Initial Radiographs Research Articles

The Utility of the Radiocapitellar View in Pediatric Medial Epicondyle Fracture Evaluation.

Anteroposterior (AP) and lateral radiographs often underestimate displacement in medial epicondyle fractures, further complicating the already debated operative indications. The radiocapitellar (RC) view is an alternative radiograph that allows for the separation of the humeroradial and humeroulnar joints. This study investigates the utility of the RC view in measuring displacement and identifying the need for operative intervention in pediatric medial epicondyle fractures. A retrospective analysis was conducted on pediatric patients who presented to our institution with a medial epicondyle fracture treated operatively from 2015 to 2022 and received initial AP and RC radiographs. Fracture displacement was measured by 3 orthopaedic surgeons using the corresponding point measurement method and inter/intra-rater reliability was computed. A fracture >5mm was considered to be within the threshold for recommendation of operative treatment. McNemar test was used to assess differences in sensitivity in detecting operative fractures between AP and RC radiographs, with a P-value of < 0.05 considered significant. A total of 45 patients met the inclusion criteria. The RC view had significantly higher sensitivity in identifying fractures greater than the operative threshold of 5mm compared with the AP view (93.3% vs. 68.9%, P=0.0127), and on average, measured 2.5mm more displacement (P<0.001) than the corresponding AP view. AP and RC radiographs both measured >5mm of displacement in 62.2% (28/45) of fractures, with 6.7% (3/45) determined as >5mm by AP view and ≤5mm by RC view. 31.1% (14/45) of fractures were measured to be >5mm by RC view and ≤5mm by AP view. The RC view significantly increases sensitivity in detecting the 5mm displacement threshold for operative treatment of pediatric medial epicondyle fractures due to improved visualization of fracture displacement. Level III, diagnostic study.

Subacute distal radio-ulnar joint subluxation after a distal radius fracture.

We report a series of 12 patients who developed early distal radioulnar joint subluxation after a distal radial fracture, not present on the initial radiographs. Early identification and management of this condition can give good clinical results.Level of evidence: IV.

Aseptic Tibial Loosening Is Associated With Thickness of the Cement: A Radiographic Case-Control Study.

The cementation technique is crucial for achieving adequate fixation and optimal survivorship in total knee arthroplasty (TKA). The thickness of the cement at the tibial bone-implant surface may be related to aseptic tibial loosening. However, to date, no studies have demonstrated a direct association between cement thickness and rates of aseptic tibial loosening. We performed a retrospective review to identify 28,327 primary cemented TKAs with at least 2 years of follow-up at an academic health system from 2013 to 2021. A total of 115 cases underwent revision surgery for aseptic tibial loosening. Cases where the implant was recalled specifically for loosening (n= 23) were excluded. The remaining 92 aseptic tibial loosening cases were 2:1 propensity score matched and implant matched to control patients who did not have tibial loosening. There were two independent reviewers who then measured the thickness of the cement interface in 10 locations along the bone-implant interface from initial postoperative radiographs. The averages of the reviewers' measurements were calculated and then compared using independent t-tests. Aseptic tibial loosening cases involving implant A tibial baseplate (n= 75) had significantly thinner cement interfaces than matched controls at all the 10 locations measured. Aseptic loosening cases involving implant B (n= 17) also displayed a thinner cement interface than matched controls in all locations, but this result was only statistically significant at the medial baseplate, medial keel, lateral keel, anterior keel, and posterior baseplate. In two widely used TKA systems, tibial aseptic loosening was associated with significantly thinner cement interfaces when compared to propensity-matched controls in two different implant types. Further prospective studies are needed to identify the optimal keel preparation and design as well as minimal cement interface thickness to avoid implant loosening. III.

Investigation of the Relationship Between ACTN3 rs1815739 Polymorphism and Openbite Cases: A Prospective Study.

