Early Postoperative X-ray Research Articles

Elastic Stable Intramedullary Nailing in Length Stable Versus Unstable Pediatric Femoral Shaft Fractures: A Comparison of Clinical, Radiographic, and Pedobarographic Outcomes.

Pediatric diaphyseal femoral fracture (PDFF) is one of the most common injuries requiring hospitalization. Elastic stable intramedullary nailing (ESIN) is commonly used for PDFFs in ages 5 to 11. The optimal treatment method for length unstable PDFF is a subject of ongoing debate. This study aimed to compare clinical, radiographic, and pedobarographic outcomes of ESIN between length stable and unstable PDFF. We retrospectively reviewed patients undergoing ESIN treatment for isolated PDFF between 2016 and 2021. Exclusion criteria were (1) history of ipsilateral or contralateral lower extremity fractures, (2) highly comminuted or segmental fractures, (3) body weight >50kg, and (4) comorbidities affecting bone quality, range of motion, or neurologic status. The patients were divided into 2 groups according to length stability. Clinical, radiographic, and pedobarographic data were then assessed to compare groups. Twenty-five patients were included (17 length stable and 8 length unstable PDFF) with a mean age of 73.6±17.8 months. There was no significant difference between groups in age, side of injury, body weight, follow-up duration, and nail-canal diameter ratio. Mean deformity in the fracture site in the early postoperative x-rays was not significantly different between groups ( P =0.661). After a mean follow-up of 27.8±14.2 months (range, 12-67), there was no significant difference in mechanical axis deviation, distal femur joint orientation angle, or limb-length discrepancy in both groups. The pedobarographic assessment revealed that the length unstable group had a significantly higher external foot progression angle in the injured extremity (9.8°±6.9° vs. 1.3°±5.6°, P =0.031). However, the length stable group had no significant difference in the foot progression angle (4.9°±5° vs. 3°±4.3°, P =0.326). There was no significant difference in either group for other pedobarographic parameters. ESIN is a safe and effective option for length-unstable PDFF, yet attention should be paid to the rotational alignment. Although significant external rotation deformity occurs in length-unstable PDFF, it has no implications for the other pedobarographic parameters. Level IV.

MIS THR using anterolateral approach – the game changer in Indian scenario, early functional and radiological outcomes

Background:Minimally invasive surgery has become a trend in the last decade in all aspects of Orthopaedic surgery, including Total Hip Replacement. The debates and the interest generated in MIS THR is considerable and several approaches have been advocated. The potential benefits include lower surgical morbidity, less pain and peri-operative blood loss, quicker rehabilitation, shorter in-patient stay and improved cosmesis. On the other hand, deficient peer-reviewed literature, a steep learning curve, increased rate of complications due to inadequate visualization, component mal-position, neurovascular injuries, dislocation and intra-operative fractures have drawn criticism.Objectives:To present the various surgical tips and tricks and early functional and radiological results of MIS THR by anterolateral approach.Study designs & Methods:The retrospective analysis of the records of patients undergoing Anterolateral MIS THR between January 2013 and January 2019 was the basis of this study. 72 hips of 70 patients were included in the study. The length of incision , duration of surgery, peri-operative blood loss, were studied. Functional assessment by Harris Hip Score, pain assessment by VAS score and radiological assessment for acetabular component and femoral stem positions were measured on plane X-rays. Data on preoperative and postoperative hemoglobin and hematocrit values, number of blood transfusions,time to ambulate as well as duration of hospital stay was studied.Results:We had no major complications in the form of mortality, fatal Pulmonary embolism , temporary femoral nerve neuropraxia was seen in 1 case, component mal-position in 3 cases , superficial infection 1 case and a non displaced proximal femoral fracture line was evident on the early postoperative X-ray of 1 case. Functional assessment by Harris Hip Score (HHS )improved from pre-operative 42 (range:26-46) to postoperative 95 (range:72-98) at 1 yr. Radiologic analysis was carried out at post-operative 6weeks, 3months,6months and 1year. Femoral stem varus alignment was seen in 3 cases, Average Acetabular cup abduction angle was 43degrees (range: 40-55 degrees). Average acetabular cup ante-version angle was 17 degrees (range: 12-25 degrees). Of the 72hips, 64 were within the Lewinnek safe zone. The average postoperative hemoglobin value was 9.7 g/dl ( range: 8.5-12.3g/dl) and the average postoperative hematocrit value was 29.8% (range: 28.1-30.6%).Conclusions:The MIS anterolateral approach allows adequate exposure for component placement, less perioperative blood loss and pain in immediate post-op period , earlier discharge from hospital along with early return to function , good cosmesis with better patient satisfaction.

Early Ultrasound Follow-Up of Extension-Type Supracondylar Fractures Treated by the Collar-and-Cuff (Blount) Technique.

