Cement Fragments Research Articles

Acetabular revision for iliopsoas impingement: a study of 55 cases at 3 years of follow-up. Does the procedure achieve the Minimal Clinically Important Difference (MCID) in the Oxford-12 score in more than 80% of cases?

IntroductionSeveral surgical options can be offered to manage iliopsoas impingement. Research published on cup replacements often concerns a small population size or multicentre studies, suggesting a variety of indications. We conducted a retrospective single centre study screening according to a specific protocol of a population of patients who had a cup replacement for iliopsoas impingement. The objectives were: 1) to specify the functional outcomes and the achievement of the Minimal Clinically Important Difference (MCID) and the Patient Acceptable Symptom State (PASS) according to the Oxford-12 score, and 2) to assess the complication rate. HypothesisOur hypothesis was that acetabular replacements achieve a Minimal Clinically Important Difference (MCID) in more than 80% of cases. Patients and methodsFifty-five hips underwent acetabular revision between 2011 and 2020. Forty-three were performed as first-line surgery, eight after failed tenotomy and four after failed anterior hip capsule thickening plasty. A CT scan of all the hips revealed a median overhang of 9 mm (7; 12) and a 7 ° cup anteversion (2; 19). Follow-up included assessment of the Oxford-12 score using MCID and PASS, the Merle d'Aubigné score, an assessment of hip flexion muscle strength using the Medical Research Council scale, and an assessment of satisfaction and complications. ResultsAt a mean follow-up of 3 years (2–10), the difference in the Oxford score before and at follow-up was 18 points (15; 27) (p < 0.001), the median Medical Research Council score was 4.5 (4; 5) and patients were satisfied or very satisfied in 73% of cases (40/55). The MCID was achieved for 87% of the hips (48/55), and the PASS was achieved in 67% of cases (33/55). The rate of complications involving surgical revision was 10.9% (6/55) with respectively: two anterior dislocations, one early infection on day 10 resolved after wound irrigation and appropriate antibiotic therapy, one intraoperative fracture of the trochanter requiring osteosynthesis and one arthroscopic revision to remove a free cement fragment. ConclusionDue to a good functional outcome but a high complication rate, a cup replacement can be offered for iliopsoas impingement associated with acetabular malposition or significant overhang. Level of evidenceIV.

Defense and Protection of the Marine Coastal Areas and Human Health: A Case Study of Asbestos Cement Contamination (Italy)

Pivotal environmental geology research was carried out in the protected area of Cape Peloro (Messina, NE Sicily, Italy). The main aims were the ascertainment of the presence of Asbestos Cement Materials (ACMs), their mapping, and, consequently, an estimation of the potential risk for human health and marine coastal environments. The beaches surveyed covered 4500 m of coastline. Through high-resolution photographic surveys, over 520 fiber cement fragments were documented on the beaches as well as in beach deposits. The materials, after microscope, SEM-EDS, and FTIR analyses, were found to be composed of Portland cement with chrysotile and crocidolite fibers. Fragments of ACMs showed typical corrugated forms with centimeter-to-decimeter sizes and prevailing well-rounded, platy, and sub-elongate shapes. In a few localities, some fragments were found to be angular or friable. Furthermore, some fragments found on the beach were covered by conspicuous encrustations of marine organisms, testifying to their long staying in shallow-water marine environments. Illicit landfills and abandoned materials were identified in natural sections on the coastal plain. Most of the rounded ACMs were characterized by their surface texture, with mm-size asbestos fibers exposed on the surface due to significant weathering and abrasion. Notably, new fragments appeared after storms. Significant criticisms have been made related to the ACMs, analogously to what was reported for other Italian marine beaches. Possible intervention and reclamation activities cannot limit themselves to removing the fragments on the beach, as fragments are immersed in the coastal sediments at different depths and are also found in the marine deposits. Here, it is underlined that any asbestos removal and reclamation activities, if not designed and based on a multidisciplinary approach and knowledge of local coastal dynamics and the meteo-marine climate, will be very expensive and ineffective.

