Plain Lateral Radiographs Research Articles

Conservative Management of Iatrogenic Membranous Tracheal Wall Injury

Management of pediatric tracheal injuries is a controversial topic not well documented in the otolaryngology literature. To present our case outcomes in 2 pediatric patients with tracheal injury and to review the literature on surgical vs conservative management of tracheal injuries in the pediatric age group. Case series and literature review. Tertiary referral pediatric hospital. Morbidity and mortality outcomes. The 2 tracheal injuries in the case studies were successfully managed with intubation, antibiotics, and careful monitoring without morbidity related to the tracheal injury. A high level of clinical suspicion is necessary for the diagnosis of tracheal injuries. Both conservatively and surgically managed patients require serial chest and lateral neck plain radiographs to follow resolution of pneumomediastinum and pneumothorax. Both require surveillance of the airway with operative laryngoscopy and bronchoscopy, in addition to long-term follow-up. Surgical repair of trachea rupture, although resulting in shorter intubation, may require tracheotomy. Promising results have been reported in the literature for conservative management with a relatively small risk of airway stenosis without the complications associated with intrathoracic repair. Conservative management should be considered in the management of tracheal injuries in the pediatric population.

Study of Degree of Lumbar Wedging Measured Using CR- 35X Digitizer

Background: Low back pain is a very common symptom. Population based normal variations of lumbar wedging (LW) in South Indian population is not well documented in literature. This study was done to compile a database of LW valid for healthy male and female subjects in the age range of 20-60 years in South Indian population. Methods: The plain lateral radiographs of lumbar spine of 150 healthy subjects (88 males and 62 females) between 20 to 60 years were studied. The lumbar vertebral body height anteriorly (HBA) and posteriorly (HBP) were measured using CR-35X digitizer. The degree of LW was determined by the ratio of HBA /HBP. Results: There was a gradual decrease in LW cranio-caudally from L1 to L5 in both sexes being maximum at L1 (0.96 in males and 0.97 in females) and minimum at L5 (1.13 in males and 1.13 in females). LW was higher in males than in females. LW is statistically significant only at L3 level and non significant at all other levels. Positive relationship of LW to age was not found. Conclusion: The study provide the best available estimates of normal LW for the South Indian healthy subjects, which will be helpful to the clinicians, therapists and researchers as ready references to LW in South Indian population. Nepal Journal of Medical Sciences | Volume 02 | Number 01 | Jan-Jun 2013 | Page 30-33 DOI: http://dx.doi.org/10.3126/njms.v2i1.7648

Secondary lumbar spondylosis in University of Uyo Teaching Hospital, Uyo, Nigeria: Radiographic correlation with incidence and concomitant discovertebral pathologies

Introduction: Lumbar spondylosis is an age-related degenerative disk disease of the lumbar spine. It could be preceded by known discovertebral lesions resulting in secondary lumbar spondylosis. Objectives: To determine the incidence of secondary lumbar spondylosis using lumbosacral radiographic evaluations. Study Designs/Settings: A cross-sectional prospective study. Radiology Department, University of Uyo teaching hospital, Uyo, Nigeria. Patient Sample: Two hundred and sixty-two patients. Outcome Measured: Pathologies are evaluated based on features seen on twin lumbosacral radiographs that demonstrate secondary spondylosis. Materials and Methods: Anterior-posterior and lateral plain radiographs of patients were done under standardized conditions. Studied period was 1 st May, 2011 to 12 th July, 2012. Results were analyzed using SSPS 13. computer package. Results: A total of 262 patients aged 10-89 years with mean age of 48.9 and standard deviation of 25.4 were studied. Males were 138 and females were 124. 173 patients constituting 66.03% of the studied population had lumbar spondylosis. A total of 57 patients (female to male ratio − 1.36:1) had secondary lumbar spondylosis. This constituites 32.95% of population with spondylosis. Secondary lumbar spondylosis was commonest in the 4 th to 6 th decade. A total of 17.54% of patients with secondary spondylosis were younger than 40 years. The commonest associated pathology was spondylolisthesis, n=25 cases (43.86%) with female predominance. The least were septic spondylitis and trauma (1.75% each). Other conditions were osteoporosis, metastasis, lumbarization, spina bifida, and Pott's disease. Conclusions: The commonest coexistence with lumbar spondylosis in Uyo, Nigeria is lumbar spondylolisthesis.

