Weightbearing CT Analysis of the Transverse Tarsal Joint During Eversion and Inversion

Background: Understanding of the movement and function of the transverse tarsal joint (TTJt) continues to evolve. Most studies have been done in cadavers or under nonphysiologic conditions. Weightbearing computed tomographic (WBCT) scans may provide more accurate information about the position of the TTJt when the hindfoot is in valgus or varus. Methods: Five volunteers underwent bilateral weightbearing CT scans while standing on a platform that positioned both hindfeet in 20 degrees of valgus and 20 degrees of varus. Each bone of the foot was segmented, and the joint surfaces of the talus, calcaneus, cuboid, and navicular were identified. The principal axes for each joint surface were determined and used to calculate the angles and distances between the bones with the foot in valgus or varus. Results: In the coronal plane, the angle between the talus and calcaneus rotated 17.1 degrees as the hindfoot moved from valgus to varus. The distance between the centers of the talus and calcaneus decreased 7.1 mm. The cuboid translated 3.9 mm medially relative to the calcaneus. There was no change in angle or distance between the cuboid and navicular. The navicular rotated 25.4 degrees into varus relative to the talus. Conclusion: The TTJt locking mechanism was previously thought to occur from the talonavicular and calcaneocuboid joint axes moving from parallel to divergent as the hindfoot inverts. The current data show a more complex interaction between the four bones that comprise the TTJt and suggests that the locking mechanism may occur because of tightening of the ligaments and joint capsules. Clinical relevance: This study uses weight bearing CT scans of healthy, asymptomatic volunteers standing on valgus and varus platforms to characterize the normal motion of the transverse tarsal joint of the foot. A better understanding of how the transverse tarsal joint functions may assist clinicians in both the conservative and surgical management of hindfoot pathology.

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Is Load Application Necessary When Using CT Scans to Diagnose Syndesmotic Injuries? A Cadaver Study

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00011 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0001

Author(s):

Alexej Barg ◽

Maxwell W. Weinberg ◽

Nathan P. Davidson ◽

Beat Hintermann ◽

Charles L. Saltzman ◽

...

Keyword(s):

Weight Bearing ◽

Cadaver Study ◽

Observer Agreement ◽

Load Application ◽

Ct Scans ◽

Deltoid Ligament ◽

3 Dimensional ◽

Detailed Assessment ◽

Axial Ct ◽

Weightbearing Ct

Category: Ankle, Trauma, Imaging Introduction/Purpose: Injury to the distal tibio-fibular syndesmosis is common and appears in up to 20% of patients with an ankle sprain or ankle fracture. While pronounced injuries can be reliably diagnosed using conventional radiographs, assessment of subtle syndesmotic injuries is challenging. With the introduction of weightbearing CT (WBCT) scans, detailed assessment of foot and ankle disorders under load bearing conditions became possible. The purpose of this cadaver study was to assess the influence of weight on assessment of incomplete and more complete syndesmotic injuries using two-dimensional (2D) measurements on axial CT images. We hypothesized that weight would significantly impact assessment of both incomplete and more complete injuries to the distal tibio-fibular syndesmosis. Methods: Fourteen paired male cadavers (tibial plateau to toe-tip) were included. A radiolucent frame held specimens in a plantigrade position while both non-weightbearing and weightbearing CT scans were taken. Four conditions were tested: First, intact ankles (Native) were scanned. Second, one specimen from each pair underwent anterior inferior tibio-fibular ligament (AITFL) transection (Condition 1A), while the contralateral underwent deltoid transection (Condition 1B). Third, the remaining intact deltoid or AITFL was transected (Condition 2). Finally, the distal tibio-fibular interosseous membrane (IOM) was transected in all ankles (Condition 3). For each condition, non-weightbearing, half-bodyweight (42.5 kg), and full-bodyweight (85 kg) CT scans were taken. Six measurements were performed to assess the integrity of the distal tibio-fibular syndesmosis on axial CT scans 1 cm above the ankle joint (Figure 1A/ B) and two measurements at the level of the talar surface (Figure 1C). Inter- and intra- observer agreement were additionally calculated. Results: Inter- and intra-observer agreement differed between measurements. Excellent agreement was evident for the tibio- fibular clear space (TFCS) and tibio-fibular overlap (TFO) with an intra-observer agreement of 0.79 and 0.94, respectively. Poor agreement was evident for Angle 1 (inter-observer, 0.39). Agreement of the other measurements (inter- and intra-observer) was either rated as fair or good and ranged from 0.44 to 0.71. Weightbearing had no significant influence on measurements. Only more complete injuries (Condition 3) differed from native ankles when using either the anterior tibio-fibular distance (ATFD) or TFO. For these two measurements, no significant differences were observed within each condition between non-, half-, and full- weightbearing. Also, no significant differences were evident between single AITFL and deltoid ligament transection for the ATFD and TFO. Conclusion: Load application does not impact the ability of WBCT scans to diagnose incomplete and also more complete syndesmotic injuries in a cadaver model. The utility of current 2D measurements on axial WBCT scans for diagnosing incomplete syndesmotic injuries is questionable. Nevertheless, the ability to reliably position the foot during imaging is an advantage of WBCT technology over other imaging options. Further investigations using more precise measurement options (e.g. 3-dimensional [3D] measurements) are necessary to better understand the potential role of weight bearing to diagnose syndesmotic injuries with CT scan imaging technology.

