Coronal Shear Fractures of the Distal Humerus

Coronal shear fractures of the distal humerus are rare, frequently comminuted, and are without consensus for treatment. The aim of this paper is to review the current concepts on the diagnosis, classification, treatment options, surgical approaches, and complications of capitellar and trochlear fractures. Computed Tomography (CT) scans, along with the Dubberley classification, are extremely helpful in the decision-making process. Most of the fractures necessitate open reduction and internal fixation, although elbow arthroplasty is an option for comminuted fractures in the elderly low-demand patient. Stiffness is the most common complication after fixation, although reoperation is infrequent.

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Use of Computed Tomography Compression Ratio in Diagnosis of Disc Injuries and Posterior Ligamentous Complex Injuries in Osteoporotic Thoracolumbar Compression Fractures

Iranian Journal of Radiology ◽

10.5812/iranjradiol.111779 ◽

2021 ◽

Vol 18 (4) ◽

Author(s):

Dong Liu ◽

Dan Zhong ◽

Aihong Cao

Keyword(s):

Computed Tomography ◽

Compression Ratio ◽

Body Height ◽

The Elderly ◽

Diagnostic Value ◽

Ct Scans ◽

Posterior Ligamentous Complex ◽

Compression Fractures ◽

Study Population ◽

Magnetic Resonance Imaging Mri

Background: Osteoporotic compression fractures are common among the elderly. It is important to predict the posterior ligamentous complex (PLC) and disc injuries in computed tomography (CT) scans of patients with magnetic resonance imaging (MRI) contraindications. Objectives: To determine the role of the CT compression ratio (CTCR) in diagnosing PLC and disc injuries and to compare it with the loss of vertebral body height (LOVBH) in osteoporotic thoracolumbar compression fractures. Patients and Methods: A total of 91 consecutive patients with vertebral fractures were included as the study population. The PLC and disc injuries were assessed using MRI, and the following radiological parameters were determined based on CT scans for further MRI examinations: CTCR, LOVBH, local kyphosis (LK), interspinous widening (ISW), vertebral translation (VBT), and posterior structures fractures (PSF). Statistical analysis was performed to identify the diagnostic value of CT features in PLC and disc injuries. Results: The PLC injuries were detected in 9/91 cases, and the number of disc injuries was 47/91. Neither CTCR nor LOVBH was associated with PLC injuries (P > 0.05). However, the CTCR was associated with disc injuries (P < 0.05), with an optimal threshold of 1.755 (sensitivity, 68.1%; specificity, 79.5%), while the LOVBH was not significantly associated with disc injuries. Based on the results, VBT was significantly related to PLC and disc injuries (P < 0.05). Conclusion: The injured vertebral CTCR was associated with disc injuries rather than PLC injuries, suggesting that compression fractures are relatively stable with less PLC injury. Overall, CTCR is a useful indicator reflecting the compression degree of the injured vertebrae; it is also a valid predictor of disc injuries.

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Ossification of the pterygoalar and pterygospinous ligaments: a computed tomography analysis of infratemporal fossa anatomical variants relevant to percutaneous trigeminal rhizotomy

Journal of Neurosurgery ◽

10.3171/2019.2.jns182709 ◽

2020 ◽

Vol 132 (6) ◽

pp. 1942-1951

Author(s):

Tomasz Matys ◽

Tariq Ali ◽

Fulvio Zaccagna ◽

Damiano G. Barone ◽

Ramez W. Kirollos ◽

...

Keyword(s):

