Routine X-ray Research Articles

Aneurysmal Bone Cyst presenting Incidentally as a Traumatic Foot Injury

Introduction: Aneurysmal bone cyst is a rare, non-neoplastic lesion affecting the metaphysis of long bones and vertebrae, characterized by blood-filled spaces separated by fibrous septae. Aims and objectives: In this study, we present a case of an aneurysmal bone cyst in a 7-year-old child with characteristic X-ray findings to increase awareness as early diagnosis and treatment can limit disability. An aneurysmal bone cyst is a rare, benign neoplastic lesion affecting the metaphysis of long bones and vertebrae, characterized by blood-filled spaces separated by fibrous septae.[1] Diagnosis depends on typical features of magnetic resonance imaging, and confirmation by biopsy is essential before surgery is considered. We present an aneurysmal bone cyst in a 7-year-old child with characteristic X-ray findings. Diagnosis of ABC should be suspected in young patients presenting with limb pain or swelling, and pain disproportionate to the mechanism of injury could indicate pathologic fracture. Early detection of ABC is possible as an incidental finding by closely examining routine X-rays so that appropriate treatment can be instituted early and complications like pathologic fractures can be avoided. This case will help to increase awareness as early diagnosis and treatment can limit disability.

Cystectomy of An Apical Root Cyst: Clinical Case and Literature Review

The root cyst is a cyst of odontogenic epithelial origin and inflammatory cause. It represents one of the most frequent cyst found on the oral cavity and has greater frequency at the maxillary level. The diagnosis is usually a casual finding on a routine X-ray. They are associated to tooth with negative vitality and the size is very variable. The treatment is a combined endodontic (root canal treatment) and surgical treatment (excision of the lesion). The diagnosis of certainty is obtained by a histopathological analysis. In this clinical case, a common situation of this type of lesions is shown, although in this case the patient comes to the clinic with symptoms. The root canal treatment of the affected tooth was performed. The periapical lesion did not disappear, so cystectomy was performed. The sample was sent for histopathological analysis that confirmed the diagnosis of radicular cyst. After 6 months follow-up, a periapical x-ray revealed how the lesion was ossifying.

P077 Bone mineral density predicts fractures when measured in more than one area: results from a large observational cohort

Abstract Background/Aims Osteoporosis is characterised by a reduction in bone mineral density (BMD). Low BMD is correlated with increased fracture risk. It is unclear whether a BMD value at a specific site is superior for predicting fracture. The Fracture Risk Assessment (FRAX™) tool is used to evaluate fracture risk, using the BMD at the non-dominant hip; focussing on the neck mean and neck total. This is despite a T score of -2.5 or below in the lumbar spine defining a patient as osteoporotic. This study aimed to determine whether the other measures of BMD that are noted are as predictive of fracture. Methods Patients referred for routine dual-energy x-ray absorptiometry (DEXA) scans at the Royal Lancaster Infirmary from 2004 to 2019 were studied. BMD data from lumbar vertebrae (L1-L4) and anatomical regions of the left and right femur were collected from DEXA images. A logistic regression model was fitted using fracture as a dependent variable and BMD values from the lumbar vertebrae, right and left femur as predictors, adjusted for age at scan and sex. Goodness of fit was assessed using a receiver operating characteristic (ROC) curve. Results A total of 31,546 patients were included in the analysis (82.9% female), of whom 37.6% had sustained a fracture, and the mean age of the cohort was 64.9 (standard deviation 12.9). Table 1 shows the results of the logistic models. Areas under the receiver operating characteristic curve (AUC) demonstrated the positive predictive ability of a reduction in BMD in the lumbar vertebrae and regions of the femur and fracture risk. BMD data from the four lumbar vertebrae were just as predictive of fracture as the right and left femur. Conclusion The study findings demonstrate that low BMD in all areas measured were equally predictive of fracture. When the non-dominant hip is not measurable, using other areas from a DEXA scan could be used to predict fracture risk. Research evaluating change in BMD over time could alter this observation. Disclosure U. Nadeem: None. M. Bukhari: None. Z. Sultan: None.

