Anteroposterior Projection Research Articles

Characteristics of Low Back Pain (LBP) in The Lumbosacral Examination in Radiological Installations: A Case of Tidore Island Hospital and Jailolo Hospital, Indonesia

The International Classification of Disease (ICD) shows that Low Back Pain (LBP) is a condition of pain and discomfort in a person below the corner of the last rib (costal margin) and above the lower gluteal fold, accompanied by pain in the legs. Low Back Pain (LBP) is not a disease or a diagnosis but instead triggers the term used for pain syndromes in which anatomical structures are affected in various ways by the duration of pain. Low Back Pain cases worldwide vary annually, reaching 15 to 45%. WHO shows that 33% of the population in developing countries experience persistent back pain. The prevalence of musculoskeletal disorders in Indonesia is 11.9% based on diagnosis by health workers, 24.7% based on diagnosis or incidence, and about 4.73% in North Maluku. Prevalence has increased significantly at the age of 35 to 55 years. The Lumbosacral Vertebrae examination technique is an initial examination to determine the presence of LBP abnormalities in the lumbosacral. The most frequently used radiological procedure in cases of LBP is a lumbosacral examination using anteroposterior (AP) and lateral projections. This research used a descriptive and retrospective approach. This research was conducted at the Radiology Installation of Tidore Islands Hospital and Jailolo Hospital for one year, January-December 2021. The results showed that the lumbosacral check in patients with clinical Low Back Pain (LBP) in the Radiology Installation of Tidore Islands Hospital and Jailolo Hospital was 64 at the Tidore Islands Hospital and 72 at the Jailolo Hospital. The people with the highest age in the two hospitals is the age range of 46-55 years, dominated by women (57.8%) at the Tidore Islands City Hospital and men (59.7%) at Jailolo Hospital. Also, the characteristics of Low Back Pain (LBP) based on the lumbosacral examination were lumbar spondylosis (43.8%) at the Tidore Islands Hospital and (41.7%) at the Jailolo Hospital.

Kinematics of lateral tongue-pushing movement in coordination with masticatory jaw movement: An anteroposterior projection videofluorographic study

ObjectiveDuring the mastication of solid food, the tongue pushes the bolus laterally to place it onto occlusal surfaces as the jaw is opened. This movement is referred to as tongue-pushing (TP). TP has an important role in efficient chewing, but its kinematic mechanisms remain unclear. The present study quantified the kinematics of TP and its coordination with masticatory jaw movements. MethodsVideofluorography (VFG) in anteroposterior projection was recorded while 14 healthy young adults ate 6 g each of cookies and meat. Small lead markers were glued to the tongue surface (left, right, and anterior) and buccal tooth surfaces (upper molars and lower canines). The position of the tongue and lower canine markers relative to the upper occlusal plane was quantified with Cartesian coordinates, using the right upper molar as the origin. Jaw motion during chewing was divided into TP and Non-TP cycles, based on the lateral movement of the food and tongue markers. The side of the jaw that compressed food particles was defined as the working side, while the other side was termed the balancing side. Horizontal and vertical displacements of tongue and jaw markers were compared between TP and Non-TP cycles, as well as between food types. ResultsThe mediolateral displacement of all tongue markers was significantly larger in TP than in Non-TP cycles. Vertical displacement was also significantly greater in TP than in Non-TP cycles for the anterior and working side tongue markers. TP cycles occurred more frequently with meat-chewing than with cookie-chewing. ConclusionTP is accomplished by rotation and lateral movements of the tongue surface on the working side and the anterior tongue blade, along with medial movement on the balancing side. These movements produce lateral shift and rotation of the tongue surface toward the working side in concert with jaw opening. Designing exercises to improve the strength of the lateral motion and rotation of the tongue body may be useful for individuals with impaired tongue function for eating and swallowing.

FEMORAL NECK FRACTURES, EPIDEMIOLOGY, ANATOMICAL DESCRIPTION, MECHANISM OF ACTION, CLASSIFICATION, CLINICAL EVALUATION, IMAGING EVALUATION, TREATMENT AND COMPLICATIONS

