Lateral X-ray Films Research Articles

The Precise Bending Rod Technique: A Novel Method for Precise Correction of Ankylosing Spondylitis Kyphosis.

To report a new technique. To introduce a new method of precise correction controlling for ankylosing spondylitis kyphosis. The exact angle method is excellent for calculating the pedicle subtraction osteotomy angle but is difficult to perform during surgery. In this study, the precise rod bending technique was proposed as a new method for precise correction controlling for ankylosing spondylitis kyphosis through illustrative cases. A preoperative plan using the exact angle method, with exact osteotomy angle and level determined, was prepared using a whole-spine lateral x-ray film. Then a precise contoured rod imitating the predicted spine correction was obtained using the lateral spine x-ray film that was of the actual size of the trunk. This rod model was disinfected and used for precisely controlling kyphosis correction in ankylosing spondylitis patients with good cervical spine and hip joints. Four ankylosing spondylitis kyphosis patients were successfully corrected using the precise bending rod technique. Their mean age was 31 years, the mean operative time was 247 minutes (160-320 min), the mean volume of bleeding was 1482 mL (727-2700 mL), and the average follow-up period was 13.8 months (9-17 mo). All patients regained their sagittal balance (all C7-SSVL≤2 cm). The predicted ostetomy degree was accurate to within 2 degrees compared with the achieved degree at the osteotomy site. No complications occurred during or after surgery. The precise rod bending technique is a simple, effective method for precise correction of kyphosis caused by ankylosing spondylitis. The surgical result corresponded to the preoperative planning.

ARTHROSCOPICALLY ASSISTED TREATMENT OF POSTERIOR CRUCIATE LIGAMENT AVULSION FRACTURE WITH MENISCUS POSTERIOR HORN TEAR

To evaluate the effectiveness of arthroscopically assisted treatment of posterior cruciate ligament (PCL) tibial eminence avulsion fractures associated with meniscus posterior horn tear. Between January 2012 and December 2014, 21 patients with PCL avulsion fracture and meniscus posterior horn tear were arthroscopically treated with polyester suture and hollow screw fixation. There were 10 males (10 knees) and 11 females (11 knees), aged 14-53 years (mean, 35.7 years). The causes included sport injury in 11 cases, traffic accident injury in 9 cases, and daily life injury in 1 case. Based on the anteroposterior and lateral X-ray films, CT, and MRI, PCL avulsion fractures were diagnosed, and 2 cases had anterior cruciate ligament avulsion fractures. The results of posterior drawer test were positive in all patients, with no end point in 14 cases and with soft end point in 7 cases; all patients showed tibial sink. The preoperative International Knee Documentation Committee (IKDC) score and Lysholm score were 46.5±5.5 and 43.3±4.5 respectively. The time from injury to operation was 6-22 days (mean, 10 days). The operation time was 60-100 minutes (mean, 75 minutes). Primary healing of incision was obtained in all patients, without no complication of infection. The mean follow-up time was 27.4 months (range, 12-46 months). The results of posterior drawer test were negative in 19 cases, and positive in 2 cases (having hard end point). Tibial sink disappeared. At last follow-up, X-ray film showed good healing of fracture, and no displacement. The patients had no locking knee, snapping or tenderness of joint space, and the Mcmurray sign was negative; the IKDC score and Lysholm score were significantly improved to 92.0±2.5 and 92.7±2.6 respectively (t=-39.903, P=0.000; t=-43.242, P=0.000). The range of motion was normal in 20 patients (0-130°) except 1 patient having limited flexion (0-80°), whose range of motion returned to 0-120° after release. The arthroscopic fixation technique has satisfactory results for the reduction and fixation of PCL avulsion fracture associated with meniscus posterior horn tear because of easy operation, firm fixation, and economic price.

