Anterior Angle Research Articles

Radiographic Outcome Following Treatment of Residual Hip Dysplasia with Pemberton Versus Salter Osteotomy

Background: Salter osteotomy (SO) and Pemberton acetabuloplasty (PA) are procedures to treat skeletally immature patients with developmental dysplasia of the hip (DDH). The purpose of this study was to compare the radiographic results and rate of residual dysplasia (RD) after treatment with SO and with PA. Methods: This was a retrospective analysis of pediatric patients treated with either SO or PA for DDH between 1980 and 2013 who were skeletally mature at the time of follow-up. The preoperative and postoperative acetabular index (AI) and postoperative lateral center-edge angle (LCEA) and anterior center-edge angle (ACEA) were collected. RD was defined as an LCEA or ACEA of <20° or an acetabular inclination (AIn) of >15° at skeletal maturity. Continuous variables were compared between treatment groups with 2-sample t tests, and categorical variables were compared using chi-square tests. Multivariable analysis was used to identify risk factors for RD with p < 0.05. Results: The study included 113 hips in 102 patients with a mean follow-up of 10.5 years. The SO group had 73 hips treated at a mean patient age of 5.4 years, and the PA group had 40 hips treated at a mean age of 5.3 years. The preoperative AI did not differ between the treatment groups (32.2° versus 31.3°, p = 0.658), nor did the immediate postoperative AI (20.0° versus 20.2°, p = 0.459). At the time of final follow-up, the SO group had a significantly smaller AIn (8.6° versus 13.2°, p = 0.001), a trend toward a greater LCEA (26.2° versus 21.6°, p = 0.056), and a similar ACEA (24.1° versus 26.1°, p = 0.808). By the abovementioned definition, 36 hips (31.9%) had evidence of RD, with a lower rate in the SO group (26.0% versus 42.5%, p = 0.07). Patients who had a positive family history of hip dysplasia were more likely to have RD (odds ratio = 4.311, 95% confidence interval = 1.125 to 16.528). Conclusions: Patients with RD could be effectively treated with either SO or PA, with overall good radiographic outcomes. However, SO achieved a better AI and may thus yield better long-term health of the affected hip. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Morphology of Nasal Septal Deviation in Obstructive Sleep Apnea Patients and its Treatment Method.

Nasal septal deviation can cause nasal breathing issues, contribute to obstructive sleep apnea (OSA) development, and often hinders successful CPAP therapy. We hypothesized that although prevalent in the general population, nasal septal deviations differ structurally between OSA and non-OSA patients. This study evaluated nasal septal deviation morphology in OSA versus non-OSA patients using computed tomography (CT). We consecutively enrolled 128 adult patients undergoing septoplasty for nasal obstruction between April and September 2019. Seven with trauma/surgery history were excluded. Polysomnography was performed preoperatively for those with significant sleep complaints. Using identical preoperative sinus CTs routines, we measured anterior, superior, and posterior deviation angles, comparing OSA and non-OSA groups. We studied 121 septoplasty patients (37 females, 84 males, mean age 45.73 ± 1.29 years), with 34 OSA and 87 non-OSA. Anterior deviation angle was significantly greater in OSA (mean 9.1 ± 0.7°) versus non-OSA (mean 6.5 ± 0.5°) groups (p = 0.001). However, no significant superior or posterior deviation differences existed between groups (p = 0.266 and 0.231, respectively). Multiple logistic regression showed anterior deviation as the only significant independent OSA predictive factor. Among the nasal septal deviations, only the anterior deviation was associated with the presence of OSA. Thus, the selection of a surgical technique for anterior deviation is an important consideration in patients with OSA. 3 Laryngoscope, 2024.

Establishment and validation of a prediction model for the outcome of rheumatic mitral valve repair surgery based on transthoracic echocardiography

