Single Anteroposterior Radiograph Research Articles

History Page: Leaders in MSK Radiology: Stanislas de Sèze, 1903-2000.

This history page is dedicated to the memory and achievements of the French rheumatologist Stanislas de Sèze whose name is connected to the so-called de Sèze view, used to evaluate the sacroiliac joints, the lumbar and lower thoracic spine, pelvis, and hip joints on a single anteroposterior radiograph.

Bilateral weighted radiographs are required for accurate classification of acromioclavicular separation: An observational study of 59 cases

IntroductionMisinterpretation of the Rockwood classification system for acromioclavicular joint (ACJ) separations has resulted in a trend towards using unilateral radiographs for grading. Further, the use of weighted views to ‘unmask’ a grade III injury has fallen out of favour. Recent evidence suggests that many radiographic grade III injuries represent only a partial injury to the stabilising ligaments. This study aimed to determine (1) whether accurate classification is possible on unilateral radiographs and (2) the efficacy of weighted bilateral radiographs in unmasking higher-grade injuries. MethodsComplete bilateral non-weighted and weighted sets of radiographs for patients presenting with an acromioclavicular separation over a 10-year period were analysed retrospectively, and they were graded I–VI according to Rockwood's criteria. Comparison was made between grading based on (1) a single antero-posterior (AP) view of the injured side, (2) bilateral non-weighted views and (3) bilateral weighted views. Radiographic measurements for cases that changed grade after weighted views were statistically compared to see if this could have been predicted beforehand. ResultsFifty-nine sets of radiographs on 59 patients (48 male, mean age of 33 years) were included. Compared with unilateral radiographs, non-weighted bilateral comparison films resulted in a grade change for 44 patients (74.5%). Twenty-eight of 56 patients initially graded as I, II or III were upgraded to grade V and two of three initial grade V patients were downgraded to grade III. The addition of a weighted view further upgraded 10 patients to grade V. No grade II injury was changed to grade III and no injury of any severity was downgraded by a weighted view. Grade III injuries upgraded on weighted views had a significantly greater baseline median percentage coracoclavicular distance increase than those that were not upgraded (80.7% vs. 55.4%, p=0.015). However, no cut-off point for this value could be identified to predict an upgrade. ConclusionsThe accurate classification of ACJ separation requires weighted bilateral comparative views. Attempts to predict grade on a single AP radiograph result in a gross underestimation of severity. The value of bilateral weighted views is to ‘unmask’ a grade V injury, and it is recommended as a first-line investigation.

Heterotopic Ossification Excision Improves Kinetic and Kinematic Gait Parameters as Demonstrated by Computerized Motion Analysis

Heterotopic ossification (HO) is defined as formation of bone in abnormal locations. HO has been extensively reported in the orthopaedic literature, particularly following total hip arthroplasty, the operative treatment of acetabular fractures, and after spinal cord, traumatic brain, and burn injuries1-24. The hip is the most common site of HO. While many patients with HO are asymptomatic, more severe cases can result in pain and substantial limitations in joint range of motion. The Brooker classification, which is based on the appearance of HO on a single anteroposterior radiograph, remains the most commonly used classification system for HO, although other modified rating systems have been suggested3,7,25. In patients who undergo procedures that result in substantial risk of HO, prophylaxis can be considered; numerous studies have reported successful prophylaxis against HO formation in patients following total hip arthroplasty and open reduction and internal fixation for acetabular fractures2,9,15,16,20,21,24,26-30. The key to preventing HO is early prophylaxis in the inflammatory stage. In patients with symptomatic HO, surgical excision may be considered. Previous studies report improved range of motion following HO excision31-35. Because the incidence of HO recurrence after surgical excision is extremely high, postoperative prophylaxis with radiation or anti-inflammatory medications is recommended. To the best of our knowledge, this is the first case report of HO excision with documentation of both static and dynamic changes of hip range of motion with use of preoperative and postoperative three-dimensional (3D) computerized motion analysis. The patient and her parents were informed that data concerning the case would be submitted for publication, and they provided consent. An eight-year-old girl with duodenal atresia had developed duodenal perforation …

2D versus 3D imaging of hip displacement in children with cerebral palsy

2D versus 3D imaging of hip displacement in children with cerebral palsy

Intraoperative evaluation of limb length in hip arthroplasty using a single AP radiograph.

