Anteroposterior Length Research Articles

Classification of Subtypes of Crouzon Syndrome Based on the Type of Vault Suture Synostosis.

Patients with Crouzon syndrome develop various types of anatomic deformities due to different forms of craniosynostosis, yet they have similar craniofacial characteristics. However, exact homology is not evident. Different pathology then may be best treated by different forms of surgical technique. Therefore, precise classification of Crouzon syndrome, based on individual patterns of cranial suture involvement is needed. Ninety-five computed tomography (CT) scans (Crouzon, n = 33; control, n = 62) were included in this study. All the CT scans are divided into 4 types based on premature closure of sutures: class I = coronal and lambdoidal synostosis; class II = sagittal synostosis; class III = pansynostosis; and class IV = "Others." The CT scan anatomy was measured by Materialise software. The class III, pansynostosis, is the most prevalent (63.6%). The classes I, III, and IV of Crouzon have significantly shortened entire anteroposterior cranial base length, with the shortest base length in class III. The external cranial measurements in class I show primarily a decreased posterior facial skeleton, while the class III presented with holistic facial skeleton reduction. Class II has the least severe craniofacial malformations, while class III had the most severe. The morphology of patients with Crouzon syndrome is not identical in both cranial base and facial characteristics, especially when they associated with different subtypes of cranial suture synostosis. The classification of Crouzon syndrome proposed in this study, summarizes the differences among each subgroup of craniosynostosis suture involvement, which, theoretically, may ultimately influence both the timing and type of surgical intervention.

Racial disparity of Crouzon syndrome in maxilla and mandible

The racial disparity of facial features in craniosynostosis patients is not fully understood. The aim of this study was to explore the difference in maxillary and mandibular morphology and spatial position in Asian and Caucasian Crouzon syndrome patients. Ninety-one computed tomography scans were included (12 Asian Crouzon syndrome patients, 22 Asian controls; 16 Caucasian Crouzon syndrome patients, 41 Caucasian controls) and measured using Materialise software. The maxillary and mandibular volumes of Asian patients were both reduced by 19% (P=0.102 and P=0.187), and those of Caucasian patients were reduced by 15% (P=0.142) and 14% (P=0.211) when compared to the respective race-specific controls. Maxilla length of Asian patients was reduced by 6.36mm (14%, P=0.003), while the reduction in Caucasian patients was 4.88mm (10%, P=0.038). ANS was retracted 11.99mm (P<0.001) in Asian patients and 11.54mm (P<0.001) in Caucasian patients. The ANB angle was narrowed by 13.17° (P<0.001) in Asian patients compared to Asian controls, and by 7.02° (P<0.001) in Caucasian patients compared to Caucasian controls. The retrusive midface profiles of Asian and Caucasian Crouzon syndrome look similar; both result from the combined effect of hypoplastic size and backward displacement. However, the insufficiency was found to be more a failure of the anteroposterior maxillary length in Asian patients, and more due to posterior maxillary positioning in Caucasian patients. Therefore, prognathism in Crouzon syndrome patients is more likely caused by displacement rather than elongation of mandibular length in both races. Crouzon syndrome results in the same extent of overall volume deficiency of the maxilla and mandible in these races.

Assessment of Anterior Cruciate Ligament Tibial Footprint Sagittal Diameter and Orientation of the Ligament in the Intercondylar Notch in Indian Population: A Magnetic Resonance Imaging (MRI) Analysis.

Aim: To study the relevant anatomy of anterior cruciate ligament tibial footprint and orientation of the ligament in the intercondylar roof in Indian population the using MRI.Methods: A total of 70 knee MRI with intact anterior cruciate ligament (ACL) was assessed for intercondylar roof angle, ACL inclination angle, ACL-bluemensaat angle, ACL sagittal center, and tibial insertion size.Results: The ACL tibial sagittal center was found to be at 43.5% of the anteroposterior tibial length. Tibial insertion size averaged 15.40 (±1.29) mm with no significant difference in males and females (p > 0.05). The roof angle was 36.29 (± 4.02) ˚ and the ACL inclination angle and ACL-bluemensaat angle were 51.22 (± 3.39) ˚ and 4.70 (±3.35) ˚ respectively with no significant sex difference (p > 0.05).Conclusion: The ACL tibial insertion size averaged 15.40 mm and its center was at 43.51% along the Staubli and Rauschning line. The mean roof angle was 36.29 degrees and the ACL-bluemensaat angle was 4.70 degrees. Understanding of the tibial footprint morphology and the relation of the ligament to the roof of the intercondylar notch helps in anatomical graft placement during reconstruction.

