Patient-Specific 3D Reconstruction of a Complete Lower Extremity from 2D X-rays

2016 ◽  
pp. 404-414 ◽  
Author(s):  
Guoyan Zheng ◽  
Steffen Schumann ◽  
Alper Alcoltekin ◽  
Branislav Jaramaz ◽  
Lutz-P. Nolte
Keyword(s):  
Lower Extremity ◽  
3D Reconstruction ◽  
Patient Specific ◽  
X Rays

Automatic Assessment of Lower Extremity Deformity Based on Patient Specific Computer Models

2011 ◽  
Author(s):  
Qi Xing ◽  
Mark M. Theiss ◽  
Wenzhen Yang ◽  
Jim X. Chen ◽  
Jihui Li
Keyword(s):  
Lower Extremity ◽  
Clinical Decision ◽  
Assessment System ◽  
Patient Specific ◽  
X Rays ◽  
Automatic Assessment ◽  
Limb Deformity ◽  
Total Knee ◽  
Correction Surgery ◽  
Aided Diagnosis

Lower extremity deformity can cause joint pain and malfunction. Patients with severe deformity usually need a correction surgery or total knee replacement (TKR) surgery to realign the orientation of the femur and tibia. Lower extremity deformity needs to be accurately assessed before any clinical decision can be made. In practice, physicians and radiologists rely mainly on X-ray images to evaluate the deformity, and CT is used in complex cases only. Manual assessment on X-rays is tedious, time consuming and inaccurate [1]. Computer aided diagnosis was proved efficient to understand patients’ anatomy, analyze lower limb deformity and plan the possible surgery [2]. However, notable interactive works were required during the identification of the anatomic features, and the accuracy was unguaranteed when the physician is not familiar with the diagnosis software. In this study we developed an automatic assessment system to identify patients’ anatomic features and quantify lower extremity deformity.

Computed Tomography-Based Patient-Specific Instrumentation Loses Accuracy with Significant Varus Preoperative Misalignment

2020 ◽  
Author(s):  
Vicente Jesús León-Muñoz ◽  
Mirian López-López ◽  
Alonso José Lisón-Almagro ◽  
Francisco Martínez-Martínez ◽  
Fernando Santonja-Medina
Keyword(s):  
Computed Tomography ◽  
Deformity Correction ◽  
Patient Specific ◽  
Control Group ◽  
X Rays ◽  
Varus Alignment ◽  
Patient Specific Instrumentation ◽  
Conventional Instrumentation ◽  
The Mean ◽  
Valgus Alignment

AbstractPatient-specific instrumentation (PSI) has been introduced to simplify and make total knee arthroplasty (TKA) surgery more precise, effective, and efficient. We performed this study to determine whether the postoperative coronal alignment is related to preoperative deformity when computed tomography (CT)-based PSI is used for TKA surgery, and how the PSI approach compares with deformity correction obtained with conventional instrumentation. We analyzed pre-and post-operative full length standing hip-knee-ankle (HKA) X-rays of the lower limb in both groups using a convention > 180 degrees for valgus alignment and < 180 degrees for varus alignment. For the PSI group, the mean (± SD) pre-operative HKA angle was 172.09 degrees varus (± 6.69 degrees) with a maximum varus alignment of 21.5 degrees (HKA 158.5) and a maximum valgus alignment of 14.0 degrees. The mean post-operative HKA was 179.43 degrees varus (± 2.32 degrees) with a maximum varus alignment of seven degrees and a maximum valgus alignment of six degrees. There has been a weak correlation among the values of the pre- and postoperative HKA angle. The adjusted odds ratio (aOR) of postoperative alignment outside the range of 180 ± 3 degrees was significantly higher with a preoperative varus misalignment of 15 degrees or more (aOR: 4.18; 95% confidence interval: 1.35–12.96; p = 0.013). In the control group (conventional instrumentation), this loss of accuracy occurs with preoperative misalignment of 10 degrees. Preoperative misalignment below 15 degrees appears to present minimal influence on postoperative alignment when a CT-based PSI system is used. The CT-based PSI tends to lose accuracy with preoperative varus misalignment over 15 degrees.

