Femoral Diameter Research Articles

Comparative Analysis of Radiographic Hip Joint Geometry Using Measurement Tools on Picture Archiving and Communication System: A Prospective Study of 100 Pelvic Radiographs of Koreans

BackgroundA contralateral normal hip joint has been often used as a reference standard in preoperative planning and intraoperative assessment of hip arthroplasty, with the assumption that bilateral hip joint geometries have no significant differences. However, one previous study using analog measurements on hardcopy films reported significant bilateral variation in hip joint geometry. We therefore investigated the level of agreement between the right and left hips for each measurement and determined index values and the range of normal bilateral variations. MethodsWe assessed 100 standard anteroposterior radiographs of the pelvis in this study. Two independent observers measured the actual value of femoral head diameter, location of the femoral head center, acetabular offset, femoral offset, hip offset, greater trochanteric height, neck-shaft angle, medullary canal diameter, and proximal femoral diameter. Intraclass correlation coefficients (ICCs) and values of mean difference were calculated for each measurement. ResultsThe results demonstrated perfect agreement (ICC >0.8) between the right and left hips for most parameters and substantial agreement for greater trochanteric height (ICC = 0.735) and femoral offset (ICC = 0.773). The mean difference and standard deviation in the measurement between the right and left hips for the location of the femoral head center and the acetabular offset were 0.60 ± 0.48 mm and 0.42 ± 0.30 mm, respectively. ConclusionHip joint geometry is not influenced by side. In hip arthroplasty, a contralateral normal hip can be reliably used as a guide for preoperative planning using measurement tools on a picture archiving and communication system.

Study of Pilasteric Index of Femur in Gujarat Region

Introduction: Pilasteric index of femur is a measure of flatness of middle of the shaft. It is obtained by dividing midshaft AP diameter of femoral shaft with midshaft transverse diameter of femoral shaft. Aims and objectives: Present study was aimed to ascertain values of pilasteric index in Gujarat region and to evaluate its possible efficacy as a racial characteristic. Material and Methods: Study sample consisted of 242 dry, human, adult femora [176male (87 right, 89 left) and 66 female (32 right, 34 left)] from skeletal collections of Anatomy departments of two different Medical Colleges of Gujarat. Midshaft AP diameter & midshaft transverse diameter of femur were measured and pilasteric index was calculated using the formula, Pilasteric index= (Mid Shaft AP diameter *100)/ Mid Shaft transverse diameter. Observations and Results: Mean values of pilasteric index of normal human adult femora from Gujarat region, in male were 102 (Right) & 100.20 (Left) and for female were 93.82 (Right) & 102.37 (Left). Mean pilasteric index of male in present study was lower than the Australia and Andaman and was similar to English, Male thai, India, Ceylonese, Japan and China. Mean pilasteric index of left side female femora in present study was lower than the Australia and Andaman and was similar to English, India, Ceylonese, Japan and China; while for right side female femora it was lower than the Australia, Andaman, English, India, Ceylonese, Japan and China.

Aplicabilidad de un método osteogeométrico para fragmentos óseos humanos esferoideos

Introducción: los restos óseos fragmentados representan un reto para los bioantropólogos y arqueólogos, ya que a partir de ellos debe reconstruirse toda pieza anatómica ósea que brinde información relevante. Como objetivo principal del estudio se demostró que midiendo la sagita de un casquete conservado de fémur humano, se obtiene el diámetro de su cabeza, con el propósito de identificar el sexo del individuo con su probable estatura. Metodología: esto se realizó mediante el uso de una relación geométrica fundamentada en el teorema de Pitágoras y una adaptación de un esferómetro doméstico al calibrador de corredera. Se tomaron 35 fémures izquierdos de 10 mujeres y 25 hombres, de un total de 149 casos disponibles en el Instituto Nacional de Medicina Legal y Ciencias Forenses de la Seccional Meta, Villavicencio, Colombia, durante el 2015 y el 2016. Resultados: se logró demostrar que existe una asociación entre la sagita del casquete y el diámetro femoral (r2 = 0,87; con valor de p = 0,05), con valores inferiores a los presentados en literaturas extranjeras para diámetros de cabezas femorales y en el que fue posible orientar el sexo conociendo la sagita. Conclusiones: el presente estudio podría ser la principal fuente de información sobre trabajos similares en una zona del país en la que es frecuente el hallazgo de restos humanos incompletos pero explorables.

