Femoral head diameters in Nepalese patients undergoing hemiarthroplasty

<p class="abstract"><strong>Background:</strong> Sizing of the femoral head is important for determining the appropriate size of implants to be used for a patient undergoing hip arthroplasty. The present study aimed to determine the mean diameter of femoral head in Nepalese population who underwent hemiarthroplasty in our department.</p><p class="abstract"><strong>Methods:</strong> We retrospectively reviewed the medical records of patients who underwent hemiarthroplasty from December 2016 till December 2020. We included patients aged more than 50 years who underwent hemiarthroplasty. The diameter of the femoral head was measured intraoperatively using standard fully circular templates. For radiological measurements, X-ray of pelvis with hips anteroposterior view were included.<strong></strong></p><p class="abstract"><strong>Results:</strong> A total of 600 femoral heads were evaluated, 400 of women and 200 of men. Of these cases, the femoral head diameter were evaluated based on x-ray pelvis in 500 cases and rest of the 100 cases were evaluated intraoperatively. The mean age of the patients in our sample was 75.2±9.4 (range 50–90) years. Overall, the mean femoral head diameter (with intact articular cartilage) was 44.9±3.2 (range 39–53 mm) mm. Among the male patients, mean femoral head diameter was 47.7±2.8 mm, which was found to be significantly higher than that of female patients, who had a mean femoral head diameter of 43.7±2.4 mm, p value &lt;0.05.</p><p class="abstract"><strong>Conclusions:</strong> Further studies are needed in other geographical locations, so that reference values could be established for specific regions.</p>

Computational Analysis of Vertebral Body for Compression Fracture Using Texture and Shape Features

The primary goal in this paper is to automate radiological measurements of Vertebral Body (VB) in Magnetic Resonance Imaging (MRI) spinal scans. It starts by preprocessing the images, then detect and localize the VB regions, next segment and label VBs and finally classify each VB into three cases as being normal or fractured in case 1, benign or malignant in case 2 and normal, benign or malignant in case 3. The task is accomplished by extracting and combining distinct features of VB such as boundary, gray levels, shape and texture features using various Machine Learning techniques. The class balance deficit dataset towards normal and fractures is balanced by data augmentation which provides an enriched dataset for the learning system to perform precise differentiation between classes. On a clinical spine dataset, the method is tested and validated on 535 VBs for segmentation attaining an average accuracy 94.59% and on 315 VBs for classification with an average accuracy of 96.07% for case 1, 93.23% for case 2 and 92.3% for case 3.

Computational Analysis of Vertebral Body for Compression Fracture using Texture and Shape Features

The primary goal in this paper is to automate radiological measurements of Vertebral Body (VB) in Magnetic Resonance Imaging (MRI) spinal scans. It starts by preprocessing the images, then detect and localize the VB regions, next segment and label VBs and finally classify each VB into three cases as being normal or fractured in case 1, benign or malignant in case 2 and normal, benign or malignant in case 3. The task is accomplished by extracting and combining distinct features of VB such as boundary, gray levels, shape and texture features using various Machine Learning techniques. The class balance deficit dataset towards normal and fractures is balanced by data augmentation which provides an enriched dataset for the learning system to perform precise differentiation between classes. On a clinical spine dataset, the method is tested and validated on 535 VBs for segmentation attaining an average accuracy 94.59% and on 315 VBs for classification with an average accuracy of 96.07% for case 1, 93.23% for case 2 and 92.3% for case 3.

Ultrasonography for noninvasive and real-time evaluation of peri-implant soft and hard tissue: a case series

Background The diagnosis of soft and hard tissue at dental implants will be challenging in the future, as high prevalence of mucositis and peri-implantitis were described in the population. Ultrasonography is a promising non-invasive, inexpensive, painless, and radiation-free method for imaging hard and soft tissue at implants, especially an ultrasound device with a 25-MHz probe demonstrating a high correlation between ultrasound, clinical, and radiological measurements. Case presentation The following case series demonstrates the use of ultrasonography with high spatial resolution probe in patients with dental implants affected by soft tissue recession and/or crestal bone loss. Conclusion These ultrasound images can provide valuable additional information for the assessment of peri-implant soft and hard tissue.