TREATMENT OF PRONATION EXTERNAL ROTATION ANKLE FRACTURE COMBINED WITH SEPARATION OF DISTAL TIBIOFIBULAR SYNDESMOSIS

To evaluate the difference between using and not using syndesmotic screw to treat pronation external rotation (PER) ankle fracture combined with separation of distal tibiofibular syndesmosis. Between April 2011 and October 2014, 46 cases of PER ankle fracture combined with separation of distal tibiofibular syndesmosis were treated, and syndesmotic screw was used in 24 cases (fixation group) and syndesmotic screw was not used in 22 cases (non-fixation group). There was no significant difference in gender, age, weight, cause of injury, side, injury to operation time, and fracture type between 2 groups (P>0.05). The time for full weight-bearing, fracture healing time, and complications were recorded after operation. Anteroposterior and lateral X-ray films were taken to measure the tibiofibular overlap (TBOL) and tibiofibular clear space (TBCS). Baird-Jackson score was used to evaluate functional recovery of the ankle. All incision healed by first intention without complications. The cases were followed up 13-18 months (mean, 15.2 months) in 2 groups. The time for full weight-bearing was 8-12 weeks (median, 11 weeks) in fixation group, which was significantly later than that in non-fixation group (range, 6-10 weeks; median, 8 weeks) (Z=-5.049, P=0.000). X-ray examination showed reduction of separation of distal tibiofibular syndesmosis. All fractures healed. The fracture healing time was (13.83±1.37) weeks in fixation group, and was (13.91±1.31) weeks in non-fixation group, showing no significant difference (t=-0.191, P=0.945). No separation of distal tibiofibular syndesmosis, delayed union, nonunion, loosening, or breakage of fixation devices was observed in 2 groups. There was no significant difference in TBOL, TBCS, Baird-Jackson score and the excellent and good rate between 2 groups (P>0.05). If the medial, lateral, and posterior structures of the ankle could be repaired according to injury, no significant influence on functional outcome of ankle or radiologic findings could be detected whether syndesmotic fixation is given or not in treating PER ankle fracture (exclude Maisonneuve fracture) combined with separation of distal tibiofibular syndesmosis.

PREVALENCE AND RISK FACTORS OF OTITIS MEDIA WITH EFFUSION IN SCHOOL AGE CHILDREN

Otitis media with effusion, which refers to the accumulation of fluid in the middle ear cavity without any signs of infection, is a common health problem both in pre-school and school age children. The etiology of otitis media with effusion is multifactorial and many risk factors may increase its incidence. The aim of this study is to determine the frequency and risk factors of otitis media with effusion in school age children in Basrah. In this descriptive prospective study; sixty patients aged between 6-12 years were included; they were 34 males and 26 females diagnosed as having otitis media with effusion in the period between July 2013 to April 2014; at Basrah General Hospital, Iraq. Pure tone audiometry, tympanometry, and lateral x-ray film of post nasal space were done for each patient after a full ENT history and examination . A questionnaire form was constructed to apply for each patient including the possible risk factors for developing otitis media with effusion such as age group, gender, parental smoking, allergy, history of acute infection, maternal education, family income, school type. Otitis media with effusion was found to be higher (66.7%) in children aged between 6-8 years, males more than females with male to female ratio 1.3:1. (61.6%) were from rural area, parental smoking present in (65%), (58.3%) had history of allergy, (66.6%) with history of upper respiratory tract infection, low maternal educational level, low financial income (66.6%), attendance to public school, and the presence of adenoid hypertrophy (71%) were found to be associated with otitis media with effusion. Conclusion and Recommendation: Environmental, epidemiologic and familial factors play an important role in etiology of otitis media with effusion. The parents must be informed about these modifiable risk factors, by this way the development or delayed diagnosis of the disease that may cause serious consequences can be prevented.

COMPARATIVE STUDY ON FIXATION WITH PERCUTANEOUS CANNULATED SCREWS ASSISTED BY ROBOT NAVIGATION AND CONVENTIONAL SURGERY WITH MANUAL POSITIONING FOR FEMORAL NECK FRACTURES

To investigate the effectiveness and the advantage of fixation with percutaneous cannulated screws assisted by robot navigation in the treatment of femoral neck fractures by comparing with the conventional surgery. Between January 2013 and December 2014, 20 patients with femoral neck fracture were treated by internal fixation with percutaneous cannulated screws assisted by robot navigation (navigation group), another 18 patients undergoing conventional surgery with manual positioning were chosen as the control group. There was no significant difference in gender, age, cause of injury, the injury side, time from injury to operation, and the classification of fractures between 2 groups (P > 0.05). The operation time, X-ray fluoroscopy time, blood loss, frequency of guide pin insertion, and healing time were recorded. At 1 week after operation, the parallel degree of screws was measured on the anteroposterior and lateral X-ray films; the Harris score was used to evaluate the hip function. All incisions of 2?groups healed by first intention after operation. There was no significant difference in operation time between 2?groups (t= -1.139, P=0.262). The blood loss, frequency of guide pin insertion, and X-ray fluoroscopy time of navigation group were significantly less than those of control group (P < 0.05). There were 2 screws penetrating into the joint cavity in control group. The patients were followed up 12-24 months with an average of 18 months. The navigation group got significantly better parallel degree of screws than control group on the anteroposterior and lateral X-ray films (t=25.021, P=0.000; t=18.659, P=0.000). Fractures healed in all patients of navigation group (100%), and the healing time was (21.8±2.8) weeks; fracture healed in 16 patients of control group (88.9%), and the healing time was (24.0 ± 3.7) weeks. There was no significant difference in healing rate and healing time between 2 groups (χ2=2.346, P=0.126; t=1.990, P=0.055). The Harris score of navigation group (87.1±3.7) was significantly higher than that of control group (79.3±4.7) at last follow-up (t= -5.689, P=0.000). Cannulated screw fixation assisted by robot navigation is a good method to treat femoral neck fractures, which has the advantages of more accurate positioning, better hip function recovery, less surgical trauma, and shorter X-ray exposure time.