Abstract Background The outcome of mitral valve repair over replacement in degenerative diseases has been recognized, but the patient selection of mitral valve repair in rheumatic diseases are still controversial. At present, there is a lack of comprehensive evaluation methods for rheumatic mitral valve disease, which cannot guide the selection of patients before surgery. Purpose The aim of this study was to establish a comprehensive evaluation method and innovative indicators for rheumatic mitral valve disease using transthoracic echocardiography, and to establish a model for predicting the outcome of rheumatic mitral valve repair. Methods This prospective, multicenter, observational cohort study included 167 patients who underwent rheumatic mitral valve surgery in 4 centers from 2022 to 2023. Each enrolled patient underwent a comprehensive transthoracic echocardiography evaluation and measured 94 ultrasound indicators, mainly covering leaflets, annulus, subvalvular apparatus, and atrial and ventricular function. The main endpoint event was the failure of mitral valve repair (including switching to replacement after repair, and moderate to severe stenosis or regurgitation during follow-up after repair). Patients were randomly assigned to the modeling and validation groups at a ratio of 7:3. In the modeling group, LASSO regression was used for variable selection, and logistic regression was used for modeling. A nomogram was drawn and a webpage rating calculator was created. In the validation group, model comparisons were conducted using the C-statistic and Net Reclassification Index (NRI). Results 112 patients (67.1%) underwent mitral valve repair with satisfactory results, 47 patients (28.1%) ultimately underwent mitral valve replacement, and 8 patients (4.8%) found moderate to severe mitral stenosis or regurgitation during follow-up after repair. Three indicators, including mitral valve orifice area, leaflet calcification score, and anterior leaflet-annulus angle, were selected through LASSO regression. No collinearity was found between the three indicators, and they were ultimately included in the logistic regression model. The C statistics in the modeling group and validation group were 0.846 and 0.958, respectively, indicating that the constructed model has satisfactory predictive ability. Compared to the Wilkins score, the proportion of correctly classified items increased by 19.8%, significantly better than the Wilkins score. Finally, a nomogram was drawn based on the model, and a web rating calculator was created to guide clinical decision-making. Conclusion This study explored a comprehensive evaluation method and innovative indicators for rheumatic mitral valve disease by transthoracic echocardiography, established and validated a model for predicting the outcome of repair surgery, and had certain guiding significance for doctors to choose suitable patients for rheumatic mitral valve repair.Validation of the predictive modelNomogram

Significance of mitral annulus apparatus morphometry in patients with persistent atrial fibrillation

Abstract Background Few data about mitral valve apparatus components deformation in patients with persistent atrial fibrillation are available. Four-dimensional transesophageal echocardiography (4DTEE) is an ideal imaging technique to evaluate the complex morphology of the mitral valve apparatus. Purpose The study aimed to find some characteristics in patients presenting with persistent atrial fibrillation and if some of them could be indicative of relapse after cardioversion. Methods The study enrolled 133 patients with persistent atrial fibrillation and mild/moderate functional mitral regurgitation (FMR) before cardioversion. 101 of the patients were at the first persistent atrial fibrillation episode, and 32 with relapse. After performing two-dimensional transthoracic echocardiography (2DTTE), the study included only patients with mild/moderate FMR. 4D TEE permitted a detailed examination of the mitral annulus and valve leaflets, using an E95 machine for acquisition and an ECHOPAC 204 for image postprocessing with mitral valve quantification (MVQ) software. The studied measured: annulus area (AA)3D, annulus perimeter (AP), antero-posterior diameter (APD), posteromedial-anterolateral diameter (PM-ALD), commissural diameter (CD), inter-trigonal distance (ITd), non-planar angle (NPa), mitral-aortic angle (MAa), and for the leaflets, morphological measured parameters were: anterior leaflet area (ALA), posterior leaflet area (PLA), anterior leaflet length (ALL), posterior leaflet length (PLL), anterior leaflet angle (ALa), posterior leaflet angle (PLa), tenting height (TH), tenting area (TA), tenting volume), closure line length (CLL). Results 1. We found significant statistic differences between mitral annulus apparatus components in patients with (32) and without relapse (101) after initial cardioversion: AA 3D: 3.12 vs. 11.65 (p=0.003), AP: 13.23 vs. 12.1 (p=0.0001), APD: 3.76 vs. 3.45 (p=0.0003), PM-ALD: 4.21vs 3.93 (p=0.004), CD:4.17 vs. 3.89 (p=0.002), ITd: 2.82 vs 2.74 (p=0.2), NPa: 158.5 vs 155.2 (p=0.09), MAa: 122 vs 120,7 (p=0.5), ALA: 5.73 vs. 5.18 (p=0.006), PLA: 7.04 vs. 6.09 (p < 0.0001), ALL: 2.19 vs. 2.07 (p=0.036), PLL: 1,73 vs. 1,6 (p=0.03), ALa: 15.31 vs. 18.82 (p=0.002), PLa: 21.38 vs. 25.31 (p=0.01), TH: 0.83 vs. 0.63 (p=0.001), TA: 1.63 vs. 1.32 (p=0.007), TV: 2.75 vs. 2.13 (p=0.007). 2. We found correlations between mitral valve leaflets area and coaptation length in atrial fibrillation patients with (ALA: r=0.72, PLA r=0.65) and without relapse. (ALA: r=0.76, PLA r=0.64). Conclusions 1. 4D TEE identified a more significant mitral annulus and leaflet remodeling in atrial fibrillation patients with relapse after initial cardioversion than in atrial fibrillation patients admitted with a first atrial fibrillation episode. 2. Mitral valve leaflets area correlated with the coaptation length. 3. Mitral annulus complex morphology in patients with atrial fibrillation could be essential in predicting relapse after initial cardioversion.Mitral annulus parameters evaluationMitral leaflets parameters evaluation

Radiographically Apparent Acetabular Sourcil Landmarks Are Created by Comparable Regions of the Pelvis With Extraarticular Bone Variably Confounding Estimates of Joint Coverage.