213 Can Styloid Process and Internal Carotid Artery Anatomy Be Used to Predict Carotid Artery Dissection?

Aim Carotid artery dissection is a common cause of stroke in the young. It has been related to the association of the carotid artery with fixed neighbouring anatomical structures. This study assesses the association between styloid process length, internal carotid artery position and cervical carotid artery dissection (CCAD). This information would provide potential predicative radiological measurements, which could prevent delays in CCAD diagnosis. Method Retrospective data was collected from two central London hospitals over five years. CCAD cases were identified from individuals who underwent computer topography angiography (CTA) of the neck for suspected CCAD. The following data was collected: evidence of CCAD; bilateral styloid process length and presence of styloid-hyoid ligament calcification; bilateral styloid process-internal carotid distance; calcification of carotid arteries and whether their position was aberrant. Cases were dissection-side, age and gender matched with two non-dissection controls. Results Three hundred and fifty-five individuals were identified. Fifty individuals had CCAD, of which 4 had bilateral dissection. In individuals with CCAD, average styloid process length was 27.5mm and styloid process-internal carotid distance was 5.14mm. There was no significant association between styloid process length or styloid process-internal carotid distance, and CCAD when compared with matched controls. Internal carotid artery aberrancy was significant for non-dissection. Conclusions In this study, there was no association between styloid process length and styloid process-internal carotid distance with CCAD. These measurements cannot be used to predict the possibility of a CCAD following trauma.

Is There a Borderline Value in the Radiological Findings of Patients With Calcaneal Malunion That May Help to Select an Appropriate Treatment Option?

Background: Despite the constant evolution of technological support, operative techniques, and rehabilitation techniques after conservative treatment and operative treatment, a considerable number of patients with calcaneal fractures have constant pain, frequently resulting in loss of occupation. There are numerous options for the operative treatment of painful calcaneal malunion; however, very few publications suggest specific radiological measurements for pre- and postoperative planning—even fewer have statistically analyzed how these radiological measurements affect clinical outcomes. Methods: We performed a retrospective study of 100 patients after operative treatment of calcaneal malunion to determine the correlation between radiological measurements and clinical outcomes. Data were used to create an algorithm that would help to choose between in situ subtalar arthrodesis and complex reconstructive operations. The algorithm was then used to treat 27 prospective patients. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score and visual analog scale (VAS) were used for clinical assessment, whereas standard weightbearing anteroposterior (AP), lateral (LAT) ankle x-rays, and long axial hindfoot view were used for radiological assessment. Results: The talar declination angle was positively correlated with clinical outcome. Patients with talar declination angles less than 6.5 degrees showed worse results in AOFAS score than patients with a greater angle did (57.3 ± 15.3 and 81 ± 15.6, respectively). Conclusion: The combination of subtalar arthrodesis with distraction bone block or calcaneal osteotomy in patients with calcaneal malunion and a talar declination angle less than 6.5 degrees showed better results than isolated in situ arthrodesis. Level of Evidence Level III, retrospective cohort study, case series.

Radiogrametric Analysis of the Thoracic Limb Phalanges in Arabian Horses and Thoroughbred Horses

In this study, it was aimed to determine the statistical differences between Arabian horses and Thoroughbred horses based on X-ray images of forelimb digital bones. Latero-medial X-ray images of digital bones of thoracic limbs were taken of 25 Arabian horses and 50 Thoroughbred healthy horses. The difference between males and females within the breed was statistically analyzed as well. Nine measurements and three indexes taken from phalanges of thoracic limbs were used. Thoroughbred horses did not differ significantly between sexes, as indicated by the ANOVA. For the Arabian horses, the length of the middle of the proximal phalanx (p < 0.05), the length of the middle of the middle phalanx (p < 0.001), and the length of the dorsal surface of the distal phalanx (p < 0.05) measurement points were found to be differentiated between sexes. In the analysis made between Thoroughbred horses and Arabian horses with no respect to sex, the critical measurement was the depth of the caput of the proximal phalanx. The discriminant analysis enabled the correct classification of 89.33% of the proximal phalanx samples to the exact breed. The correct classification rate was 77.33% in the case of middle phalanx and 54.67% in the case of distal phalanx. Measurement results of the distal phalanx were found to be insignificant between both breeds and sexes. The radiological measurements of digital bones showed that sexual dimorphism was not too expressed and that decisive differences were found between the breeds.