Mesures sanguines répétées des ions métalliques chez les patients porteurs d’une prothèse totale de hanche métal-métal (ARS™) bilatérale

BackgroundBlood metal ion measurements have become a cornerstone in the surveillance of metal-on-metal (MoM) hip replacements. Interpretation of these levels in patients with bilateral MoM hip replacements, however, is challenging. We therefore asked (1) if there is a clinically significant change in whole blood (WB) Co or Cr levels in repeated WB assessment in patients operated on with bilateral ASR hip replacements, and (2) what proportion of patients has WB Co or Cr level below the previously established safe upper limits (SUL) (Co<5.0μg/L, Cr<7.4μg/L) in the repeated WB metal ion assessment. HypothesisWe hypothesized that there is a significant difference between repeated Co and Cr level measurement performed within 1 year±4 months interval in patients with bilateral ASR hip replacements. Materials and methodsWe identified all patients (n=139) who had received bilateral ASR hip replacements (278 hips). Patients (n=76, 152 hips) who had undergone two blood metal ion measurements within eight to sixteen months’ time interval were included in the study analysis. Study cohort included 38 patients with bilateral ASR hip resurfacings (mean age: 53 years, median follow-up 4.6 years, median femoral diameter 51mm) and 38 patients with bilateral ASR XL total hip replacements (mean age: 60 years, median follow-up: 3.6 years, median femoral diameter: 49mm). ResultsThere was no significant change in Co and Cr levels between the repeated measurements in the HR cohort. Both Co and Cr was significantly higher in the THR cohort in the repeated measurement (Co: 8.3μg/L vs 12.6μg/L, Cr: 3.15μg/L vs 3.4μg/L, both P<0.001). WB Co and Cr levels remained below SUL and within their initial values during a mean one-year measurement interval in the majority of patients with bilateral high risk HR device. In contrast to this, 21.1 % of patients with THRs had WB Co ion levels exceeding the SUL in the first measurement. WB Co values significantly increased over the measurement interval in the THR group. DiscussionAnnual blood metal ion measurement is not useful in patients with bilateral hip resurfacings who have undergone at least one preliminary screening including both metal ion measurement and cross-sectional imaging. It seems, however, to be beneficial in patients with bilateral high risk MoM THR. Level of evidenceLevel III (retrospective comparative study).

Repeated metal ion measurement in patients with bilateral metal on metal (ASR™) hip replacements

BackgroundBlood metal ion measurements have become a cornerstone in the surveillance of metal-on-metal (MoM) hip replacements. Interpretation of these levels in patients with bilateral MoM hip replacements, however, is challenging. We therefore asked (1) if there is a clinically significant change in whole blood (WB) Co or Cr levels in repeated WB assessment in patients operated on with bilateral ASR hip replacements, and (2) what proportion of patients has WB Co or Cr level below the previously established safe upper limits (SUL) (Co<5.0μg/L, Cr<7.4μg/L) in the repeated WB metal ion assessment. HypothesisWe hypothesized that there is a significant difference between repeated Co and Cr level measurement performed within one year±4 months interval in patients with bilateral ASR hip replacements. Materials and methodsWe identified all patients (n=139) who had received bilateral ASR hip replacements (278 hips). Patients (n=76, 152 hips) who had undergone two blood metal ion measurements within eight to sixteen months’ time interval were included in the study analysis. Study cohort included 38 patients with bilateral ASR hip resurfacings (mean age 53 years, median follow-up 4.6 years, median femoral diameter 51mm) and 38 patients with bilateral ASR XL total hip replacements (mean age 60 years, median follow-up 3.6 years, median femoral diameter 49mm). ResultsThere was no significant change in Co and Cr levels between the repeated measurements in the HR cohort. Both Co and Cr were significantly higher in the THR cohort in the repeated measurement (Co: 8.3μg/L vs. 12.6μg/L, Cr: 3.15μg/L vs. 3.4μg/L, both P<0.001). WB Co and Cr levels remained below SUL and within their initial values during a mean one-year measurement interval in the majority of patients with bilateral high risk HR device. In contrast to this, 21.1% of patients with THRs had WB Co ion levels exceeding the SUL in the first measurement. WB Co values significantly increased over the measurement interval in the THR group. DiscussionAnnual blood metal ion measurement is not useful in patients with bilateral hip resurfacings who have undergone at least one preliminary screening including both metal ion measurement and cross-sectional imaging. It seems, however, to be beneficial in patients with bilateral high risk MoM THR. Level of evidenceLevel III (retrospective comparative study).

