Radiographic Findings In Patients Research Articles

Evaluation of treatment planning discrepancies: CT versus plain radiographic findings in patients with foot and ankle trauma.

This study aimed to compare the findings of plain radiography and computed tomography (CT) of foot and ankle in patients submitted to the emergency department with high-energy foot and ankle trauma, to demonstrate if missing fractures on plain radiographs will significantly alter the treatment plan considered for each patient based on the findings of each imaging modality. We retrospectively observed standard radiological foot and ankle x-rays and CT scans in patients who presented to our center from April 2019 to June 2020 with a history of foot and ankle trauma with either loss of consciousness, a history of high-energy trauma, or clinical presentation disproportionate to plain radiographic findings. We investigated the number of fractures of each bone detected on plain radiographs and CT scans and the treatments based on each modality's findings in patients admitted to our center. Sixty-five out of 163 (39.87%) included in our study had at least one missed fracture on plain radiography that was detected on CT. Thirty-one (19%) patients had normal radiography despite actually having fractures. In 38 (23.31%) patients CT changed the treatment plan decided by our surgeons (P < 0.001). The two imaging modalities had a moderate agreement for detecting foot and ankle fractures overall (κ = 0.432). The failure to detect fractures in patients with high-energy trauma can significantly impact treatment effectiveness. Integrating CT scans into the diagnostic process can lead to changes in treatment planning and ultimately improve patient outcomes. LEVEL OF CLINICAL EVIDENCE: IV.

Radiographic findings in patients suspected of subacromial impingement syndrome: prevalence and reliability.

Aims were to (i) report prevalence and (ii) evaluate reliability of the radiographic findings in examinations of patients suspected of subacromial impingement syndrome (SIS), performed before a patient's first consultation at orthopaedic department. This cross-sectional study examined radiographs from 850 patients, age 18 to 63years, referred to orthopaedic clinic on suspicion of SIS. Prevalence (%) of radiographic findings were registered. Inter- and intrarater reliability was analysed using expected and observed agreement (%), kappa coefficients, Bland-Altman plots, or intraclass coefficients. A total of 850 patients with a mean age of 48.2years (SD = 8.8) were included. Prevalence of the radiographic findings was as follows: calcification 24.4%, Bigliani type III (hooked) acromion 15.8%, lateral/medial acromial spurs 11.1%/6.6%, acromioclavicular osteoarthritis 12.0%, and Bankart/Hill-Sachs lesions 7.1%. Inter- and intrarater Kappa values for most radiographic findings ranged between 0.40 and 0.89; highest values for the presence of calcification (0.85 and 0.89) and acromion type (0.63 and 0.66). The inter- and intrarater intraclass coefficients ranged between 0.41 and 0.83; highest values for acromial tilt (0.79 and 0.83) and calcification area (0.69 and 0.81). Calcification, Bigliani type III (hooked) acromion, and acromioclavicular osteoarthritis were prevalent findings among patients seen in orthopaedic departments on suspicion of SIS. Spurs and Bankart/Hill-Sachs lesions were less common. Optimal reliabilities were found for the presence of calcification, calcification area, and acromial tilt. Calcification qualities, acromion type, lateral spur, and acromioclavicular osteoarthritis showed suboptimal reliabilities. Newer architectural measures (acromion index and lateral acromial angle) performed well with respect to reliability.

Comparison between Outcomes of Open and Arthroscopic Fixation of Tibial Spine Avulsion Fractures

OBJECTIVES This study aimed to compare the functional outcomes of fragment reduction and to measure the rate of postoperative complications between arthrotomy (ORIF) and arthroscopy(ARIF) pediatric tibial spine avulsion fractures using the Lysholm knee scoring system (limp, pain swelling, climbing stairs) and IKDC subjective knee evaluation form. METHODS: This Comparative Study was conducted at the Department of Orthopedic Surgery, Jinnah Hospital Lahore, between 2021-2022. A total of 42 patients who had tibial spine avulsion fracture with follow-up of 6 months were included. Twenty-one patients were treated with ORIF, and 21 were treated with ARIF. Functional outcomes were assessed using the IKDC score and LYSHOLM score (Follow-up rate was 95 %). Radiographic findings of patients were recorded, and a statistical study was done. The level of significance was set at &lt;0.05. RESULTS: The study revealed that out of 42 Participants, 36(85.71%) males and 6 (14.29 %) females participated in the survey with the age range of 8-16 years with a mean age of 12.02± (2.53) years. Out of 42 Participants, 22 (52.4%) had motor vehicle accidents with type 3(38.1%) and 4(54.8%) modified Meyers and Mckeever fracture classification. At the end of the follow-up period, the mean IKDC score was 90.52 + 1.50 (p = 0.00, CI = 95%). The Lysholm score was 90.676.11 compared to the last follow-up (p=0.20, CI = 95%). Compared to ORIF, only 5(11.9%) patients complained of post-op infection or vascular injury. CONCLUSION: This study observed better functional outcomes in arthroscopic reduction and immobilization than in open reduction internal fixation. Arthroscopy for TSAF decreases the risk of arthrofibrosis and minimizes morbidities and better management of symptoms. Compared to OIRF, ARIF showed good content validity for the IKDC and Lysholm scales.