Sedimentological features of asbestos cement fragments in coastal environments (Taranto, southern Italy)

Asbestos cement materials (ACMs) are widespread in coastal environments as result of illegal dumping activities. This study focuses on the Taranto area (Italy) in the Mar Grande basin within the northern sector of the Ionian Sea. The complex history of dumping building materials containing high amounts of ACM into the coastal zone, and the erosion, transport and deposition in Marechiaro Bay is a serious environmental hazard. An interdisciplinary research methodology defines the temporal dumping succession, and the erosional processes and phases, the diffusion of ACM, the mineralogical characteristics, and existing physical status of the ACM. A multiscale investigation was conducted. Results show that from 1992 to 2000 a significant increment of dumping operations have occurred. The current cliff has been subject to erosion and redeposition phases, developing a new beach composed of these polluted man-made sediments. The findings persuade the local authorities to close the beach requiring remediation interventions.

The Experience of General Anesthesia with Remimazolam in Patient with Cardiac Tamponade Due to Cardiac Injury by Bone Cement Embolism: A Case Report

Background: In patients with cardiac injury, it is crucial to maintain hemodynamic stability during the induction and maintenance of general anesthesia. Remimazolam provides hemodynamic stability during anesthetic induction. Case Presentation: An 83-year-old female was transferred for emergency surgery after pericardiocentesis with cardiac tamponade resulting from aorta and right atrium injury from bone cement fragments after percutaneous vertebroplasty. She was admitted to the operation room with was given inotropes, vasopressors and blood. Remimazolam was used for induction (6.0 mg/kg/h) and maintenance (1 mg/kg/h) of general anesthesia. The patient underwent surgery without major hemodynamic concerns and later recovered. Conclusion: Remimazolam can be used in patient with cardiac injury with hemodynamic instability for the induction and maintenance of general anesthesia.

Extraction of cement leakages and malpositioned spindles complicating percutaneous interventions: why, when and how?

Cement leakages in soft tissues are a common occurrence during cementoplasty. They may cause chronic pain, and thus treatment failure. Spindle malposition during reinforced cementoplasty may cause vascular, nerve or cartilage injury. Our goal was to evaluate the rate of cement leakage/spindle extraction and describe the techniques used. This retrospective monocentre study included 104 patients who underwent reinforced cementoplasty and 3425 patients who underwent cementoplasty between 2012 and 2020. Operative reports and fluoroscopic images were reviewed to identify extraction attempts and their outcomes. Six patients (5.8%) had a malpositioned spindle, and all of them underwent spindle extraction during reinforced cementoplasty, with an 80% success rate. A total of 7 attempts were performed, using 2 different techniques. One thousand one hundred thirty patients (32%) had a cement leak in soft tissues, and 7 (0.6%) underwent cement leakage extraction during cementoplasty, with a 100% success rate. A total of 10 attempts were performed, using 3 different techniques. No major complication related to the extraction procedures occurred. Spindle malpositions and soft tissue cement leakages are not uncommon. We described 5 different percutaneous techniques that were safe and effective to extract spindles and paravertebral cement fragments. • Soft tissue cement leakages or spindle malpositions are a non-rare occurrence during cementoplasty, and may cause technical failure and/or chronic pain. • Most soft tissue cement fragments and malpositioned spindles can easily be extracted using simple percutaneous techniques.

Asymptomatic cement leakage into inferior vena cava.

Abstract Although percutaneous vertebroplasty (PVP) is a minimally invasive treatment procedure for the painful osteoporotic vertebral compression fracture, cement leakage into the venous system can occur and early detection and immediate management should be initiated despite the absence of clinical symptoms. We experienced a case of accidental finding of cement fragment extending from paravertebral vein into inferior vena cava and pulmonary artery. We have to be aware of cement leakage through the paravertebral venous drain system under fluorescence. It provided a classic image for cement leakage through the venous circulatory system.

Reliability analysis of radiologic and intraoperative loosening in total elbow arthroplasty.

