Image Intensifier Research Articles

An Investigation of Reading Thermal Images Processes by a Thermal Image Receiver Made in the Image Intensifier Tube Architecture

An Investigation of Reading Thermal Images Processes by a Thermal Image Receiver Made in the Image Intensifier Tube Architecture

The Thermal Image Receiver Realized in the Image Intensifier Tube Architecture

The Thermal Image Receiver Realized in the Image Intensifier Tube Architecture

Calculation Model of an Optical System for a Single-Channel Dual-Spectrum Receiver of an Image Intensifier Tube’s Architecture

Calculation Model of an Optical System for a Single-Channel Dual-Spectrum Receiver of an Image Intensifier Tube’s Architecture

Do It Yourself (DIY) Radiolucent Drill Guide Using a 10 ml Syringe for Freehand Distal Interlocking in Intra-medullary Nailing: A Surgical Technique.

Distal interlocking during intramedullary femoral, tibial, and humeral nailing is frequently challenging. In the traditional image intensifier (II) 'bull's eye' technique, the implant's interlocking screw hole can be obscured by the radio-opaque chuck, necessitating multi-planar checks by tilting the drill bit before drilling. This manoeuvre can adversely alter the drill trajectory, compromise fixation, or damage the implant. We introduce a surgical technique that uses a 10 ml syringe to overcome this difficulty.

Clinical and immunological predictors of Graves' orbitopathy after radioiodine therapy of Graves' disease

Data on the effect of 131I on the course of Graves' orbitopathy (GO) are contradictory. A number of studies indicate a deterioration in the course of GO against the background of RAIT, in other studies such a connection has not been established. Cytokines that regulate inflammation could potentially be biomarkers for assessing GO activity and predicting the course of GO after RAIT. The purpose of this study was to evaluate the dynamics of eye symptoms and analyze immunological parameters: cytokine TGF-β1 and cytokine receptors: sTNFα-R1, sTNFα-R2, sIL-2R, sIL-6R over time after RAIT, as possible predictors of GO activation. The study included 59 patients (118 orbits) with GD in the state of euthyroidism and subclinical hyperthyroidism and low active and inactive GO, aimed at conducting RAIT. Concentrations of cytokine TGF-β1, sTNFα-RI and sTNFα-R2, sIL-2R, sIL-6R, TSH receptor antibodies (rTSH-Ab), free thyroxine (FT4) and free triiodothyronine (FT3), -thyroid-stimulating hormone (TSH) in the blood serum were determined. Ultrasound examination of the thyroid gland, multispiral computed tomography (MSCT)/magnetic resonance imaging (MRI) of the orbits was performed. The examination was carried out 3, 6, 12 months after the RAIT. The deterioration of the course of the GO (1-2 points according to CAS) was noted after 3 months. (32.5%) and to a lesser degree after 6 and 12 months (13.2% and 8.45%, respectively). Dynamics were not noted, approximately, in the same number of patients (40.5%, 41.5%, 45.8%, respectively). An improvement in the course of the GO was noted after 6 and 12 months (45.3, 45.8, respectively). After 3 and 6 months, the achievement of hypothyroidism and a significant increase in the level of rTSH-Ab were noted. In the analysis of cytokines and their receptors a significant decrease in the level of TGF-β1 was noted after 3, 6 and 12 months. There was also a significant decrease in sTNF-R1 and sIL-2R at 3 and 6 months. The level of sTNFα-R2 significantly decreased 3 months after RAIT. The level of sIL-6R has not changed significantly. After 3 months in patients with positive dynamics of image intensification, the level of TGF-β1 did not significantly change compared with the level before RAIT, in patients with worsening of the course of GO or without dynamics, the level of TGF-β1 significantly decreased. After 6 months, there was the same trend, not reaching statistical significance. The IgG4 level and the IgG4/IgG ratio increased to 6 and 12 months, which corresponded to an increase in diplopia index. The main limiting factor in the conduct of RAIT is the activity of the autoimmune process in the orbits. Since patients with inactive (CAS 0-2) or low activity (CAS 3-4) GO were referred for RAIT, there was no pronounced activation of GO after RAIT. There was a slight deterioration in the course of GO by only 1-2 points according to CAS after 3 months. (32.5%) and to a lesser degree after 6 months (13.2%). In the study, it was found that the main predictors of the deterioration of the course of GO after RAIT are uncompensated hypothyroidism, a high level of rTSH-Ab and a decrease in the level of cytokine TGF-β1.

