Standard AP Research Articles

AI-BASED AUTOMATED VARUS/VALGUS ALIGNMENT MEASUREMENT IN STANDARD KNEE RADIOGRAPHS

IntroductionAccurate assessment of alignment in pre-operative and post-operative knee radiographs is important for planning and evaluating knee replacement surgery. Existing methods predominantly rely on manual measurements using long-leg radiographs, which are time-consuming to perform and are prone to reliability errors. In this study, we propose a machine-learning-based approach to automatically measure anatomical varus/valgus alignment in pre-operative and post-operative standard AP knee radiographs.MethodWe collected a training dataset of 816 pre-operative and 457 one-year post-operative AP knee radiographs of patients who underwent knee replacement surgery. Further, we have collected a separate distinct test dataset with both pre-operative and one-year post-operative radiographs for 376 patients. We manually outlined the distal femur and the proximal tibia/fibula with points to capture the knee joint (including implants in the post-operative images). This included point positions used to permit calculation of the anatomical tibiofemoral angle. We defined varus/valgus as negative/positive deviations from zero. Ground truth measurements were obtained from the manually placed points. We used the training dataset to develop a machine-learning-based automatic system to locate the point positions and derive the automatic measurements. Agreement between the automatic and manual measurements for the test dataset was assessed by intra-class correlation coefficient (ICC), mean absolute difference (MAD) and Bland-Altman analysis.ResultAnalysing the agreement between the manual and automated measurements, ICC values were excellent pre-/post-operatively (0.96, CI: 0.94-0.96) / (0.95, CI: 0.95-0.96). Pre-/post-operative MAD values were 1.3°±1.4°SD / 0.7°±0.6°SD. The Bland-Altman analysis showed a pre-/post-operative mean difference (bias) of 0.3°±1.9°SD/-0.02°±0.9°SD, with pre-/post-operative 95% limits of agreement of ±3.7°/±1.8°, respectively.ConclusionThe developed machine-learning-based system demonstrates high accuracy and reliability in automatically measuring anatomical varus/valgus alignment in pre-operative and post-operative knee radiographs. It provides a promising approach for automating the measurement of anatomical alignment without the need for long-leg radiographs.AcknowledgementsThis research was funded by the Wellcome Trust [223267/Z/21/Z].

Two-stage robust multimodal hub network design under budgeted demand uncertainty: A Benders decomposition approach and a case study

The widening use of hub networks in urban agglomeration freight systems requires several actual extensions in conventional hub network design problems. For this purpose, we introduce a two-stage robust multimodal hub network design problem for the urban agglomeration freight system by considering incomplete hub network topology, multiple transportation modes, travel time limit and discuss the uncertainty in the constructed network from the demand point of view. Particularly, we model the demand uncertainty for the considered problem in two different ways. The basic model supposes that interval-budgeted uncertainty set is adopted to characterize uncertain demand, while the expanded model additionally considers possible states of the uncertain demand and weights summation of performances over multiple uncertainty sets, namely state-wise budgeted uncertainty set. By using a min–max criterion, we develop the path-based mixed-integer programming formulations for the proposed problem, which can significantly decrease the number of required integer variables and constraints. To handle large-sized problems, we propose an improved Benders decomposition algorithm, in which the master problem is implemented in a branch-and-bound framework and the subproblem is optimality solved by a customized two-step strategy. In addition to evaluating on the standard CAB, TR and AP datasets, we conduct a real-world case study of the Beijing-Tianjin-Hebei urban agglomeration freight system to explore the effect of incorporating uncertainty and showcase the superior performance of the proposed methods.

Prevention of screw penetration of the dorsal cortex in volar plating of distal end radius fracture by using dorsal tangential view

Background: The dorsal cortex penetration by a screw can leads to irritation and attritional extensor tendon injury in volar plating of distal end radius fracture. Our method in this study was to use dorsal tangential view (DTV) intraoperatively to detect screw protrusions in the dorsal cortex and replace these screws with screws of appropriate size. Methods: We have enrolled 60 patients from in patient department of orthopaedics in a rural tertiary care institute (Indian Institute of Medical Science and Research Warudi, Ta. Badnapur, Dist. Jalna, Maharashtra) having distal end radius fracture above 18 years of age planned for volar plating. DTV other than standard PA, lateral view was taken to evaluate the dorsal cortex penetration. Results: Seven patients required AP and lateral view while 14 patients needed DTV with 80% power (α=0.05, β=0.2). Conclusions: Our study concluded that additional DTV apart from standard AP and lateral view will detect the dorsal penetration of screws and can be changed intraoperatively. Thus, DTV is advised to minimise the iatrogenic extensor tendon injury by dorsal screw penetration which might be missed in lateral view.

