Anteroposterior Plane Research Articles

Gender Differences in Postural Stability in a Cohort of Adolescent Age

Daily tasks necessitate improved locomotive abilities and movements, which are determined by an individual’s balance control. Body postures allows us to stay in a stable and balanced stance without falling. The present study examines postural stability in males and females using centre of pressure metrics in two planes for the adolescent group. Force data was collected in three directions (Fx, Fy, and Fz) using a standard force platform (SENSIX force plates) under two support and two visual conditions, including eyes-open, stand-up on two limbs (OB), eyes-closed, stand-up on two limbs (CB), eyes-open, stand-up on single limb (OO), eyes-closed, stand-up on single limb (CO). The CoP was determined in both the antero-posterior and medio-lateral planes. Two features were derived from the CoP data: sway and average velocity in both planes. The findings demonstrate that for all experimental conditions in both directions, CoP characteristics (sway and velocity) of male gender were significantly (p<0.05) higher than female gender. This work concludes that males have higher postural stability than females of similar age, indicating that hormonal variables such as thyroid, estrogens, and others reduce postural stability.

Morphometric analysis of Kocher's and Frazier's points in a small sample taken from the South African scaphocephalic paediatric population: A preliminary study

IntroductionDue to varying cranial morphologies, ventricular access in patients with craniosynostosis using conventional techniques is often a challenge. Although ventricular access may not be frequently required in scaphocephalic patients, it is vital that an ideal location of the access points be established for safe ventricular catheterization. This study aimed to document the morphometry of commonly used ventricular access points, i.e. Kocher's and Frazier's points, within a select South African scaphocephalic paediatric population. MethodsThe craniometric dimensions of Kocher's and Frazier's points were measured relative to anatomical and craniometric landmarks on pre-operative computed tomography scans of 24 consecutive patients diagnosed with scaphocephaly between 2014 and 2020. Results were compared against age, sex, population group and the degree of severity of the deformity. ResultsKocher's point was located between 91.6 mm and 140.0 mm posterior to the nasion, and between 20.5 mm and 34.6 mm lateral to the midline. Statistically significant increases were reported in the mean distance posterior to nasion between patients in the <1 year and older age groups (>1-<9 years) (ANOVA, p < 0.001); and in the mean distance lateral to the midline (ANOVA, p = 0.004), between patients in the <1 year and 3-<6-year (post-hoc, p = 0.002) and 1-<3-year and 3-<6-year (post-hoc, p = 0.030) age groups, respectively. Frazier's point was located between 60.9 mm and 82.8 mm superior to the inion, and 25.9 mm and 41.4 mm lateral to the midline. No statistically significant differences were documented for comparisons by sex, population group and degree of severity in the tested sample. ConclusionsThe study found that the traditional landmarks used for ventricular access can be unreliable in scaphocephalic patients, particularly in those less than one year of age. Parameters measured in the anteroposterior plane were more affected than those measured lateral from the midline. This study provides novel morphometric data for neurosurgical consideration regarding ventricular catheterization procedures in scaphocephalic patients.

Malrotation of the liver in a covid-19 patient

A 55-year-old male patient presented for severe COVID-19 infection. His chest X-ray showed elevation of the right hemidiaphragm. CT of the chest showed on the abdominal cuts a liver inverted in the antero-posterior plane: what was supposed to be the anterior surface is here lying against the posterior abdominal wall The liver (L) appears on the right side, in contact with the posterior abdominal wall.

Mean Canal-body Ratio among Specimens of Dried Lumbar Vertebrae in the Department of Anatomy of a Medical College: A Descriptive Cross-sectional Study.

