scholarly journals Proposal of new classification of femoral trochanteric fracture by three-dimensional computed tomography and relationship to usual plain X-ray classification

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901769270 ◽  
Author(s):  
Etsuo Shoda ◽  
Shimpei Kitada ◽  
Yu Sasaki ◽  
Hitoshi Hirase ◽  
Takahiro Niikura ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Fracture Pattern ◽  
3D Ct ◽  
Trochanteric Fractures ◽  
Greater Trochanter ◽  
Lesser Trochanter ◽  
X Ray ◽  
Ct Classification ◽  
The Relationship

Purpose: Classification of femoral trochanteric fractures is usually based on plain X-ray findings using the Evans, Jensen, or AO/OTA classification. However, complications such as nonunion and cut out of the lag screw or blade are seen even in stable fracture. This may be due to the difficulty of exact diagnosis of fracture pattern in plain X-ray. Computed tomography (CT) may provide more information about the fracture pattern, but such data are scarce. In the present study, it was performed to propose a classification system for femoral trochanteric fractures using three-dimensional CT (3D-CT) and investigate the relationship between this classification and conventional plain X-ray classification. Methods: Using three-dimensional (3D)-CT, fractures were classified as two, three, or four parts using combinations of the head, greater trochanter, lesser trochanter, and shaft. We identified five subgroups of three-part fractures according to the fracture pattern involving the greater and lesser trochanters. In total, 239 femoral trochanteric fractures (45 men, 194 women; average age, 84.4 years) treated in four hospitals were classified using our 3D-CT classification. The relationship between this 3D-CT classification and the AO/OTA, Evans, and Jensen X-ray classifications was investigated. Results: In the 3D-CT classification, many fractures exhibited a large oblique fragment of the greater trochanter including the lesser trochanter. This fracture type was recognized as unstable in the 3D-CT classification but was often classified as stable in each X-ray classification. Conclusions: It is difficult to evaluate fracture patterns involving the greater trochanter, especially large oblique fragments including the lesser trochanter, using plain X-rays. The 3D-CT shows the fracture line very clearly, making it easy to classify the fracture pattern.

scholarly journals The role of preoperative computed tomography in surgical planning of intertrochanteric femur fractures fixation

2021 ◽  
Vol 7 (2) ◽  
pp. 211
Author(s):  
El Sayed A. Abdullah ◽  
Mina E. Salama
Keyword(s):  
Surgical Planning ◽  
Preoperative Evaluation ◽  
Fracture Pattern ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
3D Ct ◽  
X Ray ◽  
Femur Fractures ◽  
Number Of Patients ◽  
Ct Classification

<p class="abstract"><strong>Background:</strong> A precise preoperative evaluation of stability of intertrochanteric fractures is crucial for surgical planning. Three dimensional CT scanning is a useful tool for understanding the exact type of fracture pattern.  </p><p class="abstract"><strong>Methods:</strong> A prospective study included 40 patients with intertrochanteric femoral fractures. They were classified into stable and unstable intertrochanteric fractures according to the X-ray based AO/OTA classification and according to Nakano 3D-CT classification and both classifications were correlated. The patients were operated on using dynamic hip screw (DHS) and were assessed radiologically and clinically by Harris hip score (HHS) after 6 months. <strong></strong></p><p class="abstract"><strong>Results:</strong> There was significant statistical difference (p=0.031) and relation (p&lt;0.001) between X-ray based AO/OTA classification and 3D-CT classification. Six cases from the 24 cases with stable pattern in AO/OTA system have unstable patterns in the 3D-CT (25%) and their percent from the 22 unstable patterns in 3D-CT is 27.27% and their percent from the total number of patients in the study is 15%.  </p><p class="abstract"><strong>Conclusions:</strong> The superolateral support in the form of the greater trochanter which affects the lateral wall thickness is as important as the posteromedial lesser fragment in assessing the stability of the fracture pattern.  </p>

Management of two-level proximal femoral fractures

2021 ◽  
Vol 14 (5) ◽  
pp. e240684
Author(s):  
Thom Pauline Maria Johannes Vluggen ◽  
Raoul van Vugt ◽  
Bert Boonen ◽  
Mark Hendrik Franciscus Keulen
Keyword(s):  
Three Dimensional ◽  
Femoral Fractures ◽  
Ground Level ◽  
Proximal Femoral Fracture ◽  
Fracture Pattern ◽  
Primary Osteoporosis ◽  
X Rays ◽  
Greater Trochanter ◽  
Subsequent Increase ◽  
Adequate Treatment