Total Hip Arthroplasty Using the AMIS Method: Surgical Technique, Suitability of This Method for Obese Patients, Evaluation of the Study Population

This manuscript aims to introduce our surgical technique, with an emphasis on the latest recommendations. The AMIS technique is discussed in more detail in patients with Class II and Class III obesity. We seek to prove the premise claiming that the anteversion and inclination values observed in this group of patients do not differ signifi cantly from those observed in patients with the recommended BMI index. We will also compare the risk of neurovascular bundle injury and postoperative complication rate regarding the surgical wound. Patients who underwent surgery using the AMIS method in the period between 1/2020 and 4/2023 were assessed retrospectively. The study included 1150 implantations. The entire study population was assessed for neurovascular bundle injury and surgical wound healing complications. For this purpose, the patients were divided into two groups based on the BMI, namely BMI < 35 kg/m2 (n=1042) and BMI > 35 kg/m2 (n=108). In patients with the BMI ≤ 25 kg/m2 (n=280) and BMI ≥ 35 kg/m2 (n=108), the inclination and anteversion values were compared. Standard centered AP view X-rays of their operated joints were assessed. The Liaw's method was used to calculate the anteversion and inclination. In group one of patients with BMI ≤ 25 kg/m2 (208 women and 72 men), the arithmetic mean of acetabular anteversion was 25.4° (median 25°) and inclination was 38.3° (median 38°). In group two, which consisted of patients with BMI ≥ 35 kg/m2 (59 women and 49 men), the total arithmetic mean of acetabular anteversion was 25.1° (median 25) and inclination was 37.6° (median 37.5°). The anteversion and inclination were assessed using the Mann-Whitney test for equality of medians. The value of 0.05 was chosen as the level of signifi cance. The resulting p-value was 0.5359 in anteversion and 0.3763 in inclination. Since the p-value of both anteversion and inclination was greater than the chosen level of signifi cance, their medians have not been confi rmed to differ signifi cantly. A total of 6 cases of femoral nerve injury was reported, i.e. 0.5% out of 1150. Therefore, the risk of injury was 0.4% in the group with BMI < 35 kg/m2 (n=1042). On the contrary, in the group of patients with BMI > 35 kg/m2 (n=108), the risk was 2%. No injury to femoral artery was reported. The surgical wound healing complications were seen in a total of 87 cases (7.6%). In the group with BMI < 35 kg/m2 , healing complications of the surgical wound were observed in 7.4% of cases, with the need for revision surgery in 7 patients. In the group with BMI > 35 kg/ m2 , healing complications occurred in 13% of patients and wound revision was necessary in 4 cases. Our results are consistent with those in the published studies that also show no signifi cant difference in anteversion and inclination of components in the compared groups of obese patients. We also agree with the other authors that the rate of complications regarding surgical wound healing is higher in these patients. The risk of neurovascular bundle injury in this study population is not higher than the standard. The results obtained in our study population show that this method can also be used in patients with higher BMI, with no concern about the implantation of components in malposition or a higher risk of neurovascular injury. Nonetheless, potentially higher risk of surgical wound healing should be considered when this approach is opted for. With the appropriate surgical technique, AMIS is a safe method and, in our view, the fi rst choice especially for obese patients. AMIS, anteversion, inclination, hip joint, obesity, BMI, implantation, total joint replacement.

Risk of Diabetes Mellitus in Carotid Artery Involvement Among Coronary Artery Disease Patients Including History of Infection and Antibiotics Uses

