Bilateral Computed Tomography Scans Research Articles

Measuring External Rotation of the Fibula and Fibular Length in Bilateral Computed Tomography Scans: How Reliable Is This Method?

During ankle fracture surgery, goals include accurate reduction and fixation of the fibula regarding rotation and fibular length. Bilateral postoperative computed tomography (CT) can be performed to assess fibular rotation using the talar dome angle, and fibular length. The aim of this study was to compare side-to-side differences of the fibular rotation and fibular length using bilateral CT scans of uninjured ankles. Retrospective. Single center, Level I Academic Trauma Center. Patients with bilateral CT scans of uninjured ankles. External rotation using the Nault talar dome method and fibular length using the coronal method of Prior et al. The average, difference, and ratio (injured side/healthy side) and interobserver variability were calculated. There were 83 patients included (166 ankles, mean age 47 years, 77.1% male). A random set of 66 ankles (33 CT scans) were used to measure interobserver variability. The mean degrees of external rotation ranged from 6.6 to 7.7, mean difference ranged from 1.4 to 3.4 degrees, mean ratio ranged from 1.1 to 1.5, and interobserver variability ranged from 0.27 to 0.65. For fibular length, the mean ranged from 24.6 to 25.8 mm, mean difference in fibular length ranged from 0.5 to 2.1 mm, mean ratio ranged from 1.0 to 1.1 mm, and interobserver variability ranged from 0.45 to 0.73. Using bilateral ankle CT scans, mean differences in fibular rotation using the Nault talar dome method were 1.4-3.4 degrees. The distal fibular length had a mean difference between both sides of 0.5-2.1 mm. Although the intraclass correlation's were low, the interleg differences between patients were small, making them useful for clinical practice. Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Three-Dimensional Mapping of Scapular Body, Neck, and Glenoid Fractures.

The purpose of this study was to report patterns of scapular fractures and define them with a contemporary methodology. . Retrospective study, 2015-2021. Single, academic, Level 1 trauma center. Consecutive patients ≥18 years, presenting with unilateral scapula fracture, with thin-slice (≤0.5-mm) bilateral computed tomography (CT) scans of the entirety of both the injured and uninjured scapulae. Thin-slice (0.5-mm) CT scans of injured and normal scapulae were obtained to create three-dimensional (3D) virtual models. 3D modeling software (Stryker Orthopedics Modeling and Analytics, Stryker Trauma GmbH, Kiel, Germany aka SOMA) was used to create a 3D map of fracture location and frequency. Fracture zones were delineated using anatomic landmarks to characterize fracture patterns. Eighty-seven patients were identified with 75 (86%) extra-articular and 12 (14%) intra-articular fractures. The dominant fracture pattern emanated from the superior lateral border (zone E) to an area inferior to the spinomedial angle (zone B) and was present in 80% of extra-articular fractures. A second-most common fracture line propagated from the primary (most-common) line toward the inferior medial scapular border with a frequency of 36%. Bare zones (with 1 or no fractures present) were identified in 4 unique areas. Furthermore, intra-articular fractures were found to be heterogenous. The 3D fracture map created in this study confirmed that extra-articular scapular fractures occur in certain patterns with a relatively high frequency. Results provide greater insight into scapular fracture locations and may help to study prognosis of injury and improve treatment strategy including operative approaches and surgical tactics.

Restoration of glenoid joint line: a three-dimensional analysis of scapular landmarks

