Intra- and juxta-articular Osteoid Osteoma in Children and Adolescents

BackgroundOsteoid osteoma (OO) is a common benign tumor in children and adolescents, but intra-and juxta-articular OO is rare and difficult to diagnose. The purpose of this study is to investigate the distinctions between intra- and juxta-articular OO, trying to avoid delaying diagnosis and optimize treatment strategies.MethodsThirty patients diagnosed with OO in the intra- and juxta joint at our institution who underwent surgical resection were included. Clinical and epidemiological factors, preoperative radiograph parameters, including CT, MRI, and bone scan, were documented. The outcomes of the involved extremity were evaluated at the final follow-up.ResultsMean age at diagnosis, interval time, and follow-up time was 8.37 ± 3.79 years old, 4.67 ± 5.88 months, 3.57 ± 2.18 years, respectively. Factors identified to be significantly associated with intra- and juxta-articular OO including pain with activity (p=0.004) and abnormal range of motion (p=0.00). The factor of abnormal range of motion (p=0.03) also influenced the existence of complications. Four children had a secondary operation to cure the recurrence.ConclusionIt is essential for clinicians and radiologists to be aware of the atypical clinical and radiographic features of intra- and juxta-articular OO, as the delayed diagnosis can lead to unnecessary pain and further complications after surgeries. The pain with activity and abnormal range of motion is helpful to identify the location of OO. The persistently abnormal range of motion also significantly leads to complications. The open surgeries to resect the nidus in juxta-articular OO were effective.Level of Evidence: Level IV-retrospective case series

A sagittal reference line using the preoperative radiograph in total knee arthroplasty

Background: We evaluated the accuracy of a sagittal alignment of tibial component in total knee arthroplasty (TKA) with the sagittal reference line using the preoperative radiograph. Methods: We evaluated 151 patients who underwent primary TKA with posterior cruciate substituting type implant. For 75 patients, the sagittal reference line using preoperative radiograph (group A) was used, while for 76 patients the sagittal reference using intraoperative fibular shaft line (group B) was used. The parallel line (line S) to the anatomical axis of the tibia in the lateral plain radiograph was used as the sagittal reference. The distance from line S to proximal tibia cutting area and to skin surface 20 cm distal to the cutting area was measured in preoperative radiographs. Next, the distance to the extramedullary guide rod was applied intraoperatively, reflecting the results. The intraoperative fibular shaft line was determined using the connecting line between the tip of fibular head and the lateral malleolus. The postoperative tibial component slope angle and the difference to the target slope angle were compared. Results: The difference to the target angle was 1.8 ± 1.3° in group A, whereas the difference was 2.5 ± 1.4° in group B ( p = 0.04). The patients with difference within 3° to the target angle were 78.7% in group A and 61.8% in group B ( p = 0.024). Conclusion: The sagittal reference line using the preoperative lateral radiograph was helpful as a reference guide for the tibial slope in TKA.

C shaped canal: Variation and Recommendations

Root canal morphology is not uniform, variations of root canals are routinely encountered by endodontists making the root canal treatment more challenging. C shaped canal is a variation commonly encountered in mandibular second molars. The main identifying feature of such canals is presence of fins or webs interconnecting with the main canals. Such canal systems require meticulous mechanical and rigorous chemical preparation to ensure desired outcome of the treatment. Proper assessment of tooth morphology, preoperative radiograph along with consideration towards racial predilection will greatly help in accurate identification of such canals pre-operatively. This paper reports a case of C shaped canal in mandibular second molar diagnosed and treated taking all the precautions and adapting necessary modifications in the steps of conventional root canal treatment steps where required thus increasing the likelihood of success.

Mandibular Canines with Two Roots and Two Root Canals: Case Report and Literature Review

Usually, the mandibular canine only has one root and one root canal. However, there has been a noticeable increment in evidence showing variations in its morphology, such as the presence of two roots and two root canals. The aim of this article was to present a case of a mandibular canine with two roots and two root canals and to review the available literature on this anatomic variation. Root canal treatment of tooth #43 with such morphology was performed in a 47-year-old woman. Careful inspection of the preoperative radiograph indicated the presence of more than one canal. The 12-month follow-up showed normal periapical tissues, with no pain or tenderness. Literature review revealed that the overall prevalence of such root canal configuration is 5.7%, with a strong preference for female sex (87.5%). Although mandibular canines with two roots and two root canals are not common, clinicians should always anticipate the presence of possible variations. Therefore, timely diagnosis and meticulous exploration of such mandibular canines allow for planning of an individualized treatment protocol, tailored to their peculiar morphology, focused on avoiding excessive weakening or even perforation of the roots.

Endodontic therapy of a mandibular premolar with three root canals: Two case reports

The most important requirements for successful endodontic treatment are accurate diagnosis and good knowledge of canal morphology. A mandibular second premolars rarely have more than one root and one root canal. Data from the literature indicate low percentage of a mandibular premolars with three or more root canals. Unusual morphology of the root canal system is diagnostic and therapeutic challenge. It is very important to analyze preoperative radiograph and to explore thoroughly the entrance of the root canal. The aim of this study was to present two patients who had lower second premolars with three canals that required endodontic therapy.

Geometric implications of the tibial wedge osteotomy for the treatment of cranial cruciate ligament disease in dogs

SummaryThe tibial wedge osteotomy (TWO), a procedure that reduces the tibial plateau slope, has become an established surgical technique for the treatment of cranial cruciate ligament injuries in dogs, yet variation from the desired postoperative tibial plateau slope of 6° has been noted. The objectives of this study were to investigate the geometric implications of this procedure and to identify factors that affect the postoperative angles. The records of 35 consecutive cases that had a TWO performed were reviewed and comparisons were made between the alignment of the cortices and level of the osteotomy using duplicated tracings of a preoperative radiograph. The existing method for calculating the size of wedge to be removed was found to result in a postoperative slope greater than the expected 6°. Our results indicate that the desired postoperative angle is more likely to be achieved if the cranial cortices are aligned and the osteotomy is performed proximally.