Background: Diabetes mellitus causes involvement of coronary artery diseases. Objective: The purpose of the present study was to determine the risk of diabetes mellitus in the involvement of carotid artery among coronary artery disease patients. Methodology: This case-control study was conducted in the Department of Cardiology at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from July 2013 to June 2015 for a period of two years. Patients who had coronary artery diseases or ischemic heart diseases and diabetes mellitus undergoing coronary angiography were selected as case of this study. In control group, age, sex match patients of IHD undergoing CAG not having DM were included. Every patient was clinically examined by detailed history and physical examination during entry into study. ECG, chest X-ray, echocardiogram, blood sugar (fasting), blood 2 hrs. after 75 gm of glucose and or breakfast were analyzed. Coronary angiography was done in all patients through femoral approach by modified Seldinger technique. Carotid arteriography was performed selective and non­selective method by Hunter head or right Judkin's catheter in standard AP, lateral and oblique views. Results: A total number of 100 patients were included in this study. Of them 50 patients were coronary artery disease with diabetes mellitus and another 50 patients were coronary artery disease without diabetes mellitus. The mean height of the DM was 163.4±8.5 cm and in NDM was 160.6±7.1 cm, mean weight of DM 63.5±7.2 kg, in NDM was 62.0±15.4 kg and mean BMI in DM was 26.24±2.36 kg/m2 and in NDM was 26.38±2.05 kg/m2. The mean total cholesterol in DM was 236.9±34.1 mg/dL and in NDM was 208.0±36.4 mg/dL, mean serum TG in DM 240.5±76.3 mg/dl and in NDM was 207.6±57.8 mg/dl and mean serum IDL in DM was 166.1±130.6 mg/dL and in NDM was 142.8±30.4 mg/dL, no significant mean difference was observed between DM and NDM in height, weight and BMI (P&gt;0.05). Concussion: In conclusion, significant mean difference is observed between DM and NDM in total cholesterol, serum triglycerides. Bangladesh Journal of Medical Microbiology, July 2023;17 (2):82-87

Characteristics of Carotid Artery among Ischemic Heart Disease Patients with or without Diabetes Mellitus

Background: Involvement of coronary artery can vary among the ischemic heart disease patients with or without diabetes mellitus. Objective: The purpose of the present study was to assess the characteristics of carotid artery among ischemic heart disease patients with or without diabetes mellitus. Methodology: This case-control study was conducted in the Department of Cardiology at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. The study was carried out from July 2003 to June 2005 for a period of two years. Patients who had coronary artery diseases or ischemic heart diseases and diabetes mellitus undergoing coronary angiography were selected as case of this study. In control group, age, sex match patients of IHD undergoing CAG not having DM were included. Every patient was clinically examined by detailed history and physical examination during entry into study. ECG, chest X-ray, echocardiogram, blood sugar (fasting), blood 2 hrs. after 75gm of glucose and or breakfast were analyzed. Coronary angiography was done in all patients through femoral approach by modified Seldinger technique. Carotid arteriography was performed selective and non­selective method by Hunter head or right Judkin's catheter in standard AP, lateral and oblique views. Results: A total number of 100 patients were included in this study. Of them 50 patients were coronary artery disease with diabetes mellitus and another 50 patients were coronary artery disease without diabetes mellitus. Morphological character of the lesion was also assessed. The mean age was found 57.48 years with 6.04 standard deviation (SD) in DM and 55.64 years with 6.34 standard deviation in NDM group and also 56.56 years with 6.49 standard deviation in the whole study population. The value of unpaired t-test was 0.158 and it was insignificant (p&gt;0.05). The common site of lesion was bifurcation, internal carotid, common carotid and external carotid artery which were 13 cases, 9 cases, 4 cases and 1 case respectively. The individual vessel involvement was 9(18.0%) cases in right, 6(12.0%) cases in left, and 3(6.0%) cases in both in DM group whereas 5 (10.0%) cases in right, 3(6.0%) cases in left, and 1(2.0%) case in both in NDM group. It observed that out of 100 study subjects 10 had complex carotid lesion in DM and 4 in NDM. Concussion: In conclusion the common site of lesion was bifurcation and internal carotid artery mostly in right side. Journal of Current and Advance Medical Research, January 2023;10(1):7-12

The Plumbline: A Novel Radiographic Tool for Assessment of Metatarsus Adductus with Hallux Valgus

