Plain Radiographic Views Research Articles

Virtual reading room for diagnostic radiology

Rationale and ObjectiveTo assess the perceptions of radiology staff regarding the role of virtual reality technology in diagnostic radiology after using a virtual reality (VR) headset MethodsParticipants completed a pre-study questionnaire assessing their familiarity with VR technology and its potential role in radiology. Using a VR headset, participants entered a simulated reading room (SieVRt, Luxsonic Technologies) with three large virtual monitors. They were able to view plain radiographs, ultrasound, CT, and MRI images and pull up and compare multiple images simultaneously. They then completed a post-study questionnaire to re-assess their perception about the role of VR technology for diagnostic radiology. ResultsFifteen participants were enrolled, with 33.3 % attendings, 40 % fellows, and 26.7 % residents. Pre-study, 60 % reported they were “not familiar” with VR technology and 66.7 % had never used it. On a 1 to 5 scale, the median perceived likelihood of VR having a role in radiology significantly increased from 3 (IQR 2–3) pre-study to 4 (IQR 4–4) post-study; p = 0.014. Image contrast and resolution were adequate according to most participants, with 53.3 % strongly agreeing and 33.3 % agreeing. The headset was comfortable for 73.3 % and did not induce nausea in any participant. Confidence in VR technology improved after using the headset for 80 %. According to 80 %, future VR technology could replace a PACS workstation. DiscussionRadiologists’ perception regarding the role of virtual reality in diagnostic interpretation improves after a hands-on trial of the technology, and VR has the potential to replace a traditional workstation in certain situations.

Carpometacarpal Dislocation with Third Metacarpal Fracture.

Case PresentationA 17-year-old male presented to the emergency department (ED) due to trauma to the right hand and wrist after punching a locker at school. He had significant soft tissue swelling. Radiographs demonstrated intra-articular metacarpal fractures with associated carpometacarpal dislocations. The dislocation was reduced bedside in the ED and ultimately underwent closed reduction surgical management with orthopedic surgery.DiscussionMetacarpal fractures result from high-force impact injuries and account for 30–40% of all hand injuries. The most common sites of second through fifth metacarpal fractures are at the neck and the shaft, with the majority involving the fifth metacarpal neck (commonly coined “boxer’s fractures”). Carpometacarpal (CMC) dislocations are a rare injury associated with high-force impact trauma to the wrist. These injuries account for as little as 1% of all acute hand and wrist injuries.1,2 Carpometacarpal dislocations are often difficult to diagnose on physical examination due to significant soft tissue swelling, and they can easily be missed on anterior-posterior views of the hand. Lateral and oblique plain radiograph views are essential in the diagnosis as they are more likely to show dislocations. Despite appropriate plain radiographic views, subtle CMC dislocations may be difficult to discern dependent on the level of dislocation or subluxation and overlapping of joints. These injuries are rare due to otherwise highly stable ligamentous and muscular attachments within the wrist. Because of these attachments, dislocations are often associated with concomitant metacarpal fractures.3

Evaluation of Judet view radiographs accuracy in classification of acetabular fractures compared with three-dimensional computerized tomographic scan: a retrospective study

BackgroundIn the current diagnostic procedure, generally, both plain radiographs and 3D-CT scans are used for the diagnosis of acetabular fractures. There is no consensus regarding the value of a three-dimensional computerized tomographic (3D-CT) scan alone in the classification of acetabular fractures. In this study, we compared the accuracy of 3D-CT scan and plain radiography through the evaluation of their agreement with the intraoperative surgeon’s classification.MethodIn a retrospective study, patients who were referred to our center with an acetabular fracture and underwent surgical treatment were included. The classification of acetabular fractures was performed once using Judet view plain radiographs and once using a 3D-CT scan by the corresponding one Experienced musculoskeletal radiologist one independent trauma fellowship-trained orthopaedic who routinely treat acetabular fractures and based on Letournel and Judet classification (17 and 23 years of experience respectively). Cohen’s kappa value was used for the assessment agreement between the two imaging modalities, as well as between the imaging modalities and intraoperative classification.ResultsMedical files of 152 patients with acetabular fracture were retrospectively reviewed. A kappa value of 0.236 was obtained as the agreement level between radiographs and intraoperative findings (p < 0.001). A kappa value of 0.943 was obtained as the agreement level between 3D-CT and intraoperative classification (p < 0.001). An agreement level of 0.264 was found between the Judet radiographs and 3D-CT scans (p < 0.001).Conclusions3D-CT scans are reliable enough in the classification of acetabular fractures, and plain radiographs could be omitted to avoid radiation exposure as well as to reduce the cost for patients who sustain acetabular fractures.