Introduction: Femoral neck fractures (FNF) are frequent and devastating injuries in orthopedics and traumatology. It usually has several therapeutic options depending on the type of fracture and the comorbidities of the affected individual, among the conservative treatment alternatives are bed rest with or without traction and among the surgical alternatives are internal fixation. Objective: to detail the current information related to femoral neck fractures, epidemiology, anatomical description, mechanism of action, classification, clinical evaluation, imaging evaluation, treatment and complications. Methodology: a total of 40 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 31 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: fractures, femur, femoral neck, prosthesis, trauma. Results: 80% are generated in women, and the incidence doubles every 5 to 6 years in women over 30 years of age. It presents bimodal incidence. The risk factors are female sex, white race, advanced age, poor health, smoking, alcohol consumption, previous fractures, history of falls and low estrogen concentrations. Magnetic resonance imaging (MRI) is the test of choice for the diagnosis of undisplaced or occult fractures not observable on plain radiographs. Up to 40% of impacted or nondisplaced fractures will displace if they do not undergo internal fixation. Secondary displacement is 5% following internal fixation. Pseudarthrosis may complicate up to 5% of non-displaced fractures and up to 25% of displaced fractures; furthermore, osteonecrosis complicates up to 10% of non-displaced fractures and up to 30% of displaced fractures. Conclusions: femoral neck fractures present a high incidence, the mechanism of action mostly presented in young people is high energy trauma, in the elderly the most common mechanism is low energy falls. Patients with displaced femoral neck fractures are unable to walk and show shortening and external rotation of the lower limb. Anteroposterior projections of the pelvis are indicated, as well as anteroposterior and cross lateral projections of the affected proximal femur. The goals of treatment are to relieve the patients pain, restore hip function and have rapid mobilization through anatomical reduction and internal fixation or by prosthetic replacement. Conservative treatment of fractures is recommended in individuals at extreme surgical risk; it can also be considered in individuals with dementia, who do not maintain the ability to walk and have little symptomatology due to hip pain. Among the most important complications are pseudarthrosis and osteonecrosis. Surgery to treat nondisplaced femoral neck fractures is associated with a higher number of consolidation and associated with less avascular necrosis compared to conservative treatment. KEY WORDS: fractures, femoral neck, trauma, prosthesis.

PATELLAR DISLOCATION AND PATELLAR INSTABILITY PANORAMIC REVIEW

Introduction: Primary patellar dislocation is usually the initial manifestation of patellofemoral instability. Among the long-term repercussions of this disorder are recurrent dislocation and indefinable knee dysfunction. At present, there is no agreement on the optimal treatment of patellar dislocation. Objective: to detail the current information related to patellar dislocation, epidemiology, mechanism of action, clinical evaluation, imaging evaluation, classification, differential diagnosis, treatment and complications of the disease. Methodology: a total of 30 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 22 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: patella, knee anatomy, patellar dislocation, knee instability. Results: Approximately 5% of the time it is related to osteochondral fractures. To define whether a patella is high or low, a lateral radiograph should be taken with the knee in 30° of flexion to determine Blumensaats line. The increase in the Q angle facilitates patellar dislocation. Most patellar dislocations are related to congenital anomalies of the patella or trochlea, high patella, hypoplasia of the vastus medialis and hypertrophy of the lateral retinaculum. Conclusions: Patellar dislocation is usual in individuals with connective tissue disorders and hypermobility, the patella can be dislocated laterally, superiorly or intra-articularly, presenting different mechanisms of action for each case. It is important to have a good knowledge of the anatomy and to measure the Q angle because the increase of this angle facilitates patellar dislocation. It is essential to establish the etiology of the dislocation, especially in those with recurrent dislocations as this may alter the management plan. In addition to the clinical evaluation it is important to request anteroposterior, lateral knee and axial projections. When conservative treatment is chosen, reduction and immobilization with a cast or orthosis should be performed with the knee in extension, the long knee brace can be used, with or without arthrocentesis to relieve the symptomatology; surgical treatment is mostly used in recurrent dislocations. At the moment, no surgical technique is able to correct all the problems of patellar alignment. It should be kept in mind that the surgical procedure should take into account the individuals age, diagnosis, activity level and the situation of the patellofemoral joint. Patellofemoral instability should be treated with the goal of correcting all of the alignment issues. The usual complications are loss of knee mobility, recurrent dislocation and patellofemoral pain. KEY WORDS: dislocation, patella, knee, instability.

Lateral Teardrop Sign: A New Distinguishing Feature of Anteroposterior Projection of Chest Radiograph

Abstract Introduction: The posteroanterior (PA) projection is the standard view for chest radiographs with the alternative of anteroposterior (AP) chest view. Proper identification of the projection of any chest radiograph is critical to the interpretation and eventual inferences made. The teardrop sign in radiology is a well-known feature that is observed wherever two or more bones are projected over one another. This article aims to introduce a lateral teardrop sign seen on AP projections of the chest and to assess its prevalence and predictive value as a distinguishing parameter between AP and PA views of the chest radiograph. Methodology: This retrospective observational study was conducted at the outpatient X-ray unit of the Department of Radiology, University College Hospital, Ibadan. Chest radiographs with AP and PA projections acquired between August 25, 2021, and July 15, 2022, were retrieved from the Picture Archival Communication System and assessed for the presence of lateral teardrop sign. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 25. Results: Two hundred and seven radiographs were retrieved and analyzed. These included radiographs of 106 (51.2%) males and 101 (48.8%) females. Eighty-eight (42.5%) were taken in the AP projection while 119 (57.5%) were PA. Only 46 (22.2%) of these radiographs showed the lateral teardrop sign. Of the 46 radiographs showing the sign, 45 (97.8%) were AP constituting 51.1% of all AP radiographs. One hundred and eighteen (73.3%) of radiographs without the sign were PA. A negative and positive predictive value of 73.5% and 98.9% were calculated, respectively, for the lateral teardrop sign, with a sensitivity of 67.2% and specificity of 99.2%. Conclusion: Even though there are already existing parameters used to differentiate between AP and PA views, the presence of lateral teardrop sign can be a useful addition in the identification and distinguishing of AP radiographs.

