Intraoperative Radiographs Research Articles

Intraoperative arthrography monitoring assisted closed reduction and internal fixation for intercondylar fracture of humerus in children

To investigate clinical effects of intraoperative arthrography monitoring assisted closed reduction and internal fixation for intercondylar fracture of humerus in children. From January 2013 to July 2018, 18 children with intercondylar fracture of humerus were treated by operation, including 13 males and 5 females aged from 3 to 12 years old with an average age of (8.50±2.57) years old. According to Toniolo & Wilkinson classification, 8 children were typeⅠand 10 children were typeⅡ. During the operation, closed reduction and internal fixation were performed under the monitoring of intraoperative radiography, open reduction and internal fixation were performed in necessity. Mayo score of elbow joint was used to evaluate clinical effect at 6 months after operation. All children were underwent arthrography monitoring during operation, 5 children were treated with closed reduction and internal fixation for intraoperative arthrography found no fracture of articular cartilage, 11 children by closed reduction and internal fixation because of fracture of articular cartilage involving the joint space with displacement less than 2 mm, and 2 children by closed or open reduction and internal fixation for fracture of articular cartilage surface with displacement above 2 mm, which 1 child with smooth of joint surface was performed closed reduction and internal fixation, 1 child without smooth of joint surface and displacement above 2 mm was performed open reduction and internal fixation. All children were followed up from 8 to 26 months with an average of (20.28±4.40) months. All factures were healed from 6 to 9 weeks with an average of (7.33±0.77) weeks. Postoperative Mayo score of elbowjoint at 6 months was (89.44±11.36), and 12 patients got excellent results, 5 good and 1 poor. One patient occurred partial limitation of flexion or extension of elbow joint. No elbow deformity and other complications occurred. The treatment of intercondylar fracture of humerus in children under monitoring of intraoperative radiography could reduce opertaion injuries and complications, confirm the reduction effect of articular surface of cartilage in time and clearly, and promote recovery of elbow joint function.

Prediction of long-term postoperative results of disc wedge and vertebral tilt with intraoperative prone radiograph in posterior correction of thoracolumbar/lumbar curve in adolescent idiopathic scoliosis: a minimum 5-year follow-up

BACKGROUND CONTEXTPreservation of the more mobile lumbar segments is important during thoracolumbar/lumbar scoliosis surgery; however, the remaining disc wedge angle (DWA) below lowermost instrumented vertebra (LIV) and vertebral body tilt below LIV (LIV+1 tilt) can cause curve progression. PURPOSEThis study aimed to evaluate the efficacy of intraoperative radiograph to predict the postoperative DWA below LIV and LIV+1 tilt on standing radiographs in patients with LIV of L3 or L4. STUDY DESIGN/SETTINGRetrospective cohort study PATIENT SAMPLEA total of 235 patients with idiopathic scoliosis who underwent posterior correction and fusion for the structural thoracolumbar curve and were followed up for >5 years were reviewed. OUTCOME MEASURESDWA below LIV, LIV+1 tilt, Cobb angle, trunk shift, apical vertebra translation, and pelvic parameters were measured. METHODSCorrelation between intraoperative and postoperative measurements of DWA below LIV and LIV+1 tilt were assessed. Additional analysis was performed to identify risk factors and prognosis of LIV+1 tilt ≥10° and DWA below LIV of ≥4° RESULTSLIV+1 tilt measured on intraoperative radiograph was significantly correlated with the postoperative 5-day and postoperative 5-year evaluation in both groups. However, the intraoperative DWA below LIV was only correlated with the postoperative 5-year value in the L3 group (p=.018). At the 5-year follow-up, patients with LIV+1 tilt ≥10° on intraoperative radiography showed significantly greater LIV+1 tilt (p<.001), apical vertebral translation (p<.001), thoracic curve (p=.008), and thoracolumbar curve (p<.001) than patients with LIV+1 tilt <10°. Intraoperative DWA below LIV of ≥4° was only associated with higher DWA below LIV at the 5-year follow-up. CONCLUSIONSIntraoperative measurement of LIV+1 tilt was correlated with long-term postoperative outcomes, and intraoperative LIV+1 tilt ≥10° was associated with a less favorable radiographic outcome. Intraoperative DWA below LIV demonstrated less correlation with postoperative values and was not a prognostic factor for other radiographic parameters.

