Canal Ratio Research Articles

Risk Factors for Early Implant Failure in Geriatric Intertrochanteric Fractures Treated with Twin Interlocking Derotation and Compression Screw Cephalomedullary Nail (InterTAN).

Intertrochanteric hip fractures in elderly patients are a significant cause of morbidity and mortality, with increasing incidence due to the aging population. Despite advancements in intramedullary nailing (IMN) technology, fixation failure remains a concern. This study aims to evaluate pre-and postoperative radiographic risk factors for varus collapse in geriatric intertrochanteric fractures treated with twin interlocking derotation and compression screw cephalomedullary nail (InterTAN, Smith & Nephew). This retrospective study included patients over 60 years with AO 31A1 and 31A2 intertrochanteric femur fractures treated with InterTAN at a tertiary referral center from August 2012 to August 2017. Patients with high-energy fractures, AO 31A3 fractures, or those requiring open reduction were excluded. Data on demographics, fracture classification, implant sizes, imaging studies, and follow-up were collected. Radiographic assessments included Chang's medial cortical support concept, tip-apex distance (TAD), calcar-referenced TAD (CalTAD), neck-shaft angles (NSA), and screw placement according to Cleveland zones. Varus collapse was defined as a >5° change in NSA within three months postoperatively. Multivariate logistic regression analysis was used to identify risk factors for varus collapse. The study included 136 patients with a mean age of 79.8 years, of whom 38.2% were male. The early postoperative tipapex distance (TAD) averaged 21.9mm, with 30.1% of patients experiencing varus collapse greater than 5°. Positive medial cortical support (PMCS) or neutral position (NP) type reduction was highly protective against varus collapse (p < 0.001), as well as TAD less than 25mm (p < 0.001). Additionally, the placement of screws in the central-central or central-inferior zones provided a protective effect against varus collapse (p = 0.031). Conversely, having an OTA/AO type A2.2 or A2.3 fracture significantly increased the risk of varus collapse (p = 0.030). Other factors, such as CalTAD and the nail width to medullary canal ratio, did not significantly predict varus collapse (p = 0.831 and p = 0.952, respectively). Our findings align with previous studies highlighting TAD and screw placement as critical factors in preventing fixation failure. The protective effect of PMCS or NP reduction and the increased risk associated with OTA/AO type A2.2 and A2.3 fractures are noteworthy. Unlike previous studies, CalTAD was not significantly associated with varus collapse in our cohort. The study underscores the importance of surgical technique and radiographic parameters in optimizing outcomes for elderly patients with intertrochanteric fractures. In elderly patients treated with InterTAN nails, varus collapse is influenced by fracture type, TAD, reduction quality, and screw placement. Ensuring a TAD <25mm, achieving PMCS or NP reduction, and placing screws in central-central or central-inferior zones are crucial for minimizing varus collapse. These findings highlight the importance of meticulous surgical technique and radiographic assessment in managing intertrochanteric fractures in the elderly. hip fractures, intertrochanteric fractures, internal Fixation, geriatrics, cephalomedullary nail.

Evaluation of the Root Canal Centering Ratio and Canal Transportation Associated With Three Rotary File Systems Using Cone Beam Computed Tomography (CBCT) Analysis

Evaluation of the Root Canal Centering Ratio and Canal Transportation Associated With Three Rotary File Systems Using Cone Beam Computed Tomography (CBCT) Analysis

What Degree of Radiological Compression Predicts Cauda Equina Syndrome: A Retrospective Study at a National Tertiary Center

ObjectiveCauda Equina Syndrome (CES) is diagnosed both clinically and radiologically. However, it's unclear if a specific degree of cauda equina compression (CEC) on imaging can confirm the diagnosis. This study aimed to identify an optimal percentage of prolapse to canal ratio (PCR) on MRI that correlates with CEC, facilitating reliable decision-making for CES symptoms. MethodsA single-center retrospective case series analysis was conducted from 2020 to 2021. Sixty-one patients who underwent emergency lumbar discectomy within 48 hours of presentation were included, divided into a CES group and a disc prolapse (DP) group. CES cases were identified using ICD-10 code G83.4. PCR was calculated by dividing the width of the disc herniation by the total width of the spinal canal at the level of the herniation on single mid-sagittal T2 MRI scans, using the IC Measure software on Windows. ResultsCES most frequently occurred at the L4/5 level (37/61). The median PCR in CES cases was 76.19% (66.67 – 85.71), significantly higher than in DP cases, 48.08% (31.33 – 55.56) (p<0.001). A PCR threshold of 40% maximized sensitivity at 100% but had a specificity of 45%. Conversely, a threshold of 75% maximized specificity at 100% with a sensitivity of 50%. The optimal PCR, determined by the Youden index, was 66%, yielding a sensitivity of 75% and specificity of 97%, with an area under the curve (AUC) of 0.923. ConclusionsSimple radiological measurements of PCR can potentially triage CES patients and guide their management. Future studies should correlate PCR with clinical signs and symptoms for a comprehensive assessment.