The association of serum 25-hydroxyvitamin D and vertebral fractures in patients with type 2 diabetes

Vitamin D is an important regulator of bone health. Previous studies examining the association between vitamin D deficiency and osteoporotic fractures have reported conflicting results. The relationship between vitamin D status and risk of vertebral fractures in diabetic patients is unknown. The objective of this study was to examine whether low serum 25-hydroxyvitamin D [25(OH)D] levels were associated with vertebral fractures in patients with type 2 diabetes. This cross-sectional study was conducted among 161 postmenopausal women and 180 men with type 2 diabetes. Serum concentrations of 25(OH)D were measured and the presence of vertebral fracture was assessed using lateral plain radiographs of the thoracolumbar spine. Women had lower 25(OH)D levels than men (31.3 ± 17.7 vs. 41.3 ± 26.5 ng/mL, p<0.001). Vertebral fractures were found in 16% of patients. Men with a serum 25(OH)D concentration greater than 30 ng/mL showed a lower prevalence of vertebral fractures compared to those with 20-29.9 ng/mL or those with less than 20 ng/mL (9.4% vs. 17.9% vs. 21.7%, p for trend=0.036). However, there was no significant association between vitamin D status and the prevalence of vertebral fractures in women (14.4% vs. 19.2% vs. 26.6%, p for trend=0.111). After adjusting for multiple confounding factors, men with a serum 25(OH)D concentration of less than 20 ng/mL were associated with an increased risk of vertebral fractures (OR 7.87; 95% CI 1.69-36.71), but not women. In conclusion, serum 25(OH)D levels below 20 ng/mL were associated with an increased vertebral fracture risk in men with type 2 diabetes.

Tibial Tubercle Fractures

Adolescent tibial tubercle fractures are uncommon, complex, high-energy injuries. The use of lateral radiographs in isolation to diagnose and treat these injuries is the standard of practice. However, with a single 2-dimensional (2D) view, there may be a risk that the degree of injury can be underestimated. This study was performed to report on the outcomes of tibial tubercle fractures operatively treated, determine the utility of a single lateral x-ray to accurately document injury severity and pattern, delineate the role of advanced imaging and intraoperative arthroscopy/arthrotomy in injury treatment, and propose a new classification system of tibial tubercle fractures that accounts for the complex 3D nature of proximal tibial physeal closure, and recognizes the importance of intra-articular extension, providing guidance for intervention. A retrospective review of operatively treated tibial tubercle fractures at our institution from 2003 to 2010 was performed. Child age, weight, mechanism of injury, Ogden classification (x-ray), advanced imaging results [computed tomography (CT)/magnetic resonance imaging (MRI)] including intra-articular fracture patterns, surgical techniques, intraoperative articular findings, and postoperative complications were collected. In addition, we classified all of our patients into a new classification system (type A--tubercle youth, type B--physeal, type C--intra-articular, type D--tubercle teen) based on a combination of plain radiograph (anteroposterior and lateral), advanced imaging (CT/MRI), and intraoperative arthrotomy/arthroscopy findings. We found 41 tibial tubercle fractures in 40 children (all of whom were male) with a mean age of 15.0 ± 1.1 years, and mean weight of 80.3 ± 23.4 kg. Injuries mostly occurred during jumping activities. At initial presentation, compartment syndrome or vascular compromise was seen in nearly 10% of patients, all of whom had type B--physeal injuries under our new classification system. Fifty percent of injuries were underestimated and/or not appreciated by lateral x-ray alone. In patients with intra-articular involvement, consistent 3D fracture patterns were seen on CT including anterior fragments (sagittal plane), lateral fragments (coronal plane), and anterolateral fragments (axial plane). Our new 4 part classification system was able to classify all fractures: type A (2 patients, mean age, 12.7 ± 0.2 y), type B (13 patients, mean age, 14.8 ± 0.7 y), type C (22 patients, mean age, 15.3 ± 1.1 y), and type D (2 patients, mean age, 15.5 ± 0.1 y). All fractures achieved radiographic union with 2 patients (type A--tubercle youth and type B--physeal) requiring additional procedures due to premature physeal closure. Tibial tubercle fractures represent high-energy injuries with potentially devastating complications such as compartment syndrome and/or vascular compromise. Intra-articular involvement is often missed with the use of plain x-ray and drastically underestimates injury severity. The use of preoperative CT scan or MRI should be utilized as adjunct to plain lateral radiograph. If intra-articular involvement is recognized preoperatively, arthroscopy or open arthrotomy should be utilized at the time of surgery. Our new classification system is rooted in the development of the proximal tibia, accounts for intra-articular involvement, and provides guidance for treatment. Level III--diagnostic study.