RADIOGRAPHIC OUTCOMES OF ANTERIOR CERVICAL DISCECTOMY AND FUSION SURGERY BY USING CUSHIONED TITANIUM CAGE

Purpose: Anterior cervical discectomy and fusion is considered as a standard procedure for treating cervical degenerative disc disease. This retrospective study aimed to analyze the radiographic outcome of using a novel cushion titanium cage (Baui Z-Brace Dynamic Fusion Cage). Methods: Fifty-seven patients who received either single-, double-, or three-level interbody fusion surgeries were enrolled. Data from initial status after surgery and postoperative follow-ups for five years were obtained. The patients were divided into three groups according to different levels of cage implantation: 1-level ([Formula: see text]), 2-level ([Formula: see text]), and 3-level ([Formula: see text]). Follow-up time and fusion rate of radiographs were subjected to evaluation. Results: The lateral view of plain radiographs manifests no evident cage subsidence ([Formula: see text][Formula: see text]mm) and dislodgment in 1-, 2-, and 3-level cage implantation. The follow-up time is three years in 1-level and two years in 2- and 3-level. The CT scans at the final follow-up among different levels of cage implantation manifested bony fusion. The measurement of the Hounsfield unit indicates the bone growth inside the cage compared with control case, demonstrating solid bony fusion among groups at the final follow-up. Conclusions: The data confirm that the specialized Z-shaped structure of the cushion titanium cage may provide the interfragmentary motion stimulating innate bony fusion for sustained improvement.

Clinico-radiologic correlates of oral and maxillofacial radiographs: A 3-year study of 156 patients in a Nigerian teaching hospital

Background: Any discrepancy between clinical and radiographic information may have dire consequences on the optimal care of patients. Aim: The aim of this study was to determine the correlation between the clinical and radiographic findings in oral and maxillofacial surgery patients. Materials and Methods: This was a retrospective study of all patients with plain radiographic views of the oral and maxillofacial region, seen at a Nigerian Teaching Hospital, over a 3-year study period. The radiographs and patients' case files were retrieved and demographic, clinical as well as radiographic information were obtained. Radiographic information obtained included source and types of the radiographs, patients' bio-data, side and site of the pathology, clinical indication, labeling on the radiograph as well as interpretation errors in form of missed diagnosis other than missed fractures. The data were analyzed using SPSS version 13. Cohen's kappa agreement test was done between clinical and radiographic information.P Results: Radiographs from 156 patients aged 8–80 years, mean (standard deviation), 37.9 (19.22) years, were reviewed. There were 102 males and 54 females. Trauma (n = 54; 34.6%) was the most common indication for radiographs. “Transposition” of side of the lesions accounted for 9 (5.8%) of the cases. Radiographic “transposition” was significantly associated with facial fractures, temporomandibular joint ankylosis, and impacted mandibular third molars (likelihood ratio: χ2 = 16.930; df = 10;P = 0.03). There was some disagreement between clinical and radiographic information with regard to side (kappa = 0.788;P = 0.001). Conclusion: Discrepancies in the side of lesions, between clinical and radiographic information, were observed in this study. Adequate care should be taken by clinicians and radiologists to minimize errors in radiographs.

