Stabilization of the distal fibula and tibia to enable elongation-free healing of the ruptured syndesmotic ligaments. Unstable syndesmotic injuries. Unstable syndesmotic injuries in combination with an ankle fracture. Subacute or chronic syndesmotic injury in combination with another procedure (debridement, fibular osteotomy, new osteosynthesis, ligament reconstruction). Soft tissue infection. Stabilization of the distance between the fibula and tibia after repositioning using astrong suture cord, which is fixed to the cortex of the tibia and fibula via two buttons. The cord-button construct is inserted minimally invasively under image intensifier control. Two weeks of partial weight bearing with 15 kg weight, rigid ankle joint orthosis (walker) for 6weeks, accompanied by physical therapy. The results published to date demonstrate with strong evidence that cord-and-button fixation is superior to screw fixation in terms of clinical scores, correct reduction, and reoperation rates. This applies both to isolated unstable syndesmotic injuries and to syndesmotic injuries combined with fibula fractures. Another advantage of this surgical technique is that implant removal is not necessary in most cases. The disadvantage of this procedure is the high implant cost.

Automatic detection of dark stain defects in low-light-level image intensifiers based on uniformity correction and background texture filtering

The iris time is a critical parameter for high-speed gated image intensifiers. Current research primarily focuses on its characteristics in the time domain, with limited analysis of its frequency domain response. This paper investigates the frequency domain response of the radial micro-element model of image intensifiers and identifies the relationship between the iris time and the S-parameters. We propose using the frequency domain S-parameters to evaluate the iris time. Through time-domain and frequency-domain electromagnetic simulations of the image intensifier, we confirm a linear relationship between the iris time and the S-parameters. Experimental results demonstrate that the error in evaluating the iris time using S-parameters is less than 0.04ns.

Evaluation of union rate of scaphoid non-union fracture in adults by Herbert screw versus volar buttress plate.

BACKGROUNDSupracondylar humeral fractures are among the most common paediatric injuries. Displacement and consequent need for reduction impose operative treatment. Restoration of the anatomy of the distal part of the humerus prevents deformities and functional disorders of the elbow and upper limb. Stable K-wire fixation can be succeeded either by closed or open reduction method.AIMTo investigate the safety and efficacy of open reduction method in the operative treatment of Gartland type III and IV supracondylar humeral fractures in children.METHODSWe retrospectively studied 131 cases of paediatric supracondylar humerus fractures of Gartland type III-IV treated operatively by open reduction and pinning between 2001 and 2023 in our department. All patients underwent clinical and radiological examination recording elbow range of motion, function and deformity.RESULTSThe standard lateral approach was carried out in all patients while in 47 cases (35.9%) additional medial approach was used. Average follow-up time was 5.4 years (1-14 years). Fracture healing was completed at 4-6 weeks. The average operative time was 50 min (range: 37-75 minutes, SD: 11.307) and the average duration of radiation exposure based on image intensifier usage time was 20 seconds (range: 7-45 seconds, SD: 9.864). No infections or iatrogenic neurovascular complications were recorded and the functional outcome regarding range of motion, Patient-Reported Outcome Measures (Disabilities of the Arm, Shoulder, and Hand questionnaire, Mayo Elbow Performance Scores) at 2-year follow-up was satisfying.CONCLUSIONOpen reduction and K-wire fixation provide very satisfactory outcome in supracondylar fractures of the humerus in children with reduced radiation burden. Moreover, the risk of neurovascular injuries due to manipulations of closed reduction, is minimized while complications related to surgical approaches are insignificant provided there is expertise.

This study presents a photocathode subdivision calibration method to improve the accuracy of optical gate length measurement in ultrafast gated image intensifiers. By dividing the photocathode into subregions and calibrating them individually, it decouples the effects of gating pulse width and propagation delay. Experiments show local gate lengths decrease to 195 ± 22 ps from a global value of 332 ps. The method enables both shorter integration times and larger effective detection areas. It also reduces timing errors in time-resolved single-photon imaging, offering a practical approach to optimize ultrafast gated intensifier performance for high-precision optical diagnostics.