Failure Analysis Following Osteochondroplasty for Hip Impingement in Osteoporotic and Non-Osteoporotic Bones

Femoral osteochondroplasty is the most common treatment for femoroacetabular impingement (FAI). The risk of femoral neck fracture is increased following surgery and increases further when the bone is osteoporotic. The current requirement to undertake osteochondroplasty on patients with osteoporosis is forecast to increase; however, the effect of osteoporosis on the risk of post operative fracture is currently unknown. We developed three three-dimensional (3D) finite element models using computerised tomography (CT) scan data for a hip with cam-type impingement and used them to investigate the association between osteoporosis and the increased possibility of femoral neck fracture after femoral osteochondroplasty. Femoral osteochondroplasty was performed “virtually” on the intact hip model to two different resection depths, a ‘standard’ (6 mm) and a ‘critical’ resection (12 mm) depth, corresponding to 18% and 36% of the overall femoral neck diameter, respectively. Cortical and trabecular bone were included in the intact and resection hip models, and material properties representing both non-osteoporotic and osteoporotic cases employed, overall, 18 scenarios were analysed. Loading corresponding to “descending stairs” and “stumbling” activities were applied in the models enabling fracture propensity to be estimated. Our model predicted that fracture propagation can occur in the bone of osteoporotic patients following osteochondroplasty during typical daily activities, such as descending stairs. The level of damage increases significantly when patients are subjected to high load conditions and activities, even in non-osteoporotic patients, indicating an increased likelihood of fracture occurring. In the “stumbling activity” simulation, osteoporotic trabecular bone damage volume approached 50% for the 6 mm resection, rising to 70% at a resection depth of 12 mm. The corresponding rise in osteoporotic cortical bone volume damage was from 6% to 10%. Our findings support the recommendation for protected weight-bearing in patients in the postoperative phase and suggest an extended period of protected weight-bearing in osteoporotic patients could be considered.

Proximal Femoral Cortical Thickness and Medullary Canal Diameter in Soft and Hard Water Regions

This study compared proximal femoral morphology in patients living in soft and hard water regions. The proximal femoral morphology of two groups of 70 patients living in hard and soft water regions with a mean age of 72.29 (range: 50 to 87 years) was measured using an antero-posterior radiograph of the non-operated hip with magnification adjusted. The medullary canal diameter at the level of the lesser trochanter (LT) was significantly wider in patients living in the hard water region (mean width: 1.9 mm wider; p = 0.003). No statistical significant difference was found in the medullary canal width at 10 cm below the level of LT, Dorr index, or Canal Bone Ratio (CBR). In conclusion, the proximal femoral morphology does differ in patients living in soft and hard water areas. These results may have an important clinical bearing in patients undergoing total hip replacement surgery. Further research is needed to determine whether implant survivorship is affected in patients living in hard and soft water regions.