PEDICLE SUBTRACTION OSTEOTOMY ASSISTED WITH ANTERIOR COLUMN RECONSTRUCTION FOR TREATMENT OF CHRONIC OSTEOPOROTIC VERTEBRAL COMPRESSION FRACTURE

To evaluate the effectiveness of pedicle subtraction osteotomy (PSO) assisted with anterior column reconstruction in the treatment of chronic osteoporotic vertebral compression fracture (OVCF). Between January 2008 and October 2014, 11 cases of chronic OVCF were treated. There were 2 males and 9 females, aged 65-76 years (mean, 72.3 years). The vertebral compression fracture segment involved T11 in 2 cases, T12 in 2 cases, L1 in 4 cases, L2 in 2 cases, and L3 in 1 case. At preoperation, the Oswestry disability index (ODI) score was 31.1±10.2; kyphosis Cobb angle of fractured vertebrae was (36.5±10.2)° on the lateral X-ray films of the spine; and distance between C7 plumb vertical line (C7 PL) and sagittal vertical axis (SVA) of the S1 superior border was (5.2±2.5) cm. Six cases had spinal cord injury (SCI), including 4 cases of Frankel grade C and 2 cases of grade D. At last follow-up, ODI score, kyphosis Cobb angle of fractured vertebrae, and distance between C7 PL and SVA were recorded and compared with preoperative values. Postoperative Frankle scores were recorded in SCI cases. X-ray film and CT scan were taken to evaluate bone fusion at 12 months after operation. The operation was completed successfully without serious complications. Nerve root radiation symptoms occurred in 2 cases undergoing lumbar PSO, which was relieved after conservative treatment. Cerebrospinal fluid leakage occurred in 1 case and was cured after 2 weeks. All cases were followed up 12-24 months (mean, 15.6 months). No internal fixation failure or pseudarthrosis was found postoperatively.Screw loosening was found in 1 case (2 screws of the upper level) and titanium Cage cutting vertebral body was found in 1 case. Bone fusion was obtained in all cases at 12 months after operation. At last follow-up, ODI score was significantly improved to 13.7±5.7(t=4.417, P=0.018), kyphosis Cobb angle of fractured vertebrae to (7.0±15.2)° (t=5.113, P=0.009), and the distance between C7 PL and SVA to (2.8±2.2) cm (t=3.285, P=0.032). In 6 SCI cases, Frankle grade was recovered to E (1 case), to D (1 case), and no improvement (2 cases) from C, and to E from D (2 cases). PSO assisted anterior column reconstruction was an effective method in treatment of chronic OVCF.

Cephalometric norms among a sample of Yamani adults

BackgroundCephalometric norms are decisive in diagnosis and treatment planning which differ in morphological feature among different ethnic and racial group. The aim of this study was to establish the cephalometric standards for skeletal and dental relationships for Yemeni population. Material and methodsOne hundred ninety-four Yemeni university students (105 females and 89 males) aged 18–25 years, were selected from dental students in Sana’a. All participants had Class I occlusion with normal growth, facial symmetry, and no previous orthodontic, orthopedic or maxillofacial surgery treatment. A Lateral cephalometric X-ray film was taken from each selected students. Each film was traced and analyzed according to Harvold's Cephalometric Analysis. ResultsStatistical significant differences were reported among genders in the skeletal sagittal relations; SNB, ANB, SNPg and SNBa angles, whereas, SNA angle showed no significant differences. The skeletal vertical inclination also showed statistical significant differences in ML-NL, NL-NSL, ML-NSL and Gn-tgo-Ar variables.Yemeni males had statistically significant higher upper and lower facial height than female and no significant difference between genders in the dental relationship variable except for the I-NB line which is statistically higher in female. ConclusionThe results of Yemeni cephalometric features showed ethnic differences in skeletal and dento alveolar relationship, sympathetic of the dento facial pattern of each population will ensure better results of treatment in ascertain optimal facial harmony.

