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Wang D, Chen X, Han D, Wang W, Kong C, Lu S. Radiographic and surgery-related predictive factors for increased segmental lumbar lordosis following lumbar fusion surgery in patients with degenerative lumbar spondylolisthesis. Eur Spine J 2024:10.1007/s00586-024-08248-z. [PMID: 38637404 DOI: 10.1007/s00586-024-08248-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/04/2024] [Accepted: 03/28/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE This study aimed to evaluate preoperative (pre-op) radiographic characteristics and specific surgical interventions in patients with degenerative lumbar spondylolisthesis (DLS) who underwent lumbar fusion surgery (LFS), with a focus on analyzing predictors of postoperative restoration of segmental lumbar lordosis (SLL). METHODS A retrospective review at a single center identified consecutive single-level DLS patients who underwent LFS between 2016 and 2022. Radiographic measures included disc angle (DA), SLL, lumbar lordosis (LL), anterior/posterior disc height (ADH/PDH), spondylolisthesis percentage (SP), intervertebral disc degeneration, and paraspinal muscle quality. Surgery-related measures included cage position, screw insertion depth, spondylolisthesis reduction rate, and disc height restoration rate. A change in SLL ≥ 4° indicated increased segmental lumbar lordosis (ISLL), and unincreased segmental lumbar lordosis (UISLL) < 4°. Propensity score matching was employed for a 1:1 match between ISLL and UISLL patients based on age, gender, body mass index, smoking status, and osteoporosis condition. RESULTS A total of 192 patients with an average follow-up of 20.9 months were enrolled. Compared to UISLL patients, ISLL patients had significantly lower pre-op DA (6.78° vs. 11.84°), SLL (10.73° vs. 18.24°), LL (42.59° vs. 45.75°), and ADH (10.09 mm vs. 12.21 mm) (all, P < 0.05). ISLL patients were predisposed to more severe intervertebral disc degeneration (P = 0.047) and higher SP (21.30% vs. 19.39%, P = 0.019). The cage was positioned more anteriorly in ISLL patients (67.00% vs. 60.08%, P = 0.000), with more extensive reduction of spondylolisthesis (- 73.70% vs. - 56.16%, P = 0.000) and higher restoration of ADH (33.34% vs. 8.11%, P = 0.000). Multivariate regression showed that lower pre-op SLL (OR 0.750, P = 0.000), more anterior cage position (OR 1.269, P = 0.000), and a greater spondylolisthesis reduction rate (OR 0.965, P = 0.000) significantly impacted SLL restoration. CONCLUSIONS Pre-op SLL, cage position, and spondylolisthesis reduction rate were identified as significant predictors of SLL restoration after LFS for DLS. Surgeons are advised to meticulously select patients based on pre-op SLL and strive to position the cage more anteriorly while minimizing spondylolisthesis to maximize SLL restoration.
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Affiliation(s)
- Dongfan Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Xiaolong Chen
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Di Han
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Wei Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Shibao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China.
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China.
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Shin JW, Kim JE, Huh KH, Yi WJ, Heo MS, Lee SS, Choi SC. Radiological manifestations and clinical findings of patients with oncologic and osteoporotic medication-related osteonecrosis of the jaw. Sci Rep 2024; 14:8744. [PMID: 38627515 PMCID: PMC11021436 DOI: 10.1038/s41598-024-59500-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/11/2024] [Indexed: 04/19/2024] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) poses a challenging form of osteomyelitis in patients undergoing antiresorptive therapies in contrast to conventional osteomyelitis. This study aimed to compare the clinical and radiological features of MRONJ between patients receiving low-dose medications for osteoporosis and those receiving high-dose medications for oncologic purposes. The clinical, panoramic radiographic, and computed tomography data of 159 patients with MRONJ (osteoporotic group, n = 120; oncologic group, n = 39) who developed the condition after using antiresorptive medications for the management of osteoporosis or bone malignancy were analyzed. The osteoporotic group was older (75.8 vs. 60.4 years, p < 0.01) and had a longer duration of medication usage than the oncologic group (58.1 vs. 28.0 months, p < 0.01). Pus discharge and swelling were more common in the osteoporotic group (p < 0.05), whereas bone exposure was more frequent in the oncologic group (p < 0.01). The mandibular cortical index (MCI) in panoramic radiographs was higher in the osteoporotic group (p < 0.01). The mean sequestra size was larger in the oncologic group than in the osteoporotic group (15.3 vs. 10.6 mm, p < 0.05). The cured rate was significantly higher in the osteoporotic group (66.3% vs. 33.3%, p < 0.01). Oncologic MRONJ exhibited distinct clinical findings including rapid disease onset, fewer purulent signs, and lower cure rates than osteoporotic MRONJ. Radiological features such as sequestrum size on CT scan, and MCI values on panoramic radiographs, may aid in differentiating MRONJ in osteoporotic and oncologic patients.
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Affiliation(s)
- Jeong Won Shin
- Department of Orthodontics, Institute of Oral Health Science, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jo-Eun Kim
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea.
| | - Kyung-Hoe Huh
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Won-Jin Yi
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Min-Suk Heo
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Sam-Sun Lee
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Soon-Chul Choi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Republic of Korea
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Cañadillas-Rueda R, Sánchez-Agesta C, Villazán-Cervantes MÁ, Roda-Murillo O, Sánchez-Montesinos-García I, Hernández-Cortés P. Radiographic evaluation of radial flexion osteotomy effect on static scapholunate instability: a preliminary cadaveric study. Arch Orthop Trauma Surg 2024; 144:975-984. [PMID: 38063881 DOI: 10.1007/s00402-023-05124-1] [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: 07/22/2023] [Accepted: 10/29/2023] [Indexed: 01/30/2024]
Abstract
INTRODUCTION The optimal treatment of chronic scapholunate instability has yet to be established. Scapholunate ligament grafts are still far from being the ideal solution. We conducted an experimental study to evaluate whether flexion-opening wedge osteotomy of the distal radius improves misalignment and avoids rotatory subluxation of the scaphoid in a cadaveric model of static scapholunate dissociative instability. MATERIALS AND METHODS Radiographic studies were performed on 15 cryopreserved specimens after recreating a model of scapholunate instability by division of the scapholunate interosseous ligament (SLIL) and secondary stabilizers, taking radiographs at baseline, after the instability model, and after distal radius osteotomy. Static and dynamic (under controlled tendon traction) anteroposterior and lateral views were obtained to measure the length (in mm) of the carpal scaphoid and scapholunate interval, scapholunate angle, radio-lunate angle, and palmar tilt of the distal joint surface of the radius and to measure the dorsal scaphoid translation by the concentric circles method. The Wilcoxon test was used for statistical comparisons. RESULTS The scapholunate interval was significantly decreased after osteotomy in all static anteroposterior views and in all lateral views under tendon traction. Dorsal scaphoid translation was significantly reduced in static lateral view in extension and in dynamic lateral view under 5-pound flexor carpi radialis tendon tension controlled by a digital dynamometer. CONCLUSIONS Flexion-addition osteotomy of the distal radius appears to improve carpal alignment parameters in a cadaveric model of static scapholunate instability, achieving similar values to those obtained before instability.
