Lateral Wall Thickness Research Articles

Sonographic Assessment of Urinary Bladder Wall Thickness in Apparently Healthy Children, in Kaduna Metropolis, Nigeria

Normative values of urinary bladder wall thickness (UBWT) in healthy paediatrics should be established for reference in the diagnosis and management of urinary bladder health conditions (WHO). Ultrasound remains the best imaging modality for the evaluation of urinary bladder wall thickness. This study was aimed at assessing urinary bladder wall thickness in apparently healthy paediatrics in Kaduna metropolis, Nigeria. The study design was prospective and cross-sectional conducted at Yusuf Dantsoho Memorial Hospital, Tudun-Wada Kaduna, Kaduna state, Nigeria, from March 2022 to August 2022. A sample size of four hundred and three (403) participants was used in the study and a convenient sampling method was employed. Trans-abdominal ultrasound scan was performed with a full bladder. Anterior, posterior, left lateral and right lateral wall thickness was measured. SPSS version 29 was used for data analysis. The preset p-value was at 0.05. The anterior, posterior, left lateral, and right lateral bladder wall thickness were 1.0-3.1mm, 1.0.3.1mm, 1.0-3.4mm, and 1.0-3.1mm, respectively. For females were found to be 1.0-3.1mm, 1.0-3.1mm, 1.0-2.7mm, and 1.0-3.2mm, respectively. There was a statistically significant difference in posterior bladder wall thickness between males and females. There was a statistical significant difference in anterior-posterior right and left lateral bladder wall thickness between paediatric age groups (p=0.000). The study has established the normative value of urinary bladder wall thickness among healthy children in the Kaduna metropolis. There was a statistical significant difference in anterior-posterior right and left lateral bladder wall thickness between paediatric age groups.

Abstract 4136016: Higher aircraft noise exposure associates with worse heart structure and function

Introduction: Aircraft noise is a concern for communities living near airports, but its impact on heart structure and function is unknown. Methods: Night-time (L night ) and weighted 24-hour day (L den ) aircraft noise levels were provided by the UK Civil Aviation Authority for 2011 (Fig.1). Health data came from UK Biobank (UKB) participants living near four UK major airports (Heathrow, Gatwick, Manchester, and Birmingham) who had cardiovascular magnetic resonance (CMR) imaging starting from 2014 and self-reported no hearing difficulties. Generalized linear models investigated the associations between aircraft noise exposure and CMR metrics (derived using a validated convolutional neural network to ensure consistent image segmentations), after adjustment for demographics, socio-economic, lifestyle, and environmental covariates. Mediation by cardiovascular (CV) risk factors was also explored. Downstream associations between CMR metrics and major adverse cardiac events (MACE) were tested in a separate prospective UKB subcohort (n=26,658) to understand the potential clinical impact of noise-associated heart remodeling. Results: Of 3,635 UKB participants included, 3% experienced higher aircraft noise L night (≥45decibels) and 8% higher L den (≥50decibels). Participants exposed to higher L night had 7% [95% confidence interval: 4–10%] higher left ventricular (LV) mass and 4% [2–5%] thicker LV walls with a normal septal:lateral wall thickness ratio (Fig.2 A1). This LV concentric remodeling is relevant since 7% higher LV mass associates with 32% higher odds of MACE. They also had worse LV myocardial dynamics (Fig.2 A2) (e.g., 8% [4–12%] lower global circumferential strain which associates with 37% higher odds of MACE). Overall, a hypothetical individual experiencing the typical CMR abnormalities associated with higher L night exposure may have 5-times higher odds of MACE. Body mass index and hypertension appeared to mediate 20-50% of the observed associations. Findings were similar in those exposed to higher L den (Fig.2 B1-2). Participants who did not move home during follow-up and were continuously exposed to higher aircraft noise levels had the worst CMR phenotype. Conclusion: Higher aircraft noise exposure associates with adverse LV remodeling, potentially due to noise increasing the risk of obesity and hypertension. Findings are consistent with the existing literature on aircraft noise and CV disease, and need to be considered by policymakers and the aviation industry.