Restoration of the glenoid joint line in shoulder arthroplasty is important for implant positioning and function. Medialization of the glenohumeral joint line due to glenoid bone loss is commonly encountered in primary and revision of shoulder arthroplasty albeit the direction and location of bone loss varies with different pathology. Three-Dimensional (3D) planning software has assisted in preoperative planning of complex glenoid deformities. However, limited literature is available defining a reliable 3D method to evaluate the glenoid joint line preoperatively. The purpose of this study is to identify a set of reliable scapular landmarks to be used as reference points to measure the premorbid glenoid joint line using 3D segmented models of healthy scapulae. Bilateral computed tomography scans from 79 patients eligible for primary stabilization procedures were retrospectively selected from our institutional surgical database (mean age 35±10 years, 58 males and 21 females). 3D models of the contralateral healthy scapulae were created via computed tomography scan segmentation using Mimics 24.0 software (Materialise, Leuven, Belgium). Anatomical landmarks were identified using 3-Matic 16.0 software (Materialise, Leuven, Belgium). The distance between identified landmarks and a sagittal plane created on the deepest point of the glenoid was recorded for each scapula and reliability of each landmark was assessed. Inter- and intra-observer reliabilities were also evaluated using intraclass correlation coefficients (ICCs). Four landmarks showed statistically significant results: the scapular notch (SN), the centroid of the coracoid (CC), a point on the most medial border of the scapula in line with the scapular spine (TS), and the most lateral point of the acromion (AL). The mean (± standard deviation) joint line measured from the SN, CC, TS and AL were 28.36±2.97 mm, 11.66±2.07 mm, 107.52±8.1 mm, and 29.72±4.46 mm, respectively. Inter-observer reliability analysis for SN, TS, and AL showed excellent agreement with ICC values of 0.966, 0.997, and 0.944, respectively, and moderate agreement for CC with ICC of 0.728. The results from this study assist in estimating joint line medialization preoperatively and in planning its subsequent restoration. A set of reliable landmarks can be used as references to estimate the premorbid glenoid joint line preoperatively.

The Utility of Quantitative Computed Tomography to Detect Differences in Subchondral Bone Mineral Density Between Healthy People and People With Pain Following Wrist Trauma.

The mechanisms underlying chronic pain development following musculoskeletal trauma are complex and multifactorial. In their search, some researchers are turning to the subchondral bone as a potential contributor to pain due to its vascularity, using a depth-specific imaging technique. However, this technique has been mainly used in the knee. We propose the use of a quantitative computed tomography (QCT) depth-specific analysis to measure subchondral bone following wrist trauma. Ten participants (n = 5 post-trauma; n = 5 healthy) underwent bilateral computed tomography scans of their wrist accompanied by a calibration phantom with known densities. Average subchondral volumetric bone mineral density (vBMD) was studied at three depths from the subchondral surface (0-2.5, 2.5-5, 5-7.5 mm) according to radial articular surface contact in both wrists of each participant. Percentage differences and Cohen's d effect sizes were calculated to analyze bilateral vBMD and vBMD differences between groups. This image-based tool demonstrated subject-specific, depth-specific, and joint-specific measures of vBMD within the wrist. This methodology highlighted the differences between depth-specific vBMD in healthy people and people who have experienced wrist trauma. Overall, the healthy cohort demonstrated higher vBMD across all three depths and both articular surfaces. This imaging technique further distinguished between subchondral cortical and trabecular bones, wherein clinical implications can be drawn from these distinctions in future work. Our study therefore supports the utility of a QCT imaging technique in detecting differences in depth-specific vBMD in the wrist.

Effect of Modified Arthroscopic Latarjet on Acromiohumeral Distance at 5-Year Follow-up.

Background:It is unclear whether coracoacromial ligament release during the Latarjet procedure will increase superior translation of the shoulder joint.Purpose:To evaluate whether a modified suture button Latarjet procedure can decrease the acromiohumeral distance (AHD).Study Design:Case series; Level of evidence, 4.Methods:A retrospective analysis was conducted among 155 patients who underwent a modified suture button Latarjet procedure between 2013 and 2015. AHD was measured on bilateral computed tomography scans taken preoperatively and on scans of the affected shoulder taken on postoperative day 1 and postoperative month (POM) 6, POM 36, and POM 60. At each time point, we recorded pain on a visual analog scale (VAS) and objective shoulder function using the American Shoulder and Elbow Surgeons, Rowe, and Walch-Duplay scores. Preoperative and final follow-up VAS and functional scores were compared using the paired t test. Pairwise comparison of AHD values at each follow-up time point were compared with the preoperative intact side using the paired t test. Intra- and interobserver reproducibility of the AHD measurements was evaluated using the intraclass correlation coefficient.Results:A total of 104 patients who met the criteria completed the final follow-up, which occurred at 62.6 ± 2.4 months (mean ± SD). When compared with presurgery, the VAS and all functional scores improved significantly at the last follow-up (P < .001 for all). Intra- and interobserver intraclass correlation coefficients indicated good reliability for the ADH measurements. Preoperatively, there were no differences in AHD values between the intact and affected shoulders (7.8 ± 0.8 mm for both; P = .851). The AHD values at postoperative day 1 and POM 6, POM 36, and POM 60 were 9.6 ± 0.7 mm, 8.6 ± 0.9 mm, 8.0 ± 0.8 mm, and 7.9 ± 0.8 mm, respectively, all of which were larger than those of the preoperative intact side (P < .001 for all).Conclusion:The modified suture button Latarjet procedure not only offered satisfactory therapeutic effects but also did not decrease the AHD at 5-year follow-up.