Exploring the Perth Hamstring Assessment Tool and Lower Extremity Functional Scale in a Proximal Hamstring Avulsion Cohort: A Cross-sectional Study

2021 ◽  
pp. 036354652110085
Author(s):  
Elsa Pihl ◽  
Kenneth B. Jonsson ◽  
Mida Berglöf ◽  
Nina Brodin ◽  
Olof Sköldenberg ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Assessment Tool ◽  
Patient Specific ◽  
Activity Limitations ◽  
Functional Tests ◽  
Functional Scale ◽  
Proximal Hamstring Avulsion ◽  
Proximal Hamstring ◽  
Lower Extremity Functional Scale

Background: The goal of treatment for a proximal hamstring avulsion (PHA) is an objectively restored muscle and a subjectively satisfied, pain-free patient at follow-up. Different self-reported and performance-based outcome measures have been used to evaluate recovery, but their validity is poorly investigated. Purpose: To investigate 1) the correlation between the commonly used self-reported outcome measurements, the Perth Hamstring Assessment Tool (PHAT) and the Lower Extremity Functional Scale (LEFS); 2) to what extent these scores can be explained by physical dysfunction as measured by performance-based tests; 3) whether performance-based tests can discriminate between the injured and uninjured extremity; and 4) which activity limitations are perceived by patients several years after the injury. Study design: Cohort study (Diagnosis); Level of evidence, 3. Methods: We included a consecutive series of patients treated for or diagnosed with PHA in our department between 2007 and 2016 having at least 2 tendons avulsed from the ischial tuberosity. Participants attended 2 study visits, answered questionnaires (PHAT, LEFS, and Patient-Specific Functional Scale [PSFS]), and performed physical performance–based tests (single-leg hop tests, single–step down test, and isometric and isokinetic strength tests). Results: A total of 50 patients were included (26 men [52%], 24 women [48%]; mean age, 50.9 years [SD, 9.8 years]). The mean follow-up time was 5.5 years (SD, 2.7 years), and 74% had been surgically treated. The correlation between PHAT and LEFS was strong ( r = 0.832) and statistically significant ( P < .001). Seven of the performance-based tests exhibited a statistically significant but weak correlation with LEFS (0.340-0.488) and 3 of the tests to PHAT (–0.304 to 0.406). However, only peak torque could significantly discriminate between the extremities. The activity limitation most commonly mentioned in PSFS was running (16 patients [32%]). Conclusion: Although PHAT and LEFS correlated strongly, the correlations between functional tests and the patient-reported outcome scores were weak, and most functional tests failed to discriminate between the injured and uninjured lower extremity in patients with PHA 5 years after injury. In general, patients alleged few activity limitations, but running difficulty was a common sequela after PHA.

scholarly journals The Use of Patient-Specific 3D Printed Titanium Implants for Complex Foot and Ankle Limb Salvage, Deformity Correction, and Arthrodesis Procedures

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Samuel Adams ◽  
Travis Dekker ◽  
John Steele ◽  
Kamran Hamid
Keyword(s):  
Lower Extremity ◽  
Deformity Correction ◽  
Titanium Implants ◽  
Patient Specific ◽  
Allograft Bone ◽  
Foot And Ankle ◽  
Sf 36 ◽  
3D Printed ◽  
The Mean

Category: Ankle,Ankle Arthritis,Basic Sciences/Biologics,Trauma Introduction/Purpose: Large lower extremity bony defects, complex foot and ankle deformities, and high-risk arthrodesis situations can be difficult to treat. These challenging pathologies, often require a critical-sizes and/or shaped structural bone void filler which may not be available with allograft bone. The advancement of 3D printing technology has allowed for the use of custom designed implants for foot and ankle surgery. This study reports on the radiographic and functional outcomes of a case series of patients treated with patient-specific 3D printed titanium implants. Methods: Seven consecutive patients who were treated with custom designed 3D printed implant cages for severe bone loss, deformity correction, and arthrodesis procedures were included in this study. A minimum of 1-year follow-up was required. No patients were lost to follow-up. Patients completed preoperative and most recent follow-up VAS for pain, FAAM, and SF-36 outcomes questionnaires. All patients had post-operative radiographs and CT scans to assess bony incorporation. Results: The mean age of these patients was 54.6 (35-73 years of age). The mean follow-up of these seven patients was 17.1 months (range 12 to 31). Radiographic fusion with cage ingrowth and integration occurred in all seven patients verified by CT scan. There was statistically significant improvement in all functional outcome score measures (VAS for pain, FAAM, and SF-36). All patients returned were satisfied with surgery. There were no failures. Case examples are demonstrated in Figure 1. Conclusion: This cohort of patients demonstrated the successful use of custom 3D printed implants to treat complex large bony defects, deformities and arthrodesis procedures of the lower extremity. These implants offer the surgeon a patient specific approach to treat both pain and deformity that is not necessarily available with allograft bone.

