Radiographic Follow-up Research Articles

Stereotactic Radiosurgery Dose Reduction for Melanoma Brain Metastases Patients on Immunotherapy or Target Therapy: A Single-Center Experience.

Better local control but higher rates of adverse radiation events (ARE) have been reported when combining American Society for Radiation Oncology (ASTRO)-guideline-suggested dose (SD) stereotactic radiosurgery (SRS) with immunotherapy or targeted therapy for melanoma brain metastases. The objective of this study is to explore the efficacy and safety of lower prescription doses compared with ASTRO guidelines for single-fraction SRS for patients with melanoma metastases who are concurrently receiving immunotherapy or targeted therapy. We conducted a retrospective, single-center study on 194 patients who underwent SRS between 2009 and 2022. After propensity score matching, 71 patients with 292 metastases were included in the ASTRO-SD (20-24 Gy for <2 cm, 18 Gy for ≥2 to <3 cm) group and 33 patients with 292 metastases in the reduced dose (RD, <20 Gy for <2 cm, <18 Gy for ≥2 to <3 cm) group. The median diameter (5.4 vs 5.2 mm, P = .6), prescription volume (0.2 vs 0.2 cm3, P = .2), and radiographic follow-up (11 vs 12 months, P = .2) were similar in the 2 groups. The cumulative incidence of progressing metastases was significantly higher in the SD compared with the RD group (P = .018). Higher prescription volumes and ASTRO-suggested radiation doses were associated with local progression in multivariable analysis. Radiographic AREs were significantly more common in the SD compared with the RD group (8.6% vs 3.1%, P = .005). BRAF and other tyrosine kinase inhibitors' concurrent use, higher prescription volumes, and ASTRO-suggested radiation doses were associated with an increased risk of radiographic ARE. This study provides evidence that RD SRS could offer reduced toxicity rates, while maintaining high local control as compared with the current guideline-SDs for the treatment of melanoma brain metastases.

Evaluation of the effects of cementless total hip replacement on femoral length in skeletally immature dogs.

To describe percentage length changes in the femur after total hip replacement (THR) performed before skeletal maturity. Retrospective study. Twenty-four dogs younger than 8.5 months which underwent unilateral THR and had radiographic follow up. Preoperative and follow-up radiographs were reviewed. Radiographic measurements included the length of the greater trochanter, femoral diaphysis and distal epiphysis, width of the femur 10 mm distal to the distal aspect of the greater trochanter, width of the femur at 50%, and femoral condylar offset. Percentage changes in length over time were compared among operated and contralateral femurs used as controls. Measurements were collected in triplicate in 10 dogs to evaluate consistency. All repeated measurements had excellent consistency. The percentage increase in length of the greater trochanter was smaller in operated femurs than controls (mean difference: -11.5%, p = .017), but no differences were observed for the femoral diaphysis and distal epiphysis (-1.0%, p = .595), or the femur overall (-2.3%, p = .232). The percentage increase in femoral cortical width was greater in operated femurs than controls, both 10 mm distal to the greater trochanter (4.6% difference, p = .037) and at 50% length (8.5% difference, p = .030). In growing dogs, cementless THR decreased trochanteric growth by approximately 10% but did not change diaphyseal growth and femoral growth. Cementless THR performed in skeletally immature dogs with severe hip problems did not impact femoral length in a clinically relevant fashion.

Radiographic and Clinical Outcomes of First Tarsometatarsal Joint Arthrodesis With a Biplanar Locking Plate System Versus the Modified Lapidus Technique With Crossed-Screw Fixation: A Retrospective Multicenter Comparison

Background: Hallux valgus (HV) is recognized as a triplanar deformity. A biplanar locking plate (BLP) system corrects this deformity through first tarsometatarsal joint (TMTJ) arthrodesis, with specialized reduction tools and cutting guides. Yet the optimal surgical technique and fixation construct for first TMTJ arthrodesis remains controversial. Purpose: We sought to compare the BLP system with a modified Lapidus (ML) technique with crossed-screw fixation in terms of radiographic outcomes, complications, and reoperations. Methods: In this retrospective multicenter study, we identified a series of consecutive patients who underwent first TMTJ arthrodesis for HV with either the ML procedure at institution A or the BLP system at institution B. Patients 18 years of age with a minimum of 6 months of postoperative radiographs were included. There were 130 patients, 65 in each group, including 121 women (93.8%) with a median age of 58 years and mean radiographic follow-up of 7.1 months. Data included preoperative and postoperative HV angle (HVA), intermetatarsal angle (IMA), and tibial sesamoid position (TSP), plus complications and reoperations. Statistical testing included Mann-Whitney U, Wilcoxon signed rank, Fisher exact, McNemar, and multivariable regression. Results: After adjusting for confounding variables, the BLP system was associated with significantly greater improvements in postoperative IMA and HVA but not TSP. There were no significant differences in rates of complications (ML: 18.4%; BLP: 9.2%) or reoperations (ML: 4.6%; BLP: 7.7%). Conclusion: This retrospective multicenter review found that the BLP system was associated with greater improvement in radiographic HV parameters compared with the ML procedure using crossed-screw fixation. Clinical significance is unclear as complication and reoperation rates were similar between groups. Further study in this regard is warranted.