Diagnostic accuracy of upper gastrointestinal series in children with suspected intestinal malrotation

Intestinal malrotation (IM) results from an altered or incomplete rotation of the fetal midgut around the superior mesenteric artery axis. The abnormal anatomy of IM is associated with risk of acute midgut volvulus which can lead to catastrophic clinical consequences. The upper gastro-intestinal series (UGI) is addressed as the gold standard diagnosis procedure, but a variable failure degree has been described in literature. The aim of the study was to analyze the UGI exam and describe which features are the most reproducible and reliable in diagnosing IM. Medical records of patients surgically treated for suspected IM between 2007 and 2020 at a single pediatric tertiary care center were retrospectively reviewed. UGI inter-observer agreement and diagnostic accuracy were statistically calculated. Images obtained with antero-posterior (AP) projections were the most significant in terms of IM diagnosis. Duodenal-Jejunal Junction (DJJ) abnormal position resulted to be the most reliable parameter (Se = 0.88; Sp = 0.54) as well as the most readable, with an inter-reader agreement of 83% (k = 0.70, CI 0.49–0.90). The First Jejunal Loops (FJL), caecum altered position and duodenal dilatation could be considered additional data. Lateral projections demonstrated an overall low sensitivity (Se = 0.80) and specificity (Sp = 0.33) with a PPV of 0.85 and a NPV of 0.25. UGI on the sole AP projections ensures a good diagnostic accuracy. The position of the third portion of the duodenum on lateral views showed an overall low reliability, therefore it was not helpful but rather deceiving in diagnosing IM.

PATELLA FRACTURES, EPIDEMIOLOGY, ANATOMY, FUNCTION, MECHANISMS OF ACTION, CLASSIFICATION, CLINICAL PRESENTATION, IMAGING PRESENTATION, TREATMENT AND COMPLICATIONS

Introduction: The patella has a great importance in the extension and flexion activities of the knee, being paramount in the patient's quality of life. Nowadays the surgical options that stand out the most are open reduction plus internal fixation and resection of the patella. The patella increases the leverage of the quadriceps. Management following patella injury has been based on preservation of bone and vascular supply, in addition to joint restoration and extensor function. In patella fractures, it is essential to reflect on the biomechanics of the bone and the fixation technique to be used. Objective: to detail the current information related to patella fractures, epidemiology, anatomy, function, mechanisms of action, classification, clinical presentation, imaging presentation, treatment and complications. Methodology: a total of 32 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 24 bibliographies were used because the other articles were not relevant for this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: patella, patellar fractures, knee trauma. Results: Patellar fractures comprise 1% of all fractures in humans, with a 2:1 male to female ratio. They occur more frequently in individuals between 20 and 50 years of age. The frequencies of pseudarthrosis and infection are relatively lower after the surgical procedure. Approximately 2 to 7% of patellar fractures are open fractures. Their classification is descriptive. Conclusions: The patella is the largest sesamoid bone in the human body with several important functions. Frequently, patellar fractures appear after falls on the knee, blows and unexpected and energetic muscular pulls. The diagnosis is made by means of clinical history, physical examination and complementary radiography. Anteroposterior and lateral projections of the knee should be performed. For conservative treatment it is essential that the knee extensor mechanism is intact. There are several methods of surgical treatment, in general the open reduction and internal fixation present good results. Complications include post-traumatic osteoarthritis, alteration or loss of mobility of the knee, refracture, fixation failure, osteonecrosis, intolerance to osteosynthesis material, loss of strength of the extensor mechanism, loss of extension, instability of the patella and pseudoarthrosis. KEY WORDS: patella, knee, fracture, treatment, osteosynthesis.

CALCANEAL FRACTURE, EPIDEMIOLOGY, ANATOMY, MECHANISM OF INJURY, CLASSIFICATION, IMAGING PRESENTATION, CLINICAL PRESENTATION, MANAGEMENT AND COMPLICATIONS

