Radiographic Views Research Articles

Fassier-Duval Rod Failure: Is It Related to Positioning in the Distal Epiphysis?

The relationship between Fassier-Duval (FD) rod placement and rod failure rates has not previously been quantified. Retrospective review was conducted on patients with osteogenesis imperfecta treated with FD rods between 2005 and 2017. Age at first surgery, sex, Sillence type of osteogenesis imperfecta, bisphosphonate treatment, location of rod (side of body and specific bone), and dates of surgeries, radiographs, and rod failures were collected. C-arm images determined rod fixation within the distal epiphysis at the time of surgery. C-arm variables included rod deviation (percent deviation from the midline of the distal epiphysis) and anatomical direction of deviation (anterior/posterior and medial/lateral). X-ray images were examined for rod failure, which was defined as bending, pulling out of the physis, protrusion out of the bone, and/or failure to telescope. Cox proportional hazards regression models were used to compare failure rates with location of placement within the distal epiphysis allowing for clustering of the data by side (left or right) and bone (femur or tibia). The cohort was 13 patients (11 female individuals and 2 male individuals) with a total of 66 rods and 75 surgeries. Mean time from the first surgery to the last follow-up visit was 8.9 years (SD=5 y). There was a 7% increase in hazard of failure per 1-mm increase in antero-posterior (AP) deviation [hazard ratio (HR), 1.07; 95% confidence interval (CI), 1.01-1.14; P=0.029)]. Similarly, there was a 9% increase in hazard of failure for every 1-mm increase in lateral deviation (HR, 1.09; 95% CI, 1.01-1.18; P=0.019). A 12% increase in hazard of failure per 10% increase in deviation from the midline for both AP and lateral radiograph views was also found, although this was only statistically significant for lateral deviation on the AP radiograph view (HR, 1.12; 95% CI, 1.01-1.25; P=0.030). FD rod placement within the distal epiphysis has significant impact on increasing rod survival. Level III-therapeutic study.

Correlation between facial growth patterns and cortical bone thickness assessed with cone-beam computed tomography in young adult untreated patients

BackgroundThe vertical facial growth pattern is one of the most important issue in the orthodontic diagnosis and treatment. Previous studies investigated the association between interdental bone thickness and facial divergence using mainly bidimensional analysis. When two-dimensional dental radiographic views are not sufficient for diagnosis and measurements, cone-beam computed tomography (CBCT) images should be used to assess the alveolar bone structure three-dimensionally and with high accuracy and reliability.The aim of the present study was to evaluate the correlation between alveolar bone thickness and facial divergence in young adults untreated patients using a three-dimensional method analysis with CBCT images. MethodsRecords of 30 untreated patients (mean age 16 ± 2 years) with Angle Class I and mild to moderate crowding were analyzed. Subjects were classified as hypodivergent (<39˚), normodivergent (41 ± 2˚), and hyperdivergent (>43°). according to the inter-maxillary angle between the sagittal maxillary plane (ANS-PNS) and the mandibular plane (GN-ME). The alveolar bone thickness measurements were taken for the buccal and palatal/lingual surfaces of maxillary and mandibular anterior teeth. Axial-guided navigation (AGN) was used to locate all landmarks using a specific software (Horos 3.0). ResultsThe statistical analysis showed a significant difference between the hypodivergent and hyperdivergent group regarding buccal bone height (P = 0.005), buccal apical bone thickness (P = 0.003) and palatal mid-root bone thickness (P = 0.006). Moreover, buccal bone height (P = 0.006) was found to be statistically significant different in normodivergent compared with hypodivergent individuals. ConclusionsFacial types were found to be correlated with alveolar bone thickness. The hyperdivergent subjects presented thinner alveolus bone in the anterior maxilla and at almost all sites in the mandible. Clinicians should be aware of the possibility of thin cortical bone plates in hyperdivergent patients, reducing antero-posterior movements to avoid fenestration and dehiscence.

Deep convolutional neural networks in the classification of dual-energy thoracic radiographic views for efficient workflow: analysis on over 6500 clinical radiographs.