Lumbar spinal canal stenosis is assumed to be one of the chief causative factors for low back pain. The measurement of lumbar canal and body dimensions has thus become an important tool for the diagnosis and treatment of spinal stenosis. This study aims to find out the mean canal-body ratio among specimens of dried lumbar vertebrae in a medical college. A descriptive cross-sectional study was done in a medical college from May, 2021 to July, 2021. Ethical clearance was taken from the Institutional Review Committee (Reference number: 0502202103) and whole sampling was done. Seventy-three intact dried lumbar vertebrae were studied for the dimensions of the body and canal in transverse and anteroposterior planes. The findings were recorded and the canal body ratio was calculated using the transverse diameters of the spinal canal and vertebral body. The data obtained were computed and analysed using Microsoft Excel 2013. Point estimate at 95% Confidence Interval was calculated along with mean and standard deviation for continuous data. The mean canal-body ratio was observed to be 0.53±0.032. The vertebral canal-body ratio was observed to be 0.58 in L1 followed by 0.53 in L2, 0.51 in L3, 0.49 in L4 and 0.53 in L5. The mean canal-body ratio observed in the present study was comparable to studies done in similar settings. anatomy; bones; lumbar vertebrae.

Relationship between nasal polyposis and Eustachian tube function

BackgroundNo previous study investigated the relationship between different stages and duration of nasal polyposis (NP) and Eustachian tube (ET) functions. Thus, the aim of the current study was to assess the relationship between the NP and ET functions by studying different staging and duration of the NP. The study included adult patients with bilateral NP. The tridimensional endoscopic staging of the NP was performed to provide information on the location of the NP within the nasal cavity in the three dimensions; horizontal, vertical, and anteroposterior planes. Tympanometry was performed 1 day before endoscopic staging, and the tympanometric results were distinguished into 3 grades; type A, normal curve; type C; and type B.ResultsWithin 40 patients (80 nasal cavities, 80 ears), tympanometry showed type A curve in 48 ears (60%), type B curve in 14 ears (17.5%), and type C in 18 ears (22.5%). So, NP was associated with 40% ET affection with non-significant differences with different NP stages at the horizontal plan (P=0.989567), at the vertical plan (P=0.666), and at the anteroposterior plane (P=0.628). While ET affection (ET dysfunction or OME) was reported significantly more with NP of longer duration (P<0.0001).ConclusionNP is associated with a high ET dysfunction rate that is significantly higher with NP of longer duration, while different NP stages did not significantly differ in affecting the ET function.

The accuracy of restoration of femoral head centre of rotation in the anteroposterior plane after uncemented total hip arthroplasty

AimsHip arthroplasty aims to accurately recreate joint biomechanics. Considerable attention has been paid to vertical and horizontal offset, but femoral head centre in the anteroposterior (AP) plane has received little attention. This study investigates the accuracy of restoration of joint centre of rotation in the AP plane.MethodsPostoperative CT scans of 40 patients who underwent unilateral uncemented total hip arthroplasty were analyzed. Anteroposterior offset (APO) and femoral anteversion were measured on both the operated and non-operated sides. Sagittal tilt of the femoral stem was also measured. APO measured on axial slices was defined as the perpendicular distance between a line drawn from the anterior most point of the proximal femur (anterior reference line) to the centre of the femoral head. The anterior reference line was made parallel to the posterior condylar axis of the knee to correct for rotation.ResultsOverall, 26/40 hips had a centre of rotation displaced posteriorly compared to the contralateral hip, increasing to 33/40 once corrected for sagittal tilt, with a mean posterior displacement of 7 mm. Linear regression analysis indicated that stem anteversion needed to be increased by 10.8° to recreate the head centre in the AP plane. Merely matching the native version would result in a 12 mm posterior displacement.ConclusionThis study demonstrates the significant incidence of posterior displacement of the head centre in uncemented hip arthroplasty. Effects of such displacement include a reduction in impingement free range of motion, potential alterations in muscle force vectors and lever arms, and impaired proprioception due to muscle fibre reorientation.Cite this article: Bone Joint Res 2022;11(3):180–188.

Morphometric Analysis of the Cranial Fossae in Scaphocephalic Patients: An Anatomical Basis.