Computed Tomography ◽

Skull Base ◽

Infratemporal Fossa ◽

Maximum Intensity Projection ◽

Contralateral Side ◽

Surgical Anatomy ◽

Ct Scans ◽

Surgical Approaches ◽

Cross Sectional ◽

Radiological Anatomy

OBJECTIVEOssification of pterygoalar and pterygospinous ligaments traversing the superior aspect of the infratemporal fossa results in formation of osseous bars that can obstruct percutaneous needle access to the trigeminal ganglion through the foramen ovale (FO), interfere with lateral mandibular nerve block, and impede transzygomatic surgical approaches. Presence of these ligaments has been studied on dry skulls, but description of their radiological anatomy is scarce, in particular on cross-sectional imaging. The aim of this study was to describe visualization of pterygoalar and pterygospinous bars on computed tomography (CT) and to review their prevalence and clinical significance.METHODSThe authors retrospectively reviewed 200 helical sinonasal CT scans by analyzing 0.75- to 1.0-mm axial images, maximum intensity projection (MIP) reconstructions, and volume rendered (VR) images, including views along the anticipated axis of the needle in percutaneous Hartel and submandibular approaches to the FO.RESULTSOssified pterygoalar and pterygospinous ligaments were readily identifiable on CT scans. An ossified pterygoalar ligament was demonstrated in 10 patients, including 1 individual with bilateral complete ossification (0.5%), 4 patients with unilateral complete ossification (2.0%), and 5 with incomplete unilateral ossification (2.5%). Nearly all patients with pterygoalar bars were male (90%, p < 0.01). An ossified pterygospinous ligament was seen in 35 patients, including 2 individuals with bilateral complete (1.0%), 8 with unilateral complete (4%), 8 with bilateral incomplete (4.0%), 12 with bilateral incomplete (6.0%) ossification, and 5 (2.5%) with mixed ossification (complete on one side and incomplete on the contralateral side). All pterygoalar bars interfered with a hypothetical needle access to the FO using the Hartel approach but not the submandibular approach. In contrast, 54% of complete and 24% of incomplete pterygospinous bars impeded the submandibular approach to the FO, without affecting the Hartel approach.CONCLUSIONSThis study provides the first detailed description of cross-sectional radiological and applied surgical anatomy of pterygoalar and pterygospinous bars. Our data are clinically useful during skull base imaging to predict potential obstacles to percutaneous cannulation of the FO and assist in the choice of approach, as these two variants differentially impede the Hartel and submandibular access routes. Our results can also be useful in planning surgical approaches to the skull base through the infratemporal fossa.

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Challenges and Solutions in Management of Distal Humerus Fractures

The Open Orthopaedics Journal ◽

10.2174/1874325001711011292 ◽

2017 ◽

Vol 11 (1) ◽

pp. 1292-1307 ◽

Cited By ~ 1

Author(s):

Saif Ul Islam ◽

Alexander William Glover ◽

Mohammad Waseem

Keyword(s):

Current Literature ◽

Treatment Options ◽

Distal Humerus ◽

Surgical Anatomy ◽

Surgical Approaches ◽

Surgical Fixation ◽

Humerus Fractures ◽

Distal Humerus Fractures ◽

Trauma Surgeons ◽

Complex Injuries

Background:Management of distal humerus fractures remains a challenge for trauma surgeons and advancements in treatment options continue to be made to achieve the best results for patients presenting with these complex fractures. Our aim in this article is to provide the surgeons with a detailed review of current literature to help them make an evidence based decision when faced with managing such complex injuries in their surgical practice.Methods:This is a comprehensive review of the current literature that details various aspects of distal distal humerus fractures such as classification, surgical anatomy, surgical approaches, treatment options, choices of devices, outcomes and complications.Results:With the advancements in techniques and equipment, there has been improvement in patients’ outcomes following surgical management of these fractures and a large proportion of these patients are able to achieve pre-injury level of function. The contoured locking plates have enabled successful fixation of many of these fractures that were previously considered unfixable. For those not amenable to surgical fixation, total elbow arthroplasty and elbow hemiarthroplasty are considered as good alternatives.Conclusion:Since the days where the ‘bag of bones’ technique was the preferred method of treating these complex injuries, techniques and outcomes have advanced greatly. However, they still present a significant technical challenge and need meticulous technique and experience to achieve optimal results.

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SPECIFIC CHARACTERISTICS OF BONE STRUCTURES ON CT-SCANS OF PATIENTS WITH SINONASAL INVERTED PAPILLOMAS

Problems in oncology ◽

10.37469/0507-3758-2019-65-4-590-595 ◽

2019 ◽

Vol 65 (4) ◽

pp. 590-595

Author(s):

Arkadiy Naumenko ◽

Kseniya Sapova ◽

Oleg Konoplev ◽

Svetlana Astashchenko ◽

Igor Chernushevich

Keyword(s):

Computed Tomography ◽

Tumor Recurrence ◽

Inverted Papilloma ◽

Ct Scans ◽

Precise Localization ◽

Sinonasal Inverted Papilloma ◽

Bone Structures ◽

Inverted Papillomas

Precise localization and excision of the originating site of a sinonasal inverted papilloma is essential for decreasing tumor recurrence. In this study we evaluated the use of preoperative computed tomography (CT) to pinpoint the attachment/origi-nating sites of the tumor.