We present the case of an 82-year-old female, who experienced a ground-level fall on the trochanter of the right femur. X-rays showed a proximal femoral fracture (PFF) with an unclear and unusual fracture pattern. Three-dimensional CT images were obtained and showed a displaced femoral neck fracture and ipsilateral fracture of the greater trochanter. Our patient underwent unipolar hemiarthroplasty and fixation of the greater trochanter with a hook plate and cable grip. At 11 months, functional outcomes, patient satisfaction and quality of life were excellent. Primary osteoporosis was diagnosed and treatment with bisphosphonates was initiated.Two-level PFFs are rare and complex. Due to ageing and a subsequent increase in osteoporosis, numbers of PFFs with complex fracture patterns might increase in the future. Adequate treatment and early prevention of osteoporosis are key to reduce this risk and lower the overall burden. Surgical treatment should be patient-tailored and focus on minimising the risk of complications and reinterventions.

scholarly journals Evaluation of Letournel and Judet Classification of Acetabular Fracture with Plain Radiographs and Three-Dimensional Computerized Tomographic Scan

2000 ◽  
Vol 8 (1) ◽  
pp. 33-37 ◽  
Author(s):  
Boonyarak Visutipol ◽  
Pornchai Chobtangsin ◽  
Bunyat Ketmalasiri ◽  
Narongchai Pattarabanjird ◽  
Namchai Varodompun
Keyword(s):  
Ct Scan ◽  
Acetabular Fracture ◽  
Interobserver Reliability ◽  
Three Dimensional ◽  
Fracture Line ◽  
3D Ct ◽  
Plain Radiographs ◽  
Intraobserver Reproducibility ◽  
3D Ct Scan

Letournal and Judet classification of acetabular fracture is widely used. The classification is based on the identification of fracture lines on plain radiographs. Three-dimensional CT scan was claimed to give a better view of the fracture line. Our study showed that intraobserver reproducibility and interobserver reliability were almost the same when classification was done by using plain radiographs and 3D-CT scan. And 3D-CT scan did not increase either the interobserver reliability or the intraobserver reproducibility in classifying the fracture.

scholarly journals Inferior Outcome after Unstable Trochanteric Fracture Patterns Compared to Stable Fractures in the Elderly

2021 ◽  
Vol 10 (2) ◽  
pp. 171
Author(s):  
Johannes Gleich ◽  
Carl Neuerburg ◽  
Christoph Linhart ◽  
Alexander Martin Keppler ◽  
Daniel Pfeufer ◽  
...  
Keyword(s):  
Trochanteric Fracture ◽  
Fracture Pattern ◽  
Proximal Femur Fracture ◽  
Surgical Trauma ◽  
Care Hospital ◽  
Trochanteric Fractures ◽  
Lesser Trochanter ◽  
Fracture Patterns ◽  
The Impact

Background: Various risk factors affecting outcome of elderly patients after proximal femur fracture have been identified. The present study aims to evaluate the impact of the fracture pattern in trochanteric fractures on postoperative mobility and complications. Methods: Ninety-two patients with a mean age of 84 years were included. According to the revised AO/OTA classification, fractures were divided into stable (AO 31A1) and unstable (AO 31A2/3) patterns. A follow-up examination was performed 12 months after cephalomedullary fixation to assess outcome parameters for mobility/activities of daily living (Parker Mobility Score (PMS)/Barthel Index (BI)) and complications (increase in requirement of care, hospital readmission, mortality rate). Results: At follow-up, patients with unstable trochanteric fracture patterns presented with lower PMS and BI compared to stable fractures (p < 0.05). Further, higher requirement of care and higher readmission rates compared to stable patterns were observed. Conclusion: Unstable trochanteric fractures presented inferior outcome compared to simple fracture patterns. This might be explained by the increasing surgical trauma in unstable fractures as well as by the mechanical impact of the lesser trochanter, which provides medial femoral support and is of functional relevance. Subsequent studies should assess if treatment strategies adapted to the specific fracture pattern (refixation of lesser trochanter) influence outcome in unstable trochanteric fractures.

scholarly journals Unusual pulmonary vein variant in a patient with right upper lobe lung cancer

2020 ◽  
Vol 2020 (7) ◽  
Author(s):  
Rika Tobita ◽  
Ryota Nakamura ◽  
Yoshihisa Inage
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Pulmonary Artery ◽  
Pulmonary Vein ◽  
Thoracoscopic Surgery ◽  
Lung Resection ◽  
Three Dimensional ◽  
3D Ct ◽  
Anomalous Pulmonary Vein ◽  
The Relationship

Abstract It is essential to understand individual pulmonary anatomy, and the relationship between the tumor and surrounding organ, when lung resection is conducted. Recently, many anomalous pulmonary venous variations have been detected using three-dimensional computed tomography (3D-CT). Herein, we report the case of a 62-year-old women with lung cancer and an anomalous right upper lobe pulmonary vein that drained into the left atrium between the pulmonary artery and bronchus. Preoperative 3D-CT clearly demonstrated the anomalous pulmonary vein, and we safely performed lung resection by thoracoscopic surgery. Therefore, 3D-CT images can help ensure the safety of patients with aberrant vasculature during lung resection.