Surgical management and results of glenohumeral combination fractures of the anterior glenoid rim and the proximal humerus.

The combination of anterior large glenoid rim fractures (GRF) and proximal humerus fractures (PHF) is rare, with limited data available on specific treatments for these glenohumeral combination fractures (GCF). This study aimed to evaluate the treatment approaches for GCF, analyze patient outcomes, and outline surgical management strategies for different fracture types. This retrospective study included patients with GCF, excluding those with fossa glenoidalis fractures, isolated greater tuberosity fractures, or small glenoid rim fractures (< 5mm). Preoperative radiographs, CT scans, and follow-up radiographs were reviewed. Clinical outcomes were assessed using the Constant-Murley Score (CMS), Western Ontario Shoulder Instability Index (WOSI), Rowe Score (RS), and Oxford Shoulder Score (OSS). Sixteen patients with 17 GCFs (mean age 62years) were followed for an average of 39months. PHFs were categorized into three-part (76%), four-part (12%), and two-part fractures (12%). The average medial displacement of GRF was 5mm, with an average dehiscence of 4mm in the sagittal plane. Fourteen patients (88%) underwent surgical treatment; 35% had only the PHF surgically addressed, while 53% had both lesions surgically treated. Two patients (12%) received non-operative treatment. Complications were observed in 29% of cases, primarily involving the humeral side. The average CMS was 68 points, WOSI was 75%, RS was 77 points, and OSS was 41 points. Treating GCF is complex and routinely necessitates surgical intervention, with or without GRF refixation. CT imaging is crucial for precise assessment of fracture morphology. The involvement of the minor tuberosity is critical in selecting the optimal surgical approach and managing the subscapularis muscle.

Changes in the Centers of Rotation in Different Prosthetic Segments Following Continuous Two-Level Cervical Disc Replacement: A Retrospective Study

To observe the short-term to medium-term therapeutic effects and radiological outcomes of adjacent 2-level cervical spondylosis treated with artificial cervical disc replacement (ACDR) using Mobi-C and Bryan discs. To observe changes and discrepancies in the flexion-extension centers of rotation (FE-COR) of different ACDR segments. Twenty-four patients undergoing 2-level (C4/5 and C5/6) ACDR were analyzed retrospectively (11 patients in the Mobi-C group and 13 patients in the Bryan group). Clinical outcomes were assessed using modified Japanese Orthopedic Association score, Neck Disability Index, and visual analog scale. Preoperative and 2years' follow-up radiographs were collected to compare total cervical spine curvature (C2-C7) range of motion (ROM), upper and lower ACDR segmental ROM, and the operated adjacent segmental ROM. The FE-COR of the ACDR segment was measured using the mid-plumb line method. The degree of disc degeneration in the adjacent segment was observed. At the 2years' follow-up, in both group, the modified Japanese Orthopedic Association score increased significantly, and the Neck Disability Index and neck and upper extremity visual analog scale scores decreased significantly compared with preoperative (P<0.05). There were no significant statistical differences in postoperative scores between the 2 groups (P > 0.05). The overall cervical ROM, the upper and lower segmental ROM at the 2years' follow-up showed no significant statistical differences compared with the preoperative period (P > 0.05). There was no statistically significant difference in the adjacent segmental ROMs compared with the preoperative period (P > 0.05). Furthermore, the statistical analysis revealed no significant differences in the measurements of the ROM at each time points between the Mobi-C Group and the Bryan Group (P > 0.05). There was no significant difference in the preoperative FE-COR-X (indicating the horizontal position of the point in the coordinate system) and FE-COR-Y (indicating the vertical position of the point in the coordinate system) of upper or lower ACDR segments between the 2 groups (P > 0.05). At the 2years' follow-up, there were significant differences both in FE-COR-X and FE-COR-Y between the 2 groups (P < 0.05). For the Mobi-C group, in both the upper and lower segment, the FE-COR-X significantly increased compared with preoperative (P < 0.05), while the FE-COR-Y decreased compared with preoperative (P < 0.05). For the Bryan group, no significant changes were observed in the upper or lower segment in both FE-COR-X and FE-COR-Y compared with preoperative (P > 0.05). Fourty-eight adjacent segments (24 superior and 24 inferior segments) were included in the studies of adjacent segment disease. Four segments showed imaging adjacent segment disease (4/48, 8.33%) in 4 patients, of which 2 were mild and 2 were moderate according to the grading criteria. Among them, 2 were from the Mobi-C group and 2 were from the Bryan group. No severe imaging degeneration was observed. In continuous 2-level cervical ACDR surgery, both Mobi-C and Bryan artificial cervical discs achieved satisfactory clinical outcomes in the short to medium term postoperatively. The FE-COR exhibited different trends of change. In the Mobi-C group, the FE-COR for both upper and lower segments shifted anteriorly and inferiorly, whereas in the Bryan group, whether upper or lower, the FE-COR remained closer to the preoperative state. The changes in FE-COR did not significantly affect the short-term to medium-term clinical outcomes postoperatively.