The severity of hip dysplasia is characterized by radiographic measurements that require user definition of the acetabular sourcil edge, a bony landmark for which the corresponding three-dimensional (3D) anatomy is not well defined in any imaging plane. To use digitally reconstructed radiographs to determine: (1) What 3D anatomy is contributing to the "acetabular sourcil" location used to make lateral center-edge angle (LCEA) and anterior center-edge angle (ACEA) measurements in standing AP and false-profile radiographic views, respectively? (2) How do intraobserver and interobserver agreement in LCEA and ACEA translate into agreement of the 3D anatomy being evaluated? (3) How distinct are regions around the acetabular rim circumference that are evaluated by LCEA and ACEA measurements on radiographs? Between January 2018 and May 2019, 72 patients were indicated for periacetabular osteotomy to treat hip dysplasia or acetabular retroversion at our institution. From these patients, a series of 10 patients were identified of the first 12 patients in 2018 who were treated with periacetabular osteotomy, excluding two with missing or low-quality clinical imaging. A second series of 10 patients was identified of the first 11 patients in 2019 who were treated with periacetabular osteotomy and concurrent hip arthroscopy, excluding one who was missing clinical imaging. Pelvis and femoral bone surface models were generated from CT scans of these two series of 10 patients. There were 15 female and five male patients, with a median patient age of 18 years (IQR 17 to 23 years), a preoperative LCEA of 22° (IQR 18° to 24°), and a preoperative ACEA of 23° (IQR 18° to 27°). Exclusion criteria included missing preoperative CT or standard clinical radiographic imaging or severe joint incongruity. To address our first study question, digitally reconstructed radiographs matching each patient's standing AP and false-profile clinical radiographs were created from the segmented CT volumes. A board-certified orthopaedic surgeon and three trained researchers measured LCEA and ACEA on the digitally reconstructed radiographs, and the selected sourcil points were projected back into coordinates in the 3D anatomic space. To address our second study question, intraobserver and interobserver agreement in radiographic coverage angles were related to variations in 3D coordinates of the selected bony anatomy. Lastly, to address our third study question, 3D locations around the acetabular rim identified as contributing to the lateral and anterior sourcil points were summarized across patients in a clockface coordinate system, and statistical analysis of the "time" separating the 3D acetabular contributions of the sourcil edges was performed. The 3D anatomy contributing to the lateral sourcil was a variable length (27 mm [IQR 15 to 34 mm]) span of the laterosuperior acetabular edges, with contributions by the anterior inferior iliac spine in 35% (7 of 20) of hips. The anterior sourcil reflected a 28-mm (IQR 25 to 31 mm) span of bone from the medial ilium (posterior-medial to the anterior-inferior iliac spine and anterior-lateral to the arcuate line) to the anterior and lateral edges of the acetabulum. Interobserver variability was good for LCEA (intraclass correlation coefficient [ICC] 0.82 to 0.83) and moderate to good for ACEA (ICC 0.73 to 0.79), whereas the agreement in identified 3D sourcil locations varied widely (ICC 0.32 to 0.95). The acetabular edge of the 3D anatomy contributing to the anterior sourcil overlapped the circumferential range of the acetabular rim contributing to the lateral sourcil. Projection of two-dimensional radiographic landmarks contributing to the diagnosis of structural hip deformity into 3D allowed for the identification of the overlapping bony anatomy contributing to radiographically visible anterior and lateral sourcil edges. This work leveraging digitally reconstructed radiographs and 3D pelvis anatomy has found that bone outside the joint contributes to the radiographic appearance of the sourcil and may variably confound estimates of joint coverage. Furthermore, the substantial overlap between the acetabular bone contributing to measurement of the LCEA and ACEA would indicate that these angles measure similar acetabular deformity, and that additional measures are needed to assess anterior coverage independent of lateral coverage.

Immediate Effects of Two Different Methods of Trunk Elastic Taping on Pelvic Inclination, Trunk Impairment, Balance, and Gait in Stroke Patients.