The aim of this study was to examine whether ACTN3 rs1815739 polymorphism, which causes the deficiency of the alpha-actinin-3 muscle protein, is related to the formation of open bite malocclusion. Fifty-eight participants (18.5 ± 3.6 years old) with anterior open bite (n = 29) and normal overbite (n = 29) who presented to Marmara University, Department of Orthodontics for treatment were included in the study. Initial cephalometric radiographs were used for the diagnosis of malocclusion. The case group was divided into three subgroups according to degree of open bite. For DNA isolation, oral epithelial cells were collected with buccal swabs (Van Allen Way, Carlsbad, USA), and the real-time PCR method was used for the genotyping of all polymorphisms. The results were statistically analysed, and the threshold for statistical significance was set at p < 0.05. The frequencies of RR, RX and XX genotypes of ACTN3 rs1815739 polymorphism were found as 6 (20.7%), 14 (48.3%) and 9 (31.0%) in the control group and 8 (8%), 9 (31.0%) and 12 (41.4%) in the case group, respectively. There was no statistically significant difference between the groups in terms of the presence of the examined polymorphism (p > 0.05). However, the intra-group evaluation of case group revealed a significant difference in the prevalence of XX genotype (83.3%) for the subgroup with an open bite of -5 mm or above. Although no significant difference was observed between the case and control groups, a possible association was identified between ACTN3 rs1815739 polymorphism and an increased severity of open bite malocclusion.

“Scarfrodesis”—Simultaneously Addressing Hallux Valgus and Hallux Rigidus With a Scarf Osteotomy and First Metatarsophalangeal Joint Arthrodesis: A Case Report

This case report described a novel procedure used to address a concomitant hallux valgus and hallux rigidus in a patient in her sixties with rheumatoid arthritis. Initial radiographs confirmed concomitant severe hallux valgus deformity with first metatarsophalangeal joint osteoarthritis. A scarf osteotomy was performed followed by a first metatarsophalangeal joint arthrodesis in what the authors have called a “Scarfrodesis” procedure. At 1-, 2-, and 3-year follow-ups, the patient had complete resolution of pain, no limitation in mobility, and had complete consolidation of her arthrodesis. Her AOFAS Hallux Metatarsophalangeal-Interphalangeal Scale Score improved from 29 preoperatively to 72 at 1-year and 3-year follow-ups, with improvement in her Visual Analog Scale and SF-36 at 3-year follow-up. The authors advocate the use of this simple but elegant procedure, which has not been described in addressing the dual pathology in this cohort.

Oesophageal Foreign Body : A Toddler with Recurrent Stridor

Stridor is not an uncommon complaint among the paediatric population presented to the Emergency Department. It is the cardinal sign of impending total airway obstruction. One of the obstructions can be due to a foreign body (FB) lodged in the airway. We encountered one toddler boy who presented with recurrent stridor and was mistakenly treated as croup, in which the initial radiographs and flexible nasopharyngoscopy were unremarkable. A piece of rigid round aluminium foil found within the oesophagus causes tracheal narrowing and inspiratory stridor. High clinical suspicion of the treating physician is needed for the diagnosis. Timely management of FB impaction remains crucial.

The Presence of An Avulsion Fracture of the 1st Tarso-Metatarsal Joint in Lisfranc Injuries is a Useful Adjunct in Detecting 1st TMTJ Instability

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: Lisfranc fracture-dislocations are uncommon injuries that are often missed or diagnosed late. The consequences of this include post-traumatic osteoarthritis and deformity. Injuries with ligamentous involvement injuries often have avulsion fractures at the level of the tarso-metatarsal joint (TMTJ) on either plain radiographs or CT scan. A proportion of these will have a congruent TMTJ joint on initial imaging. However, it has been suggested that many of these patients will have an unstable TMTJ which requires stabilisation. The purpose of this study was to determine the relationship between the presence of an avulsion fracture on initial imaging and instability or incongruence of the first TMTJ. Methods: A prospectively maintained database of all Lisfranc fracture-dislocations presenting to our centre was collected. Initial plain radiographs and CT scans were analysed for the presence of 1st TMTJ avulsion fractures independently by two senior authors. Data were collected regarding the initial mechanism of injury, fracture classification (Myerson and Qenu). Injuries which were managed non-operatively were excluded from the study. All included cases were managed with examination under anaesthesia (EUA) and intra-operative screening with stress testing under image intensification prior to fixation or arthrodesis surgery. The rate of instability for each fracture classification type was also determined. The sensitivity and specificity of the presence of an avulsion fracture of the 1st TMTJ in detecting an unstable joint was determined. Results: 153 patients with a Lisfranc injury were included. The mean age was 35.2 years, and 68% of patients were male. 99 injuries (64.7%) were identified as having an avulsion fracture at the level of the 1st TMJ on either plain radiographs or CT scan. Of these, 76.7% were found to have a congruent joint on XR or CT scan. 91.9% of patients with an avulsion fracture of the 1st TMTJ were found to have instability on EUA stress testing. Amongst the 54 patients who had no avulsion fracture, 23 (42.6%) demonstrated instability of the 1st TMTJ on EUA. The presence of an avulsion fracture of the 1st TMTJ had a sensitivity of 79.8% and a specificity of 79.5% in the detection of an unstable joint. Conclusion: The presence of an avulsion fracture of the 1st TMJ is highly suggestive of instability of the joint and may be a useful adjunct in assessment and decision making for Lisfranc injuries. This finding on pre-operative radiographs should alert clinicians to have a low threshold to perform further imaging in the form of CT scanning or EUA and dynamic stress testing of the 1st TMTJ. A high proportion of Lisfranc injuries without avulsion fractures have instability at the level of the 1st TMTJ, and therefore the absence of this finding does not provide a reliable indication of joint stability.