Does the orientation of syndesmosis fixative device affect the immediate reduction of the distal tibiofibular joint?

IntroductionIncongruent stabilization of the distal tibiofibular joint (syndesmosis) results in poorer long-term outcome in malleolar fractures. The aim was to analyze whether the orientation of the syndesmotic stabilization would affect the immediate reduction imaged in computed tomography (CT).Materials and methodsThe syndesmotic congruity in 114 ankle fractures with stabilization of the syndesmosis were retrospectively analyzed in the post-operative bilateral CT scans. The incisura device angle (IDA) was defined and correlated with the side-to-side difference of Leporjärvi clear-space (ΔLCS), anterior tibiofibular distance (ΔantTFD) and Nault talar dome angle (ΔNTDA) regardless of the stabilization technique and separately for suture button system and syndesmotic screw. Asymmetric reduction was defined as ΔLCS > 2 mm and |ΔantTFD|> 2 mm.ResultsRegardless of the stabilization technique, no correlation between the IDA and the ΔLCS (r = 0.069), the ΔantTFD (r = 0.019) nor the ΔNTDA (r = 0.177) could be observed. There were no differences between suture button system and syndesmotic screw. Asymmetrical reduction was detected in 46% of the cases, while sagittal asymmetry was most common. No association was found between the orientation of stabilization device and occurrence of asymmetrical reduction (p > 0.05). The results of suture button system and syndesmotic screw were comparable in this respect (p > 0.05).ConclusionPoor correlation between the orientation of the stabilization device and the immediate post-operative congruity of the syndesmosis could be shown. In contrast to current literature, this study did not show difference of suture button system over syndesmotic screw in this regard. Careful adjustment of the fibula in anteroposterior orientation should be given special attention.

Three-Dimensional Quantification of Glenoid Bone Loss in Anterior Shoulder Instability: The Anatomic Concave Surface Area Method.

Background:Recurrent shoulder instability may be associated with glenoid erosion and bone loss. Accurate quantification of bone loss significantly influences the contemplation of surgical procedure. In addition, assessment of bone loss is crucial for surgical planning and accurate graft placement during surgery.Purpose:To quantify the concave surface area of glenoid bone loss by using 3-dimensional (3D) segmented models of the scapula and to compare this method with the best-fit circle and glenoid height/width methods, which use the glenoid rim for bone loss estimations.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:A total of 36 consecutive preoperative bilateral computed tomography scans of patients eligible for a primary Latarjet procedure were selected from our institutional surgical database (mean patient age, 29 ± 9 years; 31 men and 5 women). The 3D models of both scapulae were generated using medical segmentation software and were used to map the anatomic concave surface area (ACSA) of the inferior glenoid using the diameter of the best-fit circle of the healthy glenoid. Bone loss was calculated as a ratio of the difference between surface areas of both glenoids (healthy and pathological) against the anatomic circular surface area of the healthy glenoid (the ACSA method). These results were compared with bone loss calculations using the best-fit circle and glenoid height/width methods. Inter- and intraobserver reliability were also calculated.Results:The mean (± SD) bone loss calculated using the ACSA, the best-fit circle, and glenoid height/width methods was 9.4% ± 6.7%, 14.3% ± 6.8%, and 17.6% ± 7.3%, respectively. The ACSA method showed excellent interobserver reliability, with an intraclass correlation coefficient (ICC) of 0.95 versus those for the best-fit circle (ICC, 0.71) and glenoid height/width (ICC, 0.79) methods.Conclusion:Quantification of instability-related glenoid bone loss is reliable using the 3D ACSA method.