Assessment of the functional results of hemiarthroplasty in geriatric individuals with unstable intertrochanteric femur fractures

Background: The objective of our study is to measure early weight bearing, mobilization, rapid rehabilitation, complications in unstable intertrochanteric femur after hemiarthroplasty fractures in elderly patients. Methods: Prospective and retrospective, non-randomized study was conducted to assess functional results of hemiarthroplasty in elderly individuals with unstable intertrochanteric femur fractures following surgery in patients who underwent surgery from 2019 to 2021 in department of orthopaedics of Seth Nandlal Dhoot Hospital, Aurangabad. Out of total 44 participants, there were 16 males and 28 females with mean age of 79.54 years of study participants. The patients were evaluated radiologically with routine X-rays i.e. pelvis with both hip joint anteroposterior (AP) view and affected side hip lateral view and clinically early weight bearing, mobilization, rapid rehabilitation and complication with Harris hip score. Results: In our study we observed good result of 86.53±5.73 mean Harris hip score at the end of 1 year was following surgery in 44 study participants who underwent hemiarthroplasty in unstable intertrochanteric femur fractures in elderly patients. Conclusions: Primary hemiarthroplasty offers an essentially pain-free movable joint and is a preferable mode of treatment for older osteoporotic patients who suffers from unstable intertrochanteric femur fractures. Hemiarthroplasty allows for early mobilization and offers rapid stability and mobility, preventing the issues associated with recumbency. Hemiarthroplasty has a lower rate of complications and revision surgery than fixation. According to the Harris hip score, primary bipolar hemiarthroplasty results in a good functional outcome, but long-term monitoring is necessary.

Laparoscopic Retrieval of a Retained Foreign Body Embedded in the Retroperitoneum

A 38-year-old nulliparous woman without surgical history with enlarging uterine fibroids underwent laparoscopic myomectomy. A routine abdominal X-ray performed on postoperative day 2 showed a foreign body in the pelvis. Computed tomography revealed a metallic object, which was located outside the bowel. A planned laparoscopic exploration was undertaken on postoperative day 42. The foreign body was difficult to find, but unidimensional fluoroscopy revealed that it was embedded in the retroperitoneum. Local angiogenesis of the peritoneum, which rose on the right uterosacral ligament (USL), was noted in its location (Fig. 1). Laparoscopic retrieval of the foreign body was performed, along with an excision of surrounding connective tissue under the USL (Fig. 2), and it was confirmed that a 4 × 2 × 1 mm metallic object was removed (Fig. 3A). The object was confirmed to be a broken part of laparoscopic needle holder (Fig. 3B) which had been subsequently used in other surgeries following the index procedure. Fig. 2Laparoscopic image. The foreign body was retrieved by excising surrounding connective tissue en bloc. View Large Image Figure Viewer Download Hi-res image Fig. 3(A) A removed metallic object measuring 4 × 2 × 1 mm in size. (B) The jaw of laparoscopic needle holder. The object was confirmed to be a broken part (red arrow) of needle holder. View Large Image Figure Viewer Download Hi-res image

Radiological long-term follow-up up to 12 years of initially ultrasound unstable hip types D, III and IV after treatment with the Tübingen splint worn as a plaster

IntroductionThe treatment of ultrasound unstable hips with the Tübingen splint is currently under discussion. However, there is a lack of long-term follow-up data. This study presents to the best of our knowledge first radiological mid-term to long-term data of the successful initial treatment with the Tübingen splint of ultrasound unstable hips.Materials and methodsFrom 2002 to 2022 the treatment of ultrasound unstable hips type D, III and IV (age ≤ 6 weeks, no severe limitation of abduction) with the Tübingen splint worn as a plaster is evaluated. Based on data derived from routine X-rays during the follow-up period, a radiological follow-up (FU) analysis until the age of 12 years was performed. The acetabular index (ACI) and center–edge angle (CEA) were measured and classified according to Tönnis as normal findings (NF), slightly (sliD) or severely dysplastic (sevD).Results193 of 201 (95.5%) unstable hips could be successfully treated showing normal findings with an alpha angle > 65°. The few patients showing treatment failures were successfully treated applying a Fettweis plaster (human position) under anesthesia. The radiological FU of 38 hips showed a favorable trend with increase of normal findings from 52.8% to 81.1% and decrease of 38.9% to 19.9% of sliD respectively 8.3% to 0% of sevD hips. The analysis of avascular necrosis of the femoral head showed 2 cases (5.3%) of grade 1 according to Kalamchi and McEwen, which were improving over time in the further course.ConclusionsThe Tübingen splint as alternative to replace a plaster has proven a successful therapeutic option for ultrasound unstable hips type D, III and IV with favorable and over time improving radiological parameter up to the age of 12 years.