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Metacarpal Bony Dimensions Related to Headless Compression Screw Sizes

Journal of Hand and Microsurgery ◽

10.1055/s-0039-3400443 ◽

2019 ◽

Vol 12 (S 01) ◽

pp. S39-S44

Author(s):

Michael Okoli ◽

Kevin Lutsky ◽

Michael Rivlin ◽

Brian Katt ◽

Pedro Beredjiklian

Keyword(s):

Computed Tomography ◽

Fracture Fixation ◽

Ct Scans ◽

Compression Screw ◽

Metacarpal Head ◽

Headless Compression Screw ◽

Metacarpal Bones ◽

Headless Compression Screws ◽

The Mean ◽

Distal Aspect

Abstract Introduction The purpose of this study is to determine the radiographic dimensions of the finger metacarpals and to compare these measurements with headless compression screws commonly used for fracture fixation. Materials and Methods We analyzed computed tomography (CT) scans of the index, long, ring, and small metacarpal bones and measured the metacarpal length, distance from the isthmus to the metacarpal head, and intramedullary diameter of the isthmus. Metacarpals with previous fractures or hardware were excluded. We compared these dimensions with the size of several commercially available headless screws used for intramedullary fixation. Results A total of 223 metacarpals from 57 patients were analyzed. The index metacarpal was the longest, averaging 67.6 mm in length. The mean distance from the most distal aspect of the metacarpal head to the isthmus was 40.3, 39.5, 34.4, and 31 mm for the index, long, ring, and small metacarpals, respectively. The narrowest diameter of the isthmus was a mean of 2.6, 2.7, 2.3, and 3 mm for the index, long, ring, and small metacarpals, respectively. Of 33 commercially available screws, only 27% percent reached the isthmus of the index metacarpal followed by 42, 48, and 58% in the long, ring, and small metacarpals, respectively. Conclusion The index and long metacarpals are at a particular risk of screw mismatch given their relatively long lengths and narrow isthmus diameters.

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Conditional CT Strategy—An Effective Tool to Reduce Negative Appendectomy Rate and the Overuse of the CT

Journal of Clinical Medicine ◽

10.3390/jcm10112456 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2456

Author(s):

Raminta Luksaite-Lukste ◽

Ruta Kliokyte ◽

Arturas Samuilis ◽

Eugenijus Jasiunas ◽

Martynas Luksta ◽

...

Keyword(s):

Computed Tomography ◽

Acute Appendicitis ◽

Sensitivity And Specificity ◽

Surgical Outcomes ◽

Imaging Modality ◽

Ct Scans ◽

Negative Appendectomy ◽

Transabdominal Ultrasound ◽

First Choice ◽

Negative Appendectomy Rate

(1) Background: Diagnosis of acute appendicitis (AA) remains challenging; either computed tomography (CT) is universally used or negative appendectomy rates of up to 30% are reported. Transabdominal ultrasound (TUS) as the first-choice imaging modality might be useful in adult patients to reduce the need for CT scans while maintaining low negative appendectomy (NA) rates. The aim of this study was to report the results of the conditional CT strategy for the diagnosis of acute appendicitis. (2) Methods: All patients suspected of acute appendicitis were prospectively registered from 1 January 2016 to 31 December 2018. Data on their clinical, radiological and surgical outcomes are presented. (3) Results: A total of 1855 patients were enrolled in our study: 1206 (65.0%) were women, 649 (35.0%) were men, and the median age was 34 years (IQR, 24.5–51). TUS was performed in 1851 (99.8%) patients, and CT in 463 (25.0%) patients. Appendices were not visualized on TUS in 1320 patients (71.3%). Furthermore, 172 (37.1%) of 463 CTs were diagnosed with AA, 42 (9.1%) CTs revealed alternative emergency diagnosis and 249 (53.8%) CTs were normal. Overall, 519 (28.0%) patients were diagnosed with AA: 464 appendectomies and 27 diagnostic laparoscopies were performed. The NA rate was 4.2%. The sensitivity and specificity for TUS and CT are as follows: 71.4% and 96.2%; 93.8% and 93.6%. (4) Conclusion: A conditional CT strategy is effective in reducing NA rates and avoids unnecessary CT in a large proportion of patients. Observation and repeated TUS might be useful in unclear cases.

