Scapula Research Articles

Effects of Parallax and Distortion in Total Ankle Arthroplasty.

Surgeons rely on intraoperative fluoroscopy to assist in placement of implant components during total ankle arthroplasty (TAA). Parallax alters the direction of an object when viewed from two different points, resulting in image distortion. The purpose of this study was to evaluate parallax/distortion in intraoperative fluoroscopic images during TAA. A retrospective review of all TAAs performed by two surgeons (R.W.M. and B.S.) from August 2019 to April 2023 were reviewed. Intraoperative fluoroscopic anteroposterior (AP) ankle views were evaluated for any obvious parallax image distortion. Cases with obvious parallax distortion were included for angular evaluation of AP intraoperative fluoroscopic and first postoperative plain films. The tibia was marked at 2-centimeter intervals to create zones from the proximal stem of the implant. The anatomical axis of the tibia (AAT) was drawn at the mid-diaphysis. The anatomic lateral distal tibial angle (aLDTA) and anatomic axis deviation (AAD) were measured for each zone. A total of 22 TAAs were performed during the study period. Four cases were excluded due to inadequate imaging, leaving a total of 18 TAAs for review. We found 6 of 18 (33.3%) cases had obvious parallax distortion. We found the average aLDTA was 90.9° (84°-101°). At the most proximal tibial zone, the average aLDTA was 94° (91°-101°). We found the average AAD was 4.7 (0.5-17.2) mm. The AAD ranged from 0.5 to 17.2 mm lateral to 0.8 to 8.2 mm medial. Postoperative plain film radiographs displayed a normal aLDTA and an AAT centered within the ankle joint. Parallax can distort the appearance of the tibia on fluoroscopic images. Deviation from the normal aLDTA and anatomical axis should be anticipated. Surgeons should be aware of the potential impact of parallax and ways to mitigate these effects.

A New Method for Reconstruction the Medial Angle of the Eye Among Patients with Blepharophimosis Syndrome (Clinical Cases)

A New Method for Reconstruction the Medial Angle of the Eye Among Patients with Blepharophimosis Syndrome (Clinical Cases)

Association Between Hip Translation and Hip Rotation and Anatomy: A Pilot Quasi-static MRI Study.

There is little known about translation of the hip and the relationship with hip rotation and morphology in asymptomatic patients. (1) Femoral head would exhibit significant translations in asymptomatic hips, (2) femoral head translations would correlate to femoral rotations, and (3) range of femoral head translations would correlate to hip morphology. Cross-sectional study; Level of evidence, 3. A total of 11 individuals (age, 23-47 years; 64% female) with asymptomatic hips underwent hip magnetic resonance imaging (MRI) in the following postures: neutral (supine), midflexion, maximum-flexion, internal rotation, internal rotation + midflexion, internal rotation + maximum-flexion, adduction, flexion-abduction-external rotation (FABER), extension, and lateral abduction. All rotations were passive. MRI-generated 3-dimensional hip models were used to quantify femoral rotations and translations. Femoral head diameter, acetabular diameter, lateral center-edge angle, alpha angle, femoral anteversion, acetabular version and inclination, and neck-shaft angle were measured from MRI. A t test was used if measured translations were statistically significant. Linear regression was used to assess the associations between translation and rotation. Pearson correlation was used to assess the relationships between hip anatomy and range of femoral head translations. In all tested positions, the femoral head translated anteriorly by 2 ± 1 mm (maximum 5 mm, P < .001), posteriorly by 1 ± 1 mm (maximum 6 mm, P < .001), superiorly by 2 ± 2 mm (maximum 7 mm, P < .001), inferiorly by 2 ± 2 mm (maximum 6 mm, P < .001), laterally by 1 ± 1 mm (maximum 4 mm, P < .001), and medially by 2 ± 1 mm (maximum 5 mm, P < .001), relative to the rested supine position. Femoral flexion was associated with posterior translation of the femoral head (P = .038). Femoral abduction was associated with medial translation of the femoral head (P = .042). Higher femoral anteversion and smaller alpha angle were associated with a higher total magnitude of femoral head translation in the anterior-posterior direction (P < .04). Smaller femoral anteversion, higher acetabular inclination, smaller lateral center-edge angle, and lower neck-shaft angle were associated with a higher total magnitude of femoral head translation in the superior-inferior direction (P ≤ .03). Our study demonstrated that, during passive physiologic movement, asymptomatic hips on average translated up to 2 mm (with up to 7 mm maximum translation in some positions), which is potentially related to hip rotations and morphology. Further investigations are warranted to understand the normal and pathologic hip translations and their impact on hip function (ie, instability and impingement).