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Affiliation(s)
| | | | | | - Olga Roda-Murillo
- Department of Human Anatomy, School of Medicine, Granada University, Granada Avenida de la Investigación, 11, 18016, Granada, Spain.
| | | | - Pedro Hernández-Cortés
- Surgery Department, School of Medicine, Granada University, Granada, Spain
- Upper Limb Surgery Unit, Orthopedic Surgery Department, University Hospital of Granada, Granada, Spain
- Biosanitary Research Institute of Granada, Granada, Spain
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Khokhar SK, Surti A, Qamar A, Khaliq S. Radiographic assessment of sacral hiatus anatomy with backache. Pak J Med Sci 2023; 39:1757-1762. [PMID: 37936755 PMCID: PMC10626087 DOI: 10.12669/pjms.39.6.7112] [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: 09/09/2022] [Revised: 10/05/2022] [Accepted: 07/08/2023] [Indexed: 11/09/2023] Open
Abstract
Objectives To determine hiatal variations in cases of backache and controls on radiographs and association of age groups with hiatal parameters in patients with backache versus normal individuals. Methods This case control study on 178 patients (89 cases and 89 controls), aged from 18-65 years, selected by non-probability convenience sampling was conducted at Radiology Department of PNS Shifa Hospital, Karachi over six months.The sacral hiatus was identified on lumbosacral spine radiographs. Both metric and non-metric parameters of hiatus with respect to sacral vertebra were noted and compared between the groups. Results Inverted "U" was the most common type observed in cases with base of hiatus at S5 level. Comparison of hiatal shape among different age groups showed inverted "U" and inverted "V" types among all age groups. Hiatal anteroposterior diameter and width were greatest in 36-45-year age group, and it was longest in 46-55-year age group. Determination of relationship between sacral hiatal parameters and incidence of low back pain showed positive association of inverted "U" and "M" shapes with back pain. Increased risk of back pain was observed with high apex (first sacral vertebra (S1)). Conclusion Strong positive correlation was determined with inverted "U" and "M" shapes, and level of apex at S1 with low backache.
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Affiliation(s)
- Samia Khalid Khokhar
- Dr. Samia Khalid Khokhar, MPhil, Department of Anatomy, Bahria University Health Sciences, Karachi, Pakistan
| | - Ambreen Surti
- Dr. Ambreen Surti, MPhil, Department of Anatomy, Bahria University Health Sciences, Karachi, Pakistan
| | - Aisha Qamar
- Prof. Dr. Aisha Qamar, MPhil, Department of Anatomy, Bahria University Health Sciences, Karachi, Pakistan
| | - Saneed Khaliq
- Dr. Saneed Khaliq, MPhil, Department of Anatomy, Mekran Medical College, Turbat, Balochistan Pakistan
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Kourtidis S, Hempel JM, Saravakos P, Preyer S. Diagnostic value of computed tomography in Eustachian tube dysfunction. Auris Nasus Larynx 2021:S0385-8146(21)00235-2. [PMID: 34593272 DOI: 10.1016/j.anl.2021.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/03/2021] [Accepted: 09/08/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Investigate radiological findings on temporal bone computed tomography, which are associated with obstructive Eustachian tube dysfunction and determine its diagnostic validity. METHODS The present study was conducted as a prospective, cross-sectional case series study in a tertiary referral center. Forty patients with clinically diagnosed unilateral Eustachian tube dysfunction and older than 16 years old underwent pre interventional radiological assessment by temporal bone computed tomography while performing a Valsalva-maneuvre to enhance visualization of Eustachian tube lumen. The Eustachian tubes were assessed for intersite morphological differences, presence of mucus in the lumen or middle ear cleft and secretion retention or mucosal swelling in the adjacent sinuses. Image analyses and radiological statements about the side of pathology were delivered blinded to the clinical diagnoses. RESULTS The radiologic detection of mucus/mucosal edema in Eustachian tube or adjacent middle ear cleft structures was associated with the pathological side (t (1, N = 40) = 3.60, p = 0.001 < 0.05). On the contrary, there is no association between radiological findings of sinonasal disease and side of Eustachian tube dysfunction (x2 (1, N = 40) = .00, p = 1.00 > 0.05). The diagnostic value of radiologic assessment in Eustachian tube dysfunction has a sensitivity and specificity of 52,5 and 97,5% respectively. CONCLUSION The sensitivity of radiologic assessment is rather low, and hence it is inappropriate as a screening tool for Eustachian tube dysfunction in routine clinical practice. In the case of present CT-scans of the temporal bone, the focus should be laid on the detection of mucus in the Eustachian tube or adjacent structures, as a predictor of disease.
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Meccariello L, Bisaccia M, Ronga M, Falzarano G, Caraffa A, Rinonapoli G, Grubor P, Pace V, Rollo G. Locking retrograde nail, non-locking retrograde nail and plate fixation in the treatment of distal third femoral shaft fractures: radiographic, bone densitometry and clinical outcomes. J Orthop Traumatol 2021; 22:33. [PMID: 34350532 PMCID: PMC8339178 DOI: 10.1186/s10195-021-00593-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 07/24/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Distal third femoral shaft fractures are characterized by increasing incidence and complexity and are still considered a challenging problem (high morbidity and mortality). No consensus on best surgical option has been achieved. This study aims to investigate radiographic, mineral bone densitometry and clinical outcomes of locking retrograde intramedullary (LRN) nailing, non-locking retrograde intramedullary nailing and anatomical locking plate to surgically treat distal third femoral shaft fractures in young adults. Our hypothesis was that there is no significant statistical difference among the surgical options in terms of results (radiographic, bone densitometry and outcomes assessment). METHODS Retrospective study: 90 patients divided into three groups (group 1 LRN, group 2 NLRN, group 3 plating). Average age was respectively 42.67 (± 18.32), 44.27 (± 15.11) and 42.84 (± 18.32) years. Sex ratio F:M was respectively 2.75, 2.33 and 2.00. AO Classification, KOOS, NUSS and RUSH score, VAS, DEXA scans and plain radiographs were used. Evaluation endpoint: 12 months after surgery. RESULTS There were no statistical differences in terms of surgery time, transfusions, and wound healing. Results were similar with regard to average time of bone healing, RUSH scores, VAS, KOOS, regression between RUSH and VAS, average correlation clinical-radiographic results and patients outcomes. CONCLUSIONS Our results showed no statistical difference in the use of LNR, NLNR and plating for treatment of distal third femur shaft fractures in terms of radiographic, bone densitometry and clinical outcomes. Good subjective and objective results are provided by all three techniques. The choice among the studied techniques must be based on surgeons' experience, indications and subjective patients' aspects. The absence of relevant similar data in the published literature does not allow definitive validation (or rejection) of our hypothesis. A more powered study with a bigger cohort is needed for definitive validation.
