scholarly journals Correlation of Incisura Anatomy With Syndesmotic Malreduction

2017 ◽  
Vol 39 (3) ◽  
pp. 369-375 ◽  
Author(s):  
Andrzej Boszczyk ◽  
Sławomir Kwapisz ◽  
Martin Krümmel ◽  
Rene Grass ◽  
Stefan Rammelt
Keyword(s):  
Computed Tomography ◽  
At Risk ◽  
Comparative Study ◽  
Sagittal Plane ◽  
Coronal Plane ◽  
Ct Scans ◽  
Level Of Evidence

Background: The anatomy of the syndesmosis is variable, yet little is known on the correlation between differences in anatomy and syndesmosis reduction results. The aim of this study was to analyze the correlation between syndesmotic anatomy and the modes of syndesmotic malreduction. Methods: Bilateral postreduction ankle computed tomography (CT) scans of 72 patients treated for fractures with syndesmotic disruption were analyzed. Incisura depth, fibular engagement into the incisura, and incisura rotation were correlated with degree of syndesmotic malreduction in coronal and sagittal planes as well as rotational malreduction. Results: Clinically relevant malreduction in the coronal plane, sagittal plane, and rotation affected 8.3%, 27.8%, and 19.4% of syndesmoses, respectively. The syndesmoses with a deep incisura and the fibula not engaged into the tibial incisura were at risk of overcompression, anteverted incisuras at risk of anterior fibular translation, and retroverted incisuras at risk of posterior fibular translation. Conclusions: Certain morphologic configurations of the tibial incisura increased the risk of specific syndesmotic malreduction patterns. Level of Evidence: Level III, comparative study.

3D Biometrics for Hindfoot Alignment Using Weightbearing Computed Tomography

2019 ◽  
Vol 40 (6) ◽  
pp. 720-726 ◽  
Author(s):  
Jian Zhong Zhang ◽  
François Lintz ◽  
Alessio Bernasconi ◽  
Shu Zhang ◽  
Keyword(s):  
Computed Tomography ◽  
Comparative Study ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Level Of Evidence ◽  
Hindfoot Alignment ◽  
Mean Values ◽  
Intraclass Correlation Coefficients ◽  
Prospective Comparative Study

Background: Weightbearing computed tomography (WBCT) is a useful tool for the assessment of hindfoot alignment (HA). Foot ankle offset (FAO) is a recently introduced parameter, determined from WBCT images using semiautomatic software. The aim of this study was to determine the clinical relevance and reproducibility of FAO for the evaluation of HA. Methods: A prospective comparative study was performed on consecutive patients requiring bilateral WBCT between September 2017 and April 2018. Based on the clinical assessment of HA, patients were divided into 3 groups: (1) normal alignment group (G1), (2) valgus (G2), and (3) varus (G3). FAO and long axial view (HACT) were measured on WBCT images, and the groups were compared. The reproducibility of FAO and HACT was determined through intraclass correlation coefficients (ICCs). Regression analysis was performed to investigate the correlation between the 2 methods. Overall, 249 feet (126 patients) were included (G1 = 115, G2 = 78, and G3 = 56 feet). Results: The mean values for FAO and HACT were 1.2% ± 2.8% and 3.9 ± 3.1, respectively, in G1; 8.1% ± 3.7% and 9.7 ± 4.9 in G2; and −6.6% ± 4.8% and −8.2 ± 6.6 in G3. Intra- and interobserver reliability was 0.987 and 0.988 for FAO and 0.949 and 0.949 for HACT, respectively. There was a good linear correlation between HACT and FAO ( R2 = 0.744), with a regression slope of 1.064. Conclusions: WBCT was a useful method for the characterization of HA. FAO was reproducible and correlated well with physical examination. Level of Evidence: Level II, prospective comparative study.