Lighting schedule and dimming period in early life: consequences for broiler chicken leg bone development

Prolonged (>20 h) light periods during grow-out of broiler chickens have been shown to increase the occurrence of skeletal abnormalities, but the effects of early life light-dark schedules are not well known. The present experiment investigated the effect of lighting schedule and light-dark transition during the first days of a broiler chicken's life on leg bone development. In 2 experiments, Ross-308 broiler chicks (n = 2,500 per experiment) were subjected to 1 of 5 treatments for 4 d: 24L; 2L:1D lighting schedule with either an abrupt or gradual light-dark transition (“dimming”); and a 2L:6D lighting schedule with an abrupt transition or dimming. At d 4, tibia and femur weight, length, and diameter, yolk free body mass, organ weights, realized weight gain, feed intake, feed conversion ratio, and mortality were determined. In Experiment 2, chick length and relative asymmetry of the femur and tibia were determined additionally. Data were analyzed using orthogonal contrasts. 24L resulted in higher femur diameter (P < 0.028; both experiments), tibia diameter (P < 0.001; Experiment 1), relative asymmetry of tibia length (P = 0.002; Experiment 2), and relative asymmetry of femur length (P = 0.003) than applying a light-dark schedule. A 2L:1D lighting schedule resulted in higher femur length (P = 0.039; Experiment 1) and relative asymmetry of tibia length (P = 0.032; Experiment 2) and lower relative asymmetry of tibia diameter (P = 0.016) than a 2L:6D lighting schedule. An abrupt light-dark transition resulted in higher relative asymmetry of tibia length (P = 0.004; Experiment 2) and relative asymmetry of tibia diameter (P = 0.018) than dimming. To conclude, leg bone development in the first 4 d of a broiler chicken's life was higher for 24L than when a lighting schedule was applied, but relative asymmetry was higher as well, suggesting developmental instability. The effect of dimming on leg bone development was less pronounced, but the decreased relative asymmetry levels in the dimming treatment suggested lower environmental stress than for the abrupt light-dark transition.

Joint line restoration during revision total knee arthroplasty: an accurate and reliable method.

During revision total knee arthroplasty, the joint line is frequently malpositioned, due to the disappearance of the anatomical landmarks following previous interventions. This leads to decreased clinical outcome and increased risk of re-intervention. Many methods have been proposed to restore the joint line, but none of them has shown itself to be reliable. We describe an accurate and precise method to localize the exact position of the joint line which guarantees a better clinical knee score. The adductor tubercle (AT) is recognized to be the most reliable landmark used to localize the knee joint line (JL). The distance from the AT to the JL on antero-posterior radiographs (ATJL) and the femoral diameter (FD) on true lateral views were measured on 200 randomly selected normal knees. These measurements were tested for intra- and inter-observer differences. Then, the relationship between these two measurements was studied. A significant correlation and linear regression between FD and ATJL was found (p < 0.001), making the adductor tubercle a valid landmark to accurately position the prosthetic joint within 4 mm from the normal position. No significant difference was noted in the intra and inter-observer measurements (F test not significant). Sex was found to be an intervening variable (p ˂ 0.001). The correlation and regression between ATJL and FD had to be adjusted accordingly. Once the ATJL was determined preoperatively, the JL level is found during surgery by using a caliper that is held on the easily palpable AT. Knowing the femoral diameter, we can easily locate the joint line level surgically, using the adductor tubercle as a landmark. This method leads to better clinical outcomes and a reduced risk of re-intervention following revision total knee arthroplasty.

Prediction of Areal Bone Mineral Density and Bone Mineral Content in Children and Adolescents Living With HIV Based on Anthropometric Variables

Children and adolescents living with HIV have low bone mass for age. There are reliable and accurate methods for evaluation of bone mass, however, alternative methods are necessary, especially, for application in limited-resource scenarios. Anthropometry is a noninvasive and low cost method that can predict bone mass in healthy youths. The aim of the study was to develop predictive equations for bone mineral content and bone mineral density in children and adolescents living with HIV based on anthropometric variables. Forty-eight children and adolescents of both sexes (24 females) from 7 to 17 years, living in greater Florianopolis area, Santa Catarina, Brazil, who were under clinical follow-up at “Hospital Infantil Joana de Gusmão”, participated in the study. Dual-energy X-ray absorptiometry was used to evaluate whole-body bone mineral content (BMC) and areal bone mineral density (aBMD). Height, body weight, bone diameters, arm circumference, and triceps skinfold were measured and the body mass index and arm muscle area were calculated. Multiple regression models were fitted to predict BMC and aBMD, using backward selection (p ≥ 0.05). Two predictive models with high R2 values (84%–94%) were developed. Model 1 to estimate aBMD [Y = −0.1450124 + (height × 0.0033807) + (age × 0.0146381) + (body mass index × 0.0158838) + (skin color × 0.0421068)], and model 2 to estimate BMC [Y = 1095.1 + (body weight × 45.66973) + (age × 31.36516) + (arm circumference × −53.27204) + (femoral diameter × −9.594018)].The predictive models using anthropometry provided reliable estimates and can be useful to monitor aBMD and BMC in children and adolescents living with human immunodeficiency virus where limited resources are available.

