Analysis Of Deformity Research Articles

Prevalence and Prognosis of Coronal Malalignment Following Lateral Lumbar Interbody Fusion for Minimally Invasive Treatment of Adult Spinal Deformity

Study Design: Retrospective analysis of prospective multicenter adult spinal deformity (ASD) database. Objective: To determine the prevalence and prognosis of postoperative coronal malalignment following LLIF for ASD with Qiu type A coronal alignment. Summary of background data: Qiu Type A coronal alignment is defined as coronal vertical axis (CVA) <30mm.1 There is concern that circumferential minimally invasive surgery (cMIS) with lateral lumbar interbody fusion (LLIF) is associated with postoperative coronal malalignment in ASD with preoperative Qiu type A patients. Methods: Qui type A patients undergoing cMIS with LLIF for ASD were included, with ASD defined with at least: maximum CC≥20°, SVA>5 cm, PI-LL≥10°, or PT>20°. Two year (2Y) clinical outcomes were compared for type A with 2Y CVA≥30 mm (MAL) versus <30 mm (ALIGN) and were adjusted for factors reaching P<0.05 on univariate comparisons (age, BMI, and ODI). Results: 43 patients met inclusion criteria, of which 12 (27.9%) developed coronal malalignment and 31 (72.1%) remained coronally aligned at 2Y. At baseline, MAL were older (73.0 vs. 69.0, P=0.045), had a lower BMI (26.09 vs. 29.45, P=0.047), and were less disabled (ODI 42.83 vs. 51.69, P=0.016). Otherwise, the groups were well-matched for baseline characteristics. At 2Y, MAL had a greater 2Y SVA (mean 54.08 vs 19.00 mm, P=0.01). Clinically, MAL was associated with inferior 2Y SF-36 PCS (34.78 vs. 37.42, adj P=0.043) and 2Y SRS-22r function/activity domain (3.03 vs. 3.36, adj P=0.040), but otherwise similar in other patient-reported-outcome-metrics (adj P>0.05 for all). 2Y complications were similar between groups, including for reoperations and major and minor complications (adj P>0.05 for all). Conclusions: In Qui type A patients undergoing cMIS with LLIF for ASD, 27.9% develop coronal malalignment, which was associated with worse SF-36 PCS and SRS-22r function/activity. Despite radiographic malalignment, malalignment was not associated with higher 2-year complication rates including reoperations.

Titanium Cable Cerclage Increases the Load to Failure in Plate Osteosynthesis for Distal Femoral Fractures.

Background and Objectives: The reduction of two-part oblique or spiral fractures of the distal femur using steel wire cerclage prior to plate osteosynthesis is a proven procedure. In addition to being useful in fracture reduction, wire cerclage was also shown to increase the stability of osteosynthesis. Nevertheless, metal corrosion and the allergenic potency of steel remain problematic disadvantages of this method. A biomechanical study was carried out to evaluate titanium cable cerclage as an alternative supplement for plate osteosynthesis of a distal femoral two-part fracture. Materials and Methods: An unstable AO/OTA 32-A2.3 fracture was created in eleven pairs of nonosteoporotic human cadaver femora. All the samples were treated with polyaxial angular stable plate osteosynthesis. One femur from each pair was randomly selected for an additional fracture fixation with multifilament titanium cable cerclage. Stepwise cyclic axial loading was applied in a load-to-failure mode using a servohydraulic testing machine. Results: All specimens (mean age: 80 years; range: 57-91 years) withstood a cycling force of at least 1800 N. With a mean load of 2982 N (95% CI: 2629-3335 N), the pressure forces resulting in osteosynthesis failure were significantly higher in specimens with an additional titanium cerclage (Group 1) than in samples that were solely treated with plate osteosynthesis (Group 2) at 2545 N (95% CI: 2257-2834 N) (p = 0.024). In both groups, cutting out the distal screws at the condyle region, resulting in shearing of the distal fragment proximal to the fracture line, was the most frequent cause of construct failure. Among the specimens assigned to Group 1, 36% exhibited a specific fracture pattern, namely, a fracture of the dorsal buttress above the cerclage. Analysis of axial stiffness (p = 0.286) and irreversible deformity of the specimens revealed no differences between the groups (p = 0.374). Conclusion: Titanium cable cerclage application, as a supplement to an angular stable plate, resulted in an increased load to failure. In terms of stability, the use of this adjunct for fracture fixation of supracondylar two-part oblique femoral fractures might, therefore, be an option, especially in patients who are sensitive to nickel.

