Study of the radiographic parameters of normal ankles

Objective: The authors carried out a bibliographic search for the radiographic parameters used to determine tibiotalar joint alignment, and suggest a set of parameters that constitute the minimum radiographic evaluation sufficient for the proper assessment of tibiotalar alignment. Methods: The search was conducted between May 2019 and January 2020 on the online platforms PudMed and Google Scholar with the following terms, used separately or jointly: “ankle arthritis, radiographic measurement, ankle alignment, alignment, anterior ankle instability, X-ray, and ankle injury”. Results: We selected twelve studies evaluating radiographic patterns of normal ankles, and identified a total of 15 radiographic measurements. Conclusion: The authors believe that a minimum radiographic assessment of tibiotalar alignment should include the following parameters on the anteroposterior radiograph: the distal tibial articular angle, the talar tilt and talus center migration. On the lateral radiograph, it should include: lateral distal tibial angle and lateral talar station. Level of Evidence V; Diagnostic Study; Expert Opinion.

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Survey to describe variability in early onset scoliosis cast practices

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.12.170207 ◽

2018 ◽

Vol 12 (4) ◽

pp. 406-412 ◽

Cited By ~ 2

Author(s):

A. Grzywna ◽

A. McClung ◽

J. Sanders ◽

P. Sturm ◽

L. Karlin ◽

...

Keyword(s):

Early Onset ◽

Congenital Scoliosis ◽

Patient Characteristics ◽

Study Groups ◽

Early Onset Scoliosis ◽

Radiographic Evaluation ◽

Level Of Evidence ◽

Major Curve ◽

Radiographic Measurements ◽

Multicentre Research

Purpose To investigate paediatric orthopaedists’ cast practices for early onset scoliosis regarding patient selection, cast application, radiographic evaluation, treatment cessation and adjunctive bracing. Methods A casting survey was distributed to all paediatric orthopaedists in Children’s Spine and Growing Spine Study Groups (n = 92). Questions included physician and patient characteristics, technique, treatment, outcomes, radiographic measurements and comparison to other treatments. A total of 55 orthopaedists (60%) responded, and descriptive statistics were calculated on the subset who cast (n = 45). Results A majority of respondents use cast treatment for idiopathic and syndromic scoliosis patients, but not for neuromuscular or congenital scoliosis patients. Major curve angle ranked most important in orthopaedists’ decision to commence cast treatment, in comparison with rib-vertebra angle difference or clinical observations. The major curve angle threshold to initiate casting was a median of 30° (20° to 70°), and the minimum patient age was median ten months (3 to 24). First in-cast and out-of-cast radiographs are taken standing, supine, awake, under anesthesia and/or in traction. In all, 58% consistently cast over or under the arm, while 44% vary position by patient. Respondents were divided about the use of a brace after cast treatment: 22% do not prescribe a brace, 31% always do and 36% do in some patients. Conclusions Future multicentre research studies must standardize radiographic practices and consider age and major curve angle at cast initiation and termination, scoliosis aetiology, shoulder position and treatment duration. Practices need to be aligned or compared in these areas in order to distinguish what makes for the best cast treatment possible. Level of Evidence V, Expert opinion

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INTRA- AND INTEROBSERVER REPRODUCIBILITY OF THE RADIOGRAPHIC EVALUATION OF CRANIAL PARAMETERS

Coluna/Columna ◽

10.1590/s1808-185120212002235023 ◽

2021 ◽

Vol 20 (2) ◽

pp. 98-100

Author(s):

Igor Pellucci Pinto ◽

Fábio Antônio Vieira ◽

David Del Curto ◽

Renato Hiroshi Salvioni Ueta ◽

Eduardo Barros Puertas

Keyword(s):

Statistical Significance ◽

The Other ◽

Radiographic Evaluation ◽

Diagnostic Study ◽

Interobserver Reproducibility ◽

Level Of Evidence ◽

Different Levels

ABSTRACT Objective: To evaluate the intra- and interobserver reproducibility of radiographic cranial parameters. Method: A study of the reproducibility of the radiographic cranial parameters (cranial incidence, cranial tilt, cranial slope and spinocervical angle) of 40 patients by 4 observers with different levels of experience. Results: Cranial incidence (CI) showed poor intraobserver concordance; for the other cranial parameters, good to excellent concordance was observed. In the assessment of interobserver concordance, all the parameters analyzed showed statistical significance, with good CI concordance. Conclusion: Cranial parameters are easily reproducible by orthopedists with different levels of experience. CI showed good interobserver concordance, but only reasonable intraobserver concordance among more experienced observers. Level of evidence IV; Diagnostic Study.