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Development of a Functional, Internet-Accessible Department of Surgery Outcomes Database

The American Surgeon ◽

10.1177/000313480807400615 ◽

2008 ◽

Vol 74 (6) ◽

pp. 548-554

Author(s):

William L. Newcomb ◽

Amy E. Lincourt ◽

Keith Gersin ◽

Kent Kercher ◽

David Iannitti ◽

...

Keyword(s):

Data Management ◽

Surgical Outcomes ◽

Web Application ◽

Individual Performance ◽

Current Data ◽

Research Quality ◽

Insurance Companies ◽

Accurate Information ◽

Data Dictionary ◽

Entry Points

The need for surgical outcomes data is increasing due to pressure from insurance companies, patients, and the need for surgeons to keep their own “report card”. Current data management systems are limited by inability to stratify outcomes based on patients, surgeons, and differences in surgical technique. Surgeons along with research and informatics personnel from an academic, hospital-based Department of Surgery and a state university's Department of Information Technology formed a partnership to develop a dynamic, internet-based, clinical data warehouse. A five-component model was used: data dictionary development, web application creation, participating center education and management, statistics applications, and data interpretation. A data dictionary was developed from a list of data elements to address needs of research, quality assurance, industry, and centers of excellence. A user-friendly web interface was developed with menu-driven check boxes, multiple electronic data entry points, direct downloads from hospital billing information, and web-based patient portals. Data were collected on a Health Insurance Portability and Accountability Act-compliant server with a secure firewall. Protected health information was de-identified. Data management strategies included automated auditing, on-site training, a trouble-shooting hotline, and Institutional Review Board oversight. Real-time, daily, monthly, and quarterly data reports were generated. Fifty-eight publications and 109 abstracts have been generated from the database during its development and implementation. Seven national academic departments now use the database to track patient outcomes. The development of a robust surgical outcomes database requires a combination of clinical, informatics, and research expertise. Benefits of surgeon involvement in outcomes research include: tracking individual performance, patient safety, surgical research, legal defense, and the ability to provide accurate information to patient and payers.

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Can Weightbearing CT Scans Be Used to Diagnose Subtalar Joint Instability? A Cadaver Study

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00098 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0009

Author(s):

Alexej Barg ◽

Maxwell W. Weinberg ◽

Nathan P. Davidson ◽

Arne Burssens ◽

Beat Hintermann ◽

...

