Anatomical Wrist Patterns on Plain Radiographs

2019 ◽  
Vol 15 (2) ◽  
pp. 168-171 ◽  
Author(s):  
Aviv Kramer ◽  
Raviv Allon ◽  
Alon Wolf ◽  
Tal Kalimian ◽  
Idit Lavi ◽  
...  
Keyword(s):  
Significant Relationship ◽  
Classification System ◽  
Quality Evaluation ◽  
Normal Database ◽  
Radiocarpal Joint ◽  
Wrist Anatomy ◽  
Wrist Biomechanics ◽  
Midcarpal Joint

Background: Interpreting the structure in the wrist is complicated by the existence of multiple joints as well as variability in bone shapes and anatomical patterns. Previous studies have evaluated lunate and capitate shape in an attempt to understand functional anatomical patterns. Objective: The purpose of this study was to describe anatomical shapes and wrist patterns in normal wrist radiographs. We hypothesized that there is a significant relationship in the midcarpal joint with at least one consistent pattern of wrist anatomy. Methods: Seventy plain posteroanterior (PA) and lateral wrist radiographs were evaluated. These radiographs were part of a previously established normal database, had all been read by a radiologist as normal, and had undergone further examination by 2 hand surgeons for quality. Evaluation included: lunate and capitate shape (type 1 and 2 lunate shape according to the classification system by Viegas et al.), ulnar variance, radial inclination and height, and volar tilt. Results: A significant association was found between lunate and capitate shape using a dichotomal classification system for both lunate and capitate shapes (p=0.003). Type 1 wrists were defined as lunate type1and a spherical distal capitate. Type 2 wrists had a lunate type 2 and a flat distal capitate. No statistically significant associations were detected between these wrist types and measurements of the radiocarpal joint. Conclusion: There was a significant relationship between the bone shapes within the midcarpal joint. These were not related to radiocarpal anatomical shape. Further study is necessary to better describe the two types of wrist patterns that were defined and to understand their influence on wrist biomechanics and pathology.

Capitate and Lunate Morphology in Normal Wrist Radiographs-A Pilot Study

2020 ◽  
Vol 16 (3) ◽  
pp. 210-214
Author(s):  
Ronit Wollstein ◽  
Roee Rubinstein ◽  
Scott Friedlander ◽  
Frederick Werner
Keyword(s):  
Classification Systems ◽  
Normal Database ◽  
Kappa Statistics ◽  
Linear Mixed Effects ◽  
Random Intercept ◽  
Significant Difference ◽  
Log Linear ◽  
Midcarpal Joint

Background: Morphology may provide the basis for the understanding of wrist mechanics. Methods: We used classification systems based on cadaver dissection of lunate and capitate types to evaluate a normal database of 70 wrist radiographs in 35 subjects looking for associations between bone shapes. Kappa statistics and a log-linear mixed -effects model with a random intercept were used. Results: There were 39 type-1, 31 type- 2 lunates, 50 spherical, 10 flat and 10 V-shaped capitates. There was a significant difference in lunate and capitate shape between the hands of the same individual p <0.001. This may be due to different loads on the dominant vs. nondominant hands in the same individual. Conclusion: Further study to better understand the development of radiographic parameters of the midcarpal joint may aid in our understanding of the morphology and mechanics of the wrist.

scholarly journals Analysis of Radiographic Relationship between Distal Radius, Ulna, and Lunate

2019 ◽  
Vol 08 (05) ◽  
pp. 374-379
Author(s):  
Tendai Mwaturura ◽  
Frédéric-Charles Cloutier ◽  
Parham Daneshvar
Keyword(s):  
Soft Tissue ◽  
Inverse Relationship ◽  
Moderate Correlation ◽  
Notch Angle ◽  
Radial Inclination ◽  
Tilting Angle ◽  
Wrist Anatomy ◽  
Wrist Biomechanics

Background Wrist anatomy variability is associated with differing susceptibility to pathology. For example, a flat radial inclination is associated with Kienbock's disease. Lunate facet inclination (LFI) also exhibits variability. Its relationship with other wrist features is poorly documented. Purposes We tested the hypothesis that high LFI is associated with increased uncovering of the lunate, negative ulnar variance (UV), and type 2 lunates to balance forces across wrists. Methods In total, 50 bilateral and 100 unilateral wrist posteroanterior radiographs were reviewed. Lunate type, lunate uncovering index (LUI), lunate tilting angle (LTA), UV, and sigmoid notch angle (SNA) were measured, and correlation with LFI was assessed on 150 right wrist radiographs followed by an assessment of differences based on lunate morphology. Symmetry of 50 bilateral wrists was assessed. Results There was no correlation of LFI with lunate morphology, LUI, and LTA. There was a low correlation of LFI with SNA and UV. There was an inverse relationship between UV and SNA. Wrists with type 2 lunates had more oblique sigmoid notches and higher LTA in comparison to wrists with type 1 lunates. Side-to-side comparison revealed strong correlation except for LUI, which exhibited moderate correlation. Conclusions There is no correlation between LFI, LUI, and lunate morphology. Type 2 lunates are associated with higher LTA and more oblique SNA. Wrists were symmetrical. Clinical Relevance Factors other than lunate morphology are essential in balancing forces across wrists. A better understanding of soft tissue and other factors will improve the understanding of wrist biomechanics and pathology. Contralateral wrist radiographs can guide reconstructive surgery.