3D C-arm navigated acromioclavicular joint stabilization

IntroductionSurgical treatment options for acromioclavicular joint separations are varied. Frequently, suspension devices (SD) are inserted for stabilization under arthroscopic view. This study investigates the feasibility and accuracy of three-dimensional (3D) digital-volume-tomography (DVT) C-arm navigated implantation with regard to the general trend toward increasingly minimally invasive procedures.Materials and methodsThe implantation of a TightRope® suture button system (SD) via a navigated vertical drill channel through the clavicle and coracoid was investigated in 10 synthetic shoulder models with a mobile isocentric C-arm image intensifier setup in the usual parasagittal position. Thereby, in addition the placement of an additive horizontal suture cerclage via a navigated drill channel through the acromion was assessed.ResultsAll vertical drill channels in the Coracoclavicular (CC) direction could be placed in a line centrally through the clavicle and the coracoid base. The horizontal drill channels in the Acromioclavicular (AC) direction ran strictly in the acromion, without affecting the AC joint or lateral clavicle. All SD could be well inserted and anchored. After tensioning and knotting of the system, the application of the horizontal AC cerclage was easily possible. The image quality was good and all relevant structures could be assessed well.ConclusionIntraoperative 3D DVT imaging of the shoulder joint using a mobile isocentric C-arm in the usual parasagittal position to the patient is possible. Likewise, DVT navigated SD implantation at the AC joint in CC and AC direction on a synthetic shoulder model. By combining both methods, the application in vivo could be possible. Further clinical studies on feasibility and comparison with established methods should be performed.

Effectiveness of Flat-Panel Fluoroscopy in Direct Anterior Total Hip Arthroplasty: A Comparison to Image Intensifier Fluoroscopy With Radiopaque Grid

IntroductionThe use of traditional, image intensifier fluoroscopy with a radiopaque grid during direct anterior total hip arthroplasty (DA THA) has demonstrated reduced variability in component positioning and operative time compared to fluoroscopy without a grid. A disadvantage of image intensifier fluoroscopy is spatial distortion, particularly compared to flat-panel fluoroscopy systems. The purpose of this study is to determine whether flat-panel fluoroscopy decreases variability in component positioning during DA THA compared to the use of traditional grid fluoroscopy. MethodsWe retrospectively reviewed 70 consecutive DA THAs between February 2020 and February 2021: 36 using flat-panel fluoroscopy, and 34 using traditional fluoroscopy with a grid. Radiographs were independently reviewed by 2 authors to identify components exceeding goal parameters: cup abduction of 40 ± 10 degrees, as well as offset and limb lengths within 10 mm of the contralateral side. Binary values for goal parameter achievement were assigned for each THA. ResultsNo significant difference was observed in the number of hips that met goals for cup abduction (100% vs 97%, P = 1.00), hip offset (88% vs 88%, P = 1.00), limb length (91% vs 94% [ ±10 mm], P = .669, 65% vs 72% [±5 mm], P = .498), or for the number of hips that met all 3 component goals (79% vs 80%, P = 1.00). No significant difference in operative time was noted between the 2 groups (110.2 minutes vs 100.9, P = .76). ConclusionsWe demonstrated no significant difference in component positioning in DA THAs utilizing flat-panel fluoroscopy as compared to using traditional fluoroscopy with a grid.