Impact of scapula anatomical landmark positioning on scapular orientation using CT-based 3D models: an intra-observer repeatability and inter-observer reproducibility study

HypothesisThe primary objective of this study was to assess intra-observer repeatability and inter-observer reproducibility of the 3D coordinates of a set of scapula anatomical landmarks obtained by manual positioning on conventional supine CT-scan based scapula surface models. The secondary objective was to assess intra-observer repeatability and inter-observer reproducibility of the resulting 3D scapular orientation. It was hypothesized that the 3D scapular orientation reliability would be better or similar than established reliability of intra-operative baseplate positioning (i.e. version and inclination) in reverse total shoulder arthroplasty (rTSA). MethodsThree anatomical landmarks, i.e. acromial angle (AA), inferior angle (IA), and trigonum scapulae (TS), were manually positioned on 81 scapula surface models using updated landmark definitions. These models were obtained by the segmentation of CT-scan images acquired from patients undergoing elective rTSA procedures at the Department of Surgery at Geneva University Hospitals between May 2022 and December 2023. This procedure was repeated 3 times per scapula by 3 independent observers. A set of parameters corresponding to the 3D landmark coordinates (expressed in an average scapula coordinate system) and the 3D scapular orientation (expressed as three angles related to the retraction/protraction, lateral/medial rotation, and internal/external rotation) were computed. Intra-observer repeatability and inter-observer reproducibility were assessed for each of these parameters using an intra-class correlation as a relative reliability metric. Standard error of measurement (SEM) was also reported as an absolute reliability metric. ResultsIntra-observer ICC and inter-observer ICC ranged from poor to moderate for AA, poor to excellent for IA, and poor to excellent for TS. However, low SEM, ranging from 0.4 mm to 2.4 mm for intra-observer repeatability and from 0.2 mm to 1.8 mm for inter-observer reproducibility, were obtained for every coordinate of each anatomical landmark. This results in poor to moderate intra-observer ICC and inter-observer ICC for scapula angular orientation. Again, low SEM, ranging from 0.4° to 0.8° for intra-observer repeatability and 0.4° to 0.6° for inter-observer reproducibility, were obtained, arguing for reliable measurements. Discussion and ConclusionThis study demonstrates that manual positioning of the three scapula anatomical landmarks recommended by the International Society of Biomechanics can be performed in a reliable manner across measures and observers on surface bone models obtained from CT-scan images. However, a clear and standardized definition of these landmarks is needed to ensure consistency across measurements.

Modeling the elastic–plastic contact forces and deformations of nonrotationally symmetric lunar dust particles

The sharp morphological features of lunar dust particles generate significant elastic–plastic contact forces and deformations upon contact with material surfaces, which considerably affect the mechanical properties of lunar dust particles, including their contact, collision, adhesion, transport, and wear characteristics. Despite these severe effects, valid models considering the contact characteristics of typical sharp-featured lunar dust particles are currently lacking. This study proposes an elastic–plastic contact model for nonrotationally symmetric lunar dust particles showing typical sharp features. Detailed derivations of the expressions for various physical responses observed when lunar dust particles establish normal contacts with elastic and elastic–plastic half-spaces under adhesive conditions are also provided. These include derivations for elastic forces, elastic–plastic forces, contact areas, pull-off forces, residual displacements, and plastic deformation areas. Furthermore, the tangential pull-off force during the tangential loading of lunar dust particles is derived, and the tangential contact characteristics are explored. Comparisons of the results of the proposed model with those of previous experiments reveal that the proposed model shows errors of only 6.06 % and 1.03 % in the maximum indentation depth and residual displacement, respectively. These errors are substantially lower than those of conventional spherical models (60.30 % and 60.13 %, respectively), confirming the superior accuracy of the proposed model. Furthermore, the discrete element method is employed to analyze the effects of normal and tangential contacts, dynamic characteristics, and plastic deformations on the considered lunar dust particles. The results are then compared with those of existing contact models. They reveal that maximum elastic–plastic forces under normal contact conditions are positively correlated with the initial velocity but negatively correlated with the lateral angle. Furthermore, the tangential pull-off force is positively correlated with the normal force and surface energy. In addition, the contact duration of lunar dust particles is positively correlated with their initial velocities, while the residual displacement is negatively correlation. For instance, as the initial velocity increases from 10 to 50 m/s, the maximum elastic–plastic force increases from 37.64 to 321.72 mN. Comparisons of the proposed model with other contact models reveal that the maximum elastic–plastic force of the elastic–plastic triangular pyramid model is only 14.93 % that of the cylindrical model, 34.23 % that of the spherical model, and 76.27 % that of the conical model, indicating significant reductions in the maximum elastic–plastic force owing to the plastic deformations of particles with typical sharp features. Overall, the results of this study offer crucial insights into the mechanical characteristics of nonspherical lunar dust particles under various contact conditions, such as elastic–plastic and adhesive contacts, and can guide in situ resource utilization on the lunar surface and for craft landings.