Minimally invasive spine surgery for thoracolumbar vertebral fracture using a movable window method

Objective To investigate the efficacy of surgery for thoracolumbar vertebral fracture using a movable window method. Methods From September 2009 through September 2014, 24 patients with thoracolumbar vertebral fracture were treated at our department. They were 14 men and 10 women, with an average age of 31.2 years (range, 20 to 45 years). All the patients suffered from fracture of single segment, involving T8 in one, T10 in one, T11 in 3, T12 in 10, L1 in 8, and L2 in one. All the patients were treated with pedicle screw fixation through the multifidus and longissimus approach (the Wiltse approach) using a movable incision window method. Preoperatively, the movable distance between cranial and caudal skin was measured. The anteroposterior and lateral X-ray films were taken for radiological evaluation at follow-ups. Clinical outcomes were also evaluated pre- and postoperatively using visual analog scale (VAS) and Oswestry disability index (ODI). Results The movable distance of skin: craniad: 1.3 cm to 6.0 cm (mean, 3.0±0.9 cm); caudad: 0.9 cm to 2.0 cm (mean, 1.7±0.7 cm); total longitudinal move: 4.0 cm to 6.2 cm (mean, 4.8±0.4 cm). The 5 cm incision, through which internal fixation was performed, was positioned between the lower margin of the index spinal process and the lower margin of the cranial spinal process. The follow-ups ranged from 8 to 18 months. The radiological findings at the last follow-up revealed satisfying fracture reduction without loosening or breakage of the instrumentation. The VAS and ODI were significantly improved after surgery. Conclusion The movable window method, based on the human skin mobility, can be used to facilitate the thoracolumbar vertebral surgery via the multifidus and longissimus approach. Key words: Thoracic vertebrae; Lumber vertebrae; Fractures, bone; Surgical procedures, minimally invasive

Imageologic analysis of thoracolumbar burst fracture of Denis type B

Objective To investigate the roles of pedicle fracture and vertebral compression in thoracolumbar burst fractures of Denis type B. Methods A total of 211 patients with burst fracture of Denis type B were reviewed who had been treated at our department from September 2007 to May 2014. They were analyzed in terms of age, gender, diagnosis, fractured segmental level, ASIA (American Spinal Injury Association) grade of spinal cord injury, and preoperative imaging data (spinal CT and anteroposterior and lateral X-ray films). The associations of pedicle fracture (intact pedicle, unilateral and bilateral pedicle fractures) and vertebral compression (≤1/2 versus>1/2) with age, gender, fractured segmental level and ASIA grade were analyzed statistically. Results Of all the 215 fractured segments of Denis type B, 134 had intact pedicle (62.3% ), 60 unilateral pedicle fracture (27.9% ), and 21 bilateral pedicle fracture (9.8% ). 156 segments (72.6% ) had ≤1/2 vertebral compression and 59>1/2 compression (27.4% ). The incidence of pedicle fracture was 18.9% in cases of ≤1/2 vertebral compression and 36.4% in cases of>1/2 compression. Age, gender, and fractured segmental level had no significant effects on either pedicle fracture or vertebral compression (P>0.05). ASIA grade had a significant effect on pedicle fracture (P=0.020) and there was a linear association between ASIA grade and pedicle fracture (χ2=12.190, P=0.000; Spearman rank correlation coefficient=0.187, P=0.006). ASIA grade had no significant effect on vertebral compression (χ2=3.523, P=0.318). ASIA grade had a significant effect on pedicle fracture combined with vertebral compression (χ2=0.422, P=0.001). Conclusions Gender, age and fractured segmental level may have an insignificant impact on pedicle fracture or vertebral compression. The greater a vertebral compression, the more serious a pedicle fracture. The more serious a pedicle fracture, the more severe a spinal cord injury. Key words: Thoracic vertebrae; Lumber vertebrae; Fractures, bone

Minimally invasive transforaminal posterolateral approach for lumbar fractures of AO type A3 compli-cated with neurological deficits