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Affiliation(s)
- Luigi Meccariello
- Department of Orthopedics and Traumatology, AORN San Pio, Via Cupa dell'Angelo, Block: Moscati Floor:2, 82100, Benevento, Italy.
| | - Michele Bisaccia
- Division of Orthopedics and Trauma Surgery, University of Perugia, "S. Maria Della Misericordia" Hospital, Perugia, Italy
| | - Mario Ronga
- Orthopaedic and Trauma Operative Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, University Hospital G. Martino, Messina, Italy
| | - Gabriele Falzarano
- Department of Orthopedics and Traumatology, Azienda Ospedaliera "Gaetano Rummo", Benevento, Italy
| | - Auro Caraffa
- Division of Orthopedics and Trauma Surgery, University of Perugia, "S. Maria Della Misericordia" Hospital, Perugia, Italy
| | - Giuseppe Rinonapoli
- Division of Orthopedics and Trauma Surgery, University of Perugia, "S. Maria Della Misericordia" Hospital, Perugia, Italy
| | - Predrag Grubor
- School of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Valerio Pace
- Division of Orthopedics and Trauma Surgery, University of Perugia, "S. Maria Della Misericordia" Hospital, Perugia, Italy
- Orthopaedic and Trauma Operative Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, University Hospital G. Martino, Messina, Italy
- Department of Orthopedics and Traumatology, Azienda Ospedaliera "Gaetano Rummo", Benevento, Italy
- School of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
- The Royal National Orthopaedic Hospital, Stanmore, London, UK
| | - Giuseppe Rollo
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
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Uno T, Takahara M, Maruyama M, Harada M, Satake H, Takagi M. Qualitative and quantitative assessments of radiographic healing of osteochondritis dissecans of the humeral capitellum. JSES Int 2021; 5:554-560. [PMID: 34136870 PMCID: PMC8178641 DOI: 10.1016/j.jseint.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/25/2022] Open
Abstract
Background Little is known about the optimal timing of early return to sports after which the osteochondritis dissecans (OCD) lesion can completely heal. The aims of this study were to investigate the clinical outcomes of nonoperative treatment and elucidate the relationship between the radiographic findings and the timing for the return to sports. Methods We performed a retrospective review of 32 patients who presented with stable OCD of the capitellum and were treated nonoperatively for a minimum of 3 months. The mean follow-up period was 22.1 months. OCD lesions were assessed qualitatively and quantitatively on anteroposterior radiographs of the elbow at 45° of flexion every 3 months. The width of the OCD lesion (OCDw) and lateral width of the normal capitellum were measured and were associated with return to sports activities. Results In 21 patients (66%), the progression of ossification was seen at a mean period of 4.1 months. Eighteen (56%) had partial union at a mean period of 4.3 months. Twenty-nine cases (91%) returned to sports activities after a mean of 4.6 months. Nine cases (28%) achieved complete union after a mean period of 15.0 months. Fifteen (47%) required surgery after a mean period of 11.8 months. The mean OCDw (%) was 10.2 ± 3.9 mm (56%) at the initial presentation and 8.0 ± 6.0 mm (41%) at the final follow-up examination, and the decrease in OCDw was 2.2 ± 3.1 mm (15%). The mean decrease in OCDw in patients with progression of ossification during the first 3 months was significantly larger than in patients without progression of ossification (4.9 ± 4.7 mm and -0.7 ± 4.5 mm, respectively; P = .002). In patients who had both an OCDw value of <8.0 mm and a lateral width value of >2.0 mm at the time of the return to sports, the rate of successful nonoperative treatment (86%) and complete union (71%) was significantly higher in comparison with other patients (P = .03 and P = .02). Conclusions OCD lesions showed difficult healing in the middle one-third of the capitellum. The progression of ossification during the first 3 months was a significant predictor of successful nonoperative treatment and complete union. Surgery should be considered for lesions without the progression of ossification during the first 3 months. We propose both an OCD lesion width of <8.0 mm and a lateral normal width of >2.0 mm as radiographic landmarks of the timing of the return to sports.