Background and Objectives: Stroke patients often experience changes in their pelvic tilt, trunk impairments and decreased gait and balance. While various therapeutic interventions have been attempted to improve these symptoms, there is a need for interventions that are easy to apply and reduce the physical labor of physical and occupational therapists. We aimed to investigate the immediate effects of two different methods of trunk elastic taping on the pelvic inclination, trunk impairment, balance, and gait in chronic stroke patients. Materials and Methods: We performed a single-blind randomized controlled trial involving 45 patients with chronic stroke. Participants were randomly assigned to one of three groups: forward rotation with posterior pelvic tilt taping (FRPPT, n = 14), backward rotation with posterior pelvic tilt taping (BRPPT, n = 14), or placebo taping (PT = 14). This study was conducted from December 2023 to January 2024. All the measurements were performed twice: before the intervention and immediately after the intervention. The pelvic inclination was assessed using the anterior pelvic tilt angle. The trunk impairment scale (TIS) was used to measure the trunk impairment. The balance and gait were evaluated using a force plate and walkway system. Results: The pelvic inclination was significantly different in the FRPPT and BRPPT groups compared to the PT group (p < 0.05, p < 0.001). The TIS and gait were significantly increased in the FRPPT group compared to the PT group (p < 0.05). The balance significantly improved in the FRPPT and BRPPT within groups (p < 0.05). Conclusions: Two different methods of posterior pelvic tilt taping improved the anterior pelvic tilt in chronic hemiplegic stroke patients compared with PT, and the FRPPT method also improved the trunk impairment and gait. Therefore, posterior pelvic tilt taping can be used as an intervention with immediate effect.

Comparing Multipin Clamps With Outriggers With Standard Clamps for Lower Extremity Periarticular External Fixation: Similar Radiographic and Clinical Outcomes.

Staged treatment of high-energy periarticular tibia fractures involves temporization with closed reduction and external fixation, aiming to provide early reduction and stabilization while mitigating soft-tissue complications. Various external fixator configurations exist, including those that use a "multipin" clamp capable of holding multiple pins but limiting pin placement to a single plane. The purpose of this study was to compare clinical and radiographic outcomes and associated costs of standard and multipin outrigger clamp constructs in tibial plateau and pilon fractures treated with temporary external fixation. We hypothesized that use of the multipin clamp may be associated with poorly aligned reductions and increased complication rates. A retrospective review of 100 patients with periarticular tibial plateau (AO/OTA: 41B/C) or pilon (43B/C) fracture at a Level 1 trauma center from 2014 to 2023 was conducted. Patient, injury, and complication characteristics were collected. Patients were categorized based on the external fixator clamp used: multipin (MP) or standard (S). Clinical outcomes and complication rates were assessed. Radiographic alignment was evaluated by the change in anterior and lateral distal tibial angles, and sagittal plane translation for pilon fractures, and medial and posterior proximal tibial angles for plateau fractures. 70 patients underwent standard (25 pilon, 45 plateau) and 30 multipin (10 pilon, 20 plateau) external fixation. MP and S groups showed no notable differences in demographics or injury characteristics. Both groups demonstrated comparable complication rates and radiological alignment outcomes, with no notable differences observed. MP constructs were more costly than standard systems. In this retrospective study of 100 patients, there was no difference in radiographic or clinical outcomes between the standard frame and multipin frame groups. Typical costs for the multipin frame constructs were $635 to $1249 more than the standard frame constructs.

Intraoperative estimation of natural femoral anteversion from proximal femoral osseous orientation during total hip arthroplasty

BackgroundThe purpose of this study was to elucidate the relationship between the orientation of the osseous structure of the proximal femur encountered during total hip arthroplasty (THA) and preoperative femoral anteversion (FA).MethodsThree-dimensional models were constructed using full-length lower extremity computed tomography images from a total of 80 participants. Femoral neck cutting was performed at heights of 5, 10, and 15 mm relative to the lesser trochanter. Following neck cutting, the angles formed by the anterior outer cortex and posterior outer cortex with the posterior condylar line (PCL) were defined as the anterior cortical angle (ACA) and posterior cortical angle (PCA), respectively. Univariate linear regression analysis was conducted using the remaining measurements with FA as the dependent variable.ResultsThe mean age of the participants was 60.98 ± 10.82 years (males, 60.50 ± 11.36 years; females, 61.45 ± 10.37 years) (p = 0.697). All cortical angles and FA were larger in women compared to those in men. When comparing measurements by age groups, no statistically significant differences were observed. Univariate linear regression analysis with FA as the dependent variable showed statistical significance for all cortical angles. The adjusted R2 values were 0.711 (ACA5), 0.677 (ACA10), 0.572 (ACA15), 0.493 (PCA5), 0.574 (PCA10), and 0.446 (PCA15).ConclusionNatural FA can be inferred from the anterior cortical angle (ACA) from femoral neck cutting plane observed during the THA procedure without preoperative images.Trial registrationRetrospectively registered.

Acetabular morphology variations in a Hispanic population.