Intraoperative breakage of a laparoscopic needle holder confirmed by postoperative abdominal X-ray: A case report and literature review

Introduction: Intraperitoneal retention of surgical instrument fragments may lead to severe complications. Therefore, such foreign bodies must be detected before surgery completion. We present a case with intraoperative breakage of a laparoscopic needle holder confirmed by a routine postoperative abdominal X-ray and review the literature regarding intraoperative laparoscopic instrument breakage. Case Report: A 58-year-old woman with stage IB1 cervical adenocarcinoma underwent a laparoscopic radical hysterectomy. Surgery was completed without major complications; however, an abdominal X-ray as a routine postoperative examination revealed a radiopaque shadow of approximately 3 mm corresponding to a broken part of the tissue-pad of the laparoscopic needle holder tip. It was successfully removed using laparoscopy with fluoroscopic guidance without further complications. According to the literature review, most of the instrument breakage were noticed during surgery as they were either obvious or impaired function. In our case, since the detached foreign body was extremely small and did not significantly affect needle holder function, it remained unnoticed until the postoperative X-ray was taken. Conclusion: Postoperative abdominal X-rays identify instrumental fragments infrequently; however, they may help detect intraperitoneal retention of foreign bodies and avoid serious complications following laparoscopic surgery.

Impact of Crystal Nuclei on Dissolution of Amorphous Drugs.

Amorphous drugs are used to improve bioavailability of poorly water-soluble drugs. Crystallization must be managed to take full advantage of this formulation strategy. Crystallization of amorphous drugs proceeds in a sequence of crystal nucleation and growth, with different kinetics. At low temperatures, crystal nucleation is fast, but crystal growth is slow. Therefore, amorphous drugs may generate dense but nanoscale crystal nuclei. Such tiny nuclei cannot be detected using routine powder X-ray diffraction (PXRD) and polarized light microscopy (PLM). However, they may negate the dissolution advantage of amorphous drugs. In this work, for the first time, the impact of crystal nuclei on dissolution of amorphous drugs was studied by monitoring the real-time dissolution from amorphous drug films, with and without crystal nuclei, and the evolving crystallinity in the films. Three model drugs (ritonavir/RTV, posaconazole/POS, and nifedipine/NIF) were chosen to represent different crystallization tendencies in the supercooled liquid state, namely, slow-nucleation-and-slow-growth (SN-SG), fast-nucleation-and-slow-growth (FN-SG), and fast-nucleation-and-fast-growth (FN-FG), respectively. We find that although the amorphous films containing nuclei do not show obvious differences from the nuclei-free films under PLM and PXRD before dissolution, they have inferior dissolution performance relative to the nuclei-free amorphous films. For SN-SG drug RTV, crystal nuclei have negligible impact on the crystallization of amorphous films, dissolution rate, and supersaturation achieved. However, they cause earlier de-supersaturation by inducing crystallization in solution as heterogeneous seeds. For FN-SG drug POS and FN-FG drug NIF, crystal nuclei accelerate crystallization in the amorphous films leading to lower supersaturation achieved with POS, and elimination of any supersaturation with NIF. Dissolution profiles of amorphous films can be further analyzed using a derivative function of the apparent dissolution rate, which yields amorphous solubility, initial intrinsic dissolution rate, and onset of crystallization in the amorphous films. This study highlights that although crystal nuclei are undetectable with routine analytical methods, they can significantly negate, or even eliminate, the dissolution advantage of amorphous drugs. Hence, understanding crystal nucleation process and developing approaches to prevent it are necessary to fully realize the benefits of amorphous solids.