Revisions of total elbow arthroplasties (TEAs) are commonly performed because of prosthetic loosening. UK National Joint Registry data show that TEA revisions are becoming increasingly common, with 123 TEA revisions performed in 2018 and 76 performed in 2017. TEA radiologic assessment is based on subjective interpretation with no published criteria. We defined TEA loosening by the presence of at least one of the following criteria: (1) progressive widening of the bone-cement, bone-prosthesis, or cement-prosthesis interface; (2) fragmentation or fracture of cement; (3) prosthetic component migration; and (4) bead shedding in porous-coated prostheses. Using this definition, we looked at interobserver and intraobserver agreement on radiologic loosening and compared this assessment with intraoperative findings. In our tertiary care center, we conducted a retrospective review to identify TEA revisions performed between November 2008 and July 2018. Radiologic implant loosening was independently assessed by 5 orthopedic surgeons. Interobserver agreement (κ coefficient) was calculated. The majority's view of radiologic loosening was compared with intraoperative findings. We identified 93 sets of radiographs with implant stability clearly documented in their operative notes. The κ coefficient between assessors for humeral implant loosening was 0.87 (almost perfect). The κ coefficient for ulnar loosening was 0.75 (substantial). The κ coefficients for radiologic and intraoperative findings of humeral loosening and ulnar loosening were 0.67 and 0.71 (substantial), respectively. Intraobserver reliability was almost perfect for humeral loosening (κ = 0.86) and substantial for ulnar loosening (κ = 0.74). Our definition of loosening provides reproducible interobserver and intraobserver agreement on radiographic component loosening. In our center's experience, radiologic findings may not translate to intraoperative findings, and we would advise that surgical strategies for TEA revision include the possibility of needing to perform a dual-implant exchange.

Tourmaline composition and boron isotope signature as a tracer of magmatic-hydrothermal processes

Abstract This study presents a petrogeochemical and boron isotope study on tourmaline from the barren Damai, and the contemporaneous but ore-bearing Dewulu and Meiwu intrusions, to better understand the origins, sources, and fluid evolution of magmatic-hydrothermal ore systems and provide ore formation implications for gold, copper, and iron deposits in the Xiahe-Hezuo polymetallic district in the West Qinling, China. Tourmaline from all three intrusions shows similar compositions and encompasses Na-Fe schorl and Na-Mg dravite. Tourmaline at Dewulu is primarily found in tuffaceous breccias and a quartz diorite porphyry. In the tuffaceous breccia body, tourmaline occurs as fine-grained anhedral masses that fill voids and cement fragments of breccia and sickle quartz. Tourmalines in breccia are texturally similar to those formed in typical breccia pipes, which are attributed to explosion or collapse induced by a transition from magmatic to hydrothermal Si- and B-rich fluids. They display element substitutions controlled by Fe2+Mg–1, indicating a reduced environment. Values of δ11B are –6.6 to –4.0‰, representing the primary magmatic-hydrothermal fluids. Tourmaline from the Dewulu quartz diorite porphyry is coarse-grained, euhedral, and found in quartz-sulfide veins. The tourmaline displays oscillatory zoning textures but lacks correlative variations of major elements. The Fe2+Mg–1 and Fe3+Al–1 substitution mechanisms are dominant, demonstrating more oxidized fluids. The δ11B values in the cores, ranging from –7.1 to –5.6‰, suggest that the tourmalines in the quartz veins were inherited from magmatic-hydrothermal fluids that precipitated the fine-grained tourmaline in the tuffaceous breccia body. A large δ11B isotopic fractionation that decreases from cores (–5.6‰) to rims (–10.7‰) indicates significant fractionation during degassing occurred, increasing oxygen fugacity of the residual liquid. The Meiwu locality hosts fine-grained euhedral tourmalines coexisting with magnetite. Their composition is controlled by substitution between Al3+ by Fe3+ and has the lightest δ11B values ranging from –11.4 to –10.0‰. They are interpreted to result from skarn formation under oxidized conditions. In contrast, X☐Al(NaMg)–1 is the dominant substitution mechanism for Damai tourmalines and attributed to (geochemically) reduced fluids with a low salinity. We conclude that tourmalines with low Fe values, substitution mechanisms dominated by Fe3+Al–1, and large shifts of B isotopic composition are potentially an ore-forming indicator in the Xiahe-Hezuo polymetallic district.

Advantages and shortcomings of the utilization of recycled wastes as aggregates in structural concretes

Global material resources are quickly being drained by the demands of global economic development. Simultaneously, the environmental impacts of the massive amounts of waste generated globally every year are also growing exponentially. As such, the implementation of waste recycling through its utilization as a component of a construction material, particularly one with a global demand as high as concrete, is a strategy which acts in both planes: material efficiency and waste generation. This paper details the results of a systematic review performed on the scientific literature that concerns the possibility of incorporating recycled wastes as aggregates in structural ordinary Portland cement concretes. The available literature suggests that a reduced number of wastes of recycled origin may, albeit in low quantities, be used in structural OPC concretes. Furthermore, the presence of substances such as glass wastes or alkali-rich cement fragments in recycled aggregates elevates the potential for expansions originated by the occurrence, in these concretes, of the well known phenomenon known as alkali-silica reaction. Moreover, the variety, quantity and the limits to the utilization of these wastes as aggregates in structural concretes all suggest that a massification of the utilization of recycled aggregates in OPC concretes will not take place. The investigation also found that, in light of the evidence showing that the performance of alkali-activated binder concretes is less impacted by the shortcomings of recycled aggregates, recycled wastes may be better suited for reutilization as aggregates in these concrete compositions.