Keyword(s):

Ankle Joint ◽

Subtalar Joint ◽

Joint Instability ◽

Clinical Utility ◽

Observer Agreement ◽

Ct Scans ◽

Deltoid Ligament ◽

Radiographic Measurements ◽

The Impact ◽

Weightbearing Ct

Category: Hindfoot, Trauma Introduction/Purpose: Accurate assessment of subtalar joint stability is difficult. Weightbearing CT (WBCT) scans have increased in popularity among foot and ankle surgeons as it offers an accurate representation of hindfoot joint alignment under weightbearing conditions. However, the clinical utility of this imaging modality to diagnose subtalar joint instability has yet to be investigated. The purpose of this study was to assess the impact of load and torque application on the assessment of subtalar joint instability when using WBCT scans. We hypothesized that load and torque application would improve the ability to identify subtalar joint instability. Methods: Fourteen paired male cadavers (tibial plateau to toe-tip) were included. A radiolucent frame held specimens in a plantigrade position while non-weightbearing and weightbearing CT scans (with and without torque application) were taken. First, intact ankles (Native) were scanned. Second, one specimen from each pair underwent interosseous talo-calcaneal ligament (ITCL) transection (Condition 1A), while the contralateral underwent calcaneo-fibular ligament (CFL) transection (Condition 1B). Third, the lesions were reversed on the same specimens and the remaining intact ITCL or CFL was transected (Condition 2). Finally, the deltoid ligament was transected in all ankles (Condition 3). Two radiographic measurements were performed on the level of the ankle joint (talar tilt [TT], anterior talar translation [ATT]), while the subtalar tilt (STT) was measured at the anterior, middle, and posterior plane of the subtalar joint. Inter- and intra-observer agreement calculations were additionally performed. Results: Weight did not impact most measurements, while the majority of measurements differed significantly within each condition after torque application. Measurements performed at the level of the subtalar joint were more reliable and better predictors for subtalar joint instability compared to measurements performed at the level of the ankle joint. Discrete ITFL, combined ITFL/ CFL, and combined ITFL/ CFL/ deltoid ligament injuries had significantly different STT values than native ankles (Figure 1). Conclusion: Measurements to assess the stability of the subtalar joint should primarily be performed at the level of the subtalar joint rather than at the level of the ankle joint when using WBCT scans. Torque application is crucial for identifying subtalar joint instability, while the application of load should be avoided. Future clinical studies will therefore face substantial technical challenges should they attempt to determine the clinical utility of WBCT scans for assessment of subtalar joint instability.

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Automatic Motion Estimation and Compensation Framework for Weight-bearing C-arm CT scans using Fiducial Markers

IFMBE Proceedings - World Congress on Medical Physics and Biomedical Engineering, June 7-12, 2015, Toronto, Canada ◽

10.1007/978-3-319-19387-8_15 ◽

2015 ◽

pp. 58-61 ◽

Cited By ~ 2

Author(s):

K. Müller ◽

M. Berger ◽

J. -H. Choi ◽

A. Maier ◽

R. Fahrig

Keyword(s):

Motion Estimation ◽

Weight Bearing ◽

Ct Scans ◽

Fiducial Markers

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MR imaging of the forefoot under weight-bearing conditions: Position-related changes of the neurovascular bundles and the metatarsal heads in asymptomatic volunteers

Journal of Magnetic Resonance Imaging ◽

10.1002/jmri.10130 ◽

2002 ◽

Vol 16 (1) ◽

pp. 75-84 ◽

Cited By ~ 9

Author(s):

Dominik Weishaupt ◽

Karl Treiber ◽

Hilaire A.C. Jacob ◽

Hans-Peter Kundert ◽

Juerg Hodler ◽

...

Keyword(s):

Mr Imaging ◽

Weight Bearing ◽

Asymptomatic Volunteers ◽

Neurovascular Bundles

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Early Weight Bearing of Calcaneal Fractures Treated by Intraoperative 3D-Fluoroscopy and Locked-Screw Plate Fixation

The Open Orthopaedics Journal ◽

10.2174/1874325000903010069 ◽

2009 ◽

Vol 3 (1) ◽

pp. 69-74 ◽

Cited By ~ 23

Author(s):

B Kienast ◽

J Gille ◽

C Queitsch ◽

M.M Kaiser ◽

R Thietje ◽

...