The Windshield Wiper Sign Is an Instability-Related Osteochondral Defect of the Anterolateral Femoral Head

PurposeTo investigate a radiographic sign believed to be indicative of hip instability and acetabular suction seal disruption in the native hip, coined the “windshield wiper” (WSW) sign. Materials and MethodsA retrospective review was performed for patients who underwent periacetabular osteotomy (PAO) with the senior author between March 2021 and September 2023. A WSW sign was identified on plain films as a concave or flat osteochondral defect on the anterolateral femoral head extending medial to the head-neck junction with resultant loss of femoral head sphericity in the native hip. Every patient underwent a standardized series of radiographs, as well as computed tomography and magnetic resonance imaging. All patients underwent arthroscopy prior to PAO to address intra-articular pathology and other indicated procedures. The osteochondral defect and resultant suction seal disruption were verified during arthroscopy. These patients were then compared with a control group of arthroscopically treated hips without hip instability. ResultsOf 250 patients reviewed, a total of 19 hips in 17 patients (prevalence of 7.6%) demonstrated radiographic evidence of the WSW sign. All patients with a WSW sign presented with symptomatic clinical hip instability requiring a PAO. The mean patient age was 31.2 years, with a mean lateral center edge angle (LCEA) of 14.3 degrees. There were 13 hips (68.4%) with dysplasia, 4 (21.1%) with borderline dysplasia, and 2 (10.5%) with a normal LCEA. All patients with a WSW sign and LCEA ≥20° displayed significant femoral antetorsion abnormalities. All arthroscopic videos and images demonstrated a compromised suction seal. Of the 50 control group hips reviewed, the WSW sign was not identified. ConclusionsThe WSW sign is an uncommon radiographic finding in patients with hip instability. When identified, it can be predictive of substantial instability, especially in cases which are otherwise considered borderline dysplasia or normal based on LCEA. Level of EvidenceIII, case-control study

Precursor Radiographic Findings in Patients With Medication-Related Osteonecrosis of the Jaw

BackgroundOral surgical treatment, such as tooth extraction, has been identified as a risk factor for the onset of medication-related osteonecrosis of the jaw (MRONJ). However, MRONJ may already be latent, and its manifestation triggered by extraction. PurposeThe purpose of this study was to examine the association between pre-extraction imaging and MRONJ. Study design, setting, and populationWe performed a multicenter case-control analysis of patients receiving antiresorptive agents (ARAs) who underwent extraction between 2012 and 2016. We enrolled patients who had undergone tooth extraction in the setting of ARA exposure. Predictor variablesThe predictor variables comprised preoperative radiographic findings associated with MRONJ stage 0. These findings included alveolar bone loss, thickening or obscuring of the periodontal ligament, and osteosclerosis involving the alveolar bone. They were coded as present or absent before tooth extraction. Main outcome variableThe primary outcome variable was MRONJ status coded as present or absent. CovariatesSex, age, underlying diseases necessitating the administration of ARA, the type of ARA used, corticosteroid use, extraction region, and wound closure were analyzed. AnalysesMann-Whitney U test, chi-square test, Fisher’s exact test for univariate analysis, and multiple logistic regression analysis were performed. P-values < 0.05 were significant. ResultsThe subjects consisted of 26 patients and 110 controls (male: 8/36, female: 18/74). The mean ages of the MRONJ group and the control group were 77.0 ± 11.9 and 63.0 ± 15.8, respectively (P-value = 0.001). The prevalence of osteosclerosis was significantly higher in the MRONJ group than in the control group (14/72 53.9%/29.3%, p < 0.01). Multivariate analysis identified osteosclerosis (odds ratio: 8.4, 95%CI: 2.133.9, p < 0.01) as a significant independent predictor associated with the development of MRONJ after extraction. ConclusionsThese findings suggest that a precursor to MRONJ is highly likely to be present in patients with osteosclerosis at the time of extraction. The majority of patients who developed MRONJ after extraction had imaging findings that suggested infection in the surrounding alveolar bone.

