Profile Radiographs Research Articles

“Normal” Cervical Spine Radiographs and Computed Tomography Scans in the Emergency Department: Beware of Posttraumatic Instability of the Mobile Segment of the Lower Cervical Spine

The NEXUS criteria have been introduced in the 1990s to assist emergency department physicians to decide whether to perform radiographic work-up following cervical whiplash injury. Four criteria have been described on these profile radiographs of the cervical spine including angulation between cervical endplates, 3-mm listhesis, posterior facet joints overlap, and widened interspinous space. Although these criteria could help to detect patients suffering from unstable trauma of the mobile segment if the lower cervical spine, the radiographic signs may be so subtle that even specifically trained physicians like spine surgeons and neuroradiologists may miss them, especially during after-hour shifts. Hence, we present the striking case of a young female patient whose radiographs displayed slight but abnormal signs of lower cervical spine instability, but was nonetheless discharged home with dynamic X-rays of the cervical spine to be performed in a delayed setting. We hope that these striking features will help us remind the importance of radiologic semiology of posttraumatic unstable cervical spine.

Pincer Morphology Is Not Associated With Hip Osteoarthritis Unless Hip Pain Is Present: Follow-Up Data From a Prospective Cohort Study.

The objective of this study was to assess the relationship between pincer morphology and radiographic hip osteoarthritis (RHOA) over 2, 5, 8, and 10 years' follow-up and to study the interaction between pincer morphology and pain. Individuals from the prospective Cohort Hip and Cohort Knee study were drawn. Anteroposterior pelvic and false profile radiographs were obtained. Hips free of definite RHOA (Kellgren and Lawrence [KL] grade 0 or 1) at baseline were included. Pincer morphology was defined as a lateral or anterior center edge angle or both ≥40° at baseline. Incident RHOA was defined as KL ≥ 2 or total hip replacement at follow-up. Multivariable logistic regression with generalized estimating equations estimated the associations at follow-up. Associations were expressed as unadjusted odds ratios (ORs) and adjusted ORs with 95% confidence intervals (CIs). An interaction term was added to investigate whether pincer morphology had a different effect on symptomatic hips. Incident RHOA developed in 69 hips (5%) at2 years' follow-up, in 178 hips (14%) at 5 years' follow-up, in 279 hips (24%) at 8 years' follow-up, and in 495 hips (42%) at 10 years' follow-up. No significant associations were found between pincer morphology and incident RHOA (adjusted OR 0.35 [95% CI 0.06-2.15]; adjusted OR 1.50 [95% CI 0.94-2.38]). Significant interactions between pain and anterior pincer morphology in predicting incident RHOA were found at 5, 8, and 10 years' follow-up (OR 1.97 [95% CI 1.03-3.78]; OR 3.41 [95% CI 1.35-8.61]). No associations were found between radiographic pincer morphology and incident RHOA at any follow-up moment. Anteriorly located pincer morphology with hip pain, however, was significantly associated with incident RHOA. This highlights the importance of studying symptoms and hip morphology simultaneously.

Poster 118: False Profile Radiograph Sourcil-Edge and Bone-Edge Measurements Both Correlate to Different Weight-Bearing Regions of the Acetabulum: A Three-Dimensional Analysis

