Standard Radiographs Research Articles

Bone Stability After Immediate Implants and Alveolar Ridge Preservation: A 15-Year Retrospective Clinical Study

Background: In modern dentistry, alveolar socket preservation after tooth extraction plays a critical role in maintaining the alveolar ridge for future dental implants. This retrospective clinical study evaluated bone-level changes 15 years after immediate implant placement, coupled with alveolar ridge preservation. Methods: Fifty non-smoking patients aged 25 to 75 (30 males and 20 females) who underwent single-implant rehabilitation in both anterior and posterior regions of the upper and lower jaws were included. The study examined bone levels and implant survival over time, using standardized intraoral radiographs at 1, 5, and 15 years post-loading. Implants were placed immediately after atraumatic extraction, and the residual gap was grafted with bovine hydroxyapatite and covered with a collagen membrane. The primary outcome was bone-level stability, while secondary outcomes included implant failure. No temporary crowns or removable dentures were provided during healing. Radiographs were digitized for detailed analysis. Results: The results for 50 patients with immediate implant placement showed that bone-resorption levels were significantly higher in the upper jaw than in the lower jaw. Conclusions: Posterior implants exhibited greater bone loss than anterior implants, particularly at 1 year and 15 years, while no implant failures occurred.

Ultrasound in the Evaluation of Acute Trauma.

Ultrasound in the Evaluation of Acute Trauma.

The Mark Coventry Award: Does Matching the Native Coronal Plane Alignment of the Knee Improve Outcomes in Primary Total Knee Arthroplasty?

The coronal plane alignment of the knee (CPAK) classification system was developed to assess personalized alignment strategies, such as kinematic alignment, in total knee arthroplasty (TKA). However, CPAK has not been studied with regard to patient-reported outcome measures (PROMs). This study evaluated whether incidentally matching a patient's native preoperative CPAK classification with TKA implant position meaningfully impacted postoperative PROMs. A retrospective review of 2,427 primary TKAs was performed. Knees were classified using the CPAK classification on standardized preoperative and postoperative short-leg radiographs using a five-degree adjustment for the lateral distal femoral angle based on available literature. Surgeries were performed using adjusted mechanical alignment strategies with a three-degree boundary. Patients who had a matching preoperative and postoperative CPAK were compared to all other combinations. Modern PROMs and clinically important differences were analyzed utilizing univariate and multivariate analyses. There were 94.5% of native knees classified as CPAK I to III, like published CPAK distributions. The distribution of postoperative CPAK classification was significantly different, with 25.6% of TKAs classified as CPAK I to III (P < 0.001), and only 11.5% (N= 266) of postoperative CPAK matched the native preoperative classification. The CPAK was not associated with preoperative (P ≥ 0.208) or postoperative PROMs (P ≥ 0.085), except CPAK I had significantly higher preoperative pain with level walking compared to CPAK III only (P= 0.027). Patients who had matching preoperative and postoperative CPAK classes demonstrated no difference in PROMs at a median of 24 months of follow-up (P ≥ 0.143). Statisticalpower was ≥93.9%. Study results demonstrate that matching a patient's native knee coronal alignment classified by CPAK was not predictive of PROMs. This supports prior research that suggests TKA outcomes are multifactorial and related to complex interactions between implant position in three dimensions as well as soft-tissue balance and kinematics. III.

Union rates following power rasp joint preparation for foot and ankle arthrodesis: A retrospective study of 418 fusions.

Union rates following power rasp joint preparation for foot and ankle arthrodesis: A retrospective study of 418 fusions.