Dorsal roof flap rhinoplasty: Updated results and a new classification of nasal dorsal deformity

BackgroundThe dorsal roof flap (DRF) technique was developed as a modification of the retractable roof method (1), which is a variant of dorsal preservation (DP). ObjectiveThe paper aims to present new results of the DRF technique and dorsal deformity analysis created for the technique. MethodsA total of 57 primary rhinoplasty patients treated with DRF technique between 2022-2023 years were included in the study. A dorsal deformity classification based on the anticipated amount of dorsal reduction, nasal bone shape, and hump content was used. According to the classification, the noses were categorized into 3 types. All data were obtained from patient records, computed tomography views, and pre-and postoperative photographs. Aesthetic and functional results were assessed pre-and postoperatively using a visual analog scale (VAS) (0-10, 0 points means very poor). ResultsThe mean follow-up period was 10.1±3.9 months. 23 cases were type 1, 14 were type 2, and 20 were type 3. The anticipated amount of dorsal reduction in type 1 was 2-4mm, 5-7mm in type 2, and 8-10mm in type 3 deformity. Of the total, 27 cases had a V-shaped nasal bone and 30 had an S-shaped. The hump composition was cartilaginous in 13 cases and bone and cartilage in 44 cases. Pre- and postoperative aesthetic and functional VAS scores were significantly different (p ≤0.001). No complications and therefore no revisions were observed during the follow-up period. ConclusionIt is a versatile method to reshape the nasal dorsum and minimize the revisions associated with dorsal preservation when used in appropriate cases.

Medial opening wedge high tibial osteotomy performs similarly irrespective of body mass index.

This study investigates the effect of the body mass index (BMI) on the early (2 years) to midterm (5 years) results of medial opening wedge high tibial osteotomy (MOWHTO). A prospectively maintained single-centre database of 1138 knee osteotomies, between 2002 and2022, was retrospectively reviewed. Adult patients who underwent MOWHTO for symptomatic unicompartmental medial knee osteoarthritis (OA), with varus knee malalignment, having failed conservative management, were included. Patients were categorized into threegroups according to their BMI as per the classification from the National Institute for Health and Care Excellence (NICE): the healthy weight (HW) group (BMI of 18.5-24.9 kg/m2), the overweight (OW) (BMI of 25-29.9 kg/m2), and the obesity (OB) group (BMI ≥ 30 kg/m2). Multiple patient-reported outcome measures (n = 6) were recorded preoperatively and at 2 and 5 years postoperatively. Deformity analysis was undertaken preoperatively and postoperatively. The relative risk (RR) of the complications between the HW, OWand OB groups was calculated. The rate of conversion to arthroplasty, and 5and 10 years survivorship were recorded, as well as the hazard ratio (HR) of BMI on survivorship. A total of 574 cases were included in the study: the HW group (n = 96), the OW group (n = 233)and the OB group (n = 245), with a mean BMI of 23 ± 1.5 kg/m2, 27.4 ± 1.4 kg/m2 and 34.4 ± 3.8 kg/m2, respectively. The mean follow-up was 13.3 years (4.8-20.3). The mean mechanical tibiofemoral angle corrections were in the HW group: 7.1 ± 3°, OW group: 6.6 ± 3.5°and OB group: 7.1 ± 3.8°, with no intergroup significant difference (p = n.s.). Clinically, despite lower preoperative scores in the OW and OB groups, no difference was observed postoperatively amongst the three groups. The overall complication rate was 12.5% in the HW group, 6.8% in the OW group, and 9.8% in the OB group. There was no significant difference in the RR of complications between the HW and OW groups (RR = 0.6, 95% confidence interval [CI] = 0.3-1.3)(p = 0.2), and the HW and OB groups (RR = 0.8; 95% CI = 0.3-2.2)(p = 0.7). There was no overall significant difference in survival outcomes based on the BMI between the threegroups (p = 0.4). The HR of conversion to arthroplasty between the HW and OW groups was 1.4 [95% CI = 0.6-3.5](p = 0.5)and between the HW and OB groups was 1.8 [95% CI = 0.8-4.4] (p = 0.2). BMI has no significant effect on either the radiological corrections, clinical outcomes, complicationsor survivorship of MOWHTO at short- to medium-term follow-up. No specific cutoff point for BMI can be recommended as a contraindication to MOWHTO. Level IV, Retrospective cohort study.