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Affiliation(s)
- Tomohiro Uno
- Center for Hand, Elbow, and Sports Medicine, Izumi Orthopaedic Hospital, Sendai, Japan.,Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Masatoshi Takahara
- Center for Hand, Elbow, and Sports Medicine, Izumi Orthopaedic Hospital, Sendai, Japan
| | - Masahiro Maruyama
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Mikio Harada
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Hiroshi Satake
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Michiaki Takagi
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
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Tuecking LR, Ettinger M, Nebel D, Welke B, Schwarze M, Windhagen H, Savov P. 3D-surface scan based validated new measurement technique of femoral joint line reconstruction in total knee arthroplasty. J Exp Orthop 2021; 8:16. [PMID: 33634333 PMCID: PMC7907296 DOI: 10.1186/s40634-021-00330-5] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/20/2021] [Indexed: 01/16/2023] Open
Abstract
Purpose This study aimed to validate a new joint line measurement technique in total knee arthroplasty for separated assessment of the medial and lateral femoral joint line alteration with 3D-surface scan technology. Separate assessment of the medial and lateral joint line alteration may improve TKA alignment assessment regarding to joint line restoration in kinematic alignment and use of robotic-assisted TKA surgery. Methods The medial and lateral joint line difference after TKA implantation on an artificial bone model was analyzed and compared with a 3D-scan and full femoral radiographs pre- and postoperatively. Radiographic analysis included the perpendicular distance between the most distal point of the medial and lateral condyle and the reproduced preoperative lateral distal femoral angle (LDFA). For evaluation of validity and reliability, radiographs were captured initially with true anteroposterior view and subsequently with combined flexion and rotation malpositioning. Reliability of the introduced measurement technique in between three observers was tested with intraclass correlation coefficient (ICC). Results Radiographic measurement showed a mean difference of 0.9 mm on the medial side and 0.6 mm on the lateral side when compared to the 3D-surface scan measurement. The reliability of measurement accuracy was ≤ 1 mm in x-rays with < 10° flexion error regardless to malrotation in these images. The ICC test showed very good reliability for the medial joint line evaluation and good reliability for lateral joint line evaluation (ICC 0.92, ICC 0.86 respectively). Conclusion The new introduced joint line measurement method showed a sufficient reliability, accuracy and precision. It provides separated information about medial and lateral joint line alteration in TKA surgery in absolute values. Level of evidence V - Experimental Study
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Affiliation(s)
- Lars-Rene Tuecking
- Department of Orthopaedic Surgery, Medical School Hannover, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Max Ettinger
- Department of Orthopaedic Surgery, Medical School Hannover, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Dennis Nebel
- Laboratory for Biomechanics and Biomaterials, Medical School Hannover, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Bastian Welke
- Laboratory for Biomechanics and Biomaterials, Medical School Hannover, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Michael Schwarze
- Laboratory for Biomechanics and Biomaterials, Medical School Hannover, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Henning Windhagen
- Department of Orthopaedic Surgery, Medical School Hannover, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Peter Savov
- Department of Orthopaedic Surgery, Medical School Hannover, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany.
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Bellabarba C, Karim F, Tavolaro C, Zhou H, Bremjit P, Nguyen QT, Agel J, Bransford RJ. The mandible-C2 angle: a new radiographic assessment of occipitocervical alignment. Spine J 2021; 21:105-113. [PMID: 32673731 DOI: 10.1016/j.spinee.2020.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/05/2020] [Revised: 06/28/2020] [Accepted: 07/08/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Occipitocervical fusion is a rare and often challenging surgical procedure. Significant morbidity can result if care is not taken to achieve physiologic alignment. This is especially true for patients needing occipitocervical fusion in the setting of trauma where preoperative alignment is unknown. PURPOSE To assess the radiographic angles normally subtended between the C2 body and the mandible ramus, in a series of patients with neutral physiologic alignment and no pathology, and to assess its validity as a possible intraoperative radiographic tool to determine a neutral craniocervical alignment. DESIGN Validation and reliability study of radiographic parameters. PATIENT SAMPLE Hundred lateral, neutral, cervical radiographs from patients with "normal" radiographic findings. OUTCOME MEASURES Radiographic parameters of occipital-cervical alignment with assessment of reliability and correlation in data. METHODS One hundred neutral lateral cervical spine radiographs in the upright position of patients with no complaints or known pathology were obtained from two medical clinics between December of 2014 and January of 2017. Three physicians, at different levels of spine surgery training, took measurements of radiographic parameters. The new technique used four different angles measured between the C2-body/dens complex and the mandibular ramus (anterior/posterior C2 body and anterior/posterior mandible lines angles), and compared these with the Occipito-C2 angle, which is a validated assessment of occipitocervical alignment. Statistical analysis was performed to assess correlation in data and measure reproducibility. RESULTS Between the three reviewers, the mean±standard deviation were 18.0°±6.5° for Occipito-C2 angle (O-C2A), -4.2°±5.4° for anterior C2-body/anterior mandible line angle (AB/AM), -4.2°±5.9° for anterior C2-body/posterior mandible line angle (AB/PM), 5.1°±5.8° for posterior C2 body/anterior mandible line angle (PB/AM) and 5.6°±6.2° for posterior C2 body/ posterior mandible line angle (PB/PM). Overall the measurements obtained were correlative with an appropriate range for the standard deviation. Mean intraclass correlation coefficient were 0.889 for O-C2A, 0.795 for AB/AM, 0.859 for AB/PM, 0.876 for PB/AM, and 0.750 for PB/PM, showing high interobserver reliability for all the radiographic measures. Across the five techniques, 87%-92% of measurements fell within 10° of the median, 76%-83% fell within 7.5°, and 55%-66% within 5°. CONCLUSIONS The mandible-C2 angle offers a reproducible alternative to the validated O-C2A technique for determining appropriate intraoperative occipitocervical alignment, which may be especially useful when preoperative radiographic alignment is unknown, such as occurs with trauma patients, with the goal of decreasing alignment-related complications in the setting of occipitocervical stabilization.
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Affiliation(s)
- Carlo Bellabarba
- Department of Orthopaedics & Sport Medicine, Harborview Medical Center, 325 Ninth Ave Seattle, WA 98104, USA
| | - Farhan Karim
- Department of Orthopaedics & Sport Medicine, Harborview Medical Center, 325 Ninth Ave Seattle, WA 98104, USA
| | - Celeste Tavolaro
- Department of Orthopaedics & Sport Medicine, Harborview Medical Center, 325 Ninth Ave Seattle, WA 98104, USA
| | - Haitao Zhou
- Department of Orthopaedics & Sport Medicine, Harborview Medical Center, 325 Ninth Ave Seattle, WA 98104, USA
| | - Prashoban Bremjit
- Department of Orthopaedics & Sport Medicine, Harborview Medical Center, 325 Ninth Ave Seattle, WA 98104, USA
| | - Quynh T Nguyen
- Department of Orthopaedics & Sport Medicine, Harborview Medical Center, 325 Ninth Ave Seattle, WA 98104, USA
| | - Julie Agel
- Department of Orthopaedics & Sport Medicine, Harborview Medical Center, 325 Ninth Ave Seattle, WA 98104, USA
| | - Richard J Bransford
- Department of Orthopaedics & Sport Medicine, Harborview Medical Center, 325 Ninth Ave Seattle, WA 98104, USA.