The chondrocranial key: Development of the sphenoid bone in primates

It has been hypothesized that the human sphenoid bone is uniquely truncated, which in turn contributes to a reduction of forward midfacial growth. If so, the perinatal fusion of the intrasphenoidal synchondrosis (ISS) in humans may contribute to midfacial reduction. However, there is a lack of detailed knowledge on sphenoid development of non‐human primates. In this study, orientation and direction of growth of basicranial interface with the midface of late prenatal and early postnatal sphenoid development was examined in ontogenetic samples of primates including three species of monkeys (n = 25) and four species of lemurs and bushbabies (strepsirrhines; n= 28). Micro‐computed tomographic (CT) and histological methods were used to track cross‐sectional age changes in the sphenoid bone. In monkeys (Saguinus spp.), histological findings indicated the number of proliferating chondrocytes is reduced across age leading to a reduction in absolute anteroposterior length of the proliferating zone. Preliminary data from micro‐CT reconstructions suggest that absolute length of the ISS decreases more rapidly in monkeys than in strepsirrhines. Measurements of presphenoid (PS) and basisphenoid (BS) length indicate that in strepsirrhines, these bones grow similarly to one another as cranial length increases. In contrast, in monkeys, the PS increases at a faster pace (i.e. higher linear regression line slopes) than the BS. However, unlike humans, the monkeys studied have prolonged postnatal patency of the ISS. Thus, the reduced midfacial projection in humans and these monkeys cannot be explained by the timing of ISS fusion alone. Dichotomous growth patterns of the cranial base and midface among primates suggest different patterns of regional integration of the cranium. In particular, our results suggest that in monkeys, integration of the midface is stronger with the anterior compared to the posterior portion of the sphenoid bone. In strepsirrhines by comparison, growth of the midface progressively deviates from that of the sphenoid bone over time.Support or Funding InformationNSF; grant numbers BCS‐1830894, BCS‐1830919, BCS‐0959438

The Sphenoidal Synchondroses: Implications for the Midfacial Growth of Anthropoid Primates

The basicranium of anthropoid primates is more flexed than in lemurs and lorises (strepsirrhines), which has implications for orientation of facial growth. Differential growth among cranial synchondroses is one suggested mechanism for variation in basicranial development. In this study, we measured length of bony elements of the cranial base using Amira software in a cross‐sectional age sample (late prenatal to juvenile), which included three monkey species and four species of lemurs and bushbabies (n = 59). In addition, we made preliminary measurements of the anteroposterior length of the spheno‐occipital synchondrosis (SOS), intrasphenoidal synchondrosis (ISS), and prespheno‐septal synchondrosis (PSept) using newborn samples. In order to assess differences in growth potential among sync hondroses, the diameter of the proliferating (PZ) or hypertrophic (HZ) zones were also measured. Our other work has indicated that measurements of ossified elements of the cranial base reveal disproportionately more growth of presphenoid (PS) relatively to basisphenoid (BS) in monkeys. But in strepsirrhines, these bones scale similarly to one another when plotted against increasing cranial or midfacial length. When expressed as a ratio of the length of the PZ or HZ to total anteroposterior diameter of the synchondrosis, growth is relatively similar in ISS and SOS among all species studied. However, in anthropoids the length of the PZ in PSept is notably (more than two‐fold) greater than in any other synchondrosis. In strepsirrhines, length of the PZ in PSept is relatively similar to the same zone of other synchondroses. This suggests that the rapid increase in length of the presphenoid in anthropoids is mostly occurring anteriorly, at the midfacial interface. These results, taken at face value, might suggest that anthropoids have a greater magnitude of growth in the septal cartilage compared to strepsirrhines. However, our previous work established that growth at PSept in more multidirectional (radial) than in most other mammals. Instead, our findings emphasize different patterns of sphenoid growth among primates, and offer a tissue‐level explanation for the relatively large PS segment in anthropoid primates. In addition, these findings indicate suggest that growth of the sphenoid is more highly integrated with PS than BS and more interdependent with facial growth in monkeys than in strepsirrhine primates.Support or Funding InformationNSF grant # BCS‐1830894, BCS‐1830919, BCS‐0959438

Intramedullary tibia nailing with external fixation.

