Assessment of Radiographic Parameters for Adequate Reduction Following Syndesmotic Injury Causing Fibular Malrotation

2010 ◽  
Author(s):  
Meir Marmor ◽  
Erik N. Hansen ◽  
Hyun Kyu Han ◽  
Jenni M. Buckley ◽  
Amir Matityahu
Keyword(s):  
Clinical Outcomes ◽  
Ankle Instability ◽  
Ankle Injuries ◽  
Syndesmotic Injury ◽  
X Ray ◽  
Orthopaedic Surgeons ◽  
Clear Space ◽  
Radiographic Parameters ◽  
X Ray Imaging ◽  
Musculoskeletal Problems

Rotational ankle injuries are one of the most common musculoskeletal problems treated by orthopaedic surgeons. The distal tibio-fibular syndesmosis may be disrupted during injury resulting in ankle instability. The goal of surgery is to restore anatomic relation of tibia, fibula, and talus. Any malreduction including that of the syndesmosis may result in poor clinical outcomes [1]. While currently accepted radiographic criteria can adequately detect tibio-fibular diasthesis or translation malreductions, it is not yet clear if the currently these criteria are equally suited for detection of rotational malreductions of the tibio-fibular syndesmosis [2]. The goal of this study is to quantify the sensitivity of fluoroscopic measurements of tibio-fibular overlap (TFO) and tibio-fibular clear space (TCS) to rotational malreductions of the syndesmosis. Standard x-ray imaging will be compared with a 3D fluoroscan which will simulate postoperative CT [3].

scholarly journals Stress vs. Non-Stress Radiographs in Subtle Syndesmotic Injuries

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0029
Author(s):  
Nicola Krähenbühl ◽  
Travis Bailey ◽  
Nathan Davidson ◽  
Heath Henninger ◽  
Charles Saltzman ◽  
...  
Keyword(s):  
Ankle Instability ◽  
External Rotation ◽  
Paired Comparison ◽  
Weight Bearing ◽  
Deltoid Ligament ◽  
Ankle Sprains ◽  
X Rays ◽  
Syndesmotic Injury ◽  
Stress Radiographs ◽  
Clear Space

Category: Sports Introduction/Purpose: Between 1-18% of all ankle sprains and 23% of all ankle fractures involve injury to the distal tibio-fibular syndesmosis. Syndesmotic injuries can create a substantial diagnostic and therapeutic challenge for orthopaedic surgeons. While acute injuries can be assessed using conventional radiographs, subtle syndesmotic injuries may be misdiagnosed using X-rays. Misdiagnoses may result in chronic ankle instability, pain and post-traumatic osteoarthritis of the tibio-talar joint. The purpose of this study was to investigate whether syndesmotic injury was more easily diagnosed with stress vs. non-stress radiographs.radiographs.sed with stress vs. non-stress radiographs. Methods: Five pairs of cadavers (tibia plateau to toe-tip, mean 61 years, range 52-70 years) were scanned with weight-bearing CT (170 lb, w/ and w/o 10 Nm static external rotation torque). Digitally reconstructed radiographs (DRRs), which are comparable to conventional radiographs, were reconstructed from the 3D CT data. The following conditions were tested: First, intact ankles (Native) were tested. Second, one specimen from each pair underwent AITFL resection, while the contralateral underwent deltoid resection (Condition 1). Third, the remaining intact deltoid ligament or AITFL was resected in each ankle (Condition 2). Finally, the interosseous membrane (IOM) was resected in all ankles (Condition 3). Condition 3 was defined as acute syndesmotic injury. Using antero-posterior (AP) views, the tibio-fibular clear space (TFCS), tibiofibular overlap (TFO) and medial clear space (MCS) were assessed. Statistical analysis was performed using paired (comparison within groups) and unpaired (comparison between groups) t-test where p=0.05 was considered significant. Results: Regarding the TFCS, Native vs. Condition 3 in 10 Nm stress radiographs was significantly different in the deltoid group (p=0.021). Using TFO in stress and non-stressed radiographs, Native vs. Condition 2 and 3 was significantly different for the deltoid group (p=0.043), and Native vs. Condition 3 in the syndesmotic group (p=0.027). Regarding the MCS in non-stress radiographs, Native vs. Condition 3 was significantly different in the deltoid group (p=0.007), while in stress views, Native vs. Condition 2 was significant different in the syndesmotic (p=0.026) and Native vs. Condition 3 in the deltoid group (p=0.030). No differences were found comparing the conditions of the AITFL with the same conditions of the deltoid group. Conclusion: The TFCS cannot be used to assess subtle or acute syndesmotic injuries in stress and non-stress radiographs. The TFO can be used to assess a combined injury to the AITFL and deltoid ligament in stress and non-stress radiographs. The MCS can be used to assess acute syndesmotic injuries in stress and non-stress radiographs. Radiographs (stress or non-stress) cannot be used to distinguish between injuries to the AITFL or deltoid ligament. Therefore, stress and non-stress radiographs are not useful in assessment of subtle syndesmotic injuries. Stress-radiographs are not superior compared to non-stress radiographs in assessment of acute syndesmotic injuries.