Objective To investigate the clinical efficacy of minimally invasive transforaminal pos-terolateral approach (MI-TPLA) for lumbar fractures of AO type A3 complicated with neurological deficits. Methods From January 2010 to January 2013, 17 patients with lumbar fracture of AO type A3 complicated with neurological deficits were treated with neural tissue decompression through MI-TPLA, bone grafting within the injured vertebra and percutaneous pedicle screw fixation. They were 11 males and 6 females, 21 to 63 years of age (average, 45.7 years). Fracture occurred at L1 in 7 cases, at L2 in 6, at L3 in 3, and at L4 in one. According to Frankel grading system, the neurological status was evaluated as grade A in one case, as grade B in 2 cases, as grade C in 9, and as grade D in 5. Intraoperative blood loss, operation time and complications were recorded. Lumbar cobb angle and anterior height of injured vertebra were observed on lateral X-ray films. The ratio of canal median sagittal diameter occupied and the ratio of cross-section area occupied were measured and calculated at the maximally stenosed level on axial CT. Results All oper-ations were successfully completed. The operation time was 156.7 min (from 120 to 200 min), and the intra-operative blood loss was 280.9 mL (from 100 to 450 mL). All the patients were followed up for 24 months. The cobb angle reduced significantly from preoperative 26.8°±3.6° to postoperative 2.6°±1.7° (P<0.05). The anterior height ratio of injured vertebra restored significantly from preoperative 56.3% ±14.6% to postoper-ative 93.7% ±6.0% (P<0.05). The ratio of canal median sagittal diameter occupied and the ratio of cross-section area occupied significantly improved from preoperative 52.8% ±4.4% and 52.3% ±7.6% to postoperative 96.3% ±2.3% and 82.9% ±12.1% , respectively (P<0.05). At the final follow-up, im-provement in Frankel grade was observed in all the patients, with grade B in one case, grade C in one, grade D in 7 cases and grade E in 8. Conclusion MI-TPLA is less invasive, safe and effective for lumbar fractures of AO type A3 complicated with neurological deficits. Key words: Lumber vertebrae; Fractures, bone; Surgical procedures, minimally invasive; Neurological deficits

How to avoid pectus bar displacement in the MIRPE or MOVARPE technique: results of 12 years' experience: reply.

Bar displacement remains the most common complication of the minimally invasive repair of pectus excavatum (MIRPE). To date, no studies show results from 12 years' experience using a bar fixation technique with only absorbable sutures. Our aim is to show how to stabilize the bar using a modified approach for bar fixation. A retrospective review of 68 patients, who underwent MIRPE or the minor open videoendoscopic assisted repair of pectus excavatum, was performed. To stabilize the pectus bar, both wings of the pectus bar were tied to the ribs in 52 patients with circumcostal absorbable sutures using a Deschamps needle under endoscopic survey and in 16 patients with lateral stabilizers. The stability of pectus bar after the operation was assessed by lateral chest X-ray films and classified as being perfect, incomplete, or poor. No complications were observed in the perioperative period with the circumcostal suture technique. Lateral chest X-rays showed an excellent position of the pectus bar in 50 patients, incomplete position in 1, and poor position in another patient. Our technique seems to be effective in preventing bar displacement following pectus excavatum repair. It does not add any significant cost or time to the operation, and it is fairly simple to perform.

Correlation study between the reason of heterotopic ossification after cervical artificial disc replacement and the degeneration of cervical facet joints

Objective To investigate the correlation between the reason of heterotopic ossification after cervical artificial disc replacement and the degeneration of cervical facet joints. Methods From May 2009 to May 2012, 133 patients who had undergone cervical artificial disc replacement were included into this study. There were 74 males and 59 females with an average age of 42.63±4.15 years old (range, 23-56 years old). There were 109 patients who had undergone single level implant, and 24 patients double level implant. Cervical spine A-P and the flexion-extension X-rays were taken to assess the range of motion (ROM) of the surgical level. Degeneration degree of patients' cervical facet joints were evaluated by Park grading standards with the preoperative cervical CT scan images on GE-PACS system. Heterotopic ossification (HO) situation were evaluated by McAfee classification through cervical lateral X-ray film. Patients were divided into two groups (HO group and non-HO group) according to whether heterotopic ossification appeared during the follow-up period. The data were collected before surgery to the latest follow-up. Results The average follow-up time was 2.9 years (range, 2.0-4.8 years). HO was detected in 25 patients (18.80%, 25/133) at latest follow-up. The ROM of surgical level of patients in HO group was significantly lower than non-HO group (6.8°±3.9° vs 9.1°±2.4°). In addition, the degeneration degree of cervical facet joints of patients in HO group was significantly higher than that in non-HO group. There was a significant correlation between preoperative cervical facet joint degeneration and the occurrence of HO after CDR (r=0.683, P=0.033). Conclusion There was a significant correlation between preoperative cervical facet joint degeneration and the occurrence of HO after CDR. Patients present HO after surgery have significantly higher degeneration degree of cervical facet joints than patients without HO. Patients with higher degree of HO may have a higher level of cervical facet joints degeneration. Key words: Cervical vertebrae; Total disc replacement; Ossification, heterotopic

Phrenic Nerve Conduction Abnormalities Correlate with Diaphragmatic Descent in Chronic Obstructive Pulmonary Disease