Scaphocephaly is the morphological consequence of premature sagittal suture fusion. Morphologic and morphometric studies on the cranial vault in scaphocephaly flourish in the literature. However, few studies are available on the cranial base in a scaphocephalic population, let alone the morphometry of its fossae. Therefore, this study aimed to analyze and compare the morphometry of the anterior, middle, and posterior cranial fossae (ACF, MCF, and PCF) in patients with scaphocephaly.The length and width of the ACF, MCF, and PCF were measured using fixed anatomical landmarks on the two-dimensional computed tomography scans of 24 consecutive patients diagnosed with isolated sagittal synostosis between 2014 and 2020, and 14 controls.A comparison of the results between patients with scaphocephaly and the controls showed that the ACF and PCF lengths increased significantly ( P = 0.041 and P = 0.018) in patients with scaphocephaly. No differences in the MCF lengths were observed ( P = 0.278; 0.774). When compared by the degree of severity, the ACF and PCF lengths were significantly increased ( analysis of variance [ANOVAI, P = 0.033; post-hoc, P = 0.013 and ANOVA, P = 0.015; post-hoc, P = 0.036) in scaphocephalic patients within the severe group as opposed to the control group.The morphometric data obtained indicate a preponderance of deformity in the ACF and PCF with elongation along the anteroposterior plane (lengths) in scaphocephalic patients. Minimal changes were observed in the transverse plane (widths) in scaphocephaly versus controls. This data could aid craniofacial surgeons in understanding the affectation of the cranial fossae and influencing the decision on the most suitable method of corrective modality.

Delayed Soft Tissue Changes after Clockwise Rotation of the Maxillo-Mandibular Complex.

The purpose of this study was to evaluate delayed soft tissue changes of the maxilla-mandibular complex MMC using three-dimensional (3D) cone-beam computed tomography after clockwise repositioning orthognathic surgery. This study included 21 patients that underwent maxilla-mandibular complex clockwise rotational orthognathic surgery by 1 doctor from January 2015 to June 2019. Radiographic images (panorama, lateral cephalogram, posteroanterior view, and conebeam computed tomography) were taken and 3D analysis was performed using the Invivo 5 (Anatomage Inc, Santa Clara, CA) to acquire 3D images before surgery, immediately after surgery, at 6 months after surgery and 21 months after surgery. The 9 soft tissue landmarks were measured and compared in terms of postoperative changes in transverse, vertical, and anteroposterior directions. The points were at the outer commissure of the eye fissure (Exocathion; Exc_r, Exc_l), at the midline of both the nasal root and the nasofrontal suture, analogous to bony N (soft tissue nasion; N), the most prominent point on the nasal tip (Pronasale; Prn), the most lateral point in the curved baseline of each ala, indicating the facial insertion of the nasal wing base (Alare curvature; Ac_r, Ac_l), the most lateral point on the soft tissue contour of each mandibular angle (Soft tissue Gonion; Go_r, Go_l), and the most inferior midpoint on the soft tissue contour of the chin (soft tissue menton; Me). The most prominent point of the nasal tip (Prn) moved 1.36 mm upward and 1.55 mm forward in the vertical and anteroposterior planes immediately after surgery. However, there were no significant changes in Ac_r and Ac_l even immediately after surgery. Both soft tissue gonions shifted downward and forward between immediately after surgery and 6 months after surgery. However, no significant change was observed in the value of any of the 9 soft tissue points between 6 months and 21 months after surgery ( P value < 0.05). No significant changes were observed between 6 and 21 months after surgery, which suggests no delayed soft tissue changes occur in surgically treated patients after the resolution of surgically-related facial edema and swelling and postsurgical remodeling of hard tissue in overlying soft tissue.