Previous methods for determining limb length during hip arthroplasty have depended on physical examination and direct measurement techniques. A radiographic technique for assessing limb length intraoperatively with a single anteroposterior (AP) pelvis radiograph was studied in 46 consecutive hip arthroplasties in 41 patients (five with bilateral arthroplasties). Of the 41 patients, 97.6% had either an average postoperative limb length discrepancy of 2.9 mm (-1 mm to +7 mm), or the limb was lengthened no more than 7 mm. This radiographic method has led to one of the most successful results reported in the literature with regard to minimizing significant limb length discrepancy or limb lengthening (maximum of 7 mm) following total hip arthroplasty. The single AP radiograph made intraoperatively with the trial implant in place is a valuable aid in determining limb length in total hip arthroplasty. (Hip International 2005; 15: 199-205).

Intraoperative evaluation of limb length in hip arthroplasty using a single AP radiograph

Previous methods for determining limb length during hip arthroplasty have depended on physical examination and direct measurement techniques. A radiographic technique for assessing limb length intraoperatively with a single anteroposterior (AP) pelvis radiograph was studied in 46 consecutive hip arthroplasties in 41 patients (five with bilateral arthroplasties). Of the 41 patients, 97.6% had either an average postoperative limb length discrepancy of 2.9 mm (-1 mm to +7 mm), or the limb was lengthened no more than 7 mm. This radiographic method has led to one of the most successful results reported in the literature with regard to minimizing significant limb length discrepancy or limb lengthening (maximum of 7 mm) following total hip arthroplasty. The single AP radiograph made intraoperatively with the trial implant in place is a valuable aid in determining limb length in total hip arthroplasty. (Hip International 2005; 15: 199-205).

The cost-effectiveness of routine pelvic radiography in the evaluation of blunt trauma patients.

. To determine the cost-effectiveness of routine protocol-driven pelvic radiography in the evaluation of blunt trauma patients. A retrospective review was performed on 319 blunt trauma patients who underwent protocol-driven pelvic radiography to record the frequency of pelvic fracture. Medical records of the patients in whom fractures were identified radiographically were then examined to determine the clinical suspicion of injury prior to radiography. Using Medicare reimbursement data, the cost-effectiveness of routine pelvic radiography was calculated in terms cost per pelvic radiograph with evidence of fracture. These values were then compared with literature values of other screening studies, namely mammography and colonoscopy. Thirty-eight of 319 patients (11.9%) were found to have fractures identified on routine pelvic radiography. Using the 1997 Medicare reimbursement charge of $27.79 for a single anteroposterior radiograph of the pelvis, the total cost of performing these 319 trauma protocol-driven studies was calculated as $8865.01. The cost per protocol-driven pelvic radiograph with evidence of pelvic fracture was subsequently determined to be $233.29. Only 18 (47.4%) of these 38 patients were suspected to have pelvic fracture on the basis of the clinical findings alone. Trauma protocol-driven pelvic radiography is a necessary and cost-effective means of identifying acute pelvic injury in all trauma patients regardless of clinical presentation.

Determination of acetabular coverage of the femoral head with use of a single anteroposterior radiograph.

Determination of acetabular coverage of the femoral head with use of a single anteroposterior radiograph.

Determination of acetabular coverage of the femoral head with use of a single anteroposterior radiograph. A new computerized technique.

We developed a method for the estimation of three-dimensional acetabular coverage of the femoral head with use of only an anteroposterior radiograph of the hip. This technique also allows recalculation of the corrected value for coverage at neutral pelvic tilt. Provided that the acetabulum and femoral head are spherical and congruent, the results are as accurate as those obtained with computerized tomographic reconstruction, the dose of radiation is much lower, and much less time is required for calculation. The hips of 286 normal subjects showed increases with age in both anterior and posterior coverage and backward tilt of the pelvis, along with a decrease in the anterior-posterior ratio of coverage. The proportion of anterior acetabular coverage in female subjects was smaller than that in male subjects. There was more backward tilt of the pelvis and the anterior-posterior ratio of coverage was smaller when the subjects were standing than when they were supine.