Introduction: Throughout time, calcaneal burst fractures have been referred to as lovers fractures because the injury occurred when a suitor jumped off a lovers balcony to avoid detection. The calcaneus is part of the 7 tarsal bones, calcaneus, talus, cuboid, navicular, first, second and third cuneiform. Calcaneal fractures are infrequent, however, they have a high potential to weaken the limb. Objective: to detail current information related to calcaneal fractures, epidemiology, anatomy, mechanism of injury, clinical evaluation, imaging evaluation, classification, treatment and complications. Methodology: a total of 30 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 21 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: calcaneal fracture, calcaneus, calcaneal osteosynthesis, foot fractures. Results: The calcaneus is the most commonly fractured tarsal bone, representing 2% of all fractures. Calcaneal fractures are bilateral in 5 to 10%, and are usually related to fractures of the lumbar spine and other fractures of the lower limb caused by high-impact trauma. About 10 % of calcaneal fractures are open. Conclusions: The calcaneus is the most commonly fractured tarsal bone, accounting for 2 % of all fractures. Calcaneal fractures are bilateral in 5 to 10% and are usually related to fractures of the lumbar spine and other fractures of the lower limb caused by high impact trauma. About 10% of calcaneal fractures are open, and neurovascular injuries are infrequent in calcaneal fractures. Calcaneal fractures are more related to high energy impacts that generate axial loading of the bone, however they can occur with any injury to the foot and ankle. The main characteristics of individuals affected with a calcaneal fracture are pain, swelling, widening, deformity, ecchymosis and functional impotence. To make the radiological diagnosis of calcaneal fracture in the first instance it is recommended to request an anteroposterior projection of the foot, lateral projection of the rearfoot, Harris axial projection and an ankle series; if necessary, a computed tomography can be performed. In practice, calcaneal fractures can be classified as intra-articular or thalamic and extra-articular; in addition, classification systems such as Sanders and Essex-Lopresti are used. Treatment is controversial. Even with adequate reduction and management, calcaneal fractures can become extremely disabling injuries, presenting a mutable prognosis with various types of functional limitation and pain. Currently, some factors have been found to be related to better outcomes, however, the literature comparing various methods of surgical versus conservative treatment show that surgical management has increased complication rates, however, it may lead to optimal functional outcomes in some individuals. Generally, the incidence of complications of calcaneal fractures is high and increases the worse the wound. Among the most common are calcaneal osteomyelitis, post-traumatic osteoarthritis, wound dehiscence, increased heel width, loss of subtalar mobility, chronic peroneal tendonitis, and complex regional pain syndrome. KEY WORDS: fracture, calcaneus, osteosynthesis, foot.

RADIAL HEAD FRACTURES, EPIDEMIOLOGY, ANATOMY, MECHANISM OF INJURY, CLASSIFICATION, IMAGING PRESENTATION, CLINICAL PRESENTATION, MANAGEMENT AND COMPLICATIONS

Introduction: In recent years the understanding and comprehension of the elbow has improved, clarifying some aspects of the complex diarthrodial joint. The relevance of the radial head in the biomechanics of the elbow is recognized which helps to improve the management and treatment of fractures at this site. Elbow trauma is the most common origin of proximal radius fractures, this trauma can be direct or indirect and can cause an isolated fracture, a fracture associated with other fractures and ligament injuries. Objective: to detail the current information related to radial head fractures, epidemiology, anatomy, presentation, clinical evaluation, imaging evaluation, classification, treatment and complications. Methodology: a total of 42 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 31 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: radial head fractures, radial head prosthesis, radial head arthroplasty. Results: Radial head fractures have an incidence of 2.5 per 10,000 per year, which represents 1.7 to 5.4% of all fractures. Most radial head injuries are the result of a fall on the hand in extension. Usually the affected individuals show limitation of mobility of the forearm and elbow in addition to pain or discomfort when making passive rotational movement of the forearm; they also usually present pain on palpation over the radial head and joint effusion in the elbow. Sometimes there is a fracture-dislocation of the radial head related to a rupture of the interosseous membrane with lesion of the distal radioulnar joint called Essex-Lopresti lesion. Conclusions: The radial head together with the interosseous membrane of the forearm provide longitudinal stability; when the interosseous membrane is damaged, a proximal migration of the radial head may occur after removal of the radial head. When presenting clinical suspicion of elbow fracture, standard anteroposterior and lateral projections of the elbow should be requested, as well as oblique projections such as the Greenspan projection. The Manson, Mason-Johnston or Mason classification modified by Hotchkiss is usually used for classification. Among the indications for conservative treatment are solitary, undisplaced or minimally displaced fractures that do not present mechanical blockages in the range of motion or less than 3 mm of displacement. Studies report the effectiveness of open reduction and internal fixation of simple Mason type II fractures; Manson type III fractures are controversial. Complications usually arise from contracture subsequent to prolonged immobilization or secondary to persistent pain, edema and swelling; which may be due to undiagnosed osteochondral injury of the capitellum. KEY WORDS: fracture, radius, head, prosthesis, elbow.

