Head Bone Research Articles

Effects of vitamin D and high dairy protein intake on bone mineralization and linear growth in 6- to 8-year-old children: the D-pro randomized trial

Vitamin D and dairy protein may stimulate bone mineralization and linear growth in children, but previous studies show inconsistent results and have not examined their combined effects. To investigate combined and separate effects of vitamin D supplementation and high-protein (HP) compared with normal-protein (NP) yogurt intake on children's bone mineralization and linear growth. In a 2×2-factorial trial, 200 healthy, 6- to 8-year-old, Danish, children with light skin (55°N) were randomized to 20µg/d vitamin D3 or placebo and to substitute 260g/d dairy with HP (10g protein/100g) or NP (3.5g protein/100g) yogurt for 24 weeks during an extended winter. Outcomes were total body less head (TBLH) and lumbar spine bone mineral density (BMD), bone mineral content (BMC), and bone area (BA) by dual-energy X-ray absorptiometry, height, and biomarkers of bone turnover and growth. The primary outcome was TBLH BMD. In total, 184 children (92%) completed the study. The baseline serum 25-hydroxyvitamin D was 80.8±17.2nmol/L, which increased by 7.2±14.1nmol/L and decreased by 32.3±17.5nmol/L with vitamin D and placebo, respectively. The baseline protein intake was 15.4±2.4 energy percentage (E%), which increased to 18.3±3.4 E% with HP. There were no vitamin D-yogurt interactions and no main effects of either intervention on TBLH BMD. However, vitamin D supplementation increased lumbar spine BMD and TBLH BMC compared to placebo, whereas HP groups showed lower increments in lumbar spine BMD, TBLH BMC and BA, and plasma osteocalcin compared to NP groups. Height, growth factors, and parathyroid hormone levels were unaffected. Although there were no effects on whole-body BMD, vitamin D increased bone mass and spinal BMD, whereas high compared with normal dairy protein intake had smaller incremental effects on these outcomes. This supports a recommended vitamin D intake of around 20µg/d during winter but not use of HP dairy products for improved bone mineralization among healthy, well-nourished children. This trial was registered at clinicaltrials.gov as NCT03956732.

Electric Scooter–Related Upper Limb Fractures: Analysis of 458 Cases

To perform an analysis of electric scooter (e-scooter)-related upper limb fractures (ULFs), which have increased dramatically in parallel with the rapid rise in the use of e-scooters and shared e-scooter services in recent years. We retrospectively reviewed the medical charts of e-scooter-related emergency department visits between January 2017 and January 2020 at a level I trauma center. Allpatients with ULFs were included in the study, and their data were analyzed for demographics, fracture diagnosis, associated injuries, and required surgical treatment. This study included 356 patients (50% men) with 458 ULFs, of which 23 (5%) were open fractures. The mean age of the cohort was 32.9 years (standard deviation, 10.1 years). The most common mechanism of injury was rider fall (92.1%). The nondominant hand was injured in 53.1% of cases, and 32.1% of all fractures were treated with surgery. A total of 120 (33.7%) patients sustained more than 1 ipsilateral ULF, and 27 (7.6%) patients had a concomitant contralateral ULF. Radial head fracture was the most common fracture type (n= 123, 26.8%), of which 16 (13%) were bilateral. The fifth ray was injured most frequently among the metacarpal and phalangeal fractures (n= 33, 47.1%). Most of the nonextremity-associated injuries were those of the head and maxillofacial bones. The most common ULF associated with e-scooters was the radial head fracture. Physicians should be alert to and seek associated fractures during initial assessments of e-scooter-related upper limb injuries. Further investigation may be warranted to evaluate the effectiveness of protective measures in reducing the number of injuries. Therapeutic IV.

