Effect of Limb Rotation on Radiographic Measurements of Carpal Parameters in the Equine Carpus

Abstract Background With the population aging worldwide, adult degenerative scoliosis (ADS) is receiving increased attention. Frailty, instead of chronological age, is used for assessing the patient’s overall physical condition. In ADS patients undergoing a posterior approach, long-segment corrective surgery, the association of frailty with the postsurgical outcomes remains undefined. Methods ADS patients who underwent a posterior approach, long-segment fusion at the Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University (CMU), Beijing, China, in 2014–2017 were divided into the frailty and non-frailty groups according to the modified frailty index. Major postoperative complications were recorded, including cardiac complications, pneumonia, acute renal dysfunction, delirium, stroke, neurological deficit, deep wound infection, gastrointestinal adverse events, and deep vein thrombosis. Radiographic measurements and health-related quality of life (HRQOL) parameters were recorded preoperatively and at 2 postoperative years. Results A total of 161 patients were included: 47 (29.2%) and 114 (70.8%) in the frailty and non-frailty groups, respectively. Major postoperative complications were more frequent in the frailty group than the non-frailty group (29.8% vs. 10.5%, P = 0.002). Multivariable logistic regression analysis showed that frailty was independently associated with major complications (adjusted odds ratio [aOR] = 2.77, 95% confidence interval [CI] 1.12–6.89, P = 0.028). Radiographic and HRQOL parameters were improved at 2 years but with no significant between-group differences. Conclusions Frailty is a risk factor for postoperative complications in ADS after posterior single approach, long-segment corrective surgery. Frailty screening should be applied preoperatively in all patients to optimize the surgical conditions in ADS.

Download Full-text

Vancouver B and C periprosthetic fractures around the cemented Exeter Stem: sex is associate with fracture pattern

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-04113-6 ◽

2021 ◽

Author(s):

M. F. R. Powell-Bowns ◽

E. Oag ◽

D. Martin ◽

N. D. Clement ◽

C. E. H. Scott

Keyword(s):

Multivariate Analysis ◽

Interobserver Reliability ◽

Univariate Analysis ◽

Intraclass Correlation ◽

Cement Mantle ◽

Mantle Length ◽

Periprosthetic Fractures ◽

Stem Design ◽

Female Sex ◽

Radiographic Measurements

Abstract Introduction The aim of this study was to identify factors associated with the level of periprosthetic fracture involving a cemented polished tapered stem: Vancouver B or Vancouver C. Methods A retrospective cohort study of 181 unilateral periprosthetic fractures involving Exeter stems was assessed by three observers (mean age 78.5, range 39–103; mean BMI 27.1, 17–39; 97 (54%) male). Patient demographics, deprivation scores, BMI and time since primary prosthesis were recorded. Femoral diameter, femoral cortical thickness, Dorr classification and distal cement mantle length were measured from calibrated radiographs. Interobserver reliability was calculated using intraclass correlation coefficients (ICCs). Univariate and multivariate analysis was performed to identify associations with Vancouver B or C fractures. Results 160/181 (88%) Vancouver B and 21/181 (12%) Vancouver C-level fractures occurred at a mean of 5.9 ± 5.4 years (0.2–26.5) following primary surgery. Radiographic measurements demonstrated excellent agreement (ICC > 0.8, p < 0.001). Mortality was significantly higher following Vancouver C compared to B fractures: 90 day 14/160 Vs 5/21 (p = 0.05); 1 year 29/160 Vs 8/21 (p = 0.03). Univariate analysis demonstrated that Vancouver C fractures were associated with female sex, bisphosphonate use, cortical bone thickness, and distal cement mantle length (p < 0.05). On multivariate analysis, only female sex was an independent predictor of Vancouver C-level fractures (R2 =0.354, p = 0.005). Conclusion Most PFFs involving the Exeter stem design are Vancouver B-type fractures and appear to be independent of osteoporosis. In contrast, Vancouver C periprosthetic fractures display typical fragility fracture characteristics and are associated with female sex, thinner femoral cortices, longer distal cement mantles and high mortality.