Ultrafine particle dispersion in the metropolitan area of Guadalajara, Mexico

Objectives: Dust, soil and leaf samples of Ficus benjamina were collected in the metropolitan area of Guadalajara (GMA) (Peña-García et al., 2017), allowing to identify the type of metallic particles, size, shape and spatial distribution. With the results obtained, the possible effects of metallic particles on human and plant health were discussed (Peña-García et al., 2019). Methodology: The sampling was in six municipalities of the GMA; Atomic absorption spectrophotometry analyses were carried out on leaves, which identified the presence of various elements that mostly exceeded the reference values. Through X-ray fluorescence, 23 elements were identified in soil, including Th and Ac in at least 14 sites. Using the scanning electron microscopy technique and elemental mapping analysis, coarse, fine and ultrafine metallic particles were identified in human bronchus and lung tissue, as well as fragments of cement, plastic, yeast and bacteria. The similarity between the metallic particles in the collected samples and those observed in lung tissue, warns of latent risks to the health of the GMA population. Contribution: The results obtained with the methodology used in this work allow us to glimpse the polluting potential in urban areas.

Cement Plug Fragmentation Following Percutaneous Cementoplasty of the Bony Pelvis: Is it a Frequent Finding in Clinical Practice?

To report the rate of fragmentation of the cement plug following percutaneous cementoplasty with polymethylmethacrylate (PMMA) in the bony pelvis (i.e., pelvic bones or sacrum). Post-interventional and follow-up CT scans of 56 patients (36 men; mean age of 68.4 ± 15.4) with a total of 98 percutaneous cementoplasty procedures were analyzed. Indications for treatment included painful malignant tumors (42.9%; 42/98) and insufficiency fractures (57,1%; 56/98). Fragmentation of PMMA was recorded for each cement plug. Mean interval between the procedure and the last available CT scan was 29.3 ± 18.8months. There was no significant difference between the length of follow-up of malignant lesions (27.6 ± 15.1months) and insufficiency fractures (29 ± 20.5months) (p = 0.69). Fragmentation was diagnosed following 2/98 (2%) procedures, both in the malignant lesions group. The time intervals between the procedure and the first visualization of cement fragmentation were 6 for the first and 24months for the second patient. Fragmentation of the PMMA plug following percutaneous cementoplasty in the bony pelvis is a rare finding at midterm follow-up. It was only observed in cementoplasty performed in malignant lesions and seems to be more a consequence of local mechanical stresses than as a result of porosity.

Wear debris released by hip prosthesis analysed by microcomputed tomography.

Total hip arthroplasty uses commercial devices that combine different types of biomaterials. Among them, metals, ceramics and metal oxides can be used either in the prosthesis itself or in the cement used to anchor them in the bone. Over time, all of these materials can wear out and release particles that accumulate in the periprosthetic tissues or can migrate away. We used histology blocks from 15 patients (5 titanium metallosis, 5 alumina prostheses, 5 with altered methacrylic cement) to perform a microCT study and compare it with conventional histology data. An EDS-SEM analysis was done to characterise the atomic nature of the materials involved. A morphometric analysis was also performed in 3D to count the particles and assess their density and size. The metallic particles appeared to be the largest and the ceramic particles the finest. However, microCT could not reveal the wear particles of radiolucent biomaterials such as polyethylene and the very fine zirconia particles from cement fragmentation. MicroCT analysis can reveal the extent of the accumulation of these debris in the periprosthetic tissues. LAYOUT DESCRIPTION: Hip prostheses progressively degrade in the body by releasing wear debris. They accumulate in the periprosthetic tissues. Microcomputed tomography was used to image three types of radio-opaque wear debris: metal, ceramic and zirconia used in the bone cements.