X-ray microtomography study of otic capsule deficiencies: three-dimensional modelling of the fissula ante fenestram

2015 ◽  
Vol 129 (9) ◽  
pp. 840-851 ◽  
Author(s):  
J W Lee ◽  
P Sale ◽  
N P Patel
Keyword(s):  
Inner Ear ◽  
Three Dimensional ◽  
Oval Window ◽  
Otic Capsule ◽  
X Ray ◽  
Otologic Surgery ◽  
Science Group ◽  
Temporal Bones ◽  
The Relationship ◽  
Non Destructive

AbstractBackground:The postulated sites of perilymph fistulae involve otic capsule deficiencies, in particular, at the fissula ante fenestram. Histological studies have revealed this to be a channel extending from the middle ear, and becoming continuous with the inner ear medial to the anterior limit of the oval window. The relationship between a patent fissula and symptoms of perilymph fistula is contentious.Objective:The understanding of the anatomy of the fissula ante fenestram is incomplete. Histopathology is inherently destructive to the delicate ultrastructure of the middle and inner ear. Conversely, X-ray microtomography allows non-destructive examination of the otic capsule. In this study, we used X-ray microtomography to characterise the fissula ante fenestram.Materials and methods:We imaged cadaveric temporal bones with X-ray microtomography. We used the Avizo Fire (Visualization Science Group, Merignac Cedex, France) software to perform post-processing and image analysis.Results:Three-dimensional modelling of the fissula ante fenestram allowed stratification into four forms: rudimentary pit; partial fissula; complete occluded fissula; and complete patent fissula.Conclusion:X-ray microtomography showed that the fissula ante fenestram is present in various forms from rudimentary pit to complete deficiency of the otic capsule. This understanding may have implications for otologic surgery and clinical diagnosis of perilymph fistula.

scholarly journals Development of the technique for automatic highlighting ranges of interest in lungs x-ray images

2019 ◽  
pp. 128-133
Author(s):  
N Yu Ilyasova ◽  
T A Chesnokova
Keyword(s):  
Window Size ◽  
Textural Properties ◽  
Image Clustering ◽  
Large Set ◽  
Segmentation Result ◽  
X Ray ◽  
Processing Techniques ◽  
The Relationship

In this paper, information technology has been developed for highlighting ranges of interest in lung x-ray images, based on the calculation of textural properties and classification of k-means. In some cases, the highlighted objects can describe not only the current patient’s condition but also specific characteristics regarding age, gender, constitution, etc. While using the k-means method, the relationship between the segmentation error and fragmentation window size was revealed. Within the study, both a visual criterion for evaluating the quality of the segmentation result and a criterion based on calculating the clustering error on a large set of fragmented images were implemented. The study also included image pre-processing techniques. Thus, the study showed that the technology provided key objects highlighting error at 26%. However, the equalizing procedure has lessened this error to 14%. X-ray image clustering errors for fragmentation windows of 12x12, 24x24 and 36x36 were presented.

scholarly journals Three-Dimensional CT for Quantification of Longitudinal Lung and Pneumonia Variations in COVID-19 Patients

2021 ◽  
Vol 8 ◽  
Author(s):  
Qiuying Chen ◽  
Lv Chen ◽  
Shuyi Liu ◽  
Luyan Chen ◽  
Minmin Li ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Rank Correlation ◽  
Chest Ct ◽  
3D Ct ◽  
Dynamic Changes ◽  
Total Lung Volume ◽  
Cad System ◽  
Spearman’S Rank Correlation ◽  
Post Hoc ◽  
The Relationship

Objectives: Visual chest CT is subjective with interobserver variability. We aimed to quantify the dynamic changes of lung and pneumonia on three-dimensional CT (3D-CT) images in coronavirus disease 2019 (COVID-19) patients during hospitalization.Methods: A total of 110 laboratory-confirmed COVID-19 patients who underwent chest CT from January 3 to February 29, 2020 were retrospectively reviewed. Pneumonia lesions were classified as four stages: early, progressive, peak, and absorption stages on chest CT. A computer-aided diagnostic (CAD) system calculated the total lung volume (TLV), the percentage of low attenuation areas (LAA%), the volume of pneumonia, the volume of ground-glass opacities (GGO), the volume of consolidation plus the GGO/consolidation ratio. The CT score was visually assessed by radiologists. Comparisons of lung and pneumonia parameters among the four stages were performed by one-way ANOVA with post-hoc tests. The relationship between the CT score and the volume of pneumonia, and between LAA% and the volume of pneumonia in four stages was assessed by Spearman's rank correlation analysis.Results: A total of 534 chest CT scans were performed with a median interval of 4 days. TLV, LAA%, and the GGO/consolidation ratio were significantly decreased, while the volume of pneumonia, GGO, and consolidation were significantly increased in the progressive and peak stages (for all, P &lt; 0.05). The CT score was significantly correlated with the pneumonia volume in the four stages (r = 0.731, 0.761, 0.715, and 0.669, respectively, P &lt; 0.001).Conclusion: 3D-CT could be used as a useful quantification method in monitoring the dynamic changes of COVID-19 pneumonia.

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