Preoperative Joint Line Convergence Angle as an Indicator of Clinical Outcomes and Accuracy of Alignment Correction After Double-Level Osteotomy.

The relationship between postoperative alignment and clinical outcomes after double-level osteotomy (DLO) has not been clarified. To examine the radiological and clinical outcomes after DLO and specifically evaluate the influence of the joint-line convergence angle (JLCA) on the accuracy of alignment correction and surgical outcomes. Case-control study; Level of evidence, 3. Included were 74 knees in 51 patients (mean age, 61.0 years) who underwent DLO for varus osteoarthritic knees and who had a minimum of 2 years of follow-up. The target hip-knee-ankle angle (HKAA) for the intended limb alignment was set to 1° valgus. The lateral distal femoral angle, medial proximal tibial angle, JLCA, and HKAA were measured on preoperative and postoperative radiographs. Outliers in alignment correction were defined as a deviation of ≥3° from the originally intended HKAA. Clinical outcomes were assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS). In the data analysis, the influence of the radiological parameters on the postoperative outcomes was statistically assessed. Radiological and clinical evaluation at 2-year follow-up showed significant improvement from preoperative values (P < .001). The HKAA was corrected from 13.4°± 3.0° varus preoperatively to 0.5°± 2.8° varus at 2 years, indicating a slight undercorrection. Regarding clinical outcomes, significant pre- to postoperative improvement was found on the KOOS (from 185.0 ± 71.2 to 387.9 ± 70.5; P < .001). Overall, 22 of the 74 knees (29.7%) were deemed to be outliers at the 2-year follow-up (19 knees [25.7%] in undercorrection, 3 knees [4.1%] in overcorrection). Postoperative KOOS values were significantly worse in the outliers than in the nonoutliers (344.4 ± 77.7 vs 405.8 ± 59.3; P < .001), and both pre- and postoperative JLCA was significantly larger in the outlier group. The receiver operating characteristic curve analysis indicated a preoperative cutoff JLCA of 6.0° for predicting postoperative alignment outliers. A preoperative JLCA of ≥6° was found to be a significant prognostic factor affecting the radiological and clinical outcomes after DLO for varus osteoarthritic knees by compromising the accuracy of deformity correction, resulting in suboptimal postoperative alignment.

Alignment rod and gap measurement methods achieve comparable alignment correction in opening wedge high tibial osteotomy for varus osteoarthritic knees.

To compare clinical and radiological outcomes of medial opening wedge high tibial osteotomy (MOWHTO) using two different alignment methods: the alignment rod (AR) versus the gap measurement (GM) method. The primary outcome was to report the surgical accuracy of coronal plane corrections in each method. Patients who underwent MOWHTO with either AR or GM method between 2014 and 2022 at a single institution, with a minimum of 2 years of follow-up, were included. The opening gap was gradually spread with an AR under fluoroscopic control in the AR group, whereas the osteotomy site was opened to the value of the measured gap distance in addition to the thickness of the bone saw in the GM group. Radiological assessment of geometric characteristics included hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), mechanical lateral distal femoral angle and joint line convergence angle. Surgical accuracy, which is the deviation (Δ) between the intended and achieved correction, was compared between both methods. Clinical outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Scores. A total of 110 patients (n = 110 knees) with a mean age of 54.1 ± 8.4 years were included in the study. Radiological parameters were significantly improved as reflected by HKA correction from 171.6° ± 2.0° to 181.1° ± 2.6° in the AR group and from 171.0° ± 2.3° to 181.1° ± 2.8° in the GM group at 2 years (Intergroup n.s). There was no significant intergroup difference for all radiological parameters and clinical outcomes. There was no intergroup difference in the surgical accuracy as evaluated by Δvalues and absolute Δvalues of both HKA and MPTA (n.s). Comparable correction accuracy was achieved in MOWHTO using either the AR or GM method. The GM method is simple and reliable in achieving the intended correction in MOWHTO. Ⅲ retrospective comparative study.

