Radiological Evaluation Criteria Research Articles

Outcomes of Treatment of Intra-Articular Distal Radius Fractures with Volar Locked Plates in Patients Above 50 Years

Objective: Outcomes of the treatment of intra-articular distal radius fractures seen in patients above 50 years with volar locked plates were evaluated.  Study design: Twenty Eight patients (8 female and 20 male) treated in our clinic with volar locked plates because of intra-articular distal radius fractures were evaluated after a 17-month (range 8-30 months) follow-up. Mean age of the patients was 45.2 (range 50-64) years. Fractures were classified according to Frykman and AO classifications. According to the Frykman classification, 2 patients had type 3 (7%), 1 patient had type 4 (5.5%), 14 patients had type 7 (50%) and 11 patients had type 8 (37.5%) fractures. According to the AO classification, 6 patients had B2 (23.5%), 4 patients had C1 (14%), 11 patients had C2 (37.5%) and 7 patients had C3 (25%) fractures. All patients were evaluated clinically and radiologically. Clinical outcomes of the patients were evaluated using Gartland and Werley’s evaluation scores and DASH-T scores. Radiologic outcomes were evaluated according to the radiologic evaluation criteria modified by Steward et al.  Results: According to the evaluation scores of Gartland and Werley, 20 patients yielded excellent (72%), 5 patients good (18%) and 3 patients moderate (10%) results. Mean DASH-T score of the patients was 34 (range 31 to 40).  Conclusions: Treatment of intra-articular distal radius fractures seen above 50 years of age with volar locked plates is an efficient and safe method. Use of volar locked plates reduces the complication risk of reduction loss and need for grafts in osteoporotic fractures.

Comparative assessment of difficulty scales for removal of the third molar of the lower jaw depending on its position

Retention (delayed eruption) of the third molar is one of the most common pathologies in the outpatient practice of a dentist-surgeon. Such a pathology can very often be complicated by inflammatory diseases, such as pericoronitis, periostitis and other more serious diseases. Therefore, early warning and most gentle removal of the causative tooth determines the professionalism of the dental surgeon. A large number of indexes of difficulty of removal of the third molar have been proposed by different authors, but none of them is considered universal and optimal for different clinical cases. The level of complexity is most clearly characterized by a scale that takes into account not only radiological but also clinical and demographic indicators. Such scales exist in modification or in more recent literary sources. Having chosen the most clear and correct scale, it is possible for the surgeon to clearly assess the entire level of complexity and responsibility for surgical intervention on removing the third molar, thereby obtaining the most effective result, minimizing complications both during the operation and after a while. The purpose of the study: justification of the selection of the difficulty rating scale for the removal of the third molar of the lower jaw, depending on its position. The study analyzed and compared 18 basic scales of complexity that are most often used by surgeons before removing the impacted third molar of the lower jaw. Data sources that were used for the search were taken from Medline, PubMed, Google Scholar, Minerva library databases. Each of the difficulty scales was presented and translated into Ukrainian for convenient use in the practice of a dental surgeon. A general table was provided where a comparative analysis of the difficulty scales was made according to thirty parameters. It is shown that the Cosme Gay-Escoda C. scale has the most indicators for preoperative assessment of complexity. There are many difficulty scales for preoperative assessment for the removal of impacted third molars of the lower jaw. Some of them have radiological evaluation criteria, some have clinical criteria, and only the Pernumbuco index (2017), Zhang X. (2019), and Cosme Gay-Escoda C. (2022) scales also have demographic indicators. However, the latter has the largest number of criteria, according to which the difficulty of removing the third molar of the lower jaw is calculated.

A phase II, multicenter, open-label study of abemaciclib and letrozole in patients with estrogen receptor-positive rare ovarian cancer: ALEPRO trial

BackgroundLow-grade serous and endometrioid ovarian cancers and adult-type granulosa cell tumors are rare ovarian malignancies that show high estrogen receptor positivity. Recurrences of these subtypes of ovarian cancer are often...

