Assessment of the Measurement Methods in Midshaft Clavicle Fracture

Abstract Background. Clavicle fractures account for approximately 5% of all fractures in adults and 75% of clavicle fractures occur in the midshaft. Shortening greater than two centimeters is an indicative of surgical treatment. Radiographic exams are often used to diagnose and evaluate clavicle fractures but computed tomography (CT) scan is currently considered the best method to assess these deformities and shortening. Goal. 1- To investigate whether different methods of performing the radiographic exam interfere with the measurement of the fractured clavicle length. Goal 2- Compare the clavicle length measurements obtained by the different radiographic exam methods with the CT scan measurements, used as a reference.Materials and Methods. Twenty-five patients with acute (< 3weeks) midshaft clavicle fracture were evaluated. Patients underwent six radiographic images: PA Thorax (standing and lying), AP Thorax (standing and lying) and at 10º cephalic tilt (standing and lying), and the computed tomography was used as reference.Results. There wasn't any significant statistical difference in the clavicle fracture length measurement among the variety of radiographic exam performances when compared to tomography.Conclusion. 1- There is no significant statistical difference in the clavicle fracture length measurement among the variety of radiographic exam performances. Conclusion. 2- The method that comes closest to computed tomography results is the PA thorax incidence, with the patient in the lying position.

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Reliability of the radiographic views in supine position for evaluation of displaced midshaft clavicle fracture length

Journal of Orthopaedic Surgery ◽

10.1177/2309499020952295 ◽

2020 ◽

Vol 28 (3) ◽

pp. 230949902095229

Author(s):

Pinkawas Kongmalai ◽

Peeraput Chiaprasert ◽

Visit Rungsinaporn

Keyword(s):

Ct Scan ◽

Supine Position ◽

Interobserver Reliability ◽

Clavicle Fracture ◽

Intraclass Correlation ◽

Cross Sectional Study ◽

Intraobserver Reliability ◽

Radiographic Measurement ◽

Cross Sectional ◽

Fracture Length

Purpose: To analyze the agreement of the displaced midshaft clavicle fracture length measurement between each of the supine radiographic position (chest anteroposterior (AP), both clavicle AP, and 20° cephalic tilt clavicle AP view) and computed tomography (CT) scan of the clavicle. Furthermore, the inter- and intraobserver reliability of each radiographic position was analyzed. Methods: Prospective cross-sectional study was performed with patients diagnosed with displaced midshaft clavicle fracture treated conservatively. Three views of radiographs and CT scan of clavicle were obtained in supine position after informed consent. The measurement of fractured clavicle length was done by three observers at the time and after 4 weeks interval. Results: Thirty-three patients (25 males and 8 females), with a mean age of 45, were recruited. The agreement between each of the radiographic measurement and CT scan was good. The interobserver reliability was moderate to good for radiographic measurement. The highest intraclass correlation coefficient (ICC) of 0.80–0.81 was shown between the 20° cephalic tilt and the CT scan, followed by the both clavicle AP (0.75–0.77) and the chest AP (0.69–0.75), respectively. There was an excellent intraobserver reliability for all of the radiographic measurement with the ICC 0.92–0.99. Conclusion: The supine radiographs could be a useful option to measure the displaced midshaft clavicle fracture length. The recommended view was the 20° cephalic tilt clavicle AP view in supine position to best evaluate the fractured clavicle length.

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Requesting physicians’ knowledge of X-radiation exposure from computed tomography scan examinations: A case study of two Nigerian tertiary hospitals

Calabar Journal of Health Sciences ◽

10.25259/cjhs_9_2019 ◽

2020 ◽

Vol 3 ◽

pp. 36-39

Author(s):

Samson O. Paulinus ◽

Benjamin E. Udoh ◽

Bassey E. Archibong ◽

Akpama E. Egong ◽

Akwa E. Erim ◽

...