DICOM header information is frequently used to classify medical image types; however, if a header is missing fields or contains incorrect data, the utility is limited. To expedite image classification, we trained convolutional neural networks (CNNs) in two classification tasks for thoracic radiographic views obtained from dual-energy studies: (a)distinguishing between frontal, lateral, soft tissue, and bone images and (b)distinguishing between posteroanterior (PA) or anteroposterior (AP) chest radiographs. CNNs with AlexNet architecture were trained from scratch. 1910 manually classified radiographs were used for training the network to accomplish task (a), then tested with an independent test set (3757 images). Frontal radiographs from the two datasets were combined to train a network to accomplish task (b); tested using an independent test set of 1000 radiographs. ROC analysis was performed for each trained CNN with area under the curve (AUC) as a performance metric. Classification between frontal images (AP/PA) and other image types yielded an AUC of 0.997 [95% confidence interval (CI): 0.996, 0.998]. Classification between PA and AP radiographs resulted in an AUC of 0.973 (95% CI: 0.961, 0.981). CNNs were able to rapidly classify thoracic radiographs with high accuracy, thus potentially contributing to effective and efficient workflow.

Tarsal fractures: part 1

While fractures of the tarsal bones may not be common in non-racing dog and cat populations, an awareness of these injuries and the gold-standard treatment thereof remains important. Failure to diagnose these fractures and pursue appropriate treatment can have devastating consequences for long-term limb use; racing dogs may fail to return to racing and potentially be condemned to euthanasia while non-racing dogs may go on to suffer debilitating osteoarthritis. For many tarsal fractures, surgical stabilisation is indicated and in order to plan this, an accurate diagnosis must be made. While various radiographic views may assist in achieving this diagnosis, computed tomography is more sensitive for detection and classification of tarsal fractures. Fractures of the talus are generally classified as articular fractures of the body or non-articular fractures of the head or neck. Treatment of talar fractures depends on the site of the fracture and degree of comminution, with intra-articular and certain extra-articular fractures necessitating anatomical reconstruction with a lag screw or multiple K-wires. The prognosis is variable depending on fracture type and accuracy of reduction, but following articular fracture management, most patients will suffer from clinically relevant osteoarthritis later in life.

Diagnostic Value of Acromiohumeral Distance in Rotator Cuff Pathology: Implications for Advanced-Practice Physiotherapists.

Purpose: The primary purpose of this study was to examine the inter-tester reliability and criterion validity of reduced acromiohumeral distance (AHD; <6 mm) visualized on plain radiographs in detecting rotator cuff (RC) pathology. The secondary objective was to examine the relationship between this radiographic feature and patient demographics and clinical examination. Method: This was a diagnostic study of patients seen in a tertiary care centre. Two advanced-practice physiotherapists measured AHD in two radiographic views. MRI was used as the gold standard. Results: A total of 150 consecutive patients (mean age 59 [SD 11] y, 57 women, 93 men) were included. AHD less than 6 millimetres was highly specific in both views for the presence of tear (99%), tear size (96%-98%), and fatty infiltration in the supraspinatus and infraspinatus muscles (93%-96%). The absence of AHD less than 6 millimetres was associated with a lack of advanced fatty infiltration in the supraspinatus and infraspinatus muscles (92%-100%). Sensitivity values were low for the presence and size of RC tear (21%-55%). We found a statistically significant positive association between the AHD categories and clinically observed muscle wasting and weakness of the RC muscles (p<0.05). Conclusions: AHD less than 6 millimetres was reliably measured in plain radiographs and was strongly associated with important clinical and imaging features of advanced RC pathology; this may assist with clinical decision making by allowing judicious use of more costly investigations and referral for surgery.

Effects of Femur Position on Radiographic Assessment of Femoral Head and Neck Excision Completeness in Cats.