The Valid Diagnostic Parameters in Bilateral CT Scan to Predict Unstable Syndesmotic Injury with Ankle Fracture.

The purpose of this study is to evaluate the reasonable parameters to predict unstable syndesmotic injuries in ankle fractures. Seventy consecutive patients who underwent preoperative bilateral computed tomography (CT) scans were enrolled. Group A consisted of 20 patients intraoperatively diagnosed with syndesmotic injuries according to an intraoperative stress test and group B consisted of 50 patients who had nosyndesmotic injuries. The tibiofibular overlap (TFO) and tibiofibular clear space (TFCS) were measured using preoperative ankle radiographs. Measuring the anterior fibular distance (AFD), posterior fibular distance (PFD), anterior translation distance (AT), fibular diastasis (FD), anterior-posterior translation (APT), fibular length (FL), and surface area of syndesmosis (SAS) 1.0 and 1.5 which 1.0 cm and 1.5 cm above the tibial plafond was done via preoperative CT scan. The ratio of measurements (Injured/Intact) of the TFO, PFD, APD, and SAS 1.0 showed statistically significant differences. The researchers identified the SAS 1.0 as the most reasonable parameter to predict transfixation using receiver-operating characteristic (ROC) curve analysis. The SAS 1.0 is most valid parameter to predict syndesmotic injuries in this study and these results show that performing a bilateral CT scan on an ankle fracture may provide substantial information in measuring valid parameters.

Does glenoid remodeling occur with an erosion-type bone loss after arthroscopic Bankart repair?

IntroductionFragment-type glenoid bone loss is known to remodel after arthroscopic Bankart repair. To our knowledge, no studies have been reported about the morphologic changes of the erosion-type bone loss.AimTo determine the morphologic changes of erosion-type glenoid bone loss after arthroscopic Bankart repair.MethodsTwenty-eight patients (mean age: 31 years) with traumatic anterior glenohumeral instability with an erosion-type glenoid bone loss <25% underwent arthroscopic Bankart repair. The minimum follow-up was 2 years. Pre- and postoperative bilateral computed tomography scans were performed in all patients. The width and surface area of the glenoid were measured by a software program and compared pre- and postoperatively.ResultsThe recurrence rate was 7.1% (2 of 28 shoulders). The size of the bone loss was 7.2% ± 5.3% (mean ± standard deviation). The preoperative glenoid width and area were 24.9 ± 2.2 mm and 7.0 ± 0.8 cm2, respectively, and the postoperative ones (2 years after surgery) were 24.7 ± 2.2 mm and 6.8 ± 0.8 cm2, respectively. There were no significant differences between the pre- and postoperative glenoid width and area.Discussion and conclusionUnlike the fragment-type bone loss, the erosion-type bone loss <25% did not show any morphologic changes of the glenoid at least 2 years after arthroscopic Bankart repair.

The Assessment of Reduction Status Using Radiographic Parameters and Ideal Trans-Fixation Technique for Unstable Syndesmotic Injury with Ankle Fracture

Category:Ankle, TraumaIntroduction/Purpose:Anatomical restoration of distal tibiofibular syndesmosis is essential in ankle fractures with syndesmotic injury. However, intraoperative reference line of penetrating angle and evaluation of reduction status remains without consensus. The purpose of this study is to analyze the reduction status of syndesmotic injury using radiographic parameters and to find ideal fixation angle treated with trans-fixation in unstable syndesmotic injury.Methods:Twenty-six patients with ankle fractures with syndesmotic injury that underwent preoperative and postoperative bilateral computed tomography (CT) scans were enrolled. A multi-center study was performed in two tertiary medical centers. All patients were treated with tibiofibular trans-fixation screw or tight rope® fixation. The axial sections of bilateral CT scans were reviewed to measure Fibular Diastasis (FD) and Surface Area of Syndesmosis (SAS) at the level of 1.0 cm above ankle joint.Reduction status was measured by calculating the ratio of postoperative and intact side using radiologic parameters.The trans-fixation angles between the perpendicular line of incisura and distal trans-fixation material was measured. Patients were classified by trans-fixation angle into three groups, as showing 0 -1 degree (A), 1-5 degree (B), 5 or more degree (C) in absolute value.Results:The mean value of reduction status ratio was 1.13 in FD and 1.27 in SAS. The absolute mean value of trans-fixation angle was 4.11°. Trans-fixation angle and reduction status had positive correlation in FD (R = 0.522, p = 0.006) and SAS ratio (R = 0.695, p = 0.000). The absolute mean value of trans-fixation angle in group A, B, C was 0.56° (7 cases), 3.01° (12 cases), and 8.90° (7 cases). The mean value of FD ratio in group A, B, C was 1.01, 1.03 and 1.41. FD and SAS ratio had no difference between group A and B but had significant difference between group A, B and C (p < 0.05).Conclusion:Inappropriate trans-fixation technique had correlated with the loss of reduction after treatment of unstable ankle fracture associated with syndesmotic injury. An angle of 5° from the perpendicular line of the incisura is considered as the ideal trans-fixation angle to maintain the reduction status.