High-throughput phase elucidation of polycrystalline materials using serial rotation electron diffraction

Rapid phase elucidation of polycrystalline materials is essential for developing new materials of chemical, pharmaceutical and industrial interest. Yet, the size and quantity of many crystalline phases are too small for routine X-ray diffraction analysis. This has become a workflow bottleneck in materials development, especially in high-throughput synthesis screening. Here we demonstrate the application of serial rotation electron diffraction (SerialRED) for high-throughput phase identification of complex polycrystalline zeolite products. The products were prepared from a combination of multiple framework T atoms ([Si,Ge,Al] or [Si,Ge,B]) and a simple organic structure-directing agent. We show that using SerialRED, five zeolite phases can be identified from a highly complex mixture. This includes phases with ultra-low contents undetectable using X-ray diffraction and phases with identical crystal morphology and similar unit cell parameters. By automatically and rapidly examining hundreds of crystals, SerialRED enables high-throughput phase analysis and allows the exploration of complex synthesis systems. It provides new opportunities for rapid development of polycrystalline materials.

Correlation between mAs and ESAK (mGy) for male and female chest x-ray in Digital radiography

The data were collected from 350 patients, who underwent routine x-ray examinations for chest PA examination with digital imaging in the x-ray department of Alshab Teaching Hospital in Khartoum state in Sudan. During the period from November 2019 to February 2020. The data for optimization phase were collected from phantom from computed radiography, which include chest PA, chest AP in Karary University during the period from January 2020 to February 2020. It was passed successfully the extensive quality control tests performed by Sudan atomic energy commission. The objective was to correlate between mAs and ESAK (mGy) for male and female chest x-ray. The study concluded that there was a strong relationship between mAs and ESAK, also significant correlation between Age groups and incidence risk cancer and mortality.

Pica in various psychiatric disorders

Pica is the prolonged, compulsive consumption of inedible objects. Pica is sometimes attributed to an iron deficiency, and it gets better with iron supplements. Typical kind of pica is geophagy or eating clay. Apart from nutritional deficiencies, it is also seen in psychiatric disorders such as obsessive–compulsive disorder. Pica is thought to be a rare, autonomous, and separate habit in the context of schizophrenia, which is frequently ignored in the diagnosis and may lead to consequences such as intestinal obstruction, electrolyte imbalances, and heavy metal toxicity. Here, we are going to discuss a case of a 25-year-old female. She came with complaints of pain abdomen and undergone routine X-ray abdomen which showed ingested three nails. She was admitted under general surgery care. After the evacuation of nails, she undergone psychiatric evaluation. She has faint memory of nail ingestion but discussed stressful interpersonal relationship with her husband and managed on antidepressant medication. Her pica was probably due to interpersonal conflict with her husband few days ago. Her anxiety and sadness improved significantly with the tablet escitalopram and etizolam. In this case, we are trying to understand the psychopathology of pica, other than medical and known psychiatric causes.

Clinical Effect of Arthroscopic Resection of Extra-Articular Knee Osteochondroma.

Objective: The aim of this study was to investigate clinical outcomes of arthroscopic resection of extraarticular knee osteochondroma. Methods: A retrospective analysis was performed in 74 patients with extra-articular knee osteochondroma treated by arthroscopic resection between August 2011 and August 2021, including 43 males and 31 females. Overall, 26 Distal femur cases and 48 proximal tibia cases were involved, with an average age of 31.7 ± 11.3 (11−57) years. Preoperative routine knee X-ray, CT, and MRI were performed before the operation. The Lysholm knee score, International Knee Documentation Committee (IKDC) score, Tegner knee motor function score, and visual analogue scale (VAS) were used to evaluate symptoms and functions before surgery and 3, 6, 12, and ≥24 months after surgery. Results: The average course of disease was (7.9 ± 3.7) months (range, 3−14 months) in 74 patients. The average follow-up was (22.6 ± 6.4) months (range, 10−37 months). There were no cases of vascular or nerve injury or wound infection. Compared with the preoperative function, the average scores of VAS, Lysholm, IKDC, and Tegner joint motor function decreased or increased significantly compared with the last follow-up (3.6 ± 1.1 vs. 0.1 ± 0.02, 44.5 ± 2.3 vs. 91.3 ± 4.9, 53.7 ± 2.6 vs. 94.2 ± 5.1, 4.6 ± 1.2 vs. 9.4 ± 1.4, p < 0.001). There was no recurrence or metastasis during the follow up. Conclusions: With the advantages of less trauma, high precision, less pain, and rapid recovery, arthroscopic resection of extra-articular knee osteochondroma can significantly improve the function of knee. It can be gradually extended to the treatment of other benign bone tumors.