Diaphragmatic weakness in chronic obstructive pulmonary disease (COPD) is ascribed to hyperinflation-induced diaphragm shortening as well as impairment in cellular and subcellular structures. Although phrenic neuropathy is known to cause diaphragmatic weakness, phrenic neuropathy is rarely considered in COPD. This work aimed at assessing phrenic nerve conduction in COPD and its relation to radiographic hyperinflation and pulmonary function. Patients and methods: Forty COPD patients were evaluated. Radiographic parameters of lung hyperinflation were measured on postero-anterior and lateral chest x-ray films. Flow volume loop parameters were obtained from all patients. Motor conduction study of the phrenic nerves was performed and potentials were recorded over the xiphoid process and the ipsilateral 7th intercostal space. Twenty-seven healthy subjects were enrolled as controls. Results: Parameters of phrenic nerve conduction differed significantly in patients compared to controls. Phrenic nerve abnormalities were detected in 17 patients (42.5%). Electrophysiological measures correlated with diaphragmatic angle of depression on lateral view films and with lung height on postero-anterior films. They did not correlate with the flow volume loop data or disease severity score. Conclusion: Phrenic nerve conduction abnormality is an appreciated finding in COPD. Nerve stretching associated with diaphragmatic descent can be a suggested mechanism for nerve lesion. The presence of phrenic neuropathy may be an additional contributing factor to diaphragmatic dysfunction in COPD patients.

Simultaneous Use of Both Bilateral Intralaminar and Pedicle Screws for C2 Stabilization.

Four patients underwent stabilization surgery using both bilateral C2 pedicle screw (PS) and intralaminar screw (LS). Neural and vascular injury resulting from incorrect screw placement was assessed using computed tomography (CT). The evaluation of bone union was assessed by lateral flexion-extension X-ray films and CT. The symptoms were improved in all patients. There were no intraoperative complications. Furthermore, there were no cases of neurological worsening or vascular injury from incorrect screw placement. Failure of instrumentation or screw loosening during the follow-up period did not occur in any of the patients. All cases had accomplished bone union at the final follow-up. Theoretically, the stabilization technique using both bilateral C2 PS and LS at the same time can provide more stability than any other single technique. Simultaneous use of both bilateral C2 PS and LS is potentially a good choice for surgical repair.

Treatment of Sanders' type III intra-articular fracture of the calcaneus using a small dorsolateral incision

Objective To investigate the operative treatment of Sanders' type Ⅲ displaced intra-articular fractures of the calcaneus using a small dorsolateral incision.Methods From October 2006 to April 2012,90 patients with displaced intra-articular calcaneal fracture of sanders' type Ⅲ were treated by open reduction and internal fixation through a small dorsolateral incision at our department.The skin incision was made from the distal tip of the fibula to the base of the fourth metatarsal.They were 69 men and 21 women,aged from 17 to 61 years (average,39 years).On the right side were 49 cases and on the left side 41 cases.According to Sander's classification,26 fractures were of type Ⅲ AB,36 of type Ⅲ AC and 28 type Ⅲ BC.The displacements of articular facet were all larger than 1 mm.The foot functions were evaluated before and after operation by the American Orthopedic Foot and Ankle Society (AOFAS) scoring system.Results For each patient,4 to 6 calcaneal cannulated screws of 4.0 mm and 2 full threaded screws of 6.5 mm were used.No incision infection,skin necrosis or injury to the posterior tibial nerve or vessels occurred after surgery.Seventy-six patients were followed up for 10 to 56 months (average,20.5 months).Clinical union was achieved after 8 to 12 weeks (average,9.5 weeks).The lateral and axial X-ray films of the calcaneus at the last follow-up showed fine reduction and fixation of the fracture fragments and significant improvements in the length,width,height,and B(o)hler and Gissane angles of the calcaneus compared with the preoperation (P ＜ O.05).The ankle and hindfoot scored 70 to 100 AOFAS points at the last follow-up.Forty-five cases were excellent,24 good,5 fair and 2 poor (excellent to good rate of 90.8％).Follow-up observed no infection,nonunion or osteomyelitis.Conclusion Open reduction and internal fixation through a small dorsolateral incision is a good option for Sanders' type Ⅲ calcaneus fractures with a displacement of more than 1 mm,because it leads to minimal soft tissue damage,excellent exposure and convenience for later removal of internal fixators and subtalar arthrodesis. Key words: Calcaneus fracture; Fracture fixation, internal; Bone nails

Comparison of the change in pharyngeal airway space, tongue and hyoid bone positions according to the orthognathic surgical methods of mandibular prognathism