Risk Factors for Periprosthetic Femoral Fractures After Cementless Total Hip Arthroplasty

BackgroundThe present study aimed to identify the risk factors of periprosthetic femoral fracture (PFF) after cementless total hip arthroplasty and rank them based on importance. MethodsThe age, sex, body mass index (BMI), osteoporosis, canal flare index (CFI), canal bone ratio (CBR), canal calcar ratio (CCR), stem design, and stem canal fill ratio (P1, P2, P3, and P4) of the proximal femoral medullary cavity of 111 total hip arthroplasty patients who had PFF and 388 who did not have PFF were analyzed. Independent-samples student t-tests were used for continuous variables, and Chi-square tests were used for categorical variables. The importance rankings of influencing factors were assessed using a random forest algorithm. Dimensionally reduced variables were then incorporated into a binary logistic regression model to determine the PFF-related risk factors. ResultsThe mean age, BMI, CBR, CCR, and incidence of osteoporosis were higher in cases of PFF (all P < .001), while the mean CFI, P1, P2, P3, and P4 were lower in cases of PFF (P < .001, P = .033, P = .008, P < .001, and P < .001, respectively). Additionally, the stem design was also statistically associated with PFF (P < .001). Multivariate logistic regression revealed that advanced age, higher BMI, osteoporosis, stem design, lower CFI, higher CBR, higher CCR, lower P1, lower P2, lower P3, and lower P4 were the risk factors of PFF (P < .001, P < .001, P < .001, P < .001, P < .001, P = .010, P < .001, P = .002, P < .001, P < .001, and P = .007, respectively). The ranked importance of the risk factors for PFF was P3, CFI, osteoporosis, CBR, age, P4, P1, stem design, CCR, BMI, and P2. ConclusionsLower P3, lower CFI, osteoporosis, higher CBR, advanced age, lower P4, lower P1, stem design, higher CCR, higher BMI, and lower P2 increased the risk of PFF.

The influence of different root canal open access shapes on the use of rotary root canal enlargement

Background/purposeThe success of root canal treatments is influenced by the shape of the access opening and the outcomes of root canal enlargement. The aim of this study was to evaluate the impact of various rotary instruments on the maintenance of the root canal's central alignment post shaping, considering a range of access cavity designs. Materials and methodsUsing digital tooth simulation, 4 sets of 12 teeth underwent traditional (TradAC) or conservative (ConsAC) access cavity preparations. Root canals were enlarged with TruNatomy or ProTaper Ultimate rotary instruments. Canal transportation and centering ratio were separately measured. Statistical analysis was performed using JMP trial 17 software. ResultsThe analysis revealed no significant difference in buccal and lingual canal transportation among different rotary instruments or canal enlargement designs (P > 0.05). TradAC yielded higher centering ratios in MB and ML canals, while ConsAC excelled in the distal canal for the TruNatomy group. Conversely, in the ProTaper Ultimate group, ConsAC demonstrated higher ML canal ratios (P < 0.05). ConclusionTruNatomy maintained superior canal centering with ConsAC, while ProTaper performed better with TradAC.

Radiological Comparison of Canal Fill between Collared and Non-Collared Femoral Stems: A Two-Year Follow-Up after Total Hip Arthroplasty.