Double-Level Torsional Osteotomy in Severe Torsional Malalignment: A Surgical Technique

Background: Torsional malalignment of the femur and/or tibia is associated with patellar maltracking, and torsional osteotomies have shown to improve clinical symptoms. In patients with severe torsional malalignment, a double-level torsional osteotomy may be necessary. Indications: Symptomatic torsional malalignment leading to patellofemoral maltracking associated with anterior knee pain and/or patellofemoral instability. Technique Description: A double-level torsional osteotomy correcting both increased internal femoral torsion and increased external tibial torsion, is described. Meticulous preoperative deformity analysis and planning of the osteotomy is mandatory. An arthroscopy of the knee is performed first to evaluate the patellofemoral joint and patellar tracking. Tibial torsional correction is performed by a lateral approach. A biplanar osteotomy is performed, and the amount of torsional correction is controlled by 2 Schanz screws. Osteosynthesis can be done via a bended 5-hole DC-Plate or an angle-stable plate. The femoral osteotomy is performed by a medial approach. A uniplanar osteotomy is performed perpendicular to the mechanical axis of the femur. The amount of torsional correction is controlled by 2 Schanz screws. Osteosynthesis is achieved by an angle-stable plate. Results: Double-level torsional osteotomy has been shown to be an effective treatment for patients with patellar dislocation or subluxation associated with severe torsional malalignment. In a series of 18 patients, double-level osteotomy led to improved patellofemoral stability, decreased pain, and increases subjective outcome scores. Discussion/Conclusion: In patients with patellofemoral problems caused by a combined increased tibial external torsion and increased femoral internal torsion, a double-level torsional osteotomy is able to correct torsional angles to normal. Available clinical data on this procedure are promising. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Méary's angle decoded: 3D analysis of first ray plantarflexion deformity in Charcot-marie-tooth disease

BackgroundThe typical cavovarus deformity seen in patients with Charcot-Marie-Tooth (CMT) involves plantarflexion of the first ray. The exact apex of the deformity has never been proven, although it is presumed to be within the medial cuneiform. The aim of this study was to utilize weight-bearing computed tomography (WBCT) to localize and quantify first ray plantarflexion deformity in CMT patients. MethodsWBCTs of 16 CMT patients with lateral Méary’s angle > 20 degrees were compared to controls utilizing semi-automated analysis software. A local coordinate system based on the first metatarsal was used to avoid bias of proximal deformity. The tarsometatarsal angle was subdivided into components (cuneiform-cuneiform joint normal, tarsometatarsal joint and metatarsal-metatarsal joint normal) and compared between CMT and controls. CMT patient’s first, second and third rays were also compared. Means were compared with a 2-sample t test (p < .05). ResultsCMT patients had significantly more plantarflexion of the first ray than controls (16.4 versus 8.8 degrees respectively(p < 0.001)). The largest difference of was found at the medial cuneiform with 20.6 degrees of plantarflexion in CMT patients versus 14.8 degrees in controls (p < .0001). There was also approximately 2 degrees of plantarflexion at the TMT joint (p < .001). ConclusionsPlantarflexion deformity in CMT patients is primarily an osseous deformity at the level of the medial cuneiform with a lesser contribution from the tarsometatarsal joint. Level of evidenceIII Retrospective comparative study

Classification of Apple Color and Deformity Using Machine Vision Combined with CNN

Accurately classifying the quality of apples is crucial for maximizing their commercial value. Deep learning techniques are being widely adopted for apple quality classification tasks, achieving impressive results. While existing research excels at classifying apple variety, size, shape, and defects, color and deformity analysis remain an under-explored area. Therefore, this study investigates the feasibility of utilizing convolutional neural networks (CNN) to classify the color and deformity of apples based on machine vision technology. Firstly, a custom-assembled machine vision system was constructed for collecting apple images. Then, image processing was performed to extract the largest fruit diameter from the 45 images taken for each apple, establishing an image dataset. Three classic CNN models (AlexNet, GoogLeNet, and VGG16) were employed with parameter optimization for a three-category classification task (non-deformed slice–red apple, non-deformed stripe–red apple, and deformed apple) based on apple features. VGG16 achieved the best results with an accuracy of 92.29%. AlexNet and GoogLeNet achieved 91.66% and 88.96% accuracy, respectively. Ablation experiments were performed on the VGG16 model, which found that each convolutional block contributed to the classification task. Finally, prediction using VGG16 was conducted with 150 apples and the prediction accuracy was 90.50%, which was comparable to or better than other existing models. This study provides insights into apple classification based on color and deformity using deep learning methods.