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.

Effect of patient age on fifth metatarsal fracture pattern, management, and outcomes

Patients with 5th metatarsal (MT) fractures encompass a broad age distribution. This study evaluated the impact of age on the differences in clinical outcomes and management of these fractures. This was a retrospective cohort study of patients presenting to a single large, urban, academic hospital system with a 5th MT fracture over a 10-year period. Patients were stratified into groups of younger than 65 years old and equal to or greater than 65 years old. Initial and successive radiographs were reviewed, and fractures were categorized as Zone 1, Zone 2, Zone 3, Shaft, Neck, or Head fractures. 2,461 patients with 5th MT fractures were evaluated. Patients who did not follow up after initial evaluation in the emergency department or urgent care were excluded. Among 2,020 patients with mean follow-up of 1.03 years who met inclusion criteria, 76.2% were younger than 65 years and 23.8% were greater than or equal to 65 years. There was a significant difference in fracture type between groups as older patients were more likely to sustain metatarsal neck fractures but less likely to sustain Zone 1 base fractures (p < 0.05). There was no difference in time to clinical healing (p = 0.108) or time to radiographic union (p = 0.367) for all fractures between age groups. In conclusion, older patients sustain different 5th metatarsal fracture patterns compared to younger patients. However, despite the differences in age, there was no evidence for any difference in clinical and radiographic outcomes between groups.

Factors Affecting Lateral Overgrowth in Operatively Treated Lateral Condyle Fractures in Children.

The most frequent sequelae of pediatric lateral condyle fractures is lateral condyle overgrowth (LCO). The purpose of our study was to investigate LCO in relation to age, quality of reduction, type of fixation, and fracture displacement. We retrospectively analyzed operatively treated lateral condyle fractures in children. The percent change in interepicondylar width (IEW) ((final - initial)/ initial x 100) was used to quantify LCO. IEW was measured from the medial and lateral epicondyles of the distal humerus, using the AP radiographs taken at admission (initial) and follow-up visits (final). The Song classification was used to classify fractures. Fixation was classified as pins, screws or both. The quality of reduction was defined as anatomic or nonanatomic (>2mm of displacement). Patients were stratified into mild (0% to 10% overgrowth), moderate (10% to 20% overgrowth), and severe (>20% overgrowth) subgroups for further analysis. Two hundred one patients were included in the study with an average time between initial and final radiograph measurements of 11.32 weeks. There was an average 11.84 %LCO. Using multivariable analysis, three variables demonstrated significant, independent associations with %LCO: age, race, and quality of reduction. Increasing age remained inversely associated with %LCO. Compared with White patients, Black and Asian patients had significantly greater %LCO. Patients with nonanatomic reductions had a significantly greater %LCO compared with anatomic reductions. When patients were stratified into mild, moderate, and severe groups, age in the mild group, nonanatomic reduction in the moderate group, and race in the severe group were found to be independently associated with increased %LCO using multivariable analysis. The amount of LCO was found to be related to nonanatomic reduction, younger age, and Black and Asian race. Interestingly, it was not related to the amount of initial displacement or type of hardware used. To date, this is the largest study investigating LCO in surgically treated lateral condyle fractures. Level III-retrospective cohort study.

One Year Follow-Up of a 4-Year-Old Caucasian Girl Diagnosed with Stage IV Grade C Localized Periodontitis.