Cut-out risk factor analysis after intramedullary nailing for the treatment of extracapsular fractures of the proximal femur: a retrospective study

BackgroundsThe basic method of surgical treatment for extracapsular hip fractures (ECFs), including intertrochanteric fracture and basicervical fracture (BCF), is osteosynthesis. Intramedullary nails are among the most commonly used fixation devices for these fractures. Our study aimed to report the clinical outcomes of ECF treatment with two different nail devices and to analyze the risk factors associated with screw cut-out.Methods We retrospectively reviewed the medical records of 273 patients (300 cases) from a single institution who underwent surgical treatment for ECF between January 2013 and October 2018. Overall, 138 patients were eligible for the study and were divided into two groups according to the osteosynthesis device used. We evaluated the clinical outcomes of fracture surgery and performed univariate and multivariate regression analyses to identify risk factors associated with screw cut-out in each group.ResultsWe used proximal femoral nails (group 1) to treat 83 patients and cephalomedullary nails (group 2) to treat 55 patients. Nine cut-outs (group 1, 6 cases; group 2, 3 cases) occurred during follow-up. The patients’ high body mass index (BMI) (p = 0.019), BCFs (p = 0.007), non-extramedullary reduction in the anteroposterior and lateral planes (p = 0.032 and p = 0.043, respectively), and anti-rotation screw pull-outs (p = 0.041) showed a positive correlation to screw cut-out in the univariate analysis of group 1. In group 2, only BCFs was positively correlated (p = 0.020). In the multivariate analysis of group 1, the patients’ BMIs (p = 0.024) and BCFs (p = 0.024) showed a positive correlation with cut-out. Meanwhile, the multivariate analysis of group 2 did not identify any factors associated with cut-out.ConclusionsThe cut-out risk was significantly higher in the BCF cases, regardless of the nail design used. Considerable attention should be paid to treating such unstable fractures. We expect that new-generation nails using a helical blade, or interlocking derotation and interlocking screws may improve surgical outcomes.

Skeletal, Dental, and Soft Tissue Changes after Applying Active Skeletonized Sutural Distractor (ASSD) for Class III Malocclusion Patients

Background: Nonsurgical treatment of Class III malocclusion may reduce the chances for orthognathic surgery in the future. This study aimed to determine the post-treatment skeletal, dental and soft tissue changes in the anteroposterior plane applying active skeletonized sutural distractor (ASSD) in late adolescent Class III malocclusion patients. Materials and Methods: After screening 13,500 students from 18 secondary schools, a sample of 26 subjects was recruited for this study, with a mean age of 15(±1.4) years after considering the inclusion and exclusion criteria. ASSD appliances were inserted into patients, and lateral cephalometric x-rays were taken for pre- and post-treatment analysis. Dental casts of the patients were also taken and scanned using a 3D laser scanner for comparisons. Results: The intraclass correlation coefficients (ICC) for inter-examiner were 0.87 to 0.99 and 0.96 to 0.99 for lateral cephalometric and dental cast measurements, respectively. The difference in pre- and post-treatment of cephalometric measurements of the mandible showed statistically significant changes for mandibular plane angle (p &lt; 0.001) and SNB angle (p = 0.029). The dental cast measurements showed statistically significant changes of inter-molars width (p &lt; 0.001) as well as palatal (p = 0.002). Conclusions: The results showed statistically significant improvement in skeletal, dental, and soft tissue changes after treatment applying ASSD for Class III malocclusion patients.

Assessing spinal movement during four extrication methods: a biomechanical study using healthy volunteers

BackgroundMotor vehicle collisions are a common cause of death and serious injury. Many casualties will remain in their vehicle following a collision. Trapped patients have more injuries and are more likely to die than their untrapped counterparts. Current extrication methods are time consuming and have a focus on movement minimisation and mitigation. The optimal extrication strategy and the effect this extrication method has on spinal movement is unknown. The aim of this study was to evaluate the movement at the cervical and lumbar spine for four commonly utilised extrication techniques.MethodsBiomechanical data was collected using inertial Measurement Units on 6 healthy volunteers. The extrication types examined were: roof removal, b-post rip, rapid removal and self-extrication. Measurements were recorded at the cervical and lumbar spine, and in the anteroposterior (AP) and lateral (LAT) planes. Total movement (travel), maximal movement, mean, standard deviation and confidence intervals are reported for each extrication type.ResultsData from a total of 230 extrications were collected for analysis. The smallest maximal and total movement (travel) were seen when the volunteer self-extricated (AP max = 2.6 mm, travel 4.9 mm). The largest maximal movement and travel were seen in rapid extrication extricated (AP max = 6.21 mm, travel 20.51 mm).The differences between self-extrication and all other methods were significant (p < 0.001), small non-significant differences existed between roof removal, b-post rip and rapid removal.Self-extrication was significantly quicker than the other extrication methods (mean 6.4 s).ConclusionsIn healthy volunteers, self-extrication is associated with the smallest spinal movement and the fastest time to complete extrication. Rapid, B-post rip and roof off extrication types are all associated with similar movements and time to extrication in prepared vehicles.