Evaluation of the Relationship between Oxygenation Indices and the Extent of Radiographic Findings in Hospitalized COVID-19 Patients: A Cross-Sectional Study

Background: Oxygenation indices are used to assess the condition of patients with pneumonia and ARDS. These indexes determine the status of patients as well as the mortality rate of respiratory diseases and the need for intubation. The aim of this study was to determine and compare oxygenation indices and the extent of radiographic findings in patients with COVID-19 in ICU at Shariati Hospital.&#x0D; Methods: The present study was a cross-sectional study that was performed prospectively in the intensive care units of Shariati Hospital in Tehran. Patients admitted to the intensive care unit were examined if they met the inclusion criteria. Data were analysed by SPSS software version 26.&#x0D; Results: In this study, 39 patients were evaluated. Of these, 35.9% were men and 64.1% were women. The mean age of the population was 62 ±17. On average, SpO2 and PaO2 were not significantly different based on pulmonary involvement, severity of pulmonary involvement and also the pattern of pulmonary involvement (p&gt; 0.05). No significant relationship was found between the severity of ARDS and the parameters of pulmonary involvement severity on CT scan (p&gt; 0.05).&#x0D; Conclusion: It seems that there is no significant relationship between oxygenation indices and the extent of radiographic findings in hospitalized patients with COVID-19. Also, the severity of ARDS has no significant relationship with the extent of radiographic findings (CT scan). Oxygen saturation should be used as an adjunct when considering a CT scan of the lung, but should not be used as the sole means of diagnosis.

What Is the Correlation between Clinical and Radiographic Findings in Patients with Advanced Osteoarthritis of the Knee?

Knee range of motion and patient-reported outcome measures (PROMs) are often used as screening tools to assess the severity of knee osteoarthritis and guide the decision to refer patients to an arthroplasty clinic. However, there is little understanding regarding the correlation between these factors. Thus, the purpose of this study was to determine the correlation between patient-reported clinical function measured with the Oxford Knee Score (OKS), pain assessed using the visual analog scale (VAS), knee range of motion (ROM), and characteristic radiographic features in patients with advanced osteoarthritis of the knee. A prospective analysis of a consecutive series of 138 patients with advanced unilateral osteoarthritis (OA) of the knee was performed. The severity of radiographic OA was classified according to the most commonly used Kellgren and Lawrence classification (K&L). Spearman's rank correlation analysis and multiple linear regression analysis were performed. The OKS was used as a dependent variable and was adjusted for pain, ROM, and nine standardized radiographic parameters on multiple views of the tibiofemoral and patellofemoral joint. OKS and pain correlated weakly with the K&L grade (r = -0.289; p = 0.001; r = 0.258; p = 0.002). K&L grade and the degree of patellofemoral joint space narrowing were identified as independent factors being associated with a poorer OKS (coefficient -4.528, p = 0.021; coefficient -2.211, p = 0.038). Slightly worse results were identified for OKS and pain in patients with K&L grade 4 osteoarthritis compared to patients with K&L grade 3 osteoarthritis (∆OKS 5.5 points, p < 0.001; ∆VAS 1.7 points, p = 0.003). There was no significant difference for passive range of motion between patients with K&L grade 3 or 4. When counseling patients with advanced knee osteoarthritis who may be eligible for knee arthroplasty, it is essential to give primary consideration to pain levels and self-reported limitations experienced during daily activities. Relying solely on knee ROM and PROMs is not an effective screening method for guiding the decision to refer patients to an arthroplasty clinic.

A clinical prediction model to differentiate tuberculous spondylodiscitis from pyogenic spontaneous spondylodiscitis.