Glenoid morphology is associated with the development of instability arthropathy

Instability arthropathy (IA) is a major long-term concern in patients with anterior shoulder instability. This study investigated the association of glenoid morphology with the development of IA. The study included 118 patients with unilateral anterior shoulder instability and available bilateral computed tomography scans. Instability-specific information was obtained from all patients. The glenoid morphology of the affected shoulder was compared with the nonaffected contralateral side resembling the constitutional preinjury glenoid shape. Both shoulders were evaluated independently by 3 observers to assess the grade of IA according to a Comprehensive Arthropathy Rating (CAR) system. Associations between IA and the glenoid morphology parameters were investigated. The average glenoid retroversion (P < .001), glenoid depth (P < .001), glenoid diameter (P < .001), and the bony shoulder stability ratio (P < .001) of the affected shoulder were significantly reduced compared with the contralateral side due to bony defects in 79.6% of the patients. The CAR of the affected side was significantly higher (P < .001), with more osteophytes (P = .001) and more sclerosis and cysts (P < .001). Differences in CAR (Δ-CAR) correlated positively with the age at the time of the computed tomography scan (P < .001), age at the initial dislocation (P = .001), size of the glenoid defect (P = .005), and the contralateral glenoid depth (P = .011), glenoid diameter (P = .016), and bony shoulder stability (P = .029), and negatively with glenoid retroversion of the affected side (P = .027). Development of IA arthropathy is associated not only with the age of the patients but also with morphologic parameters of the glenoid, including glenoid defect size and the constitutional glenoid concavity shape.

Three-dimensional analysis of shape variations and symmetry of the fibula, tibia, calcaneus and talus.

The bones forming the talocrural joint (TCJ) and subtalar joint (STJ) are often assumed to be bilaterally symmetric. Therefore, the contralateral limb (i.e. the fibula, tibia, calcaneus and talus) is used as a template or an intra‐subject control in clinical and research practice. However, the validity of the symmetry assumption is controversial, because insufficient information is available on the shape variations and bilateral (a)symmetry of the fibula, tibia, calcaneus and talus. Using three‐dimensional spatially dense sampled representations of bone shapes extracted from bilateral computed tomography scans of 66 individuals (55 male, mean age: 61 ± 10 years; 11 female, mean age: 53 ± 15 years), we analyzed whether: (i) similar shape patterns exist in the left and right bones of the same type; (ii) gender has an effect on bone shape variations; (iii) intra‐subject shape variation is smaller than that of inter‐subject for a given shape variance direction. For the first set of analyses, all left and right instances of the same type of bone were considered as two separate groups, and statistically compared with each other on multiple aspects including group location (central tendency), variance‐covariance scale (dispersion) and orientation (covariance structure) using distance‐based permutational tests. For the second and third sets of analyses, all left and right bones of the same type were pooled into one group, and shape variations in the TCJ and STJ bones were extracted using principal component analysis. The effects of gender on age‐adjusted bone shape differences were assessed using an analysis of covariance. Moreover, intra‐class correlation was employed to evaluate intra‐ and inter‐subject bone shape variations. For each bone type, both sides had similar shape patterns (P permutational‐values > 0.05). After Bonferroni adjustment, gender led to shape differences, which were mainly in the lateral and medial condyles of the tibia (P = 0.003), the length and height of the calcaneus (P < 0.001), the posterior and anterior talar articular surfaces of the calcaneus (P = 0.001), and in the posterior aspect of the talus (P = 0.001). Intra‐subject shape variations in the tibial tuberosity together with the diameter of the tibia, and the curvature of the fibula shaft and the diameter of the fibula were as high as those of inter‐subject. This result suggests that the shape symmetry assumption could be violated for some specific shape variations in the fibula and tibia.