The Effect of Intraoperative Radiographs on Component Position and Leg Length during Routine Posterior Approach Total Hip Arthroplasty.

PurposeAccurate component placement and restoration of patient anatomy are critical in total hip arthroplasty (THA) surgery. Although intraoperative radiographs are sometimes utilized, it is unclear whether this practice can improve accuracy.Materials and MethodsThis study evaluated acetabular cup abduction, anteversion, leg length, and offset among 100 posterior approach THAs performed without imaging (No X-ray group) and compared them to a subsequent series of 100 THAs where an intraoperative radiograph was taken with the trial components in place (X-ray group). THAs were performed using a posterior approach by a single, experienced surgeon whose goal was to place the cup at 45° of abduction and 30° of anteversion. Supine anteroposterior pelvic digital radiographs taken at the first (nominal 4-week) postoperative visit were used for measurements.ResultsSlight differences in cup abduction (47°±6° vs 44°±6°, respectively, P=0.003) and anteversion angle (35°±6° vs 31°±6°, respectively, P<0.001) were observed between the X-ray and No X-ray groups; however, a similar proportion of cups within 10° of the target angles was observed (76% vs 83%, respectively, P=0.22). No difference in offset measurements (1.1±6.6 mm vs 0.3±6.9 mm, respectively, P=0.42) or leg lengths (0.3±3.8 mm vs 0.3±4.8 mm, respectively, P=0.94) was observed between the X-ray and No X-ray groups; however, the X-ray group showed less leg length variation (P=0.05).ConclusionIn this study, the routine use of intraoperative radiographs was not associated with improved implant positioning for uncomplicated primary THA.

Postoperative Correction in Idiopathic Scoliosis: Which Preoperative Imaging Technique Is Most Predictive?

Preoperative radiographic assessment of curve flexibility in patients with idiopathic scoliosis is important to determine Lenke classification, operative levels, and potential postoperative correction. However, no consensus exists regarding the optimal technique. We compared measurements from supine side bending (SB) and intraoperative traction radiographs under general anesthesia (TUGA) with actual postoperative correction followed for 1 year. We identified 235 patients with idiopathic scoliosis who underwent posterior spinal fusion with pedicle screw instrumentation between 2010 and 2018 who had preoperative and postoperative radiographs including standing posterior-anterior (PA) and lateral radiographs, preoperative SB radiographs, and TUGA radiographs. Curves were categorized into proximal thoracic, main thoracic/thoracolumbar (MT), and distal thoracolumbar/lumbar (TL/L) curves. Flexibility was calculated from SB and TUGA radiographs. Correction rates were calculated from 1 month and 1 year radiographs postoperatively. Bending radiographs that correlated significantly with postoperative correction with P<0.10 were eligible for inclusion. Preoperative demographics, etiology, deformity details, and surgical details were included in the multivariate models. On univariate analysis, TUGA radiographs correlated with postoperative correction at 1 month and 1 year on MT curves (r=0.214, P=0.001; r=0.209, P=0.001) and TL/L curves (r=0.280, P<0.001; r=0.181, P=0.006). Supine SB radiographs did not correlate with postoperative correction on either MT or T/TL curves. On multivariate analysis, major curve TUGA radiographs were independently associated with postoperative MT curve correction at 1 month (beta: 0.158, 95% confidence interval: 0.035-0.280, P=0.012) and 1 year (beta: 0.195, 95% confidence interval: 0.049-0.340, P=0.009). MT curve SB radiographs were not associated with postoperative major curve correction at 1 month (P=0.088). TUGA radiographs independently correlated with postoperative main thoracic and distal thoracolumbar/lumbar curve correction at 1 month and 1 year postoperatively. SB radiographs independently correlated only with TL/L curve correction at 1 year postoperatively. However, this correlation was not as strong as TUGA correction (beta of 0.280 vs. beta of 0.092). TUGA radiographs appear superior to SB radiographs at predicting curve correction after surgery. Level III.