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10
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Lin GX, Rui G, Sharma S, Mahatthanatrakul A, Kim JS. The correlation of intraoperative distraction of intervertebral disc with the postoperative canal and foramen expansion following oblique lumbar interbody fusion. Eur Spine J 2020; 30:151-163. [PMID: 32960343 DOI: 10.1007/s00586-020-06604-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 08/04/2020] [Accepted: 09/10/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To examine the correlation of intraoperative distraction of intervertebral disc with the postoperative central canal and foramen expansion by oblique lumbar interbody fusion (OLIF) with indirect decompression. METHODS Patients who underwent OLIF between October 2013 and April 2017 were included. Clinical outcomes included back and leg pain evaluated by visual analog scale (VAS) and Oswestry Disability Index (ODI). Intraoperative radiographic parameters of height ratio [(HR) = disc height/intervertebral body height)] and cage location were evaluated on intraoperative fluoroscopic images. Disc height (DH), foraminal height (FH), cross-sectional area of spinal canal (CSAC), and CSA of the foramen (CSAF) were measured. RESULTS A total of 47 patients involving 62 levels were enrolled in this study. Mean follow-up was 43.8 ± 12.0 months. These patients reported an improvement of 61.7% in VAS back, 68.1% in VAS leg, and 46% in ODI (all p < 0.01). Radiographic parameters including HR, DH, FH, CSAC, and CSAF were also significantly increased by 32.6%, 48.2%, 21.4%, 44.0%, and 40.1% (left-side CSAF) or 45.4% (right-side CSAF), respectively (p < 0.05). HR increment was correlated with CSA (canal and foramen) increment. Slightly higher improvements of HR, DH, FH, CSAC, and CSAF (both sides) were noted when cage was located at middle rather than anterior (p > 0.05). CONCLUSIONS The ligamentotaxis effect of OLIF is capable of supporting indirect decompression of central canal and neural foramina and clinical improvement. HR is a reliable intraoperative assessment method. In addition, intraoperative HR increment was correlated with postoperative neural elements expansion.
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Affiliation(s)
- Guang-Xun Lin
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - Gang Rui
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, Xiamen, People's Republic of China
| | - Sagar Sharma
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul, 06591, Republic of Korea
| | | | - Jin-Sung Kim
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul, 06591, Republic of Korea.
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Leow JM, Clement ND, Simpson AHWR. Application of the Radiographic Union Scale for Tibial fractures (RUST): Assessment of healing rate and time of tibial fractures managed with intramedullary nailing. Orthop Traumatol Surg Res 2020; 106:89-93. [PMID: 31786133 DOI: 10.1016/j.otsr.2019.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 12/23/2017] [Revised: 06/16/2018] [Accepted: 10/07/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Tibial fractures are devastating injuries and a cause of significant morbidity. There is limited information describing the length of time it takes for these injuries to heal. The aim of this study was to define the normal distribution of healing times of a consecutive series of tibial fractures treated with intramedullary (IM) nailing by applying the Radiographic Union Scale for Tibial fractures (RUST). METHODS 880 radiographs from 217 patients were assessed with RUST. Patients requiring more than one standard deviation from the mean were defined to have a delayed union. RESULTS 16 patients (7%) developed non-unions and 30 patients (14%) had delayed union. Of the 201 patients who achieved union, the mean time to healing was 18.7 (SD 6.9) weeks, with a wide range from 7 to 52 weeks. In the union group, the rate of healing was greatest in the 8 to 12-week period. In contrast, in the delayed union group there was a lower peak rate of change, which was reached at a later time point. DISCUSSION Our data indicates that 7% of patients with tibial fractures treated with IM nailing develop non-unions and over 10% of those progressing to union will take longer than 26 weeks. The data on healing rates is important to surgeons and orthopaedic multidisciplinary staff in guiding management. It can also be of help for patients planning their finances and for giving estimates for personal injury claims. LEVEL OF EVIDENCE IV, Retrospective cohort study.
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Affiliation(s)
- Jun Min Leow
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA, UK.
| | - Nicholas D Clement
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA, UK
| | - A Hamish W R Simpson
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA, UK
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Konomi T, Yasuda A, Fujiyoshi K, Yato Y, Asazuma T. Incidences and Risk Factors for Postoperative Non-Union after Posterior Lumbar Interbody Fusion with Closed-Box Titanium Spacers. Asian Spine J 2019; 14:106-112. [PMID: 31608613 PMCID: PMC7010511 DOI: 10.31616/asj.2019.0024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 04/17/2019] [Indexed: 11/26/2022] Open
Abstract
Study Design A retrospective, single-center clinical study with follow-up of more than 24 months. Purpose To evaluate the union rates and relevant risk factors for non-union after posterior lumbar interbody fusion (PLIF) using porous-coated closed-box titanium spacers. Overview of Literature Although the use of a closed-box interbody spacer for PLIF could avoid potential complications associated with the harvesting of autologous bone, few studies have reported detailed follow-up of fusion progression and risk factors for non-union in the early postoperative period. Methods PLIF using closed-box spacers without filling the autologous bone was performed in 78 (88 levels) consecutive patients. Surgical procedures included PLIF using traditional pedicle screw fixation (PLIF, n=37), PLIF using cortical bone trajectory screw fixation (CBT-PLIF, n=30), and transforaminal lumbar interbody fusion with traditional pedicle screw fixation (TLIF, n=11). Lateral dynamic radiography and computed tomography findings were investigated, and the relationship between the union status and variables that may be related to the risk of non-union was tested statistically. Results The overall bone union rates at 12 and 24 months were 68.0% and 88.5%, respectively. Incidences of bone cyst formation, subsidence, and retropulsion of spacers were 33.3%, 47.4%, and 14.1%, respectively. Union rates at 24 months were 94.6% in PLIF, 80.0% in CBT-PLIF, and 90.9% in TLIF. Multivariate logistic regression analyses showed that at 12 months postoperatively, the risk factor for non-union was age >75 years (p =0.02). In contrast, no significant risk factor was observed at 24 months. Conclusions These findings demonstrated the efficacy of interbody closed-box spacers for PLIF without the need to fill the spacer with autologous bone. However, the risk of non-union should be considered in elderly patients, especially intra-operatively and during the early postoperative stage.