Microbiological diagnosis of tuberculous spondylodiscitis (TS) and pyogenic spontaneous spondylodiscitis (PS) is sometime difficult. This study aimed to identify the predictive factors for differentiating TS from PS using clinical characteristics, radiologic findings, and biomarkers, and to develop scoring system by using predictive factors to stratify the probability of TS. A retrospective single-center study. Demographics, clinical characteristics, laboratory findings and radiographic findings of patients, confirmed causative pathogens of PS or TS, were assessed for independent factors that associated with TS. The coefficients and odds ratio (OR) of the final model were estimated and used to construct the scoring scheme to identify patients with TS. There were 73 patients (51.8%) with TS and 68 patients (48.2%) with PS. TS was more frequently associated with younger age, history of tuberculous infection, longer duration of symptoms, no fever, thoracic spine involvement, ≥3 vertebrae involvement, presence of paraspinal abscess in magnetic-resonance-image (MRI), well-defined thin wall abscess, anterior subligamentous abscess, and lower biomarker levels included white blood cell (WBC) counts, erythrocyte-sedimentation-rate (ESR), neutrophil fraction, and C-reactive protein (all p < 0.05). Multivariate logistic regression analysis revealed significant predictors of TS included WBC ≤9,700/mm3 (odds ratio [OR] 13.11, 95% confidence interval [CI] 4.23-40.61), neutrophil fraction ≤78% (OR 4.93, 95% CI 1.59-15.30), ESR ≤92 mm/hr (OR 4.07, 95% CI 1.24-13.36) and presence of paraspinal abscess in MRI (OR 10.25, 95% CI 3.17-33.13), with an area under the curve of 0.921. The scoring system stratified the probability of TS into three categories: low, moderate, and high with a TS prevalence of 8.1%, 29.6%, and 82.2%, respectively. This prediction model incorporating WBC, neutrophil fraction counts, ESR and presence of paraspinal abscess accurately predicted the causative pathogens. The scoring scheme with combination of these biomarkers and radiologic features can be useful to differentiate TS from PS.

1425. Changes in Clinical Presentation of TB due to the COVID-19 pandemic

Abstract Background In 2020/21, deaths due to active tuberculosis (TB) increased globally for the first time in decades with concomitant global decline in TB detection rates, suggesting that delay in TB diagnosis during the COVID-19 pandemic is associated with increased mortality. In the US and New York City, 20% decline in TB cases was reported in 2020/21. We aimed to compare symptom duration, sputum microscopy and radiographic findings in patients with newly diagnosed TB at Montefiore Medical Center (MMC) in the Bronx, New York, before and during the COVID-19 pandemic. We hypothesized that patients during the COVID-19 pandemic present with signs of more advanced TB than before. Methods Using a cross-sectional study design, we retrospectively reviewed medical records of TB patients identified through microbiology lab records from 11/1/2018 to 3/11/2022 and stratified by admission before (11/1/2018–2/29/2020) and during (3/1/2020–3/11/2022) the COVID-19 pandemic. Inclusion criteria were age ≥18 years, admission to an MMC hospital, and new diagnosis of culture-confirmed TB. Results We identified 24 TB patients who presented before and 24 during the pandemic. About 1.7 new TB cases were diagnosed monthly before vs 1.0 during the pandemic, an &amp;gt;40% decline. Patients had both pulmonary and/or extrapulmonary manifestations without differences between groups. There were no significant differences in demographics and comorbidities between the two groups aside from diabetes, which was higher in the pre-COVID group (p = 0.03). Two TB patients had a prior history of COVID and one developed nosocomial COVID during the admission. There was no difference in mortality between groups. Patients with pulmonary manifestations had higher sputum AFB smear positivity (p=0.14) and significantly higher occurrence of multilobar or miliary infiltrates on chest X-ray during compared to before COVID (p = 0.01; Table 1). Table 1.Symptoms and diagnostics on initial presentation of patients with pulmonary TB before and during the COVID-19 pandemic Depending on distribution, t-tests or Mann Whitney U tests were used for continuous and Chi-square tests or Fisher’s exact tests for categorical variables. Sputum AFB smears results are reported for the initial 3 smears. Conclusion Our findings show &amp;gt;40% decline in patients presenting with TB in the Bronx during vs before the COVID-19 pandemic and suggests patients presented with more advanced disease than before the pandemic. Whether COVID-19 could have contributed to this remains to be investigated. Our results have implications for public health and emphasizes the need for earlier identification of TB. Disclosures All Authors: No reported disclosures.

The correlation of clinical status and imaging findings in patients with chronic low back pain