Role of Cone-Beam Computed Tomography in Assessment of Lateral Wall Thickness of Maxillary Sinus in Posterior Edentulous Maxilla

ABSTRACT Objective: To use Cone Beam Computed Tomography (CBCT) to evaluate the lateral wall thickness (LWT) of the maxillary sinus in the posterior edentulous maxilla, as well as the effect of ridge height (RH), edentulous region, type of edentulism (Complete and partial), age, and gender, for the placement of dental implants. Materials and Methods: To conduct this cross-sectional study, A CBCT scan of 60 patients of different age groups was taken for analysis. Each parameter was evaluated at the edentulous sites in the premolar and molar regions due to missing one or more posterior teeth at four levels from sinus floor 3, 7, 10, and 15 mm with residual RH less than 10 mm. Data were analyzed using Friedman’s ANOVA and one-way ANOVA. Bootstrapped linear regression was performed to assess the influence of various variables on LWT. Results: LWT increased from 3 mm to 15 mm in all teeth except the first premolar region, with significant differences (P < 0.01). LWT was generally lower in premolars and higher in molars. Age, gender, and RH did not predict LWT (P > 0.05), However, the type of edentulism significantly predicted LWT. (P = 0.005). Conclusion: CBCT scans are recommended before sinus surgeries due to anatomical variations.

Lateral femoral wall thickness in trochanteric hip fractures: a systematic review.

Thin lateral femoral wall has been investigated as a sign of instability in trochanteric hip fractures, necessitating lateral wall reconstruction or the use of a cephalomedullary nail (CMN). Various cut-off values have been proposed to guide implant choice. This review aims to determine the clinical significance of the lateral femoral wall thickness (LWT) in trochanteric hip fractures and identify an optimal cut-off value for increased risk of lateral wall (LW) fracture when using Dynamic Hip Screw (DHS). A comprehensive search was conducted in databases including Medline, Embase, and the Cochrane library up to July 2023. A predefined strategy was employed, with 5 eligible studies critically appraised using the methodological index for non-randomized studies (MINORS) criteria. Outcomes assessed encompassed the standardised mean difference (SMD) of LWT between the LW fracture and non LW fracture groups, aggregate LWT mean in LW fracture group, and the relation between AO/OTA fracture type with LW fracture utilising the chi-square test. Among 481 patients from 5 studies, 112 experienced LW fractures, while 369 did not postoperatively. Analysis indicated a significantly lower LWT in the LW fracture group (SMD -1.13, I² = 41.3%, p = 0.146). The mean LWT in the LW fracture group was 18.2 mm, with a 95% confidence interval of 17.29-19.10 mm. A preoperative thin lateral femoral wall is a critical predictor of fixation failure and suboptimal functional outcomes when using a DHS. Thorough evaluation of pre- and intraoperative x-rays is essential. CMN is recommended over DHS in cases with LWT measurements <19 mm.

Objective Parameters for Evaluating Internal Nasal Valve Compromise: Beyond the Angle Perspective.

Nasal valve surgery for internal nasal valve (INV) compromise has become increasingly popular. However, this rise in popularity has sparked debates regarding its indications and disputes over insurance coverage, primarily due to the lack of a gold-standard evaluation method. Therefore, we aimed to identify objective parameters for the INV compromise. We analyzed 186 INVs in 93 patients who underwent nasal valve surgery. The data comprised facial computed tomography (CT) images, acoustic rhinometry, the modified Cottle test, and symptom scores. Patients were categorized based on their symptoms and the. of the modified Cottle test. We measured the INV angle, area, volume, lateral wall thickness, septal angle, and nasal bone area using CT. The compromised INV group, characterized by nasal obstruction with a positive modified Cottle test, exhibited smaller INV areas in both coronal and axial views, reduced INV volume in the axial view, and a thinner lateral wall in the coronal view (all P<0.05). Acoustic rhinometry indicated a smaller minimal cross-sectional area and volume in the compromised INV group (both P<0.001). Regression analysis demonstrated significant associations between a compromised INV and reduced INV area on the axial view, as well as the minimal cross-sectional area measured by acoustic rhinometry. Relying solely on the INV angle in CT scans has limitations in assessing compromised INV. Alternatively, the INV area on axial CT scans and the minimal cross-sectional area measured by acoustic rhinometry may serve as objective parameters for evaluating INV compromise.

