Anteroposterior Roentgenograms Research Articles

Non-traumatic scapholunate dissociation in a 10-year-old female: A case report

IntroductionSevere or minor repetitive trauma, inflammation, infection, tumors, and congenital ligamentous laxity have been etiologically implicated in scapholunate dissociation (SLD). While a few cases of patients with asymptomatic SLD have been reported in the literature, despite radiographically demonstrated widened scapholunate angles and rotatory subluxation of the scaphoid bone, these patients experienced only mild or no pain and no dorsal intercalated segment instability deformity. Here, we report the case of a monolateral non-traumatic SLD in a young 10-year-old girl that led to an important range of motion impairment with no wrist pain. The case represents a rarity for no previous history of trauma, young age, and no pain.Main symptoms and important clinical findingsIn our patient, an examination revealed a reduced range of motion in the left wrist and no pain during passive or active mobilization. The X-ray showed a 16 mm scapholunate gap in the anteroposterior roentgenogram. In this case, we suggested that congenital or developmental ligamentous laxity may be the cause of SLD. The diagnostic assessment was completed with a wrist MRI and CT.Therapeutic interventions and outcomesThe patient underwent an open dorsal surgery: we directly reduced the dislocated bones and fixed them with five percutaneous 1 mm k-wires. Finally, the scapholunate ligaments were repaired using bone-absorbable anchor sutures. The wrist was immobilized in a volar cast for 8 weeks. The patient was able to resume her daily life activities (included sport) within 12 months.ConclusionCarpus injuries are rare in children, and treatment, especially for young-age patients, is fraught with risks and remains controversial. Our case demonstrates that the patient has had a good clinical outcome. The physio-rehabilitation program for this patient has been of long duration. Most previous studies have shown excellent clinical results after an average of 2.4 years.

Radiological comparison of acetabular anteversion on anteroposterior roentgenograms and computed tomograms functional outcomes in total hip arthroplasty

Introduction: Orientation and Alignment of prosthetic components are vitally important for the stability of total hip arthroplasty. Poor acetabular positioning is one of the many issues implicated with persistent pain due to impingement, dislocation, edge loading and liner fracture, which may be lead to patient dissatisfaction after total hip arthroplasty. Material and methods: Post-operative radiological analysis of the version of acetabulum through X-ray images and CT images was performed. Pre & post-operative scoring according to Modified Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Oxford Hip Score (OHS) was documented. Results: A total of 55 patients were included in the study. The mean anteversion angle calculated on anteroposterior (AP) radiographs by Lewinnek’s method was 23.480 (Range 11 – 390), compared to CT Scans measured was 28.640 (Range 11.10 – 50.100). Conclusion: Majority 69.09% of patients had excellent functional outcomes in a range of 11.1 – 360 of anteversion compared to Lewinnek’s safe zone. It suggests that there is flexibility in positioning the acetabular component than previously believed. If one has to err, it should be towards more anteversion. Infact to avoid dislocation, more anteversion is required to guard against unwarranted activities on part of the patient.

OSTEOMYELITIS OF FEMUR IN A DRUG ADDICTED CHILD

One of the serious complications related to intravenous drug use is osteomyelitis. We report a 13-year-old male child with a history of intravenous heroin abuse, who was admitted to the hospital complaining of abdominal pain and pain in the left leg. Anteroposterior roentgenogram and CT scan of the left thigh and femur, confirmed the diagnosis of osteomyelitis. Pus culture was positive for Staphylococcus aureus. Despite extensive antibiotic and anticoagulant therapy, the patient’s clinical status improved very slowly. Surgical procedure was not undertaken. Femoral osteomyelitis due to injection drug use in childhood is an extremely rare and uncommon condition. Intravenous drug abuse, late-onset treatment, and secondary bacterial infection can lead to complications which occurred in the case presented. It is an extremely difficult condition to treat and is a real challenge for physicians. The rapid response and participation of a multidisciplinary team of physicians is of particular importance. Key words: antibiotics, children, femur, osteomyelitis, staphylococcus aureus.

Anatomical axis validation of lower extremity for different deformities: A radiological study.

