße 201, 90472 Nürnberg, Germany;
| | - Henning Windhagen
- Department of Orthopaedic Surgery, Annastift Hannover, Medical School Hannover, Borries Str. 1-6, 30625 Hannover, Germany;
| | - Maximilian Rudert
- Department of Orthopedics, König-Ludwig-Haus, University of Würzburg, Brettreichstraße 11, 97070 Wuerzburg, Germany
| | - Axel Jakuscheit
- Department of Orthopedics, König-Ludwig-Haus, University of Würzburg, Brettreichstraße 11, 97070 Wuerzburg, Germany
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Beresford-Cleary NJA, Silman A, Thakar C, Gardner A, Harding I, Cooper C, Cook J, Rothenfluh DA. Findings from a pilot randomized trial of spinal decompression alone or spinal decompression plus instrumented fusion. Bone Jt Open 2023; 4:573-579. [PMID: 37549931 PMCID: PMC10493898 DOI: 10.1302/2633-1462.48.bjo-2023-0049] [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] [Indexed: 08/09/2023] Open
Abstract
Aims Symptomatic spinal stenosis is a very common problem, and decompression surgery has been shown to be superior to nonoperative treatment in selected patient groups. However, performing an instrumented fusion in addition to decompression may avoid revision and improve outcomes. The aim of the SpInOuT feasibility study was to establish whether a definitive randomized controlled trial (RCT) that accounted for the spectrum of pathology contributing to spinal stenosis, including pelvic incidence-lumbar lordosis (PI-LL) mismatch and mobile spondylolisthesis, could be conducted. Methods As part of the SpInOuT-F study, a pilot randomized trial was carried out across five NHS hospitals. Patients were randomized to either spinal decompression alone or spinal decompression plus instrumented fusion. Patient-reported outcome measures were collected at baseline and three months. The intended sample size was 60 patients. Results Of the 90 patients screened, 77 passed the initial screening criteria. A total of 27 patients had a PI-LL mismatch and 23 had a dynamic spondylolisthesis. Following secondary inclusion and exclusion criteria, 31 patients were eligible for the study. Six patients were randomized and one underwent surgery during the study period. Given the low number of patients recruited and randomized, it was not possible to assess completion rates, quality of life, imaging, or health economic outcomes as intended. Conclusion This study provides a unique insight into the prevalence of dynamic spondylolisthesis and PI-LL mismatch in patients with symptomatic spinal stenosis, and demonstrates that there is a need for a definitive RCT which stratifies for these groups in order to inform surgical decision-making. Nonetheless a definitive study would need further refinement in design and implementation in order to be feasible.
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Affiliation(s)
| | - Alan Silman
- Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | | | | | - Cushla Cooper
- Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jonathan Cook
- Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Dominique A. Rothenfluh
- Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- CHUV University Hospital Lausanne and the University of Lausanne (UNIL), Lausanne, Switzerland
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Bonecka J, Skibniewski M, Zep P, Domino M. Knee Joint Osteoarthritis in Overweight Cats: The Clinical and Radiographic Findings. Animals (Basel) 2023; 13:2427. [PMID: 37570234 PMCID: PMC10417339 DOI: 10.3390/ani13152427] [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: 06/29/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Despite a high prevalence of osteoarthritis (OA) reported in the domesticated cat population, studies on feline knee joint OA are scarcer. Knee joint OA is a painful, age-related, chronic degenerative joint disease that significantly affects cats' activity and quality of life. In dogs and humans, one may consider overweight as a risk factor for the development and progression of knee joint OA; therefore, this study aims to assess the severity of knee joint OA in the body-weight-related groups of cats concerning clinical symptoms and radiographic signs. The study was conducted on sixty-four (n = 64) cats with confirmed OA. The demographic data on sex, neutering, age, and breed were collected. Then, the body condition score (BCS) was assessed, and each cat was allocated to the underweight, normal-weight, or overweight group. Within clinical symptoms, joint pain, joint swelling, joint deformities, lameness, reluctance to move, and apathy were graded. Based on the radiographic signs, minor OA, mild OA, moderate OA, and severe OA were scored. Prevalence and co-occurrence of the studied variables were then assessed. Joint pain was elicited in 20-31% of the OA-affected joints, joint deformities in 21-30%, and lameness in 20-54%, with no differences between weight-related groups. Severe OA was detected in 10-16% of the OA-affected joints, with no differences between weight-related groups. Severe OA in feline knee joints appears with similar frequency in overweight, underweight, and normal-weight cats. However, the general prevalence of clinical symptoms and radiographic signs is different in overweight cats.