Midterm Outcomes of Posterior Cruciate Ligament Substituting Total Knee Arthroplasty

Objective: In the present study, it is aimed to retrospectively investigate and present the midterm results of the cases with posterior cruciate ligament (PCL) substituting total knee arthroplasty. Materials and Methods: In this study, we included a total of 61 patients with 80 knees who underwent PCL-substituting total knee arthroplasty between July 2006 and June 2012. Results: 52 patients were female and 9 were male. The mean age of patients was 65.4 (42-85) years and the mean follow up period was 32.6 (12-72) months. Patients were evaluated according to the American Knee Society Score for knee score and knee functional score. Radiological evaluation was performed according to Total Knee Arthroplasty Radiological Evaluation criteria. Knee score was 38-71 (mean 43.7) prior to the surgery and 78-100 (mean 95) subsequently. 69 knee (86,25%) had perfect knee scores and 11 knee (13.75%) had good scores. Functional score was 10-60 (mean 35.08) prior to the surgery and 60-100 (mean 82.2) subsequently. In the evaluation according to the functional knee score, we obtained perfect results in 45 knee (56.25%) and good results in 29 knees (36.25%) and moderate results in 6 knees (7.5%). Patients had a mean 9.7o varus (8o valgus – 20o varus) prior to the surgery and mean 4.75o valgus (2o varus – 10o valgus) alignment was obtained subsequently to surgery. In 1 case revision arthroplasty was performed due to late deep infection. In 1 case insert replacement was performed due to insert fracture due to trauma. As a result of our PCL substituting total knee arthroplasty applications, we obtained 86.25%perfect knee score and 56.25%perfect functional score. Conclusion: PCL substituting total knee arthroplasty is a favorable orthopedic surgical intervention when preformed with adequate preoperative preparations and cautious surgical techniques with appropriate patient choice.

Radiologic Evaluation Criteria for Chronic Subdural Hematomas: Recommendations for Clinical Trials.

Embolization of the middle meningeal artery has gained substantial interest as a therapy for chronic subdural hematomas. For the results of the currently running chronic subdural hematoma trials to inform clinical practice, sufficient accuracy and matching definitions are necessary. We summarized the current practice in chronic subdural hematoma evaluation and derived suggestions on reporting standards using the {Nested} Knowledge AutoLit living review platform. On the basis of the most commonly reported data elements, we suggested a set of standardized image-based study end points for chronic subdural hematoma evaluation for future trials. The measurement methods and reporting standards as proposed in this article have been derived from published best practices and are endorsed by the European Society of Minimally Invasive Neurological Therapy's research committee. The standardization of radiologic outcome measures and measurement techniques in chronic subdural hematoma embolization trials would increase the impact and implication of each trial as well as facilitate data pooling for increased statistical power and, therefore, translation to clinical practice.

Is It Possible to Treat Developmental Dysplasia of the Hip with Anterior Open Reduction and Pemberton Osteotomy Under 18 Months of Age?

The purpose of the present study is to determine the outcome success of anterior open reduction with Pemberton osteotomy in patients under 18months of age with developmental dysplasia of the hip. We retrospectively reviewed the clinical and radiological results of 27developmentalhipdysplasiapatients under 18months of age(26 girls, 1 boy)who underwentanterior open reduction with Pemberton osteotomy. Bilateral surgery was performed in 18 patients and unilateral in nine patients. At the final follow-up, the clinical results were evaluated according to the McKay's clinical evaluation criteria, the radiological results according to the Severin's radiological evaluation criteria, and the presence of avascular necrosis according to the Kalamchi-MacEwen's classification criteria. We treated 36 hips of 27 patients who were younger than 18months of age (range 10-18months) at the time of surgery and followed up a minimum of 5years (mean 6.5years). At the final follow-up, 34 (94.4%) were assessed clinically as excellent, one hip (2.7%) as good and one hip (2.7%) as fair according to the McKay's clinical classification. Radiological classification revealed that, 97.2% of the hips were Severin Type-1 and 2.8% Severin Type-3. Avascular necrosis was observed in 5 of 36 hips (13.8%). Two hips were assessed as Type-2, two hips Type-3 and one hip Type-4 according to the Kalamchi-MacEwen's classification. We conclude that Pemberton osteotomy with anterior open reduction is useful technique for developmental hip dysplasia treatment of patients under the age of 18months with good clinical and radiological results as well as with low complication rates.

