scholarly journals The accuracy of gap and step-off measurements in acetabular fracture treatment

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
A. M. L. Meesters ◽  
K. ten Duis ◽  
J. Kraeima ◽  
H. Banierink ◽  
V. M. A. Stirler ◽  
...  
Keyword(s):  
Acetabular Fracture ◽  
Imaging Techniques ◽  
Ct Scans ◽  
Acetabular Fractures ◽  
Fracture Treatment ◽  
Patient Counselling ◽  
Fracture Displacement ◽  
Intraoperative Fluoroscopy ◽  
Treatment Gaps ◽  
Accurate Quantification

AbstractThe assessment of gaps and steps in acetabular fractures is challenging. Data from various imaging techniques to enable accurate quantification of acetabular fracture displacement are limited. The aim of this study was to assess the accuracy of pelvic radiographs, intraoperative fluoroscopy, and computed tomography (CT) in detecting gaps and step-offs in acetabular fractures. Sixty patients, surgically treated for acetabular fractures, were included. Five observers (5400 measurements) measured the gaps and step-offs on radiographs and CT scans. Intraoperative fluoroscopy images were reassessed for the presence of gaps and/or step-offs. Preoperatively, 25% of the gaps and 40% of the step-offs were undetected on radiographs compared to CT. Postoperatively, 52% of the gaps and 80% of the step-offs were missed on radiographs compared to CT. Radiograph analysis led to a significantly smaller gap and step-off compared to the CT measurements, an underestimation by a factor of two. Approximately 70% of the residual gaps and step-offs was not detected using intraoperative fluoroscopy. Gaps and step-offs that exceed the critical cut-off indicating worse prognosis often remained undetected on radiographs compared to CT scans. Less-experienced observers tend to overestimate gaps and step-offs compared to the more-experienced observers. In acetabular fracture treatment, gaps and step-offs were often undetected and underestimated on radiographs and intraoperative fluoroscopy in comparison with CT scans. This means that CT is superior to radiographs in detecting acetabular fracture displacement, which is clinically relevant for patient counselling regarding treatment decisions and prognosis.

scholarly journals The Retroacetabular Angle Determines the Safe Angle for Screw Placement in Posterior Acetabular Fracture Fixation

2013 ◽  
Vol 2013 ◽  
pp. 1-6
Author(s):  
Ayman M. A. Tadros ◽  
Thomas R. Oxland ◽  
Peter O’Brien
Keyword(s):  
Computed Tomography ◽  
Fracture Fixation ◽  
Acetabular Fracture ◽  
Articular Surface ◽  
Posterior Wall ◽  
Ct Scans ◽  
Acetabular Fractures ◽  
The Average Range ◽  
Acetabular Wall

Introduction. A method for the determination of safe angles for screws placed in the posterior acetabular wall based on preoperative computed tomography (CT) is described. It defines a retroacetabular angle and determines its variation in the population. Methods. The retroacetabular angle is the angle between the retroacetabular surface and the tangent to the posterior acetabular articular surface. Screws placed through the marginal posterior wall at an angle equal to the retroacetabular angle are extraarticular. Medial screws can be placed at larger angles whose difference from the retroacetabular angle is defined as the allowance angles. CT scans of all patients with acetabular fractures treated in our institute between September 2002 to July 2007 were used to measure the retroacetabular angle and tangent. Results. Two hundred thirty one patients were included. The average (range) age was 42 (15–74) years. The average (range) retroacetabular angle was 39 (30–47) degrees. The average (range) retroacetabular tangent was 36 (30–45) mm. Conclusions. Placing the screws at an average (range) angle of 39 (33–47) degrees of anterior inclination with the retroacetabular surface makes them extraarticular. Angles for medial screws are larger. Safe angles can be calculated preoperatively with a computer program.