Interobserver and intraobserver reliability of the classification and diagnosis for ossification of the posterior longitudinal ligament of the cervical spine

Ossification of the posterior longitudinal ligament (OPLL) of the cervical spine has been classified into four types by lateral plain radiographs, but the reliability of the classification and of the diagnosis of either cervical OPLL or cervical spondylotic myelopathy (CSM) was unknown. We investigated the interobserver and intraobserver reliability of the classification and diagnosis for OPLL by radiographs and computed tomography (CT) images. A total of 16 observers classified each patient's images into five groups; OPLL continuous, segmental, mixed, circumscribed type, or CSM. To evaluate interobserver reliability, the observers first classified only radiograph images, and next both radiographs and CT images. On another day they followed the same procedure to evaluate intraobserver reliability. We also evaluated interobserver and intraobserver reliability of the diagnosis of either cervical OPLL or CSM. Interobserver reliability of the classification with radiographs only showed moderate agreement, but interobserver reliability with both radiographs and CT images showed substantial agreement. Intraobserver of reliability the classification was also improved by additional CT images. Interobserver reliability of the diagnosis with both radiographs and CT images was almost similar to with radiographs only. Intraobserver reliability of the diagnosis was improved by additional CT images. This study suggested that the reliability of the classification and diagnosis for cervical OPLL was improved by additional CT images. We propose that diagnostic criteria for OPLL include both radiographs and CT images.

Determination of Sagittal Alignment Measurements in Distal Femurs

Open reduction and internal fixation is presently the treatment of choice for distal femur fractures. Anatomic reconstruction of the articular surface and restoration of biomechanical relations to the diaphysis are desired. A method to determine sagittal alignment on plain radiographs is warranted. Consecutive adult, normal, distal femur/knee, plain lateral radiographs and scanned and digitalized cadaveric distal femurs were analyzed. Measurement of 7 different angles was performed. Ninety-four adults [39 men (41.5%) and 55 women (58.5%)] with a mean age of 54 years (range, 18-92 years) and body mass index (BMI) of 29.7 kg/m(2) (range, 16.6-47.2 kg/m(2)), as well and 35 cadaveric femora [24 men (68.6%) and 11 women (31.4%)] with a mean age of 53 years (25-85 years) and BMI of 29.8 kg/m(2) (17.7-53.3 kg/m(2)) were studied. Twenty-two of the patients (23.4%) had radiographic findings of arthrosis. If arthrosis was diagnosed, measurements including the proximal rim of the articular surface were significantly greater (P = 0.001). Two angles were significantly smaller in women (P < 0.05). No significant differences in any measurement for age or BMI were recorded. The necessity for reliability and quality of intraoperative and postoperative radiographic controls of the obtained fracture reduction, implant insertion, and final healed fracture increases with popularity of less invasive indirect reduction and stabilization methods. The ability to obtain exact sagittal alignment measurements has been problematic with other studies. Two different and reliable methods of measuring sagittal plane anatomy and measurements independent of implants were confirmed using plain radiographic images.

Navigated Anterior Cruciate Ligament Reconstruction: Radiographic Validation of a Nonimage-based System

The authors compared the intraoperative navigated measurements of the location of the tibial and femoral tunnels during arthroscopic-assisted anterior cruciate ligament reconstruction to the postoperative measurements performed on standard plain radiographs in 56 patients. The position of the center of the tibial and femoral tunnels was measured intraoperatively with the OrthoPilot (B. Braun Aesculap, Tuttlingen, Germany) and postoperatively on plain anteroposterior and lateral radiographs. The center of the tibial tunnel was located at 43% of the mediolateral tibial dimension intraoperatively and at 41% of the mediolateral tibial dimension postoperatively (P=.14). The center of the tibial tunnel tibial was located at 40% of the anteroposterior tibial dimension intraoperatively and at 35% of the anteroposterior tibial dimension postoperatively (P=.01). The center of the femoral tunnel was located at 85% of the anteroposterior femoral dimension intraoperatively and at 76% of the anteroposterior femoral dimension postoperatively (P<.001). A significant correlation was found between intraoperative navigated and postoperative radiographic measurements only at the femur. Good agreement existed between all navigated and radiographic measurements. The OrthoPilot navigation system allows an accurate measurement of the location of the tibial and femoral tunnels during anterior cruciate ligament reconstruction.