This study introduces an intramedullary nailing technique with external fixation and aims to determine the safest position of Schanz screws for this technique. Patients undergoing intramedullary nailing were evaluated by computed tomography to assess the anteroposterior (AP) length of the medullary canal and the distance between the posterior cortex and the posterior border of the nail at the level of interest in the proximal and distal tibia. In this cadaveric study, screws were inserted at the level of interest, followed by a determination of the anatomical relationship between inserted screws and nearby neurovascular structures. The safe area for inserting Schanz screws in the medial to lateral direction in the proximal tibia was found to be 1.5-4.5cm distal to the knee joint line on the AP view, 1cm anterior to the posterior cortex at the distal 4.5cm level, and ≤ 24mm from the posterior cortex on the lateral view. In males, the area 1.5-3.0cm proximal to the tibial plafond and 0.5cm anterior to the posterior cortex on the lateral view was found to be a safe zone. However, in females, the safe zone was defined as an area 1.5cm proximal to the tibial plafond and just anterior to the posterior cortex. This study defined the safe zones of Schanz screws for intramedullary nailing with an external fixator. These safe zones would be helpful for external fixation during intramedullary tibia nailing.

Unilateral lingual nerve transection alters jaw-tongue coordination during mastication in pigs.

During chewing, movements and deformations of the tongue are coordinated with jaw movements to manage and manipulate the bolus and avoid injury. Individuals with injuries to the lingual nerve report both tongue injuries due to biting and difficulties in chewing, primarily because of impaired bolus management, suggesting that jaw-tongue coordination relies on intact lingual afferents. Here, we investigate how unilateral lingual nerve (LN) transection affects jaw-tongue coordination in an animal model (pig, Sus scrofa). Temporal coordination between jaw pitch (opening-closing) and 1) anteroposterior tongue position (i.e., protraction-retraction), 2) anteroposterior tongue length, and 3) mediolateral tongue width was compared between pre- and post-LN transection using cross-correlation analyses. Overall, following LN transection, the lag between jaw pitch and the majority of tongue kinematics decreased significantly, demonstrating that sensory loss from the tongue alters jaw-tongue coordination. In addition, decrease in jaw-tongue lag suggests that, following LN transection, tongue movements and deformations occur earlier in the gape cycle than when the lingual sensory afferents are intact. If the velocity of tongue movements and deformations remains constant, earlier occurrence can reflect less pronounced movements, possibly to avoid injuries. The results of this study demonstrate that lingual afferents participate in chewing by assisting with coordinating the timing of jaw and tongue movements. The observed changes may affect bolus management performance and/or may represent protective strategies because of altered somatosensory awareness of the tongue.NEW & NOTEWORTHY Chewing requires coordination between tongue and jaw movements. We compared the coordination of tongue movements and deformation relative to jaw opening-closing movements pre- and post-lingual nerve transection during chewing in pigs. These experiments reveal that the timing of jaw-tongue coordination is altered following unilateral disruption of sensory information from the tongue. Therefore, maintenance of jaw-tongue coordination requires bilateral sensory information from the tongue.

Disk Area Is a More Reliable Measurement Than Anteroposterior Length in the Assessment of Lumbar Disk Herniations: A Validation Study.