Keyword(s):

Bone Graft ◽

Weight Bearing ◽

Postoperative Treatment ◽

Joint Surface ◽

Early Weight Bearing ◽

3D Fluoroscopy ◽

Intraarticular Fractures ◽

Group B ◽

Locked Screw

Operative therapy of intraarticular fractures of the calcaneus is an established surgical standard. The aim is an accurate reduction of the fracture with reconstruction of Boehler’s angle, length, axis and subtalar joint surface. Intraoperative 3D-fluoroscopy with the Siremobil Iso-C 3D® mobile C-arm system is a valuable assistant for accurate reconstruction of these anatomical structures. Remaining incongruities can be recognized and corrected intraoperatively. The achieved reduction can be fixed by the advantages of an internal fixator (locked-screw plate interface). In the period of October 2002 until April 2007 we operated 136 patients with intraarticular fractures of the calcaneus by means of anatomical reduction, and internal plate fixator under intraoperative control of 3D-fluoroscopy. All patients were supplied with an orthesis after the operation which allowed weight bearing of 10 kg for 12 weeks for the patients operated between October 2002 and October 2004 (Group A). Transient local osteoporosis was observed in all X-Rays at follow-up after an average of 8,6 months. Therefore we changed our postoperative treatment plan for the patients operated between November 2004 and April 2007 (Group B). Weight bearing started with 20 KG after 6 weeks, was increased to 40 KG after 8 weeks and full weight bearing was allowed after 10 weeks for these patients. In no case a secondary dislocation of the fracture was seen. No bone graft was used. At follow up the average American Foot and Ankle Society Score (AOFAS) were 81 for Group_A, compared to 84 for Group B, treated with earlier weight bearing. Autologous bone graft was not necessary even if weight bearing was started after a period of six weeks postoperatively. The combination of 3D-fluoroscopy with locked internal fixation showed promising results. If the rate of patients developing subtalar arthrosis will decrease by this management will have to be shown in long term follow up.

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Functional and radiological outcome in surgically managed posterior wall and column fractures of acetabulum

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20214179 ◽

2021 ◽

Vol 7 (6) ◽

pp. 1139

Author(s):

K. Nageswara Rao ◽

Ronak Dinesh Soni ◽

C. Nagesh ◽

P. A. Shravan Kumar ◽

B. Arvind Kumar

Keyword(s):

Functional Outcome ◽

Weight Bearing ◽

Posterior Wall ◽

Joint Surface ◽

Acetabular Fractures ◽

P Value ◽

Radiological Outcome ◽

Anatomic Reduction ◽

Joint Reduction

Background: The incidence of acetabular fractures has increased following road traffic accidents. The aim of the study is to evaluate functional and radiological outcome in surgically managed posterior wall and column fractures of acetabulum.Methods: This is a prospective study done at Nizam’s Institute of Medical Sciences, Hyderabad between May 2018 and May 2020. The sample size is 20 patients between the age group 18-60 years who presented to the hospital with closed posterior wall and/or column fractures of acetabulum with or without posterior dislocation of hip joint. Functional outcome is assessed by using the modified Merle D’ Aubigne Postel clinical grading system, radiological outcome by Matta et al and perioperative complication are assessed by retrospectively analyzing medical records and radiographics examination.Results: Functional outcome according to Merle D’ Aubigne and Postel score 16 patients (75%) showed good, 3 patients (20%) showed fair, 1 patient (5%) showed poor outcome. Radiological outcome according to Matta criteria, 16 patients (75%) showed excellent quality of joint reduction, 4 patients (25%) showed good quality of reduction of joint. There was significant correlation between anatomic reduction of the joint surface and functional outcome of the patient in our study (p value <0.05).Conclusions: Accurate joint reduction is of utmost importance in reduction of posterior wall or column fractures of acetabulum as posterior wall is the weight bearing zone. Functional outcome depends on fracture type, associated injuries, selection of patient, time between injury and surgery and postoperative rehabilitation.