The aim of this study was to determine the effect of femoral position on radiographic assessment of completeness of femoral head and neck excision (FHNE) in cats. The study included 20 femurs from adult cats. Complete FHNE was performed on 10 femurs and incomplete excision consisting of inadequate excision of the distal medial femoral neck was performed on 10 femurs. The lesser trochanter was maintained in all femurs. Each femur was positioned through a predetermined set of eight radiographic views about the long axis. Sensitivity (SE), specificity (SP) and accuracy were calculated for each femoral position. Craniocaudal views of the femur in external rotation (30° and 45°) had the highest SE, SP and accuracy (SE: 97.5% and 97.5%; SP: 92.5% and 95%; and accuracy: 95% and 96%, respectively) followed by external rotation of 15 (SE: 92.5%, SP: 87.5% and accuracy: 90%) relative to standard craniocaudal (SE: 57.5%, SP: 72.5%, accuracy: 65%) and lateromedial (SE: 2.5%, SP: 0%, accuracy: 1%) radiographic views. Evaluation of craniocaudal radiographic views with the femurs in external rotation can increase the ability to assess the adequacy of the FHNE in cats.

Revisiting the tibial crest as reference for the mechanical alignment of the tibial component in total knee arthroplasty: a cadaveric study on Caucasian tibiae.

The accuracy of the tibial crest (TC) in guiding the mechanical alignment of the tibial component in total knee arthroplasty (TKA) has been investigated in a few studies on Asian patients. No study analyzed the anatomical variants of the TC. We analyzed the morphological types of the TC in cadaveric tibiae of Caucasian subjects and assessed whether the TC may be considered an accurate guide for the mechanical alignment of the tibial component in TKA. The TC and mechanical axis (MA) were identified in 86 dried cadaveric tibiae by placing metal landmarks along the TC course and a guidewire overlapping the MA. Coronal view radiographs were taken in different positions of tibial axial rotation, and the relationships between the TC and MA were analyzed. The TC showed three different patterns, comprising a curved, mixed and straight course in 47 (54.6%), 21 (24.4%) and 18 (20.9%) tibiae, respectively. When a curved course was found, the TC intersected the MA at proximal and distal points located, on average 22.4% and 63.3% along the tibial length, respectively. When a straight course was found, the mean angle between the TC and MA was 2.9°. In 35% of the cases, the two axes differed by more than 3°. The TC of Caucasian subjects exhibits a marked variability in its course and relationship with the MA. Unlike the TC in Asian subjects, the TC of Caucasians cannot be considered an accurate anatomical reference to guide the coronal alignment of the tibial component in TKA.

Patellar facet ratio affects knee pain, stair climbing and stair descent after TKA without patellar resurfacing.

To determine whether knee pain or functional impairment after total knee arthroplasty (TKA) without patellar resurfacing are correlated with preoperative patellar morphology or postoperative patellar orientation. The hypotheses were that patellar shape, increased tilt and lateral displacement would be associated with pain and functional impairment. From a consecutive series of 152 knees that received a cemented postero-stabilized TKA, the Oxford Knee Score (OKS) and the Knee injury and Osteoarthritis Outcome Score (KOOS) were collected at a minimum follow-up of 12months. Uni- and multi-variable linear regression analyses were performed to determine associations between the collected clinical scores and patient demographics and patellar morphology, measured from pre- and post-operative frontal, lateral and skyline view radiographs. The OKS was 75 ± 23, whereas the KOOS pain, stair climbing, and descent were respectively 77 ± 24, 3.9 ± 1.1 and 3.8 ± 1.2. OKS was not associated with any radiographic outcomes, whereas KOOS pain was better for knees with larger medial patellar facets. The KOOS stair climbing and descent were also better for knees with larger medial patellar facets. The findings of this study partly confirm the hypotheses that pain and functional impairments after TKA without patellar resurfacing are associated with patellar shape. No association was revealed between postoperative patellar orientation and function nor pain. Quantitative consideration of patellar congruency could therefore prevent pain and improve function after TKA without patellar resurfacing. Retrospective study, Level III.

Management of distal humerus fractures.

