Evaluation of Tarsal Navicular Stress Fracture Fixation Using Intraoperative O-arm Computed Tomography

2014 ◽  
Vol 7 (6) ◽  
pp. 515-521 ◽  
Author(s):  
Andrew R. Hsu ◽  
Simon Lee
Keyword(s):  
Computed Tomography ◽  
Stress Fracture ◽  
Guide Wire ◽  
Weight Bearing ◽  
Fracture Site ◽  
Stress Fractures ◽  
Functional Impairments ◽  
Intraoperative Ct ◽  
Intraoperative Computed Tomography ◽  
Anatomic Reduction

Stress fractures of the tarsal navicular are high-risk injuries that can result in displacement, avascular necrosis, malunion, and nonunion. Delayed diagnosis and improper treatment can lead to long-term functional impairments and poor clinical outcomes. Increased shear stress and decreased vascularity in the central third of the navicular can complicate bony healing with often unpredictable return times to activity using conservative management in a non-weight-bearing cast. There recently has been increasing debate regarding the effectiveness of treatment options with a trend toward surgical management to anatomically reduce and stabilize navicular stress fractures in athletes. However, anatomic reduction and fixation of the navicular can be difficult despite direct visualization and intraoperative fluoroscopy. We report a case of a chronic navicular stress fracture in a high-level teenage athlete treated with open reduction internal fixation (ORIF) and calcaneus autograft using intraoperative computed tomography (CT) (O-arm®, Medtronic, Minneapolis, MN) for real-time evaluation of fracture reduction and fixation. Intraoperative CT was fast, reliable, and allowed for confirmation of guide wire orientation, alignment, and length across the fracture site. Anatomic fixation of navicular stress fractures can be challenging, and it is important for surgeons to be aware of the potential advantages of using intraoperative CT when treating these injuries. Levels of Evidence: Therapeutic, Level IV: Case Report

scholarly journals Not all ankle injuries are ankle sprains - Case of an isolated cuboid stress fracture

2018 ◽  
Author(s):  
Sidharth Unnithan ◽  
Joe Thomas
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Stress Fracture ◽  
Weight Bearing ◽  
Stress Fractures ◽  
Ankle Injuries ◽  
Ankle Sprains ◽  
Resonance Imaging ◽  
Left Ankle

A 22-year old lady, had a twisting injury to her left ankle followed by pain on prolonged weight bearing and walking. Magnetic resonance imaging with computed tomography correlation was done which showed an isolated cuboid stress fracture. Isolated cuboid stress fractures are very rare and are usually misdiagnosed as ankle sprains.

Stress Fractures in Royal Marine Recruits

1970 ◽  
Vol 56 (1) ◽  
pp. 78-91
Author(s):  
J. Bertram
Keyword(s):  
Soft Tissue ◽  
Weight Bearing ◽  
Fracture Site ◽  
Stress Fractures ◽  
Vigorous Activity ◽  
Main Symptom ◽  
Soft Tissue Swelling ◽  
History Of ◽  
Radiological Changes

AbstractThe main features of stress fractures in Royal Marine recruits are that they occur in normal bones, most often those that are weight bearing. There is no history of injury, but there is usually a history of unaccustomed or more vigorous activity for some weeks before onset. The main symptom is pain on use of the affected part and this pain is relieved by rest. Localised tenderness and soft tissue swelling are present at the fracture site when the affected bone is readily palpable. Radiological changes are absent in the first seven to ten days, but become visible within two months, unless treatment starts or stress ceases early.

scholarly journals Bilateral Sacral Stress Fracture in Pregnancy without Osteoporosis - A Case Report and Literature Review

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A185-A185
Author(s):  
Yu-Fang Wu ◽  
Kenneth Lu ◽  
Christian M Girgis ◽  
Martina Preda ◽  
Veronica Angela Preda
Keyword(s):  
Stress Fracture ◽  
Imaging Modality ◽  
Case Reports ◽  
Weight Bearing ◽  
Stress Fractures ◽  
Lumbar Radiculopathy ◽  
Mineral Density ◽  
Normal Bone Mineral Density ◽  
Sacral Stress Fracture ◽  
In Pregnancy