Clinical experience and outcomes using a commercially available micro-plating system for metabone fractures in dogs and cats: 10 cases (2019-2023).

To report the clinical experience and long-term outcome following metabone fracture stabilisation using a commercially available micro-plating system (VetKISS, 1.0-mm, IMEX Veterinary, USA). Consecutive, client-owned cats and dogs weighing <7 kg, with traumatic metabone fractures stabilised using VetKISS micro-plates were prospectively enrolled with informed owner consent. Clinical and radiographic parameters were recorded. Either short-term or long-term clinical and radiographic follow-up was required for study inclusion. Four cats and six dogs were enrolled and operated by one of two board-certified surgeons. Bodyweight ranged from 1.9 to 6.6 kg. Number of metabones fractured: all four (60%), three (30%) and two (10%). Anatomical alignment was restored for each metabone. External coaptation was not used in any case. Radiographic follow-up documented clinical or bony union in all cases. Mean time to clinical union was 51 days. One major complication (screw removal) and two minor complications (partial construct failure) were observed. All patients made a complete functional recovery at the time of documented union. Long-term follow-up was available in five cases. No lameness (evaluated independently by both surgeons) or plate sensitivity was noted. This is the first clinical evaluation of the VetKISS for metabone fracture repair, and includes long-term follow-up. Results demonstrated complete functional recovery and 100% clinical union rates in all patients, with acceptable complication rates. This system can be considered for metabone repair in patients weighing <7 kg without the use of external coaptation.

Do Constrained Liners (in a 145° onlay implant) Provide Any Benefit? A Matched Retrospective Study

The purpose of this study was to compare the outcomes of primary reverse total shoulder arthroplasty (rTSA) using constrained liners (in a 145° onlay implant, Exactech, Equinoxe) with primary rTSA using standard liners with a minimum 1-year follow-up. A total of 836 primary rTSA patients were analyzed in this study. Patients treated with constrained liners (n=209) were cross-matched 1:3 for age, gender, glenosphere diameter, and follow-up duration, and compared with 627 patients who underwent primary rTSA with standard liners. Study endpoint was at one year. Outcomes were analyzed preoperatively and at the latest follow-up. Patient characteristics, postoperative range of motion (ROM), patient reported outcomes (PROs), complications and revisions were recorded. There was no statistically significant changes in improvement in pain (-4.9 vs -5.1; p=0.356), ROM (abduction, 45.7° vs 47.9°; p=0.522) (forward elevation, 44.0 vs 50.8°; p=0.057) (internal rotation score 1.0 vs 1.1; p=0.709) (external rotation, 17.9° vs 16.7°; p=0.543), or PROs (American Shoulder and Elbow Surgeons Score, 44.5 vs 43.7; p=0.107) (Shoulder Arthroplasty Smart score, 27.5 vs 30.0; p=0.052) between the constrained and standard liner cohorts at minimum 1 year follow-up. However, the constrained liner rTSA cohort had a significantly higher rate of adverse events (6.2% vs. 2.7%; p=0.012), including a higher rate of scapular notching (15.6% vs. 8.8%; p=0.015). The utilization of constrained liners in primary rTSA demonstrated no significant difference in the change in pain, abduction, forward elevation, ER and IR scores, ASES scores, and SAS scores at minimum 1-year follow-up. There was no significant difference in forward elevation or abduction compared to standard liners. However, we observed that the overall rate of adverse events, including scapular notching were significantly higher in the constrained liner cohort. Long-term clinical and radiographic follow-up is necessary to fully elucidate the durability of these results. At this time, it is unclear if constrained liners have any benefit in rTSA.

