Sacral Curvature in Addition to Sacral Ratio to Assess Sacral Development and the Association With the Type of Anorectal Malformations

Introduction: Sacral ratio (SR) is currently the only measurement to quantitatively evaluate sacral development in patients with anorectal malformations (ARM). This study proposes sacral curvature (SC) as a new indicator to qualitatively assess the sacrum and hypothesizes that sacral development, both quantitatively and qualitatively, can be an indicator to predict the type of ARM. The study aims to investigate the difference of SR and SC between ARM types and the association with the type of ARM.Methods and Materials: This study was retrospectively conducted between August 2008 and April 2019. Male patients with ARMs were enrolled and divided into three groups based on the types of ARM: (1) rectoperineal fistulae, (2) rectourethral-bulbar fistulae, and (3) rectourethral-prostatic or rectobladder-neck fistulae. SC was measured in the sagittal views of an MRI or a lateral radiograph of the sacrum.Results: Included in the study were 316 male patients with ARMs. SRs were 0.73 ± 0.12, 0.65 ± 0.12, and 0.57 ± 0.12 in perineal, bulbar, and prostatic/bladderneck fistula, respectively (p < 0.01). The SCs in perineal fistulae and bulbar fistulae were significantly higher than that in prostatic/bladderneck fistulae (0.25 ± 0.04, 0.22 ± 0.14, and 0.14 ± 0.18, p < 0.01). When SR ≥ 0.779, there was an 89.9% of possibility that the child has a perineal fistula. When SR ≤ 0.490 and SC ≤ 0, the possibilities of the child having prostatic/bladderneck fistulae were 91.6 and 89.5%, respectively. SC < 0 was also noted in 27 (27.8%), 19 (10.5%), and no (0%) patients of prostatic/bladderneck, bulbar, and perineal fistulae (p < 0.01), respectively. Sacral defect was noted in 63% of patients with SC ≤ 0, compared to none with SC > 0 (p < 0.01).Conclusions: The higher the rectal level is in an ARM, the lower are the objective measurements of the sacrum. SC ≤ 0 is associated with sacral defects and implies a high likelihood of prostatic/bladderneck fistulae.

Marker-3D Measurement Versus Traditional Radiograph Measurement in the Treatment of Tibiofibular Fracture Using Taylor Spatial Frame

Background: The Taylor Spatial Frame (TSF) has been widely used for tibiofibular fractures. However, traditional radiograph measurement method is complicated and the reduction accuracy is not high enough for correcting residual deformities. We proposed the marker-3D measurement method to solve these problems. This study aimed to compare the reduction accuracy of the traditional radiograph measurement method and the marker-3D measurement method in tibiofibular fracture treated with TSF.Methods: From January 2016 to June 2019, A retrospective analysis was performed based on the patients with tibiofibular fracture treated with TSF in our department. 41 patients were qualified for this study, including 21 patients in the marker-3D measurement group (experimental group) and 20 patients in the traditional radiograph measurement group (control group). In the experimental group, CT scan was performed for 3D reconstruction with 6 markers installed on the TSF, to determine the adjusting plan. In the control group, the anteroposterior (AP) and lateral radiographs were performed for the deformity parameters. X-rays were taken to measure the residual deformities after correction.Results: All patients reached functional reduction. The residual displacement deformity (RDD) in AP radiograph was 0.5 (0, 1.72) mm in experimental group and 1.74 (0.43, 3.67) mm in control group. The residual angle deformity (RAD) in AP radiograph was 0 (0, 1.25) ° in experimental group and 1.25 (0.62, 1.95) °in control group. As to the Lateral radiograph, the RDD was 0 (0, 1.22) mm in experimental group and 2.02 (0, 3.74) mm in control group. The RAD was 0 (0, 0) ° in experimental group and 1.42 (0, 1.93) ° in control group. Significant differences in all above comparisons were found between the groups (AP radiograph RDD: P = 0.024, RAD: P = 0.020; Lateral radiograph RDD: P = 0.016, RAD: P = 0.004). Conclusions: Both groups achieved satisfactory fracture reduction. However, the residual deformities in the experimental group were significantly smaller. This study proved that the marker-3D measurement method could further improve the reduction accuracy.

Dislocations of the second and third metatarsophalangeal joints after local steroid injection in patients with refractory metatarsalgia: A case report

Local steroid injections are frequently administered to patients with refractory metatarsalgia. No reports have described dislocation of the second and third metatarsophalangeal joints after local steroid injections. A 46-year-old woman had suffered from metatarsalgia and received multiple local steroid injections for over 2 years. The second and third metatarsophalangeal joints revealed dorsal dislocations on the lateral radiograph. Therefore, collateral ligament reconstruction of the metatarsophalangeal joints was performed. Intraoperative findings suggested that the rupture of the plantar plate may have caused dorsal dislocation of both joints. Thus, unnecessary multiple steroid injections around the lesser metatarsophalangeal joint should be avoided.