Stage IV grade C localized periodontitis (pre-puberal localized aggressive periodontitis/LPP), an extremely rare form of periodontal disease, occurs in otherwise healthy individuals (no signs of dental plaque/calculus) due a hyper-aggressive auto-immune response to high periodontopathic bacteria levels. Methods: A 4-year-old Caucasian girl with unusually high mobility of the deciduous lower left canine and localized gingival inflammation was misrecognized by multiple clinicians (initially diagnosed with hypophosphatasia, genetic and metabolic disorders, all turning negative), over a period of 4-6 months, despite initial radiographs showing clear pathognomonic signs. The LPP diagnostic was made by the last clinician, but by then the tooth was lost. Similar inflammation signs appeared around the lower deciduous right canine. X-ray examination showed similar bone and periodontal loss as previously seen, while periodontopathic bacteria tested highly positive. The patient received both mechanical cleaning and ten days of systemic antibiotic treatment (Augmentin and Metronidazole). Results: Two months later, inflammation signs disappeared, with periodontal regeneration radiologically present, and only small periodontopathic bacteria precursor concentrations. Conclusions: Despite initial periodontal loss, an adequate treatment can keep under control an LPP disease. Moreover, bone and periodontal regeneration appears if periodontopathic bacteria scores are kept lower, showing the importance of fast adequate diagnostic and treatment.

Orthopedic or Surgical Treatment in Gartland Type II Supracondylar Humerus Fractures: A Systematic Review.

There is a broad consensus among orthopedic surgeons in the treatment of Gartland type I supracondylar humerus fractures (conservative) and Gartland type III (surgical) fractures, but there is controversy regarding the treatment of choice for Gartland type II fractures. The aim was to analyze the existing current evidence on the choice of surgical or conservative treatment of Gartland type II supracondylar humerus fractures. A systematic review was carried out following the PRISMA guidelines. The search was conducted on May 24, 2023, in PubMed and Cochrane Central, introducing the terms ("humerus" AND "supracondylar") AND ("Gartland II" OR "Gartland 2"). The selected studies were evaluated with the JBI checklist for quasi-experimental studies. 5 retrospective comparative studies were included (evidence level III). Radiological and functional results were good with both treatments. Only one study obtained a better result with surgical treatment (with n = 4 in the conservative group); the other four studies did not find significant differences between the two types of treatment. There are risks of bias in all studies. Both types of treatment (conservative and surgical) are valid for type II Gartland supracondylar humerus fractures, and provide good results, both functional and radiological. There is not enough scientific evidence to be able to affirm that one of the two treatments (surgical or conservative) is superior to the other for the treatment of these fractures. Findings on the initial radiograph, such as rotational deformity, coronal malalignment, or a severely angulated distal humeral fragment, can assist in the decision-making process.

Progression of Chest X-ray Findings of Silicosis Among Fluorspar Miners and Prognostic Factors: Retrospective Cohort Study in Mongolia.

This study aimed to delineate the natural progression of silicosis in fluorspar miners after the termination of dust exposure and identify its prognostic factors. This retrospective cohort study, conducted from 2000 to 2019, included 67 former miners. Radiological images were evaluated by comparing the initial and most recent radiographs using the International Classification of Radiographs of Pneumoconiosis. Cox multivariate proportional hazard models were used to estimate the hazard ratios using follow-up time to analyze the multivariable study of associated prognostic factors. Among the participants, 50 (75%) exhibited progression over 2 to 16 years (median, 5.8 years). The Cox analysis highlighted older age as a likely precursor to the progression of significant opacities. Additionally, higher International Labour Organization category grades at onset were associated with disease progression. Nearly three-quarters of the miners diagnosed with silicosis demonstrated radiological progression even after the termination of dust exposure. Advancement in age and the degree of initial radiological opacity were associated with progression.

Comparison of Clinical Endotracheal Tube Depths with Standard Estimates for the Stabilization of Infants with Congenital Diaphragmatic Hernia.

This study aimed to compare the clinical endotracheal tube (ETT) depth after initial stabilization of infants with congenital diaphragmatic hernia (CDH) to weight and gestational age-based depth estimates. This retrospective analysis included 58 inborn infants with left-sided CDH. We compared a standard anatomic ETT depth calculated from initial chest radiographs and the clinical depth of the ETT after adjustments to predicted depths using weight and gestational age-based estimates. The standard anatomic depth was deeper than age (standard deviation 1.29 ± 1.15 cm, p < 0.001) and weight-based (standard deviation 0.59 ± 0.95 cm, p < 0.001) estimates. The clinical ETT depth was also deeper than age (standard deviation 1.01 ± 0.77 cm, p < 0.001) and weight-based (standard deviation 0.26 ± 0.50 cm, p < 0.001) estimates. Established strategies to predict ETT depth underestimate the ideal depth in infants with left-sided CDH. These data suggest utilizing caution during initial ETT placement based on standard depth estimates for patients with CDH. · CDH patients present unique stabilization challenges.. · Standard ETT depth estimates are too shallow.. · Resuscitation teams should cautiously choose ETT depth..