Rapid, midline retroperitoneal exposure for four-level anterior lumbar interbody fusion-technical case atlas.

We describe a novel, rapid midline retroperitoneal operative technique in a patient, with multi-level degenerative scoliosis, who underwent an extensive L2-S1 anterior lumbar interbody fusion in addition to posterior instrumentation. Uniquely, our approach enables an essentially midline approach to the rectus muscle and uses the diminution of the transversalis fascia-to-peritoneum transition in the pelvis to provide expedited exposure—making it particularly helpful for ALIF exposure, retraction and intraoperative radiography. We minimize morbidity around the rectus sheath by dissecting only the medial rectus muscle and then gently, bluntly mobilizing the retroperitoneum from the deep pelvis cranially.

Can Postoperative Distal Adding-On be Predicted in Lenke Type 1B and 1C Curves with Intraoperative Radiographs?

A retrospective study of consecutive collected data. To investigate risk factors for postoperative distal adding-on (DA) in Lenke Type 1B and 1C curves using intraoperative radiographs. In adolescent idiopathic scoliosis (AIS), DA radiographic complication can negatively affect postoperative clinical results. However, few studies have focused on assessing risk factors for DA using intraoperative radiographs. We retrospectively evaluated 69 AIS patients with Lenke Type 1B or 1C curves who underwent posterior selective thoracic fusion. We divided patients into DA and non-DA groups based on radiograph data at 2-year follow-up using Wang et al (Spine 2011) definition of DA. We compared coronal radiographic parameters, including relative positions of end vertebra (EV), stable vertebra (SV), neutral vertebra (NV), and last touching vertebra (LTV) to lowest instrumented vertebra (LIV), and intraoperative radiographic parameters, between the two groups. DA was present in 13 patients (18.8%) at 2-year follow-up. The mean LIV-EV, LIV-NV, LIV-SV, and LIV-LTV relative positions were significantly smaller in the DA group than in the non-DA group. Multivariate analysis showed that LIV-LTV was significantly associated with DA (DA: -0.2 ± 0.7, non-DA: 0.6 ± 0.7). Intraoperative radiographs showed that the mean angulation of the first disc below the LIV after final adjustment was significantly larger in the DA group (2.3° ± 1.1°) than in the non-DA group (0.9° ± 0.7°). Patients whose angulation of the first disc below the LIV was more than 3° were significantly associated with DA. The LIV selected at more cranial to the LTV may be a risk factor for postoperative DA in Lenke Type 1B and 1C curves. Moreover, it was suggested that LIV extension might be considered when the first disc's angulation below the LIV is >3° in intraoperative radiographs.Level of Evidence: 3.

Étude comparative entre les vis à angle fixe et les vis poly-axiales dans la fixation du radius distal avec deux plaques verrouillées palmaires

IntroductionWhen treating a distal radius fracture with a volar locking plate (VLP), numerous plate-screw designs are available. To date, there is not a screw fastening system with a clear superiority among the others. HypothesisFixed-angle screws are superior to polyaxial screws in distal radius VLP fixation with respect to screw protrusion and reduction preservation. Material and methodsA prospective cohort study based on eighty patients was performed. The first forty patients were treated by polyaxial VLP (PA group) were the next forty by a fixed-angle VLP (FA group). Fixation was performed by the flexor carpi radialis approach. Screws were placed 2mm shorter than actual measurement and intraoperative AP, lateral and tilt wrist views were done routinely. A computed tomography (CT) was conducted searching for screw protrusion. Loss of reduction was calculated from the difference between post-operative X-rays values and those at the 6-month follow-up. The total follow-up was 12 months with no losses. ResultsPostoperative CT detected dorsal screw protrusion in 17 patients in PA group and 16 patients in FA group that intraoperative radiographs were assumed as correct (p=0.48). The mean invasion of dorsal cortex was of 2.2mm (1–7mm) for PA group and 2.6mm (1–5mm) for FA group (p=0.70). As from those protruding screws, the mean size was registered founding that fixed-angle screws had protrusions with shorter screws 20 vs. 22mm (p<0.05). Intraarticular screw protrusion was registered in 3 and 2 patients respectively (p>1.0). Experienced loss of reduction in volar tilt (p=0.42), radial inclination (p=0.75) and ulnar variance (p=0.83) were equivalent in both groups while a better preservation of the radial height in the PA group was observed (p<0.05). DiscussionsIn terms of screw protrusion rate, both fastening systems where similar. However, fixed-angle group invaded the dorsal cortex with shorter screws. Polyaxial screws were associated with a better preservation of the radial height. Finally, this study reinforces the idea that dorsal and articular screw protrusion is more frequent than we expected. Level of evidenceII; therapeutic, prospective cohort study.