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Affiliation(s)
- Joanna Bonecka
- Department of Small Animal Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences (WULS-SGGW), 02-787 Warsaw, Poland
| | - Michał Skibniewski
- Department of Morphological Sciences, Institute of Veterinary Medicine, Warsaw University of Life Sciences (WULS-SGGW), 02-787 Warsaw, Poland
| | - Paweł Zep
- OchWET Veterinary Clinic, 02-119 Warszawa, Poland
| | - Małgorzata Domino
- Department of Large Animal Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences (WULS-SGGW), 02-787 Warsaw, Poland
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Park H, Yoon YS, Chin S. Fibrosarcoma of Great Toe Shown with Multimodality Radiologic Imaging Features. Curr Med Imaging 2023:CMIR-EPUB-132836. [PMID: 37431581 DOI: 10.2174/1573405620666230711090658] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 05/16/2023] [Accepted: 05/24/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Fibrosarcoma of bone is a rare malignant spindle cell tumor. CASE STUDY Herein, we present a case of fibrosarcoma in a 40-year-old male who was presented to the clinic with left-sided great toe pain for 20 years. Simple radiographs showed acrolysis at the distal phalanx of great toe. Magnetic resonance imaging (MRI) revealed a 1.5 cm sized heterogenous high signal intensity mass on T2-weighted images and iso signal intensity on T1- weighted images. Dorsal and distal portion of the mass showed markedly dark signal intensity on T1 and T2-weighted images. CONCLUSION In an enhanced image, the mass showed heterogenous enhancement. Surgical removal was performed and pathologic analysis revealed fibrosarcoma. Although extremely rare, fibrosarcoma of the bone should be kept in mind as a possibility when a lesion exhibits a black signal intensity component on an MRI with acrolysis.
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Affiliation(s)
- Hyerim Park
- Department Of Radiology, Soonchunhyang University Cheonan Hospital, Cheonan
| | - Yu Sung Yoon
- Department Of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon
| | - Susie Chin
- Department Of Pathology, Soonchunhyang University Bucheon Hospital, Bucheon
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d'Astorg H, Bourret S, Ramos-Pascual S, Szadkowski M, Le Huec JC. Comparison of Cobb angle measurements for scoliosis assessment using different imaging modalities: a systematic review. EFORT Open Rev 2023; 8:489-498. [PMID: 37289072 DOI: 10.1530/eor-23-0032] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
Purpose To report accuracy, repeatability, and agreement of Cobb angle measurements on radiographs and/or stereo-radiographs (EOS) compared against one another or against other imaging modalities. Methods This review follows Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. A literature search was conducted on 21 July 2021 using Medline, Embase, and Cochrane. Two researchers independently performed title/abstract/full-text screening and data extraction. Studies were eligible if they reported Cobb angles, and/or their repeatability and agreement, measured on radiographs and/or EOS compared against one another or against other imaging modalities. Results Of the 2993 records identified, 845 were duplicates and 2212 were excluded during title/abstract/full-text screening. Two more relevant studies were identified from references of eligible studies, leaving 14 studies for inclusion. Two studies compared Cobb angles from EOS vs CT, while 12 compared radiographs vs other imaging modalities: EOS, CT, MRI, digital fluoroscopy, or dual-energy x-ray absorptiometry. Angles from standing radiographs tended to be higher than those from supine MRI and CT, and angles from standing EOS tended to be higher than those from supine or prone CT. Correlations across modalities were strong (R = 0.78-0.97). Inter-observer agreement was excellent for all studies (ICC = 0.77-1.00), except one (ICC = 0.13 radiographs and ICC = 0.68 for MRI). Conclusion Differences of up to 11º were found when comparing Cobb angles across combinations of imaging modalities and patient positions. It is not possible, however, to determine whether the differences observed are due to the change of modality, position, or both. Therefore, clinicians should be careful when utilizing the thresholds for standing radiographs across other modalities and positions for diagnosis and assessment of scoliosis.
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Affiliation(s)
- Henri d'Astorg
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, Lyon, France
| | - Stephane Bourret
- Polyclinique Bordeaux Nord Aquitaine, Vertebra Center, Bordeaux, France
| | | | - Marc Szadkowski
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, Lyon, France
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Dash RF, Minshall GJ, Wright IM. Comparison of radiography and CT for the evaluation of third carpal bone slab fractures in Thoroughbred racehorses. Vet Radiol Ultrasound 2023. [PMID: 37288478 DOI: 10.1111/vru.13255] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 04/05/2023] [Accepted: 04/08/2023] [Indexed: 06/09/2023] Open
Abstract
Slab fractures of the third carpal bone (C3) are a common cause of lameness in Thoroughbred racehorses. Information on fracture morphology is commonly obtained from radiographs or CT. This retrospective, methods comparison aimed to explore the agreement between radiography and CT for imaging C3 slab fractures and discuss the contribution of the latter to clinical case management. Thoroughbred racehorses with a slab or incomplete slab fracture of C3 identified on radiographs that subsequently underwent CT examination were included. Fracture characteristics (location, plane, classification, displacement, comminution) and fracture length as a percentage of the proximodistal length of the bone, termed the proximodistal fracture percentage (PFP) were recorded independently from both modalities and then compared. Across all fractures (n = 82) radiographs and CT showed slight agreement on the presence of comminution (Cohen's Kappa (κ) 0.108, P 0.031) and moderate agreement on fracture displacement (K 0.683, P < 0.001). Computed tomography identified comminution in 49 (59.8%) and displacement in nine (11.0%) fractures that were not detected by radiographs. Half of the fractures were only seen on flexed dorsoproximal-dorsodistal oblique (DPr-DDiO) radiographs and therefore were of unknown length without additional CT imaging. Incomplete fractures that could be measured on radiographs (n = 12) had a median (IQR) PFP of 40% (30%-52%) on radiographs and 53% (38%-59%) on CT, a statistically significant difference (P = 0.026). Radiography and CT showed the poorest agreement when determining the presence of comminution. Additionally, radiography often underestimated the incidence of displacement, and fracture length, and resulted in more fractures being classified as incomplete when compared to CT.