Body composition and bone mineral density by Dual Energy X-ray Absorptiometry: Reference values for young children

Childhood obesity is a global public health threat, with an alarming rise in incidence. Obesity at young age has short-term and long-term morbidity. It is, therefore, important to accurately assess body composition throughout infancy and childhood to identify excess adiposity. However, reference values for age 2-5 years, needed to interpret measurements and identify young children at risk, are lacking. Our primary objective was to fill the current gap in reference values by constructing sex-specific body composition reference values and charts for fat mass (FM), fat mass percentage (FM%), fat mass index (FMI), lean body mass (LBM), lean body mass index (LBMI) and total body less head bone mineral density (BMDTBLH) for children aged 2-5 years using Dual-Energy X-ray Absorptiometry (DXA). We performed 599 accurate DXA-measurements in 340 term-born children aged 2-5 years, using Lunar Prodigy with Encore software (V14.1). Using GAMLSS, sex-specific reference values and charts were created for FM, FM%, FMI, LBM, LBMI and BMDTBLH. Sex-specific body composition reference values and charts for age 2-5 years were constructed. In boys and girls, FM and LBM increased from age 2-5 years (all p≤0.001), but body size-corrected FM% and FMI decreased (all p≤0.023). LBMI remained similar between 2 and 5 years of age. Girls had higher FM, FM% and FMI and lower LBM and LBMI compared to boys. BMC and BMDTBLH increased with age between 2 and 5 years of age (all p<0.001) and were similar for boys and girls. We present sex-specific reference values and charts for body composition and total body bone mineral density measured by DXA, based on a large cohort of healthy children aged 2-5 years. These longitudinal references can be used for clinical practice and research purposes to monitor body composition and bone mineral density development and identify children at risk for excess adiposity.

Current diagnosis and treatment of posterior shoulder instability

The incidence of posterior instability of shoulder joint was significantly lower than that of anterior instability, but the clinical diagnosis and treatment was difficult, and the misdiagnosis and missed diagnosis rate were high. Its etiology, clinical manifestation and treatment strategy are totally different from the anterior instability. Therefore, the deep understanding of the anatomical structure around the shoulder joint, the mastery of the examination method, and the classification of the shoulder instability based on the anatomy and injury mode are of great importance to improve the accuracy of diagnosis. CT three-dimensional reconstruction is helpful to evaluate the defect of humeral head and glenoid bone, and MRA is helpful for the accurate diagnosis of posterior glenoid lip and joint capsule. The treatment was divided into conservative treatment and surgical treatment. Conservative treatment is recommended for muscular instability. Surgical treatment is recommended for traumatic and dysplastic instability. Different operative methods should be performed according to the injury of glenoid side or humeral head side. According to the condition of bone defect, soft tissue operation, bone grafting or osteotomy were performed to reconstruct the posterior stable structure of the glenoid injury; according to the area of the anterior bone defect, bone grafting or subscapular muscle packing were performed to the head of humerus defect. The former has the advantages of short learning curve and firm fixation, while the latter has the advantages of minimally invasive operation and the ability to observe the lesions from multiple angles and accurately control the location of bone masses. This paper summarizes the above problems.

Farklı maloklüzyon gruplarında ortodontik tedavinin mandibular kondil kemik kalitesine etkisi

Purpose: The aim of this study was to investigate the effects of orthodontic treatment on the mandibular condyle head bone formation according to different orthodontic malocclusion groups.&#x0D; Materials and Methods: In the study, forty-eight patients were examined. Individuals included in the study were grouped according to malocclusion groups. Our study was carried out retrospectively. The quality of mandibular condyle bone in panoramic images of patients before and after orthodontic treatment were compared retrospectively. This examination was carried out by a fractal analysis method.&#x0D; Results: According to the findings we obtained from our study; the change in mandibular condyle bone quality before and after orthodontic treatment by age and gender was not found to be statistically different. After orthodontic treatment in individuals with Class I and III malocclusions, the trabecular density structure of the mandibular condyle bone increased and decreased in individuals with Class II malocclusion. The change in mandibular condyle bone quality before and after orthodontic treatment by malocclusion groups was found to be statistically different. &#x0D; Conclusion: The fractal analysis method is a technique that facilitates the diagnosis of minimal changes occurring on the radiographs of orthodontic treatment patients and to evaluate the prognosis of the disease. A relationship was found between orthodontic treatment applied to different malocclusion groups and mandibular condyle head bone formation. When evaluating orthodontic treatments, mandibular condyle head bone formation should be taken into consideration.

Normal anthropometry does not equal normal body composition in pediatric intestinal failure.