Conventional two plate fixation versus L-shaped plates in management of mandibular angle fracture: A comparative retrospective study

Purpose: In mandibular angle fractures, various treatment modalities have been used to rigidly fix the fractured segments aiming to achieve healing through stability and bone formation. In this study, a comparison between two fixation techniques was implied; one L-shaped plate versus two horizontal plates superiorly and inferiorly placed respectively, in an attempt to assess their different effect on healing and complications.Materials and methods: Sixteen patients suffering from displaced angle fractures were included in this study with a mean age of 42 years. The selected patients were divided into two equal groups; Group A employed the fixation of the fractured segments using one L-shaped plate and Group B used the conventional treatment method of utilizing two horizontal plates to fix the fragments in their normal position with subsequent immediate postoperative mandibular function. All the patients were followed-up at minimum period of evaluation of six months. Postoperative complications were recorded if present which included fragment mobility, changed occlusion, dehiscence, infection and/or parasthesia. Postoperative clinical assessment through pain evaluation via visual analogue scale (VAS; scale 0-10) and maximal non-assisted inter-incisal mouth-opening (MIO) measured in mm was performed. Plain radiographic views were performed for inter-fragment alignment assessment. Clinical readings were recorded immediately postoperative and on months 1 and 3. The collected clinical and radiographic findings were tabulated and statistically analyzed. Results: The healing in all cases was uneventful and all patients showed clinical success with no sign of fragments mobility. All the data were analyzed by Mann Whitney U test to compare between the tested groups. Friedman test used to compare between follow up periods followed by Wilcoxon signedrank test for pair wise comparison. The clinical examination and the radiographic assessment revealed no statistically significant difference between the readings of both groups. Regarding the postoperative complications, better initial results came in favor of group A patients, however, with no difference between both groups at the end of the follow up period. Conclusion: Despite of the displacement of the segments in mandibular angle fractures, this study stated that no significant benefit in MAF healing was seen when different plating techniques were used, under the condition of utilizing more than one plane in plate fixation. However, the one-plate L-shaped fixation technique presented fewer postoperative complications.

Synovial fluid anti-citrulline-containing peptide antibody and its role in the diagnosis of rheumatoid arthritis

ObjectiveThis study aimed to measure the level of anti-citrulline-containing peptide (anti-CCP) antibody (ab) in the synovial fluid (SF) of rheumatoid arthritis (RA) patients to study its relations with anti-CCP ab serum level, RA disease activity, and severity parameters as well as to explore its diagnostic value in RA.Patients and methodsThis study was conducted on 60 RA and 60 osteoarthritis (OA) patients. Patients were subjected to thorough history taking and full clinical examination including locomotor system examination. The Health Assessment Questionnaire was used for the assessment of functional capacity. Complete laboratory investigations including a complete blood count, erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, serum and SF anti-CCP ab levels were carried out. The Sharp score was calculated for the assessment of RA severity in posteroanterior plain radiographic views of both hands and feet.ResultsThe mean SF anti-CCP ab level was highly significantly increased (P=0.0001) in RA patients (133.93±41.3 ng/l) in comparison with OA patients (5±13.2 ng/l). There were statistically significant correlations of SF anti-CCP ab level with rheumatoid factor (P=0.049), serum anti-CCP ab (P=0.0001), and Sharp score (P=0.037), whereas other clinical and laboratory parameters did not show any significant correlation (P>0.05). The specificity of SF anti-CCP ab and serum anti-CCP ab of RA patients was 100%. Besides, the sensitivity of serum anti-CCP ab was 90%, whereas the sensitivity of SF anti-CCP ab was 83.3%. The positive predictive value of both serum and SF anti-CCP abs was 100% in RA patients and their negative predictive value was 90.9% in the serum of RA patients and 85.7% in the SF. The cutoff value of anti-CCP ab was 65.4 ng/l in the serum and 63.35 ng/l in the SF.ConclusionSF anti-CCP ab is significantly increased in RA compared with OA and could be considered an appreciated diagnostic marker having a major role in the identification of RA patients not fulfilling the criteria for the RA disease diagnosis. Its relation to RA disease severity could not be established.

CT-generated radiographs in patients with pelvic ring injury: can they be used in lieu of plain radiographs?