Radioanatomic Study of the Greater Palatine Canal Relevant to Endoscopic Endonasal Surgical Landmarks

2017 ◽  
Vol 157 (4) ◽  
pp. 731-736
Author(s):  
Noel Ayoub ◽  
Andrew Thamboo ◽  
Peter H. Hwang ◽  
Evan S. Walgama
Keyword(s):  
Computed Tomography ◽  
Maxillary Sinus ◽  
Sagittal Plane ◽  
Inferior Turbinate ◽  
Posterior Wall ◽  
University Hospital ◽  
Ct Scans ◽  
Endoscopic Endonasal ◽  
Greater Palatine Canal ◽  
Maxillary Sinuses

Objective A radioanatomic study of surgically relevant variations in the greater palatine canal (GPC) on computed tomography (CT) was performed to determine susceptibility during endoscopic endonasal procedures. Study Design Blinded radioanatomic analysis. Setting Tertiary university hospital. Subjects and Methods Fifty consecutive paranasal CT scans (100 sides) were analyzed. Measurements were standardized to landmarks such as the inferior turbinate (IT) and floor of the nasal cavity (FNC) to assess variability and vulnerability of the nerve. Measurements included (1) incidence of maxillary sinus pneumatization posterior to the GPC, (2) distance from the posterior wall of the maxillary sinus to the GPC at the IT and FNC, (3) width of bone containing the GPC, (4) incidence of medial GPC dehiscence, and (5) angle of the GPC extending from the IT to FNC. Results Ninety-one percent of maxillary sinuses were pneumatized posterior to the GPC. The distance from the posterior wall of the maxillary sinus to the GPC was 2.8 ± 1.7 mm (range, –2.3 to 5.9) at the posterior attachment of the IT and 4.1 ± 3.1 mm (range, –6.3 to 11.9) at the FNC. The width of bone containing the GPC was 3.3 ± 1.3 mm (range, 1-8.9), and the medial bony GPC was dehiscent in 38% of cases. In the sagittal plane, the angle of the GPC between the IT and the FNC was 31.9 ± 6.9 degrees (range, 10.8-45). Conclusion The GPC has considerable anatomic variability relative to important surgical landmarks in endoscopic procedures. Preoperative review of CTs to assess vulnerability may prevent postoperative complications.

scholarly journals TOMOGRAPHIC MORPHOLOGICAL STUDY OF THE CRANIUM AND ITS CORRELATION WITH CRANIAL HALO USE IN ADULTS

2017 ◽  
Vol 25 (1) ◽  
pp. 11-14
Author(s):  
TIAGO FERREIRA DE ALMEIDA ◽  
HOMAR TOLEDO CHARAFEDDINE ◽  
FERNANDO FLORES DE ARAÚJO ◽  
ALEXANDRE FOGAÇA CRISTANTE ◽  
RAPHAEL MARTUS MARCON ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Morphological Study ◽  
Descriptive Analysis ◽  
Parietal Bone ◽  
Frontal Bone ◽  
Ct Scans ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Significant Difference ◽  
Parietal Bones

ABSTRACT Objective: To evaluate using tomographic study the thickness of the cranial board at the insertions points of the cranial halo pins in adults Methods: This is a retrospective, cross-sectional, descriptive analysis of Computed Tomography (CT) scans of adult patients' crania. The study included adults between 20 and 50 years without cranial abnormalities. We excluded any exam with cranial abnormalities Results: We analyzed 50 CT scans, including 27 men and 23 women, at the original insertion points and alternative points (1 and 2 cm above the frontal and parietal bones). The average values were 7.4333 mm in the frontal bone and 6.0290 mm in the parietal bone Conclusion: There was no statistically significant difference between the classical and alternative points, making room for alternative fixings and safer introduction of the pins, if necessary. Level of Evidence II, Retrospective Study.

scholarly journals Syndesmotic Anatomy as a Risk Factor for Syndesmotic Injury and Syndesmotic Malreduction