Feasibility of Single-Shot Whole Thoracic Time-Resolved MR Angiography to Evaluate Patients with Multiple Pulmonary Arteriovenous Malformations.

ObjectiveTo evaluate the feasibility of single-shot whole thoracic time-resolved MR angiography (TR-MRA) to identify the feeding arteries of pulmonary arteriovenous malformations (PAVMs) and reperfusion of the lesion after embolization in patients with multiple PAVMs.Materials and MethodsNine patients (8 females and 1 male; age range, 23–65 years) with a total of 62 PAVMs who underwent percutaneous embolization for multiple PAVMs and were subsequently followed up using TR-MRA and CT obtained within 6 months from each other were retrospectively reviewed. All imaging analyses were performed by two independent readers blinded to clinical information. The visibility of the feeding arteries on maximum intensity projection (MIP) reconstruction and multiplanar reconstruction (MPR) TR-MRA images was evaluated by comparing them to CT as a reference. The accuracy of TR-MRA for diagnosing reperfusion of the PAVM after embolization was assessed in a subgroup with angiographic confirmation. The reliability between the readers in interpreting the TR-MRA results was analyzed using kappa (κ) statistics.ResultsFeeding arteries were visible on the original MIP images of TR-MRA in 82.3% (51/62) and 85.5% (53/62) of readers 1 and 2, respectively. Using the MPR, the rates increased to 93.5% (58/62) and 95.2% (59/62), respectively (κ = 0.760 and 0.792, respectively). Factors for invisibility were the course of feeding arteries in the anteroposterior plane, proximity to large enhancing vessels, adjacency to the chest wall, pulsation of the heart, and small feeding arteries. Thirty-seven PAVMs in five patients had angiographic confirmation of reperfusion status after embolization (32 occlusions and 5 reperfusions). TR-MRA showed 100% (5/5) sensitivity and 100% (32/32, including three cases in which the feeding arteries were not visible on TR-MRA) specificity for both readers.ConclusionSingle-shot whole thoracic TR-MRA with MPR showed good visibility of the feeding arteries of PAVMs and high accuracy in diagnosing reperfusion after embolization. Single-shot whole thoracic TR-MRA may be a feasible method for the follow-up of patients with multiple PAVMs.

Mismatch of short straight proximal femur nails with anterior bow of femur in Indian population- A radiological and functional analysis

IntroductionIntra-medullary devices are the most common mode of fixation of inter-trochanteric fractures. Short proximal femur nails (PFN) used for fixing these fractures, unlike the long nails, are non-anatomic and are usually straight with no curvature in antero-posterior plane. As a result, there is always a chance of the nail tip impinging against the anterior cortex of femur. Materials and methodsA total of 80 patients with trochanteric fractures (AO 31A2 and 31A3), operated with short PFN, were followed up retrospectively and prospectively from 2019 to 2021, for a period of 6 months. All fractures were fixed with PFNs, with nails ranging from 170 to 250 mm. Radiological analysis was done on hip lateral X-rays (taken at 6 months) using Angle at Distant Axis (ADA) and Nail Tip Position (NTP). Functional outcome analysis was done using Harris Hip Score. Patients were graded into 2 groups according to ADA (ADA>4° and ADA<4°). Incidence of anterior thigh pain was noted in patients on follow up and was statistically evaluated with nail size, nail diameter, ADA and NTP. ResultsMean ADA was 4.19° ± 1.45; mean NTP grade was 1.98 ± 1.11. Mean nail size was 201.87 mm with a mean nail diameter of 9.76 mm. Twenty patients complained of anterior thigh pain on follow-up. Twenty-five patients had NTP grade 3 or above of which 16 complained of anterior thigh pain (p < 0.001). Fifty-five patients had nail diameter of 10 mm or above of which 14 had anterior thigh pain (p < 0.01). Fifty-three patients had a nail length of 200 mm or above of which 16 patients complained of thigh pain on follow up (p < 0.01). ConclusionThere is a mismatch of short PFNs with anterior bow of femur. Use of shorter nails with narrow diameters will avoid this mismatch to an extent.