BackgroundPelvic ring injury classification traditionally is made using plain radiographs. Recent studies suggest that computed tomography (CT)-generated images have higher diagnostic accuracy than plain films for the classification of acetabular fractures. However, similar studies have not been performed for pelvic ring injuries. The purpose of this study was to compare CT-generated and plain radiographs in terms of the ability of surgeons at different experience levels to identify pelvic injury type.MethodsCT-generated and plain radiograph image sets were created from 15 pelvic ring injury patients with known classification morphology. Three groups, each consisting of three orthopaedic surgeons representing different levels of expertise, viewed these image sets and recorded their diagnoses. These diagnoses were compared to the gold standard findings of the treating physician and to each other.ResultsOverall, there was a significantly improved ability to correctly classify pelvic ring injury type by CT-generated radiographs as compared to plain radiographs (p < 0.01). However, analysis of the groups revealed that this difference was limited to the less experienced groups (p < 0.05).ConclusionsCT-generated radiographs are diagnostically beneficial for less experienced surgeons and at least as good as conventional plain radiographs for experienced surgeons in classifying pelvic ring injuries. Therefore, CT-generated radiographs may be clinically valuable: sparing the patient additional radiation exposure and discomfort by avoiding the reordering of plain radiographs when the initial studies are of poor quality, as well as serving as a possible alternative for supplemental initial injury plain radiographic views.

Outcome Determining Factors for displaced Intra-articular Calcaneal Fractures treated operatively.

Introduction: Calcaneal fractures are caused by high energy trauma and mostly are intra-articular fractures. Nondisplaced intra-articular calcaneal fracture (IACF) can be treated non-operatively. However, displaced intra-articular need to be reduced and fixed anatomically to facilitate early ankle rehabilitation and minimize functional impairment. This study was done to find out the outcome of the IACF patients who underwent operative treatment.Methods: 62 patients with IACF were selected in this study and had been followed up from June 2009 to May 2013. They were placed into two groups; the operative treated and non-operative treated groups. Bilateral ankle lateral view plain radiographs were taken for comparison of the Bohler and Gissane angles. Both groups of patients were assessed by the Maryland Foot Score (MFS) and the SF-36v2 general health survey questionnaire. The ability of the patients to perform activity of daily living (ADL) and /or return to work (RTW) was assessed as well.Results: The operative treatment group of displaced IACF patients achieved no significant better scores in the mean MFS and SF-36v2 mean scores as compared to non operated cases. There was no difference in RTW between the 2 groups, but earlier ADL was recorded in the operated group. However, this study had found 5 associated factors which causes major effect to the patients’ outcome to treatment.Conclusions: The patient’s compliance with post-operative rehabilitation regimen were found to be significantly related with the outcomes.

The Effect of the Pedicle-Facet Angle on Degenerative Cervical Spondylolisthesis.

ObjectiveTo measure the orientation of the facet joints of cervical spine (C-spine) segments in the sagittal plane, known as the pedicle-facet (P-F) angle, and to use these measurements to evaluate the relationship between the P-F angle and the amount of vertebral anterolisthesis in patients with degenerative cervical spondylolisthesis (DCS).MethodsA retrospective case-control study was performed including 30 age- and sex-matched patients with DCS and 30 control participants. Anterior-posterior and lateral view radiographs of the C-spine were obtained in a standing position. The P-F angle at all cervical levels and the amount of anterolisthesis at C4-5 were measured from lateral view plain radiographs.ResultsThe P-F angles at C4-5 were 141.14±7.14° for the DCS group and 130.53±13.50° (p=0.012) for the control group, and at C5-6 were 137.46±8.53° for the DCS group and 128.53±16.01° for the control group (p=0.001). The mean P-F angle at C4-5 did not correlate with the amount of anterolisthesis (p=0.483). The amount of anterior slippage did correlate with age (p<0.001).ConclusionThe P-F angle was intrinsically higher at C4-5, compared to C5-6, in both the DCS and control groups, which might explain the increased likelihood for anterolisthesis of C4. Higher P-F angles in the DCS group may be a predisposing factor to slippage. The P-F angle may interact with age to increase incidence of anterolisthesis with increasing age.

Morphometric study of the lumbosacral spine and some of its related angles in Lebanese adult females.