Distal humeral fractures represent approximately 2% of fractures in adults and are often treated operatively to restore stable humeral columns and allow early elbow motion. Diagnosis is made with orthogonal radiographs. The traction view radiograph and computed tomography with three-dimensional reconstruction can be helpful in preoperative planning. Treatment options include: (1) nonoperative management, which is reserved for lower-demand, medically unwell, elderly patients, (2) surgical osteosynthesis, which remains the treatment of choice for most fractures, and (3) prosthetic replacement with either hemiarthroplasty or total elbow arthroplasty, which is indicated for distal complex comminuted fracture patterns in elderly, low-demand patients with poor bone quality. A thorough understanding of the anatomy around the elbow is critical when planning surgical approach and reduction. Controversies exist in the following areas: (1) surgical approach, (2) management of the ulnar nerve, (3) plating technique-parallel versus orthogonal, and (4) whether osteosynthesis or prosthetic elbow replacement is superior in the elderly population.

Effect of Diagnosis by Two-Dimensional Radiography Versus CBCT on Surgical Aspects of Transmigrated Impacted Mandibular Canines.

The transmigration of mandibular canines is a rare clinical finding. The present study aimed to compare the effect of diagnosis by two-dimensional radiography and cone beam computed tomography on surgical aspects of transmigrated impacted mandibular canines. A total of 20 patients (mean age 20.18 ± 3.36years; male/female = 1.5:1), reporting to the Department of Oral and Maxillofacial Surgery with transmigrated impacted mandibular canines and planned for surgical removal, were randomly divided into two groups of ten patients each. Group A patients were diagnosed using 2D radiographs (orthopantomograms and occlusal view radiographs), and Group B patients were diagnosed using CBCT scans. The effects of the diagnosis on surgical aspects were compared in both the groups using various intraoperative and post-operative parameters. The operating surgeons experienced lesser operating time and more accuracy in terms of prediction of surgical approach in Group B patients than in Group A. Post-operative complications, including post-operative vitality of the adjacent tooth and lower lip paraesthesia, were seen to be more in Group A patients than in Group B. Increased precision in localization of transmigrated impacted mandibular canines was seen by using CBCT, leading to better surgical experience and lesser post-operative complications.

The Relationship Between the Clinical and Radiological Findings and the Outcomes of Early Surgical Treatment After Tossy Type III Acromioclavicular Joint Dislocation.

BackgroundAcromioclavicular joint (ACJ) dislocation is a common injury among young and physically active persons. Evaluating surgical outcomes clinically and radiographically is widely accepted, but it is not known which clinical tests or radiological indicators are the most important. Our hypothesis is that there is a significant correlation between clinical and radiological findings and outcomes after the early surgical treatment of Tossy type III ACJ dislocation. Materials and methodsA retrospective study was conducted on 23 patients who underwent early surgical treatment after Tossy type III ACJ dislocation. We used the constant score (CS) and the simple shoulder test (SST) to measure the outcomes. For clinical evaluation, Paxinos, O’Brien’s, Bell-van Riet’s, and horizontal adduction tests were used. Standard A-P view radiographs were evaluated for redislocation, ACJ arthrosis, coracoclavicular (CC) space ossification, and for the presence of osteolysis.ResultsThe mean time of follow-up was 16 months (range, 12-22 months). During the follow-up, all patients had one or more pathological radiological signs. All clinical tests were negative in 12 patients, seven had one positive test, three had two positive tests, and one had three positive tests. The mean CS result at the follow-up was 93.44 ± 4.90 (range, 84-100), and the mean SST result was 10.78 ± 1.51 (range, 6-12). There was no statistically significant association between the CS results and either shoulder tests or radiological findings. The SST results were statistically significantly lower for patients with positive O’Brien’s test compared to those with a negative one. In contrast, the SST results were statistically significantly higher for patients with CC space ossification, compared to those who did not have this radiological sign. Other clinical tests and radiological findings did not have any associations with the SST results.ConclusionsWe found that positive O’Brien’s test was associated with worse outcomes of early surgical treatment after Tossy type III ACJ dislocation. Despite the presence of pathological radiological signs, patients may have good or even perfect clinical outcomes after the early surgical treatment of a Tossy type III injury.

