Lateral Subtalar Joint Dislocation

2004 ◽  
Vol 94 (1) ◽  
pp. 65-69 ◽  
Author(s):  
David B. Randall ◽  
Anthony Jon Ferretti
Keyword(s):  
Computed Tomography ◽  
Subtalar Joint ◽  
Treatment Plan ◽  
Plain Film ◽  
Calcaneal Fracture ◽  
Interesting Case ◽  
Rare Injury ◽  
Joint Dislocation ◽  
Lateral Dislocation ◽  
Treatment Prognosis

Subtalar joint dislocation is a relatively rare injury, with lateral dislocation occurring less frequently than medial dislocation. Associated fractures alter the treatment plan and the prognosis, but they are often missed on plain film radiographs. A brief review of the anatomy, pathomechanics, treatment, prognosis, and complications of subtalar joint dislocation is presented. An interesting case of lateral subtalar joint dislocation with an associated calcaneal fracture not evident on plain film radiographs but delineated with computed tomography is presented. (J Am Podiatr Med Assoc 94(1): 65-69, 2004)

Pseudo Os Trigonum Sign: Missed Posteromedial Talar Facet Fracture

2003 ◽  
Vol 24 (8) ◽  
pp. 642-649 ◽  
Author(s):  
A. Ylenia Giuffrida ◽  
Sheldon S. Lin ◽  
Nicholas Abidi ◽  
Wayne Berberian ◽  
Avril Berkman ◽  
...  
Keyword(s):  
Ct Scan ◽  
Subtalar Joint ◽  
Articular Surface ◽  
Cast Immobilization ◽  
Rare Injury ◽  
Joint Dislocation ◽  
Os Trigonum ◽  
Subtalar Dislocation ◽  
Subtalar Arthritis ◽  
Facet Fracture

Background: Posteromedial talar facet fracture (PMTFF) is a rare injury, sparsely reported in the literature. This article proposes that PMTFF is often left undiagnosed by orthopaedic surgeons and suggests the routine application of advanced radiographic studies (i.e., CT scan) in the recognition of PMTFF. It also evaluates nonoperative management of PMTFF. Methods: After obtaining Institutional Review Board approval, the medical records over a 5-year period (1997–2001) were retrospectively reviewed from the foot and ankle service of a level 1 trauma center, identifying all cases of PMTFF. Charts were reviewed for relevant data. Results of treatment were assessed during follow-up physical examination. Results: Six cases of PMTFF were identified over a 5-year period. All injuries were associated with medial subtalar joint dislocation. Four of six (66%) patients were not initially diagnosed with PMTFF, but instead misdiagnosed as an os trigonum. The remaining two patients had an established diagnosis of PMTFF at the time of initial treatment. All had short leg cast immobilization for medial subtalar dislocation. CT evaluation yielded additional diagnoses in all six patients. All six patients showed a PMTFF. Five patients (83%) revealed persistent subtalar joint subluxation. Five of six (83%) patients required at least one additional procedure as a result of an undiagnosed or nonoperatively treated PMTFF. Four patients underwent subtalar joint fusion, and one patient underwent tibiotalar calcaneal fusion secondary to concomitant ankle/subtalar arthritis. The patient who did not undergo recommended fusion continued to be symptomatic. Conclusions: Diagnosis of PMTFF necessitates a heightened clinical suspicion, especially when a medial subtalar joint dislocation is present. Proper imaging studies, such as coronal CT scan, should be performed after any subtalar dislocation. Timely treatment, in the form of open reduction and internal fixation for large fragments involving the articular surface or surgical excision for smaller fragments, is recommended in order to restore proper anatomy and function of the subtalar joint. This study verifies the significant morbidity associated with an undiagnosed or nonoperatively treated PMTFF.

scholarly journals Variations in vertical mucosal thickness at edentulous ridge according to site and gender measured by cone-beam computed tomography

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Motohiro Munakata ◽  
Koudai Nagata ◽  
Minoru Sanda ◽  
Ryota Kawamata ◽  
Daisuke Sato ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cone Beam Computed Tomography ◽  
Treatment Plan ◽  
Cone Beam ◽  
Alveolar Ridge ◽  
Marginal Bone Loss ◽  
Mandibular Molar ◽  
Mucosal Thickness ◽  
And Gender ◽  
Edentulous Patients

Abstract Background The vertical thickness of the peri-implant mucosa is associated with the amount of post treatment marginal bone loss. However, the variations in mucosal thickness at the different edentulous sites have been sparsely documented. The purpose of the study was to conduct a survey of the frequency distribution of variations in mucosal thickness at the different sites of the edentulous alveolar ridge and to compare them according to gender. Our study included 125 partially edentulous patients having a total of 296 implant sites. Cone-beam computed tomography (CBCT) scans were obtained by placing a diagnostic template with a radiopaque crown indicator on the ridge to determine the mucosal thickness at the crest of the alveolar ridge. Results The mucosal thickness was 3.0±1.3 mm in the maxilla, which was significantly greater than the mucosal thickness of 2.0±1.0 mm in the mandible (p<0.001). In both the maxilla and the mandible, the mucosa was the thickest in the anterior region, followed by the premolar and molar regions. Sites were further classified into two groups based on whether the mucosal thickness was greater than 2 mm. In the mandible, more than half of the sites showed a mucosal thickness of 2 mm or less. Conclusions Although this study was a limited preoperative study, the vertical mucosal thickness at the edentulous ridge differed between the maxillary and mandibular regions. The majority of sites in the mandibular molar region had a mucosal thickness of less than 2 mm. Practitioners might be able to develop an optimal dental implant treatment plan for long-term biologic and esthetic stability by considering these factors.