Retrospective study. The goal of this study is to identify and validate the reliability and accuracy of 2 methods used to assess lumbar disk herniations (LDHs): anteroposterior length and cross-sectional area. Many clinicians characterize LDHs through the measurement of the anteroposterior length in the axial plane. Radiologists, on the other hand, have utilized software to measure the disk and canal areas to define the injury. In this study, the authors consider the reliability and accuracy of anteroposterior length in comparison with the area. Using International Classification of Diseases, 10th Revision (ICD-10) code M51.26, patients at a single academic medical center who received a diagnosis of primary lumbar radicular pain with subsequent magnetic resonance imaging documentation of a single-level disk herniation in 2015 and 2016 were identified. AGFA-IMPACS software was utilized to make the following measurements: anterior-posterior canal length; anterior-posterior disk length; mid-canal width; mid-disk width; total canal area; total disk area. Data analysis was conducted in SPSS and a 2-tailed reliability analysis using Cronbach alpha as a measure of reliability was obtained. A total of 408 patients met the inclusion and exclusion criteria for this study. Sixteen (3.9%) had L3-L4 herniation, 208 had L4-L5 herniation (51.0%), and 184 had L5-S1 herniation (47.5%). The least reliable interobserver metrics, with respective Cronbach alpha values of 0.381 and 0.659, were the linear measurements of mid-disk width and anterior-posterior canal length. Area measurements of the disk and canal areas generated Cronbach alpha values of 0.707 and 0.863. Intraobserver Cronbach alpha values for all measurements, including all areas and lengths, met or exceeded 0.982. The cross-sectional area provides a more reliable measurement modality for diskLDHs in comparison to linear measurements. Unlike anteroposterior length, cross-sectional area incorporates the shape of a herniation or canal in its measurement. Thus, it is superior in its characterization LDH particularly in light of its stronger reproducibility. Level III-retrospective study.

Meniscal Injury Does Not Significantly Affect the Dimensions of the Intact Meniscus in the Opposite Compartment of the Knee.

Background:Meniscal allograft transplant requires precise matching of the size of the allograft with the dimensions of the recipient knee. Estimation of contralateral meniscal size on magnetic resonance imaging (MRI) has been considered the ideal method to measure menisci before transplant. We questioned whether a contralateral intact meniscus with meniscal injury in the opposite compartment could be used as a reference to determine allograft size. Our question was derived from knowledge of meniscal injury influencing structures of the opposite compartment of the knee, including the meniscus.Purpose:To compare meniscal dimensions between intact meniscus with meniscal injury in the opposite compartment and normal meniscus with a normal opposite compartment.Study Design:Cross-sectional study; Level of evidence, 3.Methods:This observational, cross-sectional study was performed between 2016 and 2017. The control group consisted of 200 knees with normal medial and lateral menisci. The medial intact group consisted of 150 cases of medial intact meniscus with injured lateral meniscus, and the lateral intact group consisted of 150 cases of lateral intact meniscus with injured medial meniscus. All patients were male. Mean age, height, and weight did not differ among groups. We investigated meniscal dimensions on MRI, including anteroposterior and mediolateral lengths, distance between the anterior and posterior horns (AHPH distance), and widths and heights of the anterior and posterior horns and midbody.Results:Most medial meniscal dimensions were similar between the control and medial intact groups, but the AHPH distance was smaller in the medial intact group (P < .001). Likewise, most lateral meniscal dimensions were similar between the control and lateral intact groups, but the AHPH distance was smaller in the lateral intact group (P < .001).Conclusion:Most dimensions of the intact meniscus with meniscal injury in the opposite compartment were similar to those of the normal meniscus with normal opposite compartment. Measuring the dimensions of the contralateral intact meniscus with meniscal injury in the opposite compartment on MRI can be an appropriate method to determine meniscal allograft size.

A study of morphometric analysis of distal end of femur and its clinical importance

Introduction: Femur is an important component of the lower kinetic series and functions as a weightbearing bone. The distal end of femur’s morphometry is vital in the designing the implants for total joint arthroplasty. The design of prosthesis is based on morphometry of the distal end of the femur. To ensure the early mobility as well as fewer complications after total knee arthroplasty, the designing of prosthesis based on morphometric values of distal end of femur plays a key role. Objectives: To study the morphometric data of the distal end of femur. To compare the morphometric data between right and left femur. Materials and Methods: One hundred and eighty femurs of unidentified sex were measured for the width of Bicondylar, the maximum medial and lateral condyle anteroposterior length, the total transverse distance of the medial and lateral condyle, and the width of intercondylar notch. Results: The average bicondylar width of entire femur sample was 71.32 5.91 mm, mean anteroposterior diameter of medial and lateral condyle were 56.12 4.51 mm and 56.85 4.31 mm respectively. The medial and lateral condyle mean transverse distance of was 28.33 3.49 mm and 30.7 3 3.21 mm respectively. It was found that the mean intercondylar notch width was 21.62 2.92 mm. In this study, there were no statistically significant parameters between right and left femur. Conclusion: The data obtained from this study will help the biomedical engineers to design the knee replacement prosthesis of suitable size for Indian patients undergoing knee replacement operations. Keywords: Morphometry, Distal end of Femur, Knee prosthesis, Intercondylar notch, Bicondylar width.