Factors associated with knee pain at early stages of osteoarthritis

Objective: To investigate key risk factors associated with knee pain in early-stage osteoarthritis (OA).Material and methods. The study included 109 women aged 35–75 years with knee pain lasting no more than one year and minimal radiographic changes (Kellgren–Lawrence grades 0–II). For each patient we filled in a personalized case form including anthropometric data, medical history, physical examination findings, pain and health status assessments using visual analog scale (VAS), and questionnaires (WOMAC, KOOS, DN4), along with information on comorbidities. All participants underwent standard knee radiography, ultrasound examination, and laboratory testing.Results and discussion. One in six patients (15%) reported moderate or severe knee pain (≥40 mm on VAS). Patients with more intense pain were older than those with VAS &lt;40 mm (median age 52.5 [42; 62.5] vs. 44 [38; 52] years; p=0.02) and had a higher body mass index (28 [25; 31.6] vs. 24 [21; 28] kg/m2; p=0.04). Statistically significant differences were also observed in OA severity: the high-pain group had higher WOMAC and all its components’ scores (median 1245 [872; 1510] vs. 248 [90; 410] mm; p&lt;0.001), lower self-rated health status (60 [47; 80] vs. 29.5 [10; 50] mm; p&lt;0.001), lower KOOS total scores and its components’ scores (44 [37; 67] vs. 79 [63; 88] %; p&lt;0.001), and more frequent detection of synovitis on examination (50% vs. 19.3%; p&lt;0.001) and in the past history (75% vs. 31.1%; p=0.008). Flexion restriction (50% vs. 19.3%; p=0.01), presence of osteophytes on ultrasound (50% vs. 10.75%; p&lt;0.001), metabolic syndrome (56.25% vs. 25.8%; p=0.03), and postmenopausal status (68.75% vs. 35.48%; p=0.01) were also more frequent.A discriminant model was developed to predict the risk of pain ≥40 mm on VAS, incorporating WOMAC functional limitations, presence of metabolic syndrome, ultrasound-detected osteophytes, and clinically significant synovitis. The model achieved an accuracy of 90.8%. Predictive performance was confirmed by ROC analysis (AUC=0.898, 95% CI 0.794–1.002), indicating high prognostic accuracy.Conclusion. Severe knee pain at early stages of OA is associated with functional impairment according to WOMAC, clinical synovitis, ultrasounddetected osteophytes, and metabolic syndrome. These risk factors and the developed predictive model may be useful for planning individualized preventive and therapeutic strategies in OA patients.

Rare case of isolated trapezoid fracture: a case report

Rare case of isolated trapezoid fracture: a case report

Automated Pneumothorax Segmentation with a Spatial Prior Contrast Adapter

Pneumothorax is a critical condition that requires rapid and accurate diagnosis from standard chest radiographs. Identifying and segmenting the location of the pneumothorax are essential for developing an effective treatment plan. nnUNet is a self-configuring, deep learning-based framework for medical image segmentation. Despite adjusting its parameters automatically through data-driven optimization strategies and offering robust feature extraction and segmentation capabilities across diverse datasets, our initial experiments revealed that nnUNet alone struggled to achieve consistently accurate segmentation for pneumothorax, particularly in challenging scenarios where subtle intensity variations and anatomical noise obscure the target regions. This study aims to enhance the accuracy and robustness of pneumothorax segmentation in low-contrast chest radiographs by integrating spatial prior information and attention mechanism into the nnUNet framework. In this study, we introduce the spatial prior contrast adapter (SPCA)-enhanced nnUNet by implementing two modules. First, we integrate an SPCA utilizing the MedSAM foundation model to incorporate spatial prior information of the lung region, effectively guiding the segmentation network to focus on anatomically relevant areas. In the meantime, a probabilistic atlas, which shows the probability of an area prone to pneumothorax, is generated based on the ground truth masks. Both the lung segmentation results and the probabilistic atlas are used as attention maps in nnUNet. Second, we combine the two attention maps as additional input into nnUNet and integrate an attention mechanism into standard nnUNet by using a convolutional block attention module (CBAM). We validate our method by experimenting on the dataset CANDID-PTX, a benchmark dataset representing 19,237 chest radiographs. By introducing spatial awareness and intensity adjustments, the model reduces false positives and improves the precision of boundary delineations, ultimately overcoming many of the limitations associated with low-contrast radiographs. Compared with standard nnUNet, SPCA-enhanced nnUNet achieves an average Dice coefficient of 0.81, which indicates an improvement of standard nnUNet by 15%. This study provides a novel approach toward enhancing the segmentation performance of pneumothorax with low contrast in chest X-ray radiographs.