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Metatarsus adductus (MTA) is a complex multiplanar deformity of the foot which has a 30% reported approximate radiographic incidence in patients with symptomatic hallux valgus (HV). Various radiographic angles have been proposed for the assessment of MTA, but these measurements can be complex with a broad range of interrater reliability. We propose a simplistic radiographic assessment method termed the ‘plumbline’ to identify the presence of MTA and to ascertain if enough physical space is available to align the first metatarsal to the longitudinal foot axis via an isolated 1st ray procedure, or if necessary, through a combined approach which also addresses the lesser metatarsals. This method provides a visual reference to determine if a physical blockade to 1st ray correction is present. Methods: The plumbline is assessed on standard weight-bearing AP radiographs. Neutral foot positioning is key as a pronated or supinated clinical position of the foot will impact the alignment of this and other radiographic angular relationships. A transverse midfoot axis line is drawn by identifying and linking two individual points marked at the calcaneocuboid joint and the talonavicular joint. A third point is marked at the distal lateral apex of the medial cuneiform at the first tarsometatarsal joint. A 90° line is subtended from the transverse midfoot axis line, crosses the third point, and extends distally to the 2nd metatarsal head. A positive radiographic plumbline occurs when this line intersects the 2nd metatarsal indicating the need to correct the adducted lesser metatarsal position prior to addressing HV. A negative plumbline remains tangential to the 2nd metatarsal and indicates an isolated HV correction is possible. Results: The metatarsus adductus angle (MAA) measured via Sgarlato's method (SA), and the plumbline were recorded in patients (N=20) scheduled for HV surgery. Initially the cohort was subdivided into subjects deemed to have a normal MAA (SA &lt; 15°; N=10) and an abnormal MAA (SA&gt;15°; N=10). A mean pre-operative MAA measurement of 8.1° (SD 2.3; range 5, 12.1) and 26.5° (SD 4.5; range 19.2, 33.7) were found in these respective subsets. All subjects (100%) with an MAA &lt; 15° (N=10) were found to have a negative plumbline radiographically and subjects (100%) with a MAA &gt;15° (N=10) presented with a positive plumbline. The plumbline findings identified when an isolated HV correction would have been possible or impeded based upon 2nd metatarsal position, thus driving the surgical decision making algorithm. Conclusion: The plumbline is used to determine when concomitant MTA and HV correction is beneficial without the need to measure other more traditional radiographic angular relationships. It is a quick and simple method of evaluating the proximity of the metatarsal segments to determine if the first metatarsal is amenable to reduction in isolation or if correction will be limited due to a 2nd metatarsal bone blockade. The visual simplicity of the measurement can also aid in patient education and surgeon satisfaction when describing the surgical approach to this complex three-dimensional anatomic pathology.

DOES THE FALSE PROFILE VIEW REALLY SHOW ANTERIOR COVER?

To quantify the acetabular coverage of the femoral head, Lequesne's vertical-center-anterior edge (VCA) angle is used on the false profile view. Lateral coverage is determined by Wiberg's lateral-center-edge (LCE) angle on an ap pelvic view. The delimitation of the weightbearing area is defined by the end of the subchondral sclerosis line for both views. To our knowledge the exact anatomic location of the points used for measurement on the acetabular rim are not known.Six hips from three cadaver pelvises (3 male and 3 female) were investigated. The anterior and lateral points of interested were identified radiographically using fluoroscopy and marked with 1mm ceramic bullets. Standard false profile views and ap pelvic views in neutral inclination and rotation were taken to check the correct location of the ceramic bullets. A CT of each pelvis was made to locate the ceramic bullets and to define the exact anatomic location of the measurement points on the o'clock position. 6 o‘clock was defined as the midpoint between anteroinferior and the posteroinferior rim edges. Values were normalized for a right hip.The mean clockface location for the VCA was 1:33 (range, 1:15 to 1:40) and for the LCE 0:38 (range, 0:20 to 0:50).The LCEA is slightly anterior to the 12 o'clock position and remains useful to quantify the lateral coverage. Surprisingly, the point used for measuring the VCA is only about 30° (1h) anterior of the point used for measuring the LCEA. Its value for determining anterior cover has to be questioned. The discrepancy to other studies in the literature is because this study identifies and measures the end of the weight bearing zone, and not the border of the bony acetabulum.

Multi-Body 3D-2D Registration for Robot-Assisted Joint Reduction: Preclinical Evaluation in the Ankle Syndesmosis.

Existing methods to improve the accuracy of tibiofibular joint reduction present workflow challenges, high radiation exposure, and a lack of accuracy and precision, leading to poor surgical outcomes. To address these limitations, we propose a method to perform robot-assisted joint reduction using intraoperative imaging to align the dislocated fibula to a target pose relative to the tibia. The approach (1) localizes the robot via 3D-2D registration of a custom plate adapter attached to its end effector, (2) localizes the tibia and fibula using multi-body 3D-2D registration, and (3) drives the robot to reduce the dislocated fibula according to the target plan. The custom robot adapter was designed to interface directly with the fibular plate while presenting radiographic features to aid registration. Registration accuracy was evaluated on a cadaveric ankle specimen, and the feasibility of robotic guidance was assessed by manipulating a dislocated fibula in a cadaver ankle. Using standard AP and mortise radiographic views registration errors were measured to be less than 1 mm and 1° for the robot adapter and the ankle bones. Experiments in a cadaveric specimen revealed up to 4 mm deviations from the intended path, which was reduced to <2 mm using corrective actions guided by intraoperative imaging and 3D-2D registration. Preclinical studies suggest that significant robot flex and tibial motion occur during fibula manipulation, motivating the use of the proposed method to dynamically correct the robot trajectory. Accurate robot registration was achieved via the use of fiducials embedded within the custom design. Future work will evaluate the approach on a custom radiolucent robot design currently under construction and verify the solution on additional cadaveric specimens.

