Anteroposterior view of the knee does not reliably replace the lateral view during evaluation of femoral torsion: a case series

Background We investigated distortion of measured lengths of the first and second metatarsals between two radiographic views and ultrasound-guided measurements. Methods In a case series performed between June 29, 2012, and February 6, 2013, two standard anteroposterior and lateral radiographs of each foot were obtained from 27 asymptomatic participants. Three raters performed blinded radiographic measurements of the first and second metatarsal lengths on each view and compared results. Actual first and second metatarsal lengths were measured using diagnostic ultrasound and were compared with the radiographic measurements. The relative distances between the first and second metatarsals were obtained on the anteroposterior and lateral views and were compared. Results Absolute first metatarsal length measurements were significantly affected by view (mean difference, 5.3 mm; 95% confidence interval [CI], 4.88–5.78 mm; P < .001), with no significant difference between raters (P = .039). Absolute second metatarsal length measurements were significantly affected by view (mean difference, 2.84 mm; 95% CI, 2.8–3.6 mm) and by rater (P = .024). First and second metatarsal anteroposterior values were 13.9% and 15.3% longer, respectively, than the actual length as measured by ultrasound (P < .001). Relative first metatarsal length was significantly shorter on lateral views (mean difference, 3.85 mm; 95% CI, 2.7–5 mm; P < .001). First metatarsal length was best approximated by the lateral view. Conclusions This study demonstrates the effect of radiographic distortion on the measurement of metatarsal length. The lateral view is more accurate than the anteroposterior view for measuring the first metatarsal. Owing to variance of relative metatarsal length on the two views, conclusions regarding a relatively short or long first metatarsal compared with the second metatarsal cannot be drawn.

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FEMORAL NECK FRACTURES GARDEN I AND II: EVALUATION OF THE DEVIATION IN LATERAL VIEW

Acta Ortopédica Brasileira ◽

10.1590/1413-785220172502169349 ◽

2017 ◽

Vol 25 (2) ◽

pp. 107-109 ◽

Cited By ~ 2

Author(s):

Natália Zalc Leonhardt ◽

Lucas da Ponte Melo ◽

David Gonçalves Nordon ◽

Fernando Brandão de Andrade e Silva ◽

Kodi Edson Kojima ◽

...

Keyword(s):

Femoral Neck ◽

Comparative Study ◽

Femoral Neck Fracture ◽

Lateral View ◽

Femoral Neck Fractures ◽

Level Of Evidence ◽

X Ray ◽

Neck Fracture ◽

Anteroposterior View ◽

Retrospective Comparative Study

ABSTRACT Objective: To evaluate the rate of deviation in the lateral radiographic incidence in patients with femoral neck fracture classified as non-diverted in the anteroposterior view (Garden I and II). Methods: Nineteen selected patients with femoral neck fractures classified as Garden I and II were retrospectively evaluated, estimating the degree of deviation in the lateral view. Results: Fifteen cases (79%) presented deviations in lateral view, with a mean of 18.6 degrees (±15.5). Conclusion: Most fractures of the femoral neck classified as Garden I and II present some degree of posterior deviation in the X-ray lateral view. Level of Evidence III, Retrospective Comparative Study.

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Unusual foreign bodies of the airway: a case series regarding their management

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20182720 ◽

2018 ◽

Vol 4 (4) ◽

pp. 1089

Author(s):

Aishwarya Ullal ◽

Sanjeev Mishra ◽

R. K. Mundra

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Case Series ◽

Rigid Bronchoscopy ◽

Lateral View ◽

Virtual Bronchoscopy ◽

X Rays ◽

X Ray ◽

Radiological Studies ◽

Respiratory Reflexes

<p>Foreign bodies in the bronchi are a common problem seen by ENT surgeons. Bronchial foreign bodies are common in children because they have difficulty in swallowing hard foodstuffs such as nuts and have an inadequately developed protective respiratory reflexes, which makes them vulnerable to inhalation of foreign bodies This is a case series of four unusual cases of foreign body airway, that presented to our ENT OPD, after taking detailed history and clinical examination, these patients were subjected to radiological studies such as chest X-rays, X-ray soft tissue lateral view, virtual bronchoscopy and CT chest to confirm the foreign body, after taking informed consent rigid bronchoscopy was performed and foreign body extracted.</p>

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The distribution of bone mineral density in the femoral heads of unstable intertrochanteric fractures

Journal of Orthopaedic Surgery ◽

10.1177/2309499018778325 ◽

2018 ◽

Vol 26 (2) ◽

pp. 230949901877832 ◽

Cited By ~ 1

Author(s):

Keisuke Uemura ◽

Masaki Takao ◽

Yoshito Otake ◽

Hidetoshi Hamada ◽

Takashi Sakai ◽

...