Aim:The aim of this study was to derive a pure, unbiased, reliable and accurate objective relationship between the local knee axis measurements through a short knee anteroposterior roentgenogram and the lower limb axis measurement through an orthoroentgenogram.Patients and Methods:Radiographs of 114 patients (114 knees) were evaluated by two independent raters for measurement of lower limb axis on an orthoroentgenogram and the local knee axis on short knee anteroposterior X-ray, which was derived by cropping the orthoroentgenogram by a blinded radiology assistant. The raters measured at two different time-points separated by an interval of 30-day period. Intra-rater and inter-rater reliabilities were calculated by intra-class correlation coefficients and three models were built to establish the relationships of X-ray anatomical axis with orthoroentgenogram anatomical axis, orthoroentgenogram anatomical axis with orthoroentgenogram mechanical axis and X-ray anatomical axis with orthoroentgenogram mechanical axis.Results:For three different measurements, intra-class correlation coefficients of Rater 2 were higher than 0.90 which shows perfect reliability, while that for Rater 1 was low. Furthermore, first measurements were more consistent than the second measurement. There was a strong positive correlation in all the three models except for varus cases in the last.Conclusion:The standardized correlation derived between the two different techniques for measuring knee alignment is fairly comparable with the studies in the past and would serve as a reliable template for future studies concerning relationships between the two, in addition to helping knee surgeons make more reliable and accurate interpretations through local knee axis measurements.

The neck shaft angle: CT reference values of 800 adult hips.

A precise understanding of the radiological anatomy and biomechanics as well as reliable reference values of the hip are essential. The primary goal of this study was to provide reference values of the neck-shaft angle (NSA) for adult patients based on the analysis of rotation corrected computed tomography (CT) scans of 800 hips. The secondary aim was to compare these measurements with simulated anteroposterior roentgenograms of the pelvis. Pelvic CT scans of 400 patients (54.3 years, range 18-100 years; 200 female) were reconstructed in the derotated coronal plane of the proximal femur and as CT-based simulated anteroposterior roentgenograms of the pelvis in the anterior pelvic plane. Femora were categorized as coxa vara (<120°), physiologic (≥120° to <135°), and coxa valga (≥135°). Intra- and inter-rater reliability were analyzed. Primary research question: Mean NSA for male adults was 129.6° (range 113.2°-148.2°; SD 5.9°) and 131.9° (range 107.1°-151.9°; SD 6.8°) for females in derotated coronal reconstructions. Age (p < 0.001 in both views) and sex influenced the NSA significantly (p = 0.002 and p < 0.001); no significant differences were found between sides (p = 0.722 and p = 0.955). Overall, an excellent reliability of repeated measurements of one or two observers was found (ICC 0.891-0.995). Secondary research question: NSA values measured in the simulated anteroposterior roentgenogram and the rotation corrected coronal reconstruction differed significantly (p < 0.001). While anteroposterior pelvis radiographs are susceptible to rotational errors, the coronal reconstruction of the proximal femur in the femoral neck plane allows the correct measurement of the NSA.

A new radiographic view of the hindfoot

BackgroundA new radiographic view was proposed to evaluate the coronal plane alignment of the hindfoot under weightbearing conditions.MethodsWe studied 46 feet of individuals with normal appearing asymptomatic feet. On the antero-posterior roentgenogram using this new method, the line from the top of the sustentaculum tali to the lateral-inferior end of the posterior articular surface of the talus was obtained as the standard line showing varus or valgus of the calcaneus. We defined the angle between the longitudinal axis of the tibia and the standard line as described above as Varus-Valgus angle (V-V angle).ResultsThe mean (±SD) V-V angle of the 46 feet studied was 76.4 (±3.6) degrees.ConclusionThe findings from this study indicate that it is possible to estimate the alignment of the hindfoot quantitatively by comparing individuals to the mean V-V angle that we calculated in our sample, which was 76.4 degrees.

Congenital Lobar Emphysema Association With Double Superior Vena Cava and Horseshoe Kidney

A 22-year-old man presented with sudden onset of shortness of breath and pain in the right anterior part of the chest that was worse during exertion and deep breathing. Low-set ears and occipital flattening were observed on inspection. An anteroposterior roentgenogram of the chest showed hyperinflation of the right middle zone of the pulmonary area, with a paucity of blood vessels (Fig 1). There was a slight shift of the mediastinum to the left. Computerized tomography

Late-diagnosed bilateral intertrochanteric femur fracture during an epileptic seizure.

Although spontaneous and simultaneous bilateral hip fractures without trauma are seen rarely, epileptic seizures may lead to these fractures. We present an 82-year-old female patient with poor bone quality and a 20-year history of epilepsy. She had been using anticonvulsant drugs for almost 20 years. Following a convulsive epileptic attack, bilateral intertrochanteric femur fractures occurred (causing bilateral hip pain), which was diagnosed on the 12th day. An earlier pelvic anteroposterior roentgenogram would be helpful for early diagnosis. It should not be forgotten that bone fractures may be observed without trauma in epilepsy patients.