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Affiliation(s)
- Rupert F Dash
- Equine Referral Hospital, The Royal Veterinary College, Hertfordshire, UK
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Kawasaki S, Cheung PWH, Shigematsu H, Tanaka M, Suga Y, Yamamoto Y, Tanaka Y, Cheung JPY. Alternate In-Brace and Out-of-Brace Radiographs Are Recommended to Assess Brace Fitting and Curve Progression With Adolescent Idiopathic Scoliosis Follow-Up. Global Spine J 2023; 13:1332-1341. [PMID: 34263679 PMCID: PMC10416593 DOI: 10.1177/21925682211032559] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To determine the prevalence of missed curve progression in patients with adolescent idiopathic scoliosis (AIS) undergoing brace treatment with only in-brace follow-up radiographs, and to provide recommendations on when in-brace and out-of-brace should be obtained during follow-up. METHODS 133 patients who had documented clinically significant curve progression during brace treatment or only when an out-of-brace radiograph were studied. Of these, 95 patients (71.4%) had curve progression noted on in-brace radiographs while 38 patients (28.6%) showed curve progression only after brace removal. We analyzed differences in age, sex, curve types, Risser stage, months after menarche, standing out-of-brace Cobb angle, correction rate, and flexibility rate between the groups. Multivariate logistic regression was performed to determine factors contributing to curve progression missed during brace treatment. RESULTS There were no differences in initial Cobb angle between out-of-brace and in-brace deterioration groups. However, the correction rate was higher (32.7% vs 25.0%; P = .004) in the in-brace deterioration group as compared to the out-of-brace deterioration group. A lower correction rate was more likely to result in out-of-brace deterioration (OR 0.970; P = .019). For thoracic curves, higher flexibility in the curves was more likely to result in out-of-brace deterioration (OR 1.055; P = .045). For double/triple curves, patients with in-brace deterioration had higher correction rate (OR 0.944; P = .034). CONCLUSIONS Patients may develop curve progression despite good correction on in-brace radiographs. Those with higher flexibility and suboptimal brace fitting are at-risk. In-brace and out-of-brace radiographs should be taken alternately for brace treatment follow-up.
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Affiliation(s)
- Sachiko Kawasaki
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara City, Nara, Japan
| | | | - Hideki Shigematsu
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara City, Nara, Japan
| | - Masato Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara City, Nara, Japan
| | - Yuma Suga
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara City, Nara, Japan
| | - Yusuke Yamamoto
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara City, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara City, Nara, Japan
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
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Meyers A, Golden T, Diaz G, Khademi F. Comparing Perceived Radiograph Quality Between Radiologic Technologists and Orthopedic Surgeons. Radiol Technol 2023; 94:332-336. [PMID: 37253552] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/30/2022] [Indexed: 06/01/2023]
Abstract
PURPOSE To determine if there is a discrepancy between how orthopedic surgeons perceive the quality of plain radiographs compared with that of radiologic technologists. METHODS A prospective survey was developed including 42 deidentified plain radiographs. Included radiographs were of varying anatomical regions, patient positioning, and radiographic parameters. Participants were requested to score each radiograph on a scale from 1 (very poor) to 100 (very good) based on their overall subjective definition of radiographic quality. RESULTS Multiple analyses of variance showed that out of the 42 radiographs evaluated, 13 images had significant differences in how they were scored by each group. Technologists provided lower image quality scores for 11 images compared with the orthopedic residents and attending surgeons. Two images were scored significantly higher by the attendings compared with the technologists or residents. Of the 42 images, 29 were scored similarly by the 3 groups. DISCUSSION This study is novel because it explored perceived radiograph quality between attending orthopedic surgeons, orthopedic surgery residents, and radiologic technologists. Review of current literature revealed comparisons of radiography quality assessments between radiologic technologists and radiologists. Like the findings of the authors of the current report, the literature analysis demonstrated that radiologic technologists and radiologists appear to agree on what was considered a quality image, but technologists were more reluctant to accept images of lower quality than were radiologists. These authors believe the present study helps further establish that orthopedic surgeons typically order repeat imaging for reasons other than image quality. CONCLUSION Orthopedic surgeons and radiologic technologists appear to agree in a subjective manner on a quantitative scale. Radiologic technologists tended to be more critical than were orthopedic surgeons in judging radiograph quality, contrary to the authors' original hypothesis.