Download Full-text

Degenerative Lumbar Spine Disease, Not Fusion, May Be a Risk Factor for Instability after Total Hip Arthroplasty

The Journal of Hip Surgery ◽

10.1055/s-0040-1719114 ◽

2020 ◽

Vol 4 (04) ◽

pp. 193-200

Author(s):

Daniel K. Witmer ◽

Evan R. Deckard ◽

R. Michael Meneghini

Keyword(s):

Lumbar Spine ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Spine Fusion ◽

Joint Disease ◽

Total Hip ◽

Female Sex ◽

Lumbar Spine Fusion ◽

Radiographic Measurements ◽

Acetabular Protrusio

AbstractDislocation rates after total hip arthroplasty (THA) in patients with fixed spinopelvic motion have been reported as high as 20%. Few studies exist specifically for lumbar spine degenerative joint disease (DJD) and its relationship to THA instability. There were two study objectives: (1) report the incidence of lumbar spine DJD and previous lumbar spine fusion and (2) evaluate the relationship of these two conditions and other potential risk factors to postoperative dislocation after THA. We retrospectively reviewed 818 consecutive THAs performed by a single surgeon utilizing a posterior approach. Comprehensive medical chart and radiographic review was performed to identify patients with lumbar spine DJD and lumbar spine fusion. Radiographic measurements, patient factors, surgical factors, and incidences of dislocation also were recorded. Eight hundred and twelve THAs were analyzed. There were 10 dislocations (1.2%, 10/812). Lumbar spine DJD and previous lumbar spine fusion occurred in 33.4% (271/812) and 5.9% (48/812) of patients, respectively. Lumbar spine DJD, acetabular protrusio, and female sex were significant predictors of dislocation using a Firth penalized maximum likelihood estimation specifically for rare events (area under receiver-operator characteristic curve = 0.91, 95% confidence interval 0.86, 0.96). Interestingly, only 2 of 10 dislocations had a previous lumbar spine fusion. Lumbar spine DJD, acetabular protrusio, and female sex were significant predictors of dislocation, while lumbar spine fusion was largely unrelated. This study used data available to most practicing surgeons and provides useful information for counseling patients preoperatively.

Download Full-text

Standing radiographic measurements vs force plate gait analysis of moderate gonarthrosis

Journal of Biomechanics ◽

10.1016/0021-9290(89)90475-2 ◽

1989 ◽

Vol 22 (10) ◽

pp. 1087

Author(s):

Ola K. Svensson ◽

Lars Weidenhielm ◽

Lars-Åke Broström ◽

Jan Ekholm

Keyword(s):

Gait Analysis ◽

Force Plate ◽

Radiographic Measurements

Download Full-text

Radiographic measurements of dysplastic adult hips

Skeletal Radiology ◽

10.1007/s002560050197 ◽

1997 ◽

Vol 26 (2) ◽

pp. 75-81 ◽

Cited By ~ 128

Author(s):

S. Delaunay ◽

R. G. Dussault ◽

P. A. Kaplan ◽

B. A. Alford

Keyword(s):

Radiographic Measurements

Download Full-text

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

Download Full-text

Clinicoradiographic Assessment of Flexible Flatfoot in Children

Journal of the American Podiatric Medical Association ◽

10.7547/1000463 ◽

2010 ◽

Vol 100 (6) ◽

pp. 463-471 ◽

Cited By ~ 11

Author(s):

Maria Grazia Benedetti ◽

Lisa Berti ◽

Sofia Straudi ◽

Francesco Ceccarelli ◽

Sandro Giannini

Keyword(s):