Collared femoral stems in total hip arthroplasty (THA) offer reduced subsidence and periprosthetic fractures but raise concerns about fit accuracy and stem sizing. This study compares collared and non-collared stems to assess the stem-canal fill ratio (CFR) and fixation indicators, aiming to guide implant selection and enhance THA outcomes. This retrospective single-center study examined primary THA patients who received Corail cementless stems between August 2015 and October 2020, with a minimum of two years of radiological follow-up. The study compared preoperative bone quality assessments, including the Dorr classification, the canal flare index (CFI), the morphological cortical index (MCI), and the canal bone ratio (CBR), as well as postoperative radiographic evaluations, such as the CFR and component fixation, between patients who received a collared or a non-collared femoral stem. The study analyzed 202 THAs, with 103 in the collared cohort and 99 in the non-collared cohort. Patients' demographics showed differences in age (p = 0.02) and ASA classification (p = 0.01) but similar preoperative bone quality between groups, as suggested by the Dorr classification (p = 0.15), CFI (p = 0.12), MCI (p = 0.26), and CBR (p = 0.50). At the two-year follow-up, femoral stem CFRs (p = 0.59 and p = 0.27) were comparable between collared and non-collared cohorts. Subsidence rates were almost doubled for non-collared patients (19.2 vs. 11.7%, p = 0.17), however, not to a level of clinical significance. The findings of this study show that both collared and non-collared Corail stems produce comparable outcomes in terms of the CFR and radiographic indicators for stem fixation. These findings reduce concerns about stem under-sizing and micro-motion in collared stems. While this study provides insights into the collar design debate in THA, further research remains necessary.

Hydrochemical systematics and isotope (δ18O, δD and 3H) variations of aquifer system of southern Bengal Basin: implications for groundwater pollution.

Hydrogeological, hydrochemical and isotopic traits of the groundwater in the Quaternary aquifer system in an urban-periurban locality within and encircling the Kolkata-Howrah twin city in the south Bengal Basin have been synthesised to explain the present- and paleo-hydrological processes, surface and groundwater interaction and mixing dynamics of contamination of groundwater. Rock-weathering, evaporation, ion-exchange and active mineral dissolution are the key processes commanding the groundwater chemistry. Freshwater flushing from the recharge zones had thinned the entrapped sea water which has generated the present-day brackish water by a non-uniform fusion. The best-fit line of the plots of δD and δ18O of groundwater samples displays a slope lower than that of local meteoric water line (LMWL) and global meteoric water line (GMWL) which hints that isotopic constitution of the groundwater of the present area is primarily formed by evaporation before or in the recharging process. A wide range of δ18O values in groundwater suggests that these waters are not blended enough toremove dissimilarities in isotope configuration of recharge water. This also suggests that many groundwaters are a result of mixing of present-day recharge and an older integrant recharged under previously cooler climatic conditions. The groundwater samples are more depleted of oxygen at the shallower level. The depleted samples cluster around the Tolly's nala (canal) where upper aquitard is missing or < 10-m thick. The tritium values range between 0.70 and 15.02 which indicate the occurrence of 'sub-modern', 'a mix of modern and sub-modern water' and 'modern water'. It indicates mingling of isotope-depleted water from the Hugli River by means of Tolly's canal with relatively less-depleted groundwater of Kolkata's late Pleistocene aquifer. The tritium values and Cl/Br ratio of groundwater samples adjoining Tolly's canal and elsewhere refer the direct infiltration of 'modern wastewater and freshwater' which mixes with the 'sub-modern water' in the aquifer system.

Osseointegration of a hydroxyapatite-coated stem in femoral neck fractures in the over-80s.

In the over-80s, femoral bone is often osteoporotic and unlikely to be conducive to periprosthetic bone rehabitation. This observation often leads to cemented fixation for hemiarthroplasty in femoral neck fracture. Hydroxyapatite is a bioactive coating that has already demonstrated its osteoinductive properties. Our hypothesis is that hydroxyapatite enables prosthetic osseointegration in patients over 80, as well as periprosthetic cortical thickening. The objective was to evaluate the osseointegration of a hydroxyapatite-coated femoral stem in femoral neck fractures in the over-80s, and the evaluation of the periprosthetic bone regeneration permitted by hydroxyapatite. This was a retrospective study. Osseointegration and periprosthetic bone regeneration were assessed on pre-operative, immediate post-operative and last follow-up radiographs with Engh score, O-SS score, cortical index, Canal Bone Ration (CBR) and Canal Fill Ratio (CFR). One hundred and forty-six patients were included. At last follow-up, 99.3% (n = 145) of stems were osseointegrated. The mean Engh score was 19.9 [SD 3.1]. The mean O-SS score was 19.1 [SD 2.4], corresponding to very good osseointegration. The mean CBR at last follow-up was 0.48 [SD 0.07], corresponding to a non-osteoporotic femur. There was a significant difference with pre-operative CBR (p < 0,001). The pre-operative cortical index and the index at the last follow-up were significantly different for all levels of measurement (p < 0,001). The CFR at last follow-up was also significantly different with the post-operative CFR (p < 0,001). This study shows the value of using a hydroxyapatite-coated stem on senile, osteoporotic bone to improve cortical thickness along the entire length of femoral bone.