Non-Surgical Triumph: 8-Month Follow-Up on Managing a Large Periapical Abscess - A Case Report.

This case report presents a successful non-surgical management of a large periapical abscess with the use of combination of various conservative techniques.A 10 year-old female patient with large periapical abscess in lower left first permanent molar was treated with non- surgical endodontic treatment. Clinical and radiographic follow-ups over an 8-month period, revealed resolution of symptoms and significant reduction in periapical radiolucency.

Distal radial osteochondroma causing expansile lysis and ulna fracture in a dog.

To describe the diagnosis, management, and outcome of a dog with a right distal radial osteochondroma that penetrated the ulna, causing expansile lysis and fracture. A 9-month-old entire female German Shorthaired Pointer. The dog had a 2-month history of weight-bearing lameness of the right forelimb and a 2-week history of a progressively enlarging, firm swelling on the distolateral antebrachium. Computed tomography was used to characterize the lesion and for surgical planning. A distal ulnar ostectomy removed the affected ulnar segment, and the radial osteochondroma was excised with rongeurs. The dog was sound at 2, 16, and 45 weeks postoperatively. Radiographs at 45 weeks showed a persistent ulnar ostectomy gap with irregular but smoothly marginated edges and focal cortical irregularity at the site of radial osteochondroma excision. There was no evidence of osteochondroma recurrence. This is a newly recognized presentation of an osteochondroma penetrating the cortex of an adjacent bone in a dog resulting in expansile lysis and cortical fracture. Computed tomography was important in diagnosis and surgical planning, and surgical treatment was successful in removing the osteochondroma and ulnar lesion. This case provides long-term radiographic and clinical follow-up after osteochondroma excision and contributes to the current knowledge on prognosis following osteochondroma excision in dogs.

Ceramic-on-ceramic vs metal-on-crosslink polyethylene in a fully hydroxyapatite-coated total hip arthroplasty: Survivorship, complications and long-term results

BackgroundFew studies compare complications and results in ceramic-ceramic (CeCe) vs metal-on-crosslink polyethylene (Me-XLPE) hip prosthesis. MethodsProspective, non-randomized, observational analysis of 2 series of hydroxyapatite-coated Furlong Active implanted with identical protocol by 1 surgeon in 1 hospital from 2006 to 2014. Bearing surfaceCeCe (Biolox Forte/Delta) in 35 cases of 53.7 ± 10.6 years (25–69) (21 males, 60 %), Me-XLPE in 65 of 69.0 ± 8.9 years (42–81) (36 males, 55 %); age was different (p < 0.00001), but not sex (p = 0.6565). Head diameter: 28 mm in 19, 32 mm in 9 and 36 mm in 7 CeCe hips; 28 mm in 63, 32 mm in 1 and 36 mm in 1 Me-XLPe hips. Follow-up10.5 ± 3.1 years (1–15) in ceramic, 9.8 ± 3.8 years (2–15) in Me-XLPE. ResultsSurvivorship without additional surgery or closed reduction at 15 years: 91.0 % in ceramic, 83.8 % in Me-XLPE joints. Survivorship without component exchange at 15 years: 93.9 % in ceramic, 93.6 % in Me-XLPE joints. ComplicationsCeCe joints suffered 2 infections, 1 isolated dislocation, and 1 Vancouver-C fracture. Me-XLPE joints presented 2 infections (p = 0.6101), 5 isolated (p = 0.6621) and 2 recurrent dislocations (p = 0.5454), and 4 Vancouver-B fractures (p = 0.6548).At final follow-up, Harris Hip Score averaged 93.2 ± 13.7 (23–100) in ceramic and 94.3 ± 8.7 (65–100) in XLPE joints (p = 0.64552).Measured radiographic wear reached 0.06 ± 0.38 mm (0–1.5) (0.0057 mm/year) in CeCe and 0.16 ± 0.5 mm (0–2) (0.0163 mm/year) in Me-XLPE (p = 0.30302). At final radiographic follow-up, osteolysis was present in 8 Charnley-De Lee zones (6 patients) (17 %) of ceramic cups and in 25 zones (15 patients) (23 %) of XLPE cups (p = 0.980127). ConclusionAt 10 years follow-up, metal-XLPE and ceramic-ceramic joints in Furlong-H-A.C. Active present no significant differences in complications, clinical score, wear, acetabular osteolysis, or survivorship without component exchange.Nevertheless, survivorship without any surgery or closed reduction is different because of the high rate of dislocation in 28 mm metal-poly joints.