Traditional radiography versus computed tomography to assess reduced distal radius fractures

IntroductionThis study compares computed tomography (CT) with plain radiography in its ability to assess distal radius fracture (DRF) malalignment after closed reduction and cast immobilization.MethodsMalalignment is defined as radiographic fracture alignment beyond threshold values according to the Dutch guideline encompassing angulation, inclination, positive ulnar variance and intra-articular step-off or gap. After identifying 96 patients with correct alignment on initial post-reduction radiographs, we re-assessed alignment on post-reduction CT scans.ResultsSignificant discrepancies were found between radiographs and CT scans in all measurement parameters. Notably, intra-articular step-off and gap variations on CT scans led to the reclassification of the majority of cases from correct alignment to malalignment. CT scans showed malalignment in 53% of cases, of which 73% underwent surgery.ConclusionWhen there is doubt about post-reduction alignment based on radiograph imaging, additional CT scanning often reveals malalignment, primarily due to intra-articular incongruency.

1011 A Rare Case of Left Sided Hemiparesis Following a Pneumatic Gun-Shot Injury to Left Anterior Chest Wall in a 13-Year-Old Boy

Abstract Introduction Even though pneumatic weapons rarely cause severe direct trauma, pellet embolisation can lead to unexpected, catastrophic events. Case Report A 13-year-old, previously healthy boy was injured by an accidentally fired pneumatic gun, while playing with his twin brother. He sustained a penetrating wound to left anterior chest wall and resultant bleeding was self-limiting. He was hospitalised within 15minutes. On admission, he was hemodynamically stable with normal Respiratory, Cardiovascular and Neurological system findings. Entry wound measuring 5*5 mm was present at 5th intercostal space just left to the sternum. No exit wound was detected. Initial chest radiograph and ultra-sound abdomen and chest were normal. 2D echocardiogram revealed only a very thin layer(3mm) of pericardial effusion. Four hours later, He developed a focal seizure followed by left sided hemiparesis. Urgent NCCT brain and carotid artery duplex showed a high dense pellet in right internal carotid artery at the level of petrous temporal bone and hypo-dense Middle Cerebral Artery (MCA) suggestive of right MCA thrombosis. He was transferred to a tertiary care centre. Interventional radiological and endo-vascular attempts of pellet retrieval have been failed. Ischemic stroke pursued with worsening cerebral oedema; thus decompression craniotomy was performed on day 3. He is currently being rehabilitated in a specialised centre. Conclusions High degree of suspicion should be maintained on the possibility of projectile embolisation, in pneumatic gun-shot injuries, especially in the absence of an exit wound. Extensive early investigations should be performed to localise the projectile and retrieval should be planned.

Long-Term Clinical Outcomes Following Nonsurgical Management of Salter-Harris Type II Fractures of the Proximal Phalanx of the Small Finger: A Prospective Cohort Study

Juxta-physeal fractures at the base of the proximal phalanx (FBPP) of the small finger are one of the most common hand fractures in children. Although many of these fractures are treated nonsurgically, it is unclear which fractures benefit from surgery or the degree of acceptable angulation appropriate for nonsurgical management. Our study aimed to assess long-term, patient-reported outcomes regarding function, appearance, and pain after nonsurgical management of FBPP of the small finger in a pediatric population. Our hospital Picture Archiving and Communication Systems database was queried to identify radiographs of the small finger of children between the ages of 8 and 16 years old taken from 2011 to 2021. Displacement on initial injury radiographs was calculated using the diaphyseal-metacarpal head angle. Patient-reported function, appearance, and pain were measured using standardized assessment tools sent to patients and parents electronically. Optional clinical photographs were uploaded by parents and assessed for residual clinical deformity. One hundred eighty-one eligible subjects were identified. Eighty (44%) agreed to participate, and 40 (22%) parent and 38 patient surveys were completed. The mean age at the time of injury was 11 years old (8-14 years), and the mean age at the time of survey completion was 17 years old (11-23 years). Patient T-scores were higher than the average reference T-score on the Patient-Reported Outcomes Measurement Information System Short Form v2.0-Upper Extremity. Overall, greater than 78% of patients and parents reported appearance as 8/10 or above on a VAS. Ninety-five percent (108/114) of patients reported no pain (0/10) for pain during activities and at rest. Children with up to 26° of initial coronal plane angulation reported better function than a reference population, good appearance, and no pain, at a mean of 6 years after injury. Our findings support nonsurgical management of most FBPP of the small finger in children. Therapeutic IV.