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Comparing goniometric and radiographic measurement of Q angle of the knee

Asian Biomedicine ◽

10.5372/1905-7415.0905.433 ◽

2017 ◽

Vol 9 (5) ◽

pp. 631-636 ◽

Cited By ~ 2

Author(s):

Mohamed Faisal Chevidikunnan ◽

Amer Al Saif ◽

Harish Pai K ◽

Lawrence Mathias

Keyword(s):

Pearson Correlation ◽

Radiographic Measurement ◽

X Rays ◽

X Ray ◽

Radiographic Measurements ◽

Q Angle ◽

X Ray Imaging ◽

The Common ◽

Diagnostic Measurement ◽

Acute Knee

AbstractBackgroundThe Q angle is a relevant clinical diagnostic measurement to detect various disorders of the knee. The common method used to measure the Q angle in the routine clinical practice is by radiography. An alternative to radiographic measurement is goniometry, by which exposure to x-rays can be avoided.ObjectivesTo compare and correlate the goniometric measurement of Q angle with radiographic measurement of the Q angle in patients with acute knee pain.MethodsWe selected 45 patient participants with a mean age of 32.5 years who satisfied the inclusion criteria for this study. All the patients underwent goniometric measurement of the Q angle followed by x-ray imaging of the entire lower limb. Later the bony prominences were marked on the x-ray image and the Q angle formed was measured using a protractor. The Pearson correlation coefficient between the goniometric and radiographic measurements was determined.ResultsWe found a significant relationship between Q angles obtained using a goniometer and x-ray imaging in the supine position (r = 0.91, P = 0.001). The mean difference between the goniometric measurement of Q angle and the radiographic measurement was 0.1°, which is not significant.ConclusionsGoniometry can be used to measure Q angle as accurately as radiography, and can be used as an inexpensive and radiation free alternative.

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Total Ankle Arthroplasty Survival and Risk Factors for Failure

Foot & Ankle International ◽

10.1177/1071100719849084 ◽

2019 ◽

Vol 40 (9) ◽

pp. 997-1006 ◽

Cited By ~ 5

Author(s):

Mario I. Escudero ◽

Vu Le ◽

Maximiliano Barahona ◽

Michael Symes ◽

Kevin Wing ◽

...

Keyword(s):

Risk Factors ◽

Predictive Model ◽

Patient Characteristics ◽

Total Ankle Arthroplasty ◽

Ankle Arthritis ◽

Level Of Evidence ◽

Ankle Arthroplasty ◽

Radiographic Parameters ◽

Patient Reported ◽

Component Revision

Background: Total ankle arthroplasty (TAA) is an increasingly selected treatment for end-stage ankle arthritis; however, failure and revision of the tibial and talar components remains an issue. Although multiple risk factors have been shown to contribute to early component revision, no study has looked at combining such risk factors into a predictive model that could potentially decrease revision rates and improve implant survival. This study aimed to develop a predictive model for TAA failure based on patient characteristics, patient-reported outcomes (PROs), and immediate postoperative radiographs. Methods: A retrospective review of a single-site ankle arthritis database was conducted. All patients with current-generation ankle replacements including the Hintegra and Infinity prostheses implanted between 2004 and 2015 and with complete postoperative radiographs taken between 6 and 12 weeks postoperatively were included. Eight coronal and sagittal radiographic parameters were assessed and performed twice by 2 independent orthopedic surgeons on included TAAs. These radiographic parameters were then analyzed in association with patient demographics and PRO. Advanced statistical methods including survival analysis were used to construct a predictive model for TAA survival. A total of 107 patients were included and analyzed with a median clinical follow-up of 49 months (minimum 24 months). Results: A predictive model was created, with 4 parameters identified as being statistically associated with TAA metal-component revision: diabetes mellitus, poor baseline Ankle Osteoarthritis Scale (AOS) score, excessively dorsiflexed talar component, and an anteriorly/posteriorly translated talus relative to the tibial axis. The presence of 3 parameters predicted TAA survival of 0.60 whereas presence of all 4 parameters predicted survival of only 0.13 in the period studied. Conclusion: Our predictive model is based on a combination of patient factors, PROs, and radiographic TAA alignment. We believe it can be used by surgeons to predict failure in their TAA patients, thereby optimizing postoperative outcomes by improving patient selection and modifiable outcome-specific parameters. Level of Evidence: Level III, retrospective cohort study using prospectively collected data.