Mid-term outcomes of posterior stabilized total knee arthroplasty in severe osteoarthritis

Aim: The purpose of this study was to reveal mid-term outcomes by retrospectively investigating patients who underwent total knee arthroplasty with a posterior stabilized design.
 Material and methods: The study included a total of 68 knees of 52 patients with completed follow-up data who underwent PCL substituting (PS) total knee arthroplasty due to a diagnosis of primary or secondary osteoarthritis. The 52 patients comprised 45 (86.5%) females and 7 (13.5%) males with a mean age of 65.2±9.32 years (range, 30-82 years). The American Knee Society criteria were adopted for assessment of patient knee scores and functional knee scores. The Total Knee Prosthesis Radiological Evaluation criteria were applied for radiological evaluation of the patients.
 Results: The mean follow-up period of the patients was 32.1 ± 9.85 months (range: 18-60 months) and the Knee Society Scores (KSS) were 41.5 (range: 26 - 58) preoperatively, and 84.3 (range: 51 - 97) postoperatively. The mean preoperative and postoperative range of motion was 88.2º (range: 60º - 100º), and 106.7º (range: 90º - 120º), respectively. Two-stage revision surgery was applied to one patient due to deep infection. No cases of aseptic loosening were observed. Implant survivorship, and excellent and good results according to the functional knee score were reported as 98.8%, 41.1%, and 32.3%, respectively.
 Conclusion: Positive patient outcomes were obtained with the use of PS total knee arthroplasty in patients with severe osteoarthritis and there was no evidence of loss in mid-term follow-up.

Periacetabular Pelvic Osteotomy in Treatment of Patients with Developmental Dysplasia of the Hip

Background. Pelvic osteotomies are widely used for treatment of young active patients with developmental dysplasia of the hip (DDH) Type I according to the Crowe or type A according to Hartofilakidis classifications and the absence of severe degenerative cartilage lesions. Nowadays, Ganz periacetabular osteotomy (PAO) is the most common choice of surgeons around the world in treatment of such patients.The aim of the study was to evaluate the radiological and functional results of Ganz periacetabular osteotomy in patients with DDH.Material and Methods. A single-center retrospective analysis of 49 Ganz PAO was performed in 43 patients aged 36±9 years. The radiological evaluation criteria were Wiberg (AW), Lequesne (AL), Tonnis (AT) angles, and joint medialization. The results of treatment were evaluated using the Harris scale, iHOT-12, and VAS before treatment and 1 year after, the presence of complications was also monitored.Results. The average follow-up period was 35±15 months (from 1.0 to 6.9 years). Radiological parameters improved after surgery compared to preoperative ones: AW +19.9° (17.1° vs. 37.0°), AT -11.5° (19.9° vs. 8.4°), AL +14.1° (25.1° vs. 39.2°), joint medialization -5.5 mm (14.3 mm vs. 8.8 mm) (p0.001). Functional results and quality of life of patients also improved: the Harris scale +35.6 points (47 vs 83 points), iHOT-12 +40.9 points (44 vs 85 points), pain level -2.8 points (5 vs 2 points) (p0.001). Various complications developed in 20 out of 49 cases (40.8%). Neurological complications were resolved conservatively (22.4%). A direct correlation was evaluated between the surgical treatment of DDH in childhood and the development of neurological complications after PAO (R = 0.76; p0.001). In 9 cases out of 49 (18.4%), revision surgery was required: in 3 — total hip replacement, in 2 — reorientation of the acetabulum, in 4 — arthroscopic fixation of the anterior articular lip. In 93.9% of cases native hip joint surfaces were preserved.Conclusion. Ganz PAO has good reconstructive capabilities and sufficient efficiency. The operation allows to restore the coverage of the femoral head with the acetabulum, delays total hip replacement and provides improved functional results.