Effect of using different levels of egg shell as calcium sources in broiler diet on growth performance, blood parameters, and bone characteristics

The study was conducted at Grdarasha field in Salahaddin University –Erbil during the period from 23 November 2021 to 5 January 2022, to determine the effect of using different calcium sources in a broiler diet on growth performance, blood parameters, bone characteristics, and immunity organs. Three hundred (300) chicks have randomly distributed into three (3) treatments following a completely randomized design (CRD). Five replications for each treatment, each replicate contains 20 birds. The dietary treatments include T1: control (0% eggshell), T2 and T3 increasing levels of eggshell powder as a replacement to limestone at 50% and 100%, respectively. The results showed no significant (P&gt; 0.05) differences in broiler live body weight, body weight gain (BWQ), feed intake, feed conversation ratio, and mortality % among different weeks of experiments and different treatments used. The results of blood parameters did not note any significant variations among different treatment groups (P &gt; 0.05) in TG, HDL, LDL and P, however, the significant differences (P &lt; 0.01)was found in the Cholesterol, VLDL, and Calcium . Bone ash mainly consists of calcium and phosphorous, and their level of them differ significantly (P &lt; 0.01) among the different treatments. Also, the results of the effect of dietary treatments on the broilers' bone properties indicated that no significant differences in bone length (cm), diaphysis diameter (mm), Lateral wall thickness (mm), Medial wall thickness (mm), Medullary canal diameter (mm), Tibiotarsal index. However, the significance was found in bone weight and bone-breaking strength which is considered to affect bone fractures in poultry. Nevertheless, the results showed no significant differences in immunity organs, including spleen % and bursa %.

Effect of pulp-chamber lateral wall thickness and number on fracture resistance in endocrown-restored molars: An in vitro study

Background/purposeIt remains unclear how the thickness and number of pulp-chamber lateral walls (PCLWs) affects fracture resistance in endocrown-restored teeth. Materials and methods64 mandibular molars were collected and randomly divided into eight groups (n = 8). In group C (control group), the teeth were untreated. In groups T1, T2, and T3, the teeth were subjected to endodontic treatment and restored with nanoceramic endocrowns exhibiting different PCLW thicknesses (T1: 0.5 mm, T2: 1.0 mm, and T3: 1.5 mm). In groups N1, N2, N3, and N4, the numbers of missing PCLWs in prepared teeth were one (N1), two (N2), three (N3), and four (N4). All restored teeth were subjected to axial loading until fracture using a universal testing machine. The mean fracture loads were recorded and compared by one-way analysis of variance; the fractured samples were observed under a stereo microscope. ResultsThe results showed no statistically significant differences in fracture load among groups T1, T2, and T3 (P > 0.05). Although the fracture loads gradually decreased as the number of missing PCLWs increased, there were no statistically significant differences in fracture load among groups C, N1, N2, and N3, and N4 (P > 0.05). ConclusionBoth thickness and remaining number of PCLW does not affect fracture resistance in endodontically treated molars restored with nanoceramic endocrowns.

Radiographic assessment of maxillary sinus membrane and lateral wall thickness using cone-beam CT in different facial types in southwestern Saudi Arabia.

The anatomy of the edentulous posterior maxilla and maxillary sinus possess unique challenges in implant dentistry. The purpose of this study was to assess maxillary sinus membrane thickness (MT) and lateral wall thickness (LWT) in different facial index profiles and to describe the clinical implications. A retrospective image analysis of 75 CBCT scans was done, which yielded a total of 150 sinus images. The facial index was calculated as per the formula given in the text and grouped as euryprosopic, mesoprosopic and leptoprosopic. The images obtained were of 36 women (48%) and 39 men (52%), with maximum subjects in 30-39 years age group. MT and LWT were measured at three different points on the radiograph at every 3mm from the base of the sinus floor in premolar and molar regions of each image. Results showed females had significant differences from males in LWT in both premolar and molar regions (p = 0.018 and 0.032 respectively). Subjects in 40-49 years of age had significant differences (p = 0.021) in MT in premolar region only. Also, difference in MT in premolar and molar regions were also statistically significant. Lastly, the present study did not find any statistically significant difference in MT and LWT in all three facial indices groups. It can be concluded that different facial indices have no positive correlation with maxillary sinus membrane thickness and lateral wall thickness. Hence, surgical complications are avoidable with proper detailed knowledge and appropriate identification of the anatomic structures characteristic to the maxillary sinus.