Objectives: The acetabular sourcil has been thought of as the radiographic representation of the weightbearing dome of the acetabulum; however, there are limited modern data to support this supposition. In the literature, assessment of weightbearing acetabular coverage has been described using both the sourcil-edge and bone-edge as anatomic landmarks, leading to confusion and controversy in classification of hip dysplasia, indications for hip preservation surgery, and intraoperative coverage assessment. The purpose of this study was to localize the three-dimensional (3D) anatomic correlates of the sourcil-edge and bone-edge radiographic position on false profile radiographs. The authors hypothesized that the sourcil-edge on the false profile represents anterolateral coverage while the bone-edge represents anterior coverage. Methods: Forty hips were grouped by large or small differences between bone-edge and sourcil-edge anterior center edge angles (ACEA). The small difference group comprised the lowest quartile of sourcil-edge to bone-edge difference of an initial cohort of 80 hips, while the large difference group comprised the highest quartile of difference. 3D surface mesh models and digitally reconstructed radiographs (DRRs) were generated from hip computed tomography scans using the 3D Slicer Image Computing Platform (Figures 1 & 3). Sourcil-edge, bone-edge, and ACEAs were identified on DRRs and registered to the 3D models with fiducial markers. Intersection of bone-edge and sourcil-edge projection lines with the acetabular rim were obtained from the 3D models (Figures 2 & 4). 3D Anterior acetabular rim morphology was correlated with ACEA difference. Results: The bone-edge and sourcil-edge projections intersected the acetabular rim at a mean of 2:08 ± 0:25 and 1:20 ± 0:24 o’clock, respectively. The 3D models consistently demonstrated that, in both large and small discrepancy groups, the sourcil-edge corresponded to an area just posterior to the AIIS projection while the bone-edge corresponded to the weight-bearing region inferior to the AIIS (Figures 2 & 4). Additionally, in large discrepancy hips, the bone-edge corresponded to a more prominent acetabular coverage in the region of the AIIS than when compared to the small discrepancy hips. Conclusions: This study demonstrates that both the sourcil-edge and bone-edge projections on false profile radiographs correlate with differing weightbearing regions of the acetabulum. The sourcil-edge ACEA represents coverage at 1:20 o’clock on the acetabular rim and is consistently posterior to the AIIS, while the bone-edge measurement represents the region of the acetabular rim at 2:08 o’clock and is consistently inferior to the AIIS. In hips with a large discrepancy between bone-edge and sourcil-edge (highest quartile), ACEA measurement differs by a mean of 19.7 degrees based on the selection of these radiographic landmarks. These findings have substantial implications for hip preservation surgery technique and clinical decision making. A comprehensive understanding of femoral head coverage is essential for the treatment of young adult hip pathology. Although the sourcil and bone edge are two of the most important radiographic landmarks for assessment of acetabular dysplasia, descriptions of these landmarks are often over simplified. Some authors have advocated for greater utilization of measurements of coverage to the bone edge as it can be more consistently identified. Other authors have advocated for utilizing the sourcil-edge measurement as this is more representative of the “weight bearing dome”. These descriptions are limited as they do not improve our understanding of the anatomic and radiographic structure of the anterior acetabular rim. Although the concept of the “weight bearing dome” is classically described, it lacks anatomic precision. The present study clarifies the anatomic features of the acetabular rim that correspond to these radiographic features. Increased difference between the sourcil-edge and bone edge is generated by the differences in undulation of the anterosuperior acetabular rim. Acetabuli that have maximal anterior rim prominence at or near the superior-most aspect of the acetabulum (generally counterclockwise from the AIIS) tend to demonstrate smaller discrepancy between the bone-edge and sourcil-edge (Figure 4). Acetabuli that have maximal rim prominence medial and anterior to the superior-most aspect of the acetabulum generally demonstrate larger discrepancy (Figure 2). The present anatomic description can be utilized by the hip arthroscopist to better determine which areas of the anterior rim may cause impingement. Similarly, while conducting a periacetabular osteotomy, the surgeon may use this information to better understand how acetabular rotation is contributing to both anterior and anterolateral coverage. In conclusion, on false profile radiographs, the sourcil-edge corresponds to superior femoral head coverage, while the bone-edge corresponds to anterosuperior coverage. False profile radiographs with a large discrepancy between sourcil-edge and bone-edge measurements demonstrate a prominent weight bearing surface in the region of the AIIS. These data regarding the radiographic phenomena of the acetabular rim can aid in clinical decision-making and intraoperative technique.

Can we determine anterior hip coverage from pelvic anteroposterior radiographs? A study of patients with hip dysplasia

PurposeInsufficient coverage causes hip joint instability and results in hip pain. Anterior hip coverage can be determined on both pelvic anteroposterior (AP) radiographs and false profile (FP) radiographs. Four parameters are commonly used to determine the anterior coverage on pelvic AP radiographs: the crossover index, crossover sign, anterior wall index (AWI), and rule of thirds. This study aims to clarify the relationship between these 4 parameters on AP radiographs and the anterior center edge angle (ACEA) on FP radiographs.MethodsIn this study, 53 patients who underwent periacetabular osteotomy for hip dysplasia at our center between July 2020 and October 2020 were retrospectively reviewed. Four parameters on AP radiographs and the ACEA on FP radiographs before surgery and 6 months after surgery were measured and compared for each hip.ResultsUpon examining the 53 hips in this study, there was no correlation between either the crossover index and the ACEA (P = 0.66) or the crossover sign before surgery. The postoperative correlation between the crossover index and the ACEA was weak (r = 0.36, P = 0.007), and that between the crossover sign and the ACEA was moderate (r = 0.41, P = 0.003). There was a weak correlation between the AWI and ACEA both before (r = 0.288, P = 0.036) and after (r = 0.349, P = 0.011) the operation. Evaluation of the anterior coverage by the rule of thirds was also not consistent when determining the anterior coverage with the ACEA.ConclusionAnterior coverage on AP radiographs is largely inconsistent with ACEA on FP radiographs, especially before the surgery. It is recommended to take FP radiographs routinely for determining anterior hip coverage.