Published reports on abnormal body composition in pediatric patients with intestinal failure have been in patients with poor growth. The goal of the current study is to reportthe bodycomposition ofnormally growing patients with intestinal failure. Children 8-18 years old with a dual-energy x-ray absorptiometry (DXA) between January 1, 2013, and July 15, 2018, were included in the study. Data were retrospectively collected from the medical charts and included demographics, residual bowel anatomy, nutrition support, height, and weight. DXA data, including total body less head bone mineral density (BMD), fat mass (FM), and fat-free mass (FFM), were collected and compared with published literature controls matched for age and sex. Thirty-four children met inclusion criteria. Mean age at the time of DXA was 9.6 ± 1.8 years. Weight- and height-for-age z-scores were -0.4 ± 0.9 and -0.5 ± 1.0, respectively. Mean BMD z-score was -1.0 ± 1.3. Twenty-six percent of patients(n = 9)had reduced BMD. Patients with intestinal failure had higher FM (P = .02) and lower FFM (P = .02) compared with controls. These data show that, despite reference range z-scores for height and weight, children with intestinal failure are at risk for abnormal body composition. Body composition should be routinely measured in children with intestinal failure to direct nutrition interventions.

Bone stress injuries in the presence of tarsal coalition as a cause of hindfoot pain in adolescents: case series of 6 patients with literature review.

To highlight causal relationship between stress fracture in the presence of tarsal coalition and hindfoot pain in adolescents on magnetic resonance imaging (MRI). A retrospective review was performed of the clinical and MRI imaging findings of 6 adolescents referred for MRI to evaluate symptoms of hindfoot pain with possible tarsal coalition. MRI studies were systematically assessed for cause of hindfoot pain, types of tarsal coalition, patterns of stress fractures, bone marrow oedema and any other associated features. All the 6 patients (4 male: 2 female) aged between 12 and 19years developed insidious onset of hindfoot or midfoot pain over a period of weeks to months. On MRI, all 6 cases had features of fibrous tarsal coalition predominantly in the calcaneonavicular articulation (5 out of 6 patients). Associated stress fractures/response were in the posterior facet/body of the calcaneus (3), talar head (2), cuboid (1) and third metatarsal bone in one patient. Stress fractures/response adjacent to tarsal coalition could be because of altered biomechanics and can be an unusual cause of hindfoot pain in adolescents. A high index of suspicion and complementary MRI findings is crucial to interpret this condition to direct appropriate patient management.

Destructive Arthropathy of the Femoral Head

Destructive arthropathy of the hip refers to noninfectious arthropathy causing extensive femoral head bone destruction. It has been described in the surgical literature using a variety of diagnostic criteria, but it remains a poorly defined entity. Cases of destructive arthropathy diagnosed at our institution between July 1, 2015, and December 31, 2019, were identified by a free text search of the radiology database. The medical record of each case was reviewed for possible causes of femoral head destruction, clinical presentation, laboratory values, imaging studies, and pathologic diagnoses. Imaging studies and pathology specimens were retrospectively reviewed. Twenty femoral heads were identified in which there was 25% or greater destruction of the femoral head in the absence of infections, congenital disease, or inflammatory arthritis. Destructive arthropathy was characterized pathologically by fibromyxoid change of the marrow, aggregates of necrotic bone fragments, increased numbers of osteoclasts, increased trabecular destruction, and granuloma-like aggregates. The histologic findings were distinctive. We postulate that a variety of preexisting conditions set in motion a cascade of tissue factors that led to bone destruction.

Automatic detection and monitoring of abnormal skull shape in children with deformational plagiocephaly using deep learning

Craniofacial anomaly including deformational plagiocephaly as a result of deformities in head and facial bones evolution is a serious health problem in newbies. The impact of such condition on the affected infants is profound from both medical and social viewpoint. Indeed, timely diagnosing through different medical examinations like anthropometric measurements of the skull or even Computer Tomography (CT) image modality followed by a periodical screening and monitoring plays a vital role in treatment phase. In this paper, a classification model for detecting and monitoring deformational plagiocephaly in affected infants is presented. The presented model is based on a deep learning network architecture. The given model achieves high accuracy of 99.01% with other classification parameters. The input to the model are the images captured by commonly used smartphone cameras which waives the requirement to sophisticated medical imaging modalities. The method is deployed into a mobile application which enables the parents/caregivers and non-clinical experts to monitor and report the treatment progress at home.