Comprehensive analysis of lateral nasal wall anatomy to optimize the osteotomy in different skeletal patterns.

Variations in nasal wall anatomy are crucial in patients with dentofacial deformities undergoing Le Fort I osteotomy. These structural variations heighten the potential for complications during surgical procedures. Hence, the study focused on evaluating the differences in the lateral nasal wall anatomy across different skeletal Classes. This study evaluated 86 patients aged 18-43years with different skeletal Classes. In the axial images acquired from coronal sections, two angulations and the linear distances of the lateral nasal wall were measured in Class I, II, and III patients. The measurement between the piriform opening and the most anterior point of the greater palatine foramen was evaluated in three parts regarding the osteotomy line. Differences between the skeletal patterns were analyzed using an independent sample t-test and Mann-Whitney U test with a significance level of 0.05. The intra-class correlation coefficient was calculated for inter-observer and intra-observer agreement. There was a statistically significant difference between Class I and Class II subjects regarding the anterior lateral nasal wall (p = 0.011) and anterior nasal thickness (a) (0.004). There was a significant difference between Class I and Class III patients regarding anterior nasal thickness (a) (p < 0.001) and total lateral nasal wall length (p < 0.001). For instance, the measurements of Class III and Class II patients were relatively different from those of the Class I patients. Therefore, preoperative Cone-Beam Computed Tomographic analysis should be performed for each patient prior to Le Fort I osteotomy to ensure that the procedure is performed safely.

Lateral wall thickness is not associated with revision risk of medially stable intertrochanteric fractures fixed with a sliding hip screw.

This study aimed to determine whether lateral femoral wall thickness (LWT) < 20.5 mm was associated with increased revision risk of intertrochanteric fracture (ITF) of the hip following sliding hip screw (SHS) fixation when the medial calcar was intact. Additionally, the study assessed the association between LWT and patient mortality. This retrospective study included ITF patients aged 50 years and over treated with SHS fixation between 2019 and 2021 at a major trauma centre. Demographic information, fracture type, delirium status, American Society of Anesthesiologists grade, and length of stay were collected. LWT and tip apex distance were measured. Revision surgery and mortality were recorded at a mean follow-up of 19.5 months (1.6 to 48). Cox regression was performed to evaluate independent risk factors associated with revision surgery and mortality. The cohort consisted of 890 patients with a mean age of 82 years (SD 10.2). Mean LWT was 27.0 mm (SD 8.6), and there were 213 patients (23.9%) with LWT < 20.5 mm. Overall, 20 patients (2.2%) underwent a revision surgery following SHS fixation. Adjusting for covariates, LWT < 20.5 mm was not independently associated with an increased revision or mortality risk. However, factors that were significantly more prevalent in LWT < 20.5 mm group, which included residence in care home (hazard ratio (HR) 1.84; p < 0.001) or hospital (HR 1.65; p = 0.005), and delirium (HR 1.32; p = 0.026), were independently associated with an increased mortality risk. The only independent factor associated with increased risk of revision was older age (HR 1.07; p = 0.030). LWT was not associated with risk of revision surgery in patients with an ITF fixed with a SHS when the calcar was intact, after adjusting for the independent effect of age. Although LWT < 20.5 mm was not an independent risk factor for mortality, patients with LWT < 20.5 mm were more likely to be from care home or hospital and have delirium on admission, which were associated with a higher mortality rate.

CD137 Signaling Mediates Pulmonary Artery Endothelial Cell Proliferation Under Hypoxia By Regulating Mitochondrial Dynamics.