Rotational abnormalities of the hip have been implicated in the etiology of diseases, such as hip dysplasia, osteoarthritis, and femoroacetabular impingement. Despite the extensive literature on hip morphology, there is a gap in knowledge regarding variations in the Hispanic population. To describe the bony anatomy variations of the acetabulum in a Hispanic population. This is a cross-sectional study. We studied 182 computed tomography (CT) images in patients aged older than 21 years, who had undergone pelvic CT for any condition, except hip fracture. Measurements of acetabular version, anterior and posterior acetabular sector angles (AASA/PASA) and horizontal acetabular sector angles (HASA) were made. Acetabular variations were then compared to weight and sex data. The mean acetabular anteversion was greater in women (P < 0.001). Women exhibited a greater PASA (P < 0.05); however, men had a greater AASA (P < 0.05). Underweight individuals had a smaller PASA (P < 0.01) and HASA (P < 0.05) than individuals with a normal weight. The Hispanic hip is morphologically similar to other populations previously reported in the literature; however, Hispanic men have less coverage of the femoral head by the posterior acetabular wall when compared to women of the same ethnicity. These abnormalities have a direct impact on management and surgical approach in patients treated for femoroacetabular impingement and hip dysplasia.

Variation of chin morphology and mandibular incisor length in different facial divergence patterns: New insights from CBCT records.

Evaluate constitutional differences in chin morphology and volume, and mandibular tooth size, between different facial divergence patterns. The sample consisted of 284 pretreatment cone beam computed tomography (CBCT) images of growing and non-growing patients who were stratified into 4 groups based on mandibular plane inclination to cranial base (SN) angle. Linear and angular measurements were made on the lateral CBCT images: mandibular lateral incisor crown (I-C) total (I-A) lengths, the distances between point D (centre of symphysis) and both incisor apex (D-A) and menton (D-Me) and between cemento-enamel junction and menton (CEJ-Me); chin width at the level of the central incisor apex (CWA) and point D (CWD); and the angles of the anterior and posterior symphyseal slopes. The volume of the symphysis was measured using a specialized 3D imaging software. Group differences and associations between parameters were gauged through the three-way ANOVA analysis. I-C, I-A, D-A, D-Me and CEJ-Me were greater in the hyperdivergent group (p < .001). CWA and CWD were wider in the hypodivergent group (p = .003). Volume of the chin and inter-slope angles were similar in all groups (p > .05). The anterior slope angle decreased with hyperdivegence (p < .005) in opposite pattern to the posterior slope angle (p < .005). Shape differences in mandibular symphysis were observed between opposite divergence patterns. Mandibular incisors were longer with hyperdivergence and shorter with hypodivergence. However, chin volumes were similar across divergence groups. These findings underline the role of genetic and environmental factors that impact facial growth.

Relationship between onset of trunk muscle activities and pelvic kinematics in individuals with and without chronic low back pain.

Lumbopelvic movement patterns during prone hip extension has been proposed as a clinical screening method for trunk muscle dysfunction in patients with chronic low back pain (CLBP). However, correlations between trunk muscle onset and pelvic kinematics have not been investigated. To examine the correlation between trunk muscle onset and pelvic kinematics during prone hip extension in participants with CLBP. Fifteen patients with CLBP and 15 healthy individuals participated. We evaluated the muscle activities of the lumbar multifidus, the longissimus, and the semitendinosus via electromyogram and the displacement angles of the pelvic tilt, oblique and rotation. The onset of the multifidus at the ipsilateral side of hip extension was significantly delayed in the patients with CLBP compared to the control group (P< 0.001). The onset of the ipsilateral multifidus in the control group was significantly correlated with increased anterior pelvic tilt angle (P= 0.019, r= 0.597), whereas no significant correlation was observed in the CLBP group (P= 0.810, r=-0.068). The results suggest that pelvic kinematics during prone hip extension does not predict the delayed trunk muscle onset in patients with CLBP.

Related factors of severe osteoporotic vertebral compression fracture and clinical outcomes of percutaneous kyphoplasty: A retrospective study.