EXPLORING THE APPLICATIONS OF ISLANDED KEYSTONE FLAP IN THE INDIAN POPULATION

This study aims to explore keystone ap for various soft tissue defect reconstruction, demonstrating its exibility, efciency, reliability and practicality in the Indian population. 30 aps were performed to cover various soft tissue defects. All aps were planned according to the original ap design and standard post-operative patient and ap care was given. All the aps were easy to perform and gave satisfactory 'like tissue' replacement for the defects. Intra-operative and post-operative period was uneventful. After being discharged with necessary advice, patients were followed up regularly for up to a period of six months. All aps settled well with tissue match in function, texture, colour and sensitivity. Hence keystone ap can be considered as a versatile and sturdy one with a short learning curve and can be useful tool for even novice surgeons.

The Reliability of Acromioclavicular Joint Dislocation Classification Systems: A Comparison Between the Rockwood and Kraus Classifications.

The Rockwood system for the classification of acute acromioclavicular (AC) joint dislocations has been associated with a lack of reliability. A novel system has been proposed (Kraus classification) that is based on dynamic posterior translation of these injuries. To assess the interobserver and intraobserver reliability of the Rockwood and Kraus classification systems and also to examine the impact of surgeon experience on the assessments. Cohort study (diagnosis); Level of evidence, 3. Included were 45 patients with acute AC joint injuries who underwent a radiographic examination using standard bilateral AP and modified Alexander views. For interobserver reliability, 6 shoulder surgeons (expert group) and 6 orthopaedic residents (novice group) reviewed the radiographs to classify injuries according to the Rockwood and Kraus classifications; for each categorization, the participants chose between nonoperative management and surgical treatment. The evaluation was repeated 6 weeks later to determine intraobserver reliability. Kappa (κ) coefficients and their 95% CIs were used to compare interobserver and intraobserver reliability for each classification system according to assessor experience. Statistical differences were considered significant when the upper and lower boundaries of the 95% CI did not overlap. The overall interobserver agreement for diagnosis (both novice and expert groups) was moderate (κ = 0.52 [95% CI, 0.51-0.54]) for the Rockwood classification and substantial (κ = 0.62 [95% CI, 0.53-0.65]) for the Kraus classification; however, no significant differences were observed between the κ values. The overall interobserver agreement for treatment selection was substantial when using both the Rockwood (κ = 0.78 [95% CI, 0.72-0.81]) and Kraus (κ = 0.77 [95% CI, 0.66-0.87]) classifications. The overall intraobserver agreement for diagnosis was substantial using both the Rockwood (κ = 0.65 [95% CI, 0.61-0.67]) and Kraus (κ = 0.73 [95% CI, 0.69-0.75]) classifications. There were no significant differences between the novice and expert groups on any of the evaluations. The Kraus system was slightly more reliable than the Rockwood system for classifying AC joint injuries both between assessor groups and overall. The level of surgeon experience had no impact on the evaluations.

Acromion Morphology of Patients with Rotator Cuff Disease in Standard AP Shoulder Radiograph in Hospital Sultanah Bahiyah and Hospital Kuala Lumpur.

Rotator cuff pathology is commonly attributed to acromion morphology that is demonstrable in standard AP shoulder radiographs by measuring the critical shoulder angle (CSA), the lateral acromial angle (LAA), and the acromial index (AI). However, these parameters vary among races and countries. Therefore, our study aimed to get the local data on acromion morphology in patients with rotator cuff disease. MRI shoulder reports between January 2012 and June 2018 were reviewed. The study group consisted of 47 patients with rotator cuff injury with a partial or complete tear, and a control group of 37 patients with tendinitis or osteoarthritis and intact rotator cuffs. The CSA, LAA, and AI of both groups were measured on the anteroposterior shoulder radiograph. The risk factors for both groups and the acromion morphology were recorded. The CSA for the rotator cuff tear and the control group was 39.08° and 38.28°, LAA was 72.57 ° and 73.51°, and AI was 0.79 and 0.75. The acromion morphology differed in terms of gender, and only LAA was different among the different ethnic groups. There was a negative correlation between age and CSA, age and AI, LAA and CSA, LAA and AI, but a positive correlation between AI and CSA. The CSA for rotator cuff tear patients in our population was 39.08°, LAA was 72.57°, and AI was 0.79. The acromion morphology was significantly influenced by age and gender.