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Compressed Lateral and anteroposterior Anatomical Systematic Sequences «CLASS»: compressed MRI sequences with assessed anatomical femoral and tibial ACL's footprints, a feasibility study

Journal of Experimental Orthopaedics ◽

10.1186/s40634-022-00445-3 ◽

2022 ◽

Vol 9 (1) ◽

Author(s):

Grégoire Thürig ◽

Raùl Panadero-Morales ◽

Luca Giovannelli ◽

Franziska Kocher ◽

José Luis Peris ◽

...

Keyword(s):

Ad Hoc ◽

Interobserver Reliability ◽

Intraclass Correlation ◽

Tibial Slope ◽

Lateral View ◽

Individual Identification ◽

Diagnostic Study ◽

Level Of Evidence ◽

X Ray ◽

Femoral Intercondylar Notch

Abstract Purpose This study's main objective is to assess the feasibility of processing the MRI information with identified ACL-footprints into 2D-images similar to a conventional anteroposterior and lateral X-Ray image of the knee. The secondary aim is to conduct specific measurements to assess the reliability and reproducibility. This study is a proof of concept of this technique. Methods Five anonymised MRIs of a right knee were analysed. A orthopaedic knee surgeon performed the footprints identification. An ad-hoc software allowed a volumetric 3D image projection on a 2D anteroposterior and lateral view. The previously defined anatomical femoral and tibial footprints were precisely identified on these views. Several parameters were measured (e.g. coronal and sagittal ratio of tibial footprint, sagittal ratio of femoral footprint, femoral intercondylar notch roof angle, proximal tibial slope and others). The intraclass correlation coefficient (ICCs), including 95% confidence intervals (CIs), has been calculated to assess intraobserver reproducibility and interobserver reliability. Results Five MRI scans of a right knee have been assessed (three females, two males, mean age of 30.8 years old). Five 2D-"CLASS" have been created. The measured parameters showed a "substantial" to "almost perfect" reproducibility and an "almost perfect" reliability. Conclusion This study confirmed the possibility of generating "CLASS" with the localised centroid of the femoral and tibial ACL footprints from a 3D volumetric model. "CLASS" also showed that these footprints were easily identified on standard anteroposterior and lateral X-Ray views of the same patient, thus allowing an individual identification of the anatomical femoral and tibial ACL's footprints. Level of evidence Level IV diagnostic study

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Postoperative Pain Is Correlated with Scaphoid Dorsal Translation following Scapholunate Interosseous Ligament Reconstruction

Journal of Wrist Surgery ◽

10.1055/s-0040-1713656 ◽

2020 ◽

Vol 9 (06) ◽

pp. 487-492

Author(s):

Emil S. Vutescu ◽

Scott W. Wolfe ◽

Kevin Sung ◽

Rishabh Jethanandani ◽

Steve K. Lee

Keyword(s):