Interaction of Loading and Ligament Injuries in Subtalar Joint Instability Quantified by 3D Weightbearing Computed Tomography

2021 ◽  
Author(s):  
Burssens Arne ◽  
Nicola Krähenbühl ◽  
Amy L. Lenz ◽  
Kalebb Howell ◽  
Chong Zhang ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Subtalar Joint ◽  
Joint Instability ◽  
Ligament Injuries

scholarly journals A pulmonary hamartoma in Covid-19 pneumonia: an interesting case studied with computed tomography

2021 ◽  
Vol 16 (4) ◽  
pp. 942-944
Author(s):  
Francesco Messina ◽  
Grazia Calabrese ◽  
Lorena Turano ◽  
Carmela Tebala ◽  
Nicola Arcadi
Keyword(s):  
Computed Tomography ◽  
Interesting Case ◽  
Pulmonary Hamartoma

Non-Selective Thoracic Computed Tomography in Trauma Patients Results in Injury Severity Score Inflation

2021 ◽  
pp. 000313482110249
Author(s):  
Leonardo Alaniz ◽  
Omaer Muttalib ◽  
Juan Hoyos ◽  
Cesar Figueroa ◽  
Cristobal Barrios
Keyword(s):  
Computed Tomography ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Treatment Plan ◽  
Mortality Prediction ◽  
Trauma Patients ◽  
Mortality Benefit ◽  
Severity Scores ◽  
Score Inflation

Introduction Extensive research relying on Injury Severity Scores (ISS) reports a mortality benefit from routine non-selective thoracic CTs (an integral part of pan-computed tomography (pan-CT)s). Recent research suggests this mortality benefit may be artifact. We hypothesized that the use of pan-CTs inflates ISS categorization in patients, artificially affecting admission rates and apparent mortality benefit. Methods Eight hundred and eleven patients were identified with an ISS >15 with significant findings in the chest area. Patient charts were reviewed and scores were adjusted to exclude only occult injuries that did not affect treatment plan. Pearson chi-square tests and multivariable logistic regression were used to compare adjusted cases vs non-adjusted cases. Results After adjusting for inflation, 388 (47.8%) patients remained in the same ISS category, 378 (46.6%) were reclassified into 1 lower ISS category, and 45 (5.6%) patients were reclassified into 2 lower ISS categories. Patients reclassified by 1 category had a lower rate of mortality ( P < 0.001), lower median total hospital LOS ( P < .001), ICU days ( P < .001), and ventilator days ( P = 0.008), compared to those that remained in the same ISS category. Conclusion Injury Severity Score inflation artificially increases survival rate, perpetuating the increased use of pan-CTs. This artifact has been propagated by outdated mortality prediction calculation methods. Thus, prospective evaluations of algorithms for more selective CT scanning are warranted.

Role of multidetector computed tomography in evaluation of calcaneal fracture

2019 ◽  
Vol 47 (4) ◽  
pp. 167
Author(s):  
Nora MagdyELhusseiny ELashwah ◽  
IbrahimAbbas Nassar ◽  
Hossam AbdelHafiz Zaytoun ◽  
Mahmoud AbdelAziz Dawoud
Keyword(s):  
Computed Tomography ◽  
Multidetector Computed Tomography ◽  
Calcaneal Fracture

scholarly journals Patient-specific instrument-assisted minimally invasive internal fixation of calcaneal fracture for rapid and accurate execution of a preoperative plan: A retrospective study

2020 ◽  
Author(s):  
Chenggong Wang ◽  
Can Xu ◽  
Mingqing Li ◽  
Hui Li ◽  
Han Xiao ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Subtalar Joint ◽  
Calcaneal Fracture ◽  
Patient Specific ◽  
Calcaneal Fractures ◽  
Intraoperative Fluoroscopy ◽  
Joint Width ◽  
Preoperative Plan ◽  
Overlap Ratio ◽  
Minimally Invasive Internal Fixation