Keyword(s):

Computed Tomography ◽

Ionizing Radiation ◽

Ct Scan ◽

Radiation Exposure ◽

Work Experience ◽

Radiation Risk ◽

Radiological Protection ◽

X Ray ◽

Tertiary Hospitals ◽

Medical Exposure

Objective: Physicians who often request for computed tomography (CT) scan examinations are expected to have sound knowledge of radiation exposure (risks) to patients in line with the basic radiation protection principles according to the International Commission on Radiological Protection (ICRP), the Protection of Persons Undergoing Medical Exposure or Treatment (POPUMET), and the Ionizing Radiation (Medical Exposure) Regulations (IR(ME)R). The aim is to assess the level of requesting physicians’ knowledge of ionizing radiation from CT scan examinations in two Nigerian tertiary hospitals. Materials and Methods: An 18-item-based questionnaire was distributed to 141 practicing medical doctors, excluding radiologists with work experience from 0 to >16 years in two major teaching hospitals in Nigeria with a return rate of 69%, using a voluntary sampling technique. Results: The results showed that 25% of the respondents identified CT thorax, abdomen, and pelvis examination as having the highest radiation risk, while 22% said that it was a conventional chest X-ray. Furthermore, 14% concluded that CT head had the highest risk while 9% gave their answer to be conventional abdominal X-ray. In addition, 17% inferred that magnetic resonance imaging had the highest radiation risk while 11% had no idea. Furthermore, 25.5% of the respondents have had training on ionizing radiation from CT scan examinations while 74.5% had no training. Majority (90%) of the respondents were not aware of the ICRP guidelines for requesting investigations with very little (<3%) or no knowledge (0%) on the POPUMET and the IR(ME)R respectively. Conclusion: There is low level of knowledge of ionizing radiation from CT scan examinations among requesting physicians in the study locations.

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A rare case of right-sided varicocele in right renal tumor in the absence of venous thrombosis and IVC compression

African Journal of Urology ◽

10.1186/s12301-020-00072-3 ◽

2020 ◽

Vol 26 (1) ◽

Author(s):

Priyabrata Adhikari ◽

Siddalingeshwar I. Neeli ◽

Shyam Mohan

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

Renal Vein ◽

Renal Tumor ◽

Vena Cava ◽

Signs And Symptoms ◽

Spermatic Vein ◽

Careful Study ◽

Rare Presentation ◽

Grade 3

Abstract Background The presence of unilateral right-sided varicocele hints at a serious retroperitoneal disease such as renal cell neoplasm. Such tumors are usually associated with a thrombus in renal vein or spermatic vein. We report a rare presentation of right-sided renal tumor causing right-sided varicocele in the absence of thrombus in renal vein and spermatic vein but due to an anomalous vein draining from the tumor into the spermatic vein as demonstrated by computed tomography angiogram. Case presentation A 54-yr-old hypertensive male presented with unilateral grade 3 right-sided varicocele and no other signs and symptoms. Ultrasound examination of his abdomen showed the presence of a mass lesion in the lower pole of right kidney. Computed tomography confirmed the presence of right renal mass, absence of thrombus in right renal vein or inferior vena cava. The angiographic phase of CT scan showed an anomalous vein from the tumor draining into the pampiniform plexus causing varicocele. Conclusion The presence of right-sided varicocele should raise a suspicion hidden serious pathological retroperitoneal condition, renal malignancy in particular, and should prompt the treating physician to carry out imaging studies of the retroperitoneum and careful study of the angiographic phase of the CT scan can ascertain the pathogenesis of the varicocele.

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Total Wrist Arthroplasty Alignment and Its Potential Association with Clinical Outcomes

Journal of Wrist Surgery ◽

10.1055/s-0041-1725172 ◽

2021 ◽

Author(s):

Bardiya Akhbari ◽

Kalpit N. Shah ◽

Amy M. Morton ◽

Janine Molino ◽

Douglas C. Moore ◽

...

Keyword(s):