Postoperative Pain ◽

Rating Scale ◽

Numerical Rating Scale ◽

Level Of Evidence ◽

Interosseous Ligament ◽

Statistical Correlations ◽

Pain Scores ◽

Radiographic Parameters ◽

Radiographic Measurements ◽

Patient Reported

Abstract Background Dorsal scaphoid translation (DST) has been demonstrated to occur in patients with complete scapholunate interosseous ligament (SLIL) tears. Radiographs and magnetic resonance imaging (MRI) have demonstrated ability to detect DST in patients with documented complete scapholunate (SL) disruption, but the relevance of this parameter to outcomes of reconstruction has not been determined. Purpose The purpose of this article is to determine how radiographic parameters of SL dissociation correlate with postoperative pain and functional outcomes of SLIL reconstruction. Methods We performed a retrospective review of prospectively collected data on a cohort of 14 patients who underwent SLIL repair or reconstruction. Preoperative data included radiographic measurements of carpal posture and alignment (SL angle, radiolunate [RL] angle, SL gap, and DST), self-reported measure of average pain on a numerical rating scale (NRS) of 0 to 10, and the patient rated wrist evaluation (PRWE) survey. Postoperatively, the same data were collected at each follow-up visit. Radiographic parameters were statistically compared with postoperative NRS pain score and PRWE scores. Statistical correlations were calculated using Spearman's correlation coefficient, and mean NRS pain scores were compared using Wilcoxon's rank-sum tests, with an α value of p = 0.05. Results Mean NRS pain scores improved significantly after surgery. Mean DST improved significantly after surgery. The presence of postoperative dorsal scaphoid translation (DST) correlated strongly with postoperative pain. SL angle, RL angle, and SL gap showed no correlation with patient reported pain. There was no correlation with any radiographic parameter and PRWE. Conclusions Our study demonstrates that the presence of DST in postoperative radiographs has a strong correlation with patient reported pain following SLIL reconstruction. We conclude that correction of dorsal translation of the scaphoid is a more sensitive predictor of postoperative pain relief than SL gap, RL angle, or SL angle. Level of evidence This is a Level IV study.

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Accuracy of radiographic measurement techniques for the Taylor spatial frame mounting parameters

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04084-0 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Jan Gessmann ◽

Sven Frieler ◽

Matthias Königshausen ◽

Thomas A. Schildhauer ◽

Yannik Hanusrichter ◽

...

Keyword(s):

Measurement Techniques ◽

Image Intensifier ◽

Precise Determination ◽

Taylor Spatial Frame ◽

Radiographic Measurement ◽

Image Method ◽

X Ray ◽

Spatial Frame ◽

Radiographic Measurements ◽

Soft Copy

Abstract Aim The correction accuracy of the Taylor Spatial Frame (TSF) fixator depends considerably on the precise determination of the mounting parameters (MP). Incorrect parameters result in secondary deformities that require subsequent corrections. Different techniques have been described to improve the precision of MP measurement, although exact calculation is reportedly impossible radiologically. The aim of this study was to investigate the accuracy of intraoperative and postoperative radiographic measurement methods compared to direct MP measurement from TSF bone mounting. Methods A tibial Sawbone® model was established with different origins and reference ring positions. First, reference MPs for each origin were measured directly on the frame and bone using a calibrated, digital vernier calliper. In total 150 MPs measured with three different radiographic measurement techniques were compared to the reference MPs: digital radiographic measurements were performed using soft-copy PACS images without (method A) and with (method B) calibration and calibrated image intensifier images (method C). Results MPs measured from a non-calibrated X-ray image (method A) showed the highest variance compared to the reference MPs. A greater distance between the origin and the reference ring corresponded to less accurate MP measurements with method A. However, the MPs measured from calibrated X-ray images (method B) and calibrated image intensifier images (method C) were intercomparable (p = 0.226) and showed only minor differences compared to the reference values but significant differences to method A (p < 0,001). Conclusion The results demonstrate that MPs can be accurately measured with radiographic techniques when using calibration markers and a software calibration tool, thus minimizing the source of error and improving the quality of correction.

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DESCRIPTION OF A NEW METHOD OF MEASURING THE PELVIC INCIDENCE ANGLE THROUGH COMPUTED TOMOGRAPHY

Coluna/Columna ◽

10.1590/s1808-185120201901218227 ◽

2020 ◽

Vol 19 (1) ◽

pp. 30-33

Author(s):

MURILO TAVARES DAHER ◽

RENATO FLEURY DI SOUZA LOPES ◽

RENATO TAVARES DAHER ◽

RICARDO TAVARES DAHER ◽

NILO CARRIJO MELO ◽

...