Treatment of intertrochanteric nonunion after sliding hip screw fixation with a short cephalomedullary nail.

Intertrochanteric femur fracture nonunions are a rare complication that can be difficult to treat with limited evidence regarding treatment options. Revision fixation is typically reserved for well-aligned nonunions with sufficient femoral head bone stock. The most common implant used for revision fixation is a sliding hip screw implant. The use of a short cephalomedullary nail (CMN) for revision fixation has not been previously reported. This article presents a technique for reamed short CMN revision fixation of well-aligned nonunions with sufficient bone stock that is a simpler and potentially less morbid treatment option compared to open procedures with fixed-angle devices. For nonunions with poor femoral head bone stock and/or malaligned fractures, a fixed-angle implant, with or without a valgus osteotomy, may be necessary, while arthroplasty is reserved for nonunions with poor proximal femur bone stock that are not amenable to fixed-angle implant fixation.

Free Periosteal Flaps with Scaffold: An Overlooked Armamentarium for Maxillary and Mandibular Reconstruction.

Simple SummaryHead and neck bone reconstruction with revascularized free periosteal flaps and scaffold is an overlooked option in the literature. Aim of the present paper was to systematically analyse the results of maxillary and mandibular reconstruction with this technique. We found a total of 7 studies with 55 patients fitting with our inclusion criteria. The overall rate of complications was 43.7%. The success rate intended as scaffold integration resulted to be 74.5%. Our paper therefore highlighted that maxillary and mandibular reconstruction with revascularized free periosteal flaps and scaffold is a possible alternative in patient unable to bone free flap complex reconstruction, with a success rate higher to that of other secondary options.Introduction: Head and neck bone reconstruction is a challenging surgical scenario. Although several strategies have been described in the literature, bone free flaps (BFFs) have become the preferred technique for large defects. Revascularized free periosteal flaps (FPFs) with support scaffold represents a possible alternative in compromised patient, BFF failure, or relapsing cancers as salvage treatment. However, only few clinical applications in head and neck are reported in literature. Purpose of the study was to systematically analyse the results of functional and oncologic maxillary and mandibular reconstruction with FPF with scaffold. Materials and Methods: A comprehensive review of the dedicated literature was performed according to the PRISMA guidelines searching on Scopus, PubMed/MEDLINE, Cochrane Library, Embase, Researchgate and Google Scholar databases using relevant keywords, phrases and medical subject headings (MeSH) terms. An excursus on the most valuable FPF’ harvesting sites was also carried out. Results: A total of 7 studies with 55 patients were included. Overall, the majority of the patients (n = 54, 98.1%) underwent an FPF reconstruction of the mandibular site. The most used technique was the radial forearm FPF with autologous frozen bone as scaffold (n = 40, 72.7%). The overall rate of complications was 43.7%. The success rate intended as scaffold integration resulted to be 74.5%. Conclusions: Maxillary and mandibular reconstruction with FPF and scaffold is a possible alternative in patient unfit for complex BFF reconstruction and it should be considered as a valid alternative in the sequential salvage surgery for locally advanced cancer. Moreover, it opens future scenarios in head and neck reconstructive surgery, as a promising tool that can be modelled to tailor complex 3D defects, with less morbidities to the donor site.

Hill-Sachs Remplissage Procedure and its Role in Arthroscopic Stabilisation of the Shoulder

The arthroscopic Hill-Sachs Remplissage procedure was first described in 2004 and published in 2008. It consists of an arthroscopic posterior capsulodesis combined with an infraspinatus tenodesis to achieve a “filling in” effect of posterior humeral head defects. The technique was put forward as a solution to high rates of Bankart repair failure, in the presence of large Hill-Sachs lesions. We describe the evolution of the technique and its outcomes and report on the evolving surgical indications over the last decade in response to new paradigm shifts. Due to a better understanding of the pathophysiology of shoulder instability, emphasis was given to both Bankart soft tissue repair and to the associated bony injuries, accounting for both glenoid and humeral head (bipolar) bone loss. We present the transition from the concept of “engaging” Hill-Sachs lesions to the concept of “on-track” / “off-track” lesions and the current role of Remplissage in shoulder instability surgery which remains paramount. We believe that in view of the critical role of bipolar bone defects in shoulder instability, preoperative magnetic resonance imaging assessment of the glenoid track of Hill-Sachs lesions is becoming increasingly important in preoperative planning. This allows the orthopaedic surgeon to detect an “off-track” lesion, select the appropriate surgical technique and improve surgical outcomes.