Анализ применения оригинальных металлоконструкций для фиксации переднего отдела тазового кольца

Introduction Stabilization of chronic injuries of the pelvic ring with standard methods may result in plate breach, destabilization of the implant and the need for repeated operations. Therefore, it has become necessary to use special tactical approaches in surgical treatment of chronic injuries for fixing traumatic foci and searching for adapted implant designs for such cases. Thus, an original plate has been developed. Purpose To study the features of fixation of chronic injuries of the pelvic ring using an original plate in comparison with the standard approach. Materials and methods We conducted a retrospective analysis of the surgical treatment performed using the developed plate (Group 2) and a group of patients who underwent fixation of the anterior pelvic ring with two reconstruction plates (Group 1). Results In group 1, four patients (16.7 %) had failed osteosynthesis within two weeks to two months after the operation. In group 2, thirty patients underwent surgical treatment using the developed design, and destabilization of the metal construct was detected only in 2 patients (6.6 %). In one case, migration of plate screws was detected after 3 years during routine X-ray study while the patient was not bothered by pain and did not feel any instability. Discussion Analyzing the positive and negative aspects of the methods used, we made a choice in favor of internal plating. Due to cases of destabilization of fixation using one or two plates, an original metal structure was developed and applied to strengthen fixation. Conclusion Changing the standard approaches to the treatment of chronic injuries (after 3 weeks since injury) of the anterior pelvic ring enables to create conditions for stable fixation, using the original monolithic plate, despite the rigidity of the pelvic ring in chronic injuries.

Evaluation of patient doses for routine digital radiography procedures toward establishing an institutional diagnostic reference levels: A case study in Sri Lanka.

The present study was conducted as part of a comprehensive work to establish National Diagnostic Reference Levels (NDRLs) in Sri Lanka for the first time. DRLs can be used as an effective optimization tool for identifying unusually high or low patient doses during X-ray examinations. This study aims to propose institutional DRLs (IDRLs) by measuring the kerma-area product (KAP) of adult patients undergoing routine projection X-ray examinations. The median and the 75th percentile KAP values obtained were compared with that of the single institution KAP values reported from India and Greece. This descriptive cross-sectional study was conducted in a public hospital in Uva province, Sri Lanka, with 400 adult patients aged 18-87 years and weighing 58±20kg. The patient-specific information (age, sex, weight, and height) and corresponding exposure parameters (tube voltage and current-exposure time product) were obtained. The KAP values were measured, and descriptive statistics were utilized for data analysis. The median KAP values obtained were proposed as IDRLs. The IDRLs in Gy.cm2 were 0.23 for cervical spine anterior-posterior (AP), 0.19 for cervical spine lateral (LAT), 0.10 for chest posterior-anterior (PA), 0.06 for knee joint AP, 0.05 for knee joint LAT, 1.47 for KUB AP, 0.85 for lumbar spine AP, 1.97 for lumbar spine LAT, 0.29 for shoulder joint AP, 0.61 for skull PA, and 0.60 for skull LAT examinations. The maximum to minimum ratio of KAP values ranged from 2.4 for KUB AP to 6.3 for the cervical spine AP examinations. The median and the 75th percentile of most of the examinations were comparable to corresponding KAP values reported by the countries mentioned above, except for the skull PA and LAT examinations. Accordingly, interquartile ranges of exposure parameters are recommended for skull examinations to improve the optimization of patient doses.