Radiation exposure during the treatment of spinal deformities

2021 ◽  
pp. 1-7
Author(s):  
Jwalant S. Mehta ◽  
Kirsten Hodgson ◽  
Lu Yiping ◽  
James Swee Beng Kho ◽  
Ravindra Thimmaiah ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Ionizing Radiation ◽  
Effective Dose ◽  
Spinal Deformity ◽  
Background Radiation ◽  
Ct Scans ◽  
Intraoperative Fluoroscopy ◽  
The Difference ◽  
Risk Of Cancer ◽  
Surgical Group

Aims To benchmark the radiation dose to patients during the course of treatment for a spinal deformity. Methods Our radiation dose database identified 25,745 exposures of 6,017 children (under 18 years of age) and adults treated for a spinal deformity between 1 January 2008 and 31 December 2016. Patients were divided into surgical (974 patients) and non-surgical (5,043 patients) cohorts. We documented the number and doses of ionizing radiation imaging events (radiographs, CT scans, or intraoperative fluoroscopy) for each patient. All the doses for plain radiographs, CT scans, and intraoperative fluoroscopy were combined into a single effective dose by a medical physicist (milliSivert (mSv)). Results There were more ionizing radiation-based imaging events and higher radiation dose exposures in the surgical group than in the non-surgical group (p < 0.001). The difference in effective dose for children between the surgical and non-surgical groups was statistically significant, the surgical group being significantly higher (p < 0.001). This led to a higher estimated risk of cancer induction for the surgical group (1:222 surgical vs 1:1,418 non-surgical). However, the dose difference for adults was not statistically different between the surgical and non-surgical groups. In all cases the effective dose received by all cohorts was significantly higher than that from exposure to natural background radiation. Conclusion The treatment of spinal deformity is radiation-heavy. The dose exposure is several times higher when surgical treatment is undertaken. Clinicians should be aware of this and review their practices in order to reduce the radiation dose where possible.

scholarly journals Truncated Inception Net: COVID-19 Outbreak Screening using Chest X-rays

2020 ◽  
Author(s):  
Dipayan Das ◽  
KC Santosh ◽  
Umapada Pal
Keyword(s):  
Neural Network ◽  
World Wide ◽  
Imaging Techniques ◽  
Imaging Systems ◽  
Ct Scans ◽  
X Rays ◽  
X Ray ◽  
X Ray Imaging ◽  
Proposed Model ◽  
Different Types

Abstract Since December 2019, the Coronavirus Disease (COVID-19) pandemic has caused world-wide turmoil in less than a couple of months, and the infection, caused by SARS-CoV-2, is spreading at an unprecedented rate. AI-driven tools are used to identify Coronavirus outbreaks as well as forecast their nature of spread, where imaging techniques are widely used, such as CT scans and chest X-rays (CXRs). In this paper, motivated by the fact that X-ray imaging systems are more prevalent and cheaper than CT scan systems, a deep learning-based Convolutional Neural Network (CNN) model, which we call Truncated Inception Net, is proposed to screen COVID-19 positive CXRs from other non-COVID and/or healthy cases. To validate our proposal, six different types of datasets were employed by taking the following CXRs: COVID-19 positive, Pneumonia positive, Tuberculosis positive, and healthy cases into account. The proposed model achieved an accuracy of 99.96% (AUC of 1.0) in classifying COVID- 19 positive cases from combined Pneumonia and healthy cases. Similarly, it achieved an accuracy of 99.92% (AUC of 0.99) in classifying COVID-19 positive cases from combined Pneumonia, Tuberculosis and healthy CXRs. To the best of our knowledge, as of now, the achieved results outperform the existing AI-driven tools for screening COVID-19 using CXRs.

scholarly journals Acetabular Fractures in the Elderly

2015 ◽  
Vol 6 ◽  
pp. CMTIM.S12265 ◽  
Author(s):  
Joshua L. Gary
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Acetabular Fracture ◽  
Open Reduction ◽  
Weight Bearing ◽  
Revision Arthroplasty ◽  
Early Mobilization ◽  
Acetabular Fractures ◽  
Posttraumatic Arthritis ◽  
Total Hip