Immediate posterior pelvic ring stabilization is the prerequisite for pelvic packing. In patients "in extremis", often no adequate positioning or imaging is available. Percutaneous application of a stabilizing K-wire or even a screw at the posterior pelvic ring can give adequate stability without an increased risk damage to surrounding structures, when respecting classical landmarks. In 10 human adult whole-body cadavers, a percutaneous application of a 2.8mm K-wire was performed without image intensification. Only after insertion, standard a.p., inlet, and outlet imaging was performed to confirm wire positioning. The classical entry point for iliosacral screw fixation was used. An Arcadis© Orbic 3D C-arm (SIEMENS, Solothurn, Switzerland) was used for final control. In 16 of 20 hemipelves (80%), in all three standard radiographic planes, the K-wire was in the expected anatomic position. Malposition was observed as usually too anterior positioning of the wire in relation to the sacrum. Using standard landmarks, percutaneous application of K-wires into the posterior pelvic ring without intraoperative imaging was found to be feasible and resulted in few mal-placements as confirmed by post-insertion radiographs. The complication rate is comparable to mal-placement of pelvic C-clamp pins. This technique is feasible in patients in extremis.

A NaKSb(Cs) image intensifier with subwavelength-grating on the optical window is crucial for enhancing external quantum efficiency (EQE) and reducing halo. This study established a comprehensive 3D Monte Carlo model to simulate the photon and electron transport, photoelectric conversion, and emission processes. The simulation results demonstrate that the optical path of the photons in the photocathode is the primary factor influencing the photoelectric conversion efficiency. Multiple reflections of photons in the gap, including lens, window, photocathode and microchannel plate (MCP), are responsible for the halo formation. In addition, the grating can suppress the change in EQE with the incident angle. The model results for the non-grating and single-layer grating cases deviated by 1.57% and 2.44% for the EQE and by 1.03% and 4.35% for the halo, respectively.

Correction of adouble varus deformity and an increased tibial slope. Medial osteoarthritis (OA) and anterior instability in combination with adouble varus deformity (MPTA < 84°, JLCA > 2°) and an increased tibial slope (> 12°). Femoral varus deformity with lateral distal femoral angle of > 91°, severe lateral cartilage damage, lateral OA, lateral loss of the meniscus. Skin incision medial to the tibial tuberosity of approximately 8-10 cm. Insertion of two converging guide wires directly above the pes anserinus, ascending obliquely above the fibula tip. Check the position of the wires with the image intensifier. Incomplete osteotomy below the guide wires with the oscillating saw. Complete osteotomy of the posterior tibial cortex with achisel to move the hinge anterolateral. Insertion of two Schanz screws in the proximal and distal fragments from anterior. Ascending osteotomy and removal of asmall anterior wedge. Careful opening of the osteotomy with chisels at the level of the posterior tibial cortex. Correction of the tibial reclination with the help of the Schanz screws ("joystick"). Check the correction with the image intensifier in two planes. Osteosynthesis with medial angle-stable plate. Partial weight bearing with 10 kg for 2-6weeks, then gradually increase the load. Range of motion: free. Using the described surgical technique, 28patients (7women, 21men, age: 36.8 years) with chronic anterior instability or recurrent instability were treated. All patients had adouble varus deformity (MPTA < 84°, JLCA > 2°) and aposterior tibial reclination of > 12°. The mean postoperative tibial reclination was 9.1°. The postoperative hip-knee-ankle angle was -0.4°. The Lysholm score increased from an average of 75.2 points to 90.3 points.