PSAT287 Metastatic Thyroid Carcinoma from an Old Teratoma

Abstract Introduction Struma ovarii is rare and makes up 1% of all ovarian tumors out of which only 5-10% are malignant. We present the third reported case of delayed bony metastasis of malignant struma ovarii years after surgical removal. Clinical Case A 63 years old female with a medical history of cerebral palsy and teratoma resected in 2013, presented with complaints of right arm pain for 6 months in 2019. Routine lab work and X-rays of the right humerus were normal. An arthrogram showed a destructive process involving the proximal humeral meta-diaphysis, presumably malignant in etiology which was confirmed by a CT scan of the upper arm. A PET scan subsequently showed increased tracer activity associated with the right humeral head and neck along with replacement of marrow cavity by soft tissue density material. A fine needle aspiration of the lesion showed metastatic carcinoma of thyroid follicular origin. Serum TSH was 2.369 miu/ml (normal 0.350-5.500 miu/ml). An ultrasound of the neck demonstrated a normal thyroid without any identifiable nodules. She underwent radical resection of the right proximal humerus with endo-prosthetic reconstruction followed by postoperative radiation to the right shoulder. A repeat bone scan 3 months later showed increased activity in the ribs bilaterally and the distal right humerus. This was followed by a total thyroidectomy that showed no evidence of follicular cancer. A repeat TSH 8 weeks later came back at 88.36miu/ml but surprisingly even after the removal of thyroid gland the serum thyroglobulin remained elevated at 62.2 ng/ml (normal 2.8-40.9 ng/ml). This prompted a nuclear medicine thyroid whole body scan which revealed metastatic disease to the lumbar spine and multiple metastases to the abdomen. Treatment with radioactive iodine was started. The treatment, however was considered suboptimal in her case and she was started on radiation therapy which she is still receiving. Discussion Struma ovarii is a specialized ovarian teratoma made up of more than 50% mature thyroid tissue. Of these only 5-10% have malignant potential with less than 200 cases ever being reported. The NRAS, BRAF and JAK3 oncogene mutations have been implicated in the pathogenesis but the exact cause is unknown, resulting in the absence of any guideline directed therapy. The most common sites of metastasis are the peritoneum, mesentery and omentum. Bones are a less common metastatic site. Current treatment strategies include total thyroidectomy with iodine ablation and radioiodine scanning with serum thyroglobulin levels being followed as a tumor marker. It can rarely present as a late metastatic disease years after surgical resection of the tumor and a high index of suspicion is required to make the correct diagnosis. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

High rate of abdominal aortic calcification in COPD patients and its relationship with musculoskeletal fragility.

Osteoporosis, sarcopenia, and cardiovascular disease are frequent comorbidities in COPD. Considering routine x-ray as a simple tool to access vertebral fractures and vascular calcification, the rate and severity of abdominal aortic calcification (AAC) and its association with musculoskeletal outcomes were investigated in COPD patients. Ninety-six COPD patients (44 men and 52 women, 65.8 (51-83) and 64.3 (44-85) years-old, respectively) underwent spirometry, laboratory workout, bone mineral density (BMD) measurements with body composition analysis, and thoracolumbar spine radiography. Vertebral fractures (VFs) and AAC were defined using Genant semiquantitative approach and Kauppila score, respectively. Densitometric osteoporosis and VFs grades 2-3 were detected in almost 40% and 23% of the participants, respectively. Two-thirds of the participants had AAC ≥ 1 while significant atherosclerotic burden (extended AAC, Kauppila score ≥ 5) was seen in 40.6% of the sample. Women with significant atherosclerotic burden were older (P = 0.044) and had lower femoral neck BMD (P = 0.012) when compared to those with an AAC score < 5. Multivariate logistic regression analyses showed that body fat tended to be associated with increased odds of extended AAC in men (OR = 1.06, 95% CI 0.99-1.13, P = 0.099) while femoral neck BMD (0.01g/cm2) was found to be significantly associated with extended AAC in women (OR = 0.95, 95% CI 0.92-0.99; P = 0.018). COPD patients present a very high rate of AAC and its extended phenotype. Easily measured by conventional spine radiography, AAC severity in women with COPD is associated with low bone mass at the femoral neck, a surrogate marker for musculoskeletal fragility.

ДИАГНОСТИКА ИШЕМИЧЕСКИХ ПОВРЕЖДЕНИЙ КИШЕЧНИКА ПРИ ОСТРОЙ СПАЕЧНОЙ СТРАНГУЛЯЦИОННОЙ КИШЕЧНОЙ НЕПРОХОДИМОСТИ (ОССКН) У ДЕТЕЙ

Purpose - to determine the possibility of laboratory and endoscopic methods for the diagnosis of ischemic bowel disorders in children with ASIO. Material and methods. 40 children with ASIO underwent routine examinations, including ultrasound, abdominal x-rays, laparoscopy, and lactate (lactic acid). Results. It has been established that the lactate level and laparoscopic examination make it possible to diagnose ischemia with an accuracy in children with ASIO. Conclusion. Lactate levels and laparoscopy in children with ASIO are important factors in the diagnosis of intestinal ischemia.