Abstract Purpose: Sacral stress fractures are rare complications which can arise during pregnancy or in the early postpartum period. We report a case and discuss the findings of a confirmed postpartum sacral stress fracture in a 39-year-old multiparous woman and review previous case reports in the literature of sacral stress fracture related to pregnancy. Methods: A review of the literature was conducted to examine the main characteristics of sacral stress fractures related to pregnancy. The Ovid/Medline, Embase and Google Scholar databases were searched with the inclusion criteria: human studies, English language, intrapartum, postpartum (within 6 months of parturition), sacrum and stress fracture. Our exclusion criteria included pubic fractures, vertebral fractures and non-English articles. The search terms included “stress fracture”, “postpartum”, “pregnancy”, “atraumatic” and the wildcard “sacr*”. 34 cases were found and summarised in Table 2. Results: 65% of patients had onset of symptoms postpartum. Most patients did not have risk factors for sacral stress fractures including macrosomia, excessive pregnancy weight gain, heparin exposure, rapid vaginal delivery or predisposition to accelerated osteoporosis. Lumbar radiculopathy can be a feature of sacral stress fracture and it is more common (17.6%) than reported in the literature (2%). MRI is the preferred imaging modality for its safety profile in pregnancy and high sensitivity. 70% of reported normal bone mineral density (BMD). The mainstay treatment for sacral stress fractures includes relative bedrest, analgesia and modified weight bearing exercises. Most patients have favourable outcome with complete symptom resolution. Conclusion: Sacral stress fractures in the absence of osteoporosis are rare complications of pregnancy that can present with lumbar radiculopathy. Conservative management often produces good clinical outcomes.

Combined Image Guidance and Intraoperative Computed Tomography in Facilitating Endoscopic Orientation within and around the Paranasal Sinuses

2008 ◽  
Vol 22 (6) ◽  
pp. 635-641 ◽  
Author(s):  
Sarah K. Wise ◽  
Richard J. Harvey ◽  
John C. Goddard ◽  
Patrick O. Sheahan ◽  
Rodney J. Schlosser
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Paranasal Sinus ◽  
Image Guidance ◽  
Sinus Surgery ◽  
Intraoperative Ct ◽  
Intraoperative Computed Tomography ◽  
Significant Difference ◽  
Preoperative Ct ◽  
Anatomic Region

Background The utility of image guidance (image-guided surgery [IGS]) and intraoperative computed tomography (CT) scanning as a tool for less experienced endoscopic surgeons to aid in localization of paranasal sinus and skull base anatomic structures was evaluated. Methods Partial endoscopic dissection was performed on cadaver specimens by three fellowship trained rhinologists. Anatomic sites within and around the sinuses were tagged with radio-opaque markers. Otolaryngology residents identified tagged anatomic sites using four successive levels of technology: endoscopy alone (simulating outpatient clinic), endoscopy plus preoperative CT (simulating endoscopic sinus surgery [ESS] without IGS), endoscopy plus IGS registered to preoperative CT (simulating current ESS with IGS), and endoscopy plus IGS registered to real-time intraoperative CT. Responses were graded as follows: consensus rhinologist answer (4 points), close answer without clinically significant difference (3 points), within anatomic region but definite clinical difference (2 points), outside of anatomic region (1 point), no answer (0 points). Results Eleven residents participated. Of 20 specific anatomic sites, IGS-intraoperative CT provided the most accurate anatomic identification at 16 sites. For 8 sites, IGS-intraoperative CT had a significantly higher score than endoscopy alone (p < 0.05; eta2 = 0.29-0.67). For 6 sites, IGS-preoperative CT scan had a significantly higher score than endoscopy alone (p < 0.05; eta2 = 0.30-0.67). All participants found that IGS-intraoperative CT scan made them most comfortable in identifying anatomy. Conclusion Combined IGS and intraoperative CT scan technology may be an instructional adjunct for less experienced paranasal sinus surgeons for dissection and evaluation of unfamiliar or distorted anatomy.

scholarly journals Swimmers Are At Risk For Stress Fractures? A Systematic Review

2018 ◽  
Vol 6 (3) ◽  
pp. 25 ◽  
Author(s):  
Angelo V. Vasiliadis ◽  
Vasileios Lampridis ◽  
Dimitrios Georgiannos ◽  
Ilias Bisbinas
Keyword(s):  
Systematic Review ◽  
Stress Fracture ◽  
Weight Bearing ◽  
Sport Activity ◽  
Stress Fractures ◽  
Extrinsic Factors ◽  
Rare Type ◽  
Stress Injury ◽  
Competitive Swimming ◽  
Competitive Swimmers