Extension-type supracondylar fractures can be treated with external immobilization, with the elbow flexed 100°. However, this technique requires early evaluation by true lateral x-ray of the elbow to detect secondary fracture displacement. The purpose of this work is to evaluate whether ultrasound imaging is suitable for demonstrating initial reduction of supracondylar fractures and early secondary displacement of the fracture. Fourteen patients aged 3 to 7 years (mean, 4.8 years) were treated by closed reduction under general anesthesia and immobilization with a collar and cuff. All patients had early postoperative x-rays and ultrasonography on day 1, as well as day 8 x-rays and ultrasonography. Ultrasonograms were performed by an experienced senior radiologist. In all cases, a complete reduction was confirmed at initial follow-up on both sonogram and intraoperative fluoroscopy. In 13 of 14 cases, no secondary displacement of the fracture was noted at day 8 on either ultrasonography or x-ray images. In 1 case, a secondary displacement was noted at day 8 on ultrasonography and confirmed by the lateral x-ray. Our study found a complete agreement assessing the quality of intraoperative reduction of supracondylar fractures by radiographs and ultrasonography. These results confirm that ultrasound imaging is suitable for demonstrating secondary displacements of supracondylar fractures in children. We postulate that in Gartland types II and III fractures treated by Blount procedure, a negative ultrasound result at day 8 follow-up may reduce the need for further radiographs. However, in any doubtful situation, the need for conventional radiographs remains. Diagnostic study, level II.

Clinical and functional results of radial club hand with centralization and pollicization using the second metacarpus: A clinical case series

IntroductionRadial club hand (RCH) is a rare congenital deformity leading in several functional and psychological problems. However, our knowledge about the long-term functional outcomes of treating RCH is limited. In current study, we investigated the outcomes of centralization and pollicization using second or third metacarpal bone in RCH patients. MethodsThere were 15 hands (13 patients) with RCH underwent centralization and pollicization using second or third metacarpal bone or tendon transfer. The patients aged 1.2 ± 1 years at the time of the surgery. On early postoperative x-rays, the forearm-hand angle was measured. The patients were followed for 6.2 ± 2.3 years. At the final visit, disabilities of arm, shoulder and hand (DASH) score was completed. Furthermore, forearm-hand angle and range of motion of both wrists in sagittal and coronal planes were measured. ResultsThe mean of forearm-hand angle increased significantly. In 11 wrists, forearm-hand angle increased only 10 degrees of less. The range of operated wrist was improved in sagittal and coronal planes. The relative range of wrist motion in patients with unilateral deformity in sagittal and coronal planes was 83 ± 11 percent and 61 ± 12 percent. Three patients developed skin necrosis. ConclusionEarly centralization and pollicization using second or third metacarpal bone can significantly restore the range of motion and function in patients with RCH.

Pull-out of Upper Thoracic Pedicle Screws Can Cause Spinal Canal Encroachment in Growing Rod Treatment.

Proximal foundation failure is a common complication of growing rod (GR) treatment for early-onset scoliosis. Spinal canal encroachment due to pull-out of pedicle screw used as proximal foundation has been anecdotally reported in GR patients. The aim of this study is to report the prevalence of spinal canal encroachment of pedicle screws in GR treatment and determine risk factors using a single-center cohort. Inclusion criteria were: (1) GR for early-onset scoliosis and (2) pull-out of at least 1 proximal anchor pedicle screw. Patients were divided into 2 groups according to the presence of medial screw migration. Medial migration of the screw was confirmed by computed tomography. The extracted data included demographic, clinical, and radiographic information. A total of 21 patients (of 96) met inclusion criteria (21.8%). None of the screws appeared malpositioned on early postoperative x-ray. Average follow-up until screw failure was 50.4 months (64 to 85 mo) and average number of lengthenings 8.1 (4 to 13). Computed tomography revealed canal encroachment in 11 patients (group 1), and no encroachment in 10 (group 2). There was no significant difference between groups for age, follow-up or number of lengthenings. At the time of screw pull-out, coronal plane deformity was increased compared with early postoperative x-ray in all; however, this increase was significantly higher in group 1 (45.7 vs. 35 degrees, P=0.002). Proximal junctional angle (PJA) was increased in both groups at the time of pull-out. While not statistically significant, PJA increased linearly in group 1 but spiked in group 2 at the time of pull-out. There was no neurological event preoperatively, intraoperatively or postoperatively. Failed screws were safely revised in either planned/unplanned surgeries. In patients with proximal anchor failure of GR, especially if there is increase of coronal deformity and/or PJA, possible spinal encroachment should be kept in mind. Level IV-retrospective case series.