Abstract Comparison of the Change in the Pharyngeal Airway Space, Tongue and Hyoid Bone Positions according to the Orthognathic Surgical Met hods of Mandibular Prognathism Yoon-Sun Lee, Se-Jin Han Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook UniversityPurpose: The purpose of this study was to compare the changes in the pharyngeal airway space, tongue and hyoid bone positions according to the orthognathic surgical methods of man dibular prognathism.Methods: The subjects included 30 patients (16 males, 14 females) with the skeletal class III malocclusion. Group 1 (10 patients) underwent bilateral sagittal split ramus osteotomy (B SSRO) only; group 2 (10 patients) underwent BSSRO with genio-plasty; and group 3 (10 patients) underwent BSSRO, Le Fort I os teotomy. We measured the lines between the selected upper air way, hyoid bone and tongue landmarks on the lateral cephalo metric x-ray films of skeletal class III. The measurements were made preoperation, within 1 week after the operation, 3∼6 months after the operation and 1 year after the operation. We compared and analyzed the measurements with matched paired t -test and independent samples t-test.Results: There were no postoperative changes in the nasopharyngeal airw ay space in group 3. The measurements of group 3 also increased during the follow-up period as compared to the preoperative measurements. In group 1, 2 and 3, the immediate postoperative oropharyngeal and hypopharyngeal airway spaces we re decreased. In the following period, the hypopharyngeal airway space returned to the preoperative positions, but the or opharyngeal airway space was not significantly changed. The upper and lower tongue was posteriorly repositioned immediately after the surgery. During the follow-up period, the lower tongue position returned to the preoperative position, and the upper tongue position was not significantly changed. Immediatel y after the surgery, the B point was moved to the posterior posit ion, and a slight anterior advancement was found in the follow-up period.Conclusion: Patients who received the mandibular setback surgery showed a decrease in the posterior airway space, and those who underwent max illary advancement showed a significant increase of the nasopha ryngeal airway space, which remained stable during the evaluation period. The change of the airway s pace, position of the hyoid bone and tongue did not differ according to the presence or absence of genioplasty.Key words:Mandibular prognathism, Bilateral sagittal split ramus osteotom y, Cephalometry, Genioplasty, Orthognathic surgeries

Correlation between the coverage percentage of prosthesis and postoperative hidden blood loss in primary total knee arthroplasty

Background The aim of this study was to determine the relationship between prosthesis coverage and postoperative hidden blood loss (HBL) in primary total knee arthroplasty (TKA). Methods A total of 120 patients who had undergone unilateral TKA from August 2012 to May 2013 were retrospectively studied. The Gross formula was used to calculate the amount of HBL. Routine standard anteroposterior (AP) and lateral X-ray films of the knee joint were taken postoperatively and used to measure the percentages of coronal femoral and of coronal and sagittal tibial prosthetic coverage. Then Pearson's correlation analysis was performed to assess the correlations between the percentages of prosthetic coverage for each AP and lateral position and HBL on the first and third postoperative days. Results The volumes of HBL on the first and third postoperative days after TKA were (786.5±191.6) ml and (1 256.6±205.1) ml, respectively, and lateral X-ray film measurements of percentages of coronal femoral, tibial coronal, and sagittal prosthetic coverage were (87.9±2.5)%, (88.5±2.2)%, and (89.1±2.3)%, respectively. Pearson's correlation analysis showed statistically significant correlations between percentages of total knee prosthetic coverage for each AP and lateral position and volumes of HBL on the first and third postoperative days (P &lt;0.05). Conclusions HBL after TKA correlates with degree of prosthetic coverage. To some extent, the size of the surfaces exposed by osteotomy determines the amount of HBL. Choice of the appropriate prosthesis can significantly reduce postoperative HBL. Designing individualized prostheses would be a worthwhile development in joint replacement surgery.

Sacrum pubic incidence and sacrum pubic posterior angle: two morphologic radiological parameters in assessing pelvic sagittal alignment in human adults.