The present study was undertaken to examine the morphometric characteristics of lumbar vertebrae, lumbar intervertebral discs and some important related angles in Lebanese adult females. The subjects of this study were thirty Lebanese adult females aged between 18-22 years. The subjects were selected among students of the faculty of health sciences, Beirut Arab University. Two plain radiographic views for the lumbosacral spine were taken for each subject, an anteroposterior view and a lateral view. Measurements were made directly on the X-ray films using Vernier calliper and were recorded to the nearest tenth of a millimetre. The following measurements were taken for each lumbar vertebra: the anterior height of the body, the posterior height of the body, the horizontal diameter of the pedicle, the vertical diameter of the pedicle, the interpedicular distance, the width (transverse diameter) of the body. Also the anterior height, the posterior height and the anteroposterior diameter (disc depth) of the intervertebral disc were measured. In addition, the following angles were measured: the angle of lumbar lordosis, the lumbosacral angle and the angle of sacral inclination. The mean and standard deviation were calculated and recorded. The results offer a base line reference for normal Lebanese adult females and a guidance to clinicians for the evaluation and management of subjects complaining of low back pain, in order to propose specific preventive or rehabilitation protocols to prevent low back pain as a function of spinal alignment. Moreover, these normal figures could also be of forensic importance because of the observed racial, ethnic and regional variations.

Management of scaphoid nonunion with avascular necrosis using 1,2 intercompartmental supraretinacular arterial bone graft.

Background:1,2 ICSRA, introduced by Aidembery et al., is a well-established technique, with up to 100% union rate among different studies. The purpose of our study was to evaluate the outcome of scaphoid nonunion undergoing 1,2 ICSRA bone graft in Iran.Materials and Methods:All participants who presented sequentially over a period of 24 months between 2010 and 2013 with nonunion scaphoid fracture with AVN in proximal pole were included in the study. Anteroposterior and lateral view plain radiographs of carpal bones were obtained for diagnosis of nonunion, and a diagnosis of avascular necrosis was made by MRI of the scaphoid. Subjects underwent 1,2 ICSRA bone graft surgery. Patients were assessed based on radiographs and the Mayo Wrist Score (MWS) questionnaire on before and after surgery. Data were analyzed using SPSS ver. 18 by paired t test.Results:Overall, 16 patients (100% male) were included in the study. Mean age of subjects was 27.50 ± 5.86 (18 to 38). Mean Mayo score was 36.63 ± 8.92 and 83.75 ± 9.22 before and 6 month after surgery, respectively, and the difference was statistically significant (P < 0.001). after 8 weeks, 10 (62.5%) had union, and after 12 weeks, all subjects had union. Nine (56.25%) of our patients had excellent functional outcome, 5 (31.25%) had good and 2 (12.5%) had satisfactory functional outcome.Conclusion:1,2 ICSRA is a proper pedicle of vascularized bone graft due to the ease of visibility and dissection. The functional results and union rates were satisfactory in our study.

A Rare Case of Multifocal Giant Gell Tumor of the Tendon Sheath Involving Both the Hand and the Foot

A Rare Case of Multifocal Giant Gell Tumor of the Tendon Sheath Involving Both the Hand and the Foot

Morphometric Study of The Lumbosacral Spine and Some of Its Related Angles in Lebanese Adult Females

The present study was undertaken to examine medicolegal importance of morphometric characteristics of lumbar vertebrae, lumbar intervertebral discs and some important related angles in adult Lebanese females. The subjects of this study included thirty Lebanese adult females aged between 18-22 years. The subjects were selected among students of the faculty of health sciences, Beirut Arab University. Two plain radiographic views for the lumbosacral spine were taken for each subject (An anteroposterior view and a lateral view). Measurements were made direct from the X-ray films using Vernier calliper and were recorded to the nearest tenth of a millimetre. The following measurements were taken for each Lumbar vertebra: The anterior height of the body, posterior height of the body, horizontal diameter of the pedicle, vertical diameter of the pedicle, interpedicular distance and the width (transverse diameter) of the body. Regarding intervertebral discs, the anterior height, posterior height and anteroposterior diameter of the disc (disc depth) were measured. In addition, the following angles were measured: the angle of lumbar lordosis, lumbosacral angle and angle of sacral inclination. The mean and standard deviation of the above mentioned parameters were calculated and recorded. It is concluded that measurements obtained in this study form a base line figures in normal Lebanese adult females in terms of morphometric measurements in healthy subjects as well as giving guidance to clinicians as being applicable for evaluation and management of subjects complaining of low back pain; not only do these age related normative values help in identifying the underlying cause, but they also direct physicians towards the proper line of treatment. Whether specific preventive modalities or rehabilitation protocols could be instituted to prevent low back pain in subjects with particular spinal alignment remains unclear and should be investigated in future studies. Moreover, these normal figures could also be of forensic importance because of the racial, ethnic and regional variations which have been observed in comparison with previous studies.