Postoperative continuous catheter-infused local anesthetic reduces pain scores and narcotic use after lower extremity revascularization

Vascular ◽  
2017 ◽  
Vol 26 (3) ◽  
pp. 262-270 ◽  
Author(s):  
William Shutze ◽  
William P Shutze Jr ◽  
Purvi Prajapati ◽  
Gerald Ogola ◽  
Jordan Schauer ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Lower Extremity ◽  
Local Anesthetic ◽  
Wound Complications ◽  
X Rays ◽  
Readmission Rates ◽  
Pain Scores ◽  
Average Pain ◽  
Revascularization Procedures ◽  
Lower Extremity Revascularization

Objective Postoperative pain following lower extremity revascularization procedures is traditionally controlled with narcotic administration. However, this may not adequately control the pain and puts the patient at risk for complications from opiate use. Here we report an alternative strategy for pain management using a continuous catheter-infused local anesthetic into the operative limb. Design Retrospective case–control study. Methods Patients undergoing lower extremity revascularization procedures using continuous catheter-infused local anesthetic were compared to similar patients undergoing similar procedures during the same time period who did not receive continuous catheter-infused local anesthetic. Records were reviewed for pain scores, narcotics consumption, length of stay, need for postoperative chest X-ray, supplemental oxygen use, wound complications, and 30-day readmission. Results There were 153 patients (mean age 69.5 years) from September 2011 to December 2014 who underwent common femoral artery procedures, femoral-popliteal bypass, femoral-tibial bypass, popliteal aneurysm repair, popliteal to pedal bypass, popliteal artery thrombo-embolectomy, sapheno-popliteal venous bypass, or ilio-femoral bypass. There were no significant differences between the continuous catheter-infused local anesthetic ( n=57) and control ( n=96) groups regarding age, body mass index, cardiac history, diabetes, hypertension, and procedures performed. The continuous catheter-infused local anesthetic group showed better cumulative average pain scores, better high pain scores on postoperative days 1–3, and better average pain scores on postoperative days 2–3 ( P<0.03). The continuous catheter-infused local anesthetic group had lower median narcotics consumption on postoperative days 1–2 ( P=0.02). No differences were found in postoperative length of stay, urinary catheter use, number of postoperative chest X-rays, oxygen use, mobilization, or fever. Wound complications occurred in 8.8% of the continuous catheter-infused local anesthetic group and in 11.5% of controls (P=0.79). Readmission rates were 23% (continuous catheter-infused local anesthetic) and 21% (controls; P=0.84). Conclusion Postoperative continuous catheter-infused local anesthetic reduces pain scores and pain medication use compared to standard opiate therapy in these patients, without increasing wound complication or readmission rates. Continuous catheter-infused local anesthetic appeared to have no effect on the incidence of pulmonary complications, mobilization, or fever.

Correlation of Soft Tissue Swelling and Timing to Surgery With Acute Wound Complications for Operatively Treated Ankle and Other Lower Extremity Fractures

2019 ◽  
Vol 40 (5) ◽  
pp. 526-536 ◽  
Author(s):  
Matthew D. Riedel ◽  
Amber Parker ◽  
Mingxin Zheng ◽  
Jorge Briceno ◽  
Steven J. Staffa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Soft Tissue ◽  
Lower Extremity ◽  
Tobacco Use ◽  
Wound Complication ◽  
Timing Of Surgery ◽  
Ankle Fractures ◽  
Patient Specific ◽  
Wound Complications ◽  
Heel Pad