Treatment of pre-collapse non-traumatic osteonecrosis of the femoral head through Orthopdische Chirurgie M\xfcnchen approach combined with autologous bone mixed with \u03b2-tricalcium phosphate porous bioceramic bone graft: a retrospective study of mid-term results

BackgroundThis study aimed to evaluate the clinical efficacy of femoral head and neck fenestration combined with autologous bone mixed with β-tricalcium phosphate porous bioceramic bone (light bulb procedure) through Orthopdische Chirurgie München approach (OCM approach) for pre-collapse non-traumatic osteonecrosis of the femoral head(ONFH).MethodsThe clinical data of 47 patients (47 hips) with ONFH were retrospectively reviewed. The Harris hip score (HHS) was used to evaluate the clinical outcomes. Imaging was assessed by X-ray. Clinical failure was defined as postoperative total hip arthroplasty (THA) or the HHS was poor (< 70). The Kaplan–Meier survival curve was used to conduct a univariate analysis of risk factors. The analysis factors included gender, age, International Association Research Circulation Osseous (ARCO) stage, etiology, body mass index (BMI), 25-hydroxyvitamin D (25(OH)D), and type I collagen carboxy-terminal peptide (CTX). The COX multivariate risk model was used to analyze the risk factors.ResultsAll the 47 hips were followed up for 24–58 months, with an average of 45 months. The Harris score (76.29 ± 10.38) at the last follow-up was significantly higher than the preoperative HHS (64.45 ± 2.93) (P < 0.05). The postoperative HHS was excellent with a success rate of 36.17%. Postoperative imaging evaluation showed that 9 hips improved, 28 hips stabilized, and 10 hips progressed. Moreover, 17 out of 47 hips were defined as a postoperative clinical failure and the success rate was 63.83%. 25(OH)D and preoperative ARCO stage were risk factors for postoperative clinical failure (P < 0.05). The COX multivariate risk model analysis showed that IIIA stage was an independent risk factor for postoperative clinical failure (P < 0.05).ConclusionsThe head and neck fenestration and bone grafting via the OCM approach in the treatment of non-traumatic ONFH in the pre-collapse stage can achieve good clinical outcomes. 25(OH)D deficient patients and ARCO IIIA patients had a higher failure rate of bone graft using this approach.

Bone outcomes in virally suppressed youth with HIV switching to tenofovir disoproxil fumarate.

BackgroundTenofovir disoproxil fumarate (TDF) is included in first-line antiretroviral treatment (ART) for adolescents living with HIV (ALWH). Associated toxicities remain a concern.ObjectiveWe evaluated bone and renal safety outcomes in virologically suppressed South African ALWH after switching to TDF.MethodWe recruited virally suppressed (< 100 copies/mL) adolescents, aged 15–20 years, who switched from an abacavir (ABC)-based to a TDF-based efavirenz regimen. Bone mass and renal function were assessed at Week 0 and at Week 24 after the switch to TDF using dual-energy X-ray absorptiometry (DXA) and serum renal markers. A change in the lumbar spine (LS) and the whole-body less head (WBLH) bone mineral density (BMD) Z-scores and the estimated glomerular filtration rate (eGFR) between the two measures were compared (paired t-tests) and stratified by sex.ResultsFifty participants (48% male), with a median duration of prior ART of 11.4 years, were enrolled. Among 47 participants with 24-week DXA results, 15 (32%) had either no change or a decreased LS-BMD after the switch, with a mean change of –1.6%. Overall, more female participants experienced this outcome: 58% versus 4%, P < 0.0001. The mean change (standard deviation) in the LS-Z-score was –0.03 (0.25) and in the WBLH-Z-score was 0.02 (0.24). A decrease in the eGFR from 132.2 to 120.4 was observed (P = 0.0003); however, the levels remained clinically acceptable.ConclusionSouth African ALWH switching from abacavir to TDF-based ART experienced statistically significant decreases in eGFR but not in LS and WBLH BMD. Female ALWH were more likely to experience a decrease in LS-BMD and may require closer monitoring.