Can the contralateral scapula be used as a reliable template to reconstruct the eroded scapula during shoulder arthroplasty?

The contralateral scapula can be used as a reliable template to determine scapular offset, glenoid inclination, and version of the native scapula in view of reconstructing pathologic scapulae. Three-dimensional measurements of scapular offset, inclination, and version were performed using data from a set of 50 bilateral computed tomography scans of full scapulae to determine direct side-to-side differences. The scapula pairs had a mean bilateral difference of 2 mm in offset, 2° in inclination, and 2° in version. Ninety percent of the scapula pairs showed an offset difference smaller than 3 mm. In 96% and 94% of the scapula pairs, the inclination difference and version difference, respectively, were smaller than 5°. The maximum bilateral difference for offset, inclination, and version was 6 mm, 6°, and 8°, respectively. The anatomic parameters of scapular offset, glenoid inclination, and version are quite symmetrical and fall into the currently technically feasible accuracy of shoulder arthroplasty implantation. The healthy scapula can be used as a template to guide the reconstruction of the glenoid during shoulder arthroplasty planning in the case of unilateral advanced arthropathy.

Radiographic Analysis of the Hill-Sachs Lesion in Anteroinferior Shoulder Instability After First-Time Dislocations

To identify the relation between the Hill-Sachs (H-S) angle and arm position at the time of the initial dislocation, and to see if this correlates with the glenoid track. A total of 102 patients (89 male patients, 87.2%), with a mean age of 32years (range, 17 to 38years), were divided into 2 groups, abduction (ABD) and adduction (ADD), dependent on the position of the arm at the time of the instability event. All patients were evaluated with bilateral computed tomography scans (3-dimensional) to define the H-S position on the glenoid track and to measure the H-Sangle. One-way analysis of variance was used to compare the H-S angle between the 2 groups. Dislocation occurred in ABD in 45 patients (44.1%) and in ADD in 57 (55.9%). The H-S angle was 32.4° ± 4.7° in the ABD groupversus 16.1° ± 2.9° in the ADD group. All patients' injuries were "on-track" glenoid injuries in both groups. This study identified a difference in the H-S angle relative to arm position at the time of initial dislocation. Patients whose injury occurred in the ABD position showed a higher H-S angle, leading to an increased risk of engagement, because the long axis of the H-S lesion is parallel to the glenoid in a position of function. Thus arm position atthetime of the initial instability event may be a risk factor for engagement and higher risk of recurrence. LEVELOF Level IV, prognostic case series.

Differences in glenohumeral joint morphology between patients with anterior shoulder instability and healthy, uninjured volunteers

Traumatic glenohumeral joint (GHJ) dislocations are common, resulting in significant shoulder disability and pain. Previous research indicates that bony morphology is associated with an increased risk of injury in other joints (eg, the knee), but the extent to which bony morphology is associated with traumatic GHJ dislocation is unknown. This study assessed GHJ morphology in patients with anterior GHJ instability and in a control population of healthy volunteers. Bilateral computed tomography scans were used to measure GHJ morphology in both shoulders of 11 patients with instability and 11 control subjects. Specific outcome measures included the glenoid radius of curvature (ROC) in the anterior/posterior (A/P) and superior/inferior (S/I) directions, humeral head ROC, A/P and S/I conformity index, and A/P and S/I stability angle. Compared with the control subjects, the glenoid of the instability the injured shoulder in patients with instability was flatter (ie, higher ROC) in the A/P (P=.001) and S/I (P=.01) directions and this finding was also true for uninjured, contralateral shoulder (A/P: P=.01, S/I: P=.03). No differences in GHJ morphology were detected between the instability patients' injured and contralateral shoulders (P>.07). Similarly, no differences in GHJ morphology were detected between the control subjects' dominant and nondominant shoulders (P>.51). There are significant differences in GHJ morphology between healthy control subjects and both shoulders (injured and uninjured, contralateral) of patients diagnosed with anterior instability after GHJ dislocation. These findings are important clinically because they suggest that glenoid morphology may influence the risk of GHJ dislocation.