The morphology and position of pelvis are critical in regulating the biomechanical organization of spine-pelvis-leg in the sagittal plane. Several radiological parameters have been developed to present the sagittal morphology of the pelvis such as pelvic incidence (PI) and Jackson's angle (PRS1). In addition, the femoral sacral posterior angle (FSPA) was developed for patients with a dome-shaped deformity in the upper plate of the sacrum. The identification of hip axis, which was represented by the line connecting the centers of femoral heads in normal subjects, was important for these parameters measurement. However, in subjects with fused hip joint or deformed femoral heads, the accurate localization of hip axis become imprecise. Herein, the upper edge of the pubic symphysis, which is easy to identify on the lateral X-ray film, was selected as an alternative landmark of the hip axis, and two morphologic parameters, the sacrum pubic incidence (SPI) and sacrum pubic posterior angle (SPPA), were proposed accordingly. The present study aimed to understand the reliability of these two parameters and their value in predicting PI, PRS1 and FSPA. Upright standing spine and pelvis radiographs of 60 normal adults (30 male and 30 female) with an average age of 38.5 years were obtained. Two independent observers then measured the following radiological parameters on the films: PI, PRS1, FSPA, SPI, SPPA, sacral slope, pelvic tilt and lumbar lordosis. The SPI is the angle between the line perpendicular to the superior plate of the first sacral vertebra at its midpoint and the line connecting this point to the upper edge of the pubic symphysis, while the SPPA is the angle between the line extending from the posterior upper edge of the sacrum to the upper edge of the pubic symphysis and the posterior side of the first sacral vertebral body. The intra-observer and inter-observer reliabilities of the parameters were analyzed using intraclass correlations. The correlations between parameters were analyzed by Pearson's correlation coefficients. Regression analysis was carried out to establish formulas to predict the values of PI, PRS1 and FSPA using the SPI and SPPA. A p < 0.05 was considered statistically significant. The SPI was 64.4° ± 9.5° and 68.3° ± 9.4°, and the SPPA was 77.7° ± 7.5° and 78.7° ± 9.4° in males and females, respectively. These radiological parameters showed excellent intra- and inter-observer reliabilities, with an intraclass correlation >0.8. No gender differences were identified in these morphologic and positional radiological parameters. The SPI demonstrated strong correlation with PI and PRS1 (R (2) > 0.9, p < 0.001). In addition, strong correlation was also found between SPPA and FSPA (R (2) > 0.9, p < 0.001). Furthermore, both SPPA and FSPA showed close correlations with the other morphologic and positional parameters. Linear regression analysis established equations to predict PI and PRS1 using SPI and to predict FSPA by SPPA with significantly high reliability. Both SPI and SPPA are reliable parameters for determining the morphology of the pelvis. The SPI is precise in predicting PI and PRS1, while SPPA is reliable in predicting FSPA. The SPI and SPPA will allow further study on lateral spinal-pelvic alignment in patients with hip joint abnormalities.

Facial Growth and Development in Unilateral Cleft Lip and Palate: Comparison between Secondary Alveolar Bone Grafting and Primary Periosteoplasty

To describe the effect of secondary alveolar bone grafting in patients with unilateral cleft lip and palate by comparison with a sample of patients who have undergone primary periosteoplasty. Cephalometric analysis of lateral x-ray films in a retrospective semilongitudinal study. Lateral x-ray films of 18 secondary alveolar bone grafting patients and 48 primary periosteoplasty patients at 10 years of age and again at 15 years of age. The treatment of secondary alveolar bone grafting patients included lip repair according to Tennison, palatoplasty including retropositioning, pharyngeal flap surgery, and secondary alveolar bone grafting. The lips of primary periosteoplasty patient were repaired using the methods of Tennison and Veau, followed by primary periosteoplasty, palatoplasty including retropositioning, and pharyngeal flap surgery. Lateral radiographs were assessed using classical morphometry. There were few significant differences at 10 years of age between the secondary alveolar bone grafting and primary periosteoplasty patients. At 15 years of age, there were several significant differences. Compared with primary periosteoplasty patients, subsequent development in patients who had undergone secondary alveolar bone grafting was characterized by a significantly better position of the upper and lower dentoalveolar components in relation to the facial plane, a higher increase in the global convexity of the soft profile, a significantly better maxillary inclination, and a more favorable development of vertical intermaxillary relationships. Craniofacial development in secondary alveolar bone grafting patients was better than that in primary periosteoplasty patients due to the more marked facial convexity, the increased prominence of the nose, and better vertical intermaxillary relationships.

How to Avoid Pectus Bar Dislocation in the MIRPE or MOVARPE Technique

Bar displacement remains the most common complication of the minimally invasive repair of pectus excavatum (MIRPE). To date, no studies show results from 12 years' experience using a bar fixation technique with only absorbable sutures. Our aim is to show how to stabilize the bar using a modified approach for bar fixation. A retrospective review of 68 patients, who underwent MIRPE or the minor open videoendoscopic assisted repair of pectus excavatum, was performed. To stabilize the pectus bar, both wings of the pectus bar were tied to the ribs in 52 patients with circumcostal absorbable sutures using a Deschamps needle under endoscopic survey and in 16 patients with lateral stabilizers. The stability of pectus bar after the operation was assessed by lateral chest X-ray films and classified as being perfect, incomplete, or poor. No complications were observed in the perioperative period with the circumcostal suture technique. Lateral chest X-rays showed an excellent position of the pectus bar in 50 patients, incomplete position in 1, and poor position in another patient. Our technique seems to be effective in preventing bar displacement following pectus excavatum repair. It does not add any significant cost or time to the operation, and it is fairly simple to perform.