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0016
Author(s):  
Andrzej Boszczyk ◽  
Stefan Rammelt
Keyword(s):  
At Risk ◽  
Sagittal Plane ◽  
Research Question ◽  
Coronal Plane ◽  
Control Group ◽  
Fibular Fracture ◽  
Injury Group ◽  
Bony Anatomy ◽  
The Individual ◽  
Injured Patients

Category: Trauma Introduction/Purpose: The anatomy of the syndesmosis is variable, yet little is known on the correlation between morphology and the risk of syndesmotic disruption and malreduction with operative fixation. The study aims at (1) comparing the bony anatomy of the syndesmosis in patients who sustained a high fibular fracture with syndesmosis disruption and that of the non-injured population and (2) at identification of certain anatomical features correlating with syndesmotic malreduction. Methods: For the first research question, the CT examinations of 75 patients who sustained a high fibular fracture with syndesmosis disruption and a control group of 75 patients with unrelated foot problems and without ankle pathology were compared. For the second research question, the bilateral postreduction ankle CTs of 72 patients were analyzed. Incisura depth, fibular engagement into the incisura and incisura rotation (Figure) of the injured patients were compared with those of uninjured controls and correlated with degree of syndesmotic malreduction in the coronal plane, sagittal plane, and rotational malreduction. Results: With the median values of the control group as cutoff there were 71% shallow, 71% disengaged and 77% retroverted syndesmoses in the injury group. The differences between the groups were statistically significant for every measure (P< .002 to P> .0001). Clinically relevant syndesmosis malreduction in coronal plane, sagittal plane and rotation affected 8.3; 27.8; and 19.4% of, patients, respectively. The syndesmoses with a deep incisura and the fibula not engaged into the tibial incisura were at risk of overcompression (P< .05). Syndesmosis with an anteverted incisura were at risk of anterior fibular translation and those with a retroverted incisura were at risk of posterior fibular translation (P< .05). Conclusion: Patients with a shallow, disengaged and retroverted bony configuration of the tibial incisura at the syndesmosis are overrepresented among patients with syndesmotic disruption. Intraoperative overcompression of the syndesmosis is significantly more common in patients with a deep and less engaged incisura. Anteversion of the incisura correlates with anterior displacement of the fibula while retroversion of the incisura is correlated with posterior fibular displacement. Knowledge of the individual incisura morphology could be helpful when planning and performing reduction of an unstable syndesmosis.

scholarly journals Three-dimensional assessment of unilateral subcondylar fracture using computed tomography after open reduction

2014 ◽  
Vol 47 (02) ◽  
pp. 203-209 ◽  
Author(s):  
Sathya Kumar Devireddy ◽  
R. V. Kishore Kumar ◽  
Rajasekhar Gali ◽  
Sridhar Reddy Kanubaddy ◽  
Mallikarjuna Rao Dasari ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Statistical Difference ◽  
Sagittal Plane ◽  
Three Dimensional ◽  
Mandibular Condyle ◽  
Clinical Results ◽  
Considerable Change ◽  
Ct Scans ◽  
Open Method ◽  
Condylar Fractures