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Decision Making from the Experience of Orthognathic Surgery Patients: A Grounded Theory Approach

JDR Clinical & Translational Research ◽

10.1177/23800844211014440 ◽

2021 ◽

pp. 238008442110144

Author(s):

N.R. Paul ◽

S.R. Baker ◽

B.J. Gibson

Keyword(s):

Decision Making ◽

Grounded Theory ◽

Treatment Options ◽

Study Data ◽

Primary Objective ◽

Major Surgery ◽

Future Research ◽

Decision Making Process ◽

Theory Approach

Introduction: Patients’ decisions to undergo major surgery such as orthognathic treatment are not just about how the decision is made but what influences the decision. Objectives: The primary objective of the study was to identify the key processes involved in patients’ experience of decision making for orthognathic treatment. Methods: This study reports some of the findings of a larger grounded theory study. Data were collected through face-to-face interviews of patients who were seen for orthognathic treatment at a teaching hospital in the United Kingdom. Twenty-two participants were recruited (age range 18–66 y), of whom 12 (male = 2, female = 10) were 6 to 8 wk postsurgery, 6 (male = 2, female = 4) were in the decision-making stage, and 4 (male = 0, female = 4) were 1 to 2 y postsurgery. Additional data were also collected from online blogs and forums on jaw surgery. The data analysis stages of grounded theory methodology were undertaken, including open and selective coding. Results: The study identified the central role of dental care professionals (DCPs) in several underlying processes associated with decision making, including legitimating, mediating, scheduling, projecting, and supporting patients’ decisions. Six categories were related to key aspects of decision making. These were awareness about their underlying dentofacial problems and treatment options available, the information available about the treatment, the temporality of when surgery would be undertaken, the motivations and expectation of patients, social support, and fear of the surgery, hospitalization, and potentially disliking their new face. Conclusion: The decision-making process for orthognathic treatment is complex, multifactorial, and heavily influenced by the role of DCPs in patient care. Understanding the magnitude of this role will enable DCPs to more clearly participate in improving patients’ decision-making process. The findings of this study can inform future quantitative studies. Knowledge Transfer Statement: The results of this study can be used both for informing clinical practice around enabling decision making for orthognathic treatment and also for designing future research. The findings can better inform clinicians about the importance of their role in the patients’ decision-making process for orthognathic treatment and the means to improve the patient experience. It is suggested that further research could be conducted to measure some of the key constructs identified within our grounded theory and assess how these change during the treatment process.

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231 Breast Lymphedema After Breast Conservative Surgery; An Up-To-Date Systematic Review

British Journal of Surgery ◽

10.1093/bjs/znab134.245 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

M Abouelazayem ◽

M Elkorety ◽

S Monib

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Breast Surgery ◽

Treatment Options ◽

Conservative Surgery ◽

Breast Size ◽

Search Term ◽

Common Complication ◽

Breast Conservative Surgery ◽

Conservative Breast Surgery

Abstract Background While arm lymphedema following breast cancer treatment is a common complication; breast lymphedema following treatment is not uncommon. Several risk factors were found to contribute to breast lymphedema, Aim: We aimed to provide a systematic review to help avoiding or management of breast lymphoedema Method The search term 'breast lymphedema' was combined with 'breast conservative surgery' and was used to conduct literature research in PubMed and Medline. The term lymphedema was combined with breast, conservative and surgery to search Embase database. All papers published in English were included with no exclusion date limits Results A total of 2155 female patients were included in this review; age ranged from 26 to 90. Mean BMI was 28.4, most of the studies included patients who underwent conservative breast surgery. Incidence of breast lymphedema ranged from 24.8% to 90.4%. Several risk factors were linked to breast lymphedema after conservative breast surgery, such as body mass index (BMI), breast size, tumour size, tumour site, type of surgery and adjuvant therapy. Treatment options focused on decongestive lymphatic therapy, including Manual lymphatic drainage (MLD), self-massaging, compression bras or Kinesio taping. Conclusions Breast lymphedema is a relatively common complication, yet there is no clear consensus on the definition or treatment options.

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