1
|
Haase DR, Haase LR, Moon TJ, Mersereau EJ, Napora JK, Wise BT. Radiographic parameters associated with fracture-related infection in high energy bicondylar tibial plateau fractures managed with two-stage treatment: Identifying the bad actors. Injury 2023:S0020-1383(23)00384-4. [PMID: 37156699 DOI: 10.1016/j.injury.2023.04.046] [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: 04/09/2022] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 05/10/2023]
Abstract
INTRODUCTION High energy tibial plateau fractures are fraught with complications, particularly fracture-related infection (FRI). Previous studies have evaluated patient demographics, fracture classification, and injury characteristics as risk factors for FRI in patients with these injuries. This study evaluated the relationship between radiographic parameters (fracture length relative to femoral condyle width (FLF ratio), initial femoral displacement (FD ratio), and tibial widening (TW ratio)) and fracture-related infection following internal fixation in high energy bicondylar tibial plateau fractures. METHODS 225 patients treated for bicondylar tibial plateau fractures at two level I trauma centers were retrospectively reviewed. Patient characteristics, fracture classification, and radiographic measurements were analyzed to determine association with FRI. RESULTS The rate of FRI was 13.8%. Increased fracture length, FLF ratio, FD ratio, TW ratio, and fibula fracture were each associated with FRI on regression analysis, independent of clinical variables. Cutoff values were identified for each parameter and patients were risk stratified based on these radiographic parameters. High-risk patients had a 2.68- and 12.36-times risk of FRI compared to medium and low-risk patients, respectively. DISCUSSION This study is the first to examine the relationship between radiographic parameters and FRI in high energy bicondylar tibial plateau fractures. Fracture length, FLF ratio, FD ratio, TW ratio, and fibula fracture were identified as radiographic parameters associated with FRI. More importantly, risk stratifying patients based on these parameters accurately identified patients at increased risk of FRI. Not all bicondylar tibial plateau fractures are created equal and radiographic parameters can be utilized to help identify the bad actors.
Collapse
Affiliation(s)
- Douglas R Haase
- Resident in Orthopedic Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
| | - Lucas R Haase
- Resident in Orthopedic Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH 44106, USA
| | - Tyler J Moon
- Resident in Orthopedic Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH 44106, USA
| | - Erik J Mersereau
- Resident in Orthopedic Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Joshua K Napora
- Assistant Professor of Orthopedic Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH 44106, USA
| | - Brent T Wise
- Assistant Professor of Orthopedic Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| |
Collapse
|
2
|
Kim MB, Lee JH, Lee YH. Arc center distance as a novel quantitative radiographic parameter for volar Barton fractures. Arch Orthop Trauma Surg 2022; 142:3765-3770. [PMID: 34739580 DOI: 10.1007/s00402-021-04240-0] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/27/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The aims of this study were to investigate conventional radiographic parameters and introduce a novel parameter (arc center distance, ACD) for volar Barton fractures. METHODS Twenty-four cases of volar Barton fracture were retrospectively analyzed. We measured volar tilt angle (VTA), anteroposterior distance (APD), teardrop angle (TDA), and capitate-to-axis-of-radius distance (CARD) on lateral plain radiographs. The ACD was measured on the sagittal images of computed tomography scans. VTAs, APDs, TDAs, and CARDs were compared between the fractured and normal contralateral wrist. The area under the receiver operating characteristic curve was calculated for each parameter. RESULTS TDAs did not differ significantly between the fractured wrists and the controls. On the other hand, VTAs, APDs, and CARDs were all significantly greater in the fractured wrists (mean values were 17.25°, 20.70 mm, and - 3.40 mm, respectively). The area under the curve value was highest (0.943) for the ACD. When a cutoff value of 1.02 mm was used as a threshold, a sensitivity of 100% and specificity of 80.95% were achieved. CONCLUSIONS The mean values of conventional parameters (VTA, APD, TDA and CARD) in volar Barton fractures were presented. The ACD can be useful parameter for quantitatively evaluating volar Barton fractures.