Dental Implants Placed in Fresh Human Extraction Sockets Without Osteotomy: A Case Series

ABSTRACTObjectivesThis case series evaluates healing parameters of immediately placed implants in fresh extraction sockets without osteotomies. It examines resonance frequency analysis (RFA) trends and radiographic bone changes from placement to prosthetic restoration.Material and MethodsThe study reports on eight patients with 10 implants using a self‐tapping, knife‐shaped implant with progressive thread design and anatomical healing abutments. RFA values and standardized radiographs were recorded at three time points from placement to prosthetic restoration.ResultsImplants were placed in molar, premolar, and incisor sockets. All implants achieved insertion torque greater than 35 Ncm and high ISQ values. The median reported bone remodeling was 0.35 mm from implant placement to definitive restoration. RFA revealed a median of 64 ISQ buccolingually and 74 ISQ mesiodistally at placement, increasing to 76 ISQ buccolingually and 82 ISQ mesiodistally pre‐prosthetically.ConclusionsThe findings suggest that immediate dental implants placed without osteotomies in select anatomical conditions can achieve successful osseointegration and functional stability. However, given the small sample size, further studies with larger cohorts are necessary to validate these results.

Relationship between vitamin D and osteoarthritis

Osteoarthritis (OA) is a common joint disease and one of the leading causes of disability worldwide. The role of vitamin D in the etiology and development of OA is still unclear, but it may be important for both diagnosis and timely therapy. To evaluate the relationship of vitamin D levels with clinical and instrumental parameters in OA in a cross-sectional study. The study included 171 patients aged 40-75 with confirmed knee OA according to the American College of Rheumatology (ACR) classification, stage I-III (according to Kellgren and Lawrence). All patients signed informed consent. The mean age was 53.5±9.94 years, body mass index (BMI) was 29.8±6.4 kg/m2, and disease duration was 3 [1; 7] years. For each patient, a case record form was filled out, including anthropometric indicators, medical history, clinical examination data, an assessment of knee joint pain according to the Visual Analog Scale (VAS), WOMAC, and the patient's general health condition (PGHC). All patients underwent standard radiography, knee ultrasound examination and magnetic resonance imaging (MRI) (WORMS), densitometry of the lumbar spine and femoral neck, and laboratory tests. Statistical processing of the data was performed using the Statistica 10 software. Normal vitamin D values (≥30 ng/mL) were found in 62 (36.3%) patients, low levels (<30 ng/mL) in 109 (63.7%) patients, insufficiency (<30 ng/mL and >20 ng/mL) in 66 (38.6%) patients, and deficiency (<20 ng/mL) in 43 (25.1%). Patients were divided into three groups according to the presence or absence of vitamin D insufficiency/deficiency: Group 1 included patients with normal vitamin D levels, Group 2 included patients with insufficiency, and Group 3 included patients with vitamin D deficiency. Patients of the three groups were comparable in age and disease duration but differed significantly in body weight, BMI, and waist measurement (higher in groups with reduced vitamin D values; p<0.05). Also, these patients had significantly higher VAS pain scores, total WOMAC and its components (pain, stiffness, and dysfunction), PGHC, and worse KOOS. More patients in Groups 2 and 3 had OA of the hip and hand joints, clinically detected synovitis, flat feet, and quadriceps muscle hypotrophy. Ultrasound examination significantly more often revealed a reduction of cartilage tissue on both the anteromedial and anterolateral surfaces of the knee joint; MRI showed more often osteitis in the medial condyles of the femur and tibia (p<0.05 for all values). Our study demonstrated that low blood vitamin D levels (insufficiency/deficiency) were associated with a more severe knee OA. These patients had a large body weight, BMI, higher VAS pain values, WOMAC index (overall and its components), worse KOOS, PGHC, and smaller cartilage sizes in the medial parts of the knee joint (according to ultrasound); such patients were significantly more likely to have osteitis in the medial parts of the femur and tibia according to MRI. Also, stage II and III knee OA and OA of other localizations, clinically detected synovitis, quadriceps hypotrophy, and flat feet were more common.