Anthropometry of Nonarthritic Asian Knees: Is It Time for a Race-Specific Knee Implant?

BackgroundThis study was done to study the anthropometry of nonarthritic Asian knees; to determine the differences in morphology between knees of different ethnicities and to compare the knee anthropometry values with sizes of available knee implants.MethodsMagnetic resonance imaging scans of 100 nonarthritic Indian knees were analyzed. Anteroposterior (AP) length, mediolateral (ML) length, and aspect ratio of the distal femur and proximal tibia, patellar length, and patellar tendon length were measured. These values were compared with values of other ethnicities from literature. The values were also compared with sizes of available knee implants and evaluated for mismatch.ResultsAll the parameters of female knees were significantly smaller than those of male knees (p < 0.05). The distal femur of Indian knees resembled that of Chinese knees with similar AP and ML lengths and aspect ratio. The distal femur of Indian knees had a significantly smaller AP, ML, and aspect ratio than those of Hispanic knees did. In comparison to Caucasian distal femur, Indian knees had smaller AP and ML lengths and larger aspect ratio. In terms of the proximal tibia, the Indian knees were smaller than Chinese (only ML), Caucasian (AP and ML) and Hispanic (AP and ML) knees. On comparison with implant sizes, there was a mismatch between the distal femur morphology and the dimensions of all implants. For a given AP length, the ML dimensions of all implants were smaller than the measured ML length of the knee. However, the tibial components of all the studied implants correlated well with the tibial morphology.ConclusionsDistinct anthropometric differences exist between knees of different ethnicities. The knees of females were smaller than the knees of males. In Indian knees, the ML-AP aspect ratio of the distal femur was higher than that of the currently available femoral components. These results suggest the need for race-specific knee implants.

Corpus callosum metrics predict severity of visuospatial and neuromotor dysfunctions in ARID1B mutations with Coffin-Siris syndrome.

ARID1B mutations in Coffin-Siris syndrome are a cause of intellectual disability (0.5-1%), with various degrees of autism and agenesis of the corpus callosum (10%). Little is known regarding the cognitive and motor consequences of ARID1B mutations in humans and no link has been made between corpus callosum anomalies and visuospatial and neuromotor dysfunctions. We have investigated the visuospatial and neuromotor phenotype in eight patients with ARID1B mutations. A paramedian sagittal section of the brain MRI was selected, and corpus callosum was measured in anteroposterior length, genu and trunk width. Spearman's rank order coefficients were used to explore correlations between visuospatial and social cognitive variables and dimensions of the corpus callosum. A significant correlation between genu width size and visual cognition was observed. Retrocerebellar cysts were associated with corpus callosum anomalies. Here, we show that corpus callosum anomalies caused in ARID1B mutations may be predictive of the visuospatial and motor phenotype in Coffin-Siris syndrome.

A right whale (Mysticeti, Balaenidae) from the Pleistocene of Taiwan

Current patterns of biological distribution result from the deep past. Of particular interest, some closely related species appear at high latitudes of both hemispheres, but not in between, a pattern known as antitropical distribution. However, the timing, pathway, and drivers of antitropical distributions remain mostly unknown. Here we describe a new fossil, a left tympanic bulla (part of the ear bones), from the Middle/Late Pleistocene (0.78–0.01 mya, but not excluding the possibility of Holocene in age, as the specimen was dredged from the sea bottom and the geological horizon remains uncertain) of Taiwan. The tympanic bulla is diagnostic in baleen whales, and this specimen shows morphological features that are identical to extant Eubalaena, including: relatively large size (the anteroposterior length is 117 mm); rectangular outline in medial view; short anterior lobe, judging from the remaining of the lateral furrow; squared anterior margin; prominent transverse crease on the involucrum; transversely compressed in anterior view; well-developed and rounded outer lip; and parallel involucral and main ridges. Although incomplete, the morphological characters and overall similarity to extant Eubalaena allow a reliable taxonomic assignment to Eubalaena sp. The occurrence of a Pleistocene Eubalaena on the southern margin of the western North Pacific is the first balaenid fossil evidence indicative of the biotic interchange between two hemispheres leading to the origin of antitropical distribution in the Pleistocene; alternatively, this specimen might merely represent an extra-limital record of the North Pacific Eubalaena. Furthermore, this find suggests that the Eubalaena interchange, being one of the largest species displaying antitropical distribution pairs in the history of life, likely took place along the western Pacific. Notably, this does not preclude the Eubalaena interchange from other routes, such as the eastern Pacific or the Atlantic Ocean, and future finds should test the scenario for the biotic interchange between Northern and Southern Hemispheres of Eubalaena.