Sequence-dependent cluster analysis of biomineralization peptides

2015 ◽  
Vol 70 (7-8) ◽  
pp. 191-195 ◽  
Author(s):  
Jose Isagani B. Janairo ◽  
Frumencio Co ◽  
Jose Santos Carandang ◽  
Divina M. Amalin
Keyword(s):  
Molecular Weight ◽  
Cluster Analysis ◽  
Classification System ◽  
Clustering Analysis ◽  
Systematic Approach ◽  
Molecular Weight Heterogeneity ◽  
Representative Samples

Abstract A reliable and statistically valid classification of biomineralization peptides is herein presented. 27 biomineralization peptides (BMPep) were randomly selected as representative samples to establish the classification system using k-means method. These biomineralization peptides were either discovered through isolation from various organisms or via phage display. Our findings show that there are two types of biomineralization peptides based on their length, molecular weight, heterogeneity, and aliphatic residues. Type-1 BMPeps are more commonly found and exhibit higher values for these significant clustering variables. In contrast are the type-2 BMPeps, which have lower values for these parameters and are less common. Through our clustering analysis, a more efficient and systematic approach in BMPep selection is possible since previous methods of BMPep classification are unreliable.

scholarly journals Surgical Configurations of the Pectoralis Major flap for Reconstruction of Sternoclavicular Defects: A Systematic Review and New Classification of Described Techniques

2019 ◽  
Author(s):  
Jude Opoku-Agyeman ◽  
David Matera ◽  
Jamee Simone
Keyword(s):  
Classification System ◽  
English Language ◽  
Pectoralis Major ◽  
Cochrane Library ◽  
New Classification ◽  
Pectoralis Major Flap ◽  
Defect Reconstruction ◽  
Type 3

Abstract Objectives The pectoralis major flap has been considered the workhorse flap for chest and sternoclavicular defect reconstruction. There have been many configurations of the pectoralis major flap reported in the literature for use in reconstruction sternoclavicular defects either involving bone, soft tissue elements, or both. This study reviews the different configurations of the pectoralis major flap for sternoclavicular defect reconstruction and provides the first ever classification for these techniques. Methods EMBASE, Cochrane library, Ovid medicine and PubMed databases were searched from its inception to November of 2018. We included all studies describing surgical management of sternoclavicular defects. The studies were reviewed, and the different configurations of the pectoralis major flap used for sternoclavicular defect reconstruction were cataloged. We then proposed a new classification system for these procedures. Results The study included 5 articles published in the English language that provided a descriptive procedure for the use of pectoralis major flap in the reconstruction of sternoclavicular defects. The procedures were classified into three broad categories. In Type 1, the whole pectoris muscle is used. In Type 2, the pectoralis muscle is split and either advanced medially (type 2a) or rotated (type 2b) to fill the defect. In type 3, the clavicular portion of the pectoralis is islandized on a pedicle, either the TAA (type 3a) or the deltoid branch of the TAA (type 3b). Conclusion There are multiple configurations of the pectoralis flap reported in the English language literature for the reconstruction of sternoclavicular defects. Our classification system will help facilitate communication when describing the different configurations of the pectoralis major flap for reconstruction of sternoclavicular joint defects.

Proposal of Venous Drainage–Based Classification System for Carotid Cavernous Fistulae With Validity Assessment in a Multicenter Cohort

Neurosurgery ◽  
2015 ◽  
Vol 77 (3) ◽  
pp. 380-385 ◽  
Author(s):  
Ajith J. Thomas ◽  
Michelle Chua ◽  
Matthew Fusco ◽  
Christopher S. Ogilvy ◽  
R. Shane Tubbs ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Classification System ◽  
Internal Carotid ◽  
Treatment Approach ◽  
Venous Drainage ◽  
Validity Assessment ◽  
Drainage Channels ◽  
Type 3