Modified pendulum osteotomy to correct severe tibial varus deformity

Correction of asevere tibial varus deformity near the knee joint with only aslight influence on leg length and patella height. Medial osteoarthritis and/or cartilage damage with asevere varus deformity > 10° with amedial proximal tibial angle (MPTA) < 80°. Femoral varus deformity with lateral distal femoral angle > 91°, severe lateral cartilage damage, lateral osteoarthritis, lateral meniscus loss. Skin incision of approx. 8-10 cm between the tibial tuberosity and the head of the fibula. Exploration of the peroneal nerve. Detachment of the extensors. Insertion of an obliquely ascending guidewire ending approximately 10 mm below the medial articular surface. Insertion of asecond guidewire. This aims at the middle of the first wire (hemi wedge). Check the wire position under fluoroscopy. Osteotomy with an oscillating saw under cooling. Removal of the wedge and closure of the osteotomy. Percutaneous needling of the medial collateral ligament with acannula to carefully lengthen the ligament. Check the correction result with ametal rod. Osteosynthesis with lateral angle-stable plate. Partial weight-bearing with 10 kg for 6weeks postoperatively, free range of motion. Reports from the literature show that good clinical results can be achieved with this procedure for severe tibial varus deformities. Postoperative leg length discrepancies are less common with this procedure than with laterally closing osteotomy.

The Effectiveness of Temporary Hemiepiphysiodesis for Non-idiopathic Coronal Angular Deformity of the Knee in Children: A Comparison of Hinge Eight-Plate and Traditional Eight-Plate.

Temporary hemiepiphysiodesis (TH) is a very common technique for coronal angular deformity of the knee in children, especially non-idiopathic. However, there is currently a dearth of comparative research on the hinge eight-plate (HEP) and traditional eight-plate (TEP). This study aimed to assess the clinical effectiveness and implant-related complication rates of TH using TEP and HEP for non-idiopathic coronal angular deformity, as well as to identify clinical factors affecting correction velocity. We retrospectively observed a consecutive series of patients with non-idiopathic coronal angular deformity of the knee who underwent TH using HEP or TEP and completed the deformity correction process from July 2016 to July 2022. According to the kind of eight plates, we divided those patients into the HEP group and the TEP treatment group. Relevant clinical factors, including the mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), screw divergence angle (SDA), angle of plate and screw (APS), hinge angle of HEP (HA), and the knee zone location of the lower extremity mechanical axis, were documented. Additionally, deformity correction velocity, complications, and clinical efficacy were assessed. Categorical variables were analyzed using the chi-squared test, Fisher exact test, or Wilcoxon test, while continuous variables were evaluated using the t-test or analysis of variance (ANOVA). There were 29 patients in the HEP treatment group (seven girls and 22 boys) and 33 patients (12 girls and 21 boys) in the TEP treatment group. In all, 91.86% (79/86 knees) of the genu angular deformities were completely corrected, 6.98% (6/86 knees) had the overcorrection condition, and 10.47% (9/86 knees) had screw loosening. The swayback HEP rate was 11.29% (7/62 HEPs), which was related to the screw loosening in the HEP group (p < 0.001). The overall correction velocities and screw divergence angle change speeds in the HEP group were all significantly faster than those in the TEP group (p < 0.05). The initial APS of the HEP implanted was higher than that of TEP (p < 0.01), and multisite changes of APS during deformity correction of the HEP group were smaller than that of the TEP group. HEP proved to be an appropriate device for TH for non-idiopathic coronal angular deformities of the knee with high correction velocity in children. Avoiding the occurrence of the swayback phenomenon may reduce the complications of HEP.

Comparing Multipin Clamps With Outriggers With Standard Clamps for Lower Extremity Periarticular External Fixation: Similar Radiographic and Clinical Outcomes.