Evaluation of the anterior acetabular coverage with a false profile radiograph considering appropriate range of positioning

This study aimed to (1) set a reference value for anterior center edge angle (ACEA) for preoperative planning of periacetabular osteotomy (PAO), (2) investigate the effects of pelvic rotation and inclination from false profile (FP) radiographs on the measured ACEA, and (3) determine the “appropriate range of positioning” for FP radiograph. This single-centered, retrospective study analyzed 61 patients (61 hips) who underwent PAO from April 2018 and May 2021. ACEA was measured in each digitally reconstructed radiography (DRR) image of the FP radiograph reconstructed in different degrees of pelvic rotation. Detailed simulations were performed to determine the “appropriate range of positioning” (0.67 < ratio of the distance between the femoral heads to the diameter of the femoral head < 1.0). The vertical-center-anterior (VCA) angle was measured on the CT sagittal plane considering the patient-specific standing positions, and its correlation with the ACEA was investigated. The reference value of ACEA was determined by receiver operating characteristic (ROC) curve analysis. The ACEA measurement increased by 0.35° for every 1° pelvic rotation approaching the true lateral view. The pelvic rotation with the “appropriate range of positioning” was found at 5.0° (63.3–68.3°). The ACEA on the FP radiographs showed a good correlation with the VCA angle. The ROC curve revealed that an ACEA < 13.6° was associated with inadequate anterior coverage (VCA < 32°). Our findings suggest that during preoperative PAO planning, an ACEA < 13.6° on FP radiographs indicates insufficient anterior acetabular coverage. Images with the “appropriate positioning” can also have a measurement error of 1.7° due to the pelvic rotation.

Acetabular dysplasia and the risk of developing hip osteoarthritis at 2,5,8, and 10 years follow-up in a prospective nationwide cohort study (CHECK).

ObjectiveTo assess the relationship between acetabular dysplasia (AD) and the risk of incident and end-stage radiographic hip osteoarthritis (RHOA) over 2,5,8 and 10 years. DesignIndividuals (n = 1002) aged between 45 and 65 from the prospective Cohort Hip and Cohort Knee (CHECK) were studied. Anteroposterior pelvic radiographs were obtained at baseline and 2,5,8, and 10-years follow-up. False profile radiographs were obtained at baseline. AD was defined as a lateral center edge angle, an anterior center edge angle, or both <25° at baseline. The risk of developing RHOA was determined at each follow-up moment. Incident RHOA was defined by Kellgren & Lawrence (KL) grade ≥2 or total hip replacement (THR), end-stage RHOA by a KL grade ≥3 or THR. Associations were expressed in odds ratios (OR) using logistic regression with generalized estimating equations. ResultsAD was associated with the development of incident RHOA at 2 years follow-up (OR 2.46, 95% CI 1.00–6.04), 5 years follow-up (OR 2.28, 95% CI 1.20–4.31), and 8 years follow-up (OR 1.86, 95%CI 1.22–2.83). AD was only associated with end-stage RHOA at 5 years follow-up (OR 3.75, 95% CI 1.02–13.77). No statistically significant associations were observed between AD and RHOA at 10-years follow-up. ConclusionBaseline AD in individuals between 45 and 65 years is associated with an increased risk of developing RHOA within 2- and 5 years. However, this association seems to weaken after 8 years and disappears after 10 years.

Classe II/2ª Divisão de Angle: existe alinhamento?