Midterm Comparative Analysis of Short Femoral Stem Survivorship in Dorr Type A Femurs.

Proximal-distal mismatch has emerged as a prominent concern in Dorr type A femoral morphology, prompting the exploration of short stems as promising alternatives to conventional stems. This study aimed to evaluate clinical and radiographic outcomes of total hip arthroplasty (THA) using short femoral stems in Dorr type A proximal femoral morphology with a minimum follow-up of 5 years. Patients with short femoral stems in Dorr type A between 2011 and 2017 were included. Patients with the Short Modular Femoral (SMF) stem and Metha stem were recruited and patients with a shortened tapered stem (Tri-Lock BPS) were matched by propensity score matching based on age, sex, body mass index, calcar to canal ratio, and diagnosis. Patient-reported outcomes and the presence of thigh pain were assessed at 5 years postoperatively. Revision rate, complication rate, and radiographic outcomes were also assessed and compared. Twenty-two cases (81%) in the SMF stem and 43 cases (65%) in the Metha stem had more than 5 years of follow-up data available. The SMF stem showed a higher failure rate than the other 2 groups, with 18% requiring revision surgery in the SMF stem compared to 4.6% in the Metha stem, and 2.3% in the Tri-Lock BPS. The SMF stem showed considerable complications such as stem position change and lateral cortical hypertrophy with inferior clinical outcomes than the other 2 stem groups. When the Metha stem and the Tri-Lock BPS groups were compared, more intraoperative fractures were observed in the Metha stem, whereas stress shielding and anterior thigh pain were significantly more prevalent in the Tri-Lock BPS. The SMF stem might be less reliable than previously reported, showing a high failure rate and increased radiologic complications. Thus, its use for THA in Dorr Type A femurs needs caution. On the other hand, the Metha stem showed comparable outcomes to the shortened tapered Tri-Lock BPS.

Association of quantitative radiomic shape features with functional outcome after surgery for primary sporadic dorsal spinal meningiomas.

Spinal meningiomas (SM) account for 25%-46% of all primary spinal tumors and show an excellent long-term disease control in case of complete resection. Therefore, the postoperative functional outcome is of high importance. To date, reports on dorsally located SM are scarce. Moreover, the impact of radiomics shape features on the functional outcome after surgery for primary dorsal SMs has not been analyzed yet. We retrospectively performed an analysis of shape-based radiomic features in 3D slicer software and quantified the tumor volume, surface area, sphericity, surface area to volume ratio and tumor canal ratio. Subsequently, we evaluated the correlation between the radinomic parameters and the postoperative outcome according to Modified Japanese Orthopedic Association (mJOA) score. Between 2010 and 2022, we identified 24 Females and 2 Males operated on dorsal SMs in our institutional database. The most common SM localization was thoracic spine (n = 20), followed by cervical (n = 4), and lumbar (n = 2). The univariate analysis and the receiver operating characteristic (ROC) analysis showed a strong diagnostic performance of sphericity in the prediction of postoperative functional outcome based on mJOA score (AUC of 0.79, sphericity cut-of value 0.738; p = 0.01). Subsequently, the patients were divided into two groups (mJOA improved vs. mJOA stable/worsened). Patients with improved mJOA score showed significantly higher sphericity (0.79 ± 0.1 vs. 0.70 ± 1.0; p = 0.03). Finally, we divided the cohort based on sphericity (<0.738 and ≥0.738). The group with higher sphericity exhibited a significantly higher positive mJOA difference 3 months postoperatively (16.6 ± 1.4 vs. 14.8 ± 3.7; p = 0.03). In our study investigating primary sporadic dorsal SMs, we demonstrated that a higher degree of sphericity may be a positive predictor of postoperative improvement, as indicated by the mJOA score.