Study of afterpulsing in optical image intensifiers

We will describe the characteristics of the afterpulsing effect seen in the optical intensifiers. It can be caused by either secondary electrons produced by primary photoelectrons hitting the micro-channel plate surface or by electron emission from the photocathode induced by the ion feedback. The result of this effect are additional pulses delayed with respect to the primary parent pulses. Using a fast data-driven camera, Tpx3Cam, we were able to clearly show afterpulsing present in the data at short time differences and small distances from the primary pulse, as well as to show the evolution of the afterpulsing effect with increasing time difference. We also studied the afterpulsing spatial distribution and observed an azimuthal asymmetry, which we attribute to the afterpulsing ion component.

Surgical technique of spine-shortening vertebral osteotomy for adult tethered cord syndrome: a case report and review of the literature

BackgroundMiyakoshi et al. reported three cases of tethered cord syndrome treated by spine-shortening vertebral osteotomy, which provided relief of the patients’ symptoms with no complications. Although the details of these cases were described in a previous report, the surgical technique was not thoroughly explained. In the present report, we describe the details of our procedure with reference to a fourth case.Case presentationA 47-year-old Asian woman was admitted to our hospital with a 1-year history of worsening leg numbness and urinary dysfunction. Magnetic resonance imaging revealed a low-lying conus medullaris extending to the level of S2 and surrounded by fat tissue at that level. We diagnosed her condition as adult tethered cord syndrome, and spine-shortening vertebral osteotomy was planned. The target level for the osteotomy was L2. Bilateral pedicle screw implants were placed at L1 and L3 using an anterior–posterior image intensifier. In this procedure, it is essential to use monoaxial screws inserted exactly parallel to the rostral endplates of each vertebral body; this ensures appropriate alignment between the L1 caudal endplate and the L2 osteotomy surface. The upper one-third of the lamina of L2 was resected, and the bilateral two-thirds of the pedicle of L2 was removed with a surgical air drill. After exposure of the lateral side of the L1–2 disc, discectomy was performed with a knife and curette. Following complete discectomy of L1–2, the upper vertebral body of L2 was removed with a surgical air drill. After complete removal of the vertebral body, a straight rod was connected to two screws and applied pressure between the screws. Two polyethylene tapes were applied to the L2 lamina and bilateral rods.ConclusionSpine-shortening osteotomy that preserves the caudal one-third of the pedicle and lamina with one-above and one-below instrumentation successfully reduced the spinal cord tension without causing neural damage.

A C-Arm-Free Minimally Invasive Technique for Spinal Surgery: Cervical and Thoracic Spine.

Background and Objectives: C-arm-free MIS techniques can offer significantly reduced rates of postoperative complications such as inadequate decompression, blood loss, and instrumentation misplacement. Another advantageous long-term aspect is the notably diminished exposure to radiation, which is known to cause malignant changes. This study emphasizes that, in some cases of spinal conditions that require a procedural intervention, C-arm-free MIS techniques hold stronger indications than open surgeries guided by image intensifiers. Materials and Methods: This study includes a retrospective analysis and review of various cervical and thoracic spinal procedures, performed in our hospital, applying C-arm-free techniques. The course of this study explains the basic steps of the procedures and demonstrates postoperative and intraoperative results. For anterior cervical surgery, we performed OPLL resection, while for posterior cervical surgery, we performed posterior fossa decompression for Chiari malformation, minimally invasive cervical pedicle screw fixation (MICEPS), and modified Goel technique with C1 lateral mass screw for atlantoaxial subluxation. Regarding the thoracic spine, we performed anterior correction for Lenke type 5 scoliosis and transdiscal screw fixation for diffuse idiopathic skeletal hyperostosis fractures. Results: C-arm-free techniques are safe procedures that provide precise and high-quality postoperative results by offering sufficient spine alignment and adequate decompression depending on the case. Navigation can offer significant assistance in the absence of normal anatomical landmarks, yet the surgeon should always appraise the quality of the information received from the software. Conclusions: Navigated C-arm-free techniques are safe and precise procedures implemented in the treatment of surgically demanding conditions. They can significantly increase accuracy while decreasing operative time. They represent the advancement in the field of spine surgery and are hailed as the future of the same.