Abstract Introduction Interdisciplinary investigative study of the stomatognathic-cervical complex, necessary to understand the structure and biomechanics of this system in Angle Class I and II / 2nd Division participants. Objective To evaluate alignment and position of cranial cervical structures on radiographs and their functional relationship with the stomatognathic system. Material and method Trans Oral and Profile radiographs were submitted to biomechanical analysis, considered the linear and angular measurement of Atlas and Axis through the application included in the radiogram software. Result We observed a significant difference in the angular measurements of vertical alignment between the Skull, Axis, and the Mandible (p = &lt;0.001), and in the left joint between the Atlas and the Axis (AE: p = 0.011; SEA: p = 0.042). Among the linear measures of the distances between the Atlas and the Axis, the AOD distance presented statistics quite close to the level of significance (p = 0.0502), but above. There was no statistically significant difference in the other measures. Conclusion In this study, the alignment between the Atlas and Axis cervical vertebrae and the mandible and angles of the atlanto-occipital joints are altered in Class II / 2nd Division participants. There is no difference in the size and distance of the Atlas and the Axis between the Classes.

Surgical management of slightly or non-displaced corporal scaphoid fractures by retrograde percutaneous screw fixation through the anterior trapezium horn: A single-center retrospective French study of 33 patients between January 2015 and January 2019

Percutaneous screw fixation has recently gained popularity as an alternative to conservative treatment to avoid prolonged immobilization. The placement of a screw in the central axis of the scaphoid has been shown to be biomechanically superior to its eccentricity. Still, it poses difficulties in performing percutaneous screw fixation via both palmar and dorsal approaches. We describe a palmar percutaneous screwing of corporal fractures of the scaphoid by a simple palmar transtrapezial approach allowing an optimal centering of the screw. We selected patients operated on by the same surgeon using the palmar transtrapezial approach between January 2015 and January 2019 based on the coding used for these fractures and the operative reports. In addition, pre- and postoperative data were collected from the patient's computer and paper records and by telephone contact with the patients. Thirty-three patients were included. Percutaneous screw fixation of the scaphoid was performed under locoregional anesthesia in the operating room with one arm in the supine position on the arm table. No hyper-extension of the wrist was performed. The Kirchner guidewire passed through the anterior horn of the trapezium and then into the trapezium-scaphoid joint. A screw replaced it after satisfactory centering in the axis of the scaphoid. Management took place on average within 12 days after the trauma. 75.8% were A2 fractures, according to Herbert's classification. The average operating time was 16.63minutes, and in 91% of the cases, the patient was hospitalized for one day. The variation of the scapholunate angle on the preoperative profile radiographs with the angle defined by the axis of the scaphoid screw and the lunate postoperatively was on average 2.94°. One patient presented nonunion, and four showed an undersized screw with a screw overhang requiring revision surgery. The transtrapezial approach to fixation of acute scaphoid fractures facilitates precise percutaneous screw placement in the central axis of the scaphoid. A study of long-term complications, including the degenerative impact on the scaphotrapezial joint, is needed to assess the safety of passage through the anterior horn of the trapezium.

Sever's Disease in Mandiana (North-East Guinea): A Case Report and Review of the Literature

Introduction: Sever's disease or calcaneal osteochondrosis of the posterior apophysis affects adolescent athletes between 8 and 15 years of age, boys are more affected in about 60% of cases and the involvement is uni or bilateral, described in 1912 by the surgeon James Warren Sever. Objective: To present the first case of Sever's disease in Mandiana, supported by a review of the literature. Clinical Case: This was an 11-year-old adolescent, living in Mandiana, a soccer player (right lateral), playing with his right foot, who consulted for a right posteroinferior talalgia, progressive, of mechanical appearance, triggered by walking and physical activity, calmed by rest or by taking non- steroidal anti-inflammatory drugs (NSAID). No notion of taking fluoroquinolone-based medication, no signs suggestive of an infectious focus, particularly auto-rhino-laryngology (ENT) and dental, or tumors. The painful swelling (VAS 9/10) on palpation of the medial and lateral heel cup with degree 2 flat foot, the densification and fragmentation of the posterior calcaneal process on the right foot profile radiograph allowed the diagnosis of Sever's disease. The treatment was based on oral ibuprofen 400 mg three times a day for three weeks, diclofenac gel to rub the ankle, and the cessation of physical and sports activity for three months which gave a favorable outcome by the regression of pain (VAS at 1/10) and the normal resumption of walking. Conclusion: Sever's disease is a common condition in growing children, its diagnosis is clinical, radiology is used for differential diagnosis, and rest is essential in its management.