Treatment of acetabular fracture involving anterior and posterior columns using a single pararectus approach: surgical experience and preliminary results.

This study aims to evaluate the efficacy of single pararectus approach in patients confirmed with acetabular fracture involving anterior and posterior columns. A total of 58 patients confirmed with acetabular fracture involving anterior and posterior columns and treated at our hospital between January 2015 and January 2020 were retrospectively analyzed. A single pararectus approach was applied for all patients. Routine X-rays were performed at follow-up of one, three, six, 12, and 18months, and three-dimensional CT scans were added at six and 18months. Fracture reduction quality was assessed using the Matta score system, and functional assessment used the Modified Merle D'Aubigné and Postel score system. Post-operative complications, including fat liquefaction and deep vein thrombosis, were recorded and analyzed. The median operation time was 186min while the intra-operative blood loss was 421mL. The rate of good-to-excellent reduction was 94.8%, and the rate of good-to-excellent hip function score reached 93.1%. Seven patients presented with post-operative complications, including three intra-operative small vascular injuries, two peritoneal small perforations, one fat liquefaction, and one deep vein thrombosis. Using a single pararectus approach is convenient and effective for treating acetabular fracture involving anterior and posterior columns, especially those involving the quadrilateral area. ChiCTR, ChiCTR2100054604. Registered 21 December 2022. Retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=144783 .

Suggested Local Diagnostic Reference Levels for Possible Pediatric X-Ray Optimization in Addis Ababa, Ethiopia.

Early childhood radiation exposure carries an enhanced radiation risk of about two to three times as high as in adults. The objective of this study was to determine local diagnostic reference levels for the most frequent pediatric x-ray examinations in Addis Ababa, Ethiopia. A cross-sectional study was conducted on 18 public and private hospitals/clinics in Addis Ababa. A total of 864 pediatric patients, undergoing eight types of routine x-ray examinations with 13 projections were evaluated from December 18/2017 to March 17 /2018. All pediatrics were categorized under four age groups. Anthropometric and radiographic parameters of each patient were recorded .The minimum, maximum, mean and third quartile values of entrance surface dose were analyzed using SPSS version 23. Finally, the suggested local diagnostic reference levels were compared with national and international reference dose values. Of the 864 pediatric patients, chest (AP/PA), lower and upper extremity (AP/PA) accounted for 501(58%), 110 (13%) and 103 (12%) respectively, accounting to 714(83%) of the total pediatric x-ray examinations. The suggested local diagnostic reference levels of chest X-ray (AP/PA) examinations in mGy were: (0.09,0.13,0.17,0.17) for age group (0-<1,1-<5 ,5-<10, and 10-<15), respectively. Similarly, for same age group (0-<1,1-<5 ,5-<10, and 10-<15) the suggested local diagnostic reference levels of lower and upper extremities in mGy were: (0.06,0.08,0.09,0.09) and (0.04,0.05,0.05,0.06), respectively. The suggested local diagnostic reference levels were slightly higher than the national and international guidance levels, indicating the need for establishment of diagnostic reference levels in the country.

Congenital dislocation of patella in a preterm infant-a case report

Congenital dislocation of patella (CDP) is a rare condition which manifests after birth and is diagnosed late in childhood when the patellar ossification has already occurred and symptoms start to develop in patients. The exact etiology of this disease is still unknown. Diagnosis at such a later age leads to associated conditions like contractures, genu valgum etc. This condition should be diagnosed and treated as soon as possible after birth to significantly reduce the associated complications and to restore the normal functioning of the knee joint. Although a number of papers have been published regarding congenital patellar dislocation in India, none of them have recognized this rare disorder early in infancy. This disorder can be easily missed on routine X-ray in infancy as the patella has not yet ossified. This case report represents the first CDP diagnosed at the age of 1.5 months in India, in a 1.5-month-old preterm male patient. The patient presented with no specific symptoms other than a right knee swelling and was diagnosed with congenital patellar dislocation at the early age of 1.5 months. Radiological investigations were carried out using venous Doppler and high-resolution ultrasound. Surgical correction is the only possible treatment of CDP and it should be done as soon as possible after diagnosing the condition to re-establish the normal operation of the affected knee joint.