Comparative assessment of various cephalometric facial planes with intercanine width in orthodontic patients.

OBJECTIVE:The study was conducted to evaluate the relationship of various cephalometric skeletal patterns in the vertical and anteroposterior planes with intercanine width in untreated orthodontic patients.METHOD AND MATERIAL:This study included dental cast and cephalometric radiographs of 100 patients (69 females and 31 males) of the age range 13 to 33 years. Skeletal parameters including SNA, SNB, SNMP angles were found from lateral cephalometric radiographs. Intercanine widths including upper intercanine widths (UICW) and lower intercanine widths (LICW) were measured by a digital caliper.RESULTS:The correlation of intercanine width with SNA, SNB, and SNMP angles was analyzed by applying Pearson correlation coefficient. According to statistical analysis, the only insignificant correlation was analyzed between UICW with SNB and LICW with SN-MP.CONCLUSIONS:The overall result showed statistically significant relationship of various cephalometric skeletal patterns in the sagittal and vertical planes with intercanine width.

DO THE CHANGES OF SCAPULOTHORACIC ANGLE AFFECT WINGED SCAPULA DEVELOPMENT AND FUNCTIONAL SCORES DURING CLAVICLE FRACTURE TREATMENT?

ABSTRACTIntroduction:To compare surgical and conservative management of midshaft clavicle fractures according with scapulothoracic joint angle change, considering clinical, functional, and radiological outcomes.Methods:A total of 95 midshaft clavicle fracture patients aged between 18-70 years with a minimum follow-up duration of 12 months were included in this study. Patients were treated either conservatively (Group I) or surgically (Group 2). Plane deformities, scapulothoracic joint angle, shortness and isokinetic muscle strength were measured. Shoulder Pain, Disability Index (SPADI) and Short Form-36 (SF36) were assessed.Results:Scapulothoracic joint angles were higher in the conservative treatment group than in surgery group (p=0.036). Consequently, winged scapula was seen more commonly in the conservative treatment group than in the surgery group (p=0.001). Surgical treatment was associated with significantly better SF-36 physical scores and with SPADI pain and disability scores. However, the two groups did not differ in terms of isokinetic muscle strength. Negative anteroposterior plane deformity (p<0.001) and negative axial plane deformity (p=0.004) were more frequent in the conservative treatment group. Clavicle shortness was more common in the conservative treatment group.Conclusion:According to our findings scapulothoracic joint angle changes were seen in the conservative treatment group more than in the surgery group. Consequently, winged scapula was seen more commonly in the conservative treatment group than in the surgery group (p=0.001). Level of Evidence III; Retrospective comparative study .

Foot Loading Analysis of Intra-articular Tibia Pilon Fracture.