Staged treatment of high-energy periarticular tibia fractures involves temporization with closed reduction and external fixation, aiming to provide early reduction and stabilization while mitigating soft-tissue complications. Various external fixator configurations exist, including those that use a "multipin" clamp capable of holding multiple pins but limiting pin placement to a single plane. The purpose of this study was to compare clinical and radiographic outcomes and associated costs of standard and multipin outrigger clamp constructs in tibial plateau and pilon fractures treated with temporary external fixation. We hypothesized that use of the multipin clamp may be associated with poorly aligned reductions and increased complication rates. A retrospective review of 100 patients with periarticular tibial plateau (AO/OTA: 41B/C) or pilon (43B/C) fracture at a Level 1 trauma center from 2014 to 2023 was conducted. Patient, injury, and complication characteristics were collected. Patients were categorized based on the external fixator clamp used: multipin (MP) or standard (S). Clinical outcomes and complication rates were assessed. Radiographic alignment was evaluated by the change in anterior and lateral distal tibial angles, and sagittal plane translation for pilon fractures, and medial and posterior proximal tibial angles for plateau fractures. 70 patients underwent standard (25 pilon, 45 plateau) and 30 multipin (10 pilon, 20 plateau) external fixation. MP and S groups showed no notable differences in demographics or injury characteristics. Both groups demonstrated comparable complication rates and radiological alignment outcomes, with no notable differences observed. MP constructs were more costly than standard systems. In this retrospective study of 100 patients, there was no difference in radiographic or clinical outcomes between the standard frame and multipin frame groups. Typical costs for the multipin frame constructs were $635 to $1249 more than the standard frame constructs.

Combination of closing-wedge distal femoral osteotomy and modified tibial plateau levelling osteotomy for the treatment of medial patellar luxation and concomitant cranial cruciate ligament disease in dogs

Considering the prevalence of cranial cruciate ligament disease (CCLD) and concurrent medial patellar luxation (MPL) among dogs, and the concomitant bone deviations routinely identified, the aim of this study is to evaluate the efficacy of the combination between distal femoral osteotomy (DFO) and modified tibial plateau levelling osteotomy (mTPLO) for the treatment of MPL with distal femoral varus, tibial torsion, and CCLD. Dogs with concurrent MPL and CCLD that underwent DFO and mTPLO procedures were included. Subjective clinical evaluations of gait and pre-operative and immediate post-operative radiographic examinations were performed. Surgical data were documented. The anatomical lateral distal femoral angle (aLDFA), femoral varus angle, mechanical medial proximal tibial angle, and tibial plateau angle (TPA) were compared between the pre- and post-operative periods. A total of 12 dogs were included in this study. Closing-wedge DFO and mTPLO procedures were performed on 14 limbs. The mean pre-operative and post-operative aLDFA values were 104.8 ± 3.9° and 95.4 ± 2.4°, respectively. TPA values were 26.2 ± 3.7° pre-operatively and 6.3 ± 3.2° post-operatively. Bone healing was observed in 7.1 %, 71.3 %, and 85.5 % of patients at the first, second, and third follow-up, respectively. Lameness was resolved in 28.5 %, 78.5 %, and 100 % at 30, 60, and 90 days, respectively. No major peri- or post-operative complications were reported. The combination of mTPLO and DFO aligns the stifle extensor mechanism, promoting dynamic stabilization. It can be considered for the treatment of concurrent MPL and CCLD in dogs, performed as a single procedure, and is associated with favorable short-term outcomes.