As the population ages, the incidence of osteoporotic fractures, including those of the pelvis and acetabulum, continues to rise. Treatment of the elder patients with an acetabular fracture is much more controversial than the treatment of younger patients with similar injuries, where prevention of posttraumatic arthritis and total hip replacement remains optimal to limit need for revision arthroplasty. Arthroplasty for fractures of the proximal femur is commonplace in an older population and is a mainstay of treatment to promote early mobilization and weight-bearing. However, even with acute total hip arthroplasty for a geriatric acetabular fracture, most surgeons do not permit immediate weight-bearing postoperatively. Therefore, controversy regarding optimal treatment of these challenging fractures persists. Four treatment options have emerged: nonoperative treatment with early mobilization, open reduction and internal fixation (ORIF), limited open reduction and percutaneous screw fixation, and acute total hip arthroplasty. The exact indications and benefits of each treatment remain unknown. This article serves as a review of these four treatments and the data existing to support them.

scholarly journals Discrimination of Low-Energy Acetabular Fractures from Controls Using Computed Tomography-Based Bone Characteristics

2020 ◽  
Vol 49 (1) ◽  
pp. 367-381
Author(s):  
Robel K. Gebre ◽  
Jukka Hirvasniemi ◽  
Iikka Lantto ◽  
Simo Saarakkala ◽  
Juhana Leppilahti ◽  
...  
Keyword(s):  
Machine Learning ◽  
Risk Factors ◽  
Computed Tomography ◽  
Femoral Head ◽  
Acetabular Fracture ◽  
Ct Images ◽  
Low Energy ◽  
Acetabular Fractures ◽  
Operating Characteristics ◽  
Femoral Neck Axis

AbstractThe incidence of low-energy acetabular fractures has increased. However, the structural factors for these fractures remain unclear. The objective of this study was to extract trabecular bone architecture and proximal femur geometry (PFG) measures from clinical computed tomography (CT) images to (1) identify possible structural risk factors of acetabular fractures, and (2) to discriminate fracture cases from controls using machine learning methods. CT images of 107 acetabular fracture subjects (25 females, 82 males) and 107 age-gender matched controls were examined. Three volumes of interest, one at the acetabulum and two at the femoral head, were extracted to calculate bone volume fraction (BV/TV), gray-level co-occurrence matrix and histogram of the gray values (GV). The PFG was defined by neck shaft angle and femoral neck axis length. Relationships between the variables were assessed by statistical mean comparisons and correlation analyses. Bayesian logistic regression and Elastic net machine learning models were implemented for classification. We found lower BV/TV at the femoral head (0.51 vs. 0.55, p = 0.012) and lower mean GV at both the acetabulum (98.81 vs. 115.33, p < 0.001) and femoral head (150.63 vs. 163.47, p = 0.005) of fracture subjects when compared to their matched controls. The trabeculae within the femoral heads of the acetabular fracture sides differed in structure, density and texture from the corresponding control sides of the fracture subjects. Moreover, the PFG and trabecular architectural variables, alone and in combination, were able to discriminate fracture cases from controls (area under the receiver operating characteristics curve 0.70 to 0.79). In conclusion, lower density in the acetabulum and femoral head with abnormal trabecular structure and texture at the femoral head, appear to be risk factors for low-energy acetabular fractures.