Main oral characteristics and treatment of ligneous gingivitis and periodontitis in individuals with plasminogen deficiency: A systematic review.

This systematic review evaluated the main clinical, radiographic, histopathological and treatment-related characteristics of ligneous gingivitis (LG) and periodontitis (LP) in individuals with plasminogen deficiency (PD). Studies in humans diagnosed with PD, focusing on the evaluation of oral characteristics and treatment of the LG/LP were considered for inclusion criteria. Electronic searches were performed up to April 2024 in five databases and in the grey literature. Risk of bias was assessed according to the Joanna Briggs Institute Critical Appraisal Checklists for case reports. It was provided a narrative synthesis of the results. A total of 17 studies were included. All were case reports that analyzed 17 individuals with PD who presented with LG/LP. The relative frequency of PD type I was 56%, while type II constitutes the remaining 44%. In most studies, patients exhibited ulceration clinically, bone loss radiographically, and subepithelial eosinophilic material accumulation on histopathological evaluation. Conventional periodontal scaling was the most used management. All included studies provided well-described clinical characteristics and confirmed plasminogen deficiency through laboratory testing. Only three studies had a risk of bias values lower than 15%. Current evidence is limited and varied, complicating the diagnosis and treatment of GL/PL. Future studies should provide a more detailed account of treatments and include extended clinical and radiographic follow-up.

Positive Cutibacterium acnes Intervertebral Discs Are Not Associated with Subsidence Following Anterior Cervical Discectomy and Fusion at 3 or 6 Months.

Background/Objectives:Cutibacterium acnes (C. acnes), formerly known as Propionibacterium acnes (P. acnes), is an anaerobic, low-virulent bacterium that has been associated with postoperative infections of the shoulder, knee, and cervical spine. Recent studies have highlighted an association between C. acnes and the development of degenerative disc disease (DDD). The aim of this study is to ascertain whether C. acnes increases the risk of subsidence following anterior cervical discectomy and fusion (ACDF). Methods: After IRB approval, consecutive patients undergoing elective ACDF for DDD from 2017 to 2018 were enrolled in this prospective cohort study. Intervertebral disc samples were taken at each affected level and cultured. A total of 66 patients with radiographic follow-ups were included in the final analysis. The extent of subsidence and cervical lordosis was determined immediately postoperatively and at the 3- and 6-month follow-ups. Results: No significant difference in subsidence was observed at 3 months (p = 0.07) or 6 months (p = 0.11) between culture-positive and -negative cohorts. Additionally, there was no significant difference detected in the change in cervical lordosis observed at 3 months (p = 0.16) or 6 months (p = 0.27) between culture-positive and -negative cohorts. For the most inferiorly fused segment, there was a significant difference in subsidence observed at 3 months (1.5 mm, 95% CI: 0.2-2.7 mm, p = 0.02) but not at 6 months (p = 0.17). Conclusions: Intervertebral discs with a positive C. acnes culture were not associated with greater levels of subsidence at 3 or 6 months following ACDF for DDD. Further research is necessary to endorse these results and to gauge the clinical significance of C. acnes infection.

Monobloc vs. Modular Radial-Head Arthroplasty for Complex Elbow Trauma: Long-Term Follow-Up and Comparative Evaluation.