Scaphotrapezoid Assessment during Thumb Carpometacarpal Arthroplasty: A Cadaveric Study.

Background Due to limited sensitivity of radiographs for scaphotrapeziotrapezoid (STT) arthritis and the high rate of concurrence between thumb carpometacarpal (CMC) and STT arthritis, intraoperative visualization of the STT joint is recommended during CMC arthroplasty. Purpose We quantified the percentage of trapezoid facet of the scaphotrapezoid (ST) joint that could be visualized during this approach, and compared it to the degree of preoperative radiographic STT arthritis. Methods We performed dorsal surgical approach to the thumb CMC joint after obtaining fluoroscopic anteroposterior, lateral, and oblique wrist radiographs of 11 cadaver wrists. After trapeziectomy, the ST joint was inspected and the visualized portion of the trapezoid articulation marked with an electrocautery. The trapezoid was removed, photographed, and the marked articular surface area and total surface area were independently measured by two authors using an image analysis software. The radiographs were analyzed for the presence of STT arthritis. Results The mean visualized trapezoid surface area during standard approach for CMC arthroplasty was 60.3% (standard deviation: 24.6%). The visualized percentage ranged widely from 16.7 to 96.5%. There was no significant correlation between degree of radiographic arthritis and visualized percentage of the joint ( p = 0.77). Conclusions: On average, 60% of the trapezoid joint surface was visualized during routine approach to the thumb CMC joint, but with very large variability. Direct visualization of the joint did not correlate with the degree of radiographic STT arthritis. Clinical Relevance A combination of clinical examination, pre- and intraoperative radiographs, and intraoperative visualization should be utilized to assess for STT osteoarthritis and determine the need for surgical treatment. Level of Evidence This is a Cadaveric Research Article.

Plafond Malreduction and Talar Dome Impaction Accelerates Arthrosis After Supination-Adduction Ankle Fracture.

Supination-adduction (SAD) type II ankle fractures can have medial tibial plafond and talar body impaction. Factors associated with the development of posttraumatic arthritis can be intrinsic to the injury pattern or mitigated by the surgeon. We hypothesize that plafond malreducton and talar body impaction is associated with early posttraumatic arthrosis. A retrospective cohort of skeletally mature patients with SAD ankle fractures at 2 level 1 academic trauma centers who underwent operative fixation were identified. Patients with a minimum of 1-year follow-up were included. The presence of articular impaction identified on CT scan was recorded and the quality of reduction on final intraoperative radiographs was assessed. The primary outcome was radiographic ankle arthrosis (Kellgren-Lawrence 3 or 4), and postoperative complications were documented. A total of 175 SAD ankle fractures were identified during a 10-year period; 79 patients with 1-year follow-up met inclusion criteria. The majority of injuries resulted from a high-energy mechanism. Articular impaction was present in 73% of injuries, and 23% of all patients had radiographic arthrosis (Kellgren-Lawrence 3 or 4) at final follow-up. Articular malreduction, defined by either a gap or step >2 mm, was significantly associated with development of arthrosis. Early treatment failure, infection, and nonunion was rare in this series. Malreduction of articular impaction in SAD ankle fractures is associated with early posttraumatic arthrosis. Recognition and anatomic restoration with stable fixation of articular impaction appears to mitigate risk of posttraumatic arthrosis. Investigations correlating postoperative and long-term radiographic findings to patient-reported outcomes after operative treatment of SAD ankle fractures are warranted. Level IV, retrospective case series.