Normative MRI for Lumbar Spinal Canal and Vertebral Body Dimensions in a Jordanian Population Sample

Aim: To provide normal values for the lumbar spinal canal, lumbar vertebral body and dural sac dimensions and canal body ratio by MRI for a Jordanian population sample.&#x0D; Material and methods: Three well trained observers reviewed 218 lumbar MRI scans performed between 2019–2021 (1090 lumbar levels) and obtained from the central computerized medical archive of three main governmental hospitals in north, central and south Jordan. All MRIs with alignment abnormalities (scoliosis and kyphosis), canal compression, vertebral disease (including fractures) or technical artifacts were excluded. The following were measured from L1 to L5 levels: the midsagittal diameters of the spinal canal and vertebral body, axial anteroposterior (AP), and transverse diameter of the vertebral body, dural canal and dural canal area. Data on sex and age were also documented.&#x0D; Results: The studied MRI scans included 113 males (51.8%) and 105 females (48.2%). Age ranged between 23–86 years old (mean 52.23 ± 13.125). The mid sagittal mid vertebral AP diameter of the lumbar spine range was 2.8–3.1 cm. The mid sagittal spinal canal diameter range was 1.3–1.5 cm. Canal body ratio was 3.3–3.6. The AP, transverse dural sac diameter ranges were 1.2–1.4 cm and 1.5–1.9 cm, respectively. Finally, the dural sac area ranged from 331–362 mm2.&#x0D; Conclusion: The dimensions of the lumbar spinal canal, vertebral bodies, and vertebral canal ratio at all levels were documented for a Jordanian population sample. Dimensions varied according to sex and when compared with other ethnic groups (Asian and African). The findings suggest that canal stenosis criteria should take these differences into consideration.

Long-term results (after a mean 11.3 years, and up to 22 years, of follow-up) of the Legacy Constrained Condylar Knee (LCCK™) in primary total knee arthroplasty

IntroductionThe use of a sliding prosthesis in total knee arthroplasty (TKA) with increased stress is an intermediate solution in primary surgery, between posteriorly stabilized prostheses and hinged prostheses, in cases of ligamentous laxity and/or loss of bone substance. Favorable results have been reported in the medium term but to our knowledge, this type of prosthesis has not been evaluated in Europe beyond 10 years of follow-up. We therefore conducted a retrospective study in order to carry out: 1) the study of the survival of the Legacy Constrained Condylar Knee (LCCK™) prosthesis in primary surgery, 2) the analysis of complications, functional scores and radiographic data, 3) the analysis of the link between the diaphyseal filling rate and prosthetic loosening. HypothesisThe LCCK™ sliding prosthesis with increased constraint has equivalent long-term survival and clinical results to standard posteriorly stabilized TKA and superior to hinged TKA. Material and methodA retrospective series of 141 LCCK™ implanted in 134 patients between 1997 and 2010 was analyzed. Survival was assessed with censoring through an evaluation of partial or total revision of the implants. The functional results were evaluated using the IKS and Oxford 12 scores. Data regarding the Canal Fill Ratio (CFR) and the presence of pathological periprosthetic lines were also collected. ResultsThe average follow-up was 11.3±5.3years with a maximum follow-up of 22.7years. Survival at 20years was 90.8% [95% CI: 83.7–95.7]. The rate of early complications was 13.5% (19/141), predominantly comprised of venous thrombosis (6/141), hematomas (3/141 including two requiring surgical drainage), stiffness (3/141) and early infections (3/141). The rate of late complications was 17% (24/141), led by stiffness (4.4%; 6/141), infections (2.9%; 4/141) and hardware failure (2. 2%; 3/141). Ten of the 141 patients (7.1%) had LCCK failure, including 3 (2.1%) for stiffness, 3 (2.1%) for hardware failure, 2 (1.4%) for infection, 1 (0.7%) for laxity and 1 (0.7%) for a periprosthetic fracture. No aseptic loosening was found. The total IKS score went from 65 [0–116] to 143 [79–200] at follow-up, the IKS knee score went from 30 [0–66] to 85 [44–100], and the IKS function score went from 35 [0–70] to 57 [0–100]. The Oxford score went from 14 [2–25] to 34 [15–48] at follow-up. Only two patients (1.4%) presented with a partial periprosthetic line. The tibial CFR was 0.81 and the femoral CFR was 0.76. The influence of the CFR could not be analyzed due to the absence of loosening. DiscussionThe LCCK™ prosthesis in primary surgery has good medium-term survival, a significant improvement in functional scores and a complication rate comparable to posteriorly stabilized prostheses. The complication rate is lower than that of hinged prostheses. Level of evidenceIV; single-center retrospective study.