Osteoporosis is the most common disease in postmenopausal women and the elderly, which can lead to vertebral compression fracture. To investigate the related factors of severe osteoporotic vertebral compression fracture (SOVCF) and evaluate the long-term outcomes of percutaneous kyphoplasty (PKP) for treating SOVCF through comparison with mild OVCF (MOVCF). From September 2015 to March 2019, 294 osteoporotic vertebral compression fracture (OVCF) patients treated with PKP were analyzed. Compression of the anterior margin of the fractured vertebral body beyond 2/3 of the original height was defined as SOVCF. Baseline data, clinical and imaging findings before and after surgery and at the last follow-up were recorded. Numerical Rating Scale (NRS) was used to evaluate low back pain, the Oswestry Disability Index (ODI) was used to evaluate activity of daily life. Anterior vertebral height (AVH) and local kyphosis angle (LKA) was used to evaluate radiographic outcomes. During the follow-up, patients with recurrent back pain were examined by MRI to identify new fractures and the incidence of adjacent vertebral fracture (AVF) was recorded. Age, sex, body mass index (BMI), dual energy X-ray absorptiometry based T value, duration of symptom, history of trauma, steroid use, and fracture site were collected for univariate logistic regression analysis Variables with a P-value of less than 0.05 were then included in multivariate analysis to determine the related factors for SOVCF. Logistic regression analysis indicated that longer duration of symptom (OR = 1.109, 95%CI: 1.038-1.185, P= 0.002), lower T value (OR = 0.332, 95%CI: 0.139-0.763, P= 0.001), and steroid use (OR = 31.294, 95%CI: 1.020-960.449, P= 0.049) were related factors of SOVCF. Compared with the MOVCF group, the SOVCF group had longer operation time (57.3 ± 13.51 minutes vs 44.9 ± 8.13 minutes, P< 0.001), more radiation exposure (39.9 ± 7.98 times vs 25.5 ± 4.01 times, P< 0.001), and higher cement leakage rate (55.81% vs 18.73%, P< 0.001). At the last follow-up, the SOVCF group had higher NRS (2.28 ± 0.85 vs 1.30 ± 0.71, P< 0.001), and ODI (16.23 ± 4.43 vs 12.88 ± 3.34, P< 0.001). After operation and at the last follow-up, the SOVCF group had higher LKA and lower AVH (all P< 0.05). The AVF rate at the last follow-up was higher in the SOVCF group at the last follow-up (4.78% vs 18.60%, P< 0.001). Lower T value, longer duration of disease, and steroid use were related factors of SOVCF. Compared with MOVCF, PKP for SOVCF had longer operation time, more radiation exposure, and higher cement leakage rate, and the long-term outcomes were worsen.

Longitudinal observation of distal tibial degeneration in varus ankle osteoarthritis using plain radiograph

BackgroundThis study aimed to explore the natural history of distal tibial deformity in varus ankle osteoarthritis and to identify risk factors for its progression. MethodsThis retrospective longitudinal observational study included 97 ankles with moderate to severe varus ankle osteoarthritis, monitored for > 2 years. Radiographic assessments were conducted on weightbearing plain radiographs at the initial and final visit. ResultsSignificant tibial anterior surface angle reduction (p = 0.008), talus center medial migration (p = 0.038), and tibial lateral surface angle increase (p = 0.034) occurred. Multiple logistic analysis revealed an association between progression and coronal talar tilt angle at the first visit (odds ratio 1.17, p = 0.015) ConclusionThe progression of radiographic distal tibial deformity in varus ankle osteoarthritis was clarified, identifying the coronal talar tilt angle as a risk factor. Level of EvidenceLevel IV, retrospective longitudinal observation study

Computed tomography angiography-guided analysis of morphologic properties of the thoracic aorta and arch branches among the adult population: A cross-sectional study.

Before performing any surgical or endovascular procedure, the anatomical classification of the patient is essential for treatment planning. Computed Tomographic Angiography (CTA) is a standard method to evaluate thoracic aortic anatomy and associated variations. This cross-sectional, descriptive study was performed among adult participants without any peripheral vascular diseases undergoing thoracic CTA. Demographic data were collected along with factors retrieved from the patients CTA, such as the type of aortic arch, length, and diameter of ascending and descending aorta, the diameter of the main branches and the distance between branches, the angles by which the main arteries rise from their origins, and left anterior oblique angle of the aortic arch. 164 patients, with a mean age of 57 ± 19.3 years, entered the study. 53 (33.8%) had a bovine arch, which was mostly observed among males. A decrease in the frequency of type I arch and also an increase in the frequency of type 2 and 3 arches was observed with the increase in age (p < 0.001). The BCT diameter had a direct association with both left common carotid artery diameter (r = 0.478, p < 0.001) and left subclavian artery diameter (r = 0.470, p < 0.001). The length of the descending aorta had a direct correlation (r = 0.294, p < 0.001) with the length of the ascending aorta. Complex endovascular interventions are vital method in treating aorta, head, and neck pathologies. Accurate knowledge of thoracic aortic anatomy is becoming crucial for diagnosis and intervention planning.