Background/Aim: Chronic low back pain (LBP) is a common health problem that negatively affects quality of life. A multidisciplinary approach is recommended in treating chronic LBP. In the literature, we could not find any study examining the relationship between clinical status, activities of daily living, angular measurements in the lumbar region, and spondylosis level in patients with LBP. We aimed to reveal whether there is a relationship between the severity of the clinical condition and these angular measurements. In addition, there are opposing views in the literature about the relationship between obesity and LBP, and we planned to investigate this issue in our study. We aimed to investigate the correlation between clinical, functional evaluations, and radiographic findings in patients with chronic LBP and examine the relationship between these variables and gender and educational level. We also determine the effects of age, body mass index (BMI), and waist circumference on these variables.&#x0D; Methods: The research was designed as a cross-sectional, uncontrolled study. Seventy patients aged 18–65 years with chronic LBP and VAS (Visual Analog Scale) values ≥ 3 were included. Patients were grouped by gender and educational level. Lumbar lordosis angle (LLA), sacral inclination angle (SIA), and Kellgren-Lawrence (K-L) grade were recorded. VAS, Oswestry Disability Index (ODI), Back Pain Functional Scale (BPFS), and Katz Activities of Daily Living (Katz-ADL) scores were calculated. Pearson correlation analysis determined the normal distribution status of the variables. Spearman’s correlation analysis evaluated the linear relationship between ODI and BPFS and LLA and SIA continuous variables. A p-value of &lt; 0.05 was considered statistically significant.&#x0D; Results: A total of 70 patients (47 females and 23 males) with chronic LBP were included in the study. Mean BMI (28.2 [6.1] kg/m2) and waist circumference (95.7 [12.7] cm) of the patients were above normal ranges (normal BMI: 18.5–24.99 kg/m², normal waist circumference: &lt; 80 cm for women, &lt; 90 cm for men). Katz-ADL (P = 0.006) and BPFS scores (P = 0.027) were lower, and LLA (P = 0.042) was higher in women than men. The BPFS score was lower in the low-level education group than in the high-level education group (P = 0.004). There was a positive correlation between age and SIA (P = 0.028, r = 0.262), and between age and K-L grade (P &lt; 0.001, r = 0.633). A positive correlation was also observed between BMI and K-L grade (P = 0.001, r = 0.395) and waist circumference and K-L grade (P &lt; 0.001, r = 0.442).&#x0D; Conclusion: No correlation was found between functional clinical scales and radiographic findings in patients with chronic LBP. Increasing age, BMI, and waist circumference were associated with more severe radiographic osteoarthritis of the lumbar spine, whereas female gender and low educational level were related to lower functional levels. Further extensive studies, including a larger number of patients, are needed to clarify our results.

Do Physicians Overestimate Radiographic Findings in Patients Undergoing Knee Arthroplasty?

BackgroundTotal knee arthroplasty (TKA) is 1 of the top 2 most common and expensive surgical procedures among Medicare beneficiaries. Due to the procedure’s high annual cost, overdiagnosis and subsequent overutilization of TKA has substantial health-policy implications. Concerns regarding the overexaggeration of radiographic findings and overutilization of TKA have been expressed by medical insurers. Currently, the standard of care for assessing potential knee arthroplasty candidates includes assigning a Kellgren-Lawrence (KL) radiographic score. Our study investigated the accuracy of reported preoperative KL scores in patients undergoing TKA.Material and methodsRecords of 277 patients who had underwent TKA at our institution for knee osteoarthritis were randomly selected from a large patient data registry and retrospectively reviewed. Two blinded raters assigned KL scores to the radiographs obtained during the preoperative assessment, which were compared to the scores reported by the operative surgeon. An intraclass correlation coefficient (ICC) was calculated to determine inter-rater reliability.ResultsBetween blinded raters, ICC3k = 0.88 (95% confidence interval: 0.86-0.90, P < .001), demonstrating good reliability. Between all raters, ICC2k = 0.89 (95% confidence interval: 0.86-0.90, P < .001), also demonstrating good agreement. Raters fully agreed on the KL classification for 196 patients (70.76%). Compared with blinded raters, the operative surgeon assigned lower KL scores.ConclusionReporting of KL score is consistent between operative surgeons and independent reviewers. In cases of disagreement between reviewers, the operative surgeon was generally more conservative in their estimation of the extent of osteoarthritis present radiographically. Concerns regarding inflation of radiographic findings to support surgical preauthorization are unwarranted.

Usual Interstitial Pneumonia is the Most Common Finding in Surgical Lung Biopsies from Patients with Persistent Interstitial Lung Disease Following Infection with SARS-CoV-2.

BackgroundThere is increasing interest in persistent interstitial lung disease (ILD) following resolution of acute COVID-19. No studies have yet reported findings in surgical lung biopsies (SLB) from this patient population.MethodsOur Michigan Medicine pathology database was queried for SLB reviewed between January 2020 and April 2021 from patients with persistent ILD following recovery from acute COVID-19. Slides for our retrospective observational study were independently reviewed by two thoracic pathologists, who were blinded to patient clinical data, radiographic findings, and previous pathologic diagnosis.FindingsEighteen cases met inclusion criteria. Of these, nine had usual interstitial pneumonia (UIP). These included two patients with superimposed acute lung injury (ALI). Five cases showed a spectrum of ALI that ranged from persistent diffuse alveolar damage to organizing pneumonia. Four patients had desquamative interstitial pneumonia (1), acute and organizing bronchopneumonia (1), or no diagnostic abnormality (2). Compared to patients without UIP, those with UIP tended to be older and have pre-existing lung disease prior to COVID-19. In patients with UIP, pre-SLB chest computed tomography changes included groundglass with interstitial thickening or peripheral reticulations with bronchiectasis; no UIP patients had groundglass only. The most common radiographic finding in patients without UIP was groundglass opacities only.InterpretationUIP was the most common pathologic finding in patients undergoing evaluation for post-COVID-19 ILD. Our preliminary data suggests that CT changes described as interstitial thickening, peripheral reticulations, and/or bronchiectasis may be helpful in identifying patients with underlying fibrotic chronic interstitial pneumonia for which UIP is the chief concern.FundingNo intramural or extramural funding sources supported this work.