Deep-Learning Automation of Preoperative Radiographic Parameters Associated With Early Periprosthetic Femur Fracture After Total Hip Arthroplasty

BackgroundThe radiographic assessment of bone morphology impacts implant selection and fixation type in total hip arthroplasty (THA) and is important to minimize the risk of periprosthetic femur fracture (PFF). We utilized a deep-learning algorithm to automate femoral radiographic parameters and determined which automated parameters were associated with early PFF. MethodsRadiographs from a publicly available database and from patients undergoing primary cementless THA at a high-volume institution (2016 to 2020) were obtained. A U-Net algorithm was trained to segment femoral landmarks for bone morphology parameter automation. Automated parameters were compared against that of a fellowship-trained surgeon and compared in an independent cohort of 100 patients who underwent THA (50 with early PFF and 50 controls matched by femoral component, age, sex, body mass index, and surgical approach). ResultsOn the independent cohort, the algorithm generated 1,710 unique measurements for 95 images (5% lesser trochanter identification failure) in 22 minutes. Medullary canal width, femoral cortex width, canal flare index, morphological cortical index, canal bone ratio, and canal calcar ratio had good-to-excellent correlation with surgeon measurements (Pearson’s correlation coefficient: 0.76 to 0.96). Canal calcar ratios (0.43 ± 0.08 versus 0.40 ± 0.07) and canal bone ratios (0.39 ± 0.06 versus 0.36 ± 0.06) were higher (P < .05) in the PFF cohort when comparing the automated parameters. ConclusionsDeep-learning automated parameters demonstrated differences in patients who had and did not have early PFF after cementless primary THA. This algorithm has the potential to complement and improve patient-specific PFF risk-prediction tools.

CT-based, robotic-arm assisted total hip arthroplasty (Mako) through anterior approach provides improved cup placement accuracy but no difference in clinical outcomes when compared to conventional technique

BACKGROUND: With the restoration of the natural hip biomechanics, a successful total hip arthroplasty (THA) and long-term survival is pursued. Although robotic THA (rTHA) has been developed to increase accuracy of implant positioning, leg lengths and offsets, discussions about its radiological and clinical advantages over conventional THA (cTHA) continues. OBJECTIVE: The aim of this study was to compare clinical and radiological outcomes of robotic and conventional THA. METHODS: This retrospective study compares functional and radiological outcomes of 82 rTHA with a matched group of 82 cTHA in terms of age, sex, body mass index and preoperative functional scores. The minimum follow up was 12 months for all patients. Functional outcomes were Harris Hip Score (HHS) and the Western Ontario and McMaster University Osteoarthritis index (WOMAC) evaluated pre- and postoperatively. Radiological evaluations included position of cup placement according to Lewinnek and Callanan safe zones, Canal Fill Ratio (CFR), Leg Length Discrepancy (LLD), Lateral offset (LO) and Femoral Component Alignment (FCA). Complications were also evaluated. RESULTS: In the rTHA group, 91.5% (75 out of 82) of the acetabular cups were positioned within the safe zone whereas it was 63.4% (52 out of 82) for the cTHA group (p&lt; 0.001). According to Callanan, they were 84.1% and 50%, respectively (p&lt; 0.001). Between the groups, no statistically significant difference was found in CFR, LLD, HO, FCA, AI, AA, WOMAC, HHS and major complication rates. CONCLUSION: rTHA is superior to cTHA in terms of accuracy and reproducibility of the cup placement, however no apparent clinical benefit was found in short term follow.

Predictors of Neurological Worsening after Resection of Spinal Meningiomas.

Due to the slow-growing nature of spinal meningiomas, they are mostly asymptomatic for a long time, and become symptomatic after the compression of the spinal cord or nerve roots. The aim of this study was to identify predictors for a poor clinical outcome after the surgical resection of spinal meningiomas and thereby to allow a preoperative identification of high-risk spinal meningiomas. Data acquisition was conducted as a single-center retrospective analysis. From 1 January 2004 to 31 December 2019, 121 patients who underwent surgical resection of a spinal meningioma were reviewed. Clinical and radiological data (such as tumor size, location, occupation ratio of the spinal canal, and the degree of spinal cord compression) were assessed. The functional clinical findings of the patients were recorded using the Karnofsky Performance Score, modified McCormick scale, and Frankel scale preoperatively, at discharge, and 3-6 months after surgery. The mean patient age was 66 ± 13 years. A total of 104 (86%) patients were female and 17 (14%) were male. The thoracic spine (68%) was the most common location, followed by the cervical (29%) and lumbar (3%) spine. Preoperatively, 11.7% of patients were categorized as McCormick 1, 35.8% as 2, 39.2% as 3, 11.7% as 4, and 1.7% as 5. The neurological function of the patients with a functional deficit prior to surgery improved in 46% of the patients, remained unchanged in 52%, and worsened in 2% at discharge. At early follow-up, the proportions were 54%, 28%, and 5%, respectively. Preoperative Frankel scale was a significant predictor of a postoperative deterioration. Patients with Frankel score A to C preoperatively had a 9.2 times higher chance of clinical deterioration postoperatively (OR = 9.16). We found that the Frankel scale weakly correlated with the degree of spinal cord compression. In this study, other radiological parameters, such as the degree of cord compression and spinal canal occupation ratio, did not show a significant effect on the outcome. Surgery of intraspinal meningiomas can be considered safe. Neurological function improves in a large proportion of patients after surgery. However, a relevant preoperative deficit according to the Frankel scale (grade A-C) was a significant predictor of a postoperative neurological deterioration.