AN ANALYSIS OF INDIA'S AGRICULTURAL SECTOR: CHALLENGES AND OPPORTUNITIES

Introduction: Open fractures of the pelvis represent one of the most fatal injuries within musculoskeletal trauma so they must be treated correctly, adjusting to a multidisciplinary approach to achieve the well-being of the affected person, in addition to restoring homeostasis and normal pathophysiology related to the mechanical stability of the pelvic ring. Objective: to detail current information related to pelvic fractures, epidemiology, anatomy, mechanism of injury, classification, imaging presentation, clinical presentation, management and complications. Methodology: a total of 27 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 20 bibliographies were used because the other articles were not relevant for this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: fracturas de pelvis, fraturas do anel pelvico, anatomy of the pelvis, fractures of the pelvis. Results: Most cases of pelvic fractures occur in young people due to high-energy mechanisms, although injuries can also be generated by low-energy mechanisms and can cause fractures of individual bones. Mortality is higher in individuals with hemodynamic instability. The standard imaging examinations in trauma are anteroposterior projections of the thorax, lateral cervical spine and anteroposterior projections of the pelvis; special projections of the pelvis include the oblique alar and obturator projections. The severity of pelvic fractures is closely related to the associated injuries. Conclusions: Knowledge of anatomy is a fundamental piece in the treatment of pelvic fractures and associated injuries. There are several systems for classifying pelvic fractures, according to anatomical patterns, mechanisms of injury, resulting instability requiring surgery. The most frequently used is that of Young and Burgess. For evaluation, one should start with the ABCDE, airway, breathing, circulation, disability, and exposure and integrate a complete traumatologic evaluation. To determine whether there is pelvic instability, the anteroposterior and lateral compression test is performed for one occasion, generating internal and external rotation of the pelvis. The spine and extremities should be well assessed with an adequate neurovascular examination and a thorough neurological examination. In pelvic fractures, management and treatment begins with ABCDE. Followed by stabilization of the patient, a multidisciplinary approach is required. External or internal fixation can be performed to stabilize the pelvis, its use and recommendation usually vary according to the characteristics of each fracture, the associated injuries and the instability of the pelvic ring. Pelvic trauma with involvement of the acetabulum and injuries to the genitourinary system should not be underestimated. Complications include infection, thromboembolism, malunion and pseudarthrosis. KEY WORDS: fracture, pelvis, pelvic ring, pelvic trauma.

PELVIC FRACTURES, EPIDEMIOLOGY, ANATOMY, MECHANISM OF INJURY, CLASSIFICATION, IMAGING PRESENTATION, CLINICAL PRESENTATION, MANAGEMENT AND COMPLICATIONS

Introduction: Open fractures of the pelvis represent one of the most fatal injuries within musculoskeletal trauma so they must be treated correctly, adjusting to a multidisciplinary approach to achieve the well-being of the affected person, in addition to restoring homeostasis and normal pathophysiology related to the mechanical stability of the pelvic ring. Objective: to detail current information related to pelvic fractures, epidemiology, anatomy, mechanism of injury, classification, imaging presentation, clinical presentation, management and complications. Methodology: a total of 27 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 20 bibliographies were used because the other articles were not relevant for this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: fracturas de pelvis, fraturas do anel pelvico, anatomy of the pelvis, fractures of the pelvis. Results: Most cases of pelvic fractures occur in young people due to high-energy mechanisms, although injuries can also be generated by low-energy mechanisms and can cause fractures of individual bones. Mortality is higher in individuals with hemodynamic instability. The standard imaging examinations in trauma are anteroposterior projections of the thorax, lateral cervical spine and anteroposterior projections of the pelvis; special projections of the pelvis include the oblique alar and obturator projections. The severity of pelvic fractures is closely related to the associated injuries. Conclusions: Knowledge of anatomy is a fundamental piece in the treatment of pelvic fractures and associated injuries. There are several systems for classifying pelvic fractures, according to anatomical patterns, mechanisms of injury, resulting instability requiring surgery. The most frequently used is that of Young and Burgess. For evaluation, one should start with the ABCDE, airway, breathing, circulation, disability, and exposure and integrate a complete traumatologic evaluation. To determine whether there is pelvic instability, the anteroposterior and lateral compression test is performed for one occasion, generating internal and external rotation of the pelvis. The spine and extremities should be well assessed with an adequate neurovascular examination and a thorough neurological examination. In pelvic fractures, management and treatment begins with ABCDE. Followed by stabilization of the patient, a multidisciplinary approach is required. External or internal fixation can be performed to stabilize the pelvis, its use and recommendation usually vary according to the characteristics of each fracture, the associated injuries and the instability of the pelvic ring. Pelvic trauma with involvement of the acetabulum and injuries to the genitourinary system should not be underestimated. Complications include infection, thromboembolism, malunion and pseudarthrosis. KEY WORDS: fracture, pelvis, pelvic ring, pelvic trauma.