Assessment of Clinical Outcomes of Outpatients Following Chest X-ray Imaging Performed at King Abdul–Aziz Medical City, Riyadh, Saudi Arabia

2018 ◽  
Vol 28 (4) ◽  
pp. 1-9
Author(s):  
Ali Aldhebaib ◽  
Oinam Gokulchandra Singh ◽  
Zyad Almutlaq ◽  
Fayazul Haq ◽  
Adel Ali Alharbi ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Clinical Outcomes ◽  
X Ray ◽  
X Ray Imaging ◽  
Medical City ◽  
Chest X Ray

scholarly journals Study of the radiographic parameters of normal ankles

2020 ◽  
Vol 14 (1) ◽  
pp. 84-88
Author(s):  
Pedro Costa Benevides ◽  
Caio Augusto de Souza Nery ◽  
Alexandre Leme Godoy-Santos ◽  
José Felipe Marion Alloza ◽  
Marcelo Pires Prado
Keyword(s):  
Ankle Instability ◽  
Radiographic Measurement ◽  
Radiographic Evaluation ◽  
Diagnostic Study ◽  
Ankle Arthritis ◽  
Level Of Evidence ◽  
X Ray ◽  
Radiographic Parameters ◽  
Radiographic Measurements ◽  
Bibliographic Search

Objective: The authors carried out a bibliographic search for the radiographic parameters used to determine tibiotalar joint alignment, and suggest a set of parameters that constitute the minimum radiographic evaluation sufficient for the proper assessment of tibiotalar alignment. Methods: The search was conducted between May 2019 and January 2020 on the online platforms PudMed and Google Scholar with the following terms, used separately or jointly: “ankle arthritis, radiographic measurement, ankle alignment, alignment, anterior ankle instability, X-ray, and ankle injury”. Results: We selected twelve studies evaluating radiographic patterns of normal ankles, and identified a total of 15 radiographic measurements. Conclusion: The authors believe that a minimum radiographic assessment of tibiotalar alignment should include the following parameters on the anteroposterior radiograph: the distal tibial articular angle, the talar tilt and talus center migration. On the lateral radiograph, it should include: lateral distal tibial angle and lateral talar station. Level of Evidence V; Diagnostic Study; Expert Opinion.

A Medial Malleolar “Fleck Sign” May Predict Ankle Instability in Ligamentous Supination External Rotation Ankle Fractures

2017 ◽  
Vol 11 (3) ◽  
pp. 246-251 ◽  
Author(s):  
Kenneth Nwosu ◽  
Brian Andrew Schneiderman ◽  
Stephen Joseph Shymon ◽  
Thomas Harris
Keyword(s):  
Ankle Instability ◽  
External Rotation ◽  
Treatment Protocol ◽  
Operative Management ◽  
Ankle Fractures ◽  
Ankle Injuries ◽  
Medial Malleolus ◽  
Joint Stability ◽  
Clear Space ◽  
Supination External Rotation