Hemoptysis revealing left pulmonary artery agenesis : A case report

Hemoptysis revealing left pulmonary artery agenesis : A case report

Risk Factors of Cervical Spine Involvement in Patients With Rheumatoid Arthritis in the Imaging Era: A Cross-Sectional Study.

Cervical spine involvement remains one of the more serious complications of rheumatoid arthritis (RA). Several factors interfere with the occurrence of this complication. The aim of this work was to identify the risk factors associated with cervical involvement, specifying the contribution of MRI in screening for rheumatoid cervical spine and discussing the value of standard X-rays. A cross-sectional study included 100 patients with RA who underwent both standard radiography and MRI of the cervical spine. Clinical, paraclinical and therapeutic data were collected. Cervical pain was the predominant functional sign. It was mechanical in 44% of cases and inflammatory in 29%. Physical signs revealed on clinical examination included: pain on cervical spine mobilisation (49%), cervical stiffness (37%) and abnormal neurological examination in 3% of cases. Standard radiographs revealed C1-C2 instability in 52% of cases: vertical displacement (28%), rotatory displacement (22%), anterior displacement (19%) and lateral displacement (1%). MRI confirmed the presence of the following types of atlantoaxial subluxation: vertical (34%) and anterior subluxation (27%). Other lesions were identified on MRI: synovial thickening (31%) with contrast enhancement (17%), hyperintensity on diffusion-weighted imaging (DWI; 6%) and odontoid erosion (16%). Cervico-Medullar Angle (CMA) was pathological (CMA<135°) in 3% of patients. A study of the correlation between patient-related parameters, RA-related parameters, cervical symptomatology-related parameters and rheumatoid C1-C2 involvement concluded that age was positively correlated with C1-C2 instability (p=0.036), as was the presence of Rheumatoid Factor (RF) (p=0.038), coxitis (p=0.042) and dry eye syndrome (p=0.039). Cervical spine stiffness was positively correlated with C1-C2 instability (p=0.01). The presence of inflammatory cervical pain (p=0), and painful mobilisation on examination (p=0.03) were correlated with C1-C2 synovitis. The 'RA and cervical spine' entity is associated with phenotypes of seropositive, destructive RA, with peripheral synovitis and systemic manifestations. Systematic clinical and radiological screening for this condition is essential to preserve functional prognosis. Diffusion imaging of the craniocervical region appears to be a valuable adjunct for the quantitative assessment of synovitis.

Management and outcomes of capitellum fractures in adolescents: A case series and review of the literature.

Management and outcomes of capitellum fractures in adolescents: A case series and review of the literature.

Mixed Manufacturer Combination With a Cementless Hemispherical Dual Mobility Cup and Polished Taper-Slip Cemented Femoral Stem: Short- to Medium-Term Results in Primary Total Hip Arthroplasty in Elderly Patients.

Mixed Manufacturer Combination With a Cementless Hemispherical Dual Mobility Cup and Polished Taper-Slip Cemented Femoral Stem: Short- to Medium-Term Results in Primary Total Hip Arthroplasty in Elderly Patients.

An AI-based system for fully automated knee alignment assessment in standard AP knee radiographs.