The incidence and risk factors for stress fracture following periacetabular osteotomy.

The aims of this study were to characterize the incidence and risk factors associated with stress fractures following periacetabular osteotomy, and to determine their effect on osteotomy union. We retrospectively reviewed all periacetabular osteotomies (PAOs) performed for developmental dysplasia of the hip (DDH) at one institution over a six-year period between 2012 and 2017. Perioperative factors were recorded, and included demographic and surgical data. Postoperatively, patients were followed for a minimum of one year with anteroposterior and false profile radiographs of the pelvis to monitor for evidence of stress fracture and union of osteotomies. We characterized the incidence and locations of stress fractures, and used univariate and multivariable analysis to identify factors predictive of stress fracture and the association of stress fracture on osteotomy union. A total of 331 patients underwent PAO during the study period with 56 (15.4%) stress fractures: 46 fractures of the retroacetabular posterior column, five cases of ischiopubic stress fracture, and five cases of concurrent ischiopubic and retroacetabular stress fractures. Overall, 86% (48/56) healed without intervention. Univariate analysis revealed that stress fractures occurred more frequently in females (p = 0.040), older patients (mean age 27.6 years (SD 8.4) vs 23.8 (SD 9.0); p = 0.003), and most often with the use of the broad Mast chisel (28.5%; p < 0.001). Multivariable analysis revealed that increasing age (odds ratio (OR) 1.04; 95% CI 1.01 to 1.07; p = 0.028) and use of the broad Mast chisel (OR 5.1 (95% CI 1.3 to 19.0) compared to narrow Ganz chisel; p = 0.038) and surgeon (p = 0.043) were associated with increased risk of stress fracture. Patients with stress fractures were less likely to have healed osteotomies after one-year follow-up (76% vs 96%; p < 0.001). Stress fracture of the posterior column may be an under-recognized complication following PAO, and the rate may be influenced by surgical technique. Consideration should be given to using a narrow chisel during the ischial cut to reduce the risk of stress propagation through the posterior column.Cite this article: Bone Joint J2022;104-B(9):1017-1024.

Treatment of Pediatric Flexible Flatfoot with Subtalar Arthroereisis: Functional and Radiographic Results

Introduction: Flexible flatfoot (FFF) is one of the most frequent conditions that pediatric orthopedists face on a daily basis, with an incidence ranging from 15 to 45%. Subtalar arthroereisis has been described as a valid treatment option, which allows, through a simple and easy technique, to restore the internal plantar arch with few complications. The aim of this work is to retrospectively analyze a series of patients treated with this technique and to evaluate the clinical-functional and radiological results of this technique. Materials and Methods: We evaluated 41 patients between 9 and 15 years old, with a diagnosis of idiopathic flexible flatfoot treated by two surgeons of our institution, between January 2013 and December 2019, who underwent subtalar arthroereisis. A clinical functional and radiological evaluation was performed before and after the surgery. For the functional assessment, the Oxford ankle foot Oxford score for children in parent version (OxAFQ-C) was used. Radiologically the following angles were evaluated: Talonavicular coverage, talocalcaneal angle on the frontal radiograph, talocalcaneal angle on the profile radiograph, and Moreau Costa Bartani angle. Results: Radiographic improvement in foot alignment after surgery was observed in all the patients studied. The functional outcome evaluated by means of the Oxford score for children revealed that all the patients analyzed showed a wide improvement in their school participation, physical activities, emotional state and problems caused by the use of their footwear. Discussion: While there is no doubt about the initial orthopedic treatment when this pathology is asymptomatic, surgical treatment continues to be a matter of discussion; especially in terms of when to indicate it, patient symptoms, appropriate age, choice of surgical technique and the performance of complementary procedures. Conclusions: This study showed that subtalar arthroereisis is a valid treatment option for children with symptomatic flexible flat feet with very good results and few postoperative complications

Pyrocarbon unipolar radial head prosthesis: clinical and radiologic outcomes at long-term follow-up.