Plain radiographic indices are reliable indicators for quantitative bone mineral density in male and female patients before total hip arthroplasty

Osteoporosis is underdiagnosed in patients undergoing total hip arthroplasty (THA). Bone mineral density measurement by dual-energy X-ray absorptiometry (DXA) is the gold standard, but indices on plain hip radiographs also seemed to be reliable screening tools in female or Asian ethnicities in previous studies. Given the lack of knowledge about male patients and Caucasian ethnicities, this study was conducted to evaluate plane hip radiographic indices as a screening tool for osteopenia and osteoporosis in Caucasian female and also male patients before undergoing THA. A retrospective analysis of 216 elderly patients with pre-existing DXA before hip arthroplasty was performed and four indices were calculated on plain hip radiographs: Canal-Flare-Index (CFI), Canal-Calcar-Ratio (CCR), Canal-Bone-Ratio (CBR) 7 and 10 cm below the lesser trochanter. They were correlated with femoral neck DXA T-scores by Pearson’s correlation and intraclass correlation coefficient, and a ROC analysis was performed. A total of 216 patients (49.5% male) were included. CBR-7 and -10 were highly correlated (p < 0.001) with femoral neck T-score in males (Pearson’s correlation CBR-7 r = − 0.60, CBR-10 r = − 0.55) and females (r = − 0.74, r = − 0.77). CBR-7 and -10 also showed good diagnostic accuracy for osteoporosis in the ROC analysis in males (CBR-7: AUC = 0.75, threshold = 0.51; CBR-10: 0.63; 0.50) and females (CBR-7: AUC = 0.87, threshold = 0.55; CBR-10: 0.90; 0.54). Indices such as the Canal Bone Ratio (CBR) 7 or 10 cm below the lesser trochanter on plain hip radiographs are a good screening tool for osteopenia and osteoporosis on plain hip radiographs and can be used to initiate further diagnostics like the gold standard DXA. They differ between male and female patients.

Value of Proximal Femur Geometry in Predicting Occult Hip Fracture.

Background and Objectives: Patients with occult hip fractures are a difficult subgroup to treat. MRI is the gold standard for diagnosing occult proximal femur fractures but is costly and may not be readily available in an emergency setting. The purpose of this study was to determine whether changes in the proximal femur geometry can predict the likelihood of an occult hip fracture in patients presenting with hip pain following a ground-level fall. Material and Methods: Patients admitted to the hospital with a clinical suspicion of a hip fracture but initial negative radiographs over a seven-year period were included. All patients were additionally investigated with an MRI scan, and retrospectively, six radiologic parameters were obtained on plain radiographs: The cortical thickness index (CTI), the canal to calcar ratio (CCR), the canal flare index (CFI), the morphological cortical index (MCI), the canal bone ratio (CBR) and the canal bone aria ratio (CBAR). Subsequently the result of the plain radiographic indices of the patients with a negative MRI (Group A, no occult fracture) were compared to those with a positive MRI (Group B, occult fracture). Results: A total of 78 patients (59 female, 19 male) could be included in the study. The mean age was 82 years. The univariate analyses revealed a poor predictive ability of all radiological parameters with AUC values ranging from 0.515 (CBR) to 0.626 (CTI), whereas a multivariate prognostic model demonstrated improved prognosis (AUC = 0.761) for the CTI (p = 0.024), CBAR (p = 0.074) and CRR (p = 0.081) as the most promising predictive radiological parameters. Conclusions: Single radiologic indices obtained from conventional X-rays of the proximal femur have a weak predictive value in detecting occult fractures of the hip and cannot be used as clinical decision-making factors.