Assessment of radiographic findings in patients with osteoarthritis of knee

Background: Osteoarthritis (OA) is one of the most prevalent conditions resulting to disability particularly in elderly population. Plain radiography remains a mainstay in the diagnosis of OA. Hence; under the light of above mentioned data, the present study was undertaken for assessing radiographic findings in patients with osteoarthritis of knee. Materials and Methods: Present study was conducted on 20 patients with presenting with knee pain and clinical suspicion of osteoarthritis. Detailed radiographic and MR imaging was be done in all subjects. Radiographic examination was done. All radiographs were assigned scores by using the Kellgren-Lawrence scoring system. This summary Kellgren-Lawrence score was based on osteophyte formation, joint space narrowing, sclerosis, and joint deformity characteristics according to the five-level scale defined as follows: grade 0, normal; grade 1, doubtful osteoarthritis; grade 2, minimal osteoarthritis; grade 3, moderate osteoarthritis; or grade 4, severe osteoarthritis. Radiographic findings were compiled as per performa and subjected to analysis using appropriate statistical tests. Results: 20 percent of the patients each showed doubtful and minimal osteoarthritis while the remaining 10 percent of the patients showed moderate osteoarthritis. On MRI examination, no meniscal abnormalities were seen in 25 percent of the patients while Globular intrasubstance abnormalities were seen in 35 percent of the patients. Linear intrasubstance meniscal abnormality was seen in 25 percent of the patients while Tear (displaced/ undisplaced/ complex/ macerated) was seen in 15 percent of the patients. Conclusion: The pathologic changes of pre-radiographic OA can be detected at an earlier stage of the disease through radiographic examination.

Association between Pain, Functional Impairment and Radiographic Findings in Patients with Osteoarthritis of Knee

Objective: To explore the relationship between pain, functional impairment (disability) and the radiographic findings in patients with osteoarthritis of the knee. Study Design: Cross sectional study Place and Duration of Study: Department of Rhematology, Pakistan Air Force Hospital Islamabad from 1st September 2020 to 28th February 2021 Methodology: One hundred and thirty eight patients of knee joint osteoarthritis were included. Weight bearing antero-posterior and lateral views X-ray for both knees were performed on each patient and Kellgren-Lawrence (KL) system was used to grade the severity of OA. We used Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for assessment of pain, stiffness and functional impairment. Results: The mean age was 53.76±7.14 years and females were 92 (67 %) and males were 46 (33 %). Average duration of disease was 3.7 years and mean body mass index was 26.78±2.25 Kg/m2. There was no statistically significant association of pain, stiffness and functional impairment with Kellgren-Lawrence radiographic grades. Conclusion: Functional impairment is more associated with level of pain, stiffness in joint and body mass index of patient than the severity of radiographic changes on knee X-ray. Therefore, we would recommend considering functional status of patient alongside radiological findings while planning treatment for patient with knee osteoarthritis. Key words: Osteoarthritis, Pain, function, Radiography

A comparison of panoramic radiographic findings in patients with familial adenomatous polyposis and the general population: a multicenter study

Familial adenomatous polyposis (FAP) is a hereditable disorder characterized by early and unremitting development of intestinal polyps and extraintestinal manifestations requiring multidisciplinary surveillance. Herein we describe a multicenter cross-sectional analysis of the dento-osseous radiographic findings of patients with FAP from North and South America. Groups I and II included individuals with FAP diagnosed by standard clinical criteria. Patients were paired with age- and sex-matched participants without FAP. Panoramic radiograph of both cohorts, including children and adults, were analyzed. Of 114 panoramic radiographs, 38 were from patients with FAP, composed of group I (n=22) and group II (n=16), and 76 were from matched control participants. Evaluators had excellent agreement on key findings (intraclass correlation coefficient=0.89). The prevalence of osseous anomalies was higher in adults (75%) than in children (65.4%). Dental anomalies were also higher in children with FAP with a prevalence of 15.4%. We describe important and significant differences in the prevalence of dento-osseous anomalies in children compared with adult patients with FAP. These findings warrant careful consideration and may influence multidisciplinary management of the condition. Conversely, the presence of these abnormalities in pediatric dental patients even if not diagnosed with FAP should be borne in mind as possibly indicating de novo or unrecognized disease.