The Importance of Intraoperative Plain Radiographs during Cochlear Implant Surgery in Patients with Normal Anatomy

Although malpositioning of the cochlear implant (CI) electrode array is rare in patients with normal anatomy, when occurring it may result in reduced hearing outcome. In addition to intraoperative electrophysiologic tests, imaging is an important modality to assess correct electrode array placement. The purpose of this report was to assess the incidence and describe cases in which intraoperative plain radiographs detected a malpositioned array. Intraoperative anti-Stenver’s view plain X-rays are conducted routinely in all CI surgeries in our tertiary center before awakening the patient and breaking the sterile field. Data of patients undergoing 399 CI surgeries were retrospectively analyzed. A total of 355 had normal inner ear and temporal bone anatomy. Patients with intra or extracochlear malpositioned electrode arrays demonstrated in the intraoperative X-ray were described. There were four cases of electrode array malposition out of 355 implantations with normal anatomy (1.1%): two tip fold-overs, one extracochlear placement and one partial insertion. All electrodes were reinserted immediately; repeated radiographs were normal and the patients achieved good hearing function. Intraoperative plain anti-Stenver’s view X-rays are valuable to confirm electrode array location, allowing correction before the conclusion of surgery. These radiographs are cheaper, faster, and emit much less radiation than other imaging options, making them a viable cost-effective tool in patients with normal anatomy.

Lost clips after targeted lymph node biopsy in breast cancer patients: Follow-up of the CLIP-study

IntroductionClipping and selective removal of axillary lymph nodes in breast cancer patients presenting with initially node-positive disease and achieving a nodal downstaging after primary systemic therapy is a less invasive method for axillary staging. An imaging guided localization and successful extirpation of these clipped lymph nodes is not possible in all patients. To date no follow-up data regarding patients with lost clips are available. Material and methodsThe oncological outcome of all participants of the CLIP-study and the results of postoperative axillary imaging in those patients with unproven clip resection are presented. ResultsA total of thirty patients were included into the pilot study. In ten of these patients (33%) the removal of the clipped axillary lymph node could not be verified by intraoperative radiograph. Postoperative imaging did not find lost clips in eight of these ten patients (80%). The lost clip was detected in two patients after surgery (20%), by mammography in one patient during routine follow-up and by computed tomography scan in one patient before radiotherapy. After a median follow-up of 40 months, 26 (87%) patients were still alive. Seven patients (23%) developed distant recurrent disease. No local or axillary recurrences were observed. ConclusionLost clips were detected by postoperative imaging only in a minority of patients. The impact of lost clips on axillary recurrences in breast cancer patients is still unclear and should be further clarified in larger, multicentric trials.

Medial Patellofemoral Ligament Reconstruction: Use of All-Suture Anchors for Patellar Fixation and a Dynamic Femoral Attachment

The medial patellofemoral ligament is one of the most relevant structures preventing patellar dislocation. Numerous surgical techniques have been described to reconstruct this structure and patellar biomechanics. Complications after this procedure concern both patella and femur. This technique avoids tunneling the patella and the use of intraoperative radiographs by using the adductor magnus tendon insertion.

Intraoperative Radiographic Detection of Intrapelvic Acetabular Screw Penetration: Lessons Learned From Our Trauma Colleagues.