Background. Ankle joint stability dictates treatment in ligamentous supination external rotation ankle injuries (LSERAI). Investigation of the medial structures that support the ankle mortise is critical, and a small avulsion fracture, or “fleck”, of the medial malleolus is occasionally encountered. This study aimed to assess the utility of this medial malleolus fleck sign (MMFS) in diagnosing instability requiring surgery in LSERAI. Methods. This retrospective observational study examined 166 LSERAI at a single level I trauma center. A standardized diagnostic and treatment protocol for ankle fractures was followed. LSERAI at presentation were reported as having a normal, dynamically wide, or statically wide medial clear space. Patient demographics, MMFS characteristics, and the use of operative management were recorded. Results. MMFS incidence in the cohort was 16 (10%) of 166 and was present in 25% of patients with unstable LSERAI. Fifteen (94%) of 16 patients with a MMFS were deemed to have an unstable LSERAI (P < .005). MMFS had a 25% sensitivity and 99% specificity in diagnosing an unstable LSERAI. For the subgroup of patients without a statically wide medial clear space, MMFS had a 50% sensitivity and 99% specificity in determining instability. Conclusion. A MMFS may be indicative of an unstable LSERAI. With previous MRI studies demonstrating complete deltoid disruption in unstable LSERAI, we deduce the MMFS may be associated with extensive deltoid incompetence. The MMFS may help to diagnose a complete deltoid injury in LSERAI with a normal medial clear space, which could influence treatment and reduce patient morbidity, radiation exposure, and healthcare costs. Levels of Evidence: Level III: Retrospective Cohort Study

Heterotopic Ossification Following Decompression and Interspinous Dynamic Stabilization for Treating Lumbar Degenerative Disease Based on Minimum Follow-Up of Five Years and X-ray Imaging

2020 ◽  
Vol 10 (12) ◽  
pp. 2952-2958
Author(s):  
Haibo Lu ◽  
Yong Hai ◽  
Yangpu Zhang ◽  
Li Guan ◽  
Yuzeng Liu ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Clinical Outcomes ◽  
Rank Correlation ◽  
Clinical Results ◽  
Lumbar Degenerative Disease ◽  
X Ray ◽  
Spearman’S Rank Correlation ◽  
Spearman’S Rank Correlation Coefficient ◽  
X Ray Imaging ◽  
Post Operation

Objective: Hetertopic ossiofication (HO) was considered one of the main adverse events following lumbar decompression and could negatively affect these patients' daily activity. However, there is still a lack of evidence to assess the association between the incidence of HO at surgical segment and clinical outcomes following the implantation of a Coflex™ device. The objective of this study is determine the association between the incidence of HO and clinical outcomes following implantation of a Coflex™ device based on X-ray imaging. Methodology: One hundred sixty-nine consecutive patients who underwent decompression and implantation of a Coflex™ device from December 2007 to January 2014 were studied. A logistic regression analysis was used to analyze complications and development of HO. Spearman's rank correlation coefficient was used to analyze the correlation between clinical results and the incidence of HO based on X-ray imaging. Results: All patients showed improvement from baseline in clinical outcomes at all time points up to 5 years post-operation (all p = 0.000). Preoperative range of motion (ROM) of operated segment had a positive relationship with the incidence of HO (r = 0.194, p = 0.012). No correlation exists between the incidence of HO and clinical outcomes. The odds ratio (OR) for development of complications in patients with Pfirrmann disc degeneration classification grades III and IV compared to those with grades 0, I and II was 3.003 (p = 0.005, 95% confidence interval, 1.621–34.195). In addition, the OR for the incidence of HO in the large ROM of the surgical segment compared to that in the normal/small ROM segment was 21.670 (p = 0.001, 95% confidence interval, 21.137–22.280). Conclusions: Our findings provide evidence that high Pfirrmann disc degenerative classification grades and a large ROM of the surgical segment were the main risk factors for complications and development of HO, respectively.