Minimal invasive surgery for unicameral bone cyst using demineralized bone matrix: a case series

BackgroundVarious treatments for unicameral bone cyst have been proposed. Recent concern focuses on the effectiveness of closed methods. This study evaluated the effectiveness of demineralized bone matrix as a graft material after intramedullary decompression for the treatment of unicameral bone cysts.MethodsBetween October 2008 and June 2010, twenty-five patients with a unicameral bone cyst were treated with intramedullary decompression followed by grafting of demineralized bone matrix. There were 21 males and 4 female patients with mean age of 11.1 years (range, 3–19 years). The proximal metaphysis of the humerus was affected in 12 patients, the proximal femur in five, the calcaneum in three, the distal femur in two, the tibia in two, and the radius in one. There were 17 active cysts and 8 latent cysts. Radiologic change was evaluated according to a modified Neer classification. Time to healing was defined as the period required achieving cortical thickening on the anteroposterior and lateral plain radiographs, as well as consolidation of the cyst. The patients were followed up for mean period of 23.9 months (range, 15–36 months).ResultsNineteen of 25 cysts had completely consolidated after a single procedure. The mean time to healing was 6.6 months (range, 3–12 months). Four had incomplete healing radiographically but had no clinical symptom with enough cortical thickness to prevent fracture. None of these four cysts needed a second intervention until the last follow-up. Two of 25 patients required a second intervention because of cyst recurrence. All of the two had a radiographical healing of cyst after mean of 10 additional months of follow-up.ConclusionsA minimal invasive technique including the injection of DBM could serve as an excellent treatment method for unicameral bone cysts.

Surgical Approach to the Cervicothoracic Junction

Retrospective case series study. To determine when the standard Smith-Robinson approach can be used successfully to approach the cervicothoracic junction (CTJ). Most of techniques for exposing the anterior CTJ are associated with significant morbidity. To our knowledge, there is no reliable technique, which described to determine when the standard Smith-Robinson approach is adequate and when a more invasive approach, such as a sternal splitting approach, is necessary to approach the CTJ anteriorly. We evaluated the ability of the following technique to preoperatively determine whether a standard Smith-Robinson approach can be used to approach the CTJ: on the lateral plain radiograph, a line was drawn from the intended skin incision site to the top of the manubrium (at the suprasternal notch) to the level of the disc space. If it appeared that this trajectory would allow adequate exposure of the CTJ, then the operation was performed through the standard Smith-Robinson approach. The records and radiographs of all patients who had undergone anterior cervicothoracic arthrodesis to T1 or below were evaluated. A total of 99 patients who underwent an anterior cervicothoracic fusion using the standard Smith-Robinson approach were identifed. Using the proposed technique, there were no cases in which the planned lowest instrumented vertebra could not be safely reached through the standard Smith-Robinson approach. No procedure was abandoned or converted to a sternotomy approach. Our results suggest that if the lowest instrumented vertebra can be seen on a lateral radiograph and a line passing from the intended skin incision site to this level lies on top of the manubrium, a routine Smith-Robinson approach can be used to expose the level. To our knowledge, this is the largest series outlining a simple guideline for approaching the anterior CTJ.