The Bristol Hip View: Its Role in the Diagnosis and Surgical Planning and Occult Fracture Diagnosis for Proximal Femoral Fractures

Aim. To evaluate whether a modified radiographic view of the femoral neck improves the diagnosis of occult proximal femoral. Materials and Methods. Prospective study of patients presenting with clinically suspected proximal femoral fractures or who underwent traditional plain radiographic views and the Bristol hip view (a 30-degree angled projection). Six blinded independent observers assessed the images for presence of a fracture, anatomical level, and displacement. Results. 166 consecutive patients presenting with the clinical diagnosis of a proximal femoral fracture, of which 61 sustained a fracture. Six of these were deemed occult due to negative plain and had proven fractures on subsequent cross-sectional imaging. The Bristol hip view demonstrated five of these six fractures. It performed better than the traditional lateral hip view to identify the injury. The Bristol hip view predicted correctly the fracture type and displacement in all cases and missed only one of the occult fractures. Conclusion. The Bristol hip view is more sensitive and clearer than a lateral projection for patients. It adds useful diagnostic information and performs better than the traditional views in occult fractures. Its use may prevent the need for further cross sectional imaging and subsequent surgical delay.

A Review of Symptomatic Leg Length Inequality following Total Hip Arthroplasty

Leg length inequality (LLI) following total hip replacement is a complication which features increasingly in the recent literature. The definition of LLI is complicated by lack of consensus regarding radiological measurement, clinical measurement and the incomplete relationship between LLI and associated symptoms. This paper reviews 79 reports relating to LLI post hip replacement, detailing definitions and classification and highlighting patient populations prone to symptomatic LLI. While there is no universal definition of LLI, there is a broad consensus that less than 10 mm of difference on AP view plain radiographs is clinically acceptable. There are few techniques described that consistently produce a postoperative LLI of less than this magnitude. Where postoperative LLI exists, lengthening appears to cause more problems than shortening. In cases of mild LLI, non-surgical management produces adequate outcomes in the majority of cases, with functional LLI cases doing better than those with true LLI. Operative correction is effective in half of cases, even where nerve palsy is present, and remains an important option of last resort. Poor outcomes in patients with LLI may be minimised if individuals at risk are identified and counselled appropriately.

The lumbosacral radiographs in the initial screening of low back pain - Is one view enough?

Radiological imaging is mandatory, when investigating patients with low back pain (LBP). A minimum of three plain radiographic views of lumbosacral spine are routinely requested for by the attending clinicians. This study is therefore carried out to determine if only one view will be sufficient in the initial screening of patients with low back pain. The antero-posterior (AP) and lateral plain radiographs of patients referred to the radiology department on account of low back pains in an eighteen month period (June 2007 to November 2008) were reported by two certified radiologists. The findings were subjected to statistical analysis. The Kappa agreement for the two independent reports was between 0.602 and 0.908. The radiographs for 638 patients were reviewed. 365 (57.2%) were females and 273 (42.8%) were males. The age ranged from 20 years to 85 years with a mean of 56.4 years. Within the age group of 20-69 years, females were found to significantly present earlier than men with LBP (P< 0.041). The AP view had a significantly higher rate of reported normal findings that the lateral view (P<0.000). Osteophytic outgrowth was the commonest finding in both views although the rate of detection was higher on the lateral view, as with the other abnormal findings. This study shows that the lateral radiographs show significantly more findings than AP on plain radiographs. It is therefore recommended that lateral radiograph is adequate in the initial screening of patients with low back pain.