Keyword(s):

Bone Mineral Density ◽

Femoral Head ◽

Femoral Neck ◽

Lateral View ◽

Intertrochanteric Fractures ◽

Mineral Density ◽

Femoral Neck Axis ◽

Lag Screw ◽

Center Region ◽

Anteroposterior View

Purpose: Intertrochanteric fractures are usually treated with open reduction and internal fixation, but controversy still remains regarding the proper placement of the lag screw on the anteroposterior view. The stability of the lag screw has been shown to correlate with the bone quality around the screw, but the three-dimensional distribution of the bone mineral density (BMD) in the femoral head has not been studied in detail. Herein, the BMD along the femoral neck axis was measured to clarify the recommended position of the lag screw. Methods: Ten femoral heads acquired from intertrochanteric fractures were evaluated in this study. Each femoral head was scanned with micro computed tomography and the BMD along the femoral neck axis was measured in five regions: center, anterior, posterior, superior, and inferior. The BMD on the anteroposterior view (superior, center, and inferior) and the BMD on the lateral view (anterior, center, and posterior) were compared. Results: The BMD of the center region (173.0 ± 50.6 mg/cm3) was significantly higher than that of the inferior region (139.7 ± 50.1 mg/cm3) on the anteroposterior view ( p < 0.01). On the lateral view, the BMD was lower than the center region in the anterior region (165.7 ± 52.8 mg/cm3) and in the posterior region (157.5 ± 42.3 mg/cm3), but the difference was not significant. Conclusion: The BMD was higher in the center region of the femoral head than in the inferior region. Therefore, lag screws are recommended to be inserted into the center of the femoral head.

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Surgical anatomy of the juxtadural ring area

Neurosurgical FOCUS ◽

10.3171/foc.1998.4.6.2 ◽

1998 ◽

Vol 4 (6) ◽

pp. E2 ◽

Cited By ~ 2

Author(s):

Susumu Oikawa ◽

Kazuhiko Kyoshima ◽

Shigeaki Kobayashi

Keyword(s):

Surgical Anatomy ◽

Lateral View ◽

Horizontal Line ◽

Anterior Clinoid Process ◽

Lateral Projection ◽

Medial Side ◽

Anteroposterior View ◽

Tuberculum Sellae ◽

Planum Sphenoidale ◽

Intradural Space

Object The authors report on the surgical anatomy of the juxtadural ring area of the internal carotid artery to add to the information available about this important structure. Methods Twenty sides of cadaver specimens were used in this study. The plane of the dural ring was found to incline in the posteromedial direction. Medial inclination was measured at 21.8š on average against the horizontal line in the anteroposterior view on radiographic studies. Posterior inclination was measured at 20.3š against the planum sphenoidale in the lateral projection, and the medial edge of the dural ring was located 0.4 mm above the tuberculum sellae in the same projection. The lateral edge of the tuberculum sellae was located 1.4 mm below the superior border of the anterior clinoid process. The carotid cave was situated at the medial or posteromedial aspect of the dural ring; however, two of the 20 specimens showed no cave formation. The carotid cave contained the subarachnoid space in 13 sides, the arachnoid membrane only in three sides, and the extraarachnoid space in two sides. The authors propose that the marker of the medial side of the dural ring, which is more proximal than the lateral, is the tuberculum sellae in the lateral view on radiographic studies. In the medial aspect of the dural ring the intradural space can be situated below the level of the tuberculum sellae because of the existence of the carotid cave. Conclusions The authors found that an aneurysm arising from the medial side of the juxtadural ring area even below the tuberculum sellae is a potential cause of subarachnoid hemorrhage.

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Fusion Versus Joint-Sparing Reconstruction for Patients With Flexible Flatfoot

Foot & Ankle Specialist ◽

10.1177/1938640020950552 ◽

2020 ◽

pp. 193864002095055

Author(s):

Kathryn Whitelaw ◽

Shivesh Shah ◽

Noortje C. Hagemeijer ◽

Daniel Guss ◽

Anne H. Johnson ◽

...

Keyword(s):