Wedgeless V-Shaped Osteotomy of the Distal Medial Femur with Locking Plate Fixation for Correction of Genu Valgum in Adolescents and Young Adults.

Genu valgum is a common disorder affecting adolescents and young adults. Treatment of this disorder requires restoration of normal mechanical axis alignment and joint orientation, for which it is important to assess whether the deformity arises from the distal femur, knee joint, or proximal tibia. Most commonly, the deformity originates from the distal femur, and various osteotomies of the distal femur have been described1-6. The presently described wedgeless V-shaped osteotomy7,8 is a good option among the various alternative procedures listed below. The anesthetized patient is placed in the supine position on a radiolucent operating table. A bolster is placed beneath the knee to relax the posterior structures. A medial longitudinal skin incision is made that extends from the level of the medial joint line to 5 cm proximal to the adductor tubercle. The vastus medialis is identified and elevated anteriorly by detaching it from its distal and posterior aspects. The leash of vessels underneath the vastus medialis is identified, and the apex of the V-shaped osteotomy is kept just proximal to it. The anterior arm of the V is kept longer than the posterior one, both of them are kept perpendicular to each other, and the apex of the V is made to point distally. The osteotomy is performed on the medial cortex with use of an oscillating saw or multiple drill holes that are then connected using a thin osteotome. Care is taken not to utilize a saw or drill on the lateral cortex. A gentle valgus thrust is applied to break the lateral cortex without periosteal disruption. The apex of the V osteotomy on the proximal fragment is trimmed, and the deformity is corrected with varus force. The osteotomy site is stabilized with use of an anatomically contoured distal medial femoral locking plate or a medial proximal tibial L-shaped buttress plate (of the contralateral side). The implant position is verified under a C-arm image intensifier. The wound is closed in layers over a suction drain in a standard manner. Various types of corrective osteotomies of the distal femur have been described in the literature, including the lateral opening wedge, medial closing wedge, dome, and spike osteotomies1-6. All of these procedures have certain limitations and shortcomings. The wedgeless V-shaped osteotomy is another described procedure that is inherently stable7,8. It is a safe procedure and yields good clinical outcomes8,9. The posterior arm of the V-shaped osteotomy is kept smaller than the anterior arm. The proximal cortical bone is allowed to dig into the cancellous bone of the wider distal metaphysis during deformity correction. Trimming the apex of proximal bone end after making the osteotomy facilitates the process. In a study of 46 patients with a mean age of 16.9 years (range, 15 years to 23 years), Gupta et al.8 reported that the mean radiographic tibiofemoral angle improved from 22.2° (range, 16° to 29°) preoperatively to 5.1° (range, 0° to 10°) postoperatively (p < 0.001). Similarly, the mean lateral distal femoral angle improved from 79.2° preoperatively to 89.1° postoperatively (p < 0.001) and the mean mechanical axis deviation improved from 19.6 mm preoperatively to 3.7 mm postoperatively (p < 0.001). A total of 44 of 46 cases had an excellent functional outcome, with the other 2 having good outcomes. None of the patients in the study had an unsatisfactory outcome. It is important to keep the whole lower limb accessible to the image intensifier intraoperatively.Identification of the leash of vessels underneath the vastus medialis is important to decide the level of the osteotomy.It is important to preserve the periosteal sleeve on the lateral aspect of the femur. CORA = center of rotation of angulationECG = electrocardiogramLDFA = lateral distal femoral angleMAD = mechanical axis deviationMPTA = medial proximal tibial angle.