Effect of PEEK Polymer on Tunnel Widening After Hamstring ACL Reconstruction

The purpose of this study was to evaluate the effect of the AperFix device (Cayenne Medical, Inc, Scottsdale, Arizona), composed of polyetheretherketone (PEEK) polymer, on tunnel widening after hamstring anterior cruciate ligament (ACL) reconstruction as compared with 2 other fixation devices: the TransFix (Arthrex, Inc, Naples, Florida) and the EndoButton (Smith & Nephew Endoscopy, Mansfield, Massachusetts). Sixty-seven patients with isolated total ACL ruptures who underwent arthroscopically assisted reconstruction using hamstring autografts at the authors' institution were included in the study. Patients were assigned into 1 of 3 groups in a nonrandomized fashion: AperFix (n=18), TransFix (n=29), and EndoButton (n=20). Mean follow-up was 30 months. Tunnel widening measurements were performed on anteroposterior and lateral digital plain radiographs taken in postoperative week 1 and at final follow-up. Laxity testing, Lysholm scoring, and arthrometric evaluation were performed.All 3 graft fixation devices resulted in significant tunnel widening in both tibial and femoral tunnels at final follow-up when compared with the immediate postoperative period. Tunnel widening between groups was not significantly different in terms of coronal and sagittal femoral tunnel diameters. Tibial tunnel diameter increase in the sagittal plane in the EndoButton group was significantly smaller than that in the TransFix and AperFix groups. No correlation was found between the amount of tunnel enlargement and clinical outcomes of ACL surgery. This study's findings suggest that tunnel enlargement after ACL reconstruction is influenced by the type of graft fixation on the tibial side irrespective of clinical outcome, and PEEK polymer does not have an effect on tunnel widening after hamstring ACL reconstruction.

The Radiologic Relationship of the Shoulder Girdle to the Thorax as an Aid in Diagnosing Neurogenic Thoracic Outlet Syndrome

Neurogenic thoracic outlet syndrome (NTOS) is produced by compression of the brachial plexus in the thoracic outlet. The lower position of the shoulder girdle relative to the upper thorax may be related to NTOS. We investigated this hypothesis using plain cervical radiographs. We conducted this case-control study using plain cervical anteroposterior and lateral radiographs in 63 NTOS patients and 126 carpal tunnel syndrome patients who were matched for age and sex. To estimate the position of the shoulder girdle relative to the upper thorax, we analyzed the level of the clavicle using 2 parameters: the number of vertebrae visible in a lateral radiograph and the number of vertebrae above the line connecting both sternal ends of the clavicles in an anteroposterior radiograph. The number of vertebrae visible in a lateral radiograph was the parameter for the level of the lateral part of the clavicle relative to the upper thorax, whereas we used the number of vertebrae above the line connecting both sternal ends of the clavicles in an anteroposterior radiograph to determine the level of the medial part of the clavicle. Both parameters were greater in the NTOS group than in the control group, which suggests that the level of the shoulder girdle was lower in the NTOS group than in the control group. In addition, the risk of NTOS was increased in patients with lower shoulder girdle position. The lower placement of the shoulder girdle relative to the upper thorax was related to NTOS. Physicians may be able to estimate the position of the shoulder girdle using plain cervical radiographs when NTOS is clinically suspected. Diagnostic IV.

Comparison of Physical Examination and Conventional Radiography in Diagnosis of Nasal Fracture

Nasal bone fracture is the most common fracture which would result from facial trauma. So, the present study performed to select the most reliable way to diagnose new fractures considering CT scan results as a gold standard in this matter. All the people refer to a forensic medicine center were, at first, physically examined by general practitioners. Plain lateral radiography and ENT consult were requested afterwards. CT scan was requested to get trusty results in case of any imbalance between Radiographic finding and physical examination. The results finally were evaluated and compared. CT scan was tried for 61 (6%) patients with positive clinical findings for new fracture which were not supported by radiologic studies. New fracture was identified in 55 participants out of the above number. Trusting physical examination and its preference to the radiologic findings has special value in cases where fracture is not detectable by radiography and there is no access to CT scan.

What is the sensitivity and specificity of plain lateral radiographs in patients with acute trauma to the cervical spine? A case report

Acute traumatic injuries to the cervical spine are common consequences of motor vehicle accidents. Typically, routine radiographs are the first imaging approach to these injuries; however with the use of computed tomography and magnetic resonance scans, it can be appreciated how radiographs can miss important fractures. The aim of this article is to report a case study of a missed diagnosis of a fracture-subluxation of the lower cervical spine and present a literature review.