Routine early post-operative X-ray following internal fixation of intertrochanteric femoral fractures is unjustified: a quality improvement study

BackgroundThere is no consensus regarding the proper radiographic protocol following closed or open reduction and internal fixation for intertrochanteric femoral fractures. The objective of this study was to assess the role of early postoperative imaging studies when deciding about weight bear limitations and reoperations.MethodsA prospective cohort study of 100 patients (26 men and 74 women, at a mean age of 79.8 years) treated by closed or open reduction and internal fixation for AO31A fractures was conducted. According to the AO classification, there were 25 cases of 31A1, 54 cases of 31A2, and 21 cases of 31A3. For every patient, the intraoperative fluoroscopy studies were recorded and post-operative radiograms were taken during the first week. Excluded were patients for whom the early X-rays were clinically indicated. The intraoperative AP and axial fluoroscopy studies were compared with the radiograms taken during the first post-operative week. The investigators compared the decisions regarding weight-bearing limitations and the need for re-operation before and after conducting the radiograms.ResultsThe early post-operative imaging studies did not change weight-bearing limitations nor did they lead to consecutive surgical treatments.ConclusionsUnless indicated by physical examination, there is no value to routine post-operative radiograms within the first few days after closed reduction and internal fixation of intertrochanteric femoral fractures with regard to weight-bearing limitations and re-operation decisions.Trial registrationIdentifier: NCT02868125.

Early clinical and radiological results of minimally invasive total hip replacement.

It is critical to achieve both proper component positioning and intact muscle balance if satisfactory results are to be attained after total hip replacement (THR). There have been fewer studies on minimally invasive (MI) THR than standard approaches. The objective of this paper is to present the early clinical and radiological results of posterolateral MI THR. The retrospective analysis of the records of patients undergoing posterolateral MI THR surgery between 2011 and 2014 was the basis of this study. 73 hips of 68 patients were included in the study. The acetabular component and femoral stem positions were measured on plane X-rays. Data on preoperative and postoperative hemoglobin and hematocrit values, as well as transfusion amounts, were also studied. The clinical evaluations were carried out with Harris Hip Scores. The mean HHS at the 3rd postoperative month was 87.60 (±7.70). Of the 73 cases, 61 were within the Lewinnek safe zone. The mean PMFA was 88.12 (±7.63°), which is within the normal ranges. The mean postoperative hemoglobin value was 9.7g/dl (±1.3) and the mean postoperative hematocrit value was 29.8% (±3.8). A nondisplaced proximal femoral fracture line was evident on the early postoperative X-ray of one patient. One patient experienced early dislocation caused by acetabular component malpositioning and an early acetabular cup revision was necessary. MI posterior approach for THR is a method in which the prosthetic components can be properly placed. Posterolateral MI approaches are safe when THR is performed, and afford satisfactory results.

A Radiological Evaluation of Effect of a Single Level Trans-Foraminal Lumbar Interbody Fusion (TLIF) on Lumbar Sagittal Parameters

Aim To investigate the effect of a primary single level TLIF on the lumbar sagittal profile (segmental lordosis and total lumbar lordosis) comparing pre-operative, intra-operative and post-operative radiographs in patients with lumbar spine degenerative disease. Methods Patients over the age of 16 who underwent a single-level interbody fusion for degenerative stenosis and/or spondylolisthesis without scoliosis between March 2008 and March 2014 were reviewed. Age, gender, surgical level, surgical approach, facetectomy (unilateral vs bilateral) were recorded. Standardized pre and early and 6 month postoperative upright radiographs as well as an intra-operative lateral radiographs were analyzed for the pelvic incidence (PI), segmental lordosis (SL) at the TILF level and total lumbar lordosis (TL). Data analysis was performed after confirming normality using a paired t-test and is presented as mean (SD). p-value < 0.05 was considered significant. Results 69 patients were reviewed. The mean age was 58.6 (13.6) years, 39 males (56.5%), a Wiltse approach was used in 30 (43.5%) while 39 had a midline posterior approach. Segments operated were L2/L3 (1 case), L3/L4 (6), L4/L5 (43), L5/S1 (19) and bilateral facetectomy was performed in 13 (18.8%). SL changed from 15.2° (7.3) preoperatively to 20.4° (7.7) intraoperatively ( p-value < 0.0001) but measured 17.9° (7.2) ( p-value < 0.0001) on early postoperative images and 17.2° (7.3) at 6 months follow up ( p-value= 024). The total improvement in SL at 6 months was 2° (6.7), ( p-value= 0.001). TL change was insignificant on the early postoperative X-rays (48.5° (12.4) to 47.2° (11.3), p-value= 0.37) but significantly increased to 53.1° (11.5) at six months ( p-value < 0.0001) with a total improvement of 4.6° (10) ( p-value= 0.001). The mean pelvic incidence was 59.7° (11.2). The cage subsided in 11 (15.9%) cases and we had no metal work loosening. Conclusion At the level of the TLIF, much of the lordosis achieved intra-operatively is lost once the patient mobilizes. An improvement in the total lumbar lordosis at 6 months following surgery is likely to be due to the decompression component of the surgical intervention.