A new method for evaluating short fetal corpus callosum.

Sonographic diagnosis of short corpus callosum (SCC) is based on measurement of a short for gestational age antero-posterior length of the corpus callosum (CC) in the midsagittal plane. We suggest a new method for evaluating SCC without referring to biometry tables. We measured the ratio between the CC length and the internal cranial occipitofrontal dimension (ICOFD) in the midsagittal plane in 399 normal fetuses at 20 + 6 to 35 + 3 weeks of gestation and in 31 fetuses with a diagnosis of a SCC and compared the mean ratio between two groups. The impact of cephalic biometric parameters, fetal presentation, and gender was assessed. The ICOFD/CC length for normal pregnancies was constant throughout the pregnancy (2.35 ± 0.11). There was no correlation between the ICOFD/CC length and cephalic index, Biparietal Diameter (BPD), head circumference, fetal sex, or fetal presentation. The ratio of pregnancies with SCC was significantly higher: 3.20 ± 0.84 (P < .0001). The ICOFD/CC length practically does not change throughout a normal pregnancy. The ratio was significantly higher in pregnancies with SCC. Measuring this ratio during fetal anatomical scan may enable rapid evaluation of the CC without the need to refer to biometry tables.

Measurement of proximal tibial morphology in northeast Chinese population based on three-dimensional reconstruction computer tomography.

Tibial component of total knee arthroplasty (TKA) is designed according to morphology of proximal tibia to a large extent. Owing to racial difference, current design of tibial component based on Caucasian may not be suitable for Chinese patients. Meanwhile, data of proximal tibial morphology in Chinese population is lacking. The objective of this research was to investigate proximal tibial morphology of northeast Chinese population.Computer tomography (CT) image of 164 northeast Chinese participants was collected. After three-dimensional (3D) reconstruction, size of tibia plateau and TKA resected surface were gauged to guide the design of TKA tibia prothesis in northeast Chinese population. Measurement of tibial size mainly includes tibial mediolateral length (tML), tibial medial/lateral anteroposterior length (tMAP and tLAP). Afterwards, tML/tAP ratio of tibia plateau and TKA resected surface were calculated as feature point of tibia prothesis. tMAP/tLAP ratio of TKA resected surface was calculated to represent tibial asymmetry degree. Medial and lateral posterior tibial slope (MPTS and LPTS) were also measured to give reference to posterior angle of tibia prothesis and angle of tibia osteotomy in TKA. Independent sample t test was performed to conduct statistical analysis, P < .05 was regarded as statistically significance.Northeast Chinese male has larger knee size than female. Significant difference of tML/tAP ratio was also observed between male and female on tibia plateau (1.71 ± 0.07 vs 1.77 ± 0.09) but not on TKA resected surface (1.60 ± 0.05 versus 1.61 ± 0.06). Significant difference of tMAP/tLAP ratio between male and female was also found and they were 1.31 ± 1.03 and 1.11 ± 0.05 respectively. Northeast Chinese female has higher PTS than male (MPTS: 9.56 ± 2.96° vs 8.81 ± 2.87° and LPTS: 8.57 ± 3.19° vs 8.44 ± 2.76°).Significant gender-difference of tibial size and asymmetry degree of tibial resected surface were found between northeast Chinese male and female. Meanwhile, northeast Chinese population has smaller knee size, larger PTS and tML/tAP ratio than that of Caucasian population. Therefore, Chinese-specific and gender-specific tibial prostheses were strongly recommended to be designed.

Cranial Fossa Volume in Differing Subtypes of Apert Syndrome.