Impact of a double-layer cementing technique on the homogeneity of cementation and the generation of loose bone cement fragments in tibial unicompartmental knee arthroplasty

BackgroundThe objective of this study was to evaluate the impact of a single- vs. double-layer cementing technique on morphological cementation and the generation of microscopic cement layers or loose cement fragments in unicompartmental knee arthroplasty (UKA).MethodsUKAs were implanted in 12 cadaver knees. The specimens were divided into two groups of comparable bone mineral density. Six UKAs were implanted using a single-layer cementing technique (group A) and six UKAs were implanted using a double-layer cementing technique (group B). Morphological cementation was assessed on nine cuts through the implant–cement–bone interface in the frontal plane. Loose bone cement fragments and the microscopically quality of layer formation were evaluated.ResultsContact between bone and prosthesis was observed in 45.4% of interfaces in group A and 27.8% in group B (p = 0.126). The significant increase of areas without visible cement interlocking in the anteroposterior direction in group A (p = 0.005) was not evident in group B (p = 0.262). Penetration around the peg tended to occur more frequently in group B (67.5% vs. 90.6% p = 0.091). Scanning electron microscopy identified no evidence of fissure formations within the bilaminar cement mantle. Free bone cement fragments were documented in 66.7% in both groups with no difference concerning mass (p = 1.0).ConclusionsThis in-vitro study showed a tendency towards a more homogenous cementation of tibial UKAs using a double-layer cementing technique, although most of the differences did not reach the level of significance. However, theoretical downsides of the double-layer cementing technique such as an increased formation of free bone fragments or a microscopically fissure formation within the cement layer could not be detected either.

Results of petrographic research of new finds from the archaeological monument Tokivske-1

The purpose of the work was to determine the provenance of the raw materials of ancient stone products, found during the excavations of the Bronze-Early Iron Age monument Tokivske-1, with the aim to establish connections of the ancient population of the area with residents of other regions. The archaeological monument Tokivske-1, located in the northern outskirts of the village Tokivske, Apostolove Raion, Dnipropetrovsk Oblast, has been explored by the expedition of Dnipropetrovsk National Historical Museum named after D.I. Yavornytskyi since 2012. The authors of this article already carried out petrographic study of stone artefacts from this monument, which had been found during the first five years of excavations. However, over the past two years, a number of stone and other items were found that could expand our knowledge of the links of Tokivske-1 with ancient industrial centers of other regions. To carry out the petrographic analysis, six artefacts were taken, mainly those made from macroscopically different rocks. Most of them can be related to metalworking. The analyzed samples are represented by an amphibolite hammer for forging jewels or peening sheet copper, a dolerite anvil-prop for a specified hammer, a fragment of an abrasive stone made of ferruginous quartzite, a quartz tile, which is a fragment of an altar, and fragments of an anvil and a scepter-pestle made of sandstone. Petrographic analysis of artefacts allowed determining the probable provenance of their raw materials. Amphibolites are quite common in the territory of the Middle Dnipro area, but by the color of the hornblende, the predominance of epidotization processes over sericitization and macrostructural features, the studied rock is more similar to the amphibolites from the middle stream of the Bazavluk River. Dolerites, similar to the raw material of the anvil-prop, are also common in the area of excavations, and by the presence of the micropegmatite in its composition, its origin can be localized in the middle stream of the river Bazavluk or in the valley of the river Mokra Sura. Magnetite quartzite – the raw material of the abrasive stone – most likely comes from the territory of the city of Kryvyi Rih. Quartz tile – a fragment of an altar – is a quartz vein, similar to those that intersect granites of the Tokivskyi massif directly near the village Tokivske. Sandstones, from which the anvil and the scepter-pestle were produced, appeared to be very similar in their petrographic features. They are represented by quartz sandstones with fragments of rocks and polymineral cement with the predominance of quartz regenerative and porous sericite cement. Also, the relic chalcedony and, more rarely, clay cement are present in the pores. In the territory of Ukraine, the most similar to them, according to petrographic characteristics, are the sandstones of the Carboniferous system, which crop out in the Donbas. Thus, the obtained data testifies to the connection of the Tokivske-1 archaeological complex with other parts of the Middle Dnipro area, such as the middle stream of the Bazavluk River and the Kryvyi Rih area, as well as with more distant regions such as the Donbas. It should be noted that scepter-pestles, similar to the one studied by us, are associated with metalworking, and the Donetsk basin, where the raw material of the indicated tool originates from, was the copper production center of the Late Bronze Age.