Introduction: Mason Type 3 radial-head fractures are typically treated with open reduction and internal fixation (ORIF) or radial-head arthroplasty (RHA). Prosthetic options include traditional monobloc implants and newer modular implants designed to match patient anatomy. While short- and medium-term outcomes of metallic RHA are generally favorable, this study aims to compare the long-term outcomes of patients treated with monobloc versus modular implants. Methods: The medical records of all the patients who underwent RHA at a level I trauma center between 2000 and 2011 were retrospectively reviewed. Patients who were available for follow-up were invited for reassessment, which included physical examination, questionnaires for the assessment of elbow pain and function, and follow-up radiographs. Results: Out of 35 patients who had RHA, 13 (37%) had a monobloc prosthesis and 22 (63%) had a modular prosthesis. Out of the patients that could be traced, 4 patients from the monobloc group and 10 patients from the modular group agreed to participate in the study. The mean follow-up time was 15 years in the monobloc group and 12.4 years in the modular group. Patients in the modular group demonstrated superior functional outcomes compared to the monobloc group, with statistically significant improvements in MEPS and DASH scores and a non-significant trend towards better ASES scores and VAS scores. Physical examination revealed a decline in function in the operated arm for both groups, with statistically significant differences favoring the modular group in elbow flexion and extension. Radiographic analysis showed varying degrees of implant loosening, with the modular group exhibiting less loosening compared to the monobloc group. Mild degenerative changes and heterotopic ossification were also observed, predominantly in the modular group. Conclusions: The results suggest that modular implants offer superior functional outcomes compared to monobloc implants. The modular group showed statistically significant improvements in elbow flexion and extension. These findings indicate that modular implants may be a more favorable option for enhancing patient outcomes. Further research with larger sample sizes is recommended to confirm these trends and to better understand the long-term benefits of modular implants.

Biological Patch in the Repair of Rotator Cuff Tears: Functional and Clinical Evaluation of Twenty-Three Cases with a Mean Follow-Up of Six Years.

Background: Rotator cuff (RC) repair leads to less than optimal results when dealing with massive lesions, so the use of scaffolds as biological support has been proposed to improve RC repair site biology. The present study aims to evaluate the clinical and radiographical outcomes of a series of patients suffering from massive or irreparable RC tears treated with patch (porcine or human scaffolds) repair (augmentation or bridging). Methods: Twenty-three patients with a minimum follow-up of 24 months were subjectively, clinically, and radiographically assessed before and after surgery. Three different patient-related outcome measurements (PROMs) (American Shoulder and Elbow Surgeons score, Constant score, visual analog scale) were used for the subjective and clinical evaluation, while plain radiographs and magnetic resonance imaging where employed for radiographical follow-up. Results: Regardless of the technique (augmentation or bridging) or type of scaffold (porcine or human) employed, at follow-up, all patients experienced a statistically significant improvement in all PROMs and clinically. Conclusions: Patch repair represents a valid salvage procedure in massive or irreparable RC tears, improving the quality of life and eventually delaying the need for prosthetic replacement.

The T4-L1-Hip Axis: Sagittal Spinal Realignment Targets in Long-Construct Adult Spinal Deformity Surgery: Early Impact.

Our understanding of the relationship between sagittal alignment and mechanical complications is evolving. In normal spines, the L1-pelvic angle (L1PA) accounts for the magnitude and distribution of lordosis and is strongly associated with pelvic incidence (PI), and the T4-pelvic angle (T4PA) is within 4° of the L1PA. We aimed to examine the clinical implications of realignment to a normal L1PA and T4-L1PA mismatch. A prospective multicenter adult spinal deformity registry was queried for patients who underwent fixation from the T1-T5 region to the sacrum and had 2-year radiographic follow-up. Normal sagittal alignment was defined as previously described for normal spines: L1PA = PI × 0.5 - 21°, and T4-L1PA mismatch = 0°. Mechanical failure was defined as severe proximal junctional kyphosis (PJK), displaced rod fracture, or reoperation for junctional failure, pseudarthrosis, or rod fracture within 2 years. Multivariable nonlinear logistic regression was used to define target ranges for L1PA and T4-L1PA mismatch that minimized the risk of mechanical failure. The relationship between changes in T4PA and changes in global sagittal alignment according to the C2-pelvic angle (C2PA) was determined using linear regression. Lastly, multivariable regression was used to assess associations between initial postoperative C2PA and patient-reported outcomes at 1 year, adjusting for preoperative scores and age. The median age of the 247 included patients was 64 years (interquartile range, 57 to 69 years), and 202 (82%) were female. Deviation from a normal L1PA or T4-L1PA mismatch in either direction was associated with a significantly higher risk of mechanical failure, independent of age. Risk was minimized with an L1PA of PI × 0.5 - (19° ± 2°) and T4-L1PA mismatch between -3° and +1°. Changes in T4PA and in C2PA at the time of final follow-up were strongly associated (r2 = 0.96). Higher postoperative C2PA was independently associated with more disability, more pain, and worse self-image at 1 year. We defined sagittal alignment targets using L1PA (relative to PI) and the T4-L1PA mismatch, which are both directly modifiable during surgery. In patients undergoing long fusion to the sacrum, realignment based on these targets may lead to fewer mechanical failures. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Clinical and methylomic features of spinal meningiomas.