INTERTROCHANTERIC FEMUR FRACTURE

Introduction: Intertrochanteric fractures are a type of extracapsular fractures of the proximal femur occurring between the greater and lesser trochanter. They are frequently seen in the elderly because their incidence is higher as life expectancy increases. Objective: to describe the current information related to epidemiology, anatomy, presentation, classification, evaluation and management of intertrochanteric fractures. Methodology: a total of 35 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 27 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: transtrochanteric, intertrochanteric, femur, fracture, fratura. Results: Intertrochanteric fractures have a bimodal presentation. They have a female to male ratio ranging from 2:1 to 8:1, possibly due to changes in bone metabolism after menopause. They are frequently seen in the elderly because their incidence is higher as life expectancy increases. Plain radiographs are still the initial choice to complement the diagnosis in this type of fractures. It is preferable to take anteroposterior (AP), AP and lateral cross pelvis projections of the affected hip and full body radiographs of the affected femur. Surgical treatment is preferred over conservative treatment except in cases that contraindicate surgery or anesthesia. Conclusions: Intertrochanteric fractures are a type of extracapsular fractures of the proximal femur occurring between the greater and lesser trochanter. Femur fractures have several classifications, recently the classification of intertrochanteric fractures is based on the stability of this area. It is of vital importance to evaluate whether it is an open or closed fracture, in addition to assessing the neurovascular status. The surgical treatment has the mission of providing a stable internal fixation that allows early mobilization and full weight bearing. There are several tools and techniques to provide surgical treatment, however, in our current reality, intramedullary nails are the most used devices in the treatment of intertrochanteric fractures. Regardless of the therapeutic alternative chosen, the mortality risk is 20% to 30% in the first year after the fracture, with males being more affected than females. KEY WORDS: transtrochanteric, intertrochanteric, femur, fracture.

BENNETT FRACTURE

Introduction: The intra-articular fracture separating the palmar ulnar aspect of the base of the first metacarpal from the rest of the first metacarpal is called Bennetts fracture. Injuries are usually caused by axial loads on the partially flexed metacarpal bones. Radiographs are needed to evaluate these injuries and to schedule surgery to relieve them, since such fractures are assumed to be unstable. Surgical treatment of these fractures alters depending on the extent of the injury. It may include closed reduction with percutaneous fixation or open reduction with fixation or interfragmentary fixation. With good fracture localization and fixation, the postoperative outcome is usually good. Objective: to detail the current information related to Bennetts fracture, presentation, evaluation, comparison with Rolandos fracture, in addition to the diagnosis and treatment of the disease. Methodology: a total of 28 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 18 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: Bennett fracture. Bennetts, fratura da base do primer metacarpiano. Results: Anteroposterior, lateral and oblique projections are common when taking radiographs of the hand, however Roberts view can reveal more details about the injury. Both Bennetts and Rolandos fractures present the same pathogenic mechanism however the damaging force is of greater magnitude than in Bennets fractures. K-wire fixation is better than plate and/or screw osteosynthesis as a treatment because of the benefit of keeping costs down without harming the patient in the long term. Direct visualization is the most accurate method to assess joint separation and articular pitch, PA, AP and lateral projections on fluoroscopic examination may not be sufficient to determine the final position of a reduced Bennett fracture. Conclusions: Although there is no consensus on which treatment is best, surgical treatment of Bennett fractures is usually used because closed reduction and cast immobilization without internal fixation are often unstable due to deforming forces. Indications for surgical treatment for fractures of the base of the first metacarpal include extra-articular fractures with more than 30 degrees of angulation after reduction; loss of reduction after non-operative treatment; and intra-articular fractures: displaced Bennett fractures greater than 1 mm or any Rolando fracture.The arthroscopically assisted screw fixation of Bennett reported fewer complications, shorter immobilization time and shorter tourniquet time. Keywords: fracture, Bennett, metacarpal, first.

Эффективность рентгенологических методов диагностики нестабильности позвоночно-двигательного сегмента в шейном отделе

Introduction. Standard spine radiography is the basic method of radiodiagnosis, used for screening. X-ray imaging allows you to assess the anatomy of spinal motion segments in the cervical spine, determine the period of osteochondrosis and the tactics of further examination and treatment. Various types of dislocation of vertebrae are much more common than can be determined by spinal radiography in standard projections; as a result of dislocation, a pain syndrome occurs. Aim. To study the effectiveness of conventional methods for diagnosis of instability in the spinal motion segment (SMS) in the cervical spine. Materials and methods. We observed 50 patients (mean age 50.6 ± 2.19 years) who were admitted to the Clinic of the Irkutsk Scientific Center for Surgery and Traumatology (Neurosurgical Department) with a diagnosis Adult osteochondrosis of spine (ICD-10 code – M42.1). Conventional methods were used to diagnose SMS instability: plain radiography in anteroposterior and lateral projections, functional cervical spine radiography. Results. It was stated that the most common changes are characteristic of II and III periods of osteochondrosis: straightening of cervical lordosis – in 48 patients (96%), decrease in intervertebral disc height – in 46 patients (92%), anterior wedging of vertebral bodies – in 48 patients (96%), endplate sclerosis – in 37 patients (74%), presence of marginal osteophytes – in 45 patients (90%). In maximum flexion and extension, the CII–CVI vertebrae were involved in the formation of pathological mobility of the intervertebral segments, while the CI and CVII vertebrae remained stable. Instability in one cervical vertebra was revealed in 15 patients (30%). Most often, excessive mobility of 2 vertebrae was observed – in 22 people (44%), less often of 3 vertebrae – in 5 patients (10%). The dislocation of 4 vertebrae was quite rare – in 2 patients (4%). When analyzing the data of functional cervical spine radiography, we have found that the SMS instability in patients with intervertebral disc degeneration develops most often in the following segments: CII–CIII – 13 people (26%), СIII–СIV – 34 people (70%), CIV–CV – 29 people (58%), СV–СVI – 12 people (24%). Conclusion. The SMS instability still remains an urgent problem in neurology and neurosurgery. Plain radiography reveals only indirect signs of SMS instability. Diagnosis by functional spondylography made it possible to verify the SMS instability only in 36% of cases.