Accurate assessment of knee alignment in pre- and post-operative radiographs is crucial for knee arthroplasty planning and evaluation. Current methods rely on manual alignment assessment, which is time-consuming and error-prone. This study proposes a machine learning-based approach to fully automatically measure anatomical varus/valgus alignment in standard anteroposterior (AP) knee radiographs. We collected a training dataset of 566 pre-operative and 457 one-year post-operative AP knee radiographs from total knee arthroplasty patients, along with a separate test set of 376 patients. The distal femur and proximal tibia/fibula were manually outlined using points to capture the knee joint. The outlines were used to develop an automatic system to locate the points. The anatomical femorotibial angle was calculated using the points, with varus/valgus defined as negative/positive deviations from zero. Fifty test images were clinically measured on two occasions by an orthopaedic surgeon. Agreement between points-based manual, automatic, and clinical measurements was assessed using intra-class correlation coefficient (ICC), mean absolute difference (MAD) and Bland-Altman analysis. The agreement between automatic and manual measurements was excellent pre-/post-operatively with ICC 0.98/0.96 and MAD 0.8°/0.7°. The agreement between automatic and clinical measurements was excellent pre-operatively (ICC: 0.97; MAD: 1.2°) but lacked performance post-operatively (ICC: 0.78; MAD: 1.5°). The clinical intra-observer agreement was excellent pre-/post-operatively with ICC 0.99/0.95 and MAD 0.9°/0.8°. The developed system demonstrates high reliability in automatically measuring varus/valgus alignment pre- and post-operatively, and shows excellent agreement with clinical measurements pre-operatively. It provides a promising approach for automating the measurement of anatomical alignment.

Associated Risk Factors, Pathogenesis, Diagnosis, and Treatment Options for Multifocal Osteonecrosis: A Systematic Review.

Multifocal osteonecrosis (MFON) is defined as the diagnosis of osteonecrosis in at least three distinct anatomic sites that can occur consecutively or concurrently. It is important for arthroplasty surgeons to be aware of and manage these patients appropriately. There is a paucity of data surrounding the characterization, diagnosis, and treatment of MFON. The purpose of this investigation was to systematically review the literature to identify: (1) clinical presentation/epidemiology, (2) pathophysiology, (3) diagnostic modalities, and (4) treatment guidelines/algorithms of MFON. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic review across three databases, resulting in a total of 12 articles. Articles met the inclusion criteria if they provided data regarding: (1) clinical presentation/epidemiology, (2) pathophysiology, (3) diagnostic modalities, and (4) treatment guidelines/algorithms of MFON. There are many etiologies of MFON, though autoimmune diseases such as lupus and prior use of corticosteroids are most commonly implicated in the disease. The femoral head is the most common anatomic site involved, though other joints such as the knee, shoulder, and ankle can be commonly affected. Diagnosis is reserved for standard radiography and whole-body magnetic resonance imaging (MRI) for screening, with regional MRI reserved for additional staging of the disease. Treatment is similar to standard single or oligofocal osteonecrosis and involves joint preservation procedures if the joints are found before collapse and the use of arthroplasty following collapse if nonoperative modalities fail. Although MFON is a rare clinical condition, it is one that arthroplasty surgeons should be aware of and meticulously screen for in their patients. It is defined as the presence of osteonecrosis in three or more distinct anatomic sites either concurrently or consecutively. Arthroplasty surgeons should be wary of patients who have osteonecrosis and should be meticulous in screening these patients for multiple joint involvement.

X-Ray Diagnostics of Femoral Head Destruction in Patients with Hemophilia A

Abstract: Hemophilia A is a hereditary coagulation disorder that often leads to recurrent haemarthroses and progressive joint destruction, particularly in weight-bearing joints such as the hip. This study aims to evaluate the diagnostic capabilities of conventional X-ray imaging in detecting femoral head destruction in patients with Hemophilia A. A total of 36 male patients aged 12–45 years with moderate to severe Hemophilia A underwent standard anteroposterior pelvic radiographs. Radiological findings were assessed using the Arnold–Hilgartner classification and correlated with clinical data. The majority of patients exhibited Grade III or higher arthropathy, with common features including joint space narrowing, subchondral cysts, and femoral head flattening. A significant correlation was found between disease duration and severity of radiographic damage. The study confirms the continued relevance of X-ray imaging as an accessible, cost-effective method for assessing joint degeneration in hemophilia, especially in resource-limited settings

Non Operative Management of Post-Traumatic Esophageal Perforation in Children: A Case Report

Cervical esophageal perforation in children is generally less severe than thoracic or abdominal perforations, with slower spread to the mediastinum due to anatomical barriers. Common symptoms include neck pain, dysphagia, dysphonia, and subcutaneous emphysema, which is present in approximately 95% of cases. Diagnosis primarily relies on contrast-enhanced CT, which is the most sensitive modality (92–100%) and provides valuable information on disease extent and complications. Contrast esophagography remains the gold standard, with water-soluble agents like Gastrografin preferred initially. Standard radiographs may reveal prevertebral air or other signs, but early imaging can be falsely negative. Management depends on the severity and location. Nonoperative treatment may be appropriate for small, contained, iatrogenic perforations. Early-detected cases may be treated with endoscopic clipping. Surgical intervention, typically via left cervicotomy with primary repair and drainage, is reserved for more extensive or complicated cases. We present a case of cervical perforation of the esophagus in a 7 years old patient.