Comparison of the functional and radiological results of the conservatively and surgically treated displaced acetabulum fractured patients.

The purpose of the study was to compare the functional and radiological results of the conservatively and surgically treated displaced acetabular fractured patients. The study included 61 patients with a displaced acetabulum fracture over the age of 18, who have been treated con-servatively or surgically for acetabular fractures, between 2000 and 2014. Patients were divided into two groups according to their treatment type. Group 1 consisted of conservatively treated 31 between 2000 and 2010 patients and Group 2 consisted of surgically treated 30 patients between 2010 and 2014. The fractures were classified according to Judet and Letournel classification. Clinical evaluation of the patients was conducted according to Modified Merle D'Aubigne Score, SF-36, and Harris Hip Score. Radiological evaluation was evaluated according to Matta's Radiological Evaluation Criteria. Kolmogorov-Smirnov, t-test, Mann-Whitney U-test, and two Wilcoxon paired sample tests were used for statistical analysis. The significance limit was chosen as p<0.05. The mean follow-up time was 10 years for the conservative group and 5.5 years for the surgery group. There was no statistically significant difference in functional scores between both groups (p>0.05), Matta's radiological staging score was significantly higher in the operated group (p=0.023). Radiological scores are not directly correlated with the functional capacity. We obtained good radiological and functional scores in the surgical group, operative treatment should be considered when absolute indications are there. The outcome of conservatively managed fractures is not bleak. We think that there is an alternative to surgical treatment in displaced acetabular fractures and that similar functional results can be obtained in selected cases.

Clinical and Radiological Results of Crowe Type 3 or 4 Dysplasia Patients Operated on With Total Hip Arthroplasty Using a Cementless Rectangular Femoral Component Without Fixating or Grafting the Transverse Osteotomy Site

BackgroundTotal hip arthroplasty (THA) involving shortening osteotomy for patients with Crowe type 3 or 4 dysplasia is a challenging surgical procedure. This study aims to demonstrate that rectangular femoral component use in anatomical reconstructions with THA and transverse shortening osteotomy yields successful results without the use of bone graft or any fixation material at the osteotomy site. MethodsFifty hips from 41 patients were identified retrospectively as per study objectives. All patients were evaluated using the Harris Hip Score and Visual Analog Scale for pain. Complications were reported. Radiological evaluation criteria were then evaluated, including leg length discrepancy, degree of trochanter caudalization and stem subsidence, radiolucent and radiodense lines for both components and bone atrophy or hypertrophy around the stem according to Gruen zones, and the canal fill ratio of the stem. ResultsPostoperative Harris Hip Score was excellent for 68% of patients. No patient had poor results. Complication rate was 32%. One patient had nonunion (2%). The mean postoperative leg length discrepancy was 0.8(±0.6) cm. No patient had a subsidence of more than 5 mm. Radiolucent and radiodense lines were present in up to 34% of patients, and bone atrophy was present in the proximal femur in up to 96% of patients. No patient had osteolysis or loosening in neither component. ConclusionSuccessful clinical and radiological results can be obtained from Crowe type 3 and 4 dysplastic hips operated on with THA using a rectangular femoral component and transverse shortening osteotomy technique. The use of graft or any fixation material at the osteotomy site is not mandatory.

Case-control study on calcaneal traction and external fixator fixation of fractional delayed surgery for type C Pilon Fracture