Anterior cervical discectomy and fusion with a dynamic translational plating versus a rigid carbon fiber reinforced PEEK plating system – a comparison study of radiographic parameters

Purpose In this study the authors compare the radiographic findings of patients undergoing 1-3 level ACDF a rigid CFRP plate and a translational titanium plate system with a focus on radiographic alignment. Material and Methods A retrospective review 70 consecutive patients undergoing a 1 to 3 level ACDF for cervical spondylosis was conducted. 2 groups depending on the cervical plating system were created including 38 patients in group 1 (dynamic plate) and 32 in group 2 (rigid CFRP plate). Plain neutral radiographs preoperatively, immediately after surgery and at most recent follow-up were used to assess parameters on sagittal alignment, fusion height, adjacent segment ossification (ASO), fusion rate and implant failure. Results There were no significant differences between groups preoperatively. Both groups had a more than 12 months follow-up (p = 0.327). Improvement of C2-7 lordosis was seen in both groups but only in group 1 it reached statistical significance at final follow-up. Significant improvement in sagittal segmental alignment was noted in both groups following surgery. A significant sagittal correction of 5.5 ± 9.1 degrees (p = 0.002) was maintained through follow-up only in group 2. No significantly different was seen for segmental fusion rates and loss of fusion height. There were no instances of implant failure within both groups. Worsening of ASO was 20% for both groups. Conclusion ACDF allows for correction and maintenance of cervical alignment. Rigid rigid plate appears more effective at maintaining segmental lordotic correction. The fusion rate and implant failure was not different for both groups.

Is there a correlation between functional results and radiographic findings in patients with distal radius fracture A0 type A3 treated with volar locking plate or external fixator?

Purpose:The aim of this study was to test the hypothesis that precise restoration of distal radius fractures is correlated to better patient-reported outcome.Methods:The correlation between radiographic results and functional outcome was explored in 156 patients with extra-articular distal radius fractures included in a multicenter, randomized controlled trial comparing 2 surgical interventions, Volar Locking Plate or External Fixator. The primary functional outcome was the Patient Rated Wrist and Hand Evaluation score (PRWHE). Radiographically we assessed volar tilt, radial inclination, radial height, ulnar variance, and the presence of ulnar styloid fracture. The Pearson correlation analysis was used to estimate correlations between parameters.Results:At 1-year follow-up the mean difference in radiographic findings compared with the uninjured side (min, max) was: reduced volar tilt 5.3° (−15°, 25°), reduced radial inclination 2.3° (−6°, 12°), radial height 1.3 mm (−4 mm, 7 mm), and ulnar variance −0.5 mm (−6 mm, 3 mm). Overall, we found no correlation between radiographic parameters and the PRWHE at 1-year follow-up within the whole group, regardless of which treatment was chosen. At the time of injury 53% (N = 80) had sustained an additional ulnar styloid fracture. After 1 year this fracture was still radiographically present in 31% (N = 43) of the patients. No correlation between PRWHE score and the presence of an ulnar styloid fracture at 1-year follow-up was found.Conclusions:We found no correlation between functional outcome (PRWHE) and radiographic findings after 1 year in patients operated on with a Volar Locking Plate or External Fixator. Patient-specific factors were more important than radiographic measurements in this study group.Level of evidence: Therapeutic Level 2Trial registration: Norway: National Committee for Medical and Health Research Ethics 213/555ClinicalTrials.gov ID: NCT01904084Randomization of first patient: 02.09.2013

Patterns of request and radiographic findings in patients with pulmonary tuberculosis in a secondary healthcare center in Borno State, Nigeria

BACKGROUND AND AIM: Pulmonary tuberculosis (PTB) is a major public health problem globally with relatively high morbidity and mortality rates. Chest radiography plays a key role in describing the patterns of appearances which help in predicting treatment progress. In this study, we evaluated the patterns of radiographic findings among patients diagnosed with PTB. MATERIALS AND METHODS: This was a retrospective study of clinical and chest radiographic features of PTB in 105 patients. All the radiographs were reported by a consultant radiologist. The age, gender, clinical presentation, nature and location of the lung changes, and diagnosis were recorded. Descriptive statistics were employed in analysing mean ± standard deviation, percentages, and frequencies. Data were analyzed using the SPSS software version 22.0. RESULTS: The male-to-female ratio was 3:2 with 58.1% (n = 61) male and 41.9% (n = 44) female. The average age of the patients was 36.29 ± 15.95 years with 21–30 years age group most affected. Fibrocavitatory changes alone were the most common finding and the majority of the lung changes involved the entire both lungs. CONCLUSION: Fibrocavitatory changes and involvement of the entire both lungs were found to be the common radiographic findings of patients diagnosed with PTB. Age group 21–30 years was most commonly affected.