Evaluation of Computed Tomography for Determining the Diagnosis of Acetabular Fractures

We assessed whether, in contrast to reports in the literature, computed tomographic (CT) scans improve the ability to classify acetabular fractures in comparison with plain radiographs. Prospective. Level I trauma center. Seventy-five patients with 75 acetabular fractures treated between June 2005 and May 2006. Four different image sets for each patient were evaluated: image set A, Judet view plain radiographs plus axial view CT scans; image set B, Judet view plain radiographs alone; image set C, three-dimensional CT reconstructions; and image set D, CT-simulated anteroposterior and Judet views of the pelvis. The 300 image sets were viewed in random order by four orthopaedic trauma fellowship-trained surgeons who independently recorded a diagnosis. A gold standard diagnosis was determined by group consensus. Agreement among four imaging methods was evaluated by using kappa statistics for multiple raters and nominal data. Comparing the gold standard diagnosis with the four image sets, Judet view plain radiographs had a worse kappa value than CT scans (P < 0.05). The adjusted kappa values for all three image sets that included CT scans averaged greater than 0.62, showing substantial agreement, whereas the image set with plain radiographs alone (image set B) had a lower kappa value of only 0.48 (P < 0.05). In contrast to previous reports in the literature, the accuracy of plain radiographs alone was less than the accuracy of CT scans in terms of diagnosis. The interobserver reliability was also worse for plain radiographs alone.

267: Using Body Mass Index to Predict the Adequacy of Cervical Spine Radiography in Trauma Patients

Plain radiography is the first line study for low-risk trauma patients undergoing ED evaluation of possible cervical spine injury because of its lower cost and radiation exposure relative to CT. We sought to determine if body mass index (BMI), as a measurable indicator of body habitus, is a useful tool to predict who should go directly to CT because plain radiographic views would be inadequate to rule out injury, thereby reducing the time, expense, and radiation associated with two radiographic studies.

Treatment of the Humeral Shaft Aseptic Nonunion Using Plate or Unilateral External Fixator

Although the use of a plate and bone graft is described as a well-known treatment for aseptic humeral shaft nonunion, unilateral external fixator can be alternative as a minimally invasive method. There has been no report comparing two methods of plate and external fixator for humeral shaft nonunion. Also, a few studies described humeral shaft aseptic nonunion treatment using unilateral external fixator. We retrospectively reviewed 31 patients (15 men and 16 women) with aseptic humeral shaft nonunion treated by plate (n = 20) and unilateral external fixator (n = 11). Patients were followed for a mean of 31.8 months. The right upper arm was involved in 19 patients (17 dominant) and left in 12 patients (2 dominant). The inclusion criteria were aseptic, middle shaft nonunion, without bone defects more than 2 cm. Four patients had hypertrophic, and 27 patients had atrophic nonunion. Solid union, as documented on plain radiographic views, was obtained in 28 (90.3%) patients without additional operation. The average operative time was 92.8 minutes in plate group and 47.8 minutes in external fixator group (p < 0.05). The average blood loss was 142.5 mL in plate group and it was 45.5 mL in external fixator group (p < 0.05). Average hospital stay was 10.9 days in plate group and 3.9 days for external fixator group (p < 0.05). Overall, healing time in the plate group was 4.4 months, compared with 3.6 months in the external fixation group (p < 0.05). The mean Constant and Murley score for plate group was 85.6 points and it was 74.3 points for the external fixator group. According to Stewart and Hundley criteria, 16 (80%) patients in the plate group and 6 (54.5%) patients in the external fixator group had good outcome. Two-pin track infection of the external fixator (18.2%) and two transient radial nerve palsy (10%) were recorded. In this retrospective study of the humeral shaft nonunion, unilateral external fixator tended to yield equally favorable treatment results as did plate fixation. Advantages of the plate are good stability on the nonunion site and comfortability for patient. On the contrary, the advantages of the unilateral external fixator are minimal exposure to the nonunion site with minimal surgical trauma to the soft tissue, easy application of the fixator and consecutively minimal blood loss and short operative time. Unilateral external fixator could be a valuable alternative to plate fixation in aseptic humeral shaft nonunions.