Factors associated with acetabular degeneration and protrusion in bipolar hip hemiarthroplasty

Purpose&#x0D; This study aims to investigate the effect of some factors such as the diameter of bipolar prosthetic heads, body mass index (BMI), age, gender, bone mineral density (BMD) and leg length discrepancy (LLD) on the acetabular protrusion in elderly patients who had hip bipolar hemiarthroplasty (BHA) after femoral neck fractures.&#x0D; Methods&#x0D; The study included a total of 209 patients with a mean age of 77.4 ± 6.0 years who underwent BHA. The difference between the femoral head diameter of the patients and the diameter of the bipolar prosthetic head was divided into two groups, ranging from 0 to -2 mm (same and 1,2 mm small size) . Acetabular enlargement and cartilage degeneration were followed by standard AP pelvis radiographs and clinical outcomes were evaluated by the Harris Hip Score (HHS) after surgery and during 5 years of follow-up.&#x0D; Results&#x0D; During the 5-year follow-up, while HHS values decreased, acetabular diameter increased. Acetabular protrusion developed in 21 (10%) patients, acetabular revision surgery was performed for 36 (17%) patients, the difference between native femoral head diameter and prosthetic head diameter was significantly higher in these groups, as was mean LLD (p = 0.0001). Mean T scores obtained with BMD were lower in these groups (p = 0.0001).&#x0D; Conclusion&#x0D; It is safer and more reliable to use a bipolar prosthetic head the same size as the patient’s native femoral head in BHA. When considering the acetabular protrusion and revision surgery rate in this study, small-size bipolar prosthetic head implantation is not recommended and may cause devastating complications.

Remote Control and Fault Diagnosis of Port Mechanical Equipment Based on Wireless Communication Technology

In order to solve the problem that there is a huge amount of port machinery operating state data, the traditional fault diagnosis method is difficult to effectively obtain the mechanical fault information from the massive data and also cannot accurately diagnose the fault. This paper presents a fault diagnosis method for port machinery based on the FastAP algorithm. By analyzing the characteristics of the FastAP algorithm, the algorithm is introduced into port machinery fault diagnosis, and a port machinery fault diagnosis model based on FastAP is proposed. Through simulation experiments, the algorithm and its application in port machinery fault diagnosis are verified. The experimental results show that compared with the standard AP algorithm, the FastAP algorithm performs well in the sum of similarity, clustering accuracy, and clustering calculation time and has better performance, which is more suitable for fault diagnosis. The fault diagnosis method based on the FastAP algorithm has a high diagnosis accuracy of port machinery fault, reaching more than 92%, and can accurately diagnose the normal state, inner and outer ring fault state, and rolling element fault state of the actual port mechanical belt conveyor. The research on remote control and fault diagnosis of port machinery equipment based on wireless communication technology can effectively solve the problem that there is a huge amount of port machinery operating state data, and the traditional fault diagnosis methods are difficult to effectively obtain mechanical fault information from the massive data and thus cannot accurately diagnose the fault.

Functional and radiological outcomes of distal humerus fractures treated with pre-contoured locking compression plate

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Distal humerus intra-articular fractures are one of the complicated fractures managed by orthopaedic surgeons. We did a prospective and a retrospective study on 21 patients with these fractures treated with pre-contoured locking compression plate.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The&lt;strong&gt; &lt;/strong&gt;21 patients in this series were followed for a minimum of 1 year. The prospective study cases were followed at 3 months, 6 months and annually. The rating system of the Mayo elbow functional scoring system was used. The radiological evaluation was done using standard AP and lateral views.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We had 14 patients with range of motion of 50-100 degrees. There was only one patient with range of motion of &amp;lt;50 degrees. 6 patients had the maximum range motion of &amp;gt;100 degrees. We had 6 (23.57%) excellent, 9 (42.85%) good, 5 (23.80%) fair and 1 (4.7%) poor in the Mayo elbow scoring at the end of 1 year. We were able to compare our outcomes with a study done by Kumar et al done in 2017. They had 27 (89.66%) of excellent and good results as opposed to 27 (79.4%) in our study. Out of 21 patients in our study 17(80.95%) patients had good 11 (52.5%) / excellent 6 (28.5%) results. This was comparable with Jupiter et al. His study of 34 patients 26 (79.40/0) patients showed good 14 (41%) / excellent 13 (38.4%) result.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Pre-contoured locking compression plate appears to be technically an ideal implant for comminuted osteoporotic bone providing an angle stable construct.&lt;/p&gt;