Retrospective analysis of ideal needle puncture angles and depths for temporomandibular joint arthrocentesis using CBCT data

BackgroundThis study aimed to investigate the range of angles and depths necessary for effective entry into the TMJ using CBCT images, focusing on classical Holmlund Hellsing points and a two-needle approach.MethodsA retrospective cohort of CBCT images from January 2020 to November 2023 was analysed using 3D analysis to determine the variance in the required angles and depths.ResultsThe average age of the 68 participants included in the study was 29.5 ± 11.1, 58.8% of the participants were female and 41.2% were male. The anterior needle measurements showed a relatively low standard deviation(SD) in depth(SD:3.6) with a low variance coefficient(12.5%), whereas the axial and coronal angles exhibited greater variability(SD:9.1 and 7.6, respectively). For the posterior needles, moderate SDs in depth(SD:3.5) and greater variabilities in axial and coronal angles(SD:9.6 and 5.3, respectively) were observed. A weak negative correlation was observed between the axial angle of the posterior needle and age(p: 0.028, Pearson r: -0.29) Anterior needle depth (p:0.037) and posterior needle axial angle(p:0.014) were greater in males than females. The anterior needle depth in patients with temporamandibular disease was greater than in those without(p:0,03).ConclusionThere were significant differences in the angle measurements for both anterior and posterior needles, but lower variance in depth. The depths and angles of the needles did not correlate with age.

Lens height paraments comparison according to ciliary sulcus width (CSW): a pilot study of the predictive role of CLR and STSL for vault after ICL implantation

BackgroundTo assess the relationship between postoperative implantable collamer lens (ICL) vault and lens height obtained from two different measurements.MethodsA retrospective case series study enrolled eyes with horizontally implanted ICL. Crystal lens rise (CLR) and the distance between STS plane and anterior crystalline lens surface (STSL) were measured in the horizontal and vertical directions using ultrasound biomicroscopy (UBM). We compared the differences in the parameters measured in both horizontal and vertical directions. The participants were categorized into three groups according to ciliary sulcus width (CSW) which is defined as the distance between the posterior angle of the iris and the anterior angle of the ciliary process: narrow CSW group (NSG); medium CSW group (MSG); and wide CSW group (WSG). The correlations between CLR/STSL and vault were examined in each of the three groups. Biased correlation analysis was used further to contrast the correlation between CLR/STSL and vault.ResultsThis retrospective study included 223 myopic eyes. Vertical STSL (VSTSL) and vertical CLR (VCLR) exhibited significantly greater values compared to their horizontal counterparts (both P < 0.05). None of the indicators were statistically different between the three groups. In both NSG and MSG, STSL/CLR correlated with vault, while in WSG, only STSL correlated with vault (r=-0.316, P = 0.013). In contrast to HCLR, the correlation between HSTSL and vault remained after controlling for HCLR (r=-0.162, P = 0.015).ConclusionsSTSL should deserve more attention in the preoperative evaluation of ICL compared to CLR especially when CSW is large.

Joint Preservation Surgery Using Supramalleolar Osteotomy Combined with Posterior Tibial Tendon Release and Lateral Ligament Augmentation in Advanced Varus Ankle Arthritis.

Background: Recent studies utilizing weight-bearing computed tomography have identified abnormal internal rotation of the talus in advanced varus ankle arthritis (VAA) with a large talar tilt (TT), influenced by the posterior tibial tendon (PTT). This study aimed to evaluate the clinical and radiographic results of supramalleolar osteotomy (SMO) combined with PTT release and lateral ligament augmentation for VAA with a large TT. Methods: From January 2015 to September 2018, 15 patients with VAA and a large TT (greater than 5°) underwent SMO combined with PTT release. Clinical results, including visual analog scale (VAS) for pain, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and ankle osteoarthritis scale (AOS), were assessed. Radiographic results were assessed with various parameters, including medial distal tibial angle (MDTA), anterior distal tibial angle (ADTA), talar tilt (TT), talus center migration (TCM), Meary angle, hindfoot alignment angle (HAA), and hindfoot moment arm (HMA) on foot and ankle weight-bearing radiographs. Clinical and radiographic results were evaluated preoperatively and at the last follow-up. Results: VAS, AOFAS ankle-hindfoot score, and AOS improved significantly from 7.5, 54.4, and 72.6 preoperatively to 3.1, 82.5, and 34.5 postoperatively, respectively. All radiographic parameters exhibited significant changes postoperatively, with the exception of the Meary angle, which demonstrated no significant change. Four patients exhibited improvement in radiographic stage postoperatively; however, average radiographic stage did not significantly improve postoperatively in all patients. One patient progressed to end-stage arthritis postoperatively, necessitating additional ankle arthrodesis. Conclusions: In conclusion, lengthening and lateral ligament augmentation combined with bony realignment procedures may be a reasonable option for treating VAA with a large TT greater that 5°.

Flexible Nasal Tip Produced by Slender Septal Extension Graft.