Right-Sided Bochdalek Hernia Associated with Group B Streptococcal Sepsis in a Preterm Neonate.

We report here a compelling case of a premature female newborn who was originally treated for breathing difficulties that arose a few hours after delivery. The initial chest radiograph showed no abnormalities, and the blood culture detected sepsis caused by group B streptococcus (GBS). The antibiotic treatment was modified accordingly. Later on, she experienced a gradually increasing opacification in the right side of her chest, which did not respond to medical treatment. A subsequent imaging examination conducted a few days later indicated the presence of a hernia in the right side of the diaphragm. The neonate, who was 14 days old, received surgical intervention to fix the abnormality in the diaphragm. The procedure was successful, and there were no complications during the postpartum period. This case report aims to emphasize the distinctive correlation between early-onset GBS sepsis and the postponed occurrence of right-side diaphragmatic hernia.

Long-term clinical and radiographic outcomes of arthroscopic acromioclavicular stabilization for acute acromioclavicular joint dislocation.

Standard open acromioclavicular (AC) stabilization is associated with increased postoperative complications including deltoid injury, infection, tunnel complications, loss of reduction, and wound/cosmetic concerns. Arthroscopy may offer superior visualization and advantages that limit these risks. The aim of this prospective non-randomized study is to evaluate advantages and long-term reliability of arthroscopic AC stabilization. Thirty-two patients with acute grade III, IV and V AC dislocations underwent arthroscopic AC reconstruction with long-term assessment by clinical AC examination, Simple Shoulder Test, American Shoulder and Elbow Surgeons scores, visual analog scale, Specific AC Score and Quick Disabilities of the Arm, Shoulder and Hand scores. Radiographs verified conservation of initial reduction and presence of coracoclavicular (CC) ossifications. Complications, revision rate, and satisfaction were assessed and compared to the literature. Mean follow-up time was 67.6 months. All clinical outcome scores improved and differences were statistically significant (P<0.001). Initial postoperative radiographs consistently showed complete reduction. Two patients experienced relapse to grade II AC dislocation without clinical implications. In total, 71.8% showed CC ossifications without functional impairment, and in 31.3% concomitant injuries were observed. Reintervention rate was 9.4%, and 96.9% of patients were satisfied with procedure outcomes. Arthroscopic stabilization for acute AC joint dislocations offers satisfactory clinical and radiographic outcomes, and our results show that the arthroscopic technique is reliable in the long run. We report better reduction in maintenance, fewer complications, and similar reoperation rates compared to other techniques. Level of evidence: III.

Probability of Occult Ankle Fracture Based on Radiograph-Measured Swelling.

Pediatric ankle injuries are a common presentation in the emergency department (ED). A quarter of pediatric ankle fractures show no radiographic evidence of a fracture. Physicians often correlate non-weight bearing and tenderness with an occult fracture. We present this study to predict the probability of an occult fracture using radiographic soft-tissue swelling on initial ED radiographs. This is a retrospective study at a Level 1 pediatric trauma center from 2021 to 22. Soft-tissue swelling between the lateral malleolus and skin was measured on radiographs, and weight-bearing status was documented. Statistical analysis was conducted using Stata software. The study period involved 32 patients with an occult fracture, with 8 (25%) diagnosed with a fracture on follow-up radiographs. The probability of an occult fracture was calculated as a function of the ankle swelling in millimeters (mm) using a computer-generated predictive model. False-negative and false-positive rates were plotted as a function of the degree of ankle swelling. Magnitude of ankle soft-tissue swelling as measured on initial ED radiographs is predictive of an occult fracture. Although weight-bearing status was not a sign of occult fracture, it improves the predictive accuracy of soft-tissue swelling.