SURGICAL TREATMENT OF FEMORAL SHAFT FRACTURES IN POLYTRAUMATIZED PATIENTS

Fractures of the femur are common, usually serious and are the result of high-energyaccidents. They can be associated with involvement of other organs, causing deformities and sequelae for the patient, due to immediate or late complications. Anatomical reduction and stable internal fixation are essential in order to achieve the treatment objectives in patients with good bone quality. Treatment is eminently surgical as it allows early rehabilitation and reduces the risk of systemic complications. There are numerous therapeutic options, but osteosynthesis with an intramedullary plate and nail stands out. However, some factors influence the choice of the type of surgical intervention to be performed, such as hospital resources, availability of suitable material for the procedure, trained staff and availability of an image intensifier.

Unilateral neurostimulation-assisted cervical epidural anesthesia for upper limb surgeries—a case series

BackgroundThe role of neurostimulation-aided cervical epidural anesthesia (CEA) in shoulder surgery has been described in the literature. The use of nerve stimulators and the infusion of local anesthetic (LA) in the cervical epidural space has also been mentioned. Epidural needle rotation prior to insertion of the catheter is not described, and it is not clear if general anesthesia was administered in these cases.Case presentationIn this case series, we performed CEA at the level of C7-T1 in 12 patients undergoing various surgeries on the proximal open shoulder and mid humerus after informed consent. Ipsilateral motor responses elicited by continuous electrical stimulation were used to identify lateralization of the epidural catheter tip. The placement of catheters was confirmed under an intraoperative image intensifier. Using the median approach at the level of C7-T1, an ipsilateral twitch was noted in all patients. Neurostimulation persisted with an advancement of stimulating catheter 3–4 cm in the cervical epidural space in all patients. A cervical radiograph confirmed the placement of an ipsilateral catheter and contrast injection there upon revealing the spread of the LA agent. All patients had successful awake shoulder and mid-humerus surgeries under sole cervical epidural anesthesia as evidenced by the absence of pain response at the surgical incision.ConclusionsIpsilateral CEA can be offered for unilateral upper limb surgeries. Low volumes of LA can be injected after precise placement of the tip of the catheter corresponding to the level of surgical incision.

Treatment of Non-Union with Bone Loss in Femur Fracture Using Non-vascularized Fibular Graft: A Case Report

Abstract: Fibula is a very versatile source of autogenous graft and has been used for decades in the field of limb reconstruction. Bony defects of the lower extremity are usually the result of high-energy trauma, tumor resection, or severe sepsis. Non-vascularized fibular graft (NVFG) is useful in the reconstruction of skeletal defects, especially in cases of scarred and avascular recipient sites, or in patients with combined bone and soft tissue defects. This study aimed to assess the effectiveness of NVFG in the management of non-union bone fracture. We reported a 16-years-old male with non-union femur fracture. Debridements were applied at the first time of admission to the hospital. Open reduction of fracture with internal femur fixation. Fibula bone was extracted as the donor of vascularized graft for the bone loss. After two years of follow-up, the patient acquired his motor functions back well, and was able to carry out daily activities as expected. In conclusion, taking together the repair and reconstruction of non-union bone in the lower extremity with NVFG and internal fixation is an effective and important option for treating non-union femoral fracture. NVFG osteosynthesis has encouraging results in such instances. It is technically less demanding, simple, and can be performed in almost all centers where image intensifier is available. Keywords: bone fracture; non-vascularized fibular graft; reconstructive microsurgery; femoral non-union

Ultrafast optical gated image intensifier with a temporal resolution of 230 picosecond using uniform underlayer

An Au uniform photocathode underlayer is employed in this paper to obtain picosecond (ps) optical gating width for image intensifier tube. The transmittances and gating pulse transmission efficiencies of the underlayer with different thicknesses are tested and compared to determine the optimal thickness. An 18 mm diameter proximity focused microchannel plate image intensifier tube with S25 photocathode is fabricated using this uniform underlayer. The profile measurement shows the tube has an optical gating time as low as 230 ps full width at half maximum (FWHM) when gated with a 176 ps width gating pulse. The measured iris delay is between 83 ps and 108 ps, which approaches the theoretical limit of its kind.