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Affiliation(s)
- Andrew Meyers
- Andrew Meyers, DO, R.T.(R), is an orthopedic resident at Community Memorial Health System in Ventura, California
| | - Thomas Golden
- Thomas Golden, MD, is program director of the Community Memorial Health System Orthopaedic Surgery Residency program in Ventura. He is certified through the American Board of Orthopaedic Surgery, a fellow of the American Academy of Orthopaedic Surgeons, and belongs to several professional organizations including the Arthroscopy Association of North America and American Association of Hip and Knee Surgeons
| | - Graal Diaz
- Graal Diaz, PhD, is a research consultant for Community Memorial Health System in Ventura
| | - Fazl Khademi
- Fazl Khademi, BS, is a third-year medical student attending Western University of Health Sciences
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Grobman M, Reinero C. A One Health review of aerodigestive disease in dogs. J Vet Intern Med 2023; 37:817-834. [PMID: 36987535 DOI: 10.1111/jvim.16661] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/02/2023] [Indexed: 03/30/2023] Open
Abstract
This review article seeks to define and describe aerodigestive disease in dogs, and review current and emerging methods of diagnostic evaluation. Aspiration of gastric contents into the respiratory tract is associated with the development and progression of numerous respiratory diseases in humans. In veterinary medicine the term "aspiration" is considered synonymous with "aspiration pneumonia" which, while frequently encountered, does not accurately reflect the breadth of aspiration associated respiratory syndromes (AARS). In the clinical veterinary literature, the effect of alimentary dysfunction on respiratory disease and vice versa (aerodigestive disease) is rarely investigated despite evidence in the human literature, animal models, and some studies and case reports linking alimentary and respiratory disease in small animals. Current methods of investigating aerodigestive diseases in veterinary patients are limited by inadeqate sensitivity or specificity, potential for bias, cost, and availability. This necessitates investigations into advanced diagnostics to identify potentially underrecognized animals with AARS. Additionally, similarities in anatomy, physiology, and several disorders between dogs and humans, make experimental and naturally occurring canine models of AARS integral to translational research. Thus, evaluating dogs with aerodigestive disease might represent an area of substantial clinical relevance in human as well as veterinary medicine.
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Affiliation(s)
- Megan Grobman
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, Alabama, USA
- Department of Veterinary Medicine & Surgery, University of Missouri Veterinary Health Center, Columbia, Missouri, USA
| | - Carol Reinero
- Department of Veterinary Medicine & Surgery, University of Missouri Veterinary Health Center, Columbia, Missouri, USA
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Rajan PV, Steiner R, Ritzman TF, Moberly T, Floccari LV. Do Preoperative Supine Radiographs Predict Postoperative Residual Lumbar Curvatures in Adolescent Idiopathic Scoliosis? A Retrospective Cohort Study. Global Spine J 2023:21925682231162556. [PMID: 36884351 DOI: 10.1177/21925682231162556] [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] [Indexed: 03/09/2023] Open
Abstract
STUDY DESIGN Retrospective comparative study. OBJECTIVES This study compares supine vs bending flexibility radiographs and evaluates their ability to predict residual postoperative lumbar curvature after selective thoracic fusion for Lenke 1 and 2 curves across different lumbar modifiers (A, B, and C) in adolescent idiopathic scoliosis (AIS). METHODS This was a retrospective review of AIS Lenke 1 and 2 patients who underwent posterior fusion. All patients had preoperative flexibility radiographs including side-bending and supine posteroanterior (PA) films, in addition to pre- and post-operative standing PA and lateral radiographs. We used SurgiMap 2.0 software for all radiographic measurements. Pearson correlations and linear regression models were developed in SAS. RESULTS A total of 86 patients were included mean age 14.9 years and follow-up 72.3 months. Preoperative supine lumbar Cobb angle and preoperative side-bending Cobb angles had similar, positive correlations with postoperative lumbar Cobb angle, r = .55 (P < .001) and r = .54 (P < .001), respectively. Three regression models were built to predict postoperative lumbar Cobb angles from preoperative information: Model S (R2 = .39) uses preoperative supine lumbar curve; Model B (R2 = .44) uses preoperative side-bending lumbar curve; Model SB (R2 = .49) uses both preoperative supine and side-bending lumbar curves. Model S and B performed just as well as Model SB. CONCLUSION Either supine or side-bending radiographs alone may be used to estimate mean residual postoperative lumbar curvature after selective posterior thoracic fusion, but little is to be gained by taking both supine and side-bending radiographs.