Altered mitochondrial dynamics affect pulmonary artery endothelial cells (PAECs) proliferation, contributing to the development of pulmonary hypertension. CD137 signaling promotes mitochondrial fission. We hypothesize CD137 signaling is involved in the excessive proliferation of PAECs. The levels of CD137 protein were increased in the lung tissue of hypoxic mice and hypoxic-stimulated PAECs. Activation of CD137 signal in hypoxic-PAECs upregulated the levels of hypoxia-inducible factor-2α (HIF-2α), glucose transporters type 4, the lactate transporter monocarboxylate transporter 4, key glycolysis rate-limiting enzymes and promoted mitochondrial division; moreover, increased glucose uptake, lactic acid and ATP production and proliferative cells were observed in these PAECs. Whereas, knockdown HIF-2α reversed CD137 signal-mediated effects in PAECs mentioned above. Compared with wild-type mice, the proliferation of PAECs and the percentage of vascular lateral wall thickness decreased in CD137 knockout mice. Together, CD137 signal participated in pulmonary vascular remodeling through the regulation of mitochondrial dynamics dependent on HIF-2α in PAECs.

Immunohistochemical Characterization of Heart Left Ventricle Morphogenesis in Rats Fetuses

Rats are the most common objects of preclinical studies, which determines the relevance of studying fetal cardiomorphogenesis in rats using modern methods of morphological studies. The aim is to study the dynamics of markers of proliferation (Ki67), apoptosis (caspase 3), vascularization (CD31), and stromal remodeling (MMP2 and MMP9) of the left ventricular myocardium of Wistar rat fetuses. Material and methods. A histological, immunohistochemical and morphometric study of the rat heart left ventricle wall was carried out on the 18th, 19th, 20th, 21st and 22nd days of the prenatal period of ontogenesis. Results. From the 18th to the 22nd day of the prenatal period of ontogenesis in rats, a twofold increase in the thickness of the left ventricle lateral wall is observed, due to both proliferation and differentiation and an increase in the size of cardiomyocytes. Ki67-positive cardiomyocytes are diffusely localized in the wall of the left ventricle, their number increases on day 19 of the prenatal period of development and remains at a high level until the end of the prenatal period in rats. From the 18th to the 22nd day of the prenatal period of ontogeny in rats, single caspase 3-positive cardiomyocytes are detected in the left ventricle. The growth of the left ventricular myocardium in the fetal period in rats is accompanied by an adequate rate of vascularization. The vascularization and proliferation of cardiomyocytes are accompanied by remodeling of the myocardial stroma, with the highest intensity of MMP2- and MMP9-immune staining observed at the beginning of the fetal period of ontogeny in rats. Conclusion. The short duration of prenatal ontogenesis in rats determines the high dynamics of cardiomorphogenetic processes. In the fetal period of rat ontogenesis in the left ventricle of the heart, the proliferation of cardiomyocytes prevails over the intensity of apoptosis. The intensity of proliferation of cardiomyocytes of the left ventricle of rats is high up to the 22nd day of the prenatal period of ontogenesis.

Association between sinus septa and lateral wall thickness with risk of perforation during maxillary sinus lift surgery: A systematic review and meta-analysis.

Sinus membrane perforation is a common complication of sinus lift surgery. This review aimed to examine if anatomical factors such as the presence of septa and lateral wall thickness influence the risk of membrane perforation. This study was registered on PROSPERO (CRD42023488259). PubMed, Embase, and Web of Science were searched for relevant studies published up to 26th June 2024. The outcome of interest was the risk of perforation based on presence of septa and lateral wall thickness. Random-effects meta-analysis was conducted with dichotomous data to obtain the odds ratio (OR) of perforation using Review Manager. Ten studies with 1865 patients undergoing 2168 "lateral" sinus lift procedures were included. The total incidence of Schneiderian membrane perforations was 19% (405 cases). Schneiderian membrane perforation was present in 169/425 cases (39.76%) with sinus septa and 184/1492 cases (12.33%) without septa. Meta-analysis showed that septa were significantly associated with an increased risk of perforation (OR: 4.03 95% CI: 1.77, 9.19) with high heterogeneity (I2 = 87%). The certainty of the evidence was very low. Data on lateral wall thickness and risk of perforation was too heterogeneous for a meta-analysis. Studies reported mixed results on the risk of perforation based on lateral wall thickness. Our results show, with very low-quality evidence, that the presence of septa significantly increases the risk of perforations during maxillary sinus lift surgery. Evidence on the association between lateral wall thickness and a risk of perforations during sinus lift surgery is conflicting, and no clear conclusions can be derived at this stage.