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The use of radiological imaging alongside reverse transcriptase PCR in diagnosing novel coronavirus disease 2019: a narrative review

Future Microbiology ◽

10.2217/fmb-2020-0098 ◽

2020 ◽

Vol 15 (10) ◽

pp. 897-903 ◽

Cited By ~ 1

Author(s):

Michael Naguib ◽

Fathi Moustafa ◽

Mustafa Thaer Salman ◽

Nermin Kamal Saeed ◽

Manaf Al-Qahtani

Keyword(s):

Reverse Transcriptase ◽

Clinical Relevance ◽

Current Data ◽

Ct Scans ◽

Radiological Imaging ◽

Reference Test ◽

Reverse Transcriptase Pcr ◽

Control And Prevention ◽

Novel Coronavirus

The diagnosis of novel coronavirus disease 2019 (COVID-19) has been a challenge in many countries due to nonspecific symptoms and variable incubation period. The current reference test is reverse transcriptase PCR. Many studies have reported high sensitivities of CT scans and suggested that they can be used in the diagnosis of COVID-19 alongside reverse transcriptase PCR. The current data about CT scans are highly variable and incoherent. Therefore, new multicentric studies in different countries are needed to better understand the role of CT scans in COVID-19 diagnosis. In this report, we will discuss the clinical relevance of each test and the current Centers for Disease Control and Prevention and American College of Radiology recommendations regarding the use of imaging in the diagnosis of COVID-19.

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Three Dimensional Weightbearing CT Assessment of Metatarsal Osteotomies for Hallux Valgus Correction

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00150 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0015

Author(s):

Jarrett D. Cain ◽

Jordan T. Stolle ◽

Sorin Siegler

Keyword(s):

Hallux Valgus ◽

Weight Bearing ◽

Three Dimensional ◽

3D Models ◽

Two Dimensions ◽

Axial Plane ◽

Ct Scans ◽

First Metatarsal ◽

3D Measurements ◽

2D And 3D

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Hallux valgus (HV) is a tri-plane deformity of the foot corresponding to a medial deviation of the first metatarsal and a lateral deviation of the hallux. Understanding key angles between bones, as well as how these deformity changes in each plane, is critical to generating pre-operative insights into the most effective surgical correction of the deformity. While two- dimenional (2D) imaging can provide some information; utilizing three-dimensional (3D) imaging can include more precise and accurate measures of hallux valgus. The purpose of this study is to evaluate the metatarsal osteotomies for correction of hallux valgus deformity in axial, coronal and sagittal plane with 2D and 3D measurements with the hypothesis that 3D measurements will provide greater accuracy of pre and post surgical changes Methods: Ten cadaveric specimens were selected and weight-bearing CT scans were taken pre operatively with an applied an axial load of 80 pounds. Midshaft osteotomies were then performed on the cadaveric specimens followed by weight-bearing CT scans taken post-operatively.3D models of the pre-operative and post-operative specimens were created and differences in pre and post operative changes were analyzed using conventional 2D and 3D models of the first metatarsal (M1), second metatarsal (M2), fifth metatarsal (M5), and proximal phalanx of the hallux (PP1) using a paired student t-test. Quantitative examination of foot and ankle offset (FAO) alignment along with congruity of first metatarsal phalangeal and first tarsometatarsal joints Results: 3D measurements of the Inter-Metatarsal (IM) Angle, was 12.3 degrees pre-opeative and 10.4 degrees post-operative with no significant differences in all three planes while the M1M5 Angle, measured between the principle axes of the first metatarsal and fifth metatarsal was 25.3 degrees pre-operative and 22.0 degrees post-operative were statistically significant with the greatest change in the axial plane. 2D measurements of the hallux valgus angle, measured the longitudineal axes of the first metatarsal and proximal phalange of the hallux was 22.6 degrees pre opereative and 21.7 degrees post opereative with no statistical difference while the metatarsal parabola, measured in two dimensions projected onto the axial plane was 157.1 degrees before and 141.5 degrees after surgery was statistical significant. Conclusion: When comparing 2D and 3D pre and post surgical hallux valgus values, the only significant differences were identified in the absolute M1M5 values in the axial plane and a significant change was also observed in the metatarsal parabola angle. While the metatarsal parabola angle are sensitive measures, these results suggest that the M1 M5 angle allows for precise, efficient measurements in axial, coronal and sagittal planes that is previously unknown through two-dimensional radiographic measurements for quantifying the effect of metatarsal osteotomies on hallux valgus

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