Osteotomy around the painful degenerative varus knee has broader indications than conventionally described but must follow a strict planning process: ESSKA Formal Consensus Part I.

The European consensus was designed with the objective of combining science and expertise to produce recommendations that would educate and provide guidance in the treatment of the painful degenerative varus knee. Part I focused on indications and planning. Ninety-four orthopaedic surgeons from 24 European countries were involved in the consensus, which focused on the most common indications for osteotomy around the knee. The consensus was performed according to an established ESSKA methodology. The questions and recommendations made were initially designed by the consensus steering group. And 'best possible' answers were provided based upon the scientific evidence available and the experience of the experts. The statements produced were further evaluated by ratings and peer review groups before a final consensus was reached. There is no reliable evidence to exclude patients based on age, gender or body weight. An individualised approach is advised; however, cessation of smoking is recommended. The same applies to lesser degrees of patellofemoral and lateral compartment arthritis, which may be accepted in certain situations. Good-quality limb alignment and knee radiographs are a mandatory requirement for planning of osteotomies, and Paley's angles and normal ranges are recommended when undertaking deformity analysis. Emphasis is placed upon the correct level at which correction of varus malalignment is performed, which may involve double-level osteotomy. This includes recognition of the importance of individual bone morphology and the maintenance of a physiologically appropriate joint line orientation. The indications of knee osteotomies for painful degenerative varus knees are broad. Part I of the consensus highlights the versatility of the procedure to address multiple scenarios with bespoke planning for each case. Deformity analysis is mandatory for defining the bone morphology, the site of the deformity and planning the correct procedure. Level II, consensus.

Morphological characterization and transcriptome analysis of opercular deformity in golden pompano (Trachinotus ovatus)

Skeletal deformity is one of the major threats to aquaculture because of its negative effects in important economic losses. Recently, a high rate of opercular deformities was observed in farmed golden pompano (Trachinotus ovatus), which is a key species for marine cage culture in the South China Sea. In the present study, a structural, histological, and biochemical analysis of the deformed opercular complex in T. ovatus was carried out using micro-CT, Inductively Coupled Plasma Mass Spectrometry (ICP-MS), paraffin section, and staining. A 3D reconstruction of the deformed and normal opercular complex has revealed an inward folding of both opercle and subopercle, and frequently affected branchiostegal rays being coated by the deformed opercle and subopercle. In addition, an increased Ca, P, and Mg content was identified in the deformed opercle. The Hematoxylin-eosin (HE) and tartrate resistant acid phosphatase (TRAP) staining of the deformed opercle have shown a higher osteoclast activity and increased bone resorption area. Further analyses on the difference of gene expression between the deformed and normal opercle have been performed using Illumina sequencing platform. As a result, a total of 1220 DEGs (including 508 up-regulated and 712 down-regulated genes) were identified. DEGs related to osteoblast and osteoclast differentiation revealed an important role of bone metabolism in opercular deformity. Moreover, GO and KEGG analysis of these DEGs showed that they were significantly enriched in functions and pathways related to muscle form, development and contraction. Additionally affected pathways including ion homeostasis suggested that functions of gills such as breathing and osmoregulation might be affected by the deformed opercle.

Multicentric development and validation of a multi-scale and multi-task deep learning model for comprehensive lower extremity alignment analysis