To compare clinical effects of calcaneal traction and external fixator fixation of fractional delayed surgery in treating type C Pilon fractures. From January 2012 to December 2017, clinical data of 45 patients with tibial Pilon fractures were respectively analyzed. There were 24 patients in traction group, including 16 males and 8 females, aged from 21 to 57 years old with an average age of (38.6 ±10.5) years old; 18 patients caused by falling down, 6 patients caused by traffic accident; 15 patients on the left side and 9 patients on the right side; according to AO/OTA classification, 3 patients classified type C1, 9 patients classified type C2 and 12 patients classified type C3; treated by calcaneal traction on the first stage, and open reduction and internal fixation on the second stage. There were 21 patients in external fixation group, including 15 males and 6 females, aged from 19 to 58 years old with an average age of (37.8 ±11.2) years old; 17 patients caused by falling down, 4 patients caused by traffic accident; 11 patients on the left side and 10 patients on the right side; according to AO/OTA classification, 2 patients classified type C1, 8 patients classified type C2 and 11 patients classified type C3; treated by external fixator on the first stage, and open reduction and internal fixation on the second stage. All patients were closed fracture. Preoperative waiting time, hospital stays, operative time, postoperative complications, fracture reduction and healing time between two groups were compared, VAS score was used to evaluate relief of pain before internal fixation on the second stage, Burwell-Charnley radiological evaluation criteria was applied to evaluate fracture reduction after internal fixation, AOFAS score was used to evaluate recovery of ankle joint function. There were no statistical difference in operative time, following-up time and fracture healing time between two groups. VAS score before internal fixation in traction group was 3.73± 0.87, while in external fixation group was 2.67±0.69, there was statistical difference between two groups. Preoperative waiting time, and hospital stays in traction group were (9.20±1.40) d ,(12.30±3.60) d; while in external fixation group were (7.60± 1.50) d ,(10.80±2.60) d; and had significant difference between two groups. There was no difference in complications between two groups. According to Burwell-Charnley radiological evaluation criteria, 20 patients obtained anatomical reduction, and 4 patients received normal reduction in traction group; 18 patients obtained anatomical reduction, and 3 patients received normal reduction in external fixation group; while without difference between two groups. There was no difference between two groups in AOFAS score. For type C Pilon fractures, one-stage calcaneus traction or temporary external fixation also could achieve temporary fixation and provide better soft tissue conditions for the second stage internal fixation, and could receive better ankle joint function after internal fixation. The operation of calcaneus traction is simple, while external fixation may be increase the number of operation times, but external fixation has more advantages in reducing preoperative pain, shortening preoperative waiting days and hospitalization time than traction.

Immunotherapy in non-small cell lung cancer patients: back to the future.

With the advent of immunotherapy, the life expectancy of patients with advanced non-small cell lung cancer (NSCLC) is dramatically improved. As described in the most recent clinical trials, the addition of immunotherapy to the available therapeutic strategies, restoring an efficient immune response against neoplasms and establishing an immunological memory, is able to improve both patient's survival and quality of life. This paved the way for new therapeutic algorithms, new combination strategies, as well as the possible use of adoptive immunotherapy. Although the use of immunotherapy is now widely employed in the different phases of lung cancer, we have not yet fully understood what are both the actual mechanisms of action and resistance to checkpoint inhibitors, predictive factors of response, immuno-related response criteria, and interferences between immunotherapy and tumor microenvironment, as well as angiogenesis and its interactions with conventional therapies, such as chemotherapy. The objective of this critical review is to frame the relevant results obtained with immunotherapy in NSCLC, providing insights to help overcome decision-making for a better therapeutic choice. In addition, returning to the study of pulmonary physiology and preclinical data, we will address the new issues on the heterogeneity of response to anti-PD1/anti-PD-L1, including their combinations, in NSCLC. Moreover, to date, we are facing with patterns of response different from those previously seen with cytotoxic or target therapies. Indeed, different radiological evaluation criteria have been proposed to evaluate response to immunotherapy and further efforts are needed to identify a unique system of evaluation and other than PDL1 biomarkers, to integrate radiology in the assessment of response.