Based on an established classification system of Apert syndrome subtypes, detailed regional morphology and volume analysis may be useful to provide additional clarification to individual Apert cranial structure characteristics, and treatment planning. Computed tomography scans of 32 unoperated Apert syndrome and 50 controls were included and subgrouped as: type I, bilateral coronal synostosis; type II, pansynostosis; type III, perpendicular combination synostosis. Three-dimensional analysis of craniometric points was used to define structural components using Materialise Mimics and 3-Matics software. Occipitofrontal circumference of all subtypes of Apert syndrome patients is normal. Intracranial volumes of types I and II were normal, but type III was 20% greater than controls. Middle cranial fossa volume was increased in all 3 types, with the greatest increase in type II (86%). Type II developed a 69% increase in anterior cranial fossa volume, whereas type III had 39% greater posterior cranial fossa volume. Increased cranial fossa depth contributed most to above increased volume. The anteroposterior lengths of middle and posterior cranial fossae were reduced in type I (15% and 17%, respectively). However, only the anterior cranial fossa was significantly shortened in type III. Occipitofrontal circumference and overall intracranial volume is not always consistent in individual subunits of Apert syndrome. Detailed and segmental anterior, middle, and posterior cranial fossae volumes and morphology should be analyzed to see what impact this may have related to surgical planning.

Trans-tendon suture bridge rotator cuff repair with tenotomized pathologic biceps tendon augmentation in high-grade PASTA lesions.

The purpose of this study was to evaluate whether trans-tendon suture bridge repair with tenotomized pathologic biceps tendon augmentation improves mid-term clinical outcomes for high-grade partial articular-sided supraspinatus tendon avulsion (PASTA) lesions or not. A retrospective review of a consecutive series of arthroscopic trans-tendon suture bridge repair with tenotomized pathologic biceps tendon augmentation was conducted. Total 115 patients (44 men and 71 women) with minimum 2years follow-up were enrolled in our study. Their mean age was 59.7 ± 7.6 (38-77) years and mean follow-up were 6.9 ± 2.5 (2 ~ 10) years. Clinical assessment and radiological outcomes using post-operative MRI were evaluated at last follow-up. All these tears were high-grade PASTA lesions in which mean cuff tear size (exposed footprint) was anteroposterior length 15.7 ± 6.3mm (5-25mm) and mediolateral width 10.1 ± 3.6mm 6.4mm (5-16mm). At last follow-up, mean pain VAS, ASES, UCLA, and SST scores were improved from pre-operative values of 5, 59, 21, and 7 to post-operative values of 1, 84.4, 29.5, and 9.4, respectively (p value < 0.001). ROM such as forward flexion, abduction, and internal rotation to the back were improved from a pre-operative mean of 148° (±24), 144° (±24), L2 (Buttock-T7) to a post-operative mean of 161° (±10), 160.0° (±12), and T12 (L3-T5), respectively (p value < 0.001). Follow-up MRI showed Sugaya classification type I in 24 patients (20.9%), type II in 78 patients (67.8%), type III in 11 patients (9.6%) and type 4 in 2 patients (1.7%) were found. As complications, shoulder stiffness was found in five patients, Popeye deformity in two patients and retear in two patients. Revision surgery of the retear was performed in 2 patients. At the last follow-up, 17% (20/115 patients) reported occasional discomfort at the extremes of range of motion during a heavy work or sports activities. In high-grade PASTA lesions, arthroscopic trans-tendon suture bridge repair with tenotomized pathologic biceps tendon augmentation could be a useful treatment modality capable of preserving rotator cuff footprint, providing simultaneous biceps tenodesis, inducing better tendon healing and possibly preventing tendon buckling and residual pain of the conventional trans-tendon repair methods. These specific methods showed satisfactory outcomes and decreased residual shoulder discomfort (17%) at mid-term follow-up. Level IV, Retrospective case study.

Volar Locking Plate Fixation for Intra-Articular Distal Radius Fractures with Volar Lunate Facet Fragments Distal to the Watershed Line.