Fatal cardiac perforation and pulmonary embolism of leaked cement after percutaneous vertebroplasty

Percutaneous vertebroplasty consists of percutaneous injection of polymethylmethacrylate (PMMA) via a transpedicular approach for the treatment of collapsed osteoporotic or metastatic vertebrae. Even if percutaneous vertebroplasty is considered to be minimally invasive, threatening complications can occur. Cement leakage is the most common complication of percutaneous vertebroplasty. Rigorous patient selection and individual therapeutic strategy may reduce the occurrence of leakage, in particular the risk of cement entry into the venous system and the spinal canal is the potent major hazard of this technique. Cement pulmonary and cardiac embolism are reported in literature as a cause of unexpected death after percutaneous vertebroplasty. Authors report a fatal case of pulmonary cement embolization occurred after vertebroplasty with haemopericardium, due to the perforation of the right atrium wall from a cement solidified fragment. A complete post mortem examination documented the presence of multiple cement fragments in the pulmonary arteries and transmural perforation of the wall of the right atrium by a whitish needle-like foreign body. Pulmonary microembolization was observed under polarized light.

Arthroscopic treatment of total knee arthroplasty complications.

The most frequent indications for arthroscopy in patients with total knee arthroplasty (TKA) are soft-tissue impingement, arthrofibrosis (knee stiffness), periprosthetic infection and removal of free bodies or cement fragments.When performing a knee arthroscopy in a patient with a symptomatic TKA, look for possible free/retained bone or cement fragments, which can be anywhere in the joint.Patellar tracking should be evaluated and soft-tissue impingement under the patella or between the femoral and tibial prosthetic components should be ruled out.Current data suggest that knee arthroscopy is an effective procedure for the treatment of some patients with symptomatic TKA.The approximate rates of therapeutic success vary according to the problem in question: 85% in soft-tissue impingement; 90% in arthrofibrosis; and 55% in periprosthetic infections.More clinical studies are needed to determine which patients with symptomatic TKA can be the best candidates for knee arthroscopy.Cite this article: EFORT Open Rev 2019;4:33-43. DOI: 10.1302/2058-5241.4.180035.

Intravascular Cement Leak after Vertebroplasty Treated with Stent Graft Placement in the Inferior Vena Cava

A 75-year-old man presented with a large amount of cement extravasation into the inferior vena cava (IVC) after undergoing L4-S1 surgical fusion with vertebroplasty for prostate cancer metastases. Cement extended from L4 to the suprarenal IVC (Fig 1). Given the risk for embolization, a decision was made to intervene. The brittle consistency of set cement raised concern for fracture and embolization during snaring maneuvers. It was decided to stabilize this cement column and exclude it from the flow lumen. Under general anesthesia, a 3-pronged approach was used. Through a 16-F internal jugular vein sheath, a Coda balloon (Cook, Inc, Bloomington, Indiana) was positioned in the suprahepatic IVC and inflated for flow interruption and embolic protection; the acute drop in preload was mitigated by aggressive fluid resuscitation with pressor support. A second Coda balloon positioned from the right groin was used to displace and compact the cement into the infrarenal IVC, allowing for deployment of a 32 mm × 57 mm Endurant II aortic extension stent graft (Medtronic, Minneapolis, Minneapolis) caudal to the renal veins, placed from a left groin access (Figs 2, 3). This stabilized most of the cement, excluding it from the flow lumen (Fig 4). Inadvertent embolization of a small piece of cement to the left lung occurred without clinical consequences (Fig 5). The patient was discharged on aspirin and clopidogrel. Six-month clinical follow-up was uneventful. The patient had no further embolization or IVC thrombosis on 1-month follow-up computed tomography (CT) (Fig 6). Figure 2Fluoroscopy image demonstrates undeployed stent graft placed from left femoral access (short arrow), positioned just caudal to lowest (right) renal vein—marked by wire placed from jugular approach (black arrow). The large cement piece extended from the level of L5 up to intrahepatic IVC (white arrows). Note an additional guide wire that had been advanced from a right common femoral vein access (asterisk). View Large Image Figure Viewer Download Hi-res image Figure 3A Coda balloon (black arrow) placed from the jugular access was inflated in the suprarenal IVC to interrupt blood flow and minimize embolization risk. A second Coda balloon placed from a right femoral access was inflated above the cement piece and pulled down to displace cement (white arrows) caudal to the ostia of the renal veins. Note a small fragment of cement that inadvertently broke off (short arrow), which was seen only retrospectively. View Large Image Figure Viewer Download Hi-res image Figure 4The stent graft was deployed in the infrarenal IVC while trapping most of the cement against the vein wall (white arrow). A wire placed from jugular access into the right renal vein courses through the uncovered portion of the stent graft (black arrow), designed for suprarenal fixation. View Large Image Figure Viewer Download Hi-res image Figure 5Fluoroscopy of the chest demonstrates a small cement fragment in the left lung (arrow) owing to embolization. View Large Image Figure Viewer Download Hi-res image Figure 6Coronal oblique multiplanar reformat from contrast-enhanced CT performed 1 month after procedure confirms exclusion of cement from the IVC lumen by the stent graft (white arrow) and patency of IVC and right renal vein draining through the uncovered portion of the stent graft (short arrow). The left renal vein was also patent, draining above the stent graft (not shown). Hyperdensities to the left of the IVC correspond to aortic atherosclerotic plaques (asterisk). View Large Image Figure Viewer Download Hi-res image