DXA images vs. Pelvic Radiographs: Reliability of Hip Morphology Measurements

ObjectiveDual-energy x-ray absorptiometry (DXA) images are increasingly used to study hip morphology. Whether hip morphology measurements are consistent between DXA images and radiographs is unknown. Therefore, we investigated the agreement and reliability of the measurements performed on DXA images and radiographs. DesignWe included participants from the Rotterdam study, a population-based cohort study, who received a hip DXA image and pelvic radiograph on the same day. The acetabular depth-width ratio (ADR), modified acetabular index (mAI), alpha angle (AA), Wiberg and lateral center edge angle (WCEA, LCEA), extrusion index (EI) and triangular index ratio (TIR) were automatically determined on both imaging modalities. The intraobserver and intermethod agreement were studied using Bland-Altman methods, and the reliability was assessed using intraclass correlation coefficients (ICC). Secondly, the diagnostic agreement regarding dysplasia, cam, and pincer morphology was assessed using percent agreement and Cohen’s kappa. Results750 hips from 411 individuals, median age 67.3 years (range 52.2 – 90.6), 45.5% male, were included. The following intermethod ICCs (95% CI) were obtained: ADR 0.85 (0.74-0.91), mAI 0.75 (0.52-0.85), AA 0.72 (0.68-0.75), WCEA 0.81 (0.74-0.85), LCEA 0.93 (0.91-0.94), EI 0.88 (0.84-0.91), and TIR 0.81 (0.79-0.84). We found comparable intraobserver ICCs for each morphological measurement. ConclusionDXA images and pelvic radiographs could both reliably be used to study hip morphology. Due to the lower radiation burden, DXA images could be an excellent alternative to pelvic radiographs for research purposes.

Combined Bending-Torsion and Compression-Bending-Torsion Behaviours of Reinforced Concrete-Filled Thin-Walled Corrugated Steel Tubes

Reinforced concrete-filled thin-walled galvanized corrugated steel tube (RCFCST) is a novel composite member that has application potential in extremely corrosive environments and seismic activity regions. A series of preliminary works have been conducted on its compressive, flexural, shear, and torsional behaviour. However, the combined loading condition is almost inevitable in practice. The correlations between the flexural and torsional behaviour of RCFCSTs are unique due to the special spiral corrugated profile, which is unclear and needs to be addressed. This paper, therefore, presents an experimental investigation of the RCFCST under combined bending-torsion and compression-bending-torsion loads, encompassing the main test variables of torsion-to-bending ratios, torsional directions, and axial compression ratios. The loading set-up and instruments have been introduced in detail. The failure modes, lateral load versus lateral displacement curves, bending moment versus flexural lateral displacement curves, torsion moment versus torsional angle curves, and strain distributions are carefully addressed. The working mechanisms of the RCFCST under combined loads are discussed, with a particular explanation of the dependent behaviour on the torsion-to-bending ratios and torsional directions. The applicability of the existing design methods for the bearing capacity of RCFCST specimens under combined loads is examined carefully, with specific design suggestions proposed.

A high-resolution method for direction of arrival estimation based on an improved self-attention module.

The high-resolution direction of arrival (DOA) estimation is a prominent research issue in underwater acoustics. The existing high-resolution methods include subspace methods and sparse representation methods. However, the performance of subspace methods suffers from low signal-to-noise ratio (SNR) and limited snapshots conditions, and the computational complexity of sparse representation methods is too high. The neural network methods are emerging high-resolution methods. However, insufficient support for big data is frequently observed in underwater acoustics, and conventional network structures present challenges in further enhancing performance. To address the aforementioned problems, we propose a neural network method based on an improved self-attention module to achieve high accuracy and robust DOA estimation. First, we design a multi-head self-attention module with large-scale convolutional kernels and residual structures to improve the estimated accuracy. Second, we propose an improved input feature to enhance the robustness to non-uniform noise and unequal-intensity targets. The simulations demonstrate that the proposed method exhibits superior angle resolution compared to sparse representation methods under the same simulation conditions. The proposed method demonstrates exceptional accuracy and robustness in DOA estimation under challenging conditions of low SNR, limited snapshots, and unequal-intensity targets. The experimental results further prove the effectiveness of the proposed method.

Minimally Invasive Combined Medial and Lateral Approach for Treating Displaced Scapular Body and Neck Fractures.

BACKGROUND Traditional open surgery for displaced scapular body and neck fractures often results in significant trauma and complications. This study aimed to assess the efficacy of a combined medial and lateral minimally invasive approach compared with the traditional Judet approach. MATERIAL AND METHODS A retrospective analysis was conducted on 36 patients (22 men, 14 women; mean age 45.6 years) with displaced scapular body and neck fractures treated between May 2016 and May 2022. Nineteen patients underwent the minimally invasive approach, while 17 received the traditional Judet approach. Primary outcomes included surgical incision length, intraoperative blood loss, complication rate, time to postoperative pain relief (VAS score ≤3), and Constant-Murley shoulder score at 12 months. Statistical analysis was done using the t test and chi-square test. RESULTS The minimally invasive group had shorter incision lengths (mean difference: 10.0 cm; 95% CI: 8.1-11.9; P<0.001) and lower blood loss (mean difference: 129.4 mL; 95% CI: 119.0-139.8; P<0.001). They also experienced faster pain relief (mean difference: 3.0 days; 95% CI: 2.5-3.5; P<0.001) and higher Constant-Murley scores (mean difference: 7.4 points; 95% CI: 4.9-9.9; P<0.001). There were no significant differences in operative duration or fracture healing time. CONCLUSIONS The combined medial and lateral minimally invasive approach offers superior outcomes in reducing incision length, blood loss, complications, and pain, with enhanced shoulder function, making it a safe and effective alternative to the traditional Judet approach.