Computed Tomography ◽

Clinical Outcomes ◽

Three Dimensional ◽

Radial Component ◽

Single Type ◽

Radiographic Images ◽

Computed Tomography Images ◽

Total Wrist Arthroplasty ◽

Flexion Extension ◽

Wrist Arthroplasty

Abstract Purpose There is a lack of quantitative research that describes the alignment and, more importantly, the effects of malalignment on total wrist arthroplasty (TWA). The main goal of this pilot study was to assess the alignment of TWA components in radiographic images and compare them with measures computed by three-dimensional analysis. Using these measures, we then determined if malalignment is associated with range of motion (ROM) or clinical outcomes (PRWHE, PROMIS, QuickDash, and grip strength). Methods Six osteoarthritic patients with a single type of TWA were recruited. Radiographic images, computed tomography images, and clinical outcomes of the wrists were recorded. Using posteroanterior and lateral radiographs, alignment measurements were defined for the radial and carpal components. Radiographic measurements were validated with models reconstructed from computed tomography images using Bland–Altman analysis. Biplanar videoradiography (<1mm and <1 degree accuracy) was used to capture and compute ROM of the TWA components. Linear regression assessed the associations between alignment and outcomes. Results Radiographic measures had a 95% limit-of-agreement (mean difference ± 1.96 × SD) of 3 degrees and 3mm with three-dimensional values, except for the measures of the carpal component in the lateral view. In our small cohort, wrist flexion–extension and radial–ulnar deviation were correlated with volar–dorsal tilt and volar–dorsal offset of the radial component and demonstrated a ROM increase of 3.7 and 1.6 degrees per degree increase in volar tilt, and 10.8 and 4.2 degrees per every millimeter increase in volar offset. The carpal component's higher volar tilt was also associated with improvements in patient-reported pain. Conclusions We determined metrics describing the alignment of TWA, and found the volar tilt and volar offset of the radial component could potentially influence the replaced wrist's ROM. Clinical Relevance TWA component alignment can be measured reliably in radiographs, and may be associated with clinical outcomes. Future studies must evaluate its role in a larger cohort.

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Postoperative analgesia effects of sulfentanyl plus dexmedetomidine in patients received VATS

Pteridines ◽

10.1515/pteridines-2020-0007 ◽

2020 ◽

Vol 31 (1) ◽

pp. 55-60

Author(s):

Haoyu Jiang ◽

Ying Zheng ◽

Chang Liu ◽

Ying Bao

Keyword(s):

Statistical Difference ◽

Control Group ◽

Control Groups ◽

Significant Statistical Difference ◽

Post Surgery ◽

Intravenous Analgesia ◽

The Mean ◽

Nsclc Patients ◽

And Control ◽

Time Point

AbstractBackground To evaluate sulfentanyl combined with dexmedetomidine hydrochloride on postoperative analgesia in patients who received video-assisted thoracic surgery (VATS) and its effects on serum norepinephrine (NE), dopamine (DA), 5-hydroxytryptamine (5-HT), and prostaglandin (PGE2).Material and Methods Ninety-nine non-small cell lung cancer (NSCLC) patients who received VATS were included in the study. All the patients received intravenous inhalation compound anesthesia. Of the 99 cases, 49 subjects (control group) received sulfentanyl for patient controlled intravenous analgesia (PICA) and other 50 cases (experiment group) received sulfentanyl combined with dexmedetomidine hydrochloride for PICA after operation of VATS. The analgesic effects of the two groups were evaluated according to Visual Analogue Scales (VAS) and the Bruggrmann Comfort Scale (BCS). The serum pain mediator of NE, DA, 5-HT, and PGE2 were examined and compared between the two groups in the first 24 h post-surgery.Results The VAS scores for the experiment group were significant lower than that of control group on the time points of 8, 16, and 24 h post-surgery (pall<0.05), and the BCS scores of the experiment group in the time points of 8, 16, and 24 h were significantly higher than that of controls (p<0.05). However, the VAS and BCS scores were not statistical differently in the time point of 1, 2, and 4 h post-surgery (pall>0.05). The mean sulfentanyl dosage was 63.01 ± 5.14 μg and 67.12 ± 6.91 μg for the experiment and control groups respectively with significant statistical difference (p<0.05). The mean analgesic pump pressing times were 4.30 ± 1.31 and 5.31 ± 1.46 for experiment and control groups respectively with significant statistical difference (p<0.05). The serum NE, DA, 5-HT, and PGE2 levels were significantly lower in the experimental group compared to that of control group in the time point of 12 h post-surgery (pall<0.05). The side effects of nausea, vomiting, delirium, rash, and hypotension atrial fibrillation were not statistically different between the two groups (pall>0.05).Conclusion Patient controlled intravenous analgesia of sulfentanyl combined with dexmedetomidine hydrochloride was effective in reducing the VAS score and serum pain mediators in NSCLC patients who received VAST.

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Dilatation of Vascular Prostheses in Ascending Aortic Position: A Long-Term Follow-Up Computed Tomography Study with Comparison of Different Measurement Methods

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0036-1597116 ◽

2016 ◽

Vol 66 (03) ◽

pp. 206-214

Author(s):

Matthias Endlich ◽

Christian Krämer ◽

Chris Probst ◽

Armin Welz ◽

Kai Wilhelm ◽

...