In-depth learning of automatic segmentation of shoulder joint magnetic resonance images based on convolutional neural networks

ObjectiveMagnetic resonance imaging (MRI) is gradually replacing computed tomography (CT) in the examination of bones and joints. The accurate and automatic segmentation of the bone structure in the MRI of the shoulder joint is essential for the measurement and diagnosis of bone injuries and diseases. The existing bone segmentation algorithms cannot achieve automatic segmentation without any prior knowledge, and their versatility and accuracy are relatively low. For this reason, an automatic segmentation algorithm based on the combination of image blocks and convolutional neural networks is proposed. MethodsFirst, we establish 4 segmentation models, including 3 U-Net-based bone segmentation models (humeral segmentation model, joint bone segmentation model, humeral head and articular bone segmentation model as a whole) and a block-based Alex Net segmentation model; Then we use 4 segmentation models to obtain the candidate bone area, and accurately detect the location area of the humerus and joint bone by voting. Finally, the Alex Net segmentation model is further used in the detected bone area to segment the bone edge with the accuracy of the pixel level. ResultsThe experimental data is obtained from 8 groups of patients in the orthopedics department of our hospital. Each group of scan sequence includes about 100 images, which have been segmented and labeled. Five groups of patients were used for training and five-fold cross-validation, and three groups of patients were used to test the actual segmentation effect. The average accuracy of Dice Coefficient, Positive Predicted Value (PPV) and Sensitivity reached 0.91 ± 0.02, respectively. 0.95 ± 0.03 and 0.95 ± 0.02. ConclusionsThe method in this paper is for a small sample of patient data sets, and only through deep learning on 2D medical images, very accurate shoulder joint segmentation results can be obtained, provide clinical diagnostic guidance to orthopedics. At the same time, the proposed algorithm framework has a certain versatility and is suitable for the precise segmentation of specific organs and tissues in MRI based on a small sample data.

Analysis of Calcium (Ca) Levels in Milkfish’s (Chanos chanos) Bone Using Atomic Absorption Spectrophotometry (AAS)

Milkfish (Chanos chanos) is famous for Indonesian and has high economic value. Milkfish bone can be processed into flour. A milkfish bone sample was obtained from the Sioyong Market in Dampelas, Donggala. The purpose of this study was to determine the calcium (Ca) levels in milkfish bone using atomic absorption spectrophotometry (AAS). The sample preparation method used dry destruction with sample ignition. The results showed that the average calcium levels in the flesh and head bones of milkfish aged two months were 0.052 ± 0.0007% and 0.132 ± 0.0056%, while those at aged five months milkfish were 0.197 ± 0.0014% and 0.138 ± 0 0007%, respectively. This study concludes that the older the age of milkfish is, the higher the calcium levels in the bones.

ВОЗМОЖНОСТЬ ИСПОЛЬЗОВАНИЯ ЩЕЧЕК ГОЛОВ СУДАКА В КАЧЕСТВЕ ВТОРИЧНОГО СЫРЬЯ В ПРОИЗВОДСТВЕ РЫБНЫХ КОНСЕРВОВ ДЛЯ ДЕТСКОГО ПИТАНИЯ

The article considers the purpose of the research as defining the possibility of using recycled fish raw material (zander’s cheeks and fat) in production of canned fish baby food. The components of the developed pasteurized canned fish “Sudachok” (heads and cheeks of pike perch, blanched carrots, oatmeal or buckwheat flour, fat from zander’s intestine, concentrated fish broth prepared from zander’s head and vertebral bones) were tested for the concentration of fat, protein, carbohydrates; zander’s muscle tissue - for the concentration of essential amino acids. It was determined that zander’s cheeks make up 4.4 - 8.8% of head’s mass, they being high-protein tissue (protein content is more than 19%), low-fat (fat content is 0.7%) secondary raw material and contain non-protein nitrogen (NPN), where formol and titrate nitrogen (FTN) and volatile bases nitrogen (VBN) are 370.5, 39.3 and 8.0 mg/100g, respectively. Formulations were developed and the pasteurized fish cans for babies were produced using zander’s cheeks and vegetable components (carrots, oatmeal flour, or buckwheat flour), fat and concentrated broth from boiling zander’s head bones. The composition has an optimized protein and fat content. In terms of quality, the pilot samples of canned fish with the corrected number of individual components of the recipe were found to meet the requirements of All-Union State Standard 29276 “Canned fish for baby food”.