ABSTRACT Objective: The aim was to assess the accuracy of three-dimensional anatomical reductions achieved by open method of treatment in cases of displaced unilateral mandibular subcondylar fractures using preoperative (pre op) and postoperative (post op) computed tomography (CT) scans. Materials and Methods: In this prospective study, 10 patients with unilateral sub condylar fractures confirmed by an orthopantomogram were included. A pre op and post op CT after 1 week of surgical procedure was taken in axial, coronal and sagittal plane along with three-dimensional reconstruction. Standard anatomical parameters, which undergo changes due to fractures of the mandibular condyle were measured in pre and post op CT scans in three planes and statistically analysed for the accuracy of the reduction comparing the following variables: (a) Pre op fractured and nonfractured side (b) post op fractured and nonfractured side (c) pre op fractured and post op fractured side. P <; 0.05 was considered as significant. Results: Three-dimensional anatomical reduction was possible in 9 out of 10 cases (90%). The statistical analysis of each parameter in three variables revealed (P <; 0.05) that there was a gross change in the dimensions of the parameters obtained in pre op fractured and nonfractured side. When these parameters were assessed in post op CT for the three variables there was no statistical difference between the post op fractured side and non fractured side. The same parameters were analysed for the three variables in pre op fractured and post op fractured side and found significant statistical difference suggesting a considerable change in the dimensions of the fractured side post operatively. Conclusion: The statistical and clinical results in our study emphasised that it is possible to fix the condyle in three-dimensional anatomical positions with open method of treatment and avoid post op degenerative joint changes. CT is the ideal imaging tool and should be used on a regular basis for cases of condylar fractures.

scholarly journals Lesion Size Measured on MRI Does Not Accurately Reflect Arthroscopic Measurement in Talar Osteochondral Lesions

2019 ◽  
Vol 7 (2) ◽  
pp. 232596711882526 ◽  
Author(s):  
Youichi Yasui ◽  
Charles P. Hannon ◽  
Ethan J. Fraser ◽  
Jakob Ackermann ◽  
Lorraine Boakye ◽  
...  
Keyword(s):  
Sagittal Plane ◽  
Preoperative Evaluation ◽  
Lesion Size ◽  
Coronal Plane ◽  
Osteochondral Lesions ◽  
Consecutive Series ◽  
Level Of Evidence ◽  
Bone Marrow Stimulation ◽  
Custom Made ◽  
Magnetic Resonance Imaging Mri

Background: Lesion size is a major determinant of treatment strategy for osteochondral lesions of the talus (OLTs). Although magnetic resonance imaging (MRI) is commonly used in the preoperative evaluation of OLTs, the reliability of the MRI measurement compared with the arthroscopic measurement is unknown. Purpose: To compare preoperative lesion size measured on MRI versus intraoperative lesion size measured during arthroscopy. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: We retrospectively reviewed a consecutive series of patients treated with bone marrow stimulation for OLTs. The diameter of the lesion was measured at its widest point in 2 planes, and MRI measurements were compared with those made during arthroscopy using a custom-made graduated probe. Results: A total of 39 patients with 45 OLTs were analyzed. Mean ± SD area measurements on MRI were significantly greater than the equivalent arthroscopic measurements (42.2 ± 30.5 vs 28.6 ± 23.1 mm2, respectively; P = .03). Compared with the arthroscopic measurement, MRI overestimated OLT size in 53.3% (24/45) of ankles and underestimated OLT size in 24.4% (11/45). The mean MRI diameter measurement was significantly greater than the arthroscopic measurement in the coronal plane (MRI diameter vs arthroscopic measurement coronal plane, 6.1 ± 2.6 vs 4.9 ± 2.3 mm, P = .03; sagittal plane, 8.0 ± 3.6 vs 6.3 ± 3.6 mm, P = .05). Further, MRI overestimated coronal diameter in 48.9% (22/45) of ankles and underestimated in 26.7% (12/45) compared with the arthroscopic measurement. Similarly, sagittal plane MRI diameter measurements overestimated lesion size in 46.7% (21/45) of ankles and underestimated lesion size in 28.9% (13/45) compared with the arthroscopic findings. Conclusion: In a majority of lesions, MRI overestimated OLT area and diameter compared with arthroscopy. Surgeons should be aware of the discrepancies that can exist between MRI and arthroscopic measurements, as these data are important in making treatment decisions and educating patients.