Computer modeling and validation testing for glenoid component rotation and optimal glenoid screw angles for reverse shoulder arthroplasty in an Asian population.

Good initial fixation of glenoid component for reverse total shoulder arthroplasty (RTSA) relies on component placement and screw purchase in the scapula bone. This is especially difficult in an Asian population with small glenoid geometry. Optimal glenoid component roll angle and screw angulation to achieve the longest screws for best fixation has not been defined in the current literature. Computer 3D modelling of 133 scapulas with RTSA performed were analyzed to determine patient specific optimal glenoid roll angle (GRA) for the longest bi-cortical screws attainable. The cranial-caudal angle (CCA), anterior-posterior angle (APA) and lengths for the superior and inferior screws were measured. Validation testing using calculated average (CA) angles and rounded average (RA) angles to the nearest 5 degree were recomputed for each case to determine the bi-cortical screw lengths achievable. The CA and RA screw lengths were compared against patient specific modelling using paired-sample t-tests. Average GRA was - 1.6°, almost perpendicular to the long axis of the glenoid and achieves an average bi-cortical screw length of 51.3mm and 45.5mm for the superior and inferior screws respectively. The CCA and APA were 9.1° cranial and 6.5° posterior for the superior screw and screw angulation of 11.2° caudal and 0.7° anterior for the inferior screw. Validation testing shows statistically shorter screw lengths in the CA and RA models compared to patient specific modelling (p < 0.01). Validation testing with average angles for GRA, CCA and APA demonstrates strong patient heterogeneity and anatomical variation. Despite this, screw lengths attainable in the RA group were > 38mm with good safety profile. Surgeons may consider the additional use of navigation-assisted, or 3D printed patient specific instrumentation to optimize baseplate and screw configuration for RTSA.

Morphometric evaluation of suprascapular notch and superior angle of the scapula using three-dimensional computed tomography in the Indian population

BackgroundAmong the various aspects of scapular anatomy, the suprascapular notch has gained attention as its anatomical variation is a predisposing factor for compression of the suprascapular nerve in this region, potentially impacting orthopedic surgery. This study aims to investigate the morphology of suprascapular notch (SSN) and its variation with age and sexual dimorphism. It also seeks to classify and correlate the superior angle of the scapula with the SSN in the Indian population. MethodsA retrospective analysis of 360 computed tomography scans of scapulae of 180 adults was conducted. The morphology of SSN was classified according to Rengachary's classification (types I-VI), and the maximum depth (MD) and maximum width (MW) of SSN were measured. The superior angle of the scapula was classified based on morphological characteristics. ResultsType I SSN was the most prevalent, suggesting lower susceptibility to suprascapular nerve entrapment. Males had significantly greater MD than females. Identical types of SSN and superior angles on both sides of the scapula were statistically significant, though variations on each side were also observed. There was no significant difference in age. The superior angle of the scapula was classified into four types: Hilly, mountain peak, crescent, and chimney, with the hilly type being the most common. No correlation was found between SSN and the superior angle. ConclusionThese findings may provide a comprehensive understanding necessary for accurate diagnoses of related abnormalities and for performing safe and effective endoscopic and open surgical procedures in the suprascapular region.

Borderline Hip Dysplasia - Best Treated with Hip Arthroscopy or Periacetabular Osteotomy?