Multimodality imaging in shoulder arthroplasties Part 1: Biomechanics, indications, preoperative imaging, and types of arthroplasties – A pictorial review

Shoulder biomechanics, shoulder arthroplasty indications and types and appropriate pre-operative imaging are discussed in part one of this two-part pictorial review. Shoulder biomechanics in severe osteoarthritis and following reverse shoulder arthroplasty are represented graphically, with discussion on the principles of reverse shoulder arthroplasty. Case examples are utilized to demonstrate the main indications for shoulder arthroplasty. The decision of whether to proceed with arthroplasty and the arthroplasty type is heavily influenced by the pre-operative imaging. Factors for type of arthroplasty include arthroplasty indication, the integrity of the deltoid and rotator cuff musculature, and the amount of glenoid and humeral head bone stock. The key findings to look for and comment on across a range of imaging modalities are reviewed, using multiple cases including plain radiography, CT, ultrasound, and MRI. Examples of arthroplasty options are provided including humeral head resurfacing arthroplasty, hemiarthroplasty, anatomical total shoulder arthroplasty, and reverse total shoulder arthroplasty. A good understanding of the above principles is crucial for the radiologist to interpret pre-operative imaging correctly and aid in surgical planning.

Ethnozoological Study on Ichthyotherapy among the Suku People (Feshi Territory, Kwango Province), Democratic Republic of the Congo

A survey was conducted from August 15, 2019 to February 20, 2020 among 67 traditional healers in order to know the species of fish that are used in the composition of traditional medicines used to treat some diseases in the Kambundi-Nganga Group, Ganaketi Sector, Feshi Territory in Kwango (DR Congo). The results obtained show that seventeen (17) species of fish belonging to 14 genera, 12 families and 8 orders are used by traditional healers to treat 24 pathologies. The fish of the order Siluriformes offer eight (8) species of fish which are used in the preparation of medicines for treating diseases. The fish species frequently used are respectively: Parauchenoglanis punctatus (31.3%), Clarias ebriensis and Gymnallabes typus representing respectively 16.4% and Malapterurus electricus (12%). It is followed by the order of Characiformes and Perciformes with respectively two species of fish. Fish of the orders Osteoglossiformes, Channiformes, Cyprinodontiformes, Symbranchiformes and Cypriniformes are represented by one species. The most treated pathologies are: bronchitis, asthma, dysmenorrhea and rheumatism. The most used parts of the fish are bones (32%), head bones (24%), fins (19%), scales (6%) or sometimes the whole fish (15%). It is therefore desirable that in-depth chemical and pharmacological studies be conducted in order to scientifically validate the use of fish in ichthyotherapy and to identify the active principles with therapeutic value for each species.

Reliability of three dimensional CT measurement of glenoid track in patients with recurrent anterior dislocation of shoulder

To evaluate the reliability and repeatability of three-dimensional (3D)-CT measurement of glenoid track. Glenoid and Hill-Sachs bone defects in 60 patients with recurrent anterior dislocation of the unilateral shoulder were evaluated by 3D-CT and analyzed by three independent observers(shoulder orthopedists) according to the Di Giacomo method. These injuries were classified to formulate a surgical protocol. All the patients were repeatedly measured 1 week later. Intraclass correlation coefficient (ICC) and coefficient of variation (COV) were used for reliability analysis. Interobserver reliability was "very good" for both measurements of glenoid diameter and glenoid bone defects, and "good" for measurements of Hill-Sachs interval. Interobserver agreement was high on the assessment of the extent of the glenoid defect, and poor on track/off track assessment of the Hill-Sachs lesion. Intraobserver reliability for measurements of glenoid diameter, glenoid defect, and Hill-Sachs interval was "very good". The COV was 4.1% for glenoid diameter, 4.4% for glenoid defect, and 21.1% for Hill-Sachs interval. The reliability and reproducibility of 3D-CT measurements of glenoid bone defects are good, but the assessment of humeral head bone defects shows large variability with poor reliability.