Although pilon fractures are rare, they are important for orthopedic surgeons because of the difficulty of their treatment and their adverse effects on gait function. The aim of this was study to evaluate the relationship between the reduction quality of the fracture, functional results, ankle arthrosis, and plantar pressure distribution in patients with tibia pilon fractures. In this study, a total of 62 patients treated for an intraarticular pilon fracture in our clinic between January of 2015 and January of 2019 were evaluated retrospectively. Postoperative reduction qualities of the patients were evaluated with the Ovadia-Beals criteria; ankle functional scores were evaluated with the Teeny-Wiss score; and ankle arthrosis was evaluated with the Takakura classification. At the last patient follow-up, foot loading analysis was performed, and the results were evaluated for their relation with postoperative reduction quality, ankle function, and ankle arthrosis. There were 62 patients (50 men and 12 women). The average age was 43.3 years (range, 19-78 years). The mean follow-up was 34.3 months (range, 24-58 months). The mean Ovadia-Beals score was 12.35 ± 4.6 on the postoperative plain radiographs of the patients; the mean Teeny-Wiss score at the last follow-up was 76.82 ± 17.69; and the mean Takakura score was 1.47 ± 1.35. Based on the pedobarographic measurements, 47.58% of the patients put weight on the anterior portion and 52.42% on the posterior portion of the foot in the anteroposterior plane. In the mediolateral plane, 42.15% loaded on the medial portion of the ankle and 57.85% loaded on the lateral portion of the foot. Intra-articular tibia pilon fractures can be demonstrated by lateralization of the walking axis and changes in gait patterns and can be associated with clinical outcome.

Nailing distal tibial fractures: does entry technique affect distal alignment?

In treating distal third tibial fractures, restoration of the axial alignment and therefore accurate reduction of the distal fragment minimise the risk of tibiotalar joint malalignment. The aim of this study is to investigate whether there was a difference in accuracy of reduction and axial alignment, when nailing distal third tibial fractures using either the suprapatellar or the infrapatellar tibial nailing entry technique. This retrospective cohort study compared alignment of intramedullary nails performed for distal third tibial fractures between 2015 and 2018 through the suprapatellar and infrapatellar approach at a UK Level 1 trauma centre. It compared a consecutive series of 74 suprapatellar nails and 51 infrapatellar nails, with radiographic assessment of tibial alignment in the antero-posterior and sagittal planes. It included inter- and intra-observer analyses of radiographic measurements. In the coronal plane, mean malalignment in the suprapatellar technique group was 2.8 ± 0.7° and 4.7 ± 0.9° in the infrapatellar technique group (P < 0.01). In the sagittal plane, mean malalignment in the suprapatellar technique group was 4.0 ± 0.8° and 3.5 ± 0.9° in the infrapatellar technique group (P = 0.42). Intra- and inter-observer analysis showed strongly positive correlations between observers. We suggest that the suprapatellar technique may improve coronal plane alignment when intramedullary nailing distal tibial fractures. There was no significant difference in alignment in the sagittal plane. We conclude that the suprapatellar technique may be superior in preventing malalignment when treating distal third tibial fractures, potentially improving clinical outcome.

Effect of Skeletal Maturity on Fixation Techniques for Tibial Eminence Fractures.

Background:Several fixation methods have been reported for the operative treatment of tibial eminence fractures. Previous biomechanical studies have demonstrated that suture fixation may be a stronger construct; however, the maturity status of these specimens was not scrutinized.Purpose:To examine if suture fixation remains a biomechanically superior fixation method to screw fixation in both skeletally mature and immature specimens.Study Design:Controlled laboratory study.Methods:Sixteen total matched porcine (Yorkshire) knees (8 skeletally immature knees and 8 skeletally mature knees) were procured, and a standardized tibial eminence fracture was created. In each age-matched group of knees, 4 knees underwent randomization to fixation with 2 screws while 4 knees were randomized to fixation using a dual-suture technique. Once fixation was complete, the specimens underwent cyclic loading (200 cycles) in the anteroposterior plane of the tibia and load-to-failure testing, both with the knee positioned at 30° of flexion. Relevant measurements were recorded, and data were analyzed.Results:Among mature specimens, load to failure was 1.9 times higher in the suture fixation group compared with the screw fixation group (1318.84 ± 305.55 vs 711.66 ± 279.95 N, respectively; P = .03). The load to failure was not significantly different between the groups in immature specimens (suture: 470.00 ± 161.91 N vs screw: 348.79 ± 102.46; P = .08).Conclusion:These findings suggest that suture fixation may represent a better construct choice for fixation of tibial eminence fractures in the skeletally mature population. However, in the skeletally immature population, fixation with screws or suture may be equivalent. Displacement after cyclic loading did not appear to differ by fixation method, nor did stiffness.Clinical Relevance:A stronger fixation construct may be beneficial and allow for earlier range of motion to help potentially decrease postoperative stiffness. Clinical studies are warranted to see if these results may be replicated in humans.