OH* Chemiluminescence Characteristics of the RP-3 Fueled Dual-Swirl Direct-Mixing Combustor.

The flame structure characteristics of the RP-3 fueled dual-swirl direct-mixing combustor are studied experimentally. The flame shape is marked by the OH* radical, which is captured by a CMOS camera with an image intensifier. The flow fields and spray distributions are obtained by particle image velocimetry. The variation of pilot/main-stage flame structure with global fuel-air ratio (FAR), fuel ratio (FR), pilot/main-stage swirl numbers (Sp and Sm), and Δp/p (total pressure loss coefficient) is further investigated. The typical flame structure, consisting of two main-stage combustion zones (pilot-stage and main-stage combustion zones), is first analyzed. Then, according to the relationship between integral OH* intensity and global heat release rate, increasing swirl number will weaken the effect of strain rate on OH* chemiluminescence. The global FAR has little impact on the flame structure, while modifying the FR will alter the flame mode. The influence of the Sp on the flame structure is more significant than that of the Sm. Within the range of experimental conditions, the greater the swirl number, the smaller the Δp/p is required to obtain the maximum OH* radical intensity. The addition of non-swirl flow in the main-stage swirler can improve the stability of the pilot-stage flame. The equivalent swirl number is further evaluated by the neural network.

A comparative study to evaluate the cervical spine movements during laryngoscopy using Macintosh and Airtraq laryngoscopes.

Intubation with Macintosh requires flexing the lower cervical spine and extending the atlanto-occipital joint to create a "line of sight." Primary aim of study was to compare the extent of cervical spine movement during laryngoscopy using conventional Macintosh laryngoscope and Airtraq. A total of 25 patients of either sex between the age group of 18 and 60 years, having American Society of Anesthesiologists (ASA) physical status of Grade-I and Grade-II, scheduled for elective surgery under image control requiring general anesthesia and intubation were enrolled. A baseline image of the lateral cervical spine including the first four cervical vertebrae was taken by an image intensifier. After administration of general anesthesia, laryngoscopy was first performed using a Macintosh laryngoscope and a second X-ray image of the lateral cervical spine was taken. The second laryngoscopy using a Airtraq laryngoscope was done and the third image of the lateral cervical spine was taken. Angles between occiput and C1; C1 and C2; C2 and C3; C3 and C4; and occiput and C4 were calculated. Atlanto-occipital distance (AOD) was calculated as the distance between occiput and C1. Macintosh showed greater cervical movement as compared with Airtraq but a significant difference in the movement was observed at C2-C3 and C0-C4. Baseline mean AOD was 2.21 ± 1.25 mm, after Macintosh and Airtraq laryngoscopy was found to be 1.13 ± 0.60 and 1.6 ± 0.78 mm, respectively, and was found to be significant (P < 0.05). We conclude that Airtraq allows intubation with less movement of the upper cervical spine makes Airtraq preferred equipment for intubation in patients with a potential cervical spine injury.

Does radiation exposure during pediatric supracondylar humeral fracture surgery change according to the C-arm position? A comparison of two different techniques

IntroductionIn the surgical treatment of supracondylar humeral fractures (SHF), the surgeon has to stand right next to the fluoroscopy device, so it is very important to know how to use it in the most appropriate way to reduce radiation exposure. The aim of this study was to investigate the effect of using C-arm in uniplanar (inverted) and biplanar (standard-horizontal) configurations on (1) the radiation exposure to the surgeon, and (2) surgical time and fluoroscopy exposure time. Material and methodsThis prospective randomised study was conducted on 20 patients who underwent fluoroscopy during closed reduction and percutaneous pinning for a SHF. In the first configuration, the C-arm was inverted and the image intensifier was used as a surgical table. In the second configuration, the C-arm was used biplanar. The operations were performed by 5 surgeons, with each surgeon using each method only twice. During the operation, to find a value closed to direct radiation exposure measurement was made by attaching a dosimeter to the wrist and scatter radiation exposure was measured by attaching a dosimeter to the neck and waist of the surgeons. The operation time and fluoroscopy exposure time were determined. ResultsThe duration of operations performed with the biplanar C-arm position and the fluoroscopy exposure time in operations performed with the uniplanar method were found to be statistically significantly longer (p = 0.001). The measurements on the dosimeter worn on the neck of surgeons were found to be statistically significantly higher while using the uniplanar C-arm configuration (p = 0.001). There was no statistically significant difference between the dosimeter measurements on the wrists and waists of the surgeons and the C-arm configurations (p = 0.820; p = 0.185). ConclusionsAlthough the use of biplanar C-arm has no effect on radiation exposure to the surgeon's wrist, the most important advantages are that the neck area is exposed to less radiation and it shortens the fluoroscopy time so the use of a biplanar C-arm can be recommended. Level of evidenceLevel II