Abstract BACKGROUND: Carotid cavernous fistulae (CCFs) are most commonly classified based on arterial supply. Symptomatology and treatment approach, however, are largely influenced by venous drainage. OBJECTIVE: To propose an updated classification system using venous drainage. METHODS: CCFs with posterior/inferior drainage only, posterior/inferior and anterior drainage, anterior drainage only, and retrograde drainage into cortical veins with/without other drainage channels were designated as types 1, 2, 3, and 4, respectively. CCFs involving a direct connection between the internal carotid artery and cavernous sinus were designated as type 5. This system was retrospectively applied to 29 CCF patients. RESULTS: Our proposed classification was significantly associated with symptomatology (P.001). Type 2 was significantly associated with coexisting ocular/orbital and cavernous symptoms only (P.001), type 3 with ocular/orbital symptoms only (P.01), and type 4 demonstrated cortical symptoms with/without ocular/orbital and cavernous symptoms (P.01), respectively. There was a significant association of our classification system with the endovascular treatment approach (P.001). Types 1 and 2 were significantly associated with endovascular treatment through the inferior petrosal sinus (P.01). Type 3 was significantly associated with endovascular treatment through the ophthalmic vein (P.01) and type 5 with transarterial approach (P.01), respectively. Types 2 (27.6%) and 3 (34.5%) were most prevalent in this series, whereas type 1 was rare (6.9%), suggesting that some degree of thrombosis is present, with implications for spontaneous resolution. Type 2 CCFs demonstrated a trend toward partial resolution after endovascular treatment (P = .07). CONCLUSION: Our proposed classification system is easily applicable in clinical practice and demonstrates correlation with symptomatology, treatment approach, and outcome.

scholarly journals Diagnosis of Type 1 and Type 2 Myocardial Infarction Using a High-Sensitivity Cardiac Troponin I Assay with Sex-Specific 99th Percentiles Based on the Third Universal Definition of Myocardial Infarction Classification System

2015 ◽  
Vol 61 (4) ◽  
pp. 657-663 ◽  
Author(s):  
Yader Sandoval ◽  
Stephen W Smith ◽  
Karen M Schulz ◽  
MaryAnn M Murakami ◽  
Sara A Love ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Classification System ◽  
Cardiac Troponin ◽  
Troponin I ◽  
High Sensitivity ◽  
The Third ◽  
Universal Definition ◽  
Definition Of

Abstract BACKGROUND The frequency and characteristics of myocardial infarction (MI) subtypes per the Third Universal Definition of MI (TUDMI) classification system using high-sensitivity (hs) cardiac troponin assays with sex-specific cutoffs is not well known. We sought to describe the diagnostic characteristics of type 1 (T1MI) and type 2 (T2MI) MI using an hs–cardiac troponin I (hs-cTnI) assay with sex-specific cutoffs. METHODS A total of 310 consecutive patients with serial cTnI measurements obtained on clinical indication were studied with contemporary and hs-cTnI assays. Ninety-ninth percentile sex-specific upper reference limits (URLs) for the hs-cTnI assay were 16 ng/L for females and 34 ng/L for males. The TUDMI consensus recommendations were used to define and adjudicate MI based on each URL. RESULTS A total of 127 (41%) patients had at least 1 hs-cTnI exceeding the sex-specific 99th percentiles, whereas 183 (59%) had hs-cTnI within the reference interval. Females had more myocardial injury related to supply/demand ischemia than males (39% vs 18%, P = 0.01), whereas males had more multifactorial or indeterminate injury (52% vs 33%, P = 0.05). By hs-cTnI, there were 32 (10%) acute MIs, among which 10 (3%) were T1MI and 22 (7%) were T2MI. T2MI represented 69% (22 out of 32) of all acute MIs, whereas T1MI represented 31% (10 out of 32). Ninety-five patients (31%) had an increased hs-cTnI above the 99th percentile but did not meet criteria for acute MI. The most common triggers for T2MI were tachyarrhythmias, hypotension/shock, and hypertension. By contemporary cTnI, more MIs (14 T1MI and 29 T2MI) were diagnosed. By contemporary cTnI, there were 43 MIs, 14 T1MI, and 29 T2MI. CONCLUSIONS Fewer MI diagnoses were found with the hs-cTnI assay, contrary to the commonly accepted idea that hs-cTnI will lead to excessive false-positive diagnoses.