Collapse
Affiliation(s)
- Min Bom Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, 101, Dae-hak road, Jongro-gu, Seoul, 03080, Republic of Korea
| | - Jeong Hyun Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, 101, Dae-hak road, Jongro-gu, Seoul, 03080, Republic of Korea.
| | - Young Ho Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, 101, Dae-hak road, Jongro-gu, Seoul, 03080, Republic of Korea
| |
Collapse
|
3
|
Kim J, Park S, Ahn JH. Preoperative radiographic parameters in the case of using a narrow-version femoral implant in total knee arthroplasty. Arch Orthop Trauma Surg 2022; 142:2065-2074. [PMID: 34405258 DOI: 10.1007/s00402-021-04111-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/08/2021] [Accepted: 07/28/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Recently, total knee arthroplasty (TKA) designs that allow the use of narrow-version femoral implants have been introduced to avoid femoral overhang. The purpose of this study was to investigate the frequency of the use of narrow-version femoral implants and identify the difference in radiographic parameters between using a narrow-version femoral implant and a standard-version femoral implant in TKA. METHODS A retrospective study was conducted on 504 primary TKAs using a TKA system (Anthem or Persona) that allowed narrow-version femoral implants. Anteroposterior (AP) dimension, mediolateral (ML) dimension, and modified aspect percentage ratio (ML/AP dimension) of the distal femur in preoperative radiographs were compared between a standard-version group (n = 275) and a narrow-version group (n = 229). A cut-off value of a modified aspect percentage ratio indicating the need for a narrow-version femoral implant was determined using the receiver operating characteristic (ROC) curve. RESULTS Mean ML dimension was 80.9 ± 6.1 mm in the standard-version group and 77.3 ± 4.4 mm in the narrow-version group (p < 0.001). Mean modified aspect percentage ratio was 138.8 ± 8.1% in the standard-version group and 131.7 ± 6.3% in the narrow-version group (p < 0.001). The optimum cut-off point of the modified aspect percentage ratio for narrow-version femoral implants was 135.4% (sensitivity: 72.0%; specificity: 66.7%) for Anthem and 133.3% (sensitivity: 75.9%, specificity: 76.4%) for Persona. CONCLUSION In the narrow-version femoral implant group, the ML dimension and the mean modified aspect percentage ratio were smaller than in the standard-version femoral implant group. A smaller modified aspect percentage ratio of the distal femur in preoperative radiographs could predict the need for narrow-version femoral implants in TKA. It was suggested that the cut-off point could be suggested as 135.4% for Anthem TKA design and 133.3% for Persona TKA design. These radiographic parameters are cost-effective and easily applicable for planning a TKA.A smaller modified aspect percentage ratio of the distal femur in preoperative radiographs could predict the need for narrow-version femoral implants in TKA. The cut-off point was 135.4% for Anthem TKA design and 133.3% for Persona TKA design.
Collapse
Affiliation(s)
- Jaehyun Kim
- Department of Orthopedic Surgery, International Baro Hospital, Incheon, Republic of Korea
| | - Seongyun Park
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyang, Gyeonggido, Republic of Korea
| | - Ji Hyun Ahn
- Department of Orthopedic Surgery, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, 29, Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea.
| |
Collapse
|
4
|
Kim HT, Can LV, Ahn TY, Kim IH. Analysis of Radiographic Parameters of the Forearm in Traumatic Radial Head Dislocation. Clin Orthop Surg 2017; 9:521-528. [PMID: 29201306 PMCID: PMC5705312 DOI: 10.4055/cios.2017.9.4.521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 07/18/2017] [Indexed: 11/06/2022] Open
Abstract
Background Various deformities can occur in the forearm bones when the traumatically dislocated radial head is untreated for a long period. Without correction of all deformities, reduction of the dislocated radial head is difficult to maintain, and forearm and elbow motion will deteriorate after reduction. We evaluated radiographic parameters of forearms with traumatically dislocated radial heads (and of the normal sides) to understand the resulting deformities and the effectiveness of surgical treatment. Methods We analyzed pre- and postoperative anteroposterior and lateral radiographs of 22 forearms (22 patients) with traumatic radial head dislocation. We divided the forearm into three equal parts and measured various morphological parameters. All patients underwent surgical treatment and evaluation of radial head reduction and range of motion pre- and postoperatively. Results Before treatment, the middle of the ulna was significantly different from the unaffected side in both anteroposterior and lateral views. After surgery, the proximal ulna was significantly different from the unaffected side and the abnormal proximal radial neck angle persisted. The radial head was successfully reduced in 20 of 22 cases. Overall, the mean range of motion decreased after surgery, except for increased flexion-extension. Conclusions Complicated deformities developing during long-term remodeling after injury indicate that stable reduction is difficult to achieve with conventional one-bone osteotomy. Even after successful reduction, secondary deformity in the proximal ulna and/or remaining deformity in the proximal radius can hinder forearm rotation.