Prevalence and features of metacarpal pseudoepiphysis in Hong Kong Chinese children

Prevalence and features of metacarpal pseudoepiphysis in Hong Kong Chinese children

Reliability and Agreement of Four Patellar Height Measurement Methods in Knee Radiographs

This study aimed to evaluate and compare the reliability and agreement of four commonly used methods for patellar height measurement: Insall-Salvati (IS), Modified Insall-Salvati (mIS), Caton-Deschamps (CD), and Blackburne-Peel (BP) indices, using standardized lateral knee radiographs. This prospective study included seventy adult patients with standardized lateral knee radiographs. Radiographs met strict criteria for true-lateral views and appropriate knee flexion angles. Three observers independently measured patellar height using the four methods, each performing two rounds of measurements at a 15-day interval. Intraclass Correlation Coefficients (ICC) were calculated for intra-observer and interobserver reliability. Pairwise agreements between methods were analyzed using Cohen’s kappa with 95% confidence intervals (CI). Correlation coefficients (Pearson’s r) were computed to assess the relationships between the methods. The BP method exhibited the highest inter-observer reliability (ICC = 0.848, 95% CI: 0.754–0.910) and intra-observer reliability (average ICC = 0.908, 95% CI: 0.829–0.986). This was followed closely by the CD method, while the IS and mIS methods demonstrated moderate reliability. Correlation analysis revealed strong relationships between the BP and CD methods (r = 0.871, p &lt; 0.01) but weaker correlations between IS and the other methods. Despite high correlation coefficients, agreement in classification was poor, particularly between IS and BP (κ = -0.131) and IS and mIS (κ = -0.047).The Blackburne-Peel method is the most reliable and reproducible for patellar height measurement under standardized conditions, making it a robust tool for clinical and research applications. However, the methods were not interchangeable, emphasizing the need for consistent imaging protocols and method selection tailored to clinical objectives.

Classification of Adolescent Idiopathic Scoliosis Curvature Using Contrastive Clustering.

Retrospective image analysis study. To propose a novel classification system for adolescent idiopathic scoliosis (AIS) curvature using unsupervised machine learning and evaluate its reliability and clinical implications. Existing AIS classification systems, such as King and Lenke, have limitations in accurately describing curve variations, particularly long C-shaped curves or curves with distinct characteristics. Unsupervised machine learning offers an opportunity to refine classification and enhance clinical decision-making. A total of 1,156 AIS patients who underwent deformity correction surgery were analyzed. Standard posteroanterior radiographs were segmented using U-net algorithms. Contrastive clustering was employed for automatic grouping, with the number of clusters ranging from three to 10. Cluster quality was assessed using t-SNE and Silhouette scores. Clusters were defined based on consensus among spine surgeons. Interobserver reliability was evaluated using kappa coefficients. Six clusters were identified, reflecting variations in structural curve location, single (C-shaped) versus double (S-shaped) curves, and thoracolumbar curve characteristics. Cluster reliability was moderate (kappa = 0.701-0.731). The silhouette score was 0.308, with t-SNE demonstrating distinct clustering patterns. The classification highlighted differences not captured by the Lenke classification, such as thoracic curves confined to the thoracic spine versus those extending to the lumbar spine. Unsupervised machine learning successfully categorized AIS curvatures into six distinct clusters, revealing meaningful patterns such as unique variations in thoracic and lumbar curves. These findings could potentially inform surgical planning and prognostic assessments. However, further studies are needed to validate clinical applicability and improve clustering quality. 3.