Standard volar plating of distal radius fractures may not adequately fix the volar lunate facet (VLF) fragment, which can result in volar carpal subluxation. We hypothesized that the size of VLF fragments distal to the watershed line might affect reduction loss after distally placed volar locking plate fixation for intra-articular distal radius fracture and examined if the presence of small displaced VLF fragments was a risk factor for reduction loss. Twenty-seven hands of 27 patients with intra-articular distal radius fractures with VLF fragments distal to the watershed line were treated by using Acu-Loc 2 volar distal radius locking plate fixation. At final follow-up, the mean Mayo Performance Score was 90.9, and the mean Quick Disabilities of Arm, Shoulder, and Hand score was 13.6. On radiography, 5 patients had a reduction loss of >2 mm in ulnar variance from immediately postoperatively to final follow-up (group 1), while 27 had no reduction loss (group 2). The mean longitudinal, transverse, and anteroposterior lengths and joint surface area of the VLF fragment were significantly smaller in group 1 than in group 2. Three-dimensional computed tomography revealed that the fracture patterns of the radiocarpal and distal radioulnar joints in group 1 were mainly volar-displaced VLF fragments. By stabilizing fragments, distally placed volar locking plate fixation effectively treated intra-articular distal radius fractures with VLF fragments distal to the watershed line. However, the presence of small displaced VLF fragments may increase the risk of reduction loss in ulnar variance.

Quantifying normal head form and craniofacial asymmetry of elementary school students in Taiwan

Defining three-dimensional (3D) normal craniofacial morphology in healthy children could provide craniofacial surgeons a reference point to assess disease, plan surgical reconstruction, and evaluate treatment outcome. The purposes of this study were to report normal craniofacial form and quantify craniofacial asymmetry of healthy children in Taiwan by implementing the 3D stereophotogrammetry technique. Healthy Taiwanese elementary school children (n = 652) aged 6-12 years with no known craniofacial anomaly were recruited. After the 3dMD scanning procedure, 32 landmarks were manually placed on the 3D cranial images. Thin plate spline algorithm based on landmarks and closest point matching was applied to deform a symmetric 3D template into the scale of each scanned images. Skull asymmetry and facial asymmetry were calculated using 3dMD vultus and MATLAB. Average head shape models were also presented. Overall, the mean head transverse width, height, anteroposterior length, and circumferences were 163.02, 220.79, 179.07, and 526.55 mm, respectively. On average, the skull asymmetry and facial asymmetry were 2.47±1.26 mm and 0.96±0.53 mm, respectively, with no significant (all p>0.05) differences found when comparing males and females. In the average head shape model, certain craniofacial areas on the right side were found to be more protruded than those on the left side. This study shows that the baseline craniofacial form of the Taiwanese elementary school children is asymmetric with a tendency of more protrusion of the head on the right side.

Influence of Infant Cleft Dimensions on Velopharyngeal Function in 5-Year-Old Danish Children Born With Unilateral Cleft Lip and Palate.

To examine the association of cleft severity at infancy and velopharyngeal competence in preschool children with unilateral cleft lip and palate operated with early or delayed hard palate repair. Subgroup analysis within a multicenter randomized controlled trial of primary surgery (Scandcleft). Tertiary health care. One surgical center. One hundred twenty-five infants received cheilo-rhinoplasty and soft palate repair at age 3 to 4 months and were randomized to hard palate closure at age 12 or 36 months. Cleft size and cleft morphology were measured 3 dimensionally on digital models, obtained by laser surface scanning of preoperative plaster models (mean age: 1.8 months). Velopharyngeal competence (VPC) and hypernasality assessed from a naming test (VPC-Sum) and connected speech (VPC-Rate). In both scales, higher scores indicated a more severe velopharyngeal insufficiency. No difference between surgical groups was shown. A low positive correlation was found between posterior cleft width and VPC-Rate (Spearman = .23; P = .025). The role of the covariate "cleft size at tuberosity level" was confirmed in an ordinal logistic regression model (odds ratio [OR] = 1.17; 95% confidence interval [CI]:1.01-1.35). A low negative correlation was shown between anteroposterior palatal length and VPC-Sum (Spearman = -.27; P = .004) and confirmed by the pooled scores VPC-Pooled (OR = 0.82; 95% CI: 0.69-0.98) and VPC-Dichotomic (OR = 0.82; 95% CI: 0.68-0.99). Posterior cleft dimensions can be a modest indicator for the prognosis of velopharyngeal function at age 5 years, when the soft palate is closed first, independently on the timing of hard palate repair. Antero-posterior palatal length seems to protect from velopharyngeal insufficiency and hypernasality. However, the association found was significant but low.