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Affiliation(s)
- Tsunehiko Konomi
- Department of Orthopaedic Surgery, Murayama Medical Center, National Hospital Organization, Tokyo, Japan
| | - Akimasa Yasuda
- Department of Orthopaedic Surgery, Murayama Medical Center, National Hospital Organization, Tokyo, Japan
| | - Kanehiro Fujiyoshi
- Department of Orthopaedic Surgery, Murayama Medical Center, National Hospital Organization, Tokyo, Japan
| | - Yoshiyuki Yato
- Department of Orthopaedic Surgery, Murayama Medical Center, National Hospital Organization, Tokyo, Japan
| | - Takashi Asazuma
- Department of Orthopaedic Surgery, Murayama Medical Center, National Hospital Organization, Tokyo, Japan
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Hategan SI, Kamer AR, Sinescu C, Craig RG, Jivanescu A, Gavrilovici AM, Negrutiu ML. Periodontal disease in a young Romanian convenience sample: radiographic assessment. BMC Oral Health 2019; 19:94. [PMID: 31142373 PMCID: PMC6542117 DOI: 10.1186/s12903-019-0774-9] [Citation(s) in RCA: 5] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/26/2019] [Indexed: 11/25/2022] Open
Abstract
Background The goal of this study was to determine the distribution of periodontal disease in a population seeking oral rehabilitation in a Romanian prosthodontics department and to identify the factors associated with each type of periodontal condition. Methods The study population consisted of patients presenting consecutively to the Prosthodontics Department of the Faculty of Dental Medicine, Victor Babeş University of Medicine and Pharmacy, Timisoara. The diagnosis and classification of periodontal conditions, as well as dental pathologies and conditions, were based on examination of panoramic radiographs. A standardized questionnaire was administered to obtain socio-demographic characteristics (age, gender, ethnicity, education, residency, marital status), medical history, dental/periodontal history (family history of periodontal disease), and behavior (smoking, brushing, flossing and regular cleaning). Results Among subjects presenting to the Prosthodontics department, only 34.2% were periodontal disease-free and 65.8% had periodontal disease, of which 11.4% had aggressive periodontitis. In univariate models, age, education, marital status, smoking, and tooth number were associated with chronic periodontitis. Age, education, family history, smoking, and tooth number were associated with aggressive periodontitis. However, in a multivariable model, only age, tooth number and family history were significant. Conclusions This study found a high prevalence of periodontal disease in patients seeking oral rehabilitation from the Prosthodontics department. Age, tooth number and family history of periodontal disease were associated with the type of periodontal disease. These results suggest the need for periodontal examination prior to prosthetic oral rehabilitation in this population.
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Affiliation(s)
- Simona Ioana Hategan
- Department of Prosthodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy "Victor Babeş" Timisoara, Bd. Revolutiei din 1989, Nr.9, 300041, Timişoara, Romania
| | - Angela Ruth Kamer
- Department of Periodontology and Implant Dentistry, New York University, College of Dentistry, 345 East 24th Street, New York, NY, 10010, USA.
| | - Cosmin Sinescu
- Department of Prostheses Technology and Dental Materials, Faculty of Dentistry, University of Medicine and Pharmacy "Victor Babes" Timisoara, Bd. Revolutiei 1989, Nr.9, sc.C, et.IV, 300070, Timisoara, Romania
| | - Ronald George Craig
- Department of Basic Sciences and Craniofacial Biology, New York University, College of Dentistry, 345 East 24th Street, New York, NY, 10010, USA
| | - Anca Jivanescu
- Department of Prosthodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy "Victor Babeş" Timisoara, Bd. Revolutiei din 1989, Nr.9, 300041, Timişoara, Romania
| | - Andrei Mihai Gavrilovici
- Department of Prosthodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy "Victor Babeş" Timisoara, Bd. Revolutiei din 1989, Nr.9, 300041, Timişoara, Romania
| | - Meda-Lavinia Negrutiu
- Department of Prostheses Technology and Dental Materials, Faculty of Dentistry, University of Medicine and Pharmacy "Victor Babes" Timisoara, Bd. Revolutiei 1989, Nr.9, sc.C, et.IV, 300070, Timisoara, Romania.
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Sanda M, Fueki K, Bari PR, Baba K. Comparison of immediate and conventional loading protocols with respect to marginal bone loss around implants supporting mandibular overdentures: A systematic review and meta-analysis. Jpn Dent Sci Rev 2019; 55:20-25. [PMID: 30733841 PMCID: PMC6354284 DOI: 10.1016/j.jdsr.2018.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 03/10/2018] [Revised: 08/18/2018] [Accepted: 09/18/2018] [Indexed: 11/15/2022] Open
Abstract
Purpose To compare marginal bone level changes (MBLCs) of immediately- and conventionally-loaded implants supporting a mandibular implant overdenture (IOD). Materials and methods Both electronic (MEDLINE, PubMed, and The Cochrane Library) and manual searches were conducted for all relevant studies published from 1 January 2000 to 1 November, 2017. Randomized controlled trials (RCTs) and prospective studies with a minimum follow-up of 12 months were selected. Studies which utilized implants narrower than 3 mm were excluded from analysis. Results Four studies met the criteria, with two evaluating horizontal bone loss. There were 70 patients in the test group (immediate loading) and 60 in the control group (conventional loading). Follow-up lasted 6–36 months, with MBLCs being interpreted from standardized periapical x-rays, panoramics or cone beam computed tomography. Each patient was given 2–3 implants. After 6 and 12 months, the differences in MBLCs were 0.04 mm (95% CI: −0.21, 0.29) and 0. 00 mm (95% CI: −0.35, 0.36) respectively. Subgroup analysis of RCTs with 2 implants revealed group differences in MBLCs as 0.13 mm (95% CI: −0.22, 0.48) and that in horizontal bone loss as 0.04 mm (95% CI: −0.02, 0.10). No statistically significant differences were identified (p > 0.05). Conclusion The MBLCs of immediately-loaded implants for mandibular IODs seems comparable to those of conventional loading.