Osteoarthritis of the knee, a widespread cause of knee disability, is commonly treated in orthopedics due to its rising prevalence. Lower extremity misalignment, pivotal in knee injury etiology and management, necessitates comprehensive mechanical alignment evaluation via frequently-requested weight-bearing long leg radiographs (LLR). Despite LLR’s routine use, current analysis techniques are error-prone and time-consuming. To address this, we conducted a multicentric study to develop and validate a deep learning (DL) model for fully automated leg alignment assessment on anterior–posterior LLR, targeting enhanced reliability and efficiency. The DL model, developed using 594 patients’ LLR and a 60%/10%/30% data split for training, validation, and testing, executed alignment analyses via a multi-step process, employing a detection network and nine specialized networks. It was designed to assess all vital anatomical and mechanical parameters for standard clinical leg deformity analysis and preoperative planning. Accuracy, reliability, and assessment duration were compared with three specialized orthopedic surgeons across two distinct institutional datasets (136 and 143 radiographs). The algorithm exhibited equivalent performance to the surgeons in terms of alignment accuracy (DL: 0.21 ± 0.18°to 1.06 ± 1.3°vs. OS: 0.21 ± 0.16°to 1.72 ± 1.96°), interrater reliability (ICC DL: 0.90 ± 0.05 to 1.0 ± 0.0 vs. ICC OS: 0.90 ± 0.03 to 1.0 ± 0.0), and clinically acceptable accuracy (DL: 53.9%–100% vs OS 30.8%–100%). Further, automated analysis significantly reduced analysis time compared to manual annotation (DL: 22 ± 0.6 s vs. OS; 101.7 ± 7 s, p ≤ 0.01). By demonstrating that our algorithm not only matches the precision of expert surgeons but also significantly outpaces them in both speed and consistency of measurements, our research underscores a pivotal advancement in harnessing AI to enhance clinical efficiency and decision-making in orthopaedics.

MR-based Bony 3D models enable radiation-free preoperative patient-specific analysis and 3D printing for SCFE patients.

Slipped capital femoral epiphyses (SCFE) is a common pediatric hip disease with the risk of osteoarthritis and impingement deformities, and 3D models could be useful for patient-specific analysis. Therefore, magnetic resonance imaging (MRI) bone segmentation and feasibility of 3D printing and of 3D ROM simulation using MRI-based 3D models were investigated. A retrospective study involving 22 symptomatic patients (22 hips) with SCFE was performed. All patients underwent preoperative hip MR with pelvic coronal high-resolution images (T1 images). Slice thickness was 0.8-1.2 mm. Mean age was 12 ± 2 years (59% male patients). All patients underwent surgical treatment. Semi-automatic MRI-based bone segmentation with manual corrections and 3D printing of plastic 3D models was performed. Virtual 3D models were tested for computer-assisted 3D ROM simulation of patients with knee images and were compared to asymptomatic contralateral hips with unilateral SCFE (15 hips, control group). MRI-based bone segmentation was feasible (all patients, 100%, in 4.5 h, mean 272 ± 52 min). Three-dimensional printing of plastic 3D models was feasible (all patients, 100%) and was considered helpful for deformity analysis by the treating surgeons for severe and moderate SCFE. Three-dimensional ROM simulation showed significantly (p < 0.001) decreased flexion (48 ± 40°) and IR in 90° of flexion (-14 ± 21°, IRF-90°) for severe SCFE patients with MRI compared to control group (122 ± 9° and 36 ± 11°). Slip angle improved significantly (p < 0.001) from preoperative 54 ± 15° to postoperative 4 ± 2°. MRI-based 3D models were feasible for SCFE patients. Three-dimensional models could be useful for severe SCFE patients for preoperative 3D printing and deformity analysis and for ROM simulation. This could aid for patient-specific diagnosis, treatment decisions, and preoperative planning. MRI-based 3D models are radiation-free and could be used instead of CT-based 3D models in the future.

Acceptable range of forearm deformity derived from relation to three-dimensional analysis and clinical impairments.

This study aimed to investigate deformity patterns that cause clinical impairments and determine the acceptable range of deformity in the treatment of forearm diaphyseal fractures. A three-dimensional (3D) deformity analysis based on computed bone models was performed on 39 patients with malunited diaphyseal both-bone forearm fractures to investigate the 3D deformity patterns of the radius and ulna at the fracture location and the relationship between 3D deformity and clinical impairments. Clinical impairments were evaluated using forearm motion deficit. Cutoff values of forearm deformities were calculated by performing receiver operating characteristic analysis using the deformity angle and the limited forearm rotation range of motion (less than 50° of pronation or supination) resulting in activities of daily living (ADL) impairment as variables. The extension, varus, and pronation deformities most commonly occurred in the radius, whereas the extension deformity was commonly observed in the ulna. A positive correlation was observed between pronation deficit and extension deformity of the radius (R = 0.41) and between supination deficit and pronation deformity of the ulna (R = 0.44). In contrast, a negative correlation was observed between pronation deficit and pronation deformity of the radius (R = -0.44) and between pronation deficit and pronation deformity of the ulna (R = -0.51). To minimize ADL impairment, radial extension deformity should be <18.4°, radial rotation deformity <12.8°, and ulnar rotation deformity <16.6°. The deformities in the sagittal and axial planes of the radius and in the axial plane of the ulna were responsible for the limited forearm rotation.