BackgroundIntraoperative vascular injury during total hip arthroplasty represents a catastrophic complication. Acetabular screw placement represents one possible mode of injury. The purpose of this study was to evaluate the utility of various fluoroscopic views in the detection of intrapelvic screw penetration.MethodsA radiopaque pelvis Sawbones model was instrumented with a hemispherical acetabular component. Four intrapelvic quadrants were defined. Screws were placed, 3 in each quadrant, and imaged sequentially at 3 depths: 0 mm, 5 mm, and 10 mm penetrated. Eight fluoroscopic images were used: anteroposterior, inlet, outlet, iliac oblique, obturator oblique, “down the wing,” obturator outlet, and a “quad” view. Three blinded, independent surgeons evaluated the images for intrapelvic screw penetration. Images were analyzed in isolation and as a “triple-shot series” consisting of the “quad,” obturator outlet, and iliac oblique views. Sensitivity and specificity values were then calculated.ResultsIn isolation, the “quad” view had the highest sensitivity for screw penetration (62%). The triple-shot series was found to be 100% sensitive in all 4 quadrants for detecting 10 mm of screw penetration. The specificity of the series was found to be 100% in all quadrants except for the posterior superior quadrant where it was 67%. Interobserver agreement approached perfection (Kappa ≥0.947) between all surgeons (P < .001) when using the 3-view series.ConclusionsThis study is the first to assess the use of fluoroscopy in the detection of intrapelvic penetration of transacetabular screws. We found that a 3-radiograph series provided a sensitive and specific metric for the detection of intrapelvic screw penetration.

Identification of a localization wire tip in an occult breast lesion using a handheld magnetometer.

The Sentimag hand-held probe detects the magnetic response from iron oxide particles trapped in a sentinel node. To investigate if an electromagnetic probe can be helpful in the identification of a hook wire tip located in an occult breast lesion. Forty-two patients undergoing lumpectomy without axillary procedure were enrolled. In all cases, suspicious non-palpable microcalcifications without mass were found, and a vacuum-assisted stereotactic biopsy was performed. On the day of surgery, a traditional localization wire (LW) was placed under imaging guidance. The Sentimag magnetometer was used to precisely detect the wire tip through the skin. Then, the skin incision was made and Sentimag was used again to guide the surgeon to the lumpectomy bed. The accuracy of excision was assessed with intra-operative specimen 3D tomosynthesis. Median lesion size was 16 mm (range: 4-38 mm) and median depth was 33 mm (range: 14-78 mm). In all cases, the wire tip was successfully identified. Neither wire displacement nor transection occurred. Intraoperative radiography demonstrated doubtful margin requiring selective cavity shaving in 6 patients (14%). The need for cavity shaving was significantly influenced by the lesion size and histology: median size 30 mm (range: 24-38 mm) compared to 15 mm (range: 4-28 mm) and histology of ductal carcinoma in situ (DCIS) compared to atypical ductal hyperplasia (ADH) and lobular neoplasia (LN). Tumors requiring cavity shaving tended to be deeper - they had a median depth of 43 mm (range: 17-78 mm) compared to 32 mm (range: 14-76 mm) in patients who did not need cavity shaving, but this parameter was statistically significant. Intraoperative identification of the wire tip using Sentimag is a simple technique facilitating targeted excision without excessive removal of breast tissue. Since it is not associated with additional costs, it may be worth considering, particularly in developing countries.

Clinical utility of immediate postoperative radiographs following uncomplicated primary reverse shoulder arthroplasty.

It is common practice to order an immediate postoperative radiograph in the postanesthesia care unit (PACU) following reverse shoulder arthroplasty (RSA). However, with a growing emphasis on value-based care and cost-effectiveness, we question the necessity for immediate postoperative radiographs following uncomplicated, primary RSA. From 2014-2020, patients undergoing primary RSA at a single institution by one of 3 surgeons were included in this cohort. Radiographs from the PACU and any clinic visit during the initial 3-month postoperative period were reviewed to determine if any radiographic findings from the PACU altered clinical care or decision making. A total of 157 patients were included in this study and 13 patients had abnormal findings during the initial 3-month postoperative period where the immediate postoperative radiograph provided clinical utility for decision making. In 9 of the 12 patients requiring revision surgery, the postoperative complication was instability. In those patients requiring revision surgery during the initial 3 months, the most common indication for primary surgery was proximal humerus nonunion. Immediate postoperative radiographs were read by the radiologist as normal/unremarkable for 100% of patients. The typical amount billed for the immediate postoperative radiograph was $544.00 per patient. Based on our findings, we see utility for an intraoperative or immediate postoperative radiograph following uncomplicated, primary RSA, especially when done as a salvage procedure for indications such as proximal humerus nonunion. However, there is low utility for obtaining an immediate postoperative radiograph in the PACU when indications include osteoarthritis or rotator cuff tear arthropathy.