Comparison of reconstructive procedures for glenoid bone loss associated with recurrent anterior shoulder instability

A tibial plafond allograft, iliac crest allograft, and coracoid autograft in a congruent arc Latarjet reconstruction better restore radius of curvature, depth, and surface area for glenoid bone loss in recurrent instability compared with the coracoid autograft in a standard Latarjet reconstruction for anteroinferior glenoid bone loss of the shoulder. Three-dimensional shoulder models were generated from bilateral computed tomography scans in 15 patients, who were a mean (standard deviation [SD]) age of 23 (7.7) years, with recurrent anterior shoulder instability and known glenoid bone loss. The surface areas of the glenoid in the involved and contralateral normal shoulder were measured. Virtual surgery was then performed using standard and congruent arc Latarjet reconstruction, tibial plafond, and iliac crest allografts. Grafts were optimally positioned to restore articular congruity and defect fill. Radius of curvature and restoration of glenoid depth were compared with the contralateral glenoid. Glenoid surface area (11.04% [6.95% SD]) and depth (0.75 [0.57 SD] vs 1.44 [0.65 SD] mm) were significantly reduced (P<.012) in the injured glenoid. The mean (SD) coronal plane radius of curvature of the congruent arc Latarjet reconstruction (60.3 [39.0 SD] mm) more closely matched the radius of curvature of the injured glenoid (67.5 [33.2 SD] mm) compared with the other grafts. Restored glenoid depth was greater in the tibial plafond (1.8 [1.1 SD] mm) and iliac crest (2.0 [0.6 SD] mm) allografts compared with other grafts (P<.002). Congruent arc Latarjet reconstruction more closely restores native glenoid coronal radius of curvature, whereas tibial plafond and iliac crest allografts more adequately restore depth compared with standard Latarjet reconstruction.

The Functional Consequence of Syndesmotic Joint Malreduction at a Minimum 2-Year Follow-Up

To examine the correlation between syndesmotic malreduction and functional outcome. Prospective evaluation of bilateral computed tomography scans and functional outcome scores. Level I regional trauma center. From January 1, 2004, to December 31, 2006, 107 of 681 operatively treated ankle fractures (15.7%) had associated syndesmotic injuries requiring reduction and fixation. All patients available at a minimum of 2 years postindex procedure underwent clinical and radiographic examination, computed tomographic (CT) scanning of both ankles (injured and uninjured), and functional outcome scoring using the Short Form Musculoskeletal Assessment and Olerud/Molander questionnaires. Sixty-eight of 107 (63.5%) syndesmotic injuries in 68 patients were available for follow-up. Twenty-seven (39%) were malreduced (rotational or translational asymmetry) when compared with the contralateral uninjured syndesmotic joint. Fifteen percent of the open syndesmotic reductions were malreduced on postoperative CT scans, whereas 44% (A/B) of the closed syndesmotic reductions were malreduced on postoperative CT scan (P = 0.11). Patients with a malreduced syndesmosis recorded significantly worse functional outcome scores (P < 0.05) on both the Short Form Musculoskeletal Assessment and Olerud/Molander questionnaires when compared with those patients whose syndesmosis had healed in anatomic alignment. At a minimum of 2 years follow-up, patients with malreduced syndesmotic injuries demonstrated significantly worse functional outcome using the Short Form Musculoskeletal Assessment and Olerud/Molander questionnaires. Open reduction of the syndesmosis resulted in a substantially lower rate of malreduction when evaluated by postoperative CT scan. Based on these findings, we recommend that surgeons not only perform a direct, open visualization of the syndesmosis during the reduction maneuver, but obtain a postoperative CT scan with comparison to the contralateral extremity as well. If the syndesmosis is found to be malreduced, consideration must be given to revising the osteosynthesis. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.