Background. Minimally invasive Chevron and Akin osteotomy (MICA) for hallux valgus is a high-tech procedure, with certain stages potentially being time-consuming and requiring intraoperative fluoroscopic guidance. The aim of the study – to evaluate the impact of the original guide device on the operative time, fluoroscopy time, and radiation exposure during minimally invasive Chevron and Akin osteotomy of the first metatarsal bone. Methods. The study included 42 patients with hallux valgus, divided into two groups. All patients underwent surgery using a minimally invasive technique. The Guiding Device Group consisted of 21 patients who underwent osteotomy with the use of the original guide. The Freehand Group included 21 patients who underwent osteotomy without the guide. At the end of the procedure, the duration of the surgery and the radiation dose – measured using the image intensifier sensors – were recorded. Results. The median duration of surgery in the Guiding Device Group was 25.00 minutes [25.00; 30.00], while in the Freehand Group it was 45.00 minutes [40.00; 57.50]. The observed differences were statistically significant (p 0.001). The mean radiation dose was 0.30±0.06mGy in the group where the guide was used, and 0.79±0.20mGy in the group where guidewires for screws were inserted freehand. The mean difference between the groups for this parameter was 0.49mGy (95% CI 0.39-0.58mGy; p 0.001). Pain intensity assessed by the VAS at 2, 4, and 8 weeks, and at 6 months postoperatively, was lower in patients who underwent surgery with the guide (p 0.05 for all time points). Conclusion. The use of the original guiding device in minimally invasive corrective osteotomies for hallux valgus deformity significantly reduced operative time and radiation exposure for both the patient and the surgeon.

BackgroundIntraoperative fluoroscopy has been the gold standard in direct anterior approach (DAA) total hip arthroplasty (THA) to assess the position of the components. Fluoroscopy could be aided by software to help surgeons plan and execute the THA optimally; however its clinical effectiveness has not been proven. This study assessed the use of fluoroscopy with intraoperative software to evaluate the ability of the software to accurately measure the component position and leg length discrepancy (LLD) in DAA.MethodsThirty-eight patients (39 procedures) were prospectively selected from consecutive patients treated using software-aided fluoroscopy (Group 1). Thirty-eight patients (38 procedures) were retrospectively enrolled into the control group (Group 2) from patients using intraoperative fluoroscopy without software analysis. Patients in both groups underwent THA using DAA. A mobile C-arm image intensifier unit was used to obtain images of the affected hip intraoperatively. In Group 1, the LLD and cup inclination were calculated intraoperatively by the software. The LLD, cup inclination and anteversion were measured for both groups using antero-posterior (AP) X-rays at six weeks postoperatively and were compared to the preoperatively planned targets.ResultsThe mean postoperative LLD was significantly less in Group 1 when compared to Group 2 (2.2mm vs 4.6mm, p<0.01). In Group 1, 100% of hips (39/39) had a radiographic LLD within 10mm compared with 97% (37/38) in Group 2. The cup inclination and cup anteversion achieved within Group 1 were closer to the planned inclination and anteversion when compared to the control.ConclusionsIntraoperative software analysis of fluoroscopy in THA aids accurate implantation of THA using the DAA approach with regard to leg length equality and acetabular component positioning.

Objective detection for dark stain defects of low-light-level image intensifiers based on adaptive erasure of regular defects and automatic frequency-domain bandpass filtering

ABSTRACT In BWRs, the boiling two-phase flow structure determines the heat transfer characteristics in the core. It is also crucial for evaluating cooling characteristics during severe accidents. Therefore, the boiling two-phase flow has been studied by many researchers for reactor core design and safety assessment. In this study, neutron imaging is applied to visualize the two-phase boiling flow dynamics in a heated tube, and the flow structure is evaluated by the void fraction distributions estimated from the neutron transmission images. The test section is a stainless-steel circular pipe, and it is installed vertically in the neutron beam. A high-speed neutron imaging system with a high-speed camera and an image intensifier is applied to observe fast two-phase flow phenomena at a time resolution of 1000 fps. The axial flow development in the heated tube could be visualized, and the processes of bubble generation and growth, as well as the transition to annular flow, were clearly observed.