Case Series ◽

Bivariate Analysis ◽

Complication Rates ◽

Retrospective Case ◽

Patient Demographics ◽

First Metatarsal ◽

Surgery Patient ◽

Radiographic Measurements ◽

Flexible Flatfoot ◽

Anteroposterior View

Aims Passively correctible, adult-acquired flatfoot deformities (AAFD) are treated with joint-sparing procedures. Questions remain as to the efficacy of such procedures when clinical deformities are severe. In severe deformities, a primary fusion may lead to predictable outcomes, but risks nonunion. We evaluated pre- and postsurgical flexible AAFD patients undergoing joint-sparing or fusion procedures, comparing reoperation and complication rates. Methods We identified patients with flexible AAFD between January 1, 2001 and 2016. Exclusion criteria were incomplete medical record, rigid AAFD, and prior flatfoot surgery. Patient demographics, pre- and postsurgical radiographic measurements, surgery performed, and postoperative complications were evaluated by bivariate analysis, comparing joint-sparing versus fusion procedures. Results Of 239 patients (255 feet) (mean follow-up 62 ± 50 months), 209 (87%) underwent joint-sparing reconstructions, 30 (12.6%) underwent fusions. Fifty-four (24.1%) feet underwent joint-sparing reconstruction with reoperation versus 11 (35.5%) in fusion patients ( P = .17). Radiographic improvement in talonavicular angle, talar first-metatarsal (anteroposterior view), and Meary’s angle was higher in fusion patients ( P < .001, P < .001, and P = .003, respectively). Discussion More nonunion reoperations among fusion patients were offset by reoperations in joint-sparing patients. Fusion uniquely corrected Meary’s angle. Nonunion is of less concern for joint-sparing versus fusion for patients with severe flexible AAFD. Degree of deformity versus advantage of joint motion should improve decision making. Levels of Evidence: Level IV: Retrospective case series

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Paediatric Capitellar Fracture

Asian Journal of Medicine and Biomedicine ◽

10.37231/ajmb.2020.4.1.325 ◽

2020 ◽

Vol 4 (1) ◽

pp. 19-22

Author(s):

Kow RY ◽

Jaya Raj J ◽

Nik Nor Imam N.M.Z ◽

Mohd Daud KN

Keyword(s):

Open Reduction ◽

Case Reports ◽

Plain Radiograph ◽

Case Series ◽

Paediatric Population ◽

Lateral View ◽

Type I ◽

Range Of Movement ◽

Oblique View ◽

Excellent Outcome

Capitellar fracture in the paediatric population is extremely rare. There have been only a handful of case reports or case series in the literature. For this reason, it is likely to be missed or misdiagnosed. An untreated capitellar fracture poses a risk of severe compromise of the elbow function and range of movement. We present a rare case of type I capitellar fracture in an 11-year-old girl. She underwent open reduction and percutaneous Kirschner wiring and she subsequently recovered with excellent outcome. A high index of suspicion is needed to diagnose a capitellar fracture. The lateral view of a plain radiograph must be carefully screened and sometimes an oblique view may be helpful in making the diagnosis. Keywords: capitellum; fracture; open reduction

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Initial Fibular Displacement as a Predictor of Medial Clear Space Widening in Weber B Ankle Fractures

Foot & Ankle International ◽

10.1177/1071100717739615 ◽

2017 ◽

Vol 39 (2) ◽

pp. 166-171 ◽

Cited By ~ 1

Author(s):

Zachary S. Cavanaugh ◽

Simran Gupta ◽

Vinayak M. Sathe ◽

Lauren E. Geaney

Keyword(s):

Sensitivity And Specificity ◽

Strong Predictor ◽

Linear Regression Analysis ◽

Case Series ◽

Lateral View ◽

Ankle Fractures ◽

Characteristic Analysis ◽

Level Of Evidence ◽

Clear Space ◽

Initial Injury

Background: The diagnosis of medial ankle instability in Weber B ankle fractures remains controversial. Manual stress and gravity stress radiographs as well as magnetic resonance imaging (MRI) are used, but there is no consensus gold standard. The purpose of this study was to determine the relationship between initial fibular displacement and medial clear space widening on a gravity stress radiograph as a predictor of instability. Methods: A retrospective review was conducted of all patients with isolated Weber B ankle fractures with both initial injury radiographs and gravity stress view from August 1, 2014, through April 1, 2016. A total of 17 patients were identified. On the mortise view of initial injury radiographs, medial clear space (MCS), superior clear space, lateral fibular displacement (LFDP), and fibular shortening (FS) were measured, and on the lateral view, anterior to posterior fibular gap (A to P FG) was measured. MCS was again measured on the gravity stress view (MCS-W). Statistical analyses identified the correlations of each displacement variable relative to MCS-W as well as the sensitivity and specificity of each parameter. Results: A cutoff point for MCS-W was set as less than 5.0 mm (n = 8) and 5.0 mm or more (n = 9). Strong significant correlations with MCS-W were found for A to P FG (0.84, P < .001), with a trend for LFDP (0.62, P = .008), but no significance with FS (0.38, P = .84). Linear regression analysis revealed significant ability to predict MCS-W for both LFDP ( P = .002) and A to P FG ( P = .001) but not FS. Receiver operating characteristic analysis for A to P FG using a threshold value of 1.0 mm yielded sensitivity and specificity of 100% in predicting an MCS-W of 5.0 mm or more. Conclusion: The initial fibular displacement was a strong predictor of MCS-W in Weber B ankle fractures. On lateral radiographs, an A to P FG greater than 1.0 mm showed a sensitivity and specificity of 100% in predicting an MCS-W of 5.0 mm or more on gravity stress view. Level of Evidence: Level III case series, prognostic.

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