Collapse
Affiliation(s)
- Hui Taek Kim
- Department of Orthopaedic Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Le Viet Can
- Department of Orthopaedic Surgery, University of Medicine and Pharmacy, Ho Chi Minh, Vietnam
| | - Tae Young Ahn
- Department of Orthopaedic Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - In Hee Kim
- Department of Orthopaedic Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| |
Collapse
|
5
|
Passias PG, Soroceanu A, Scheer J, Yang S, Boniello A, Smith JS, Protopsaltis T, Kim HJ, Schwab F, Gupta M, Klineberg E, Mundis G, Lafage R, Hart R, Shaffrey C, Lafage V, Ames C. Magnitude of preoperative cervical lordotic compensation and C2-T3 angle are correlated to increased risk of postoperative sagittal spinal pelvic malalignment in adult thoracolumbar deformity patients at 2-year follow-up. Spine J 2015; 15:1756-63. [PMID: 25862507 DOI: 10.1016/j.spinee.2015.04.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 02/26/2015] [Accepted: 04/02/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Cervical deformity (CD) is prevalent among patients with adult spinal deformity (ASD). The effect of baseline cervical alignment on achieving optimal thoracolumbar alignment in ASD surgery is unclear. PURPOSE This study assesses the relationship between preoperative (preop) cervical spinal parameters and global alignment after thoracolumbar ASD surgery at 2-year follow-up. STUDY DESIGN/SETTING This study is a retrospective review of a multicenter, prospective database. PATIENT SAMPLE Surgical ASD patients with 2-year follow-up and cervical X-rays were included. OUTCOME MEASURES The outcome measures were radiographic parameters and self-reported health-related quality-of-life measures (Short-Form 36 [SF-36], Oswestry Disability Index [ODI], and Scoliosis Research Society 22 [SRS-22]). METHODS Surgical ASD patients of 18 years and older with scoliosis greater than or equal to 20° and one of the following radiographic parameters were included: sagittal vertical axis (SVA) greater than or equal to 5 cm, pelvic tilt (PT) greater than or equal to 25°, or thoracic kyphosis (TK) greater than 60°. The SRS-Schwab sagittal modifiers (PT, global alignment, and pelvic incidence and lumbar lordosis [PI-LL]) were assessed at 2-year postoperatively as either normal ("0") or abnormal ("+" or "++"). Patients were classified in the aligned group (AG) or malaligned group (MG) at 2-year follow-up if all three sagittal modifiers were normal or abnormal, respectively. Patients were assessed for CD based on the following criteria: C2-C7 SVA greater than 4 cm, C2-C7 SVA less than 4 cm, cervical kyphosis (CL greater than 0), cervical lordosis (CL less than 0), any deformity (C2-C7 SVA greater than 4 cm or CL greater than 0), and both CD (C2-C7 SVA greater than 4 cm and CL greater than 0). Univariate testing was performed using t or chi-square test, looking at the following preop parameters: CD, C2-C7 SVA, C2-T3 SVA, CL, T1 slope (T1S), T1S-CL, C2-T3 angle, LL, TK, PT, C7-S1 SVA, and PI-LL. RESULTS One hundred four patients met the initial inclusion criteria with 70 in the AG and 34 in MG. Preoperative, patients in the MG had a higher CL (11.7 vs. 4.9, p=.03), higher C2-T3 angle (13.59 vs 4.9 p=.01), higher PT (p<.0001), higher SVA (p<.0001), and higher PI-LL (p<.0001) compared with the AG. Interestingly, the prevalence of CD at baseline was similar for both groups. There was no statistically significant difference among groups in the amount of improvement more than 2 years on the ODI or the Physical Component Summary of SF-36. CONCLUSIONS Patients with sagittal spinal malalignment associated with significant cervical compensatory lordosis are at increased risk of realignment failure at 2-year follow-up. Assessment of the degree of cervical compensation may be helpful in preop evaluation to assist in realignment outcome prediction.