Subsidence of a metaphyseal-anchored press-fit stem after 4-year follow-up: an EBRA-FCA analysis

Purpose Uncemented stem migration analysis by EBRA-FCA (Einzel-Bild-Roentgen Analyse, Femoral Component Analyse) has been seen to be a good predictive indicator for early implant failure. In this study, we investigated the migration behavior of a cementless metaphyseal-anchored press-fit stem after 4-year follow-up. Methods Applying a retrospective study design, we reviewed all consecutive patients who between 2012 and 2017 received a cementless Accolade II press-fit stem at our Department. We reviewed medical histories and performed radiological measurements using EBRA-FCA software. EBRA-FCA measurements and statistical investigations were performed by two independent investigators. Results A total of 102 stems in 91 patients (female 60; male 31) fulfilled our inclusion criteria. Mean age at surgery was 66.2 (range 24.3–92.6) years. EBRA migration analysis showed a mean subsidence of 1.4 mm (range 0.0–12.0) at final follow-up. The angle between stem and femur axis was 0.5° (range 0.0°–2.8°) after 48 months. No correlations between gender or Dorr types and subsidence were found (p > 0.05). A body mass index > 30 kg/m2 showed a significant increase in stem subsidence within the first 6 (p = 0.0258) and 12 months (p = 0.0466) postoperative. Conclusions Migration pattern of the metaphyseal-anchored stem and a low subsidence rate at final follow-up may predict a good long-term clinical result. Trial registration Number: 20181024-1875.

Robot-Assisted Electrode Array Insertion Becomes Available in Pediatric Cochlear Implant Recipients: First Report and an Intra-Individual Study

Background: As an advanced surgical technique to reduce trauma to the inner ear, robot-assisted electrode array (EA) insertion has been applied in adult cochlear implantation (CI) and was approved as a safe surgical procedure that could result in better outcomes. As the mastoid and temporal bones are generally smaller in children, which would increase the difficulty for robot-assisted manipulation, the clinical application of these systems for CI in children has not been reported. Given that the pediatric candidate is the main population, we aim to investigate the safety and reliability of robot-assisted techniques in pediatric cochlear implantation.Methods: Retrospective cohort study at a referral center in Shanghai including all patients of simultaneous bilateral CI with robotic assistance on one side (RobOtol® system, Collin ORL, Bagneux, France), and manual insertion on the other (same brand of EA and CI in both side), from December 2019 to June 2020. The surgical outcomes, radiological measurements (EA positioning, EA insertion depth, mastoidectomy size), and audiological outcomes (Behavior pure-tone audiometry) were evaluated.Results: Five infants (17.8 ± 13.5 months, ranging from 10 to 42 months) and an adult (39 years old) were enrolled in this study. Both perimodiolar and lateral wall EAs were included. The robot-assisted EA insertion was successfully performed in all cases, although the surgical zone in infants was about half the size in adults, and no difference was observed in mastoidectomy size between robot-assisted and manual insertion sides (p = 0.219). The insertion depths of EA with two techniques were similar (P = 0.583). The robot-assisted technique showed no scalar deviation, but scalar deviation occurred for one manually inserted pre-curved EA (16%). Early auditory performance was similar to both techniques.Conclusion: Robot-assisted technique for EA insertion is approved to be used safely and reliably in children, which is possible and potential for better scalar positioning and might improve long-term auditory outcome. Standard mastoidectomy size was enough for robot-assisted technique. This first study marks the arrival of the era of robotic CI for all ages.

O28 Can styloid process and internal carotid artery anatomy be used to predict carotid artery dissection?

Introduction Carotid artery dissection is a common cause of stroke in the young. It has been related to the association of the carotid artery with fixed neighbouring anatomical structures. This study assesses the association between styloid process length, internal carotid artery position and cervical carotid artery dissection (CCAD). This information would provide potential predicative radiological measurements, which could prevent delays in CCAD diagnosis. Method Retrospective data was collected from two central London hospitals over five years. CCAD cases were identified from individuals who underwent computer topography angiography (CTA) of the neck for suspected CCAD. The following data was collected: evidence of CCAD; bilateral styloid process length and presence of styloid-hyoid ligament calcification; bilateral styloid process-internal carotid distance; calcification of carotid arteries and whether their position was aberrant. Cases were dissection-side, age and gender matched with two non-dissection controls. Result Three hundred and fifty-five individuals were identified. Fifty individuals had CCAD, of which 4 had bilateral dissection. In individuals with CCAD, average styloid process length was 27.5 mm and styloid process-internal carotid distance was 5.14 mm. There was no significant association between styloid process length or styloid process-internal carotid distance, and CCAD when compared with matched controls. Internal carotid artery aberrancy was significant for non-dissection. Conclusion In this study, there was no association between styloid process length and styloid process-internal carotid distance with CCAD. These measurements can not be used to predict the possibility of a CCAD following trauma. Take-home Message Anatomy of the styloid process and calcification of the styloid-hyoid ligament are highly variable and many independent factors may contribute to the risk of cervical carotid artery dissection. Radiological measurements of the styloid process alone cannot be used to predict risk and likelihood of cervical carotid artery dissection.