Background: Stress fractures occur most commonly in the weight-bearing bones of the lower extremities. Swimming, a non-weight-bearing activity, is a potential activity form which associated with stress fractures? Objective: This systematic review aims to provide an answer in the above question and also to identify the reported cases of stress fractures among swimmers. Method: A systematic and comprehensive search was conducted using PubMed and Research Gate databases before January 2017. The search process was completed using the keywords: “stress fracture”, “stress injury”, “fatigue fracture”, “swimming” and “swimmers”. Results: There have been only 10 studies describing stress fractures in swimmers. This rare type of injury is commonly diagnosed in the ribs of young competitive swimmers, irrespective of their preferred swimming stroke. The etiology is multifactorial and includes a combination of intrinsic and/or extrinsic factors. Conclusion: Although any sport activity can potential cause a stress fracture, competitive swimming seems to be relatively safe in this respect. Rib stress fractures appear as the most common stress fracture in competitive swimmers that clinicians should consider. A prompt diagnosis can shorten the time required for healing and decrease the risk of complication.

scholarly journals Association Between Intraoperative Computed Tomography Navigation System and Incidence of Surgical Site Infection in Patients with Spinal Surgeries: A Retrospective Analysis

2021 ◽  
Author(s):  
GENTARO KUMAGAI ◽  
Kanichiro Wada ◽  
Sunao Tanaka ◽  
Toru Asari ◽  
Yohshiro Nitobe ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Navigation System ◽  
Odds Ratio ◽  
Intraoperative Imaging ◽  
Clinical Status ◽  
Japanese Orthopaedic Association ◽  
Intraoperative Ct ◽  
Intraoperative Computed Tomography ◽  
Intraoperative Fluoroscopy ◽  
Significant Difference

Abstract Purpose: Although the use of intraoperative computed tomography (CT)-based navigation systems is unlikely to cause intraoperative contamination more than the use of intraoperative fluoroscopy, the association between intraoperative CT/navigation and surgical site infections (SSIs) remains unclear. We investigated the incidence of SSIs and the association between intraoperative CT/navigation and SSIs for spinal surgeries.Methods: Of the 512 patients who underwent spinal surgery between April 2016 and December 2020, 304 underwent C-arm intraoperative fluoroscopy and/or Medtronic O-arm intraoperative CT/navigation system. We investigated the incidence of SSIs in patients with four techniques; no intraoperative imaging C-arm only, O-arm only, and both O- and C-arm used. Multivariate logistic analyses were conducted using the prevalence of SSIs as the dependent variable. The independent variables were age, sex, and potential confounders including preoperative Japanese Orthopaedic Association (JOA) score, use of instrumentation, C-arm and/or O-arm. Results: The incidence of the SSIs in patients with no imaging, C-arm only, O-arm only, and both modalities used was 1.9％, 7.3%, 4.7%, and 8.3%, respectively. There was no significant difference in the incidence of SSIs between the four techniques. Multivariate logistic analyses showed a significant correlation between the prevalence of SSI and JOA scores (odds ratio, 0.878; 95%CI, 0.759-0.990) and use of instrumentation (odds ratio, 6.241; 95%CI, 1.113-34.985), but not use of O-arm.Conclusions: The incidence of the SSIs in patients with only O-arm used was 4.7%. Preoperative clinical status and use of instrumentation, but not use of the O-arm, was associated with SSIs after spinal surgeries.

scholarly journals 2 The incidence of undiagnosed coeliac disease in patients presenting with stress fracture to a tertiary referral centre

2019 ◽  
Vol 53 (13) ◽  
pp. 843.2-843
Author(s):  
R Smith ◽  
J Baldock ◽  
M FitzPatrick ◽  
N Jones ◽  
J Newton
Keyword(s):  
Coeliac Disease ◽  
Stress Fracture ◽  
Bone Fractures ◽  
Tissue Transglutaminase ◽  
Fracture Site ◽  
Stress Fractures ◽  
List Type ◽  
Mineral Density ◽  
Tertiary Referral Centre ◽  
Increased Risk