Several studies have already reported good short-term results with a pyrocarbon unipolar radial head prosthesis (Pyc-uRHP). The aim was to evaluate the evolution from mid- to long-term clinical and radiographic outcomes of a Pyc-uRHP. This was a retrospective, single-center study. We followed up all the patients who underwent Pyc-uRHP surgery in our original study at 2 years of follow-up (52 patients), reaching a minimum of 7 years of clinical and radiologic follow-up. This study included 26 patients who underwent a clinical examination assessing mobility, the Mayo Elbow Performance Score, and the visual analog scale score and radiologic evaluation with anteroposterior and profile radiographs at a mean follow-up of 110 months (range, 78-162 months). The radiologic study analyzed signs of proximal osteolysis, stem loosening, capitellar wear, and humeroulnar osteoarthritis. No patients required revision. Eight patients required reoperation: coronoid screw removal in 1 and arthrolysis for stiffness in 7. The mean time to reoperation was 11 months. The mean Mayo Elbow Performance Score at last follow-up was 96 ± 9 (of 100), with a pain score of 42 ± 7 (of 45), mobility score of 19 ± 2 (of 20), stability score of 10 (of 10), and function score of 25 (of 25). Comparison with clinical data from the mid-term delay did not reveal any significant difference. All patients presented with proximal osteolysis around the neck but without progression. No stem loosening was noted. The rates of humeroulnar osteoarthritis (12% at mid-term vs. 80% at last follow-up, P < .0001) and capitellar lesions (34% at mid-term vs. 80% at last follow-up, P = .001) increased significantly. We have shown that a Pyc-uRHP at 9 years' follow-up provided stable and satisfactory clinical results. Osteolysis of the radial neck was always present but it did not evolve, and no stem loosening was noted. Finally, we have shown a clear worsening of radiologic humeroulnar osteoarthritis and capitellar lesions that remained asymptomatic.

The Variation of the Patellar Height in Total Knee Arthroplasties and its Relationship with the Replacement or not of the Patella.

Objective To compare the measurement of patellar height in the pre- and postoperative period of total knee arthroplasties (TKAs) and its variation in patients with and without patellar replacement. Methods Retrospective evaluation of radiographs of patients submitted to TKA between 2014 and 2020. Profile radiographs were evaluated using the modified Caton-Deschamps patellar height index, comparing the pre- and postoperative measurements of 90 patients, with a total of 100 knees. Next, two groups were compared with a different surgical technique, considering the replacement or not of the patella. All patients who had x-rays evaluated had indication of TKA by osteoarthrosis without previous procedures that could interfere at patellar height. Results The statistical analysis showed a statistically significant difference, with the preoperative index superior to the postoperative rate, evidencing an overall decrease in patellar height. The Caton-Deschamps index modified for mean preoperative TKA was 1.41 (±0.25), and it was 1.31 (± 0.25), p < 0.001for postoperative TKA. No significant difference was found in the variation of this index when comparing the groups with and without patellar replacement. The mean difference of the index in the group without patella was 0.11, and 0.08 in the group with patella, and this difference was considered nonsignificant, p = 0.510. Conclusion We can conclude that patellar height had significant variation in the total group, with reduction of patellar height in the postoperative period. However, the height did not vary significantly between the postoperative groups with and without patellar replacement, regardless of the choice of the surgeon.

Craniofacial Growth Analysis of Individuals With and Without Cleft Lip and Palate in Colombia.

Craniofacial growth is a dynamic and unpredictable process influenced by genetic and environmental factors, presenting phenotypic and gender differences. Evaluate the differences in craniofacial growth and development in a group of Colombian individuals with complete unilateral and bilateral cleft lip and palate (CLP) and without CLP, classified by gender and age. Five hundred forty-one profile radiographs of 126 patients with unilateral CLP, 126 with bilateral CLP, and 289 without CLP. All patients of affected groups had a history of CLP correction surgery without nasoalveolar molding with orthopedic and orthodontic treatments. This cross-sectional study was performed comparing 8 cephalometric measurements on radiographs, 5 linear/3 angular. Analysis was performed by median and interquartile range for all cephalometric measurements. Comparison between the groups was performed using Kruskal-Wallis and Mann-Whitney U, with a 95% confidence. Significant differences between the groups of patients with and without CLP, between types of clefts and genders. The skeletal structures of patients with CLP were smaller than those of control but improved with growth. Patients with unilateral CLP presented flat profiles and predominant class III malocclusions, while patients with bilateral CLP, at early ages, were class II and in the prepubertal stage, the values were progressively negative until the end of the growth period, suggesting class III. Patients with CLP presented posteroinferior rotation of the mandible, vertical measurements increased, and deflection of the cranial base. Given their growth alterations, patients with CLP benefit from orthopedic and orthodontic treatment.