Which head element is more effective for cement augmentation of TFNA? Helical blade versus lag screw

BackgroundEarly fixation and rehabilitation is the gold standard treatment for intertrochanteric femur fractures. Cement augmentation through perforated head elements has been developed to avoid postoperative complications such as cut-out or cut-through. The purpose of this study was to compare two head elements in terms of cement distribution using computed tomography (CT) and to examine their initial fixation and clinical outcomes.MethodsElderly patients who had intertrochanteric fractures were treated with a trochanteric fixation nail advanced (TFNA) helical blade (Blade group) or a TFNA lag screw (Screw group). In both groups, 4.2 mL of cement was injected under an image intensifier (1.8 mL of cement was directed cranially and 0.8 mL each caudally, anteriorly, and posteriorly). Patient demographics and clinical outcome were investigated post-operatively. Cement distribution from the center of the head element was evaluated with CT. Maximum penetration depth (MPD) were measured in the coronal and sagittal planes. On each axial plane, the cross-sectional areas in the cranial, caudal, anterior and posterior directions were calculated. The sum of cross-sectional areas (successive 36 slices) was defined as the volume of the head element.ResultsThe Blade group included 14 patients, and the Screw group included 15 patients. In the Blade group, MPD in the anterior and caudal direction was significantly greater than that in the posterior direction (p < 0.01). In the Screw group, volume in the cranial and posterior direction was significantly greater than that in the Blade group (p = 0.03). Subsequently, the total volume in the Screw group was significantly larger than that in the Blade group (p < 0.01). No significant correlation was detected between bone mineral density, T score, young adult mean, and total cement volume. Change in radiographic parameters and clinical outcome such as Parker score and visual analog scale were similar in both groups. No patients suffered from cut-out / cut through or non-union.ConclusionsThe position of cement distribution through the lag screw is different from that through the helical blade, and the total volume of the head element is significantly larger in the lag screw. Both groups had similarly effective results in terms of mechanical stability after surgery, postoperative pain and early phase of rehabilitation.Trial registrationCurrent Controlled Trials ISRCTN45341843, 24/12/2022, Retrospectively registered.

A case report on the rare presentation of aneurysmal bone cyst on proximal radius with management

Aneurysmal bone cyst (ABC) is a non-neoplastic vaso-cystic tumor of the second decade. A 16-year-old male patient presented to the outpatient department with gradual dull aching pain and progressive increasing swelling, which was localized to right lateral elbow and upper part of the forearm. There was no restriction in the range of motion. After getting an x-ray, a lytic lesion is found at the proximal radius. MRI and cytology, are both investigations done to confirm the diagnosis. Two injections of 10 ml polidocanol (3%) were administered percutaneously two months apart under the guidance of an image intensifier. After one year X-ray showed marked sclerotic, however, the tumor size remained almost the same. Although ABC is a non-aggressive benign lesion. ABC responds to treatment very well. recurrence is also common. Proximal radius is a less common site for ABC and the case report suggests that it is curable. We found no recurrence. Treatment with polidocanol is less expensive, less morbid, has a good functional outcome, early discharge from the hospital, and highly effective.