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Affiliation(s)
- Prashant V Rajan
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
- Department of Orthopaedic Surgery, Akron Children's Hospital, Akron, OH, USA
| | - Richard Steiner
- Department of Statistics, The University of Akron, Akron, OH, USA
| | - Todd F Ritzman
- Department of Orthopaedic Surgery, Akron Children's Hospital, Akron, OH, USA
| | - Trey Moberly
- Department of Orthopaedic Surgery, Akron Children's Hospital, Akron, OH, USA
| | - Lorena V Floccari
- Department of Orthopaedic Surgery, Akron Children's Hospital, Akron, OH, USA
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Katz RS, Leavitt F, Cherny K, Small AK, Small BJ. The Vast Majority of Patients With Fibromyalgia Have a Straight Neck Observed on a Lateral View Radiograph of the Cervical Spine: An Aid in the Diagnosis of Fibromyalgia and a Possible Clue to the Etiology. J Clin Rheumatol 2023; 29:91-94. [PMID: 36322055 PMCID: PMC9940839 DOI: 10.1097/rhu.0000000000001912] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A straight cervical spine is an underappreciated and often overlooked finding in fibromyalgia. The aim of this medical records review study was to evaluate the cervical curvature on radiographs of patients with fibromyalgia. METHODS A consecutive series of 270 cervical spine radiographs of patients with neck pain from 2015 to 2018 were retrospectively analyzed for cervical curvature using the Cobb angle measurement. One hundred fifty-five patients met full American College of Rheumatology criteria for fibromyalgia, whereas 115 subjects with other rheumatic diseases who were similar in age and education served as control subjects. RESULTS Mean cervical curvature in fibromyalgia was 6.4 ± 5.2 degrees and 13.8 ± 7.4 degrees in control subjects. The more than 7-degree difference was significant ( p < 0.001). Curvature in the magnitude of 21 degrees is at the low end of normal. At ≤10 degrees, where the cervical spine is essentially straight, there were 129 fibromyalgia patients (83.2%) and 37 control subjects (32.2%). The 51% difference was significant ( p < 0.001). CONCLUSION Most patients with fibromyalgia share an abnormality in common that is verifiable by a simple radiograph. In 83.2% of the patients, the cervical spine was essentially straight (Cobb angle ≤10 degrees). In fibromyalgia patients, the loss of cervical curvature was approximately 6.5 times greater than in control subjects (50.3% vs. 7.8%). A straight neck without other radiographic abnormalities may be a major anatomical abnormality in fibromyalgia that has gone unnoticed. It may assist in the diagnosis, as well as suggest increased muscle tension/pressure as a possible etiology.
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Affiliation(s)
| | | | | | | | - Ben J. Small
- Northwestern University Medical Center, Chicago, IL
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Duffaut CJ, Goldman J, Miller EM. Clinical Evaluation of the Knee Arthritis Patient. Tech Vasc Interv Radiol 2023; 26:100876. [PMID: 36889841 DOI: 10.1016/j.tvir.2022.100876] [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] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The evaluation of a patient with knee osteoarthritis (OA) has 3 main components: clinical history, physical examination, and radiographic imaging. The clinician should assess for inciting and aggravating factors for the knee pain as well as for the presence of any mechanical symptoms. A history of prior knee injury or surgery can suggest the development of early osteoarthritis. A thorough physical examination of the knee should be performed. Some features of OA include limited range of motion, crepitus in the patellofemoral compartment, and joint line tenderness. Depending on the severity of OA varus or valgus alignment can develop. Special tests such as the McMurray for meniscal tears may cause increased pain as patients with OA will often have degenerative meniscal tears. Weight bearing radiographs can confirm the diagnosis of OA. Several scales exist to grade the severity of OA with the Kellgren-Lawrence being one that is often used. Radiographic features of OA include joint space narrowing, osteophytes, sclerosis of bone and bone end deformities. If after the above evaluation the diagnosis is still unclear, advanced imaging or laboratory testing can be performed to evaluate for alternative diagnoses.
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Affiliation(s)
- Calvin J Duffaut
- Departments of Family Medicine and Orthopaedics, UCLA Division of Sports Medicine, Los Angeles, CA
| | - Joshua Goldman
- Departments of Family Medicine and Orthopaedics, UCLA Division of Sports Medicine, Los Angeles, CA
| | - Emily M Miller
- Departments of Family Medicine and Orthopaedics, UCLA Division of Sports Medicine, Los Angeles, CA.