Correlation Analysis of the Anatomical Structures Related to Maxillary Sinus Augmentation

Aims: Preoperative evaluation of maxillary sinus anatomy is crucial to minimize procedural complications. The aim of this study was to assess the anatomical structures associated with sinus augmentation and investigate the correlation between these structures. Materials and Methods: This retrospective study included cone-beam computed tomography scans of patients referred for the reconstruction of the posterior maxilla with dental implants. The intraosseous anastomosis (PIA) and septa were evaluated on the images. Lateral wall thickness (LWT), the diameter of the PIA (DIA), the vertical distance of the PIA to the sinus floor (DSF), and sinus floor angle (SFA) were also measured. Results: A total of 250 sinuses were examined. PIA was detected in 46.8% of the sinuses. The mean SFA value was 77.11° ±11.11° (range 48.25°–112.33°). The LWT ranged from 0.63 to 10.23 mm with a mean value of 1.35 ± 0.79 mm. Of 250 sinuses, 82 (32.8%) showed septa. A strong negative correlation was found between SFA and PIA detection (r = 0.98, P = 0.008), SFA and DSF (r = 0.99, P = 0.000), and SFA and septa (r = 0.98, P = 0.000). LWT showed a positive correlation with DIA (r = 0.72, P = 0.082), although not statistically significant. Conclusions: The relationships highlight the combined effect of the structures on membrane perforation. As this makes the lateral window approach more problematic, the surgeon may seek minimally invasive approaches. Moreover, the strong correlation of SFA-PIA-DSF may significantly affect graft vascularization and needs to be evaluated with clinical studies.

The remnant axial cortical length of the proximal femur in pertrochanteric fractures: a three-dimensional computed tomography study and its clinical implications

BackgroundCortical buttress are important factors for postoperative stable reconstruction of per/inter-trochanteric fractures. The study aimed to measure the remnant axial cortical length (RACL) of the proximal circumference of the femur, and to determine which part of the RACL can be used reliably to postoperatively sustain the head–neck fragment as a cortical support pattern.MethodsEighty patients with trochanteric hip fractures admitted from January 2015 to January 2016 were included in a retrospective study. Their pre-operative computed tomography (CT) images were used to form 3D-CT reconstructions via Mimics software. After simulated rotation and movement for fracture reduction, the RACL, its three component parts—namely, the remnant anterior cortex (RAC), remnant lateral cortex (RLC), and remnant posterior cortex (RPC) —the γ angle between the anterior and posterior cortex, and the Hsu’s lateral wall thickness (LWT) were evaluated.ResultsPatients with an A1 fracture (21/80) had a longer RACL (88.8 ± 15.8 mm) than those with an A2 fracture (60.0 ± 11.9 mm; P < 0.01). The RAC, RLC, and RPC of the RACL in A1 fractures were also significantly longer than those in A2 fractures (P < 0.001). However, the most significant difference among the three components of the RACL was in the RPC, which was 27.3 ± 7.8 mm in A1 fractures and 9.2 ± 6.6 mm in A2 fractures. In addition, the coefficient of variation of the RAC was only 20.0%, while that of the RPC was 75.5%. The average γ angle in A1 fractures was 16.2 ± 13.1°, which was significantly smaller than that in A2 fractures, which was 40.3 ± 14.5° (P < 0.001). There was a significant statistical difference in the LWT between A1 and A2 fractures (P < 0.001). There were significant differences in the RACL, RAC, RLC, RPC, γ angle, and LWT among the five subtypes (P < 0.001).ConclusionsThe RAC is relatively stable in pertrochanteric fractures. Fracture reduction through a RAC buttress may help to enhance the postoperative stable reconstruction of per/inter-trochanteric fractures and make possible good mechanical support for fracture healing.