3D analysis of the preoperative deformity in AIS can be used to guide surgical treatment decisions for selective thoracic fusion.

To identify 3D measures of scoliosis from preoperative imaging that are associated with optimal radiographic outcomes after selective thoracic fusion (STF) for adolescent idiopathic scoliosis (AIS). Subjects with primary thoracic curves (Lenke 1-4, B or C modifiers) fused selectively (L1 or above) who had preoperative 3D reconstructions and minimum 2 years of follow-up were included. An optimal outcome at 2 years was defined as having 4 of 5 parameters previously defined in the literature: (1) lumbar curve < 26º, (2) deformity flexibility quotient < 4, (3) C7-CSVL < 2cm, (4) lumbar prominence < 5º and (5) trunk shift < 1.5cm. Univariate and CART analyses were performed to identify preoperative variables associated with achieving an optimal outcome 2 years postoperatively. Ninety-nine (88F, 11M) patients met inclusion. Mean age was 15 ± 2years. Fifty-one subjects (52%) had an optimal outcome. Seven preoperative deformity measures representing smaller thoracolumbar/lumbar deformity in the optimal group were found to be significant on univariate analysis. CART analysis identified the following variables associated with optimal outcomes: difference in apical rotation > 30° = 27% optimal outcomes, difference in apical rotation ≤ 30° and coronal vertebral wedging of lumbar apex > 3° = 46% optimal outcomes, and difference in apical rotation ≤ 30° and coronal vertebral wedging of lumbar apex ≤ 3° = 80% optimal outcomes (p < 0.05). Optimal outcomes after STF were associated with a preoperative difference in apical vertebral rotation in the axial plane less than 30° between thoracic and lumbar curves as well as coronal plane vertebral wedging of the lumbar apical vertebra less than 3°.

Three-dimensional analysis of biplanar glenoid deformities: what are they and can they be virtually reconstructed with anatomic total shoulder arthroplasty implants?

Descriptions of glenoid deformities in glenohumeral osteoarthritis (GHOA) have focused on the axial plane. Less is known regarding arthritic glenoids with higher amounts of superior inclination and little evidence exists to guide management of inclination or combined version-inclination deformity when performing anatomic total shoulder arthroplasty (aTSA). We hypothesized that biplanar deformities (BD) would be present in a higher proportion of GHOA patients than previously appreciated, and these deformities would be difficult to adequately reconstruct with contemporary aTSA implants. A retrospective query was performed of GHOA patients indicated for TSA 2012-2017 with a computed tomography (CT) scan within three months of surgery. Images were uploaded to three-dimensional (3D) software for automated measurements. Glenoids with superior inclination ≥10°, and retroversion ≥20° were considered to have BD. Walch classification was determined, and C-type glenoids were excluded. Rotator-cuff muscle cross-sectional area (CSA) was measured and fatty infiltration was graded. Glenoids withBD were virtually planned for aTSA with correction to neutral inclination and version, then with 5° superior inclination and 10° retroversion. Two-hundred and sixty-eight shoulders in 250 patients were included; average age was 65years, 67% male. There were no differences in inclination between Walch types (P=.25). Twenty-nine shoulders with BD were identified (11%). These deformities were not associated with age (P=.47) or gender (P=.50) but were skewed towards Walch B-type, specifically B2 (P=.03). Acromial index and posterior humeral head subluxation were higher in BD patients (P=.04, P<.001, respectively). Biplanar deformities had similar cuff CSA compared to those without but were less frequently associated with fatty infiltration of the subscapularis (P=.05). When correcting to neutral version and inclination, 41% BD could not be reconstructed. Of those that could, 94% required augmented implants. When correcting to 5° superior inclination and 10° retroversion, 10% could not be reconstructed. Of those that could, 58% required augmented implants. With partial correction, augment use was predicted by retroversion >26° (P=.009). Inclination did not predict augment use (P=.90). Final implant position commonly involved unseating in the posterosuperior quadrant and cancellous exposure in the anteroinferior quadrant. This retrospective computed tomography (CT)-based study of 268 shoulders with GHOA found an 11% prevalence of BD. These deformities were commonly associated with Walch B2 wear patterns. Virtual aTSA planning showed a high failure rate (41%) when correcting to neutral version and inclination. Posteriorly augmented implants were frequently required, and often still involved unseating in the posterosuperior quadrant, increased cancellous exposure in the anteroinferior quadrant, and vault perforation.