Keyword(s):

Computed Tomography ◽

Measurement Methods ◽

Point Of View ◽

Cross Sectional ◽

Vascular Prostheses ◽

Aortic Replacement ◽

Ascending Aortic Replacement ◽

Long Term Follow Up ◽

Methods Of Measurement

Background The aim of this study was to evaluate long-term dilatation of Hemashield Gold and Hemashield Platinum vascular prostheses in ascending aortic position using different measurement methods to obtain precise results. Methods Between 1999 and 2007, 73 patients with Stanford type A dissection received ascending aortic replacement with Hemashield Gold and Hemashield Platinum prostheses. Measurements were performed using multiplanar reconstruction mode of electrocardiogram (ECG)-gated, multislice spiral computed tomography (MSCT) in strictly orthogonal cross-sectional planes. Different methods of measurement were compared and maximum dilatation was estimated for different time spans. Results Diameters calculated from the measured circumference showed a significant (p = 0.037) but clinically not relevant difference (0.1 mm) to the mean between the largest and the shortest cross-sectional diameter of the prosthesis. Dilatation after 24.2 ± 10.2 months was 8.5 ± 4.5%. Long-term dilatation after 91.8 ± 34 months amounted to 11.8 ± 4.2%. Conclusion Based on ECG-gated MSCT images, the presented methods of measurement provided reliable results. Long-term analysis shows low dilatation rates for Hemashield prostheses, which therefore can be considered as safe from this point of view. Nevertheless, a maximal dilatation of 20% could be relevant in valve sparing root replacement. It remains unclear if a dilatation like this contributes to the formation of suture aneurysms.

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Visualizing Fluid Flows With X-Rays

Volume 1: Symposia, Parts A and B ◽

10.1115/fedsm2007-37023 ◽

2007 ◽

Cited By ~ 4

Author(s):

Theodore J. Heindel ◽

Terrence C. Jensen ◽

Joseph N. Gray

Keyword(s):

Computed Tomography ◽

Flow Visualization ◽

Three Dimensional ◽

Fluid Flows ◽

X Rays ◽

Radiographic Images ◽

Optical Access ◽

X Ray ◽

X Ray Computed ◽

Density Map

There are several methods available to visualize fluid flows when one has optical access. However, when optical access is limited to near the boundaries or not available at all, alternative visualization methods are required. This paper will describe flow visualization using an X-ray system that is capable of digital X-ray radiography, digital X-ray stereography, and digital X-ray computed tomography (CT). The unique X-ray flow visualization facility will be briefly described, and then flow visualization of various systems will be shown. Radiographs provide a two-dimensional density map of a three dimensional process or object. Radiographic images of various multiphase flows will be presented. When two X-ray sources and detectors simultaneously acquire images of the same process or object from different orientations, stereographic imaging can be completed; this type of imaging will be demonstrated by trickling water through packed columns and by absorbing water in a porous medium. Finally, local time-averaged phase distributions can be determined from X-ray computed tomography (CT) imaging, and this will be shown by comparing CT images from two different gas-liquid sparged columns.

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The Effectiveness of Antibiotic-Coated Ventriculoperitoneal Shunts for Prevention of Shunt Infections in Patients with Myelomeningocele

Pediatric Neurosurgery ◽

10.1159/000516379 ◽

2021 ◽

pp. 1-4

Author(s):

Bilal Ertuğrul ◽

Metin Kaplan ◽

Ömer Batu Hergünsel ◽

Bekir Akgün ◽

Sait Öztürk ◽

...

Keyword(s):

Protective Effect ◽

Statistical Difference ◽

Shunt Infection ◽

Infection Rates ◽

Ventriculoperitoneal Shunts ◽

Significant Statistical Difference ◽

Shunt Infections

Purpose: Hydrocephalus is a common comorbidity among the newborns, with myelomeningocele (MMC) and ventriculoperitoneal (VP) shunts being frequently used for the treatment of such patients. In this study, we aimed to compare the effectiveness of antibiotic-free and antibiotic-coated shunts to reduce the rate of shunt infection in patients with hydrocephalus and accompanying MMC. Methods: 116 patients with hydrocephalus and MMC who were treated with VP shunts were included in the study. Shunt infection rates among antibiotic-free and antibiotic-coated shunts were compared. Results: Of the 116 patients included in the study, 39 had antibiotic-coated shunts and 77 had antibiotic-free shunts. Shunt infection developed in 4 of the 39 cases treated with antibiotic-coated shunts and in 5 of the 77 cases treated with shunts without antibiotics. No significant statistical difference was found between antibiotic-coated and antibiotic-free VP shunts in terms of shunt infection (p = 0.450, p > 0.05). Conclusion: In patients with MMC, using VP shunts containing antibiotics was found not to have a protective effect in preventing shunt infection. Whether the sac is intact or ruptured does not affect this result.