Diagnostic efficacy and suitability of trans-thoracic ultrasonography for pleural fluid detection – The future non-invasive gold-standard?

ABSTRACT&#x0D; Background: Conventionally Pleural effusions are suspected by history of pleuritis, evaluated by physical signs and multiple view radiography. Trans-thoracic pleural aspiration is done and aspirated pleural fluid is considered the gold-standard for pleural effusion. Chest sonography has the advantage of having high diagnostic efficacy over radiography for the detection of pleural effusion. Furthermore, ultrasonography is free from radiation hazards, inexpensive, readily available and feasible for use in ICU, pregnant and pediatric patients. This study aims to explore the diagnostic accuracy of trans-thoracic ultrasonography for pleural fluid detection, which is free of such disadvantages. The objective is to determine the diagnostic efficacy of trans-thoracic ultrasound for detecting pleural effusion and also to assess its suitability for being a non-invasive gold-standard. &#x0D; Subject and Methods: This retrospective study of 4597 cases was conducted at pulmonology OPD-Gulab Devi Teaching Hospital, Lahore from November 2016 to July 2018. Adult patients with clinical features suggesting pleural effusions were included while those where no suspicion of pleural effusion, patients &lt; 14 years and pregnant ladies were excluded. Patients were subjected to chest x-ray PA and Lateral views and chest ultrasonography was done by a senior qualified radiologist in OPD. Ultrasound-guided pleural aspiration was done in OPD &amp; fluid was sent for analysis. At least 10ml aspirated fluid was considered as diagnostic for pleural effusion. Patient files containing history, physical examination, x-ray reports, ultrasound reports, pleural aspiration notes and informed consent were retrieved, reviewed and findings were recorded in the preformed proforma. Results were tabulated and conclusion was drawn by statistical analysis.&#x0D; Results: Out of 4597 cases, 4498 pleural effusion were manifested on CXR and only 2547(56.62%) pleural effusions were proved by ultrasound while 2050 (45.57%) cases were reported as no Pleural effusion. Chest sonography demonstrated sensitivity, specificity, PPV, NPV and diagnostic accuracy 100 % each.&#x0D; Conclusions: Trans-thoracic ultrasonography revealed an excellent efficacy that is why it can be considered as non-invasive gold standard for the detection of pleural effusion.

Radiological and clinical outcome of conservative management of thoracolumbar spinal tuberculosis in adults

Method: This study was done between January 2018 and June 2019, patients with age >18 years with thoraco-lumbar spinal tuberculosis were studied. Relevant X-rays, Mri, Esr, Crp, Vas (Visual Analog Score) and ODI (Owestry Disability Index) was done. Changes in kyphotic angles pre and post op were calculated in lateral views of pain radiographs of dorsolumbar spine via Cobb’s method.

Reduced acromiohumeral distance and increased critical shoulder angle: implications for primary care clinicians

ABSTRACT Objectives: The literature indicates that reduced acromiohumeral distance (AHD) and increased critical shoulder angle (CSA) are associated with large and massive rotator cuff (RC) tears which may not be amenable to a successful repair. The purpose of this study was to examine the overall accuracy of these two radiographic features in diagnosing significant RC pathology. Methods: This was a diagnostic study of patients with shoulder pain. To examine the overall accuracy of the measurements, the area under the Receiver Operating Characteristic curves (AUC) were calculated. The validity indices (sensitivity, specificity and likelihood ratios) examined the predictive value of specific cutoff categories of AHD<6 mm and the CSA >35°. Results: Data of 200 consecutive patients; mean age: 59(11), 117 males were used for analysis. There was a weak inverse correlation (r = 0.46) between the AHD and CSA. The AUCs for presence and size of RC tear and different stages of fatty infiltration of supraspinatus and infraspinatus muscles varied from fair to excellent for AHD and poor to good for CSA. Specificity was high for the cutoff categories of both AHD and CSA (>90%). The positive LRs were large for AHD and small to moderate for CSA. Conclusion: The AHD and CSA were reliably measured in the true AP radiographic view. Both radiographic features (AHD<6mm and CSA>35°) were able to confirm the presence of a major RC pathology. However, the AHD<6 mm, an acquired radiologic abnormality secondary to failure of the RC muscles/tendons had better measurement properties. This information is of value to primary care physicians, sports medicine specialists and advanced practice physiotherapists in their clinical decision making.