Keyword(s):

Computed Tomography ◽

Femoral Head ◽

Pelvic Incidence ◽

Incidence Angle ◽

Accurate Method ◽

Diagnostic Study ◽

Lumbosacral Region ◽

Level Of Evidence ◽

X Ray ◽

The Mean

ABSTRACT Objective To describe a more accurate method for measuring the pelvic incidence angle using computed tomography, without the influence of the positioning of the pelvis in relation to the X-ray tube. Methods Thirteen CT scans of the lumbosacral region, abdomen or pelvis were randomly assessed, as all these exams include the sacrum and femoral heads. All the exams were performed in multichannel devices with six channels. The technique of overlapping images, already common in other musculoskeletal exams, such as TT-TG, was used. The centered sagittal cut of the left femoral head, the center of S1, and the right femoral head were used. From these, a fourth image was created, analogous to an X-ray of the pelvis, from which measurements were taken using the dedicated software. Results Of the thirteen exams, three were of the lumbar spine and 10 were of the total abdomen, six of them being of males.. The mean age was 56 years. The mean PI was 45°, ranging from 31 to 81 degrees. Among the women, the mean was 52° (31 to 81°) and among the men, 38° (32 to 46°). Conclusion CT can be used to calculate the PI, using the technique of overlapping images common to other musculoskeletal exams, such as TT-TG. Level of Evidence IIIB. Diagnostic study; Retrospective study.

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Assessment of Radiographic Parameters for Adequate Reduction Following Syndesmotic Injury Causing Fibular Malrotation

ASME 2010 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2010-19082 ◽

2010 ◽

Author(s):

Meir Marmor ◽

Erik N. Hansen ◽

Hyun Kyu Han ◽

Jenni M. Buckley ◽

Amir Matityahu

Keyword(s):

Clinical Outcomes ◽

Ankle Instability ◽

Ankle Injuries ◽

Syndesmotic Injury ◽

X Ray ◽

Orthopaedic Surgeons ◽

Clear Space ◽

Radiographic Parameters ◽

X Ray Imaging ◽

Musculoskeletal Problems

Rotational ankle injuries are one of the most common musculoskeletal problems treated by orthopaedic surgeons. The distal tibio-fibular syndesmosis may be disrupted during injury resulting in ankle instability. The goal of surgery is to restore anatomic relation of tibia, fibula, and talus. Any malreduction including that of the syndesmosis may result in poor clinical outcomes [1]. While currently accepted radiographic criteria can adequately detect tibio-fibular diasthesis or translation malreductions, it is not yet clear if the currently these criteria are equally suited for detection of rotational malreductions of the tibio-fibular syndesmosis [2]. The goal of this study is to quantify the sensitivity of fluoroscopic measurements of tibio-fibular overlap (TFO) and tibio-fibular clear space (TCS) to rotational malreductions of the syndesmosis. Standard x-ray imaging will be compared with a 3D fluoroscan which will simulate postoperative CT [3].

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Correction of radiographic measurements of acetabular cup wear for variations in pelvis orientation

Proceedings of the Institution of Mechanical Engineers Part H Journal of Engineering in Medicine ◽

10.1177/0954411918754924 ◽

2018 ◽

Vol 232 (3) ◽

pp. 299-309

Author(s):

Brian Derbyshire

Keyword(s):

Mathematical Method ◽

Pelvic Tilt ◽

Radiographic Measurement ◽

Linear Wear ◽

Two Dimensional ◽

Acetabular Cup ◽

Correction Formula ◽

X Ray ◽

Radiographic Measurements

Radiographic measurement of two-dimensional acetabular cup wear is usually carried out on a series of follow-up radiographs of the patient’s pelvis. Since the orientation of the pelvis might not be consistent at every X-ray examination, the resulting change in view of the wear plane introduces error into the linear wear measurement. This effect is amplified on some designs of cup in which the centre of the socket is several millimetres below the centre of the cup or circular wire marker. This study describes the formulation of a mathematical method to correct radiographic wear measurements for changes in pelvis orientation. A mathematical simulation of changes in cup orientation and wear vectors caused by pelvic tilt was used to confirm that the formulae corrected the wear exactly if the radiographic plane of the reference radiograph was parallel to the true plane of wear. An error analysis showed that even when the true wear plane was not parallel to the reference radiographic plane, the formulae could still provide a useful correction. A published correction formula was found to be ineffective.

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