Harmony concept of craniofacial morphology among young Serbian population on Kosovo and Metohia

Background/Aim. Analyses of the cephalometric value of profile radiographs are very important for orthodontic diagnosis and planning of therapy. These values differ morphologically depending on ethnic and racial affiliation. The aim of this study was to confirm variations of cephalometric norms and the extent of their value and, according to them, confirm the harmony concept of craniofacial morphology among the young Serbian population in Kosovo and Metohija. Methods. This retrospective study comprised 183 profile radiograms of patients from Kosovo and Metohija, Serbia, aged 8?33, from which Class I was ascertained among 82 patients (53 female and 29 male). Five cephalometric angles were measured and analyzed. Pearson?s correlation coefficient was used to define the strength of correlation between the five variables. Bivariable linear regression was used to form harmonious combinations of individual values in the insight of craniofacial harmonious form. Multiple regression and standard error were used to form a harmonious schema. Results. Linear regression equations were used to define cephalometric floating norms. They helped us form a harmonious box and harmonious schema of craniofacial norms of the participants. The ex-tent of harmonious value for orthognathic profile of our examinees varies for sella nasion subspinale (SNA) angle from 78? to 81?, for sella nasion supramentale (SNB) angle from 75.1? to 78.1?, for maxillary line ? nasion sella line (NL-NSL) angle from 11.5? to 5.5?, for nasion sella basion (NSBa) angle from 134.7? to 125.8?, and for mandibulary line ? nasion sella line (ML-NSL) angle from 40.5? to 30.6?. Conclusion. Cephalometric floating norms that describe the individual craniofacial pattern among the young Serbian population in Kosovo and Metohija, determined and defined by five cephalometric variables, and presented in the form of a harmonious box and harmonious schema and can accurately determine the craniofacial pattern.

Estudo comparativo entre os valores de ANB e WITS para diagnóstico ortodôntico

Justification and Objectives: Based on current literature, there are divergences regarding ANB and WITS skeletal assessment, justifying the importance of comparative assessment of these methods, verifying in practice whether there is clinical relevance, which support the use of techniques association or advantages with the use of one of the techniques, avoiding misreadings and contributing to the correct diagnosis by the professional, in order to obtain an effective treatment plan for the patient, favoring correct alignment and skeletal development. Methods: Data were obtained from Sartori Clinic profile radiographs of patient’s assessment, a total of 201 patients out of 420 at random, assessing both with different techniques and comparing the results. Results: Assessment analyzed 115 women (57.3%) and 86 men (42.7%), aged 7 to 64 years, of these 109 of the cases (54.3%) obtained the same result when comparing the ANB and WITS techniques, while 92 of the cases (45.7%) had divergence in results. The highest change rate occurred in patients classified as Class III (43.5%), followed by Class I (39.1%) and the lowest rate was of Class II patients (17.4%). Conclusion: There are divergences regarding the comparison of assessments, with need for an accurate assessment in order to obtain a correct diagnosis, enabling an appropriate treatment plan.

Relationship between body posture and dento-facial deformities

The aim of this study is to investigate the possible relationship between dento-facial deformities, craniofacial morphology and body posture anomalies. It is recommended that specialists in orthodontics give attention to the cervical vertebral column area on profile radiographs to include any deviations in the cervical vertebral column morphology and head posture, while considering diagnosis and evaluation of etiology in orthodontic patients with skeletal craniofacial deviations and in patients with obstructive sleep apnea (OSA).

Sonographic evaluation of anterior inferior iliac spine morphology demonstrates excellent accuracy when compared to false profile view.