AimStress fracture aetiology is often multifactorial and laboratory blood tests (LBT) can unmask underlying metabolic bone risk factors and disorders. Coeliac disease (CD) is associated with low bone mineral density and an increased risk of fractures.1 In addition, there are rare reports of occult CD presenting with stress fractures.2 Anti-tissue transglutaminase antibody (TTG) testing has a high sensitivity and specificity for CD and is used as a screening test.3 This report examines the incidence of undiagnosed CD in patients presenting with stress fractures to a Sport and Exercise Medicine (SEM) clinic.MethodsA retrospective analysis of 100 consecutive patients with radiologically proven stress fractures presenting to a single tertiary NHS SEM clinic was performed. Age, gender, fracture site, co-morbidities, TTG result and subsequent investigations were examined. Records were reviewed to confirm LBT, including TTG, had been performed at the time of diagnosis.ResultsSeventy patients (70%) were female and mean age was 37 years (range 18–69). Metatarsal (35%) and tibial (21%) fractures were most common. TTG was performed in 85 patients. Two patients were excluded due to pre-existing CD. Five patients (5/83 (6%), mean age 38 years (28–57), 80% female) had a positive TTG; three of whom had CD confirmed by endoscopic biopsy and two are awaiting investigation. Four patients with a positive TTG underwent dual energy X-ray absorptiometry, with osteopenia (T-Score between −1.0 and −2.5) found in 75% of cases, although only one had a Z-score less than -2.0.ConclusionIn this cohort, the incidence of undiagnosed CD was between 3.6% to 6%, with a prevalence between 5% to 7%, approximately 5-fold higher than UK population estimates. We recommend that TTG screening should be performed in all patients presenting with stress fractures to identify underlying CD. Further work is required to confirm this association and elucidate potential underlying mechanisms.ReferencesHeikkilä K, Pearce J, Mäki M, et al. Celiac disease and bone fractures: a systematic review and meta-analysis. J Clin Endocrinol Metab 2015;100(1):25–34.Gilbody J, Trevett M. Coeliac disease presenting with bilateral fibular stress fractures. Foot Ankle Surg 2009;15:96–100.3. Downey L, Houten R, Murch S, Longson D, Group GD. Recognition, assessment, and management of coeliac disease: summary of updated NICE guidance. BMJ 2015;351:h4513.

Preoperative Magnetic Resonance and Intraoperative Computed Tomography Fusion for Real-Time Neuronavigation in Intramedullary Lesion Surgery

2016 ◽  
Vol 13 (2) ◽  
pp. 188-195 ◽  
Author(s):  
Francesco Costa ◽  
Alessandro Ortolina ◽  
Andrea Cardia ◽  
Marco Riva ◽  
Martina Revay ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Magnetic Resonance ◽  
Ct Scan ◽  
Real Time ◽  
Ct Scanning ◽  
Intraoperative Ct ◽  
Intraoperative Computed Tomography ◽  
Intramedullary Lesion ◽  
Preoperative Magnetic Resonance ◽  
Dural Opening

Abstract BACKGROUND: Image-guided surgery techniques in spinal surgery are usually based upon fluoroscopy or computed tomography (CT) scan, which allow for a real-time navigation of bony structures, though not of neural structures and soft tissue remains. OBJECTIVE: To verify the effectiveness and efficacy of a novel technique of imaging merging between preoperative magnetic resonance imaging (MRI) and intraoperative CT scan during removal of intramedullary lesions. METHODS: Ten consecutive patients were treated for intramedullary lesions using a navigation system aid. Preoperative contrast-enhanced MRI was merged in the navigation software, with an intraoperative CT acquisition, performed using the O-armTM system (Medtronic Sofamor Danek, Minneapolis, Minnesota). Dosimetric and timing data were also acquired for each patient. RESULTS: The fusion process was achieved in all cases and was uneventful. The merged imaging information was useful in all cases for defining the exact area of laminectomy, dural opening, and the eventual extension of cordotomy, without requiring exposition corrections. The radiation dose for the patients was 0.78 mSv. Using the authors’ protocol, it was possible to merge a preoperative MRI with navigation based on intraoperative CT scanning in all cases. Information gained with this technique was useful during the different surgical steps. However, there were some drawbacks, such as the merging process, which still remains partially manual. CONCLUSION: In this initial experience, MRI and CT merging and its feasibility were tested, and we appreciated its safety, precision, and ease.

scholarly journals Intraoperative Computed Tomography-Based Navigation with Augmented Reality for Lateral Approaches to the Spine