Radiological assessment of collapse of distal end radius fracture followed by close reduction and cross k wire fixation

Background: Distal end radius fractures are the commonest occurring fractures occurring in upper extremity. They represent one-sixth of all fractures treated in emergency department. The present study was conducted to assess collapse in distal end radius fracture following close reduction and cross K wire fixation using standard AP and lateral radiological parameters of reduction.Materials & Methods: A sample of 40 patients who underwent K wire fixation for unstable fractures of distal radius over a period of 18 months reporting serially to the orthopaedics OPD a single tertiary hospital were included.Results: The mean immediate postoperative volar tilt was 10.08°, while at 6 weeks postoperative, it was found to be 8.91° respectively. The mean immediate postoperative radial inclination was 24.02°, while at 6 weeks postoperative, it was found to be 22.67° respectively. The mean immediate postoperative Ulnar variance was 0.38 mm while at 6 weeks postoperative, it was found to be – 0.008 mm respectively. Significant results were obtained while comparing the Ulnar variance at different postoperative time intervals. Collapse in volar tilt after K wire removal was seen in 71.11 percent of the patients. Among these, 1°, 2° and 3° collapse of volar tilt was seen in 31.11 percent, 33.33 percent and 6.67 percent of the patients respectively.Conclusion: The closed reduction and percutaneous K-wire fixation is a least invasive, safer, and effective method to maintain the reduction, prevent significant collapse during healing, and maintain the stability of the distal radio-ulnar joint even when the fracture is grossly comminuted, intra-articular, or unstable.

The Effect of Adjuvant Concentration on Changes of Spray Characteristics and Spraying Parameters for Selected Types of Nozzles

Abstract The paper presents the results of the research on the influence of the adjuvant concentration on the size of the drops produced by the spray nozzles of agricultural sprayers. For the tests, adjuvant Normaton with the composition of total nitrogen, amide nitrogen (N-NH2) and phosphorus pentoxide (P2O5) was used. The adjuvant was added to the water taken from the municipal water supply system of the city of Lublin. The tests were carried out for three concentrations, i.e. 75%, 100%, and 125% of the adjuvant concentration recommended by the manufacturer, and water without the adjuvant. The surface tension of water with adjuvant was examined for each nozzle. Then, the size of the obtained droplets was measured for each adjuvant concentration. Two types of nozzles were used for spraying, standard nozzle AP 120-03 and 6MSC injector nozzle, both with the same nozzle flow rate, but with a different design. The size of the droplets produced was measured on a HELOSVARIO laser diffractometer by Sympatec. The droplet measurement was performed at a pressure of 3 bar. The nozzle was placed 50 cm above the diffractometer laser light line. The droplet size was measured in three places of the sprayed liquid, i.e. in the position of the nozzle axis, 30 and 60 cm from the nozzle axis. It was shown that the addition of the adjuvant influenced the number of droplets produced in the indicated droplet size classes.

Diagnosis, imaging, and potential morbidities of the hallux interphalangeal joint os interphalangeus.