Use of Genetic Algorithms and Neural Networks in the Analysis of Foot Deformities

Use of Genetic Algorithms and Neural Networks in the Analysis of Foot Deformities

Correction of Multiapical Deformities of Long Bones of the Lower Extremities: A Review

Background. Multiapical deformities of the long bones of the lower extremities represent a complex and widely prevalent orthopedic pathology. A numerous of publications address its individual aspects: diagnosis, planning, and correction. However, no single study was found that offers a comprehensive assessment of contemporary views on treating patients with multiapical deformities of long bones.&#x0D; Aim of the review — to define current concepts and unresolved issues in the analysis, planning, and correction of multiapical deformities of the long bones of the lower limbs based on the scientific literature.&#x0D; Methods. Electronic databases were utilized for literature search: PubMed/MEDLINE, SAGE Publishing Journals, Embase, eLIBRARY, Google Scholar. Particular attention was paid to studies that provide information on diagnosis, planning, and correction methods for multiapical deformities. A total of 46 publications were included in the review.&#x0D; Results. In the literature, the terms “multiapical deformity” and “multilevel deformity” are used synonymously. At the same time, the term “multilevel deformity” is used to denote uniapical deformities of different limb segments. The main diagnostic feature of a multiapical deformity is the location of the apex outside the bone. Unlike uniapical deformities, the correction planning of multiapical deformities uses the axis of the intermediate fragment(s). Most authors define it as the mid-diaphyseal line. The correction of multiapical deformities is performed either acute or gradually. Acute correction with internal fixation is undoubtedly more comfortable for the patient. If there are contraindications to it, the deformity correction is performed gradually using Ilizarov hinges or orthopedic hexapods.&#x0D; Conclusion. The term “multiapical deformity” inherently indicates that the deformed bone has more than one apex, so it should take precedence over the term “multilevel deformity”. The diagnostic feature of the multiapical deformity “localization of the AOD outside the bone” is not absolute and requires clarification. There are challenges in planning the correction using mechanical axes, as well as in determining the axis of the nonlinear (bowing) intermediate fragment(s). The “spring technique” has significant advantages over other variants of using orthopedic hexapods in correcting a multiapical deformity. However, a rationale for the optimal characteristics of springs, their fixation points to supports, and clarification of the computer program’s use method is required. Addressing these issues will enhance the treatment efficiency for patients with multiapical deformities.

Recent Advances in Bioimage Analysis Methods for Detecting Skeletal Deformities in Biomedical and Aquaculture Fish Species.

Detecting skeletal or bone-related deformities in model and aquaculture fish is vital for numerous biomedical studies. In biomedical research, model fish with bone-related disorders are potential indicators of various chemically induced toxins in their environment or poor dietary conditions. In aquaculture, skeletal deformities are affecting fish health, and economic losses are incurred by fish farmers. This survey paper focuses on showcasing the cutting-edge image analysis tools and techniques based on artificial intelligence that are currently applied in the analysis of bone-related deformities in aquaculture and model fish. These methods and tools play a significant role in improving research by automating various aspects of the analysis. This paper also sheds light on some of the hurdles faced when dealing with high-content bioimages and explores potential solutions to overcome these challenges.

Patent bibliometrics in spinal deformity: the first bibliometric analysis of spinal deformity's technological literature.