Ultrasound-assisted closed reduction and percutaneous pinning for displaced and rotated lateral condylar humeral fractures in children.

It is difficult for surgeons to successfully perform closed reduction and percutaneous pinning on displaced and rotated lateral condylar humeral fractures in children. This study aimed to introduce an ultrasound-assisted closed reduction and percutaneous pinning technique and determine its usefulness in the treatment of displaced and rotated lateral condylar humeral fractures in children. Between 2013 and 2018, 42 of 44 displaced and rotated pediatric lateral humeral condylar fractures were successfully treated with ultrasound-assisted closed reduction and percutaneous pinning. All surgical procedures were performed by 1 senior surgeon. Demographic and clinical data including age, sex, affected side, time from injury to reduction, operative time, and number of intraoperative radiographs (without fluoroscopy) were analyzed. Postoperative data were evaluated in terms of Kirschner wire in situ duration, follow-up duration, range of motion, carrying angle, cosmetic result, and complications. The average operative time was 67 minutes from 2013 to 2015 and 51 minutes from 2016 to 2018. All 42 patients who successfully underwent ultrasound-assisted closed reduction were followed up for >3 months, and 31 of 42 patients were followed up for >1 year. Among these 31 patients, the range-of-motion outcomes were excellent in 25 and good in 6. The carrying angle outcomes were excellent in 28 patients and good in 3. Two instances of wire infection, 9 instances of granulation tissue hyperplasia, and 23 instances of lateral spur formation occurred. No nonunion, avascular necrosis, or postoperative nerve issues were identified. The surgical technique of ultrasound-assisted closed reduction and percutaneous pinning presented in this study can effectively help surgeons reduce displaced and rotated lateral condylar humeral fractures in children to avoid some open reductions and achieve satisfactory outcomes.

Endplate injury as a risk factor for cage retropulsion following transforaminal lumbar interbody fusion: An analysis of 1052 cases.

Although transforaminal lumbar interbody fusion (TLIF) is a widely accepted procedure, major complications such as cage retropulsion (CR) can cause poor clinical outcomes. Endplate injury (EI) was recently identified as a risk factor for CR, present in most levels developing CR. However, most EIs occurred in non-CR levels, and the features of EIs in CR levels remain unknown.The aim of this study was to identify risk factors for CR following TLIF; in particular, to investigate the relationship between EIs and CR, and to explore the features of EIs in CR.Between October 2010 and December 2016, 1052 patients with various degenerative lumbar spinal diseases underwent bilateral instrumented TLIF. Their medical records, radiological factors, and surgical factors were reviewed and factors affecting the incidence of CR were analyzed.Twenty-one patients developed CR. Nine had back pain or leg pain, of which six required revision surgery. A pear-shaped disc, posterior cage positioning and EI were significantly correlated with CR (P < .001, P = .001, and P < .001, respectively). Computed tomography (CT) scans revealed the characteristics of EIs in levels with and without CR. The majority of CR levels with EIs exhibited apparent compression damage in the posterior part of cranial endplate on the decompressed side (17/18), accompanied by caudal EIs isolated in the central portion. However, in the control group, the cranial EIs involving the posterior part was only found in four of the total 148 levels (P < .001). Most of the injuries were confined to the central portion of the cranial or caudal endplate or both endplates (35 in 148 levels, 23.6%). Additionally, beyond cage breaching into the cortical endplate on lateral radiographs, a characteristic appearance of coronal cage misalignment was found on AP radiographs in CR levels with EIs.A pear-shaped disc, posterior cage positioning and EI were identified as risk factors for CR. EI involving the posterior epiphyseal rim had influence on the development of CR. Targeted protection of the posterior margin of adjacent endplates, careful evaluation of intraoperative radiographs, and timely remedial measures may help to reduce the risks of CR.

Does preoperative and intraoperative imaging for anterior vertebral body tethering predict postoperative correction?