A Preliminary Model of the Wrist Midcarpal Joint

2021 ◽  
Author(s):  
Martin Pendola ◽  
Catherine Petchprapa ◽  
Ronit Wollstein
Keyword(s):  
Ex Vivo ◽  
Three Dimensional ◽  
Ct Scans ◽  
Ex Vivo Model ◽  
Carpometacarpal Joints ◽  
Force Transfer ◽  
Midcarpal Joint

Abstract Background A challenge to deciphering the effect of structure on function in the wrist involves difficulty in obtaining in-vivo information. To provide a platform to study wrist mechanics using in vivo acquired forces, we developed a model of the midcarpal joint based on computed tomography (CT) scans of normal wrists. Finite element analysis (FEA) can enable application of in vivo collected information to an ex vivo model. Objectives The objectives of this study are to (1) create a three-dimensional model of the midcarpal joint of the wrist based on CT scans and (2) generate separate models for the midcarpal joint based on two distinct wrist types and perform a pilot loading of the model. Methods CT scans from a normal patient database were converted to three-dimensional standard template library (STL) files using OsiriX software. Five type 1 and five type 2 wrists were used for modeling. A simulated load was applied to the carpometacarpal joints in a distal-to-proximal direction, and FEA was used to predict force transfer in the wrist. Results There were 33% type 1 and 67% type 2 wrists. The midcarpal joint dimensional measurements estimated from the model had intermediate agreement between wrist type as measured on CT scan and as predicted by the model: 56% Cohen's kappa (95% confidence interval) = 0.221 (0.05–0.5). Surface stress on the carpometacarpal joints is different in type 1 and type 2 wrists. On loading the neutral wrist, the capitolunate angle was 90 degrees in type 1 wrists and 107 degrees in type 2 wrists (p < 0.0001). Conclusions The model predicted differences in movement and force transfer through the midcarpal joint dependent on structural type. This knowledge can improve our understanding of the development of disparate patterns of degeneration in the wrist.

scholarly journals CLASSIFYING ISCHIAL TUBEROSITY AVULSION FRACTURES BY OSSIFICATION STAGE AND TENDON ATTACHMENT

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0007
Author(s):  
Brendon C. Mitchell ◽  
JD Bomar ◽  
Dennis Wenger ◽  
Andrew T. Pennock
Keyword(s):  
Classification System ◽  
Ischial Tuberosity ◽  
Fracture Type ◽  
Avulsion Fractures ◽  
Avulsion Injury ◽  
Non Union ◽  
Adductor Magnus ◽  
Ossification Centers

Background: Currently, there is no classification system for ischial tuberosity avulsion fractures. Hypothesis/Purpose: To provide a new classification system for ischial tuberosity fractures based on the ossification pattern of the apophysis. Methods: We performed a retrospective records review of patients diagnosed with ischial tuberosity avulsion fractures at our institution from 2008 to 2018. Skeletal maturity (Modified Oxford score [MOS], Risser score), fracture type, size, and displacement were recorded based on initial injury radiographs. We reviewed a large series of pelvic CT and MRI scans from patients aged 10-19 years old to assess the ossification pattern and tendinous attachments of the ischial tuberosity. Pelvic CT review demonstrated a reproducible 5-stage pattern of ossification spanning the age of 13-19 years for males and 12-17 years for females (Figure 1). Review of available CTs and MRIs indicated that the semimembranosus attaches at the most lateral ossification center, followed by the conjoint tendon and adductor magnus as one moves medially (Figures 1). We created a classification system based on location of the ischial tuberosity avulsion fracture: Type 1 (lateral – semimembranosus and conjoint tendons) or Type 2 (complete – semimembranosus, conjoint, and adductor magnus tendons). An A or B descriptor was then added to distinguish minimally displaced (<1 cm) and displaced (≥1 cm) fractures, respectively (Figure 2). Results: We identified 45 ischial tuberosity fractures. Mean age was 14.4 years (range, 10.3–18). Males accounted for 82% of the cohort. Type 1 fractures accounted for 47% of cases and 53% were classified as Type 2. Type 1 fractures were associated with younger age chronological age (p=0.001), lower MOS (p=0.002), lower Risser score (p=0.002), less displacement (p=0.001), and smaller size (p<0.001), when compared with Type 2 fractures (Table 1). Of the 45 patients, 18 had >6 month follow-up with 56% going on to non-union. Non-union was associated with greater displacement (p=0.016) and size (p=0.027). When comparing union rates by fracture location, 33% of Type 1 fractures progressed to non-union, while 78% percent of Type 2 suffered a non-union; however, this difference did not reach statistical significance (p=0.153) (Table 2). Conclusion: In younger patients (ages 13-15 years), the lateral ossification centers of the ischial tuberosity, at which the hamstrings attach, are at risk for isolated avulsion injury. However, in older patients (16-18 years), coalescence of the hamstring and adductor magnus ossification centers predispose patients to a combined avulsion injury consisting of a larger fragment and with greater displacement. [Figure: see text][Figure: see text][Table: see text][Table: see text]

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