Bibliometric analyses have gained popularity for studying scientific literature, but their application to evaluate technological literature (patents) remains unexplored. We conducted a bibliometric analysis on the top 100 most-cited patents in scoliosis surgery. Multiple databases were queried using The Lens to identify the top 100 scoliosis surgery patents, which were selected based on forward patent citations. These patents were then categorized into 8 groups based on technological descriptors and assessed based on various factors including earliest priority date, year issued, and expiration status. The top 100 most-cited patents included technology underlying anterolateral tethering and distraction systems (n = 11), posterior tethering and distraction systems (n = 23), posterior segmental bone anchor and rod engagement systems (n = 29), interbody devices (n = 10), biological and electrophysiological agents for scoliosis treatment and/or improved arthrodesis (n = 8), intraoperative arthroplasty devices (n = 5), orthotic devices (n = 12), and implantable devices for non-invasive, postoperative alterations of skeletal alignment (n = 2). Seventy-five patents were expired, 21 are still active, and 4 were listed as inactive. The late 1970s and early 2000s saw increased numbers of patent filings. Demonstrated trends showed no meaningful correlation between patent rank and earliest priority date (linear trendline y = 0.2648x - 477.27; R2 = 0.0114), while a very strong correlation was found between patent rank and citations per year (power trendline y = 118.82x--0.83; R2 = 0.8983). Patent bibliometric analyses in the field of spinal deformity surgery provide a means to assess past advancements, better understand what it takes to make a difference in the field, and to potentially facilitate the development of innovative technologies in the future. The method described is a reliable and reproducible technique for evaluating technological literature in our field.

Analysis of freshwater diatom deformities in the Karoo, South Africa

Several studies regarding the effects of excess nutrients and metals as possible causes of deformities found in diatom cells have been conducted in Europe, North America and Australia. This is the first study in South Africa which catalogued and analysed diatom deformities in detail. We assessed diatom deformities in response to a large water chemistry dataset, including pH, electrical conductivity, alkalinity, hardness, nutrients, heavy metals and radioactive elements. The freshwaters of the Karoo exhibited wide ranges in many of their environmental variables. Diatom deformities were categorised into four types (outline, raphe, striation and mixed/other), and each cell measured and photographed. Correlations and multivariate analyses between environmental variables and deformity type, as well as diatom species, were performed. A cumulative criterion unit (CCU) ratio, using South African aquatic ecosystem limits, was calculated for Al, Cd, Cu, Mn, Pb, Se and Zn to determine if the combined effect of these metals exerted any influence on the cause of deformities. No single stressor could be linked to the deformities. Instead, variables showing to be most probable to exert an influence are electrical conductivity, oxidised nitrogen, sulphate and lithium, with selenium and strontium having a lesser influence. The CCU application did not yield expected results. This could be due to the naturally highly mineralised water found in the Karoo.

The effect of copepod Acartia tonsa during the first days of larval rearing in skeleton ontogeny and skeletal deformities in greater amberjack (Seriola dumeliri Risso, 1810)

The effect of feeding greater amberjack (Seriola dumerili) with copepod nauplii (Acartia tonsa) on osteological development was observed until 35 days after hatching (DAH). The skeletal deformities were observed at the end of the trial. Copepods are the natural food of marine fish larvae, and they are rich in highly unsaturated fatty acids and free amino acids. In a commercial marine fish hatchery in Greece (Galaxidi Marine Farm S.A.), four 2700 l cylindroconical tanks were stocked with amberjack yolk-sac larvae at a density of about 55 larvae/l. The larvae were initially fed from 3 to17 DAH in two tanks with copepod nauplii and rotifers (Brachionus sp.) (Copepods group), while in the other two tanks, only with rotifers (Control group). After 12 DAH, all the tanks were also fed with rotifers (3–27 DAH), Artemia nauplii (12–22 DAH), enriched Artemia metanauplii (20–30 DAH), and formulated diet (25–30 DAH). Fish samples were taken every three days, fixed in phosphate-buffered 5% formalin (pH = 7.2). Bone and cartilage were stained with alizarin red and alcian blue, respectively. Specific meristic characters were chosen to compare the first appearance and the completion of the formation of a structure as well as the completion of the calcification between the two rearing protocols (Copepods - Control), correlated with total length data. These meristic characters included replacement and membranous bones from the vertebral column and all the fins. The ontogeny of the meristic characters was observed earlier in fish larvae from the Copepods group compared with the Control, and for most of the meristic characters, these differences were significant (p < 0.05). TL50 data analysis was performed, and the results were similar. At the end of the trial, 35 DAH sixty fish from each tank were sampled for the analysis of skeletal deformities. A higher number and more significant deformities were observed in the Control group compared with the Copepods group (p < 0.05). In conclusion, the use of copepod nauplii during the first feeding period of greater amberjack had a positive effect on the osteological development and skeletal deformities of the larvae.