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Epidemiology of Clavicle Fractures Sustained at a Colorado Ski Resort

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211006722 ◽

2021 ◽

Vol 9 (5) ◽

pp. 232596712110067

Author(s):

Lauren Oberle ◽

Lauren Pierpoint ◽

Jack Spittler ◽

Morteza Khodaee

Keyword(s):

Medical Center ◽

Descriptive Analysis ◽

Clavicle Fracture ◽

Sports Injury ◽

Common Mechanism ◽

Ski Resort ◽

Incidence Data ◽

Injury Mechanisms ◽

Fracture Diagnosis ◽

Clavicle Fractures

Background: Although clavicle fractures are a common sports injury, there are limited studies on the incidence and causes of clavicle fractures among winter sports athletes. Purpose: To evaluate the characteristics and injury mechanisms associated with clavicle fractures among patients evaluated at a Colorado ski resort. Study Design: Descriptive epidemiology study. Methods: This was a retrospective descriptive analysis of patients with clavicle fractures at the Denver Health Winter Park Medical Center during the 2012-2013 to 2016-2017 ski seasons. Chart review was performed on the patient cohort to confirm clavicle fracture diagnosis and to evaluate factors associated with clavicle fracture. Results: A total of 393 clavicle fractures (6.2% of total clinic visits) occurred during the study period, corresponding to an overall clavicle fracture incidence of 8.4 per 100,000 participant-visits. The mean patient age was 26.4 years (range, 5-73 years). The majority were middle-third fractures (85.5%), occurring mainly in men (87.3%). More than half of the fractures were comminuted (54.5%) and occurred in snowboarders (55.0%). The most common mechanism of injury was a fall onto snow while skiing or snowboarding (92.4%). Women sustained more clavicle fractures while skiing compared with snowboarding (82.0% vs 18.0%; P < .001), while men sustained more fractures while snowboarding compared with skiing (60.3% vs 39.7%; P < .001). Conclusion: Clavicle fractures are relatively common, but there are scant incidence data for clavicle fractures in mountain sports. Consistent with prior studies, clavicle fractures were more common in younger patients and men. The most common anatomic fracture location was the midclavicle. A greater proportion of clavicle fractures among men were sustained during snowboarding and among women during skiing.

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Delayed Extradural Hematoma after Evacuation of Contralateral Acute Extradural Hematoma

Indian Journal of Neurotrauma ◽

10.1055/s-0040-1713722 ◽

2020 ◽

Author(s):

Majid Anwer ◽

Atique Ur Rehman ◽

Farheen Ahmed ◽

Satyendra Kumar ◽

Md Masleh Uddin

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

Postoperative Period ◽

Road Traffic ◽

Case Reports ◽

Mass Effect ◽

Extradural Hematoma ◽

Traumatic Head Injury ◽

Neurologic Deterioration ◽

The Right

Abstract Introduction Traumatic head injury with extradural hematoma (EDH) is seen in 2% of patients. Development of EDH on the contralateral side is an uncommon complication that has been reported in various case reports. Case Report We report here a case of an 18-year-old male who had a road traffic injury. He was diagnosed as a case of left-sided large frontotemporoparietal acute extradural bleed with a mass effect toward the right side. He was managed with urgent craniotomy and evacuation of hematoma. A noncontrast computed tomography (NCCT) scan performed 8 hours after postoperative period showed a large frontotemporoparietal bleed on the right side with a mass effect toward the left side. He was again taken to the operating room and right-sided craniotomy and evacuation of hematoma were performed. A postoperative NCCT scan revealed a resolved hematoma. The patient made a complete recovery in the postoperative period and is doing well. Conclusion Delayed onset epidural hematoma is diagnosed when the initial computed tomography (CT) scan is negative or is performed early and when late CT scan performed to assess clinical or ICP deterioration shows an EDH. The diagnosis of such a condition requires a high index of suspicion based on the mechanism of injury along with fracture patterns. Additionally, change in pupillary size, raised intracranial pressure, and bulging of the brain intraoperatively are additional clues for contralateral bleeding. Neurologic deterioration may or may not be associated with delayed EDH presentation. An early postoperative NCCT scan within 24 hours is recommended to detect this complication with or without any neurologic deterioration.

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