Collapse
Affiliation(s)
- Peter G Passias
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 301 E 17th St #1402, New York, NY 10003, USA.
| | - Alexandra Soroceanu
- Department of Orthopaedic Surgery, University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada
| | - Justin Scheer
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, 303 E Chicago Ave., Chicago, IL 60611, USA
| | - Sun Yang
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 301 E 17th St #1402, New York, NY 10003, USA
| | - Anthony Boniello
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 301 E 17th St #1402, New York, NY 10003, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, 1215 Lee St, Charlottesville, VA 22903, USA
| | - Themistocles Protopsaltis
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 301 E 17th St #1402, New York, NY 10003, USA
| | - Han J Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA
| | - Frank Schwab
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 301 E 17th St #1402, New York, NY 10003, USA
| | - Munish Gupta
- Department of Orthopaedic Surgery, University of California-Davis, 4860 Y St, Sacramento, CA 95817, USA
| | - Eric Klineberg
- Department of Orthopaedic Surgery, University of California-Davis, 4860 Y St, Sacramento, CA 95817, USA
| | - Gregory Mundis
- San Diego Center for Spinal Disorders, 4130 La Jolla Village Dr, La Jolla, CA 92037, USA
| | - Renaud Lafage
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 301 E 17th St #1402, New York, NY 10003, USA
| | - Robert Hart
- Department of Orthopaedic Surgery, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Rd, Portland, OR 97239, USA
| | - Christopher Shaffrey
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, 303 E Chicago Ave., Chicago, IL 60611, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 301 E 17th St #1402, New York, NY 10003, USA
| | - Christopher Ames
- Department of Neurosurgery, University of California-San Francisco, 505 Parnassus Ave., San Francisco, CA 94143, USA
| | | |
Collapse
|
6
|
Rhee SH, Kim J. Distal radius fracture metaphyseal comminution: a new radiographic parameter for quantifying, the metaphyseal collapse ratio (MCR). Orthop Traumatol Surg Res 2013; 99:713-8. [PMID: 24035653 DOI: 10.1016/j.otsr.2013.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 02/16/2013] [Accepted: 05/27/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Metaphyseal comminution is widely considered as a key radiographic parameter that predicts fracture instability for distal radius fractures. However, no quantitative parameter is available to measure this degree of comminution. To quantify metaphyseal comminution objectively, the authors devised and validated the metaphyseal collapse ratio, a new radiographic index. MATERIALS AND METHODS Seventy-four cases of distal radius fracture in the elderly were included in this analysis. After closed reduction, a strictly lateral plain radiograph was obtained and digitally adjusted. The metaphyseal collapse ratio (MCR) was calculated expressing the maximal radiolucent extent as a percentage of the intercortical distance. Furthermore, correlations between MCR and age, gender, DXA scores, and other radiographic parameters, namely, radial shortening, volar tilt, radial inclination, and the presence of an associated ulnar fracture were investigated. RESULTS Mean metaphyseal collapse ratio in the cohort was calculated to be 51.7% by one observer and 53.7% by a second, showing good interobserver and mean intraobserver reliability (0.812, P<0.001 and 0.826, P<0.001, respectively). MCR was found to be significantly correlated with conventionally accepted radiographic parameters of fracture instability, that is, radial shortening (P<0.001), volar tilt (P<0.001), and radial inclination (P=0.002), but not with age, gender, DXA scores, and the presence of a combined ulnar fracture. CONCLUSIONS Metaphyseal collapse ratio, a novel radiographic parameter, was found to provide a reliable measure of metaphyseal comminution, and to be significantly correlated with other radiographic parameters that predict distal radius fracture instability. LEVEL OF EVIDENCE Level III, diagnostic.
Collapse
Affiliation(s)
- S H Rhee
- Department of Orthopedic Surgery, Seoul National University Boramae Medical Center, Seoul, South Korea.
| | | |
Collapse
|