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Affiliation(s)
- Minoru Sanda
- Department of Prosthodontics, School of Dentistry, Showa University, 2-1-1 Kitasenzoku, Ota-ku, Tokyo 145-8515, Japan
| | - Kenji Fueki
- Removable Partial Prosthodontics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan
| | - Pranjal Radke Bari
- VSPM Dental College & Research Centre, Digdoh Hills, Hingna Road, Nagpur, Maharashtra 440019, India
| | - Kazuyoshi Baba
- Department of Prosthodontics, School of Dentistry, Showa University, 2-1-1 Kitasenzoku, Ota-ku, Tokyo 145-8515, Japan
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Hartmann F, Nusselt T, Mattyasovszky S, Maier G, Rommens PM, Gercek E. Misdiagnosis of Thoracolumbar Posterior Ligamentous Complex Injuries and Use of Radiographic Parameter Correlations to Improve Detection Accuracy. Asian Spine J 2018; 13:29-34. [PMID: 30326695 PMCID: PMC6365780 DOI: 10.31616/asj.2017.0333] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 07/20/2018] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN Retrospective study. PURPOSE To evaluate radiological parameters as indicators for posterior ligamentous complex (PLC) injuries in the case of limited availability of magnetic resonance imaging. OVERVIEW OF LITERATURE Traumatic thoracolumbar spinal fractures with PLC injuries can be misdiagnosed on X-rays or computed tomography scans. This study aimed to retrospectively assess unrecognized PLC injuries and evaluate radiographic parameters as indicators of PLC injuries requiring surgery. METHODS In total, 314 patients with type A and type B2 fractures who underwent surgical treatment between 2001 and 2010 were included. The frequency of misdiagnosis was reassessed, and radiographic parameters were evaluated and correlated. RESULTS The average age of the patients was 51.8 years. There were 225 type A3/A4 and 89 type B2 fractures; 39 of the type B2 fractures (43.8%) had been misdiagnosed as type A fractures. Type B fractures presented with a significantly higher kyphotic wedge angle and Cobb angle and a lower sagittal index (SI) than type A fractures. In addition, the normalized interspinous distance was higher in type B2 fractures. The significant mathematical indicators for PLC injuries were as follows: Cobb angle+kyphotic wedge angle >29°; Cobb angle2 >170°; and vertebral angle/SI >25. CONCLUSIONS The results demonstrated that PLC injuries are frequently misdiagnosed. Correlations between certain radiological parameters associated with PLC injuries can be useful indicators of the presence of such injuries requiring surgery.
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Affiliation(s)
- Frank Hartmann
- Center for Trauma and Orthopedic Surgery, Gemeinschaftsklinikum Mittelrhein, Ev. Stift Koblenz, Koblenz, Germany
| | - Thomas Nusselt
- Center for Trauma and Orthopedic Surgery, Gemeinschaftsklinikum Mittelrhein, Ev. Stift Koblenz, Koblenz, Germany
| | - Stefan Mattyasovszky
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Gerrit Maier
- University Hospital of Orthopaedic Surgery, Pius-Hospital, Carl von Ossietzky University, Oldenburg, Germany
| | - Pol Maria Rommens
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Erol Gercek
- Center for Trauma and Orthopedic Surgery, Gemeinschaftsklinikum Mittelrhein, Ev. Stift Koblenz, Koblenz, Germany
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Imai T, Tanaka S, Kawakami K, Miyazaki T, Hagino H, Shiraki M. Health state utility values and patient-reported outcomes before and after vertebral and non-vertebral fractures in an osteoporosis clinical trial. Osteoporos Int 2017; 28:1893-1901. [PMID: 28265719 DOI: 10.1007/s00198-017-3966-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 10/21/2016] [Accepted: 02/09/2017] [Indexed: 10/20/2022]
Abstract
UNLABELLED We assessed the health state utility value (HSUV) reductions associated with vertebral fractures using data collected in the Japanese Osteoporosis Intervention Trial-03 (JOINT-03). Our analysis revealed that assessment of HSUVs after morphometric vertebral fracture is important to capture the burden of vertebral fractures. INTRODUCTION Evaluation of the HSUV after fracture is important to calculate the quality-adjusted life years (QALYs) of osteoporosis patients, which is essential information in the context of health economic evaluation. METHODS JOINT-03 study patients were aged ≥65 years and treated with risedronate and vitamin K2 or risedronate alone. Radiographic information and patient-reported outcomes measured by EQ-5D and a visual analogue scale (VAS) were assessed at registration and followed up after 6, 12, and 24 months. According to differences among the dates of these assessments and the radiographic information, we classified the follow-up HSUVs calculated based on EQ-5D results into before or after fracture categories regardless of clinical symptoms. RESULTS Among 2922 follow-up HSUVs, 201 HSUVs were categorized as HSUVs that were observed after incident vertebral fractures on X-ray films. The median time from the detection of an incident vertebral fracture until the EQ-5D assessment was 53 days (25th percentile, 0 day; 75th percentile, 357 days). The impact of incident vertebral fractures on HSUVs was quantified as -0.03. Among the five health profile domains on the EQ-5D, an incident vertebral fracture had significant effects on anxiety/depression, self-care, and usual activities. CONCLUSIONS The results suggest that incident morphometric vertebral fracture was associated with impairment of the HSUV for patients with osteoporosis not only immediately but also several months after the fracture.
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Affiliation(s)
- T Imai
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, 606-8501, Japan
| | - S Tanaka
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, 606-8501, Japan
| | - K Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, 606-8501, Japan.
| | - T Miyazaki
- Public Health Research Foundation, Tokyo, Japan
| | - H Hagino
- School of Health Science, Tottori University Faculty of Medicine, Tottori, Japan
| | - M Shiraki
- Department of Internal Medicine, Research Institute and Practice for Involutional Diseases, Nagano, Japan
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Ravanshad S, Khayat S, Freidonpour N. The Prevalence of Pulp stones in Adult Patients of Shiraz Dental School, a Radiographic Assessment. J Dent (Shiraz) 2015; 16:356-61. [PMID: 26636125 PMCID: PMC4664034] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
STATEMENT OF THE PROBLEM Pulp stones are calcifications found in the pulp chamber or pulp canals of the teeth. Its different prevalence in different population is a matter of concern. PURPOSE This study aimed to assess the prevalence of pulp stones in a sample of Iranian population and to report its occurrence regarding gender, dental arch, tooth type and dental status. MATERIALS AND METHODS Dental records of patients who attended Shiraz Dental School were selected randomly. Only bitewing and periapical radiographs of maxillary and mandibular permanent posterior teeth were studied. Teeth were classified in the case of presence or absence of pulp stones, and the prevalence was analyzed in different gender, tooth types, dental arch, and dental status (intact, carious, or restored) groups. Statistical analysis was performed using X(2) test. RESULTS Of the 652examined subjects, 306 (46.9%) had one or more teeth with pulp stones. Of the 8244 posterior teeth examined, 928 (11.25%) had pulp stones in the pulp chamber. These pulp stones were detected in 76(37.6%) of males and 230 (51%) of females. The frequency of pulp stones among different teeth between maxillary and mandibular arches had almost a similar pattern. Among teeth demonstrating the condition, first molars were the most prevalent, followed by second molars. In maxillary molars the frequency of occurrence (26%) was higher than mandibular molars (18.7%). No Significant difference was found between dental status and pulp stones occurrence. CONCLUSION The occurrence of pulp stones noted in this study was significantly higher in female, molar teeth than premolar and 1st maxillary molar than mandibular. There was no significant association between pulp stone and condition of the crown.