To compare ultrasound examination to false profile radiographs in identification and classification of AIIS morphology. The study hypothesis stated that sonographic imaging of the AIIS correlates well to AIIS morphology seen on false profile radiographs. Fifty-three hips in 30 consecutive patients met the inclusion criteria. A single, fellowship trained, orthopedic surgeon performed an ultrasound on all of the patients to evaluate the AIIS morphology. The patients underwent standing false profile radiographs. The US and radiographic images were independently reviewed and classified according to Hetsroni classification of AIIS morphology by two senior, fellowship trained, orthopedic surgeons. Agreement between the two raters was calculated for each imaging modality (inter-rater agreement) as well as the agreement between the rating in each modality by the same rater ("inter-method" agreement). The agreement between the raters (inter-rater agreement) for morphologic evaluation of the AIIS by means of FP view was 88.8% (p < 0.001) and that by means of US was 81.5%(p < 0.001). The overall accuracy of the US compared to the FP view was 92.3% (48/52) for both rater 1 and 2. This study showed near-perfect agreement in analyzing the morphology of the AIIS in a group of patients with hip pathology. Office sonographic evaluation of the AIIS is reliable and, therefore, may be routinely utilized in the clinic setting avoiding unnecessary radiation exposure to the patient. Level II.

A Narrow Posterior Joint Space on a False Profile Radiograph Does Not Correlate With Posterior Joint Cartilage Degeneration in Hip Preservation Patients

PurposeTo evaluate whether a narrow posterior joint space (<2 mm) correlated with posterior joint cartilage degeneration in the hip preservation patient population. MethodsA retrospective chart review of 155 consecutive hip arthroscopy cases by a single surgeon (SKA) from March 2012 to February 2013 was performed. Patients were included in the study if they had an adequate perioperative false profile radiograph and clear intraoperative arthroscopic images of the posterior hip joint. The narrowest posterior joint space (NPJS) width and the directly posterior, posterosuperior, superior, and anterosuperior joint space widths were measured on the false profile radiograph. Femoral and acetabular cartilage of the posterior hip joint were graded according to the International Cartilage Repair Society (ICRS) classification system using arthroscopic images obtained at the time of surgery. The cartilage grades of patients with <2 mm NPJS were compared with cartilage grades of patients with ≥2 mm NPJS. ResultsThere was no difference in cartilage grading between patients with <2 mm NPJS (19 patients) and those with ≥2 mm NPJS (81 patients) (P = .905). The mean age of patients with NPJS ≥2 mm and <2 mm was 34.0 (median 31.2; interquartile range [IQR] 23.7, 42.9) and 38.7 (median 43.0; IQR 26.1, 50.9) respectively, and was not statistically different (P = .183). No correlation between cartilage grade and NPJS measurement was found (P = .374). ConclusionIn this predominantly cam-type femoroacetabular impingement patient cohort, our findings indicate there is no correlation between a <2 mm posterior hip joint narrowing seen on false profile radiographs and posterior hip cartilage degeneration confirmed with arthroscopy. Although posterior arthritis can be visualized on a false profile radiograph, a posterior joint space measurement <2 mm should not be interpreted as isolated posterior joint wear and should not be considered a hip arthroscopy contraindication. Level of EvidenceLevel IV, case series.

Radiographic and clinical characteristics associated with a positive PART (Prone Apprehension Relocation Test): a new provocative exam to elicit hip instability.

Hip instability due to mild dysplasia can be a diagnostic challenge. The physical exam is an important adjunct to radiographic evaluation for the clinical diagnosis of hip instability. Herein, we describe a new maneuver to replicate hip instability pain, called the PART (Prone Apprehension Relocation Test). We retrospectively identified patients in our institution’s hip preservation registry who presented for evaluation of hip pain. We divided patients into ‘positive’ or ‘negative’ PART and analyzed associated clinical and radiographic findings. Ninety patients (159 hips) were included, 83 female and 7 male, average age 27.3 ± 9.1 years. Thirty-four hips (21.4%) had a positive PART. There were no significant differences in hip range of motion, lateral center edge angle, or in acetabular depth. There was, however, a significant difference in acetabular version at 3 o’clock between the two test groups (18.5 ± 6.9° in negative, 21.2 ± 4.9° in positive, P = 0.045). There was no association between PART and previously described anterior apprehension testing. Historical methods of diagnosing hip dysplasia may not adequately identify patients with clinical hip instability. We describe a new provocative exam, the PART, which may be helpful in replicating hip instability symptoms in patients with anterior acetabular undercoverage. PART positive patients had significantly more acetabular anteversion at the 3 o’clock position, which is measured on computed tomography and is not visible on standard anteroposterior (AP) pelvis or false profile radiographs. We believe that the PART is a valuable supplement to clinical examination and radiographic measurements to identify patients with symptomatic hip instability.