Hand X-ray examination in two planes is not required for radiographic assessment of hand osteoarthritis.

Aims:Radiographic imaging is essential in the diagnosis of hand osteoarthritis (HOA); however, it is unknown whether a multiplanar examination would add essential information to dorso-palmar (dp) views alone. This study evaluated whether an additional radiographic view would aid clinicians in the diagnostic process of HOA.Methods:The dp radiographs of both hands from 159 HOA patients were assessed according to the scores described by Kellgren and Lawrence (K/L). In oblique view images, structures similar to classic ostophytes (OPs) were found, namely bony proliferations on the dorsal and/or ventral margins of joints, and were documented as dorsal/ventral OPs (dvOPs). Function and pain were assessed by applying standardised read-out systems. Logistic regression analysis and Mann–Whitney tests were implemented.Results:The presence of dvOPs was associated with the degree of joint damage; however, dp views were sufficient to estimate radiographic changes. Only a few joints showed dvOPs as the only structural alteration; nevertheless, in almost all cases, classical radiographic OA changes were found in dp views of other joints of the same or the contralateral hand. The presence of dvOPs did not affect joint function or pain according to established scores, but was associated with radiographic progression in distal interphalangeal joints.Conclusion:This is the first study to confirm that additional radiographic planes, oblique/lateral views, are not necessary in the diagnostic process in HOA in daily clinical practice. Nevertheless, the presence of dvOPs reflect more severe joint damage and is associated with radiographic progression in HOA; hence, oblique/lateral views could be a useful tool for academic purposes.

Radiographic parameters of the digit in a cohort population of Amiata donkeys.

Background:The most common musculoskeletal conditions reported in donkeys are related to the foot. Radiographic examinations are clinically important in the diagnosis of foot abnormalities and are commonly used. However, few studies have been conducted to establish the normal radiographic appearance of a donkey’s foot.Aim:To determine the radiographic features of the front digit in healthy Amiata donkeys.Methods:Radiographic examinations were performed on 56 forefeet of 28 Amiata donkeys. Three radiographic views of each front foot were taken: lateromedial, dorsopalmar and dorso-65°proximal/palmarodistal oblique. Seventeen angular and linear radiographic parameters and the crena solearis were evaluated in all forefeet, and 18 morphometric parameters were evaluated in 16 out of 56 forefeet. Statistical analysis was carried out on all the measures assessed.Results:The radiographic appearance of the forefoot was ascertained, and data were reported as median ± standard error, minimum and maximum values. No statistical differences were obtained between the right and left forefeet.Conclusion:The normal baseline parameters of the forefeet of Amiata donkeys were recorded and described and compared with other donkey breeds and horses. The findings highlighted that the donkey breed affects the radiographic parameters of the digit.

Morphometric variations in sigmoid notch and condyle of the mandible: A retrospective forensic digital analysis in North Indian population