As the field of hip preservation evolves, the diagnosis of borderline dysplasia (defined as a lateral center edge angle between 18°-25°) has shown itself to be one of the more challenging diagnoses to treat. As the nuances of acetabular coverage have come to light, the question of whether borderline hip dysplasia is best treated with isolated hip arthroscopy, periacetabular osteotomy, or whether a combined procedure is best, is now top of mind. The goal of these procedures is to not only improve patient symptoms, but to correct underlying pathology and ideally slow the development of hip osteoarthritis. The purpose of this review is to summarize the recent literature and clinical findings regarding both isolated hip arthroscopy and periacetabular osteotomy in the surgical management of borderline hip dysplasia. Current research demonstrates improved postoperative clinical outcome scores for both patients who had isolated hip arthroscopy in the setting of borderline hip dysplasia and for those patients who underwent periacetabular osteotomy. Mid-term outcomes for patients in both groups have showed low rates of conversion to total hip arthroplasty. No gold standard in the surgical management of borderline hip arthroscopy exists. Improved clinical outcomes have been seen postoperatively in patients who undergo hip arthroscopy and in patients who undergo periacetabular osteotomy. Successful clinical outcomes seem to rely on treatment of the underlying clinical pathology and are largely based on the appropriate surgical indications and appropriate surgical techniques. Surgical decision making in this patient population should be individualized based on a comprehensive evaluation of the patient.

A case of masquerade syndrome caused by metastatic iris tumor diagnosed by a high CEA level in the aqueous humor and iris biopsy

BackgroundWith the advent of targeted therapies, the survival prognosis for metastatic tumors has extended, and it has become necessary to diagnose and consider treatment that takes into account Quality of Life for metastatic tumors of the eye. The reports of checking tumor marker in the aqueous humor for diagnosis of metastatic intraocular tumors are few. Here, we report a case of masquerade syndrome with secondary glaucoma in which a high carcinoembryonic antigen (CEA) level in the aqueous humor could assist diagnosis, and continuing targeted therapy and trabeculectomy were effective.Case presentationA 73-year-old man was referred to us for iritis and high intraocular pressure (IOP) with severe eye pain in the left eye. He had Stage IVB lung adenocarcinoma treated with a molecularly targeted drug, Osimertinib. His best corrected visual acuity was 0.15, and IOP was 52 mmHg in the left eye. Anterior chamber cells (+), numerous small nodules in the iris, and small masses in the inferior angle were observed. In the aqueous humor, the CEA level was higher than in the blood. Napsin A and Thyroid Transcription Factor-1 (TTF-1) positive cells showed in the resected tissue at iridectomy performed during trabeculectomy. The pathological diagnosis of metastatic iris tumor of the lung adenocarcinoma was made, and we injected bevacizumab intravitreally once and continued Osimertinib. His IOP lowered to 8–10 mmHg, and the iris masses disappeared. He lost vision by metastasis to the left optic nerve after termination of Osimertinib one and a half years later. The metastasis shrank after restarting the drug. He passed away from an exacerbation of his primary lung cancer two years and nine months after the first visit. Although he lost vision in his left eye, the metastatic tumor in his left eye and optic nerve had disappeared, and his quality of life was maintained without any pain in his eye.ConclusionsChecking tumor markers in the aqueous humor can aid in diagnosis, and aggressive treatment of metastatic iris tumors must help maintain patients’ Quality of Life.

Automated Measurements of Long Leg Radiographs in Pediatric Patients: A Pilot Study to Evaluate an Artificial Intelligence-Based Algorithm.

Assessment of long leg radiographs (LLRs) in pediatric orthopedic patients is an important but time-consuming routine task for clinicians. The goal of this study was to evaluate the performance of artificial intelligence (AI)-based leg angle measurement assistant software (LAMA) in measuring LLRs in pediatric patients, compared to traditional manual measurements. Eligible patients, aged 11 to 18 years old, referred for LLR between January and March 2022 were included. The study comprised 29 patients (58 legs, 377 measurements). The femur length, tibia length, full leg length (FLL), leg length discrepancy (LLD), hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), and mechanical medial proximal tibial angle (mMPTA) were measured automatically using LAMA and compared to manual measurements of a senior pediatric orthopedic surgeon and an advanced practitioner in radiography. Correct landmark placement with AI was achieved in 76% of the cases for LLD measurements, 88% for FLL and femur length, 91% for mLDFA, 97% for HKA, 98% for mMPTA, and 100% for tibia length. Intraclass correlation coefficients (ICCs) indicated moderate to excellent agreement between AI and manual measurements, ranging from 0.73 (95% confidence interval (CI): 0.54 to 0.84) to 1.00 (95%CI: 1.00 to 1.00). In cases of correct landmark placement, AI-based algorithm measurements on LLRs of pediatric patients showed high agreement with manual measurements.