Periprosthetic Fracture following Partial Knee Arthroplasty.

Partial knee arthroplasty is a procedure with long-term successful outcomes. However, there are several potential complications including retained cement fragments, bearing dislocation, infection, component loosening, medial collateral ligament injury, and overcorrection, leading to progressive arthritis. Periprosthetic fracture is an uncommon complication, with multiple reports showing an incidence of less than 1%. Hence, there are no established algorithms to guide treatment. A consecutive series of 2,464 patients who underwent partial knee arthroplasty between January 2009 and April 2017 was reviewed. We identified 16 patients with early periprosthetic fracture, with an incidence of 0.6%. All of these were tibial fractures, which occurred at a mean of 35 days postoperatively. There were 5 males and 11 females, with an average age of 70 years at the time of surgery. Average follow-up was 62 months. Two patients had contralateral compartment insufficiency fractures that were successfully treated nonoperatively, five patients immediately underwent total knee arthroplasty (TKA), and nine patients underwent open reduction internal fixation (ORIF). Two of these cases had a failed ORIF and required conversion to TKA. Seven patients were successfully treated with a medial buttress plate in compression. Average Knee Society Score at final follow-up was 81, and average flexion was 115 degrees, with no patients having greater than 5-degree flexion contracture. Periprosthetic fracture following partial knee arthroplasty resulted in a high rate of conversion TKA. However, ORIF in select patients resulted in fracture healing and retention of the partial knee replacement. All patients were successfully treated with low complication rates, excellent range of motion, and acceptable knee scores at final follow-up.

Automated cement fragment image segmentation and distribution estimation via a holistically-nested convolutional network and morphological analysis

The distance between two rollers in a ball grinding mill is determined by the size of cement fragments. As such, automated detection of fragment size distribution is of great importance to the cement production industry. Therefore, we propose a holistically-nested convolutional network (HCN) and corresponding morphological analysis to estimate cement fragment distributions. This procedure can be divided into three stages. First, a cement fragment image training set was input to the HCN, helping the algorithm distinguish between fragments and the background. A series of morphological operations including morphological clean and opening operation were then employed to improve segmentation performance and the accuracy of fragment size calculation. Finally, the ‘open’ operation was employed to obtain the fragment distribution from a segmented image. Experimental results demonstrated that the segmentation and size calculation achieved using our algorithm were superior to those using comparable conventional techniques. The precision,F1-measure, PRI and VI using proposed method are improved at least 1.3%, 3.3%, 9.5% and 36.5% respectively.

Minimally Invasive Translaminar Endoscopic Approach to Percutaneous Vertebroplasty Cement Leakage: Technical Note

Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty are 2 common procedures that could be applied simply in treatment of vertebral compression fractures. Despite simplicity and safe application of these procedures, there are some drawbacks as well. Cement leakage into the spinal canal is the most common complication of PVP and PKV procedures. The aim of this article is to present a minimally invasive alternative technique for removing cement leakage fragment after thePVP. A 44-year-old female patient began to complain of L4 radiculopathy after L4 PVP. The lumbar computed tomography demonstrated cement fragment closed to upper medial aspect of the left L4 pedicle. A minimally invasive translaminar endoscopic procedure was performed to remove the cement fragment. Following the endoscopic procedure, the patient's complaints resolved completely and she was discharged on postoperative day 1. The minimally invasive intervention provided shorter operation time, minimal blood loss, and reduced complication rate due to its simplicity. In particular, there was no need to undergo general anesthesia. Endoscopic translaminar approach could be safely performed in patients with symptomatic cement leakage after PVP or a percutaneous kyphoplasty procedure.