Introduction: The peculiarity of anatomical structures such as mandible, frontal sinus, sella turcica, nasal septum, and styloid process present in human skull and their variations leads to the revolution in forensic anthropology. The digitization in radiology enables a health professional to store the previous antemortem records and thereby compare it with postmortem records in case of mass disasters. Aim: The present retrospective analysis was conducted to evaluate the morphological variations in the sigmoid notch and condyles of the mandible and also to determine its peculiarity in establishing individual's identity. Materials and Methods: The study included 1200 panoramic radiographs of individuals in the age range of 10–60 years among population of Jodhpur, Rajasthan. The radiographs were taken using PLANMECA machine and enrolled radiographs were outlined using tracing tool installed in the software. The morphological variations of sigmoid notch and condyle in the panoramic radiographs were analyzed bilaterally for both males and females using Statistical Package for the Social Sciences (SPSS) software version 21.0. Results: The sloping shape of the sigmoid notch was most commonly found (43%), followed by wide (37.66%) and round shape (19.25%). The most common shape of condyle observed was round (46.12%), followed by angled (29.29%), convex (21.95%), and flat shape (2.62%). The distribution of sigmoid notch and condylar shape variations among right and left sides was not statistically significant. Conclusion: In forensic anthropology, the morphological variations among sigmoid notch and condyle of mandible using single panoramic radiographic view can be used as an adjuvant for personal identification.

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.

Effects of malalignment and disease activity on osteophyte formation in knees of rheumatoid arthritis patients.

Rheumatoid arthritis (RA) patients with secondary osteoarthritis (OA) in a knee joint following a total knee arthroplasty (TKA) procedure have been increasing. Here, we investigated osteophyte formation in knee joints of RA patients and associated factors. We retrospectively examined findings of 35 knees in 30 RA patients (26 females, 4 males; mean age: 63.0 years; median disease duration: 15 years) who underwent TKA, including preoperative anteroposterior view radiographs of the knee joint. Using the ImageJ software package, osteophyte size in the medial femur (MF), medial tibia (MT), lateral femur (LF), and lateral tibia (LT) regions was also determined. The mean femorotibial angle was 179°, while Larsen grade was 2 in 1, 3 in 12, 4 in 18, and 5 in 2 patients. Osteophyte sizes in the MF, MT, LF, and LT regions were 37.2, 17.0, 27.2, and 4.57 mm2, respectively, and significantly greater in the medial compartment (MC; MF+MT) than the lateral compartment (LC; LF+LT) (p < 0.001). In varus cases, osteophyte size in the MC was significantly larger than normal and valgus cases (p = 0.0016). Furthermore, osteophyte size in the MC was negatively correlated with the inflammatory markers C-reactive protein (r = -0.492, p = 0.0027) and erythrocyte sedimentation rate (r = -0.529, p = 0.0016), whereas that in the LC was negatively correlated with disease activity (r = -0.589, p = 0.0023). Our results suggest that alignment and disease activity influence osteophyte formation in RA patients, with secondary OA a more prominent symptom in RA patients with controlled inflammation.

Minimally invasive treatment of tibial plateau depression fractures using balloon tibioplasty: Clinical outcome and absorption of bioabsorbable calcium phosphate cement.

The exact reconstruction of the tibial plateau and articular surface is the main operative aim in the treatment of tibial plateau depression fractures. For selected cases, a novel technique with the use of balloon tibioplasty in combination of bioabsorbable calcium phosphate cement is available. In this study, the first objective was to answer the question whether the clinical outcome parameters after balloon tibioplasty are comparable to open reduction procedures described in the literature. Secondly, we asked whether the cement absorption is safe in relation to adverse effects like osteolysis and measured the absorption ability during the bone conversion process in the proximal tibia bone. Eight patients (mean age 54 years; 4 males and 4 females) received the abovementioned surgical procedure. Mean follow-up period was 27 months. This study evaluated clinical outcome and radiological measured cement absorption within the postoperative course. Cement absorption was measured on X-rays and calculated based on the greatest extend on anterior-posterior and lateral view radiographs just after the operation on the latest available follow-up. WOMAC score showed a mean of 93. Radiologic absorption was 1/5 at a mean of 18 months. No osteolysis reaction was seen surrounding the cement. This far, promising clinical and radiological results have been shown with WOMAC scores comparable to the results of noninjured knees. The indication for this relatively new technique is restricted to isolated depression fractures. It is a useful tool to facilitate the reduction of select depressed tibial fractures. The radiologic absorption effect seems to be quite fast in bone remodeling and safe without any osteolysis or osseous reaction.