Anterior vertebral body tethering (AVBT) is an emerging approach for idiopathic scoliosis. However, overcorrection and under-correction are common causes of revision surgery, and intraoperative tensioning of the cord is one key component to achieve appropriate curve correction. We sought to determine whether preoperative flexibility radiographs or intraoperative radiographs would predict correction at first erect imaging for scoliosis patients undergoing anterior vertebral body tethering (AVBT). Single-center retrospective review. Fifty-one patients with a diagnosis of idiopathic scoliosis underwent anterior body tethering. Preoperative flexibility films and intraoperative radiographs were compared to first erect standing radiographs to determine if there was a correlation in Cobb angle. Preoperative major Cobb angle measured 52° ± 9°. Major Cobb angle on bending films was 24° ± 8°. Intraoperative imaging showed correction to a mean of 17° ± 8°. Postoperative first erect standing radiographs showed correction to a mean of 26° ± 10°. The mean difference in major Cobb angle between intraoperative radiograph and a first erect radiograph was 10° ± 4°, whereas the mean difference from preoperative bending radiograph at first erect was 2° ± 7°. Thus, correction on preoperative flexibility films correlated with the first erect radiograph. Preoperative bending radiographs provide a reasonable estimate of postoperative correction for patients undergoing AVBT with tensioning of the cord. Surgeons should expect the major Cobb angle to increase on first erect radiographs compared to intraoperative radiographs. These findings may guide patient selection and assist surgeons in achieving appropriate correction intraoperatively.

Comparative study between fixed-angle and polyaxial screws in distal radius fixation with two volar locking plates

IntroductionWhen treating a distal radius fracture with a volar locking plate (VLP), numerous plate-screw designs are available. To date, there is not a screw fastening system with a clear superiority among the others. HypotesisFixed-angle screws are superior to polyaxial screws in distal radius VLP fixation with respect to screw protrusion and reduction preservation. Material and methodsA prospective cohort study based on eighty patients was performed. The first forty patients were treated by polyaxial VLP (PA group) were the next forty by a fixed-angle VLP (FA group). Fixation was performed by the flexor carpi radialis approach. Screws were placed 2mm shorter than actual measurement and intraoperative AP, lateral and tilt wrist views were done routinely. A computed tomography (CT) was conducted searching for screw protrusion. Loss of reduction was calculated from the difference between post-operative x-rays values and those at the 6-month follow-up. The total follow-up was 12 months with no losses. ResultsPostoperative CT detected dorsal screw protrusion in 17 patients in PA group and 16 patients in FA group that intraoperative radiographs were assumed as correct (p=0.48). The mean invasion of dorsal cortex was of 2.2mm (1–7mm) for PA group and 2.6mm (1–5mm) for FA group (p=0.70). As from those protruding screws, the mean size was registered founding that fixed-angle screws had protrusions with shorter screws 20 vs. 22mm (p<0.05). Intraarticular screw protrusion was registered in 3 and 2 patients respectively (p>1.0). Experienced loss of reduction in volar tilt (p=0.42), radial inclination (p=0.75) and ulnar variance (p=0.83) were equivalent in both groups while a better preservation of the radial height in the PA group was observed (p<0.05). DiscussionsIn terms of screw protrusion rate, both fastening systems where similar. However, fixed-angle group invaded the dorsal cortex with shorter screws. Polyaxial screws were associated with a better preservation of the radial height. Finally, this study reinforces the idea that dorsal and articular screw protrusion is more frequent than we expected. Level of evidenceII; therapeutic, prospective cohort study.

Intraoperative Radiographs in Single-level Lateral Lumbar Interbody Fusion Can Predict Radiographic and Clinical Outcomes of Follow-up 2 Years After Surgery.

Some of the improvements in DH, FH, and SLL achieved intraoperatively during lateral lumbar interbody fusion surgery were lost by the postoperative 1-week follow-up. An intraoperative radiograph can predict radiographic and clinical outcomes of the 2-year follow-up. The difference between preoperative DH and intraoperative DH should be >4.18 mm.