Evaluation criteria for the assessment of occupational diseases of the lumbar spine - how reliable are they? -

BackgroundIn 2005, the German Association of Occupational Accident Insurance Funds (DGUV) defined radiological evaluation criteria for the assessment of degenerative occupational diseases of the lumbar spine. These include the measurement of intervertebral osteochondrosis and classification of vertebral osteosclerosis, antero-lateral and posterior spondylosis, and spondyloarthritis via plain radiography. The measures currently remain in daily use for determining worker compensation among those with occupational diseases. Here, we aimed to evaluate the inter- and intra-observer reliability of these evaluation criteria.MethodsWe enrolled 100 patients with occupational degenerative diseases of the lumbar spine. Native antero-posterior and lateral radiographs of these patients were evaluated according to DGUV recommendations by 4 observers with different levels of clinical training. Evaluations were again conducted after 2 months to assess the intra-observer reliability.ResultsThe measurement of intervertebral osteochondrosis showed good inter-observer reliability (ICC: 0.755) and excellent intra-observer reliability (ICC: 0.827). The classification of vertebral osteosclerosis exhibited moderate kappa values for inter-observer reliability (К: 0.426) and intra-observer reliability (К: 0.441); the remaining 3 criteria showed poor inter- and intra-observer reliabilities.ConclusionThe measurement of intervertebral osteochondrosis and classification of vertebral osteosclerosis showed adequate inter- and intra-observer reliability in the assessment of occupational diseases of the lumbar spine, whereas the classification of antero-lateral and posterior spondylosis and spondyloarthritis stage exhibited insufficient reliability. Hence, we recommend the revision of the DGUV recommendations for the evaluation of occupational diseases of the lumbar spine.

Mid-term Clinical and Radiological Results of Oxford Phase 3 Medial Unicompartmental Knee Arthroplasty.

IntroductionThe popularity of unicompartmental knee arthroplasty (UKA) for the treatment of isolated compartment osteoarthritis of the knee has risen over the past two decades. Currently, UKA covers a considerable amount of all knee arthroplasties worldwide. The aim of this study was to present the clinical and radiological outcomes of UKA in patients with medial compartment osteoarthritis.MethodsBetween January 2010 and January 2014, mobile-bearing UKA was applied to 44 knees of 37 (three men, 34 women) patients with isolated medial compartment osteoarthritis. The mean age, body mass index (BMI), and follow-up were 54 ± 6.1, 26.3± 2.2, and 48 ± 9.4, respectively. Oxford Knee Score (OKS), Knee Society Score (KSS), visual analog scale (VAS), and range of motion (ROM) were used for clinical assessment, and the Oxford Radiological Evaluation Criteria were used for radiological assessment.ResultsCompared to preoperative values, knee flexion increased from 116° to 123° (p<0.001). Statistically significant increases in OKS and KSS and decrease in VAS was obtained postoperatively (p<0.001). All of the components were aligned within the acceptable ranges radiologically. One bearing dislocation was revised and one conversion to TKA was performed during the 5.9-year follow-up. No major complications occurred, including infection, deep vein thrombosis, pulmonary emboli, and neurovascular injury.ConclusionThe mid-term clinical and radiological outcomes of UKA were excellent in this study, and our results demonstrate that Oxford mobile-bearing UKA for the proper indication is effective, with considerable success in the treatment of medial compartmental knee osteoarthritis, regardless of age.

Crescent Technique with Dual C-Shaped Reconstruction Plates for Posterior Acetabular Wall Fractures

Background: Here we have defined a novel technique for repairing posterior acetabular wall fractures called the “crescent technique,” in which dual C-shaped reconstruction plates overlap at the distal ends and, if necessary, at the proximal ends. We also analyzed the efficacy and reliability of this method. Patients and Methods: This was a retrospective analysis of 27 patients undergoing the crescent technique. All of the fractures were treated by the senior author for a mean of 7.9 days (0–15 days) after the trauma. The mean follow-up period was 19 months (13–29 months). The clinical results were evaluated using the modified clinical grading system developed by Merle d’Aubigne and Postel, and then modified by Matta. The radiographs were graded according to the criteria described by Matta. Results: In the clinical grading, 16 (59%) of the patients were excellent and very good, 5 (19%) were good, 3 (11%) were moderate, and 3 (11%) were poor. According to the Matta radiological evaluation criteria, 19 (70%) were excellent, 4 (15%) were good, 4 (15%) were fair, and none were poor. Statistically significant consistency was seen between the clinical and radiological results (p = 0.002). Conclusions: The crescent technique is a dual plate technique modification that can provide a stable fixation. It appears to be an effective and reliable method for treating posterior wall fractures of the acetabulum.