The common marmoset (Callithrix jacchus) is a valuable model for studying aging due to its physiological and social similarities to humans, including shared susceptibilities to age-related diseases. However, the effects of healthy aging on marmoset mastication and swallowing are poorly understood, despite their importance for modeling human aging and understanding marmoset ecology and longevity (efficient food processing impacts foraging success and predation risk). Given their specialized diet, dental adaptations, and relatively long lifespan compared with other biomedical models commonly used, like rodents, understanding how elderly marmosets maintain feeding efficiency is particularly important, yet lifespan research on their feeding physiology is scarce. Using cineradiography (with a microfocal X-ray source and beryllium image intensifier), we examined masticatory and swallowing physiology across the marmoset lifespan (1 month to 19 years) in 26 healthy individuals, analyzing 45 recordings (80 feeding events, 784 swallows). Our study revealed a developmental trajectory in marmoset chewing and swallowing, from infancy to old age, characterized by progressively refined handling of larger food portions and boluses. We identified distinct anatomical, functional, and behavioral differences in feeding physiology among age groups. Elderly marmosets exhibited significantly faster feeding rates than infants and adults, consuming larger portions and forming larger boluses, requiring fewer mastications and swallows, likely reflecting age-related adaptations. Notably, old and very old marmosets showed comparable feeding efficiency, suggesting compensatory mechanisms to maintain function despite age-related challenges (e.g., tooth loss or muscle weakness) and may contribute to longevity. The consistent pattern of esophageal retention across age groups indicates this pattern is likely typical for the species. This study establishes baseline feeding characteristics for marmosets, reinforcing their value as a translational aging model and enhancing their utility for investigating age-related changes in human chewing and swallowing, including dysphagia. Future research should explore the underlying mechanisms and functional implications of these changes.

Accurate measurement of joint kinematics is a key requirement for understanding injury mechanisms, evaluate rehabilitation techniques, and improve the implant designs and techniques used in total knee arthroplasty (TKA). Fluoroscopy is an experimental technique to directly measure joint kinematics without being affected by soft-tissue artefacts. However, because of its limited field-of-view (FOV), stationary fluoroscopy can only measure small parts of more dynamic/progressive movements, such as walking. This manuscript presents a new generation of moving fluoroscope: The tracking dual-plane fluoroscope (tDPF) combines optical tracking with a bi-planar X-ray system on mechanically independent source and intensifier carriages on rails and model-predictive-control to measure the kinematics of the tibio-femoral joint in vivo during dynamic activities, such as level walking and stair ascent/descent, at all gait speeds. In this proof-of-concept study, the tDPF tracked the knees of 16 young and healthy subjects during complete, consecutive gait cycles of level walking, ramp ascent, ramp descent, stair ascent, and stair descent at self-selected gait speeds. For all gait speeds (average and standard deviation: during level walking), tracking performance for each activity was excellent and the knee centre stayed within both simulated image intensifiers’ FOVs for of frames (no X-ray images were captured in this study). The tDPF is the first dual-plane fluoroscope to track the knee joint during entire cycles of stair and ramp ascent at self-selected gait speeds for young and healthy subjects. Notably, our device does not require any pre-recording of movement patterns—by using real-time position estimates of the tracked joint and tracking each trial independently, even the challenging measurements of tasks with high variability between trials become possible.

Accurate measurement of joint kinematics is a key requirement for understanding injury mechanisms, evaluate rehabilitation techniques, and improve the implant designs and techniques used in total knee arthroplasty (TKA). Fluoroscopy is an experimental technique to directly measure joint kinematics without being affected by soft-tissue artefacts. However, because of its limited field-of-view (FOV), stationary fluoroscopy can only measure small parts of more dynamic/progressive movements, such as walking. This manuscript presents a new generation of moving fluoroscope: The tracking dual-plane fluoroscope (tDPF) combines optical tracking with a bi-planar X-ray system on mechanically independent source and intensifier carriages on rails and model-predictive-control to measure the kinematics of the tibio-femoral joint in vivo during dynamic activities, such as level walking and stair ascent/descent, at all gait speeds. In this proof-of-concept study, the tDPF tracked the knees of 16 young and healthy subjects during complete, consecutive gait cycles of level walking, ramp ascent, ramp descent, stair ascent, and stair descent at self-selected gait speeds. For all gait speeds (average and standard deviation: [Formula: see text] during level walking), tracking performance for each activity was excellent and the knee centre stayed within both simulated image intensifiers' FOVs for [Formula: see text] of frames (no X-ray images were captured in this study). The tDPF is the first dual-plane fluoroscope to track the knee joint during entire cycles of stair and ramp ascent at self-selected gait speeds for young and healthy subjects. Notably, our device does not require any pre-recording of movement patterns-by using real-time position estimates of the tracked joint and tracking each trial independently, even the challenging measurements of tasks with high variability between trials become possible.