Proximal Femur Size and Geometry in Cementless Total Hip Arthroplasty Patients

Introduction:Accurate femoral prosthesis press-fit is essential for successful cementless total hip arthroplasty (cTHA) and dependent upon proximal femur size and geometry. Study objectives were to determine the variability of proximal femur size and geometry in primary cTHA patients and correlate them with patient demographics and body mass index (BMI).Methods:Medical records of 127 consecutive primary cTHA patients were reviewed retrospectively. The demographic (ethnicity, sex, age) and BMI data were collected. Intertrochanteric (IT) distance, inner/outer proximal femur diameters and cortical thickness for the subtrochanteric (ST) and cortical diaphyseal (DP) regions were measured from anteroposterior radiographs. Descriptive statistics were used to correlate patient demographics and BMI with radiographic measurements.Results:The study included 96 cTHA patients (mean age 60 years, range 22-91 years; 34 females; 72 Caucasian, 18 Black, and six Hispanic) with four underweight; 13 normal; 34 overweight, and 45 obese BMI. No correlation existed for patient age or race with radiographic measurements. Males had significantly larger proximal femur dimensions and cortical thickness than females. No BMI correlations existed for IT distance; BMI was directly proportional to outer diameter and cortical thickness in ST and DP regions, and inversely proportional to inner diameter in these regions.Discussion:Greater proximal femur size appears to correlate with gender, but not with age or race. Larger subtrochanteric and diaphyseal outer diameters are significantly associated with higher BMI. A trend exists for larger subtrochanteric and diaphyseal inner diameters to be associated with lower BMI. These findings may have implications for optimal cTHA femoral component design.

Femoral diameter and stem type are independent risk factors for ARMD in the large-headed ASR THR group.

BackgroundAdverse soft-tissue reaction to metal debris (ARMD) continues to be major source of concern in metal-on-metal (MoM) hip replacements. In our earlier study we were able to establish several risk factors for ARMD in patients who had received a small-diameter (<50 mm) Articular Surface Replacement (ASR, DePuy, Warsaw, IN, USA). The aims of the present study were to analyze whether these previously established risk factors also apply to patients who have received a large-headed (>50 mm) ASR™ XL THR.MethodsLarge-headed ASR total hip replacements were used in 225 operations (196 patients) at our institution. 176 patients (203 hips) attended a screening programme, consisting of a clinical evaluation, whole blood cobalt and chromium measurements, and cross-sectional imaging.ResultsRevision surgery was performed on 84 hips (37%) in 75 patients. ARMD was diagnosed in the majority (n = 73 [87%]) of these revisions. Cumulative 8-year survivorship was 52%. The previously established risk factors for ARMD were not applicable. Interestingly, increasing femoral diameter and stem type were identified as independent risk factors for ARMD but reduced cup coverage had no significant association with ARMD.ConclusionsStem type and increasing femoral size as independent risk factors for ARMD in the cohort of ASR XL THR patients, support the importance of taper failure in the development of ARMD. The present results suggest that the degree of taper failure may be variable and dependent on the taper design.