Determining the Relationship between Severity of Clinical Symptoms and Severity of Radiographic Findings in Patients with Knee Osteoarthritis

Objective: This study was conducted to determine the relationship between severity of clinical symptoms and severity of radiographic findings in patients with knee osteoarthritis.Methods: In this cross-sectional analysis, 84 patients with knee osteoarthritis were studied. Clinical signs, including pain, joint effusion, morning stiffness, and limb deformity, were compared with the Kellgren and Lawrence radiographic classification reviewed by each patient.The relationship between K/L garde and BMI, age, duration of disease and gender was also investigated.Results: This study conducted on 84 patients with knee osteoarthritis found a significant direct relationship betweenquantitative pain, VAS, and K/Lscore,as well asqualitative pain and K/L score(P=0.000).Moreover, there was a significant relationship between morning stiffness duration and gender (P=0.012). A direct relationship was also reported between disease duration and K/L score of patients (P=0.000) and Pearson coefficient was positive.Conclusion: this study proved that with increasing VAS and patients’ pain, patients are in a higher classification of K/L score.

Pertrochanteric Calcifications in Patients With Greater Trochanteric Pain Syndrome: Description, Prevalence, and Correlation With Intraoperatively Diagnosed Hip Abductor Tendon Injuries

Background: Pertrochanteric calcifications can be found in patients with greater trochanteric pain syndrome (GTPS). A systematic description of the types and prevalence of these calcifications has not been undertaken. Furthermore, there is conflicting evidence regarding their association with abductor tendon injuries. Purpose: (1) To describe the various types and prevalence of pertrochanteric calcifications in patients presenting for the surgical management of recalcitrant GTPS. (2) To evaluate the association of the various calcifications with intraoperatively diagnosed hip abductor tendon injuries, including tendinosis, partial-thickness tears, and full-thickness tears. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients undergoing surgical management for GTPS, in isolation or as an ancillary procedure during hip arthroscopy for femoroacetabular impingement, between April 2008 and February 2020 were included. Of these, 85 procedures were isolated treatment of GTPS and the remaining 628 were ancillary to hip arthroscopy. Radiographs were scrutinized for the presence of pertrochanteric calcifications. The hip abductor tendon status was intraoperatively classified as intact, partial-thickness tear, or full-thickness tear. The prevalence and correlation of the various radiographic findings in relation to the intraoperatively classified tendon condition were analyzed via the odds ratio (OR). Results: Surgery was performed on 713 hips with recalcitrant GTPS. No tear was found in 340 hips (47.7%), 289 hips (40.5%) had a partial-thickness tear, and 84 hips (11.8%) had a full-thickness tear. Radiographically, 102 hips (14.3%) demonstrated proximally directed enthesophytes, and 34 (4.8%) had distally directed enthesophytes. In addition, 75 hips (10.5%) had amorphous calcifications, 47 (6.6%) had isolated ossicles, and 110 (15.4%) had surface irregularities. The presence of any calcification was associated with partial-thickness tears (OR, 1.67 [95% CI, 1.21-2.21]; P = .002) and full-thickness tears (OR, 6.40 [95% CI, 3.91-10.47]; P < .001). Distally directed enthesophytes (OR, 10.18 [95% CI, 3.08-33.63]; P < .001) and proximally directed enthesophytes (OR, 8.69 [95% CI, 4.66-16.21]; P < .001) were the findings with the highest OR for the presence of any type of tear. Distally directed enthesophytes were the findings with the highest OR for a full-thickness tear (OR, 15.79 [95% CI, 7.55-33.06]; P < .001). Isolated ossicles were the findings with the highest OR for a partial-thickness tear (OR, 1.73 [95% CI, 0.96-3.13]; P = .070). Conclusion: Pertrochanteric calcifications were common radiographic findings in patients with GTPS and can help guide management in these patients. Proximally and distally directed enthesophytes were strong predictors for the presence of a hip abductor tendon tear, and specifically a full-thickness tear, and increasing size of the findings was associated with more severe tendon injuries.