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Affiliation(s)
- Shohreh Ravanshad
- Dept. of Endodontic, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.
| | | | - Najmeh Freidonpour
- Dept. of Prosthodontics, School of Dentistry, Busheher University of Medical Sciences, Busheher, Iran.
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Nitschke A, Lambert JR, Glueck DH, Jesse MK, Mei-Dan O, Strickland C, Petersen B. Validation of a new radiographic measurement of acetabular version: the transverse axis distance (TAD). Skeletal Radiol 2015; 44:1679-86. [PMID: 26239191 DOI: 10.1007/s00256-015-2225-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 03/18/2015] [Revised: 06/23/2015] [Accepted: 07/22/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This study has three aims: (1) validate a new radiographic measure of acetabular version, the transverse axis distance (TAD) by showing equivalent TAD accuracy in predicting CT equatorial acetabular version when compared to a previously validated, but more cumbersome, radiographic measure, the p/a ratio; (2) establish predictive equations of CT acetabular version from TAD; (3) calculate a sensitive and specific cut point for predicting excessive CT acetabular anteversion using TAD. MATERIALS AND METHODS A 14-month retrospective review was performed of patients who had undergone a dedicated MSK CT pelvis study and who also had a technically adequate AP pelvis radiograph. Two trained observers measured the radiographic p/a ratio, TAD, and CT acetabular equatorial version for 110 hips on a PACS workstation. Mixed model analysis was used to find prediction equations, and ROC analysis was used to evaluate the diagnostic accuracy of p/a ratio and TAD. RESULTS CT equatorial acetabular version can accurately be predicted from either p/a ratio (p < 0.001) or TAD (p < 0.001). The diagnostic accuracies of p/a ratio and TAD are comparable (p =0.46). Patients whose TAD is higher than 17 mm may have excessive acetabular anteversion. For that cutpoint, the sensitivity of TAD is 0.73, with specificity of 0.82. CONCLUSION TAD is an accurate radiographic predictor of CT acetabular anteversion and provides an easy-to-use and intuitive point-of-care assessment of acetabular version in patients with hip pain.
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Ouchida J, Yukawa Y, Ito K, Machino M, Inoue T, Tomita K, Kato F. Functional computed tomography scanning for evaluating fusion status after anterior cervical decompression fusion. Eur Spine J 2014; 24:2924-9. [PMID: 25537819 DOI: 10.1007/s00586-014-3722-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 12/07/2014] [Accepted: 12/08/2014] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Nonunion is a major complication of anterior cervical fusion that causes poor outcomes and occasionally requires additional operative intervention. The purpose of this study is to evaluate the accuracy of functional computed tomography (CT) scanning for determining fusion status after anterior cervical fusion by comparing with functional radiographs. MATERIALS AND METHODS The fusion status in 59 patients treated by anterior cervical fusion was assessed by functional radiography and functional CT scanning at 6 and 12 months after surgery. Fusion rates and clinical symptoms were evaluated. Fusion on functional radiography was defined as less than 2 mm of motion between adjacent spinous processes and a particular bony trabeculation on functional CT; fusion was defined as nonexistence of a clear zone or a gas pattern and a particular bone connection on reconstructed sagittal-view images. RESULTS Functional radiographs demonstrated solid fusion in 83.9% at 6 months and 91.1% at 12 months postoperatively; functional CT showed solid fusion in 55.3 and 78.6%, respectively. The fusion rate detected on functional CT images was significantly lower than that on functional radiographs at each period. At 6 months postoperatively, patients with incomplete union on functional CT were more likely to have neck pain than those who had complete union on functional CT. (46.2 vs 13.3%, P < 0.05) CONCLUSION: Functional CT can detect nonunion more clearly than functional radiography. At 6 months postoperatively, patients with incomplete union on functional CT images were likely to have more neck pain. Functional CT may allow accurate detection of symptomatic nonunion after anterior cervical fusion.
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Affiliation(s)
- Jun Ouchida
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Labor Health and Welfare Organization, 1-10-6 Komei, Minato-ku, Nagoya, Aichi, 455-8530, Japan.
| | - Yasutsugu Yukawa
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Labor Health and Welfare Organization, 1-10-6 Komei, Minato-ku, Nagoya, Aichi, 455-8530, Japan
| | - Keigo Ito
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Labor Health and Welfare Organization, 1-10-6 Komei, Minato-ku, Nagoya, Aichi, 455-8530, Japan
| | - Masaaki Machino
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Labor Health and Welfare Organization, 1-10-6 Komei, Minato-ku, Nagoya, Aichi, 455-8530, Japan
| | - Taro Inoue
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Labor Health and Welfare Organization, 1-10-6 Komei, Minato-ku, Nagoya, Aichi, 455-8530, Japan
| | - Keisuke Tomita
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Labor Health and Welfare Organization, 1-10-6 Komei, Minato-ku, Nagoya, Aichi, 455-8530, Japan
| | - Fumihiko Kato
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Labor Health and Welfare Organization, 1-10-6 Komei, Minato-ku, Nagoya, Aichi, 455-8530, Japan
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Kuner EH. Indications, techniques and complications in surgical treatment of the acetabulum. Orthopade 1997; 26:327-35. [PMID: 28246786 DOI: 10.1007/PL00003388] [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] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Almost 50 % of acetabular fractures occur in polytraumatized patients; in over 80 % additional injuries are found. The surgical goal is anatomical restoration of the acetabulum and stable fixation, in order to avoid postoperative external fixation.Careful clinical and radiological evaluation is essential to successful surgery. Standard radiological investigations include an anteroposterior view of the pelvis, a "spot" radiograph of the affected hip as well as obturator and iliac oblique views. The latter arc is especially helpful in assessing the central segment of the acetabulum ("dome fragment"). The documentation of any primarily traumatic sciatic nerve lesion is very important, and the quality of reduction depends greatly on the timing of surgery. The operation should be performed as early as possible after the surgical procedure has been carefully planned. A 3-D CT scan provides good information in choosing the surgical approach for complex fractures. In most cases, adequate reduction cannot be accomplished without appropriate aids. For internal fixation, both curved ASIF plates and straight plates are used. The operation demands a high degree of experience.Postoperative complications include iatrogenic nerve palsy, insufficient reduction, incorrectly placed implants, unstable fixation, redislocation, etc. With scrupulous aseptic conditions, the postoperative wound infection rate is low. Ectopic bone formation can occur after extensive surgical approaches and may, depending on size (Brooker III and IV), impair the range of motion of the hip. Indometacin given perioperatively is always indicated. Postoperative radiation treatment should as a rule be viewed critically.
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