Daily Living ◽

Functional Limitation ◽

Standing Position ◽

Valgus Deformity ◽

Lateral View ◽

Heel Pain ◽

Clinical Parameters ◽

Radiographic Assessment ◽

Radiographic Measurements ◽

Flexible Flatfoot

Background: Radiographic assessment is still used to evaluate flexible flatfoot in children. Methods: To find a set of radiologic parameters for assessing this disease, we studied 53 children aged 10 to 14 years. The degree of plantar collapse was measured by Viladot’s classification (grades 0–4). The degree of valgus deformity measured in the heel in a standing position, the presence of painful points, and functional limitation during daily-living activities were also reported. The children underwent standard radiography of the foot under load. On the dorsoplantar view, the talocalcaneal, hallux metatarsophalangeal, and first intermetatarsal angles were measured. On the lateral view, the talocalcaneal, Costa Bertani, talometatarsal, talonavicular, and tibiotalar angles were measured. The radiographic measurements were compared with the data reported in the literature and were correlated with the clinical parameters studied (degree of flatfoot, valgus deviation of the heel, pain, and functional limitation). Results: The radiographic measures that resulted increased with respect to the reference values reported in the literature for the Costa Bertani (93.1% of feet), talometatarsal (93.5%), talonavicular (89.1%), and tibiotalar (69.7%) angles, all in the lateral view. Of the angles assessed in the dorsoplantar view, the hallux metatarsophalangeal (11.1%) and first intermetatarsal (24.2%) angles were increased. The degree of flatfoot was correlated with the Costa Bertani angle (P < .0005). In the group with pain, the lateral talocalcaneal (P = .016) and first intermetatarsal (P = .02) angles were increased compared within the group without pain. Conclusions: Despite technical limitations, we still consider standard radiography of the foot, combined with clinical examination, to be a valid tool for assessing flexible flatfoot in children, especially when surgical treatment is expected and when a basic measure of the structural setup of the foot is necessary. (J Am Podiatr Med Assoc 100(6): 463–471, 2010)

Download Full-text

Radiographic Measurements of the Affected and Unaffected Feet in Patients with Unilateral Hallux Limitus

Journal of the American Podiatric Medical Association ◽

10.7547/14-137 ◽

2016 ◽

Vol 106 (3) ◽

pp. 172-181

Author(s):

Andrew F. Knox ◽

Alan R. Bryant

Keyword(s):

Metatarsal Head ◽

Radiographic Evaluation ◽

Head Shape ◽

Intrinsic Factors ◽

Hallux Limitus ◽

First Metatarsal ◽

Radiographic Measurements ◽

Angle Data ◽

Significant Difference ◽

First Ray

Background: Controversy exists regarding the structural and functional causes of hallux limitus, including metatarsus primus elevatus, a long first metatarsal, first-ray hypermobility, the shape of the first metatarsal head, and the presence of hallux interphalangeus. Some articles have reported on the radiographic evaluation of these measurements in feet affected by hallux limitus, but no study has directly compared the affected and unaffected feet in patients with unilateral hallux limitus. This case-control pilot study aimed to establish whether any such differences exist. Methods: Dorsoplantar and lateral weightbearing radiographs of both feet in 30 patients with unilateral hallux limitus were assessed for grade of disease, lateral intermetatarsal angle, metatarsal protrusion distance, plantar gapping at the first metatarsocuneiform joint, metatarsal head shape, and hallux abductus interphalangeus angle. Data analysis was performed using a statistical software program. Results: Mean radiographic measurements for affected and unaffected feet demonstrated that metatarsus primus elevatus, a short first metatarsal, first-ray hypermobility, a flat metatarsal head shape, and hallux interphalangeus were prevalent in both feet. There was no statistically significant difference between feet for any of the radiographic parameters measured (Mann-Whitney U tests, independent-samples t tests, and Pearson χ2 tests: P > .05). Conclusions: No significant differences exist in the presence of the structural risk factors examined between affected and unaffected feet in patients with unilateral hallux limitus. The influence of other intrinsic factors, including footedness and family history, should be investigated further.

Download Full-text