Obesity-related changes in bone structural and material properties in hyperphagic OLETF rats and protection by voluntary wheel running

PurposeTo examine how the development of obesity and the associated insulin resistance affect bone structural and material properties, and bone formation and resorption markers in the Otsuka Long-Evans Tokushima Fatty (OLETF) rat model. MethodsThis was a 36-week study of sedentary, hyperphagic, male OLETF rats (OLETF-SED), exercise-treated OLETF rats (OLETF-EX) and sedentary non-hyperphagic controls (LETO-SED) with data collection at 13, 20, and 40weeks of age (n=5–8 animals per group per timepoint). ResultsBody mass and fat (%) were significantly greater in OLETF-SED versus controls. OLETF-SED were insulin resistant at 13 and 20weeks, with overt diabetes by 40weeks. At 13weeks, OLETF-SED had lower total body BMC and BMD and serum P1NP compared with LETO-SED. Differences in total body BMC and BMD between OLETF-SED and LETO-SED persisted at 20weeks, with reductions in total and cortical BMD of the tibia. OLETF-SED also had lesser femur diameter, cross-sectional area, polar moment of area, and torque at fracture than LETO-SED. By 40weeks, OLETF-SED had elevated bone resorption and reduced intrinsic bone strength. OLETF-EX did not show the excessive weight gain, obesity, insulin resistance or diabetes observed in OLETF-SED. OLETF-EX had greater BMD than OLETF-SED, and structural and material properties of the femur were significantly increased in OLETF-EX relative to OLETF-SED and LETO-SED. ConclusionsThe negative skeletal effects of excessive adiposity and insulin resistance were evident early in the progressive obesity with lasting negative impacts on intrinsic and extrinsic bone strength. Exercise protected against obesity-associated skeletal changes with marked benefits on the biomechanical properties of bone.

Important tips and numbers on using the cortical step and diameter difference sign in assessing femoral rotation – Should we abandon the technique?

Rotational malalignment during femoral nailing is common despite having various intraoperative assessment methods. The cortical step sign and diameter difference sign (CSSDDS) is commonly used because of convenience, yet it lack proper scientific scrutiny and is thought to be error prone.Using a software algorithm, cross-sectional dimensions were obtained from CT scans of 22 intact adult femurs at the proximal, mid and distal diaphysis. With multiple simulated scenarios the sensitivity of CSSDDS was comprehensively determined at all possible C-arm positions.At rotation, cortical width changed most significantly around the thick linea aspera and femoral diameter changed most significantly at the sagittal plane. At 15 degrees of rotation and with the linea aspera in view, CSSDDS thresholds of 0.3mm, 0.6mm and 1mm had sensitivities of 98.8%, 93.1% and 73.8%. With the linea aspera masked behind the femur and out of view, the sensitivities significantly deteriorated to 96.4%, 77.1% and 44.1% respectively.CSSDDS is sufficiently sensitive only when strict rules are followed. It is imperative that the operator position the image intensifier in lateral view under proper magnification so that steps of less than 0.6mm around the linea aspera may be appreciated.

Cadaveric analysis of capsular attachments of the distal femur related to pin and wire placement

ObjectivesSeptic arthritis following intra-capsular penetration of the knee by external fixation devices is a complication of traction/fixation devices inserted in the lower extremity [1,2]. The authors were unable to find reference to or exact measurements of the capsular attachments relating to the distal femur documented in the current literature. This study aimed to demonstrate the capsular attachments and reflections of the distal femur to determine safe placements of wires or traction devices. MethodsThe attachments of the capsule to the distal femur were measured in 10 unembalmed cadaveric knees. Capsular attachments were measured anteriorly at the maximal extension of the supra-patella pouch. Medially and laterally measurements were expressed as percentages related to the maximal AP diameter of the distal femur. ResultsMean distance from the centre of the anterior part of the notch to the superior fold was 79.5mm (Range 48.1–120.7mm). The medial capsular reflections measured in a plane from the adductor tubercle to the anterior edge of the medial femoral condyle demonstrated the capsular reflection was attached an average of 57% back from the anterior edge (Range 41–74%). Laterally the capsular reflections on a line drawn from the maximal diameter in the sagittal plane were attached an average of 48% from the anterior reference point (Range 33–57%). Measuring the reflections at 45 degrees to the long axis of the femur in the sagittal plane the attachment was an average of 51% from the anterior reference point. ConclusionsCapsular reflections varied among specimens. Medially the capsule attachment was up to 74% of diameter of distal femur at the level of the adductor tubercle. Therefore, the insertion of distal femoral traction pins or similar should be placed proximal to the adductor tubercle and no further than 25% of the distance to the anterior cortex. Care is also needed to ensure pins do not travel to exit too anteriorly on the lateral side as capsular attachments were found to be up to a distance 48% of the diameter of the femur from anterior reference point. Distal condylar extra-articular fixation with Schanz screws is feasible if orientated in the oblique plane.