IMPROVED DOUBLE OPERATIVE APPROACHES FOR TREATMENT OF Pilon FRACTURES ACCOMPANIED WITH FIBULA FRACTURES

To investigate the clinical effect of surgical treatment of Pilon fractures accompanied with fibula fractures with the improved double operative approaches. Between January 2012 and June 2015, 19 patients with closed Pilon fractures accompanied with fibula fractures (Rüedi-Allgöwer type Ⅲ) underwent open reduction and internal fixation with improved anterior-median incision and posterior-lateral incision. There were 13 males and 6 females, aged 35 years on average (range, 23-68 years). Injury was caused by traffic accident in 11 cases, falling from height in 7 cases, and crash injury of heavy object in 1 case. According to AO/OTA classification, there were 4 cases of type C2, and 15 cases of type C3. According to Tscherne-Gotzen classification of soft tissue defect, 6 cases were rated as grade 1 and 13 cases as grade 2. The interval of injury and operation was 6-18 days (mean, 10.3 days). After operation, reduction of Pilon fracture was evaluated by the Burwell-Charnley radiological evaluation criteria, and the ankle joint function was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. The operation time was 1.8-4.6 hours (mean, 2.4 hours); the intraoperative blood loss was 200-500 mL (mean, 310 mL). All the 19 patients were followed up for 13.7 months on average (range, 12-18 months). The fracture healing time was 3.6 months on average (range, 2.5-8.0 months). Postoperative complications included anterior-median incision necrosis in 2 cases, traumatic arthritis in 2 cases, and ankle instability in 1 case. According to Burwell-Charnley radiological evaluation criteria, anatomical reduction was obtained in 15 cases and satisfactory reduction in 4 cases. According to AOFAS score, the excellent and good rate was 84.2% (excellent in 11 cases, good in 5 cases, and fair in 3 cases). The improved anterior-median incision combined with posterior-lateral incision is a safe and effective method to treat complex Pilon fractures accompanied with fibula fractures, which has the advantages of simple operation, adequate exposure and minimal invasion.

Minimum 10-year clinical and radiological follow-up of trapeziectomy with interposition or suspensionplasty for basal thumb arthritis

HypothesisThe aim of this article is to analyze clinical and radiological outcomes of trapeziectomy performed for basal thumb arthritis after a minimum follow-up of 10 years to gain further insight from shorter and medium-term studies reporting satisfactory evolution. MethodsWe reviewed 67 trapeziectomies, operated on by the same senior surgeon after a minimum follow-up of 10 years. The sample included 16 cases of suspensionplasty and 51 interpositions. Clinical outcome evaluated strength, pain, joint amplitude, Kapandji opposition score, Disabilities of the Arm, Shoulder and Hand score, complications and revision surgery. Radiological evaluation criteria included osteoarthritis and collapse of the trapezial void. ResultsAfter a 10-year follow-up, clinical results remained stable despite radiological degradations. Long-term clinical outcomes of trapeziectomy for basal thumb arthritis are very positive, with interpositioning as an isolated procedure appearing, clinically, to be the preferred treatment despite greater radiological degradation when compared to suspensionplasty. ConclusionIn addition to offering insight into minimum 10-year follow-up, this study also pinpoints this paradoxical dissociation of clinical-radiological outcomes. Type of study/level of evidenceTherapeutic III.