Open Reduction and Internal Fixation of OTA Type C2–C4 Fractures of the Calcaneus with a Triple-plate Technique

The purpose of this study was to present a surgical technique of open reduction and internal fixation of displaced intra-articular calcaneal fractures with 3 AO mini-fragment plates and to evaluate the clinical and radiological outcome of a consecutive group of patients after a mean follow-up of 41.7 months. A series of 54 patients (16 women and 38 men) with 62 calcaneal fractures were treated over a period of 6.5 years. Forty-five patients with 50 calcaneal fractures were completely clinically and radiologically followed up. Clinical follow-up included assessment of range of motion, pain according to a visual analogue scale, the American Orthopaedic Foot and Ankle Society hindfoot score, and the short-form 36 health survey. Radiological follow-up included plain axial and lateral radiographs and measurement of the Böhler's angle and Gissane's angle. Independent Student's t test and paired Student's t test were used alongside the chi-square test to compare clinical and radiological data and score values between different groups of patients. Eleven patients showed breakage of the osteosynthesis material during the healing process and 2 patients sustained deep wound infection requiring revision surgery. At the final follow-up all fractures had healed. The average range of motion was supination 26.4° (range 0° to 50°; SD 11.6°), pronation 15.4° (range 0° to 30°; SD 6.4°), dorsal extension 14.3° (range –10° to 30°; SD 8.0°), and plantarflexion 39.6° (range 20° to 65°; SD 11.7°). Patients with OTA type C4 fractures achieved significantly lower supination (p < .01) and plantarflexion (p < .01) compared with other fracture types. The mean visual analog scale pain score was 3.6 (range 0 to 8; SD 2.3) points, average American Orthopaedic Foot and Ankle Society hindfoot score was 70.8 (range 33 to 100; SD 17.1) points, and the mean short-form 36 score was 60.98 (range 22.9 to 93.0; SD 18.4) points. The mean postoperative Böhler's angle was 28.9° (range 8° to 38°; SD 7.1°), which decreased to 23.6° (range 4° to 34°; SD 8.7°) at the final follow-up, and the mean postoperative Gissane's angle was 108.6° (range 80° to 140°; SD 11.8°), which finally decreased to 102.4° (range 72° to 126°; SD 12.7°). No statistically significant differences regarding Böhler's and Gissane's angles were found between different OTA fracture types. In conclusion, the presented surgical technique was found to provide comparable and adequate reduction of OTA type C2–C4 injuries based on statistically insignificant differences in radiographic measures of postoperative fracture reduction. Greater limitation in subtalar motion was observed in OTA type C4 fractures in comparison with less severe fractures (p < .01).

Ossification of the Posterior Longitudinal and Yellow Ligaments on the Lumbar Spine

Ossification of the posterior longitudinal ligament and ossification of the yellow ligament are the main causes of spinal canal stenosis. This article describes a case of ossification of the posterior longitudinal and yellow ligaments on the lumbar spine. The patient presented with gradually worsening left lower-extremity ache and pain. The deep tendon reflex was hyperreflexia in the lower extremities. Disturbances existed in the blade and bowel. The ossified lesion of ossification of the posterior longitudinal ligament was observed at L5-S1, and plain lateral radiographs and computed tomography revealed ossification of the yellow ligament on L3, which occupied a large part of the spinal canal. Because of the findings on the preoperative radiographs, we performed posterior approach decompression and bone grafting and excisied the ossified lesion. Pedicle screws were inserted from L3 to S1. The patient's symptoms disappeared postoperatively, and his Japanese Orthopaedic Association score was 25 two weeks postoperatively. No standard surgical procedure exists for the treatment of lumbar ossification of the posterior longitudinal ligament, but it is important to select a surgical procedure according to individual patient conditions. Many factors, such as local mechanic stress, tissue metabolism, high glucose, and genetics, contribute to the progression of ossification of the posterior longitudinal and yellow ligaments on the lumbar spine. However, the mechanism is unclear. Further study and long-term follow-up on lumbar ossification of the posterior longitudinal ligament is needed.