Overstuffing in total knee replacement: no effect on clinical outcomes or anterior knee pain

With total knee replacement (TKR), correct sizing and rotational alignment are essential for good clinical outcomes. Overstuffing may result in loss of flexion and adversely affect the outcome of TKR. The purpose of this study was to correlate overstuffing with patient reported clinical outcomes and anterior knee pain (AKP). Baseline and follow-up clinical and radiological data of 262 patients who had NexGen LPS posterior stabilized TKR without patellar resurfacing between 2008 and 2009 were prospectively collected. We measured anterior femoral offset, femoral diameter, and posterior condylar offset on the pre-operative and postoperative lateral non-weight bearing radiographs. Overstuffing was defined as an increase in pre-operative to postoperative values. Repeated measures analysis of variance (ANOVA) was used to analyse for differences from preoperative to postoperative WOMAC scores between patients with and without overstuffing. A total of 193 sets of lateral radiographs (preoperative and postoperative) were adequate for analysis. Anterior overstuffing was noted in 84 patients (43.5%), posterior overstuffing in 168 (87%), and total overstuffing in 155 patients (80%). Total WOMAC scores were similar in patients with and without anterior, posterior or total overstuffing (p = 0.11, p = 0.65, and p = 0.06, respectively). We found no relation between the presence of AKP with either anterior, posterior or total overstuffing (chi-square: p = 0.14, p = 0.24, and p = 0.54, respectively). We found no relation between radiological anteroposterior overstuffing with patient reported outcome measures or AKP.

Effects of age and dietary soybean oil level on eggshell quality, bone strength and blood biochemistry in laying hens

1. The objective of the study was to investigate the differences in eggshell quality, bone quality and serum bone biochemistry markers associated with changes in age and dietary soybean oil levels in laying hens.2. A total of 54, 19-week-old Hy-Line Brown laying hens were housed in 18 battery cages (3 birds/cage) and randomly divided into three diet treatments for 90 d: control-fat (CF, 1.9% soybean oil), moderate-fat (MF, 7% soybean oil) and high-fat (HF, 10% soybean oil).3. The hens’ body weights (BW), egg production, egg weights, eggshell thickness and femoral diameter were higher at d 90 than at d 60 or d 30. Meanwhile, feed intake, relative bone weights, all bone strength parameters and serum Ca were lower at d 90 or 60 than at d 30.4. Compared to the CF hens, the feed intake, BW, abdominal fat pad weights and serum alkaline phosphatase activity were elevated in MF or HF hens. The eggshell thickness, relative femoral and tibial weight, femoral stiffness, femoral modulus, tibial mixed force and serum calcium and phosphorus levels were lower in MF or HF hens than CF hens.5. These findings suggest that bone loss in caged hens starts from an early stage of the laying period, and dietary oil (particularly with diets over 10% soybean oil) has harmful effects on eggshell quality, bone strength and bone mineralisation from an early stage of the laying period.

Poster - Thur Eve - 59: Atlas Selection for Automated Segmentation of Pelvic CT for Prostate Radiotherapy