Guidelines for skeletal surveys in suspected child abuse

Introduction Child abuse imaging differs from general musculoskeletal imaging in that there is exceptional necessity for high quality images. The images are directly involved in legal processes and the child and the family faces major consequences if imaging is sub-optimal. The consequences of misdiagnosis are serious. Should head trauma or fractures be overlooked, or if the radiological diagnosis is uncertain, abused children may be sent home with violent parents or caregivers. Conversely, where no abuse has taken place, but the certainty of the diagnosis is questionable, the unnecessary hospitalization of an innocent family may result. In Southern Denmark approximately 15-20 children per year are examined. The examinations are performed in four different radiology departments throughout the region. Until the autumn of 2012, a variety of imaging protocols and techniques were used in pediatric skeletal surveys. This led to difficulties, because some cases are subject to second opinion report. In many cases, supplemental images or a complete reexamination of the child was required in order to facilitate a second opinion, resulting in unnecessary exposure. Methods An initial consensus meeting with 20 participants was arranged in 2012. Pediatric radiologists, managers and radiographers with special competencies in pediatric radiology attended. Research evidence, cases and clinical experience was discussed. A follow-up meeting was arranged in 2013 with similar participants. This second meeting focused mainly on follow-up skeletal surveys in children &lt;2 years of age Results The first meeting resulted in the agreement on which projections to acquire, image quality criteria, how to cooperate with the parents, radiologic evaluation criteria and the role of the radiographer in imaging the abused child. The second meeting resulted in consensus on the necessary projections required for follow-up skeletal surveys. Conclusion Common protocols for child abuse imaging have been established and fully implemented in the Region of Southern Denmark. Annual meetings have also been established where legal aspects, best practice and best evidence in imaging and cooperation with pediatric departments is discussed.

Sa1935 Variation and Utility Ofchromogranin a Assays for Gastric Carcinoid Type 1

Introduction: Chromogranin A (CgA) is considered as the best and most sensitive general marker for the diagnosis and follow-up of neuroendocrine tumors (NETs) and is also of prognostic value. However, there are no available studies to date, which analysed the role of CgA as a predictor of radiological disease progression in all NETs. Aim: To investigate the prognostic value of CgA as a predictor of radiological disease progression in NET patients. Methods: Patients with metastatic NETs and evidence of Radiological Progression (RP) according to Radiological Evaluation Criteria In Solid Tumors (RECIST 1.1) were identified from our NETs database. Plasma CgA were measured 6 and 12 months before RP and at the event of RP. CgA was measured with the Supra-regional-Assay-Service radioimmunoassay (Hammersmith Hospital). In our laboratory, the reference value of CgA has been established as 20%). Results: 152 patients were evaluable including 91 midgut NETs (mNETs) and 61 pancreatic NETs (PNETs). Of these, 56 were G1 NETs, 65 G2, 10 G3, 21 of unknown histology. The majority of the patients (95.4%) had liver metastases, whereas bone and lung metastases were present in a smaller proportion of patients (27.6% and 9.9%, respectively). Median CgA for all NETs, 6 months before RP,

The effects of osteoporosis on functional outcome in patients with distal radius fracture treated with plate osteosynthesis

The aim of this study was to evaluate the effect of osteoporosis on functional results in patients with distal radius fracture treated with plate osteosynthesis. The study included 37 female patients who underwent osteosynthesis using volar locking plate for distal radius fracture between 2006 and 2008. Diagnosis of osteoporosis was made with bone mineral density measurement. Patients were divided into two groups; Group 1 patients (20 patients; mean age: 56.5 years) had osteoporosis and a mean T-score of -2.6 SD, and Group 2 patients (17 patients; mean age: 37.1 years) did not have osteoporosis and had a T-score of -0.7 SD. Radiological results were evaluated according to the Stewart's criteria and activities of daily living were assessed with the modified Gartland and Werley score, the modified Mayo wrist scoring system, and the DASH scoring system. According to the Stewart's radiological evaluation criteria and modified Gartland and Werley scores, there was no statistically significant difference between Group 1 and 2 (p>0.05). However, a statistically significant difference was found between Group 1 and 2 according to the modified Mayo wrist scoring system and DASH scoring system (p<0.05). There was no radiological difference between the osteoporotic and non-osteoporotic patients with distal radius fractures treated with plate osteosynthesis. However, osteoporosis had a negative effect on the results and range of motion of the wrist, and activities of daily living were significantly restricted.