Septal extension grafts (SEGs) can increase projection. However, it requires a large amount of graft and can result in a frozen tip. Thus, this study introduces a modified SEG, called a partial SEG. Partial SEGs minimize the amount of graft material requirement, avoid the occurrence of frozen tips, and increase nasal tip projection. This method is comparable to the fixed-mobile SEG (Rohrich et al. in Plast Reconstr Surg 149: 1350-1356, 2022) and anterior nasal septal angle (ANSA) banner (Neves and Tagle in Ann Plast Reconstr Surg 4(3): 1059, 2020); however, unlike those techniques, the tip is not sutured to the graft and the alar complex is not fixed, allowing free movement of the nasal tip within its anatomical limits. To further prevent long-term displacement or minimize loss of nasal tip projection, a method of fixing the graft with Prolene and a third end-to-end SEG method for preventing sliding between grafts were used, which was also effective. Among the patients who underwent surgery between September 2019 and September 2023, 238 were followed up for over 6 months. Most patients were satisfied with the natural and flexible nature of the nasal tip. In conclusion, the alar wrap around a slender SEG technique can be an option for who want a flexible nasal tip that is projected adequately rather than excessively.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Modeling of reinforced-concrete cutting with shield rippers using FEM-DEM-coupling method

With the increase in the number of underground structures, it is common to encounter reinforced concrete (RC) pile foundations of existing buildings or bridges during shield machine tunneling in densely constructed urban areas. The cutting of RC piles with the shield machines is a challenging task due to cutter damage and cutting efficiency issues. In this paper, the interaction between a ripper and an RC was studied based on the FEM-DEM coupling method. A three-dimensional transient dynamic model of two typical rippers (angular ripper and curved ripper) cutting RC piles was established, respectively. In the FEM-DEM coupling model, the mechanical behavior of concrete was described via DEM, and the impact of steel bars in concrete was considered via FEM. In addition, an experimental verification was conducted to validate the effectiveness of the numerical results. The damage characteristics of the steel bars and concrete, and the force patterns of the rippers were analyzed. The influence of the geometric parameters of the ripper, including blade width, blade angle, and blade anterior angle on the cutting performance was also investigated through a parametric study. Some recommendations are made for the geometric design of rippers used for cutting reinforced concrete. The results of this study could provide some references for cutting RC obstacles with a shield machine.

False-Profile Radiograph Sourcil-Edge and Bone-Edge Measurements Correlate to Different Weightbearing Regions of the Acetabulum: A 3-Dimensional Analysis

Background: The acetabular sourcil is commonly interpreted as a reliable radiographic representation of the weightbearing dome of the acetabulum, despite limited modern data. Assessment of weightbearing acetabular coverage has been described using both the sourcil edge and bone edge as anatomic landmarks, leading to confusion and potential misguidance in surgical decision-making and thus compromised patient outcomes. Purpose/Hypothesis: The purpose of this study was to characterize the 3-dimensional (3D) anatomic correlates of the sourcil-edge and bone-edge radiographic measurements on false-profile radiographs. It was hypothesized that the sourcil edge would represent anterolateral coverage and the bone edge would represent anterior coverage. Study Design: Descriptive laboratory study. Methods: A total of 80 hips were grouped by large or small differences between bone-edge and sourcil-edge anterior center-edge angles, based on upper and lower quartiles of discrepancy. Three-dimensional surface mesh models and digitally reconstructed radiographs were generated from hip computed tomography scans. Sourcil-edge and bone-edge anterior center-edge angles were identified on digitally reconstructed radiographs and registered to the 3D models with fiducial markers. Intersections of bone-edge and sourcil-edge projection lines with the acetabular rim were obtained from the 3D models. Results: The bone-edge and sourcil-edge projections intersected the acetabular rim at clockface means of 2:05 ± 0:22 and 1:12 ± 0:25, respectively. The 3D models consistently demonstrated that, in both large- and small-discrepancy groups, the sourcil edge corresponded to the acetabular area just posterior to the anterior inferior iliac spine (AIIS) projection, and the bone edge corresponded to the weightbearing region inferior to the AIIS. Additionally, in large-discrepancy hips, the bone edge corresponded to more prominent acetabular coverage in the region inferomedial to the AIIS when compared with the small-discrepancy hips. Conclusion: On false-profile radiographs, the sourcil edge corresponds to superior femoral head coverage, and the bone edge corresponds to anterosuperior coverage. Radiographs with a large discrepancy between sourcil-edge and bone-edge measurements demonstrate acetabular rim prominence in the region of the AIIS. Clinical Relevance: Characterizing the anatomic weightbearing regions of the acetabulum represented on false-profile radiographs facilitates improved clinical and intraoperative decision-making in hip preservation surgery, including acetabuloplasty and periacetabular osteotomy.