The objective of our study was to analyze methylomic and clinical features of a cohort of spinal meningiomas (SMs) resected at our institution. This is a retrospective study of patients undergoing SM resection at our institution between 2010 and 2023. Clinical and radiographic characteristics were reviewed and analyzed with standard statistical methods. A Partitioning Around Medoids approach was used to cluster SMs with methylation data in a combined cohort from our institution and a publicly available dataset by methylation profiles. Clinical variables and pathway analyses were compared for the resulting clusters. Sixty-five SMs were resected in 53 patients with median radiographic follow-up of 34 months. Forty-six (87%) patients were female. The median age at surgery was 65 years and median tumor diameter was 1.9cm. The five-year progression-free survival rate was 90%, with subtotal resection being associated with recurrence or progression (p = .017). SMs clustered into hypermethylation, intermediate methylation, and hypomethylation subgroups. Tumors in the hypermethylated subgroup were associated with higher WHO grade (p = .046) and higher risk histological subtypes (p <.001), while tumors in the hypomethylated subgroup were least likely to present with copy-number loss in chromosome 22q (p <.0001). SMs classified as immune-enriched under a previously developed intracranial meningioma classifier did not have increased leukocyte fractions or hypomethylation of genes typically hypomethylated in immune-enriched tumors. SMs are more benign than their intracranial counterparts, and gross-total resection results in long term PFS. Methylation profiling identifies subgroups with differences in clinical variables.

Immobilisation in a collar and cuff with high elbow flexion is a safe and effective treatment option to reduce and immobilise Gartland type II supracondylar fractures.

This study aimed to report the proportion of children requiring subsequent surgical intervention, rate of complications and radiologic outcomes following collar and cuff immobilisation with high elbow flexion (>90°) for Gartland type II supracondylar fractures. A retrospective case series of consecutive patients aged <18 years with Gartland type II fractures treated at a level 1 trauma centre from December 2020 to April 2023 was conducted. The need for surgical intervention and complications were recorded from electronic clinical notes. The initial, post-immobilisation and final Baumann's angle and lateral humeral-capitellar angle (LHCA) were measured and compared. In total, 42 patients were included in this study. Thirty-four were treated definitively in a collar and cuff with a mean elbow flexion of 109.4°. Two patients underwent closed reduction and Kirschner wire fixation. No patient required subsequent corrective osteotomy. There were no cases of recorded complications. Immobilisation in a collar and cuff with >90° elbow flexion was associated with a significant improvement in the mean LHCA (initial 80.9° vs final 65.6°, p < 0.001). There was no significant change in the LHCA post immobilisation in a collar and cuff until final radiographic follow-up (post immobilisation 68.3° vs final 65.6°, p=0.274). Immobilisation in a collar and cuff with high elbow flexion is a safe and effective nonoperative treatment method to reduce and immobilise Gartland type II supracondylar fractures. Surgical treatment could be reserved for cases with unsatisfactory alignment or early loss of reduction following attempted nonoperative treatment.

Comparison of Surgical and Conservative Treatments for Gartland Type II Supracondylar Humerus Fractures: Evaluation of the Need for Surgical Treatment.

Supracondylar humerus fractures (SHFs) are common pediatric injuries, with type II fractures being a topic of debate regarding optimal treatment. Our goals are to compare the functional and radiographic outcomes of conservative and surgical treatment of type II SHFs and their subgroups and to identify parameters for determining the optimal treatment option. We retrospectively reviewed a total of 55 patients (23 conservative, 32 surgical) between 2010 and 2020. The mean follow-up was 66 months. Neurovascular status, range of motion, complications, and functional scores (Mayo elbow, Quick DASH) were evaluated. We performed radiographic assessment on initial, postreduction, and final follow-up radiographs using the humerocondylar angle (HCA), Baumann angle, and anterior humeral line (AHL). Neither groups nor subgroups showed significant differences in clinical and functional outcomes. HCA was significantly higher in the operative group than in the conservative group. The subgroup analysis revealed that the HCA difference resulted from the difference between the conservative IIb and operative IIb subgroups. None of the patients required a corrective osteotomy, but 1 patient initially treated conservatively underwent operative treatment due to loss of reduction. Reconstructing the sagittal, coronal, and rotational alignment in type II SHFs led to good mid-term results in the range of motion and functional scores for the elbow joint, whether conservative or surgical treatment was used. A limited range of remodeling might be expected in the long term. Level III-retrospective comparative study.