Relation Between Mucoid Degeneration of the Anterior Cruciate Ligament and Posterior Tibial Slope

The purpose was to analyze the association between posterior tibial slope (PTS) and mucoid degeneration of the anterior cruciate ligament (ACL). From October 1999 to May 2010, 84 arthroscopies were performed in 82 patients (18 men and 64 women) with mucoid degeneration of the ACL. The mean patient age was 53 years (range, 25 to 75 years). In addition to this patient group (group I), the study included a control group without mucoid degeneration of the ACL that was randomly matched for age, sex, body mass index, left or right side, and associated lesions (group II). For each group, the diagnosis was made by use of magnetic resonance imaging and arthroscopy, and a plain lateral radiograph was used to measure the PTS. The mean PTS was 13.5° ± 2.6° (range, 8.2° to 19.5°) in group I and 9.4° ± 2.5° (range, 4.8° to 15.5°) in group II. The mean PTS in group I was significantly greater than that in group II (P < .001). For group I, the mean PTS of the involved knee was significantly greater than that of the uninvolved contralateral knee (P = .044). There were no differences according to age, sex, left or right side, body weight, and body mass index (P > .05). Mucoid degeneration of the ACL was found to be associated with an increased PTS. The patients with mucoid degeneration of the ACL had a greater mean PTS than matched control patients (13.5° v. 9.4°, P < .001). Level III, diagnostic study of nonconsecutive patients without consistently applied gold standard.

Three-dimensional measurement of growth of ossification of the posterior longitudinal ligament

Ossification of the posterior longitudinal ligament (OPLL) is a progressive disease that causes cervical myelopathy. Because 2D evaluation of ossification growth with plain lateral radiographs has limitations, the authors developed a unique technique to measure ossification progression and volume increase by using multidetector CT scanning. The authors used serial thin-slice volume data obtained by multidetector CT scanning in 5 patients. The mean patient age was 63 years, and the mean follow-up duration was 3.1 years. First, a 3D model of OPLL was semiautomatically segmented at a specific threshold. Then, a preoperative model of OPLL was superimposed on a postoperative model using voxel-based registration of the vertebral bodies. Progression and volume increase were measured using a digital viewer that was developed by the authors. Progression was visualized using a color-coded contour on the surface of the OPLL model. All patients had progression of 0.5 mm or greater. The mean values concerning OPLL growth were as follows: maximum progression length, 4.7 mm; progression rate, 1.5 mm/year; volume increase, 1622 mm(3); volume expansion rate, 37%; and volume increase rate, 484 mm(3)/year. The accuracy of superimposition by voxel-based registration, defined as closeness to the true value, was less than 0.31 mm. For intraobserver reproducibility of the volume measurement, the mean intraclass correlation coefficient, root mean square error, and coefficient of variation were 0.987, 16.0 mm(3), and 1.7%, respectively. Ossification of the posterior longitudinal ligament progresses even after surgery. Three-dimensional evaluation with the aid of CT scans is a useful and reliable method for assessing that growth.

Radiographic identification of the equine ventral conchal bulla

Involvement of the ventral conchal sinus (VCS) is an important diagnostic and prognostic feature in cases of the equine sinus disease. The authors aimed to ascertain if the caudo-dorsal extension...

Remodeling Capacity of Malunited Odontoid Process Fractures in Kyphotic Angulation in Infancy

A retrospective case study. To confirm the remodeling potential of the kyphotic malunited odontoid fracture in the pediatric spine. Nonsurgical reduction and immobilization is the gold standard for the odontoid fracture in infancy. However, the reduction occasionally results in incomplete repositioning of the odontoid process. The cervical spine is subsequently immobilized until fusion in most cases in the hope of achieving remodeling with the growth of the remaining displacement and kyphotic angulation, although there are no precise data on the acceptable limit of the deformity. Three patients (age at injury = 1 year 2 months to 3 years) with odontoid process fracture in infancy were treated conservatively and the fractures were observed on plain lateral radiographs until at least the age of 20 years. For evaluation of the angulated odontoid process, we used our original measurement method of the odontoid process tilting angle (OPTA). In addition, the OPTAs were also measured in 127 Japanese adult patients (57 male patients and 70 female patients; average age = 43 years) without a history of odontoid fracture, as normal controls. The OPTA in the normal controls was -21.4° ± 23.3°. The OPTAs ranged from 41° to 62° at the initial evaluation, from 12° to 30° at the time of bony union, and from -4° to -14° at the final follow-up at more than 20 years of age, which were all within one standard deviation of the mean in the normal adult controls. Angulated odontoid fractures with the OPTA around 30° at the time of bony union in infants younger than 3 years of age could have the capacity for remodeling to the normal morphology. No surgical reduction might be needed to recommend complete apposition of the odontoid process in the absence of severe or deteriorating neural impairment.