Quantitative SSM-based analysis of humeral head migration in rotator cuff tear arthropathy patients.

Rotator cuff tear arthropathy (RCTA) is characterized by massive rotator cuff tearing combined with humeral head migration (HHM). The aim of this study is to investigate the quantitative characteristics of this migration and its association with glenoid erosions and prearthropathy scapular anatomy. We quantified HHM and prearthropathy scapular anatomy of 64 RCTA patients with statistical shape modeling-based techniques. Glenoid erosion was classified according to Sirveaux et al.A cutoff value for confirming HHM was 5 mm based on a control group of 49 patients. Group 1 (RCTA without HHM) consisted of 21 patients, with a mean subluxation distance (SLD) of 3 mm. Group 2 (RCTA with HHM) consisted of 43 patients, with mean SLD of 9 mm, SLD in the anteroposterior plane of -1 mm (SD ± 4 mm), SLD in the superoinferior plane of 7 mm (SD ± 3 mm), and subluxation angle (SLA) of -5° (SD ± 40°). Analysis with Fisher's exact test showed a clear association between HHM and glenoid erosions (p = 0.002). Multivariate regression analysis of Group 2 showed that prearthropathy lateral acromial angle combined with critical shoulder angle (p = 0.004) explained 21% of the observed variability in SLD. The prearthropathy glenoid version explained 23% of the variability in SLA (p = 0.001). HHM in RCTA patients has a wide variation in both magnitude and direction leading to a distorted glenohumeral relationship in the coronal and axial plane. HHM is highly associated with the occurrence of glenoid erosions. There is a correlation between the prearthropathy scapular anatomy and the magnitude and direction of HHM.

Conventional fluoroscopic views are inadequate to predict the Tip Apex Distance and articular clearance of sliding screw devices: A computed tomography-based analysis

Tip-apex-distance (TAD) has been widely advocated as the index to predict the risk of screw cut out in hip fractures treated with sliding hip screw devices. The fluoroscopic extents of the femoral head can change with the slightest change in the limb position which includes internal and external rotations, adduction and abduction. These changes can affect the visible TAD and articular-clearance of the screw-tip. The purpose of this Computed-tomography(CT) based analysis is to analyze the variations of the radiographically visible articular-clearance and TAD measurements with limb positioning and to determine the appropriate fluoroscopic projections for different screw-positions within the femoral head. We retrospectively analysed CT studies of twenty healthy proximal femora. Spatial markers simulating screw tips were placed in the different combinations of anteroposterior(AP) and cephalocaudal(CC) positions. Software-based AP and lateral radiographs were developed for each screw position. Additional AP radiographs with femur in internal and external rotation, and lateral radiographs with the femur in adduction and abduction were developed. The variation of TAD and articular-clearance of the screw was measured among these radiographs for individual screw tip positions. Screw tip placed centrally in AP and CC planes position didn't show any significant variation in TAD and articular-clearance with modified AP and lateral radiographs. Significant differences were observed in TAD and articular-clearance values for other screw tip positions. Anteriorly placed screw tips had higher TAD and articular-clearance values with external rotation and similar changes were observed with posteriorly placed tips in internal rotation. Inferiorly placed tips had higher articular-clearance and TAD with limb abduction and similar changes were observed for superiorly placed tips with limb adduction. For the sliding screws placed in non-central locations, the clearance of the screw tip from the articular margins can not be appropriately estimated with conventional AP and lateral views. Additional views with the limb in internal rotation and external rotation in AP view, and adduction-abduction in lateral view are required to safely place the sliding screw in the femoral head. The limb should be brought to a neutral alignment for the accurate estimation of TAD.