Thoracic Reciprocal Change Can Be Predicted Before Surgery in Adult Spinal Deformity

Study Design: Retrospective cohort study. Objective: Analysis of postoperative sagittal alignment of the unfused spine is lacking in patients with adult spinal deformity (ASD). The present study aims to evaluate the efficacy of the whole spine full-flexion lateral radiograph to predict the reciprocal change of the unfused spine after correction surgery. We hypothesized that the novel parameter (T1-UIV angle: angle between the upper vertebral endplate of the T1 and the upper vertebral endplate of the upper instrumented vertebra) of the preoperative whole spine full-flexion lateral radiograph is similar to that of the postoperative lateral radiograph if the patient has the ideal sagittal alignment. Methods: Twenty-six ASD patients who underwent correction surgery with a minimum 2-year follow-up were enrolled and separated into the Ideal and Non-Ideal groups according to the Scoliosis Research Society (SRS)-Schwab classification of the final follow-up radiograph. Radiographic parameters, including T1-UIV of the preoperative whole spine full-flexion lateral radiograph, were obtained. Results: Thirteen patients were included in the Ideal group and 13 were in Non-Ideal group. Preoperative T1-UIV of the whole spine full-flexion lateral radiograph exhibited significant correlations with the T1-UIV angles of the postoperative and final follow-up radiographs ( r = 0.64, P < .01, y = 0.800 x + 8.012, and r = 0.69, P < .01, y = 0.857 x + 2.960, respectively). Interestingly, this correlation was stronger for the Ideal group ( r = 0.77, P < .01, y = 1.207 x − 1.517, and r = 0.89, P < .01, y = 0.986 x + 0.694, respectively). Conclusion: A novel radiographic strategy (T1-UIV of preoperative the whole spine full-flexion lateral radiograph) could estimate the postoperative alignment of the unfused spine correctly.

Comparing of the reduction accuracy of marker-3D measurement method and traditional radiograph measurement method in the treatment of patients with tibia fracture treated with Taylor Spatial Frame: a retrospective study

Background The Taylor Spatial Frame (TSF) has been widely used on tibia fractures. However, traditional radiograph measurement method is complicated and the reduction accuracy is not high enough for correcting residual deformities. We proposed the marker-3D measurement method to solve these problems. This study aimed to compare the reduction accuracy of the traditional radiograph measurement method and the marker-3D measurement method in tibia fracture treated with TSF. Methods From January 2016 to June 2019, A retrospective analysis was performed based on the patients with tibia fracture treated with TSF in Tianjin Hospital. Forty-one patients were qualified for this study, including 21 patients in the marker-3D measurement group (experimental group) and 20 patients in the traditional radiograph measurement group (control group). In the experimental group, CT scan was performed for 3D reconstruction with 6 markers installed on the TSF, to determine the adjusting plan; in the control group, the Anteroposterior (AP) and Lateral radiographs were performed for the deformity parameters. All fractures were corrected after TSF adjusting, and then X-rays were taken to measure the residual deformities. Results All patients reached functional reduction. The residual displacement deformity (RDD) in AP radiograph was 0.5 (0, 1.72) mm in experimental group and 1.74 (0.43, 3.67) mm in control group; the residual angle deformity (RAD) in AP radiograph was 0 (0, 1.25) ° in experimental group and 1.25 (0.62, 1.95) °in control group. As to the Lateral radiograph, the RDD was 0 (0, 1.22) mm in experimental group and 2.02 (0, 3.74) mm in control group; the RAD was 0 (0, 0) ° in experimental group and 1.42 (0, 1.93) ° in control group. Significant differences in all above comparisons were found between the groups (AP radiograph RDD: P = 0.024, RAD: P = 0.020; Lateral radiograph RDD: P = 0.016, RAD: P = 0.004). Conclusion Both groups achieved satisfactory fracture reduction. However, the residual deformities in the experimental group were significantly smaller. This study proved that the marker-3D measurement method could further improve the accuracy of the reduction.

A new reference to evaluate the collapse of the posterior facet in displaced intra-articular calcaneal fractures

BackgroundWe proposed a new method to evaluate the height of the posterior articular surface in displaced intra-articular calcaneal fractures (DIACFs) by drawing two lines on the lateral radiograph of hindfoot: one line was drawn from the apex of the posterior facet to the apex of the posterior tuberosity (the apex line), and the other line was drawn from the apex of the anterior process to the posterior process (the anterior posterior process line). The aim of this study was to analyze the relationship between these two lines in normal calcanei and their changes in DIACFs.MethodsLateral radiographs of normal calcanei and DIACFs between January 2018 and February 2020 were collected. We draw two lines on the lateral radiograph, one line was the apex line and the other line was the anterior posterior process line. The value of the angle formed by these two lines was recorded, if these two lines were parallel to each other, the angle was recorded as 0°. if these two lines formed an angle anteriorly this was recorded as positive, and if these two lines formed an angle behind the calcaneum this was recorded as negative.ResultsIn 135 normal calcanei lateral radiographs, the minimum angle was − 8°, and the maximum angle was 6°, with an average angle of -1 ± 3°. In 145 DIACFs, the minimum angle was 6°; the maximum angle was 37°, and the average angle was 17°±6°. The difference between normal calcanei and DIACFs was statistically significant (P༜.001).ConclusionThe relationship between the apex line and the anterior posterior process line on lateral radiograph can evaluate the height of the calcaneal posterior facet simply and accurately. The two lines are approximately parallel or angulated backward in the normal calcanei, in DIACFs, these two lines angulated forward.Level of Evidence: Level III-retrospective comparative study.