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Malin SW, McCallister AE, Abu-Sultaneh SM, Valentine KM. A Quality Improvement Initiative to Reduce Unneeded Screening Chest Radiographs in a Pediatric Cardiovascular ICU. Respir Care 2023; 68:392-399. [PMID: 36191928 PMCID: PMC10027155 DOI: 10.4187/respcare.10375] [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] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/08/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Adult critical care and radiographical societies have recommended changing practice from routine screening radiographs to on-demand chest radiographs (CXRs) for stable mechanically ventilated adult patients. There are no similar recommendations for patients in the pediatric ICU. Reducing the frequency with which unneeded CXRs are obtained can decrease radiation exposure and reduce waste, a substantial contributor to rising health care costs. We aimed to reduce unneeded daily screening CXRs in a pediatric cardiovascular ICU (CICU) by 20% in 6 months. METHODS Criteria delineating which subjects in the CICU required daily screening CXRs were created and added to the daily rounding sheet for discussion for each subject. The primary goal of this study was to reduce CXRs in mechanically ventilated subjects as our previous practice had been to order daily CXRs. Respiratory therapists increased the frequency of evaluating and documenting endotracheal tube positioning prior to the initiation of this project. The outcome measure was the percentage subjects who received a daily screening CXR. The ratio of daily screening CXRs to the number of total CXRs ordered and unplanned extubations were followed as balancing measures. RESULTS The number of subjects who received a daily screening CXR decreased from a baseline of 67% to 44% over the course of this project. There was no change in the ratio of daily screening CXRs to the number of total CXRs ordered or an increase in unplanned extubations. With an estimated cost of $268 per CXR, a reduction of 33% in routine screening CXRs saves an estimated $250,000 annually. CONCLUSIONS A decrease in daily screening CXRs can be sustained through the development of specific criteria to determine which patients need screening radiographs. This can be achieved without an increase in CXRs obtained at other times throughout the day or an increase in unplanned extubations. This eliminates unneeded health care expenditures, improves resource allocation for radiology technicians, and decreases disruptive interventions for patients.
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Affiliation(s)
- Stefan W Malin
- Division of Pediatric Critical Care, Department of Pediatrics, Riley Hospital for Children at Indiana University Health and Indiana University School of Medicine, Indianapolis, Indiana.
| | - Anne E McCallister
- Division of Pediatric Critical Care, Department of Pediatrics, Riley Hospital for Children at Indiana University Health and Indiana University School of Medicine, Indianapolis, Indiana
| | - Samer M Abu-Sultaneh
- Division of Pediatric Critical Care, Department of Pediatrics, Riley Hospital for Children at Indiana University Health and Indiana University School of Medicine, Indianapolis, Indiana
| | - Kevin M Valentine
- Division of Pediatric Critical Care, Department of Pediatrics, Riley Hospital for Children at Indiana University Health and Indiana University School of Medicine, Indianapolis, Indiana
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Gabay E, Asbi T, Horwitz J, Zigdon Giladi H, Machtei EE. Comparing operators and imaging techniques when performing trans-crestal sinus augmentation : A pilot study. J ORAL IMPLANTOL 2023:490901. [PMID: 36796067 DOI: 10.1563/aaid-joi-d-21-00245] [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: 10/07/2021] [Revised: 06/20/2022] [Accepted: 09/27/2022] [Indexed: 02/18/2023]
Abstract
AIMS To compare baseline residual ridge height using CBCT and panoramic radiographs. A secondary aim was to examine the magnitude of vertical bone gain 6-months following trans-crestal sinus augmentation and compare it between operators. METHODS Thirty patients, who underwent trans-crestal sinus augmentation simultaneously with dental implant placement were included in this retrospective analysis. Surgeries were done by two experienced surgeons (EM and EG) using the same surgical protocol and materials. Pre-operative residual ridge height was measured on panoramic and CBCT images. The final bone height and the magnitude of the vertical augmentation were measured on panoramic x-ray taken 6 months following surgery. RESULTS Mean residual ridge height measured pre-operatively using CBCT was 6.07±1.38 mm, while these same measurements on the panoramic radiographs yielded similar results (6.08±1.43 mm), which were statistically insignificant (p=0.535). Postoperative healing was uneventful in all cases. All 30 implants were successfully osseo-integrated at 6 months. The mean overall final bone height was 12.87±1.39 mm (12.61±1.21 and 13.39±1.63 mm, for operators EM & EG respectively (p=0.19). Likewise, mean post-operative bone height gain was 6.78±1.57 mm. which was 6.68±1.32 mm and 6.99±2.06 mm for operators EM and EG respectively, p=0.66. A moderate positive correlation was found between residual bone height and final bone height (r=0.43, P= 0.002). A moderate negative correlation was found between residual bone height and augmented bone height (r=-0.53, p= 0.002). Conclusion: Sinus augmentation performed trans-crestally produce consistent results with minimal inter-operator differences between experienced clinicians. Both CBCT and panoramic radiographs produced similar assessment of the pre-operative residual bone height.