Short-column acetabular fracture fixation through a mini-pararectus approach in anteriorly displaced acetabular fractures

2019 ◽  
Vol 30 (6) ◽  
pp. 539-543
Author(s):  
Mahmoud Badran ◽  
Osama Farouk ◽  
Ayman Kamal ◽  
Hossam Abubeih ◽  
Mohamed Khaled
Keyword(s):  
Fracture Fixation ◽  
Acetabular Fracture ◽  
Acetabular Fractures ◽  
Short Column ◽  
Pararectus Approach

scholarly journals Comparison of two reinforcement rings for primary total hip arthroplasty addressing displaced acetabular fractures: a biomechanical analysis

2020 ◽  
Vol 140 (12) ◽  
pp. 1947-1954
Author(s):  
Johannes Becker ◽  
M. Winkler ◽  
C. von Rüden ◽  
E. Bliven ◽  
P. Augat ◽  
...  
Keyword(s):  
Acetabular Fracture ◽  
Weight Bearing ◽  
Biomechanical Analysis ◽  
Acetabular Fractures ◽  
Full Weight Bearing ◽  
Acetabular Cup ◽  
Partial Weight Bearing ◽  
Quadrilateral Plate ◽  
Stable Conditions ◽  
Partial Weight

Abstract Introduction Aim of this study was to biomechanically compare two different acetabular cup fixation constructs in terms of fracture fixation for displaced acetabular fractures involving the anterior column with hemitransverse fracture under partial and full weight-bearing conditions. Methods Two different reinforcement rings designed as cages for primary THA were biomechanically tested in terms of managing a complex acetabular fracture. Single-leg stance cyclic loading was performed to assess fracture gap movement and fragment rotation. Twelve hemi pelvis Sawbones were divided into two groups: primary THA with acetabulum roof reinforcement plate (ARRP) (n = 6) and primary THA with Burch–Schneider reinforcement cage (BSRC) (n = 6). Results During loading under partial weight-bearing (250 N) fracture gap movement tended to be larger in the BSRC group as compared to the ARRP group. Under full weight-bearing conditions, the ARRP showed 60% significantly less motion (p = 0.035) of the os ilium to os ischii gap compared to BSRC. Fracture gap movements between the os ilium and spina iliaca fragments were significantly reduced by 76% (p = 0.048) for ARRP in contrast to BSRC. The ARRP group also demonstrated significantly less movement in the fracture gaps os ischii to quadrilateral plate (62% reduction, p = 0.009) and quadrilateral plate to spina iliaca (87% reduction, p < 0.001). Significantly less rotational movement of the quadrilateral plate to the os ilium was exhibited by the ARRP group (p = 0.015). Conclusions The presented acetabulum roof-reinforcement plate (ARRP) provides stable conditions at the acetabular component with adequate stabilization of a displaced acetabular fracture.

scholarly journals As an unusual traumatic presentation, acetabular fracture and concomitant ipsilateral intertrochanteric femur fracture: a retrospective case series of 18 patients

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Bo Liu ◽  
Wenhui Ma ◽  
Sikai Liu ◽  
Xiao Chen ◽  
Mengnan Li ◽  
...  
Keyword(s):  
Risk Factor ◽  
Internal Fixation ◽  
Acetabular Fracture ◽  
Poor Prognosis ◽  
Femur Fracture ◽  
Acetabular Fractures ◽  
Intertrochanteric Fractures ◽  
Harris Score ◽  
Intertrochanteric Femur Fracture ◽  
Dislocation Of The Hip