Defects of Platelet Function Recognized by X-Ray Imaging and Scanning Electron Microscopy

1985 ◽  
Vol 43 ◽  
pp. 610-613
Author(s):  
M.G. Baldini ◽  
S. Morinaga ◽  
D. Minasian ◽  
R. Feder ◽  
D. Sayre ◽  
...  
Keyword(s):  
Electron Microscopy ◽  
Scanning Electron Microscopy ◽  
Cell Biology ◽  
Imaging Technique ◽  
Human Platelets ◽  
X Rays ◽  
X Ray ◽  
X Ray Imaging ◽  
Complex Phenomena ◽  
Scanning Electron

Contact X-ray imaging is presently developing as an important imaging technique in cell biology. Our recent studies on human platelets have demonstrated that the cytoskeleton of these cells contains photondense structures which can preferentially be imaged by soft X-ray imaging. Our present research has dealt with platelet activation, i.e., the complex phenomena which precede platelet appregation and are associated with profound changes in platelet cytoskeleton. Human platelets suspended in plasma were used. Whole cell mounts were fixed and dehydrated, then exposed to a stationary source of soft X-rays as previously described. Developed replicas and respective grids were studied by scanning electron microscopy (SEM).

Designing high-resolution slow scan CCD-based TEM camera systems

1992 ◽  
Vol 50 (2) ◽  
pp. 946-947
Author(s):  
James F. Mancuso ◽  
William B. Maxwell ◽  
Russell E. Camp ◽  
Mark H. Ellisman
Keyword(s):  
Fiber Optics ◽  
Ccd Camera ◽  
High Energy ◽  
Phosphor Layer ◽  
X Ray ◽  
Light Production ◽  
Camera Systems ◽  
X Ray Imaging ◽  
Electron Image ◽  
Scintillating Fiber

The imaging requirements for 1000 line CCD camera systems include resolution, sensitivity, and field of view. In electronic camera systems these characteristics are determined primarily by the performance of the electro-optic interface. This component converts the electron image into a light image which is ultimately received by a camera sensor.Light production in the interface occurs when high energy electrons strike a phosphor or scintillator. Resolution is limited by electron scattering and absorption. For a constant resolution, more energy deposition occurs in denser phosphors (Figure 1). In this respect, high density x-ray phosphors such as Gd2O2S are better than ZnS based cathode ray tube phosphors. Scintillating fiber optics can be used instead of a discrete phosphor layer. The resolution of scintillating fiber optics that are used in x-ray imaging exceed 20 1p/mm and can be made very large. An example of a digital TEM image using a scintillating fiber optic plate is shown in Figure 2.

Ionic homeostasis and subcellular element compartmentation

1990 ◽  
Vol 48 (2) ◽  
pp. 150-151
Author(s):  
Ann LeFurgey ◽  
Peter Ingram ◽  
J.J. Blum ◽  
M.C. Carney ◽  
L.A. Hawkey ◽  
...  
Keyword(s):  
Leishmania Major ◽  
Ionic Homeostasis ◽  
X Ray ◽  
Functional Studies ◽  
Cell Compartments ◽  
X Ray Imaging ◽  
Resolution Electron ◽  
Multiple Cell ◽  
Role Of Zn

Subcellular compartments commonly identified and analyzed by high resolution electron probe x-ray microanalysis (EPXMA) include mitochondria, cytoplasm and endoplasmic or sarcoplasmic reticulum. These organelles and cell regions are of primary importance in regulation of cell ionic homeostasis. Correlative structural-functional studies, based on the static probe method of EPXMA combined with biochemical and electrophysiological techniques, have focused on the role of these organelles, for example, in maintaining cell calcium homeostasis or in control of excitation-contraction coupling. New methods of real time quantitative x-ray imaging permit simultaneous examination of multiple cell compartments, especially those areas for which both membrane transport properties and element content are less well defined, e.g. nuclei including euchromatin and heterochromatin, lysosomes, mucous granules, storage vacuoles, microvilli. Investigations currently in progress have examined the role of Zn-containing polyphosphate vacuoles in the metabolism of Leishmania major, the distribution of Na, K, S and other elements during anoxia in kidney cell nuclel and lysosomes; the content and distribution of S and Ca in mucous granules of cystic fibrosis (CF) nasal epithelia; the uptake of cationic probes by mltochondria in cultured heart ceils; and the junctional sarcoplasmic retlculum (JSR) in frog skeletal muscle.

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