Use of the False-Profile Radiographic View to Measure Pelvic Incidence

2018 ◽  
Vol 46 (9) ◽  
pp. 2089-2095 ◽  
Author(s):  
Ryan T. Li ◽  
Raymond W. Liu ◽  
Mithun Neral ◽  
Heath Gould ◽  
Emily Hu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pelvic Incidence ◽  
Intraclass Correlation ◽  
Important Variable ◽  
Lateral View ◽  
Ct Scans ◽  
Acetabular Coverage ◽  
Reasonable Accuracy ◽  
Level Of Evidence ◽  
Spinopelvic Balance

Background: Pelvic incidence (PI) is an important variable in assessing spinopelvic balance that is associated with hip pathology. A lateral radiograph of the pelvis can be used to measure PI, but this view is not routinely performed in the clinical setting during evaluation of hip pain. The false-profile (FP) radiographic view of the hip is commonly obtained to measure acetabular coverage. Purpose: To evaluate the tolerance of PI measurements to pelvic rotation and assess the feasibility of using an FP radiograph to obtain an accurate measurement of PI. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A mathematical model was developed to predict the change in PI with rotation. Fluoroscopic images were obtained of 6 reconstructed cadaveric adult pelvis and femur specimens at varying degrees of rotation, including a perfect lateral and FP image. PI was measured with the midpoint between the centers of the femoral heads as a reference point. The findings were confirmed clinically by retrospectively reviewing FP radiographs and computed tomography (CT) scans of 40 clinical patients. PI was measured on FP radiographs and CT scans by 2 independent reviewers. Results: With dry cadaveric pelvis specimens, the discrepancy in PI measured between fluoroscopic FP and lateral views was 1.6° (95% CI, 0.7°-2.4°). There was excellent agreement between CT and FP radiographs with regard to measurement of PI (intraclass correlation coefficient = 0.92; 95% CI, 0.78-0.98). Mean discrepancy in PI measured between the 40 clinical FP radiographs and CT scans was 2.8° (range, 0.1°-9.1°). Conclusion: Increased rotation from a lateral view results in greater error in measuring PI, although relatively nominally with a 2.8° error with the 25° of rotation in clinical true FP views. These data demonstrate that FP radiographs can be used to measure PI with reasonable accuracy.

Low-Dose Brain Computer Tomography Sensitivity: A Comparative Study with a Conventional Technique

2012 ◽  
Vol 25 (2) ◽  
pp. 151-162 ◽  
Author(s):  
I. Aprile ◽  
I. Ottaviano ◽  
E. Buono ◽  
A. Di Renzo ◽  
P. Fiaschini ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Comparative Study ◽  
Computer Tomography ◽  
Low Dose ◽  
Signal To Noise Ratio ◽  
Conventional Technique ◽  
Brain Lesions ◽  
Ct Scans ◽  
Signal To Noise ◽  
Conventional Ct

A comparative study between brain conventional computed tomography (CT) examinations and low-dose examinations was performed. The aim of the work was to show if a low-dose technique can be used instead of a standard one. Forty patients with 51 brain lesions were studied with both techniques. The low-dose technique was optimized with mAs reduction to obtain a 25% dose reduction compared to standard acquisitions. Even if images have a poor signal-to-noise ratio, the low-dose technique visualized all the lesions disclosed by conventional examination except three chronic vascular lacunar infarcts. In conclusion, the low-dose technique can be adopted instead conventional CT scans in selected cases.

Do Coronal or Sagittal Plane Measurements Have the Highest Accuracy to Arthroscopically Diagnose Syndesmotic Instability?

2021 ◽  
pp. 107110072110041
Author(s):  
Rohan Bhimani ◽  
Bart Lubberts ◽  
Pongpanot Sornsakrin ◽  
Jafet Massri-Pugin ◽  
Gregory Waryasz ◽  
...  
Keyword(s):  
Operating Characteristic ◽  
Sagittal Plane ◽  
Area Under The Curve ◽  
Coronal Plane ◽  
Deltoid Ligament ◽  
Roc Curve Analysis ◽  
Level Of Evidence ◽  
Interosseous Ligament ◽  
Tibiofibular Ligament ◽  
Anterior Inferior Tibiofibular Ligament