Background: Considerable debate exists regarding how soft-tissue edema should influence timing of surgery for ankle and other lower extremity fractures. Assessment of swelling is subjective, and timing varies among surgeons. However, timing of surgery is one of the few modifiable factors in fracture care. Ultrasonography can objectively measure swelling and help determine optimal timing. The purposes of this study were to determine whether objective measures of swelling, timing to surgery, and patient-specific risk factors correlated with wound complications and to try to create a prediction model for postoperative wound complications based on identified modifiable and nonmodifiable risk factors. Methods: Patients with closed ankle and other lower extremity fractures requiring surgery with an uninjured, contralateral extremity were included. Demographic information and sonographic measurements on both lower extremities were obtained pre-operatively. Subjects were followed for 3 months and wound complications were documented. A predictive algorithm of independent risk factors was constructed, determining wound complication risk. Given that patients with ankle fractures made up the majority of the study cohort (75/93 or 80%), a separate statistical analysis was performed on this group. A total of 93 subjects completed the study, with 75/93 sustaining ankle fractures. Results: Overall wound complication rate was 18.3%. Timing to surgery showed no correlation with wound complications. A heel-pad edema index >1.4 was independently associated with wound complications. Subgroup analysis of ankle fractures demonstrated a 3.4× increase in wound complications with a heel-pad edema index >1.4. Tobacco history and BMI >25 were independent predictors of wound complications. An algorithm was established based on heel-pad edema index, BMI >25, and tobacco history. Patients with none of the 3 factors had a 3% probability of a wound complication. Patients with 1/3, 2/3 and 3/3 factors had a 12-36%, 60-86% and 96% probability of a wound complication, respectively. Conclusions: Timing to surgery had no correlation with wound complications. Heel-pad edema index >1.4, BMI >25, and tobacco-use correlated with wound complications. When separately analyzing the cohort that sustained ankle fractures, the heel-pad edema index of >1.4 was still demonstrated to be predictive of wound complications corresponding to a 3.4× increase in wound complication rates (11.1% vs 37.5%). Risk of wound complications significantly increased with each factor. In patients with increased BMI and/or tobacco use, resolution of heel edema may significantly reduce wound complications in lower extremity trauma. Level of Evidence: Level II, prognostic, prospective cohort study.

scholarly journals An accuracy study of the Intracavitary Electrocardiogram (IC-ECG) guided peripherally inserted central catheter tip placement among neonates

Open Medicine ◽  
2017 ◽  
Vol 12 (1) ◽  
pp. 125-130 ◽  
Author(s):  
Lian-juan Zhou ◽  
Hong-zhen Xu ◽  
Mei-fang Xu ◽  
Yan Hu ◽  
Xiao-Fang Lou
Keyword(s):  
Logistic Regression ◽  
Lower Extremity ◽  
Dynamic Change ◽  
Multivariate Logistic Regression Analysis ◽  
X Rays ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
P Waves ◽  
Catheter Tip ◽  
Accuracy Study

AbstractObjectiveTo explore the clinical application of the intracavitary electrocardiogram (IC-ECG) guided Peripherally Inserted Central Catheter (PICC) tip placement among neonates.Backgroundthe ECGs of neonates are difficult to perform and their wave shapes are of doubtful accuracy due to various interfering factorsMethod115 neonates were admitted to perform PICC guided by IC-ECG. Logistic regression was performed to analyze all possible influencing factors of the accuracy from the tip placement. The puncture site of the PICC, gestational age, height, weight, basal P/R amplitude and positioning P/R amplitude might be related to the accuracy of IC-ECG location.ResultThe accuracy in the lower extremity was higher than that in the upper extremity. Multivariate logistic regression analysis showed that the weight (Odds Ratio (OR)=1.93, 95%Confidence Interval(CI):1.06-3.50) and positioning P/R amplitude (OR=32.33, 95%CI: 2.02-517.41) are statistically significant risks to the accuracy PICC tip placement.ConclusionsPossible methods to improve the accuracy might be Catheterizing through lower extremity, keeping the neonates calm, enhancing the electrocardiogram signal and strengthening technical training. Therefore it is practical to perfrom a tip placement by the dynamic change in the P waves from an electrocardiogram (ECG) guided PICC among neonates and as reliable as using X-rays.

scholarly journals The Management of Unstable Cervical Spine Injuries

2014 ◽  
Vol 5 ◽  
pp. CMTIM.S12263
Author(s):  
Venu M. Nemani ◽  
Han Jo Kim
Keyword(s):  
Cervical Spine ◽  
Medical Condition ◽  
Treatment Plan ◽  
Neurological Status ◽  
Patient Specific ◽  
X Rays ◽  
Mechanism Of Injury ◽  
Imaging Studies ◽  
Cervical Spine Injuries ◽  
Spine Injuries

Injuries to the cervical spine can cause potentially devastating morbidity and even mortality. In this review we discuss the anatomy and biomechanics of the cervical spine. The evaluation and treatment of cervical spine injuries begins with the prompt immobilization of suspected injuries in the field. Once an assessment of the patient's neurological status is made, imaging studies are obtained, which can include X-rays, CT, and MRI. Careful scrutiny of the imaging studies for bony and/or ligamentous injury allows the physician to determine the mechanism of injury, which guides treatment. The ultimate treatment plan can consist of non-operative or operative management, and depends on patient specific factors (medical condition and neurological status), the mechanism of injury, and the resultant degree of instability. With prompt diagnosis and appropriate management, the morbidity of these injuries can be minimized.

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