Roentgenographic measurement study for locating femoral insertion site of anterior cruciate ligament: a cadaveric study with X-Caliper.

The purpose of this study was to determine the relationships of the anterior cruciate ligament (ACL) femoral insertion site with femoral bony landmarks and develop a new method of location. Sixteen unpaired normal Chinese human cadaveric knees were used. Femoral insertion sites of the ACL were marked with metal wires. Four pairs of bony landmarks were selected: anatomical axis of distal femur (A) and parallel tangent of posterior condyles (B); tangent of anterior condyles parallel to landmark A (C) and landmark B; Blumensaat's line (D) and parallel tangent of distal condyles (E); and tangent of posterior condyles (F) and parallel tangent of anterior condyles (G). The X-Caliper was used to measure the distance between the centre of the insertion site and each pair of bony landmarks. The ratio of distances to each pair of bony landmark was calculated. Clock position of the ACL femoral footprint was measured on anteroposterior (AP) roentgenograms at 90 degree flexion. The centre of the ACL footprint was found at 65.3% +/- 1.1% between A and B, 78.1% +/- 1.0% between B and C, 38.3% +/- 2.7% between D and E, and 43.1% +/- 4.6% between F and G. The distances to bony landmarks A, B, D, and E have smaller variations. Blumensaat's line and the anatomical axis of the distal femur were regarded as more useful and made location of the insertion site more precise. A parallelogram made up of these two bony landmarks can be used. On AP roentgenograms, the centre of the femoral footprint should be moved to lower than the 10:00 o'clock (2:00) position.

Meningomyelocele: management in utero and post natum.

We report a four year follow-up of 39 of 47 infants born after pre-labour Caesarean section and 68 of 79 born vaginally. Loss of motor function due to late complications was more frequent in the Caesarean section group (Fisher's Exact; P = 0.004). However, the means of the differences between the X-ray levels (measured as the last intact vertebral arch seen on standard anteroposterior roentgenograms of the spinal column) subtracted from the motor levels still favour Caesarean section (mean = 3.24; SD = 2.7) over vaginal delivery (mean = 1.2; SD = 2.7) (Student's t-test; P = 0.0003). The frequencies of other complications, death and neonatal meningitis, were not significantly different. Another 38 infants born by Caesarean section after labour were more paralysed (mean of X-ray and motor difference = 1.8, SD = 2.2) following rupture of amniotic membranes than those with intact amniotic membranes with or without labour (mean = 3.4; SD = 2.2) (Student's t-test; P = 0.0067). The differences between X-ray and motor levels for patients born by Caesarean section with intact amniotic membranes and without labour (mean = 3.6; SD = 2.4) were not significantly different from those with labour and intact amniotic membranes (mean = 2.89; SD = 1.5). The number of new cases of meningomyelocele presenting to our clinic has decreased from an average of 30 per year between 1970 and 1987 to 14 between 1988 and 1992.

Lining Up the Liner: 2 Case Reports of Early Ceramic Liner Fragmentation

We present 2 cases of early ceramic liner fragmentation in patients undergoing ceramic-on-ceramic uncemented total hip arthroplasty. The reports highlight the significance of correct liner insertion at the time of operation and the importance of a meticulous evaluation of postoperative radiographs. Tilting of the liner may not be visualized on the anteroposterior roentgenogram alone. Preradiological ceramic fragmentation can occur.

THE CLASSIC: Surgical Treatment of Fresh Injuries to the Major Ligaments of the Knee

THE CLASSIC: Surgical Treatment of Fresh Injuries to the Major Ligaments of the Knee

Posterior dislocation of the shoulder joint

Background: Posterior dislocation of shoulder is a rather uncommon injury that is often not diagnosed at the initial examination. However certain constant clinical signs may lead the examiner to suspect the presence of this condition. Even the routine antero-posterior roentgenogram may provide a few clues to diagnosis but the axillary view is mandatory to verify diagnosis. Material and methods : We report a series of 15 shoulders (14 patients) with a locked posterior dislocation. Electric shock (7 patients), vehicular accident (4 patients) and epileptic seizure (3 patients) was causes of dislocation in these patients. The diagnosis was missed initially in 10 cases. An axillary radiograph confirmed the diagnosis in all. Treatment consisted of closed reduction, which was successful in 5, Neer's modification of McLaughlin procedure (transfer of subscapularis) in 6, hemireplacement arthroplasty in one shoulder and tuberosity fixation in one patient. Results : Follow-up ranged from 1 year to 4 years. Five patients had excellent, five good, two poor and one had fair result. Conclusion : Key to diagnosis is a high index of suspicion. The prognosis became less favorable and the therapeutic difficulties were found to be increased in direct proportion to the length of time, these lesions remain undiagnosed. With early recognisition of dislocation, prompt reduction is relatively easy. Surgical intervention is necessary for old unreduced posterior dislocations.