Nonoperative management of glenoid baseplate failure in reverse shoulder arthroplasty

BackgroundGlenoid baseplate failure in reverse total shoulder arthroplasty (RSA) remains a challenging problem. Nonoperative management may be an option in certain patients. The purpose of this study was to evaluate outcomes following nonoperative management of glenoid baseplate failure after RSA. MethodsUtilizing a single-institution database, a retrospective review was performed to identify patients from 2010 to 2019 who sustained glenoid baseplate failures after RSA and were treated nonoperatively. The exclusion criteria included revision surgery and presence of active infection. Included patients had a minimum 2-year clinical and radiographic follow-up. Chart review captured patient demographics, surgical indications, and techniques. Radiographs were reviewed to determine the etiology of baseplate failure and other implant complications. Glenosphere inclination angle was measured on true anteroposterior radiographs immediately postoperatively and after baseplate failure. ResultsEighteen patients had glenoid baseplate failures treated nonoperatively during the study period. Five patients were deceased, leaving 13 patients who were available for clinical follow-up. Twelve (92%) patients were successfully contacted. The mean age was 77 years, body mass index was 28, and 8 out of 12 were female. The mean Charlson Comorbidity Index score was 4.1. The mean preoperative American Shoulder and Elbow Surgeons (ASES) score was 43.0, and visual analog scale (VAS) pain was 6.3. At a mean 5.7-year follow-up, patients had an ASES score of 49.2, VAS pain of 4.3, single assessment numeric evaluation of 49%, and 50% of patients were satisfied with their outcome. The preoperative and final follow-up ASES and VAS scores were similar. The average time from index surgery to baseplate failure was 19 months. Of the eighteen identified patients, 16 (89%) failures resulted in increased baseplate superior tilt (7 with concomitant broken baseplate screws). For these 16 patients, the mean glenosphere inclination angle after failure (131°) was significantly greater than the initial inclination angle (100°), P = .03. The other 2 failures resulted in increased baseplate anteversion. 8 out of 18 (44%) patients had bone grafting at the time of surgery. When comparing dissatisfied and satisfied patients, there were no specific patient characteristics or radiographic parameters that were associated with satisfaction. ConclusionNonoperative management of glenoid baseplate failure yields modest patient-reported outcomes, with 50% patient satisfaction at mid-term follow-up. The mortality rate in this cohort of patients was almost 30%. Therefore, in select patients, nonoperative treatment of RSA baseplate failure may be a reasonable option.

Long-Term Results of Meniscus Allograft Transplantation With Bone Fixation Show Improved Outcomes but Progression of Joint Space Narrowing, Osteoarthritis, and Cartilage Degeneration

PurposeTo investigate the clinical and objective outcomes of meniscal allograft transplantation (MAT) using bone fixation in patients after a minimum follow-up duration of 15 years, and to compare the demographic factors and allograft status between patients who experienced progression of osteoarthritis and those who did not. MethodsThe consecutive patients who underwent primary MAT between December 1996 and January 2008 were retrospectively reviewed. The inclusion criteria was primary MAT with a minimum follow-up duration of 15 years. Clinical outcomes were evaluated using the modified Lysholm score, along with an evaluation of clinical failure. In objective outcomes, the progression of joint space narrowing, osteoarthritis, and the status of the associated cartilages and allografts were evaluated with follow-up radiographs and MRI. ResultsAmong the 79 cases, 54 knees in 52 patients were included in the study and evaluated for clinical outcomes. The mean Lysholm score improved from 73.9 ± 17.5 preoperatively to 86.4 ± 15.6 over a mean follow-up period of 17.5 ± 3.8 years (P<0.001). Regarding the Minimal clinically important differences (MCID), 38 cases (70.4%) showed an improvement in the Lysholm score. The cumulative clinical survival rate was 87.0%. Objective evaluations evaluated in 32 cases with a minimum of 15 years of radiographic data revealed significant progression of joint space narrowing, osteoarthritis, and cartilage degeneration at the final follow-up, with 11 (34.4%) out of 32 cases exhibiting allograft tears involving ˃50% of the allograft. Patients with osteoarthritis progression exhibited more meniscal allograft tears and extrusion on the last follow-up MRI scan than those without progression. ConclusionNotable progression in joint space narrowing, osteoarthritis, and cartilage degeneration were observed in objective assessment. The progression of osteoarthritis might be associated with allograft tears and extrusion. In clinical evaluations, favorable long-term clinical outcomes were consistently demonstrated after MAT using the bone fixation technique. Level of EvidenceLevel Ⅳ, therapeutic case series.