Background: To compare the accuracy of arthroscopic sagittal versus coronal plane distal tibiofibular motion toward diagnosing syndesmotic instability. Methods: Arthroscopic assessment of the syndesmosis was performed on 21 above-knee cadaveric specimens, first with all ligaments intact and subsequently with sequential transection of the anterior inferior tibiofibular ligament, the interosseous ligament, the posterior inferior tibiofibular ligament, and the deltoid ligament. A lateral hook test, an anterior-to-posterior (AP) translation test, and a posterior-to-anterior (PA) translation test were performed under 100 N of applied force. Anterior and posterior third coronal plane diastasis and AP and PA sagittal plane fibular translations were measured relative to the static tibia. Results: Receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) was higher for the combined AP and PA sagittal measurements (AUC, 0.91; accuracy, 83.5%; sensitivity, 78%; specificity, 89%) than the coronal plane measurements (anterior third: AUC, 0.65; accuracy, 60.5%; sensitivity, 63%; specificity, 59%; posterior third: AUC, 0.73; accuracy, 68.5%; sensitivity, 80%; specificity, 57%) ( P < .001), underscoring the higher accuracy of sagittal plane measurements. Conclusion: Arthroscopic measurement of sagittal plane fibular translation is more accurate than coronal plane diastasis for evaluating syndesmotic instability. Clinical Relevance: Clinicians should focus on distal tibiofibular motion in the sagittal plane when arthroscopically evaluating suspected syndesmotic instability. Level of Evidence: Biomechanical cadaveric study.

scholarly journals How Does Robotic Technology Influence TKA Implant Placement For Surgeons In Fellowship Training?

10.29007/7wck ◽  
2019 ◽  
Author(s):  
Laura Scholl ◽  
Emily Hampp ◽  
Kevin de Souza ◽  
Ta-Cheng Chang ◽  
Geoffrey Westrich ◽  
...  
Keyword(s):  
Sagittal Plane ◽  
Fellowship Training ◽  
Coronal Plane ◽  
Ct Scans ◽  
Teaching Hospitals ◽  
Computer Assisted ◽  
Implant Position ◽  
Implant Placement ◽  
Accuracy And Precision ◽  
System Errors

Implant malalignment during TKA may lead to suboptimal outcomes. Accuracy studies are typically performed with experienced surgeons; however, it is important to study less experienced surgeons when considering teaching hospitals where younger surgeons are operating. Therefore, the purpose of this study was to assess whether computer-assisted TKA (CATKA) allows for more accurate and precise implant position to plan when compared to manual TKA (MTKA) when the surgery is performed by less experienced surgeons.Two surgeons, currently in their fellowship training and having minimal CATKA experience, performed a total six MTKA and six CATKA on paired cadaveric knees. Computed tomography (CT) scans were obtained for each knee pre- and post- operatively. CT scans were analyzed to compare post-operative implant position to the pre-operative planned position. Mean system errors and standard deviations were compared between CATKA and MTKA for the femoral component sagittal, coronal, and axial planes and the tibial component in the sagittal and coronal planes. A 2-Variance testing was performed using an alpha=0.05.CATKA had greater accuracy and precision to plan than MTKA for: femoral axial plane (1.1o±1.1o vs. 1.6o±1.3o), coronal plane (0.9o±0.7o vs. 2.2±1.0o), femoral sagittal plane (1.5o±1.3o vs. 3.1o±2.1o), tibial coronal plane (0.9o±0.5o vs. 1.9o±1.3o) and tibial sagittal plane (1.7o±2.6o vs. 4.7o±4.1o). There was no statistical difference between surgical groups or between the two surgeons performing the cases.With limited CATKA experience, the fellows showed increased accuracy and precision to plan for femoral and tibial implant positions. Furthermore, these results are comparable to what has been reported for an experienced surgeon performing CATKA.

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