Evaluation of 238 consecutive patients with the extended data set of the Standardised Audit for Hip Fractures in Europe (SAHFE)

Purpose: The aim of this paper is to introduce the extended data set inquiries of the Standardised Audit of Hip Fractures in Europe (SAHFE) and to report our experiences of its use.Method: The extended SAHFE data set was applied to 238 consecutive patients (mean age 78.4 (50 – 102) years, 52 males, 186 females) aged over 50 years with non-pathological fractures of the hip. The extended data set contains 95 questions concerning the patient's abilities prior fall and at follow-up, detailed background factors, concomitant diseases, additional details of the injury, treatment, fracture type and reduction and complications.Results: Thirty-nine percent of the fractures occurred at home and 38% in a hospital. Thirteen percent of the cervical fractures were non-displaced (Garden 1 & 2) and half of the trochanteric fractures intertrochanteric two-part fractures (A11 – A13). The mean Garden alignment index evaluated from antero-posterior roentgenograms changed from the preoperative 144° to the postoperative 168° and that from lateral projections from 144° to 171°, respectively. Most of the patients (89%) had associated diseases, especially cardiovascular conditions. The patients' functioning was significantly impaired at four months compared with the preoperative situation according to the ADL score. The need for social support and assistance had increased, respectively. A total of 63% of the surgeries were delayed for more than 24 hours. Low molecular weight heparin was given to every patient for thromboembolic prophylaxis and 92% received antibiotic prophylaxis. Urinary tract (21%) and chest infections (7%) were the most common complications. The deep infection rate was 2.5%.Conclusion: The extended SAHFE data set is useful and makes it possible to study in more detail the background and outcome factors of hip fractures in a standardized manner.

Body height correction in scoliosis patients for pulmonary function test.

We studied standing anteroposterior roentgenograms from 140 scoliosis patients and obtained a correction equation for body height by Cobb angle. This equation is applicable to patients with a double curve or special curve pattern as well as patients with a single curve. The repeatability of the method examined with this equation was higher than that with the previous correction method for body height by Cobb angle, and the difference between the corrected values and the measured values was small. Therefore, this method is considered to be more reliable.

MONTEGGIA LESION IN A CHILD: VARIANT OF A BADO TYPE-IV LESION. A CASE REPORT

Monteggia described a lesion that consisted of a fracture of the proximal third of the ulna and an anterior dislocation of the proximal end of the radius1. Bado, in a series of forty patients, found that the fracture and dislocation could be displaced in various directions; he modified the original definition of a Monteggia lesion to “a group of traumatic lesions having in common a dislocation of the radio-humero-ulnar joint, associated with a fracture of the ulna at various levels or with lesions at the wrist.”2 This is a case report of a four-year-old boy who sustained a Monteggia fracture-dislocation that was Bado2 type IV. The child had a posterolateral angulation deformity of the fracture of the ulna, posterolateral dislocation of the radial head, and a fracture of the middle third of the radial shaft. A four-year-old boy fell from a height of about ten feet (three meters) and sustained an injury of the right forearm. He had a severe posterolateral angular deformity in the proximal part of the forearm without any neurovascular deficit. Motion of the elbow and wrist was very painful and restricted. Roentgenograms showed a fracture of the proximal third of the ulna, with 55 degrees of lateral angulation on the anteroposterior roentgenogram and 30 degrees of posterior angulation on the lateral roentgenogram. The radial head was displaced posterolaterally, and there was a fracture through the middle third of the radial shaft (Fig. 1). In addition, at the site of the fracture, there was plastic deformation of the ulna in an anteromedial direction. Roentgenograms showing a Bado2 type-IV Monteggia lesion with posterolateral angulation of the ulna and posterolateral dislocation of the radial head. Two attempts at closed reduction with the patient under general anesthesia were unsuccessful. The angular deformity of the ulna …