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Affiliation(s)
- Eran Gabay
- Rambam Medical Center: Rambam Health Care Campus Periodontology haaliya hashniya 8 ISRAEL HAIFA Haifa 3109601 Rambam Medical Center: Rambam Health Care Campus
| | - Thabet Asbi
- Department of Periodontology, Rambam Health Care Campus, Haifa, IsraelRappaport Faculty of Medicine, Technion institute of technology, Haifa, Israel
| | - Jacob Horwitz
- Department of Periodontology, Rambam Health Care Campus, Haifa, IsraelRappaport Faculty of Medicine, Technion institute of technology, Haifa, Israel
| | - Hadar Zigdon Giladi
- Department of Periodontology, Rambam Health Care Campus, Haifa, IsraelRappaport Faculty of Medicine, Technion institute of technology, Haifa, Israel
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Budge MD, Orvets N. Stemless total shoulder arthroplasty using a novel multiplanar osteotomy and elliptical humeral head results in both improved early range of motion and radiographic center of rotation compared with standard total shoulder arthroplasty. J Shoulder Elbow Surg 2023; 32:318-25. [PMID: 36049701 DOI: 10.1016/j.jse.2022.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/17/2022] [Revised: 07/08/2022] [Accepted: 07/10/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Restoration of the native glenohumeral anatomy is an important consideration in obtaining optimal range of motion (ROM) after anatomic total shoulder arthroplasty (TSA). Recently, a new stemless TSA system has been developed that uses both a multiplanar osteotomy (MPO), to improve the surgeon's ability to restore humeral center of rotation (COR), and an elliptical humeral head to improve ROM. The purpose of our study was to compare the difference in early postoperative ROM and restoration of radiographic COR, between this stemless TSA and standard stemmed TSAs. METHODS This was a retrospective review of 50 consecutive primary TSAs performed by a single surgeon for glenohumeral osteoarthritis. The initial cohort underwent TSA with a standard stemmed humeral component with a circular humeral head (n = 25), whereas the subsequent cohort underwent stemless TSA using an MPO and an elliptical humeral head (n = 25). Postoperative data collection included active shoulder ROM as measured by goniometer, complications or revision surgery, and measurements of radiographic COR. Patients were assessed at 6 weeks, 12 weeks, 6 months, and 12 months after surgery. Change in COR was determined on postoperative radiographs by 2 fellowship-trained surgeons on 2 separate occasions. Intra- and interrater reliability were computed using intraclass correlation coefficients. RESULTS For both mean forward flexion (FF) and external rotation (ER), there was greater ROM in the MPO-elliptical group at all time points, which was statistically significant. Mean change in FF favored the MPO group at 6 and 12 weeks and was statistically significant and above the minimal clinically important difference (MCID): 6 weeks, standard -15.8° vs. MPO 8.4° (P = .004); 12 weeks, standard 6.4° vs. MPO 29.2° (P = .001). Mean change in ER favored the MPO group at 6 weeks and was statistically significant: standard 5.4° vs. MPO 14.0° (P = .02). There were no revision surgeries in either group. Average change in COR was 2.7 mm in the standard group and 1.8 mm in the MPO-elliptical group, which was statistically significant (P < .001). Number of patients with >3 mm of difference in COR was 10 (40%) in the standard group and 1 (5%) in the MPO-elliptical group, which was statistically significant (P = .002). Average intraclass correlation coefficient was 0.75, indicating good reliability within and between surgeon measurements. CONCLUSION The use of a multiplanar osteotomy and elliptical humeral head was associated with improved early range of motion and better reproduction of the radiographic COR compared with standard stemmed TSA.
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Shibayama Y, Imamura R, Hirose T, Sugi A, Mizushima E, Watanabe Y, Tomii R, Emori M, Teramoto A, Iba K, Yamashita T. Reliability and accuracy of the critical shoulder angle measured by anteroposterior radiographs: using digitally reconstructed radiograph from 3-dimensional computed tomography images. J Shoulder Elbow Surg 2023; 32:286-291. [PMID: 36067938 DOI: 10.1016/j.jse.2022.07.017] [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: 04/23/2022] [Revised: 07/08/2022] [Accepted: 07/10/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Accuracy of current standard radiographic measurement of the critical shoulder angle (CSA) is not well established. This study analyzed the reliability and accuracy of the CSA measurements obtained via anteroposterior (AP) radiographs, using a digitally reconstructed radiograph (true AP view) generated from a computed tomography image as the gold standard. METHODS The CSA was measured on the radiographs and true AP views of 88 consecutive patients who had undergone shoulder arthroscopy for rotator cuff tears. Intraobserver and interobserver reliabilities of the CSA, measured by 2 orthopedic surgeons, were evaluated, and the average deviation of the CSA between radiographs and true AP views was calculated. Moreover, we compared the deviation of CSA between standard AP films (types A1 and C1) and nonstandard AP films (other types) against the Suter-Henninger criteria. RESULTS Intraobserver and interobserver reliabilities were almost perfect on radiographs (0.96, 0.86) and true AP views (0.93, 0.85). The average deviation of CSA was 2.1° ± 1.6° for observer 1 and 2.2° ± 1.9° for observer 2. The percentage of cases with deviations of 2° or more when compared with the true AP view was 42% (37 of 88) for observer 1 and 53% (47 of 88) for observer 2. Only 22% (19 of 88) of films were standard AP films. The average deviation of CSA was not significantly different between standard and nonstandard AP films for observer 1 (standard 1.9° ± 1.3°; nonstandard 2.1° ± 1.7°; P = .76) and observer 2 (standard 1.6° ± 1.5°; nonstandard 2.4° ± 1.9°; P = .09). CONCLUSION The CSA measurements using radiography were highly congruent, but a large measurement deviation occurred between radiographs and true AP views. The clinical usefulness and role of CSA in diagnosis require careful consideration.