Abstract Background: Traditional methods for minimally invasive internal fixation (MIIF) of calcaneal fractures require extensive intraoperative fluoroscopy, and fracture recovery is usually not ideal. We developed a new surgical procedure using digital surgical simulation and constructed a patient-specific instrument (PSI) for calcaneal fracture that we used during the operation. This study investigated whether PSI-assisted MIIF of calcaneal fracture enables rapid and accurate execution of the preoperative plan.Methods: We retrospectively analyzed patients with Sanders type III or IV fresh calcaneal fractures who had undergone PSI-assisted MIIF at our hospital from January 2016 to December 2018. We analyzed perioperative data including intraoperative fluoroscopy time, concurrence of internal fixation actual usage (IFAU) with the preoperative plan, surgery time, and complications. We also compared pre- and postoperative actual measurements from X-ray radiographs and computed tomography images including Böhler, Gissane, and calcaneus valgus angles; subtalar joint width; and calcaneal volume overlap ratio with the preoperative design. All patients had been followed up and their American Orthopedic Foot and Ankle Score (AOFAS) score was available.Results: Mean intraoperative fluoroscopy time was 3.95±1.78 h; IFAU in 16 patients (16 feet) was the same as the preoperative plan; mean surgery time was 28.16±10.70 min; and none of the patients developed complications. Böhler, Gissane, and calcaneus valgus angles and subtalar joint width did not differ between pre- and postoperative plans; however, the actual preoperative values of each of these parameters differed significantly from those measured postoperatively. The calcaneal volume overlap ratio with the preoperative design was 91.2%±2.3%. AOFAS scores increased with time, with significant differences in the score at each time point.Conclusions: The newly developed PSI-assisted calcaneal fracture MIIF method can rapidly and accurately execute the preoperative plan.

scholarly journals Pneumatosis Cystoides Intestinalis: An Unusual Cause of Intestinal Ischemia and Pneumoperitoneum

2015 ◽  
Vol 100 (2) ◽  
pp. 221-224 ◽  
Author(s):  
Hayri Ogul ◽  
Berhan Pirimoglu ◽  
Abdullah Kisaoglu ◽  
Leyla Karaca ◽  
Nuri Havan ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Multidetector Computed Tomography ◽  
Intestinal Ischemia ◽  
Plain Film ◽  
Intestinal Wall ◽  
Pneumatosis Cystoides Intestinalis ◽  
Unknown Etiology ◽  
Computed Tomography Imaging ◽  
Free Air ◽  
Uncommon Disease

Pneumatosis cystoides intestinalis (PCI), with an unknown etiology, is an uncommon disease characterized by the presence of multiple gas-filled cysts within the submucosa or subserosa of the intestinal wall. Intestinal obstruction and/or perforation are relatively uncommon complications associated with PCI. The patients are often prone to misdiagnosis or mistreatment. The diagnosis of PCI is based on plain radiography or endoscopy. Multidetector computed tomography (MDCT) provides data on other intra-abdominal pathologies. Therefore, it is an important modality for the diagnosis of PCI. We present a case of PCI in a 58-year-old man affected by peritoneal free air with multidetector computed tomography imaging findings. We performed the plain film of the abdomen, and MDCT studies that showed numerous, diffuse, bubble-like intramural gas collections into the jejunum, ileum, and colon walls at the left-upper quadrant of the abdomen. MDCT findings were confirmed by surgical exploration.

scholarly journals 2005 to 2014 CT and MRI Utilization Trends in the Context of a Nondenial Prior Authorization Program

2017 ◽  
Vol 4 ◽  
pp. 233339281773201 ◽  
Author(s):  
Adam C. Powell ◽  
David C. Levin ◽  
Erin M. Kren ◽  
Roy A. Beveridge ◽  
James W. Long ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Initial Level ◽  
Plain Film ◽  
High Tech ◽  
Prior Authorization ◽  
Imaging Utilization ◽  
Ct Utilization ◽  
Long Term Trends ◽  
Magnetic Resonance Imaging Mri ◽  
Ct And Mri

Purpose: Reducing unnecessary testing may benefit patients, as some computed tomography (CT) and magnetic resonance imaging (MRI) expose patients to contrast, and all CTs expose patients to radiation. This observational study with historical controls assessed shifts in CT and MRI utilization over a 9-year period after a private health insurer’s implementation of a nondenial, consultative prior authorization program. Methods/Materials: Normalized rates of exams per 1000 person-years were plotted over 2005 to 2014 for people with commercial and Medicare Advantage health plans in the San Antonio market, with 2005 utilization set as the baseline. The program was implemented at the start of 2006. Computed tomography and MRI utilization changes were compared with contemporaneous changes in low-tech plain film and ultrasound utilization. Results: Growth in high-tech imaging utilization decelerated or reversed during the period. In 2006, CT utilization dropped to between 76% and 90% of what it had been in 2005, depending on the plan. In 2014, it was between 52% and 88% of its initial level. MRI utilization declined to between 86% and 94% of its initial level in 2006, and then to between 50% and 75% in 2014. Ultrasound utilization was greater in 2014 than in 2005 for some plans. Plain film utilization declined between 2005 and 2014 for all plans. Conclusion: There was an immediate and sustained decline in CT and MRI utilization after the introduction of the program. While many factors may have impacted the long-term trends, the mixed trends in low-tech imaging suggest that a decline in low-tech imaging was not responsible for the decline in CT and MRI utilization.

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