Clinico-radiological correlation of reverse shoulder arthroplasty outcomes

<p>Positioning of prosthetic components is essential for the success and longevity of the prosthesis. Judging prosthetic implantation radiologically is always beneficial; plain radiographs and computed tomography can provide information regards inclination and version of glenoid component, besides, lateralization of prosthetic components.<strong> </strong>This study aims at postoperative radiological evaluation of component positioning of reverse shoulder prosthesis and correlating measured radiological parameters with clinical outcome.<strong> </strong>Radiological assessment was carried on by radiographs taking advantage of true anteroposterior projection, and midaxial two-dimensional computed tomography cut. Radiographs evaluated glenoid inclination in coronal plane (superior-inferior tilt) via global inclination angle, and critical shoulder angle. Center of rotation was evaluated by calculating acromion index. Additionally, acromiohumeral interval, and deltoid lever arm distance were documented. Midaxial CT cuts evaluated glenoid version. Each parameter was correlated to postoperative clinical outcome represented in range of motion and total functional scores.<strong> </strong>the mean acromion index revealed significant change to 63.82±9.06%, total medialization surged significantly with average 1.51 cm with a mean postoperative calibrated center of rotation-distance of 3.72±0.78 cm. The mean increase in acro-mio-humeral interval was 1.57 cm with a new postoperative value of 2.49±0.9 cm. The mean glenoid version declined to 5.7º±5º, however, this change was not significant.<strong> </strong>In conclusion, accurate positioning of shoulder prosthesis components with proper tensioning of soft tissue envelope within acceptable measurement parameters is considered crucial for stability and longevity of implant with the best clinical outcomes.<strong></strong></p>

Patient's effective dose and performance assessment of computed radiography systems

Computed tomography is widely used for planar imaging. Previous studies showed that CR systems involve higher patient radiation doses compared to digital systems. Therefore, assessing the patient's dose and CR system performance is necessary to ensure that patients received minimal dose with the highest possible image quality. The study was performed at three medical diagnostic centers in Sudan: Medical Corps Hospital (MCH), Advance Diagnostic Center (ADC), and Advance Medical Center (AMC).The following tools were used in this study: Tape measure, Adhesive tape, 1.5 mm copper filtration (>10 × 10 cm), TO 20 threshold contrast test object, Resolution test object (e.g., Huttner 18), MI geometry test object or lead ruler, Contact mish, Piranha (semiconductor detector), Small lead or copper block (∼5 × 5 cm), and Steel ruler, to do a different type of tests (Dark Noise, Erasure cycle efficiency, Sensitivity Index calibration, Sensitivity Index consistency, Uniformity, Scaling errors, Blurring, Limiting spatial Resolution, Threshold, and Laser beam Function. Entrance surface air kerma (ESAK (mGy) was calculated from patient exposure parameters using DosCal software for three imaging modalities. A total of 199 patients were examined (112 chest X rays, 77 lumbar spine). The mean and standard deviation (sd) for patients ESAK (mGy) were 2.56 ± 0.1 mGy and 1.6 mGy for the Anteroposterior (AP) and lateral projections for the lumbar spine, respectively. The mean and sd for the patient's chest doses were 0.1 ± 0.01 for the chest X-ray procedures. The three medical diagnostic centers' CR system performance was evaluated and found that all of the three centers have good CR system functions. All the centers satisfy all the criteria of acceptable visual tests. CR's image quality and sensitivity were evaluated, and the CR image is good because it has good contrast and resolution. All the CR system available in the medical centers and upgraded from old X-ray systems to new systems, has been found to work well. The patient's doses were comparable for the chest X-ray procedures, while patients' doses from the lumbar spine showed variation up to 2 folds due to the variation in patients' weight and X-ray machine setting. Patients dose optimization is recommended to ensure the patients received a minimal dose while obtaining the diagnostic findings.