Hallux pain is a common entity with a differential diagnoses including hallux valgus, hallux limitus/rigidus, and gout and specifically at the interphalangeal joint (IPJ), flexor hallucis longus (FHL) tenosynovitis, and joint arthrosis. An under-recognized source of pain is the os interphalangeus, an ossicle typically located at the plantar aspect of the hallucal interphalangeal joint. This ossicle is radiographically visible in its ossified form in 2-13% of individuals, but can also be present as an ossified or non-ossified nodule in patients. The os interphalangeus may be centrally or eccentrically located, and although originally believed to be a sesamoid bone in the FHL tendon, it is an ossicle located in the joint capsule of the IPJ and separated from the tendon by a bursa. When the ossicle is absent, the bursa is also absent and the tendon is attached to the joint capsule. Infrequently, the os may be located eccentrically under the first IPJ and reflect persistence of one of the distal phalanx. Rarely, the os interphalangeus may be dorsal to the IPJ. The os interphalangeus is best evaluated on radiographs, ultrasound, and MRI. Pain is a result of altered mechanics with arthrosis or frictional effects with bursitis, tenosynovitis, or intractable plantar keratosis (IPK). The ossicle may also displace into a dislocated IPJ, preventing reduction. The os interphalangeus may be centrally or eccentrically located, and although originally believed to be a sesamoid bone. This has been found within the plantar joint capsule of the distal hallucal interphalangeal joint and separated from the tendon by a bursa. Uncommonly, the location may be plantar eccentric and reflect persistence of one of the ossification centers of the distal phalanx. Although the ossicle can be imaged with standard AP and lateral radiographs in many cases, in those cases of unexplained pain with no radiographically visible ossicle, and the presence of friction blisters, intractable plantar keratosis (IPK), hyper-extension of the IPJ, hallux limitus/rigidus, or metatarsophalangeal joint (MTPJ) arthrodesis, an MRI or CT should be considered to identify a non-ossified fibrocartilaginous node. This is of particular concern in a patient with a history of underling diabetes mellitus or other metabolic disorders associated with diminished pedal sensation where neurotrophic changes place them most at risk for complications associated with excessive plantar pressure. Pain is a result of altered biomechanics with arthrosis, or frictional effects causing bursitis, tenosynovitis, or IPK. The ossicle may also displace into a dislocated IPJ, preventing reduction. In this article, we will describe the anatomy and imaging appearance of the common os interphalangeus variants and associated complications including frictional effects, arthrosis, and IPK and discuss conservative and surgical management of a symptomatic ossicle.

Medial cortical positive support: A key factor for the postoperative stability of proximal humerus fractures.

Treatments for proximal humerus fractures (PHFs) often fail to achieve anatomical reduction. The purpose of this study was to evaluate the role of positive medial cortical support (PMCS) in the nonanatomical reduction of PHFs.A retrospective analysis was performed of 78 patients with PHFs who underwent surgery from August 2014 to September 2017 and whose treatments did not achieve anatomical reduction. Based on the results of standard AP radiographs of the shoulders 3, 6, and 12 months after surgery, the patients were divided into PMCS or negative medial cortical support (NMCS) groups. The postsurgical change in head-shaft angle (HSA) between the 2 groups was compared. Shoulder joint function and visual analog scale (VAS) scores of the 2 groups were also compared at the same time.Of the 78 patients analyzed, 37 were in the PMCS group and, 41 in the NMCS group. There was no statistically significant difference in any of the characteristics of the 2 groups (P > .05), or in postsurgical HSA. However, the HSA of the 2 groups had become significantly different (P < .05) 3, 6, and 12 months following surgery. The changes in HSA of the 2 groups were different at various time points (P < .05). One year after surgery, the shoulder function score of the PMCS group was significantly better than that of the NMCS group, as was the VAS score (both P < .05).Patients whose surgery for PHF does not achieve anatomical reduction during surgery can undergo PMCS to achieve improved results, postoperatively. NMCS should be avoided as far as possible.

INTEROBSERVER VARIABILITY IN LIMB LENGTH DISCREPANCY IN THR ON RADIOGRAPH - A MULTICENTRIC STUDY.

Introduction: Restoration of limb length is one of the most important aims after total hip replacement . The measurement is often done by various radiological methods ,but its measurement is often difcult and variable. We studied to check if measurements of limb length discrepancy has interobserver variability using standard anteroposterior radiograph. Material and methods: Forty patients (40 hips) underwent measurement of limb length discrepancy on standard AP radiographs. The measurement was done by two observers from two different institutions (On digital X-ray AP view of hip, a line is drawn at the level of &amp; parallel to inter teardrop area and intersecting the lesser trochanter on each side. Compare 2 points of intersection &amp; measure difference to determine the amount of limb discrepancy). Results:There was excellent inter-observer agreement for radiological measurments kappa=0.867 (good aggrement) for pre-operative radiographic measurements and kappa=0.811(good aggrement) for post-operative radiographic measurements. Conclusions: Our data show use of radiological measurement of Limb Length Discrepancy (using intertear drop as pelvic reference and lesser trochanter as femoral reference) has excellent interobserver agreement and hence is more reliable than manual measurement of Limb Length Discrepancy