Determination of the Canal Discharge Capacity Ratio and Roughness to Assess Its Maintenance Status: Application in Egypt

Waterlogging and soil salinity issues can be handled using surface or subsurface drainage networks, soil bed elevation, and soil and crop management patterns. A properly operating and maintained drainage system is important for both rural and urban inhabitants to protect lives and property from flooding and high groundwater levels, enhance health conditions, and safeguards water purity, soil salinity, and waterlogging. It also supports and increases crop yields and consequently rural incomes. This study assessed the maintenance condition of the main surface drains (Baloza and ELFarama) located in the Tina Plain (50,000 acres) and a portion of the Southeast El-Kantara regions (25,000 acres) in North Sinai, Egypt, based on the values of the Discharge Capacity Ratio (DCR) and Manning’s roughness (n). Ten measurement locations at the drain cross-section were used in the investigation. For the ELFarama Drain, the average values of n and DCR were found to be 0.029 and 86.2%, and for the Baloza Drain, they were 0.032 and 78.6%, respectively. Compared to the design values, the actual Manning’s roughness was higher, indicating that the drainage canals’ capacities had been reduced and that their upkeep was inadequate. In both drains, sedimentation is present and they need to be maintained, according to the hydrographic surveying results for the actual cross-sections compared to the planned cross-sections. A methodology for the channel maintenance method is presented. For removing vegetation and dredging sediment, a long-boom mechanical hydraulic excavator with a bucket is suggested and to be conducted every two years. To the results of this study, the amount of weed infestation in vegetated channels is the main factor that affects Manning’s roughness coefficient value. It is now easier to calculate the proportion of weeds that are submerged in vegetated channels using echo-sound sonar technology. The DCR is an affordable and simple methodology to assess the channel maintenance status for sustainable agriculture.

Vestibular hydrops in patients with semicircular canal malformation

ObjectiveTo investigate the vestibular endolymphatic hydrops in patients with semicircular canal malformation. MethodsWe searched 7864 patients who underwent MR Imaging after contrast injection and found 21 patients with semicircular canal malformations. Another 9 non-malformed patients with unilateral hearing loss were randomly included. We asked patients about their medical history and measured the volume of total vestibular fluid space and endolymphatic space. The vestibular volume ratio = endolymphatic space/total fluid space × 100. ResultsHearing loss was observed in 18 of 30 malformed ears and in 7 of 12 non-malformed ears. Statistical analysis showed no association between semicircular canal malformation and hearing loss. In the semicircular canal malformation group, the average vestibular volume ratio (22.6%) in the ears with hearing loss was higher than that in the ears without hearing loss (11.4%). There was no statistically significant difference in the average vestibular %EL in ears with hearing loss between the malformed inner ear group (22.6%) and non-malformed group (28.2%) (P>0.05). ConclusionThere was no correlation between semicircular canal malformation and hearing loss. The mean vestibular hydrops volume ratio of the semicircular canal deformed ears with hearing loss was about 22.6%, which was not different from that of normal ears.

The relevance of the number of distal locking planes and nail to canal ratio in bone healing after intramedullary nailing in tibial shaft fractures.

The objective of this retrospective study was to assess the effect of the nail to canal ratio and the number and configuration of distal locking screws in bone healing in tibial shaft fractures. We analyzed 223 consecutive tibial shaft fractures treated with reamed intramedullary nailing between January 2014 and December 2020. We recorded and evaluated the nail to canal ratio (NCR) and the number and configuration of distal locking screws. Median NCR was 0.87 (IQR 0.82-0.94). Ten (4.48%) fractures were treated with one distal locking screw, 173 (77.57%) with two, and 40 (17.93%) with three. Uniplanar fixation was used in 63 (28.25%), biplanar in 150 (67.26%), and triplanar in 10 (4.48%) cases. Uni-, bi-, and multivariate analyses were performed to compare patients who achieved bone union with those who did not. Bone union was achieved in 195 (87.44%) patients. Uni- and bivariate analyses showed that bone union increased significantly with larger NCR (p = 0.0001) and a greater number of locking planes (p = 0.001) and distal screws (p = 0.046). NCR > 0.78 (OR 48.77 CI 95% 15.39-154.56; p = < 0.0001) and distal locking screw configuration (OR 2.91 CI 95% 1.12-9.91; p = 0.046) were identified as independent variables for union. Our findings suggest that in tibial shaft fractures treated with intramedullary nailing, NCR should be equal to or greater than 0.79. Additionally, distal locking screws should be used with a biplanar or triplanar configuration.