Developing a Spine Internal Rotation Angle Measurement System Based Machine Learning Using CT Reconstructed X-ray Anteroposterior Image

The purpose of this study was to develop a predictive model for estimating the rotation angle of the vertebral body on X-ray anteroposterior projection (AP) image by applying machine learning. This study is intended to replace internal/external rotation of the thoracic spine (T-spine), which can only be observed through computed tomography (CT), with an X-ray AP image. 3-dimension (3D) T-spine CT images were used to acquired reference spine axial angle and various internal rotation T-spine reconstructed X-ray AP image. Distance from the pedicle to the outside of the spine and change in distance between the periphery of the pedicle according to the rotation of the spine were designated as main variables using reconstructed X-ray AP image. The number of measured spines was 453 and the number of variables for each spine was 13, creating a total of 5889 data. We applied a total of 24 regression machine learning methods using MATLAB software, performed learning with the acquired data, and finally, the Gaussian regression method showed the lowest RMSE value. X-rays obtained with the phantom of the human body tilted by 16 degrees showed results with reproducibility within the RMSE range.

Distal radius fractures: Classifications concordance among orthopedic residents on a teaching hospital

BackgroundSeveral classification systems have been developed to support orthopedic surgeons regarding diagnostic, treatment, or prognostic outcomes of distal radius fracture (DRF). However, the best classification system for this fracture remains controversial. We aimed to identify the reliability of three different DRF classifications among orthopedists in training (medical residents). MethodsOrthopedic residents (n = 22) evaluated thirty cases of DRF in anteroposterior and lateral projections in three different periods (0, 6, 12 months). Each radiography was sorted with three different classifications: Frykman, AO/OTA, and Jupiter-Fernandez. All assessments were blinded to the investigators. The inter- and intra-observer reliability was evaluated using the Cohen's kappa coefficient. An additional analysis was performed for a simpler sub-classification of the AO/OTA (27, 9, or 3 groups). ResultsInter-observer agreement for AO/OTA, Frykman, and Jupiter-Fernandez classifications was slight (k = 0.15), fair (k = 0.31), and fair (k = 0.30), respectively. Intra-observer agreement showed similar results: AO/OTA, k = 0.14; Frykman, k = 0.28; and Jupiter-Fernandez, k = 0.28. When the AO/OTA classification was simplified (9 or 3 descriptions), the inter-observer agreement improved from slight (k = 0.16) to fair (k = 0.21 and k = 0.30, respectively). A similar improvement from slight (k = 0.14) to fair (k = 0.32 and k = 0.21) was detected for intra-observer agreement. ConclusionsThe more complex the DRF classification system, the more complex is to reach reliable inter- and intra-observer agreements between orthopedic trainees. Senior residents did not necessarily show greater kappa values in DRF classifications.

The impact of body mass index on patient radiation dose in general radiography

The aim of the present study was to determine the influence of the body mass index (BMI) on the dose area product (DAP) and effective dose (ED) in overweight and obese patients. We also wanted to determine the typical dose values as well as suggest adjustments to clinical practice for overweight and obese patients. In this study we considered 597 patients referred for imaging of the chest in posteroanterior and lateral projection, the lumbar spine in anteroposterior (AP) and lateral projection, the pelvis, the knee in AP and lateral projection, and the shoulder in AP projection. For each examination, the image field size, tube voltage, mAs product, source-to-image receptor distance and values of DAP were collected. Based on their BMI, the patients were divided into three groups (normal weight, overweight and obese). At the end, PCXMC 2.0 software was used to calculate the ED. The study showed a statistically significant DAP and ED increase in overweight and obese patients by 28.9% up to 275.4% in the case of DAP and an increase in ED from 11.0% to 241.9% in all mentioned examinations except knee and shoulder imaging. Typical DAP values ranged from 2.2 to 54.8 µGym2 for normal-weight patients, from 2.2 to 87.6 µGym2 for overweight patients, and from 2.2 to 172.5 µGym2 for obese patients. Spearman’s correlation coefficient revealed very weak to very strong correlations when comparing BMI and DAP, as well as when comparing BMI and ED. A strong and very strong correlation was found in the case of examinations of the torso (except for the comparison of BMI and ED in the case of lateral lumbar spine projection).

Radiography of Clavicula Os with Suspected Avulsion Fracture in Advent Medan General Hospital

The clavicle is an S-shaped bone that articulates laterally with the acromioma process of the scapula, medially with the manubrium of the clavicular notch to form the clavicular joint. An avulsion fracture is a disconnection of the clavicle bone caused by direct and indirect trauma in the position of the arm being cut off or pulled out (outstretched hand) because the trauma continues from the wrist to the clavicle. Radiography is an appropriate method to show abnormalities in the os calvicula. The aim is to show the anatomy of the clavicle bone and its abnormalities. This examination uses the Antero-Posterior projection. The X-ray aircraft used is GE with a capacity of 500 mA. The tape used is 30 cm x 40 cm. Processing film used is Computed Radiography.