Usefulness of X-Ray in the Detection of Complications and Side Effects After Laparoscopic Sleeve Gastrectomy

Laparoscopic sleeve gastrectomy (LSG) is a surgical procedure which reduces the gastric volume causing a feeling of early fullness while decreasing hunger due to a reduced secretion of ghrelin. This leads to a considerable loss of body weight. The purpose of this study was to assess the usefulness of early x-ray examination and subsequent x-ray follow-up in the detection of postoperative complications and long-term functional recovery. From March 2010 to April 2011, 101 consecutive patients underwent LSG for morbid obesity and were subsequently included in this retrospective study. All patients were submitted to early x-ray examination 1-3 days after surgery and x-ray follow-up 3-6 months after surgery to detect the presence and persistence of surgical and functional complications. Early postoperative x-ray examination detected one case of suture leakage 1 day after surgery as well as one abscess and one gastric fistula in two patients who had become symptomatic 9 and 10 days after surgery. Early x-ray examination showed that complications were mainly functional and rarely surgical. Subsequent follow-up showed that functional disturbances were significantly reduced over time. X-ray is an easy and reliable method for detecting complications and side effects of LSG. However, in view of the extremely low incidence of surgical complications revealed at the early x-ray examination, this procedure may not be required as a routine examination in all operated patients and should be performed only in patients who become symptomatic and those considered at risk of developing more serious complications.

Is there a need for early post-operative x-rays in primary total knee replacements? Experience of a centre in the UK

Early post-operative x-rays are often taken in total knee replacements (TKRs). Patient mobilisation may be delayed until these x-rays are obtained and this may prolong discharge. The aim of this study was to assess the value of such early x-rays and whether they influenced the early post-operative management of these patients. A total of 624 consecutive TKRs performed at the Blackpool Victoria Hospital over a 34-month period were evaluated. Plain anteroposterior and lateral x-rays were examined. Two patients were found to have significant abnormalities: an undisplaced periprosthetic tibial fracture and a partial inferior pole patellar avulsion. Neither of these required further treatment or influenced mobility. No other complications were noted that changed routine post-operative management. These results question the need for immediate x-rays in primary TKRs.

Dorsal Corporectomy in a Ewing Sarcoma Situated in the Pedicle of the L5 Vertebral Body

The clinical case of a 34-year-old patient is presented who was diagnosed with Ewing sarcoma in the right pedicle of the L5 vertebral body on the basis of persisting dorsolumbar pain. Staging examinations including CT scan of the thorax and abdomen as well as bone scintigraphy were inconspicuous. The patient underwent 6 cycles of neoadjuvant chemotherapy (VIDE, similar to Euro Ewing 99). Presurgically, embolisation of the L4 and L5 vertebral bodies was performed on both sides. The tumour was removed via a dorsal approach with corporectomy of L5 and resection of the right nerve root of L5. The defect was bridged by a titanium cage filled with bone cement; a dorsal L4-S1 instrumentation was performed. Early postoperative X-rays showed a screw dislocation in S1, making a revision intervention and screw replacement necessary. For additional fixation, S2 was instrumented. Histopathology classified the tissue samples as containing no active tumour cells. Surgery was followed by additional chemotherapy. The patient has remained free of recurrence until now. The aim of this case report is to call attention to the unusual site of the Ewing sarcoma as well as to discuss therapy options, especially dorsal corporectomy, and the prognosis together with a review of the most current literature.

Quality assessment of early versus late post-operative radiographs in joint replacement surgery

The aim of this study was to evaluate the quality of early postoperative radiographs in comparison to the late ones following total hip and knee replacement surgery. We assessed the post-operative radiographs of 87 patients who had total hip (46 patients) or total knee arthroplasty (41 patients). The antero-posterior and the lateral views in both the early and late post-operative films were evaluated using pre-defined criteria. A total score (out of 8) was given to each set of post-operative radiographs. The mean early and late post-operative X-ray scores for the hip radiographs were 4.54 and 6.87 respectively, while those for the knee radiographs were 5.84 and 6.83. The differences in the early and late post-operative X-ray scores were statistically highly significant (p<0.001). We question the value and necessity of early post-operative X-rays particularly in total knee arthroplasty and recommend obtaining them in the first follow-up visit.

Early post-operative irradiation in the treatment of keloid scars

Summary 1.A series of sixteen keloids in ten patients treated by early post-operative X-ray therapy is described. 2.The advantages of the method over more standard techniques are discussed.