2021 ◽  
Vol 11 (5) ◽  
pp. 646
Author(s):  
Mirza Pojskić ◽  
Miriam Bopp ◽  
Benjamin Saß ◽  
Andreas Kirschbaum ◽  
Christopher Nimsky ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Augmented Reality ◽  
Tumor Resection ◽  
Pedicle Screws ◽  
Lumbar Vertebra ◽  
Lateral Approach ◽  
Herniated Disc ◽  
Intraoperative Ct ◽  
Intraoperative Computed Tomography ◽  
Cardiorespiratory Failure

Background. Lateral approaches to the spine have gained increased popularity due to enabling minimally invasive access to the spine, less blood loss, decreased operative time, and less postoperative pain. The objective of the study was to analyze the use of intraoperative computed tomography with navigation and the implementation of augmented reality in facilitating a lateral approach to the spine. Methods. We prospectively analyzed all patients who underwent surgery with a lateral approach to the spine from September 2016 to January 2021 using intraoperative CT applying a 32-slice movable CT scanner, which was used for automatic navigation registration. Sixteen patients, with a median age of 64.3 years, were operated on using a lateral approach to the thoracic and lumbar spine and using intraoperative CT with navigation. Indications included a herniated disc (six patients), tumors (seven), instability following the fracture of the thoracic or lumbar vertebra (two), and spondylodiscitis (one). Results. Automatic registration, applying intraoperative CT, resulted in high accuracy (target registration error: 0.84 ± 0.10 mm). The effective radiation dose of the registration CT scans was 6.16 ± 3.91 mSv. In seven patients, a control iCT scan was performed for resection and implant control, with an ED of 4.51 ± 2.48 mSv. Augmented reality (AR) was used to support surgery in 11 cases, by visualizing the tumor outline, pedicle screws, herniated discs, and surrounding structures. Of the 16 patients, corpectomy was performed in six patients with the implantation of an expandable cage, and one patient underwent discectomy using the XLIF technique. One patient experienced perioperative complications. One patient died in the early postoperative course due to severe cardiorespiratory failure. Ten patients had improved and five had unchanged neurological status at the 3-month follow up. Conclusions. Intraoperative computed tomography with navigation facilitates the application of lateral approaches to the spine for a variety of indications, including fusion procedures, tumor resection, and herniated disc surgery.

Intraoperative Computed Tomography in Orthopaedic Trauma Surgery

2021 ◽  
Author(s):  
Holger Keil ◽  
Sven Y. Vetter ◽  
Paul Alfred Grützner ◽  
Jochen Franke
Keyword(s):  
Computed Tomography ◽  
Image Quality ◽  
Trauma Surgery ◽  
Pedicle Screws ◽  
Pelvic Surgery ◽  
Intraoperative Ct ◽  
Intraoperative Computed Tomography ◽  
Metal Implants ◽  
Implant Placement ◽  
High Level

Abstract Background When using mobile 3D C-arms, impairments in image quality occur due to artefacts caused by metal implants as well as to the limited field of view. To avoid these restrictions, special computed tomography devices were designed, in order to improve image quality and to meet requirements for intraoperative usage. Objectives To analyse practicability and benefits of a mobile intraoperative CT device (Airo, Brainlab, Munich, Germany) on the basis of several parameters that were obtained during a 40-month period. Materials and Methods All procedures that were performed with usage of intraoperative CT between January 2017 and April 2020 were analysed with respect to anatomical region, count of scans, duration of scans, consequences drawn from the scans and use of navigation. Results 354 CT-scans were performed in 171 patients (mean 2.07 [1 – 6] scans per procedure). 47.81% of the procedures were spinal, 52.19% affected the pelvis. 83% of the procedures were navigated. In 22% of patients, improvement in implant placement or reduction was achieved; in most patients (55%), a guidewire for pedicle screws was corrected. The mean scan duration was 10.33 s (3.54 – 21.72). Conclusions Use of intraoperative CT was reliable and helpful. Integration in OR standards requires more effort than mobile 3D C-arms. Image quality was outstanding for intraoperative conditions and allowed proper assessment of implant placement and reduction in all cases. Due to the high financial outlay of the system and the good image quality of 3D C-arms in the extremities, we assume that this procedure can be applied in intraoperative CT in traumatological cases in spinal and pelvic surgery in high-level trauma centres.

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