Monteggia Lesion in a Child

BHANDARI, NAGESH M.S.(ORTH)†; JINDAL, PANKAJ M.S.(ORTH)‡, AHMEDABAD, INDIA Author Information

Radiologic measurement of superior displacement of the humeral head in the impingement syndrome

A method for directly measuring the position of the humeral head on the face of the glenoid in different positions of abduction of the arm was developed. We studied three subject groups: 12 patients with normal shoulders (group 1), 15 patients with stage II impingement syndrome (group 2), and 20 patients with rotator cuff tears or stage III impingement (group 3). The study consisted of a series of anteroposterior roentgenograms in the plane of the scapula with the arm in neutral rotation. Roentgenograms were obtained at 20 degrees intervals as the arm was elevated in the plane of the scapula from 0 degree to 120 degrees. Patients held a weight equal to 2 1/2% of body weight in the hand. The parameters measured were excursion of the humeral head on the glenoid face, expressed as the distance that the center of the head lies above or below the center of the glenoid, arm angle, scapulothoracic angle, and glenohumeral angle. For patients with normal shoulders (group 1), there was no significant change in position of the humeral head with arm elevation. In contrast, those with stage II impingement (group 2) had significant (p < 0.05) superior displacement of the center of the humeral head with arm elevation. Patients with rotator cuff tears (group 3) demonstrated a significant rise (p < 0.05) during the first 40 degrees of abduction. The average position of the humeral head in the two pathologic patient groups was superior (p < 0.05) to the average head position in the normal patient group. There was no significant difference in head position between patients with stage II impingement and patients with rotator cuff tear. The ratio of the glenohumeral angle to the scapulothoracic angle during abduction was calculated for our patient groups. In both patient groups, arm abduction had a larger scapulothoracic component than for normal shoulders. The superior migration of the humeral head is a probable result of cuff failure, either partial or complete.

The Pelvic Tear-Figure

Fluoroscopy and three-dimensional CT analysis were used to define the contributing anatomy and changes in appearance of the tear-figure with rotation of a pelvis. The tear-figure is a cortical structure of iliac and ischial bone that appears on anteroposterior (AP) roentgenograms of the pelvis. The contribution of these cortices to the pelvic tear-figure changes with rotation of a pelvis in a radiographic field. Cortices contributing to the tear-figure are not continuous throughout. The lateral border, inferior margin, and inferior one third of the medial border of the tear-figure is formed by a continuous segment of cortical bone extending from the deepest portion of the acetabulum around the cylindric acetabular notch, and along the inferior medial wall of the ischium. The superior two thirds of the medial border of the tear-figure consists of cortical bone extending superiorly along the medial wall of the ilium, which is not in continuity with the remainder of the components of the tear-figure. The tear-figure is not a structure of constant radiographic dimension. Its apparent dimensions change with rotation of the pelvis. The positioning of the patient for the AP pelvic roentgenogram is thus important when studying the effects of acetabular pathology on the appearance of the pelvic tear-figure.

Scoliosis in Rett syndrome. Clinical and biological aspects.

The natural history of progression of scoliosis was studied. The authors included a wide range of ages and correlated progression and progression rate to both age of the patient and the neurobiologic staging of the disease. The authors studied information compiled by Hagberg and coworkers regarding Rett syndrome. The total number of patients was 78, with age ranging from 1 to 34 years. Standing or sitting anteroposterior roentgenograms were collected and measured. The material was studied initially separately regarding orthopedic and radiologic analysis on one hand and neurobiologic staging on the other. Radiographic films were measured both retrospectively and prospectively, and scoliosis angle and progression and progression rate was calculated. Staging of patients with Rett syndrome was done according to Hagberg. When correlating curve magnitude and progression, the authors found that patients progressing > 15 degrees/year were classified as IV-A or IV-B stages. In the 0-5 year group, of the patients already having a curve of 15 degrees or more, all but one rapidly progressed to stage IV. The ten worst cases were characterized by early hypotonia, weakness, and gross motor disturbance. The scoliosis in Rett syndrome is of a neurogenic type, and it develops earlier than idiopathic scoliosis. The development of scoliosis is dependent more on stage of disease than on age. Curve progression is usually more rapid than in idiopathic scoliosis and in most other types of neurogenic scoliosis in childhood and occurs in a broader age span. Early hypotonia, weakness, and muscular insufficiency, and an early clinical referral to disease stages IV-A or IV-B are ominous factors. Clinical follow-up should begin early and be repeated regularly and frequently.