Image enhancement inside the water and reconstruction is becoming a challenging task and has gained priority in recent years, as the human eye cannot clearly perceive underwater images.Due tothe absorption andscattering effect on light when travelling in water, underwater images exhibit color deviation, low contrast and blurry details. The existing methods, such as supplementary information- based methods, nonphysical model-based methods and physical method-based methods rely on polarization filters, modify image pixel values and assume the attenuation coefficients to improve visual quality. These methods may give unstable results and provide less accuracy. The main objective of the proposed system is to improve the quality of the image by adjusting the contrast, illumination and enhancing the pixel edge are applied to an underwater image.White Balance algorithmis used to correct the color casts, Histogram Equalization is used to improve the contrast and Gamma Correction controls the overall brightness of an image. We have used the Convolution Neural Network algorithm for image classification and trained all the images from dateset based on three techniques to improve overall accuracy. Index Terms -Image Preprocessing. White Balance, Histogram Equalization. Gamma Correction and CNN.

Background Treating nonunion remains a significant challenge in orthopedic surgery. Approximately 5% to 10% of fractures result in delayed or nonunion, leading to impaired function and necessitating repeated hospitalizations and surgeries. The aim of this prospective study was to evaluate the effectiveness of percutaneous bone marrow injection for treating fractures with delayed union and nonunion following internal fixation.MethodsAdult patient with closed long bone fracture treated surgically with internal fixation with acceptable alignment, good bone opposition and stable fixation who presented with delayed or non-union were included in the study. Desired amount of non-heparinized bone marrow was injected under image intensifier guidance immediately after aspiration. Second bone marrow injection was repeated at interval of 4-6 weeks of first injection. Serial X-rays were taken at each review until 9 month post procedure.ResultsThe study included 27 patients with delayed union and 3 cases of nonunion of long bones, all of whom were treated with percutaneous autologous bone marrow injections. Our study demonstrated an 85.18% success rate in achieving union following bone marrow injection in case of delayed union while, 33.33% success in case of non-union. Our results were excellent in 53.33% (16/30) of cases, good in 23.33% (7/30), and poor in 23.33% (7/30).Conclusions The use of bone marrow to accelerate fracture healing is one of the promising methods of treating delayed union and non-union.

Disagreements persist in current theoretical models of image intensifier resolution regarding the selection of photoemission parameters for photocathodes. To address this issue, a study was performed to investigate the photoemission characteristics of photocathodes. The Monte Carlo method was employed to theoretically calculate the spatial resolution of photoelectrons striking the MCP under varying emission characteristics. A theoretical mechanism was developed to link photoelectron emission characteristics with spatial resolution degradation resulting from voltage drops.Experimental studies on S20 and GaAs photocathodes at various voltage levels revealed that the angular distribution of emitted electrons follows a cosine distribution, and appropriate energy distributions were identified. These results provide essential electron emission characteristics of commonly used photocathodes, establishing a theoretical foundation for simulation analyses and the optimal design of high-spatial-resolution image intensifiers.

This paper aims to analyze the operational principles and clinical applications of image intensifiers in traumatology, evaluate their impact on surgical success and procedural accuracy, and discuss the limitations and future prospects of this technology in improving trauma care.