Therapeutic ratio and defined phases: proposal of ethical framework for palliative care.

radiation and surgical intervention and, in addition, resources are wasted. Large studies of children who have swallowed foreign bodies do not show that ingested coins that have passed beyond the cardia cause complications in children with a normal gastro? intestinal tract13; only one such case seems to have been described.4 Furthermore, the potential hazard of prolonged asymptomatic gastric retention of swallowed coins (more than two weeks) may have been exag? gerated. In our experience such coins eventually pass spontaneously and, under experimental conditions of gastric acidity, the dissolution of toxicologically significant quantities of metal is unlikely to occur (I M House, National Poisons Unit, Guy's Hospital, London, personal communication). The management of swallowed coins in children in the United Kingdom could be improved. Adopting the scheme outlined in the figure would reduce the radiation dose received by many children and produce a considerable financial saving. An initial single antero posterior radiograph of the neck and chest is advisable even in asymptomatic patients because of the dangers from silent oesophageal impaction.5 A lateral radio? graph may then be necessary to localise coins in the neck and upper chest. When the coin is below the cardia only symptomatic patients require further assessment. Searching of stools is both unpleasant and inaccurate.

The three-dimensional anatomy of the proximal femur in Perthes' disease.

A new method of recording the three-dimensional anatomy of the proximal femur from a single anteroposterior radiograph is described. This technique shows that in Perthes' disease the femoral head and neck are in significant anteversion and true varus. This anatomical configuration may be important in the pathogenesis and treatment of this disorder.

Radiographic assessment of progression in osteoarthritis.

We evaluated methods of grading radiologic progression of osteoarthritis (OA). Sets of radiographs were assessed separately by 8 readers who were blinded to the time sequence. Included were radiographs of patients with OA of the hands (24 pairs), hips (40 pairs), and knees (32 pairs). Most films were taken 12-60 months apart. The relative contribution of individual joints (such as particular interphalangeal joints), of observations (such as narrowing or spurs), and of a single joint compartment (such as the medial or lateral compartment of the knee) toward evidence of OA progression was evaluated, as well as the reliability and concordance of scoring, and the sensitivity in detecting change. In assessing OA of the hand, the greatest sensitivity was achieved by reading a single posteroanterior bilateral hand radiograph for narrowing, spurs, and erosions, and scoring 10 joints (second and third distal interphalangeal, second and third proximal interphalangeal, and trapeziometacarpal joints, bilaterally), using a scale of 0-3. In OA of the hip, a single anteroposterior radiograph assessed for joint space narrowing and cyst formation yielded the greatest sensitivity. In OA of the knee, an anteroposterior radiograph, with weight-bearing, assessed for narrowing, spurs, and sclerosis in both the medial and lateral compartments yielded the greatest sensitivity. These techniques will be useful to the investigator in designing experimental studies and to the clinician in determining the rate of disease progression in an individual patient.

The lateral projection of the shoulder.

A single antero-posterior radiograph of the recently injured shoulder constitutes, by itself, an inadequate examination. The standard methods of taking radiographs by vertical projections are not practicable in patients who are unable to abduct the arm at the gleno-humeral joint and two simple modifications are described which are of value in such cases.

POSTERIOR DISLOCATION OF THE SHOULDER JOINT

Posterior dislocation of the shoulder is an unusual injury and there is often much delay before the diagnosis is made. Nevertheless, if the condition is borne in mind when examining the patient and studying the X-ray films the diagnosis should not be missed. A single antero-posterior radiograph of the shoulder joint is inadequate. For the radiologist a pair of stereoscopic films is desirable; but for routine emergency work in hospital other projections are necessary. A vertical view should be taken, either with the limb abducted and the tube in the axilla, or with the tube above the shoulder and a curved cassette in the axilla. When this is impossible a profile or posterior oblique view of the scapula may be substituted.