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Affiliation(s)
- Yuji Shibayama
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
| | - Rui Imamura
- Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital, Sapporo, Japan
| | | | - Akira Sugi
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Emi Mizushima
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Yuto Watanabe
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Rira Tomii
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Makoto Emori
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Kousuke Iba
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
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Buchan SJ, Lindisfarne EA, Stabler A, Barry M, Gent ED, Bennet S, Aarvold A. The Free-Gliding screw for slipped capital femoral epiphysis : is it safe, does it glide, and does age matter? Bone Joint J 2023; 105-B:215-219. [PMID: 36722064 DOI: 10.1302/0301-620x.105b2.bjj-2022-0700.r1] [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] [Indexed: 02/02/2023]
Abstract
AIMS Fixation techniques used in the treatment of slipped capital femoral epiphysis (SCFE) that allow continued growth of the femoral neck, rather than inducing epiphyseal fusion in situ, have the advantage of allowing remodelling of the deformity. The aims of this study were threefold: to assess whether the Free-Gliding (FG) SCFE screw prevents further slip; to establish whether, in practice, it enables lengthening and gliding; and to determine whether the age of the patient influences the extent of glide. METHODS All patients with SCFE who underwent fixation using FG SCFE screws after its introduction at our institution, with minimum three years' follow-up, were reviewed retrospectively as part of ongoing governance. All pre- and postoperative radiographs were evaluated. The demographics of the patients, the grade of slip, the extent of lengthening of the barrel of the screw and the restoration of Klein's line were recorded. Subanalysis was performed according to sex and age. RESULTS A total of 19 hips in 13 patients were included. The mean age of the patients at the time of surgery was 11.5 years (9 to 13) and the mean follow-up was 63 months (45 to 83). A total of 13 FG SCFE screws were used for the fixation of mild or moderate SCFE, with six contralateral prophylactic fixations. No hip with SCFE showed a further slip after fixation and there were no complications. Lengthening occurred in 15 hips (79%), with a mean lengthening of the barrel of 6.8 mm (2.5 to 13.6) at final follow-up. Remodelling occurred in all hips with lengthening of the barrel. There was statistically more lengthening in patients who were aged < 12 years, regardless of sex (p = 0.002). CONCLUSION The FG SCFE screw is effective in preventing further slip in patients with SCFE. Lengthening of the barrel occurred in most hips, and thus allowed remodelling. This was most marked in younger children, regardless of sex. Based on this study, this device should be considered for use in patients with SCFE aged < 12 years instead of standard pinning in situ.Cite this article: Bone Joint J 2023;105-B(2):215-219.
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Affiliation(s)
| | | | | | | | - Edward D Gent
- Mediclinic Airport Road Hospital, Abu Dhabi, United Arab Emirates
| | - Simon Bennet
- Southampton Children's Hospital, Southampton, UK
| | - Alexander Aarvold
- Southampton Children's Hospital, Southampton, UK.,University of Southampton, Southampton, UK
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Stotter C, Klestil T, Röder C, Reuter P, Chen K, Emprechtinger R, Hummer A, Salzlechner C, DiFranco M, Nehrer S. Deep Learning for Fully Automated Radiographic Measurements of the Pelvis and Hip. Diagnostics (Basel) 2023; 13. [PMID: 36766600 DOI: 10.3390/diagnostics13030497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/20/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
The morphometry of the hip and pelvis can be evaluated in native radiographs. Artificial-intelligence-assisted analyses provide objective, accurate, and reproducible results. This study investigates the performance of an artificial intelligence (AI)-based software using deep learning algorithms to measure radiological parameters that identify femoroacetabular impingement and hip dysplasia. Sixty-two radiographs (124 hips) were manually evaluated by three observers and fully automated analyses were performed by an AI-driven software (HIPPO™, ImageBiopsy Lab, Vienna, Austria). We compared the performance of the three human readers with the HIPPO™ using a Bayesian mixed model. For this purpose, we used the absolute deviation from the median ratings of all readers and HIPPO™. Our results indicate a high probability that the AI-driven software ranks better than at least one manual reader for the majority of outcome measures. Hence, fully automated analyses could provide reproducible results and facilitate identifying radiographic signs of hip disorders.
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