Automated atlas-based segmentation has recently been evaluated for use in planning prostate cancer radiotherapy. In the typical approach, the essential step is the selection of an atlas from a database that best matches the target image. This work proposes an atlas selection strategy and evaluates its impact on the final segmentation accuracy. Prostate length (PL), right femoral head diameter (RFHD), and left femoral head diameter (LFHD) were measured in CT images of 20 patients. Each subject was then taken as the target image to which all remaining 19 images were affinely registered. For each pair of registered images, the overlap between prostate and femoral head contours was quantified using the Dice Similarity Coefficient (DSC). Finally, we designed an atlas selection strategy that computed the ratio of PL (prostate segmentation), RFHD (right femur segmentation), and LFHD (left femur segmentation) between the target subject and each subject in the atlas database. Five atlas subjects yielding ratios nearest to one were then selected for further analysis. RFHD and LFHD were excellent parameters for atlas selection, achieving a mean femoral head DSC of 0.82 ± 0.06. PL had a moderate ability to select the most similar prostate, with a mean DSC of 0.63 ± 0.18. The DSC obtained with the proposed selection method were slightly lower than the maximums established using brute force, but this does not include potential improvements expected with deformable registration. Atlas selection based on PL for prostate and femoral diameter for femoral heads provides reasonable segmentation accuracy.

Transient flow response after femoral artery catheterization for diagnostic neuroangiography in infants and children: Doppler US assessment of the ipsilateral femoral artery.

Hemodynamic changes in the distal arteries during transfemoral catheterization in children have not been documented. To evaluate arterial flow changes of the lower extremities ipsilateral to the puncture site using Doppler US during transfemoral cerebral angiography in children. Twenty-seven children who underwent transfemoral cerebral angiography at our institution between April 2013 and August 2013 compose our study population. Doppler US was performed to evaluate diameters and peak systolic velocities of the common femoral artery and superficial femoral artery before and after femoral sheath insertion. Children were classified into three groups based on the spectral waveform changes of the superficial femoral artery after femoral sheath insertion. Thereafter, one-way ANOVA followed by the Bonferroni post-hoc comparisons test were performed to compare values among the groups. Mean common femoral artery and superficial femoral artery baseline diameters were 4.10 mm and 3.32 mm, and mean baseline peak systolic velocities were 218.26 and 166.51 cm/s, respectively. Fourteen of 27 children showed persistent triphasic flow in the superficial femoral artery (group 1); 7 children showed altered flow of biphasic (n = 3) or monophasic (n = 4) waveforms (group 2); and 6 children showed pulsus tardus et parvus pattern (group 3) after femoral sheath insertion. Mean baseline diameter of the common femoral artery and mean subtracted value between common femoral artery and femoral sheath size were significantly smaller in group 3 than the other groups. Size discrepancy between common femoral artery and femoral sheath was <1 mm in all cases of group 3. Superficial femoral artery diameter and peak systolic velocity significantly decreased after femoral sheath insertion in group 3 compared to groups 1 and 2. A significant skin temperature drop after sheath insertion in the ipsilateral lower extremity was noted in group 3 (-1.83°C), compared to groups 1 and 2 (+0.42 and -0.86°C, respectively). Changes in the spectral waveforms of superficial femoral arteries frequently occur in children during transfemoral cerebral angiography (13/27, 48%). Significant arterial flow disturbance was noted on Doppler US in children with a common femoral artery <1 mm larger than the femoral sheath diameter.

Antegrade rigid nailing through the tip of the greater trochanter for pediatric femoral shaft fractures

The aim of this work was to evaluate the results of rigid nailing of pediatric femoral shaft fractures inserted antegrade through the tip of the greater trochanter. Twenty-three femoral shaft fractures in 23 children were fixed with rigid interlocking nails inserted through the tip of the greater trochanter at Mansoura Emergency Hospital in the period between June 2009 and August 2011. The average age of the patients at the time of injury was 12.6 years (range 9.2-15 years). The final follow-up radiographs were assessed for evidence of avascular necrosis (AVN) of the femoral head and any deformity of the proximal femur, the neck-shaft angle, the articulotrochanteric distance, and the femoral neck diameter. Patients were followed to a mean period of 31 months (range from 25 to 36 months) postoperatively. All fractures united in a range of 9 weeks (from 8 to 13 weeks) with no limb length discrepancy more than 2 cm and no clinically evident rotation in either direction; no case had a vascular necrosis of the femoral head or significant proximal femoral deformity by the final follow-up. Fixation of fractures of the shaft of the femur in children with rigid interlocking nails inserted through the tip of the greater trochanter is a rigid way for fixation controlling rotation and length. It is a safe technique without causing AVN of the femoral head or proximal femoral deformity.