Abstract Background Acetabular fracture and concomitant ipsilateral intertrochanteric femur fracture has been suggested as an unusual traumatic presentation and rarely reported in the literature. The aims of this study were (1) to identify the etiological characteristics, (2) to summarize the treatment strategy, and (3) to present the mid- to long-term results of patients with this rare traumatic presentation. Methods In this retrospective study, 18 patients (15 males, 3 females; mean age = 42.77 ± 17.74 years, range = 16 to 87 years) who were diagnosed and treated for simultaneous acetabular fracture and ipsilateral intertrochanteric fracture were included. Injury mechanisms, fracture classifications, and treatment strategies were noted. To assess functional status, the Harris score was used. To evaluate pain intensity, visual analogous scale (VAS) was used. The reduction quality of acetabular fractures was examined as per Matta’s standard. Postoperative complications were also recorded. Results The mean follow-up was 10.04 ± 3.38 (range = 6.2 to 16 years). The most common injury mechanism was traffic accident, followed by falling from a tall height. As per the Evans classification, intertrochanteric fractures were defined as type 3 in 13 patients, type 2 in one patient, and type 4 in 4 patients. In acetabular fracture site, the most common fractures were posterior wall fractures, followed by anterior column fractures. All patients received internal fixation for their intertrochanteric fractures. Ten out of 18 patients also received internal fixation for their acetabular fracture. However, for the remaining patients, acetabular fractures were treated conservatively or with fracture fragment resection. Bony healing was achieved in all but one patient who died postoperatively. Twelve patients achieved excellent and good results (Harris score ≥ 80 points) whereas five patients achieved fair and poor results (Harris score < 80 points). The proportion of patients who achieved an excellent-good Harris score was 70.6%. Dislocation of the hip was found to be an independent risk factor (HR = 9.194, 95% CI = 1.024-82.515) for the poor patient outcome. Conclusion To sum up, high-impact trauma is the main cause of acetabular fracture and concomitant ipsilateral intertrochanteric femur fracture. For patients who have undergone surgical treatment, fracture healing is usually achieved. However, the occurrence of complications, especially avascular necrosis, is the major cause of a poor prognosis. Dislocation of the hip joint at the time of injury is considered to be an important risk factor for a poor prognosis.

The Value of Interpretation of Intraoperative Fluoroscopy by Radiologists During Pediatric Fracture Treatment

2014 ◽  
Vol 34 (3) ◽  
pp. 359-361 ◽  
Author(s):  
Shital N. Parikh ◽  
Albert d’Heurle ◽  
Emily A. Eismann ◽  
Roger Cornwall
Keyword(s):  
Fracture Treatment ◽  
Intraoperative Fluoroscopy ◽  
Pediatric Fracture

Patient-reported outcome measures after surgery for an acetabular fracture

2018 ◽  
Vol 100-B (5) ◽  
pp. 640-645 ◽  
Author(s):  
B. Frietman ◽  
J. Biert ◽  
M. J. R. Edwards
Keyword(s):  
Outcome Measures ◽  
Hip Joint ◽  
Acetabular Fracture ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Ct Scans ◽  
Sf 36 ◽  
Patient Reported ◽  
Post Traumatic

Aims The aim of this study was to record the incidence of post-traumatic osteoarthritis (OA), the need for total hip arthroplasty (THA), and patient-reported outcome measures (PROMS) after surgery for a fracture of the acetabulum, in our centre. Patients and Methods All patients who underwent surgery for an acetabular fracture between 2004 and 2014 were included. Patients completed the 36-Item Short Form Health Survey (SF-36) and the modified Harris Hip Score (mHHS) questionnaires. A retrospective chart and radiographic review was performed on all patients. CT scans were used to assess the classification of the fracture and the quality of reduction. Results A total of 220 patients were included, of which 55 (25%) developed post-traumatic OA and 33 (15%) underwent THA. A total of 164 patients completed both questionnaires. At a mean follow-up of six years (2 to 10), the mean SF-36 score for patients with a preserved hip joint was higher on role limitations due to physical health problems than for those with OA or those who underwent THA. In the dimension of bodily pain, patients with OA had a significantly better score than those who underwent THA. Patients with a preserved hip joint had a significantly better score on the function scale of the mHHS and a better total score than those with OA or who underwent THA. Conclusion Of the patients who were treated surgically for an acetabular fracture (with a mean follow-up of six years), 15% underwent THA at a mean of 2.75 years postoperatively. Patients with a THA had a worse functional outcome than those who retain their native hip joint. We recommend using PROMS and CT scans when reviewing these patients. Cite this article: Bone Joint J 2018;100-B:640–5.

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