Effect of bladder volume and compliance on ultrasonographic measurement of bladder wall thickness in children with neurogenic bladder dysfunction

Spina bifida is the most common cause of neurogenic bladder dysfunction in children. Measurement of bladder wall thickness (BWT) is non-invasive, low-cost, and may be complementary to urodynamics in demonstrating bladder condition. It is still unknown the wall thickness response to volume change in bladders with different compliance states. To determine the most appropriate measurement technique by revealing the differences in measurements performed in different compliance and volume conditions in children with neurogenic bladder. In the prospective study in 2022, patients with spina bifida who continued their urological follow-up in our spina bifida center were included. Patients with a diagnosis of the neurogenic bladder who performed clean intermittent catheterization at least 4-6 times a day and had a recent urodynamic result in the last 6 months were included in the study. According to urodynamic results, patients were divided into two groups normocompliant (NC) and low-compliant (LC) bladders. BWT measurements were made from the anterior, posterior, right lateral, and left lateral walls of the bladder 3 times as full, half-volume, and an empty bladder. The study included 50 patients (NC group n:21, LC group n:29). The mean age of 24 female and 26 male patients was 6.45±4.07 years. In all BWT measurements, a significant increase in wall thickness was observed with decreasing bladder volume. The best correlation between bladder volume and BWT was found in the anterior wall with a weak negative correlation (p=0.049, r=-0.280). However, lateral wall measurements were significantly higher in low compliant patients compared to normocompliant patients when the bladder was full. The mean right lateral wall thickness was 1.58±0.68mm in the NC group and 2.18±1.35mm in the LC group (p=0.044). Left lateral wall thickness was 1.45±0.44mm in the NC group and 2.02±1.4mm in the LC group (p=0.033). Although standardization has been tried to be achieved in BWT measurements, we understand from the studies in the literature that there is no unity in practice. Lateral wall measurements were found to be significantly higher in LC patients compared to normocompliants in full bladder suggesting that more accurate BWT follow-up can be performed with lateral wall measurements in neurogenic bladder patients if bladder compliance is low. The present study seems to be the first study in the literature in which bladder compliance and ultrasonographic bladder wall thickness measurements were evaluated together in children with neurogenic bladder dysfunction.

Traction images heavily influence lateral wall measurement in trochanteric hip fractures. A prospective study

Introductionhip fracture represents a global health problem, with a high morbidity and mortality rate and an increasing incidence. The treatment of trochanteric fractures is reduction and osteosynthesis, and implant selection depends mainly on the stability of the fracture and lateral wall competence. Lateral wall competence has gained relevance in recent years, which led to the modification of the AO/OTA classification. However, determination of lateral wall integrity is difficult from plain radiographs; the influence of images with traction on its measurement has not been evaluated. Methodsprospective concordance study, emergency and post-traction radiographs of 65 patients with trochanteric fracture were evaluated by six orthopedic surgeons independently, measuring the lateral wall, classifying the fracture according to the AO/OTA 2018 classification and selecting the implant for osteosynthesis. A comparison of incompetent to intact lateral wall proportion between each image set was made. Secondary outcomes were the inter-observer correlation of lateral wall measurement and inter-observer agreement of classification and implant choice. Resultsthe proportion of patients with an incompetent lateral wall in emergency x-ray was 37.43% (CI 95% 0.326–0.422), while the proportion in post-traction fluoroscopy was 15% (CI 95% 0.115–0.185), with a statistically significant difference (p < 0.001). 40.1% of patients with an incompetent lateral wall changed to an intact one. Inter-observer correlation for the lateral wall thickness was 0.399 (CI 95% 0.292–0.519) in emergency x-ray and 0.658 (CI 95% 0.564–0.748) in post-traction fluoroscopy, with a substantial agreement. Inter-observer agreement for the fracture classification was fair to moderate using emergency x-ray (κ 0.369 95%CI 0.330–0.408) and fair to moderate with post-traction fluoroscopy (κ 0.400, 95% CI 0.334–0.466). Conclusiontraction images significantly change the measurement of the lateral wall in trochanteric fractures, changing from an incompetent to a competent wall in 40% of patients. The correct classification of trochanteric fractures is crucial to make the best decision when deciding which implant to use, and the measurement of the lateral wall is determinant in the actual AO/OTA classification. Therefore, traction images appear as necessary for correct decision-making.

The Role of Computed Tomography and Radiographs in the Management of Intertrochanteric Fractures.

The Intertrochanteric fracture is a common hip trauma encountered in elderly patients. There is a lack of general agreement regarding its surgical management and choice of implant. Purpose of this study to conclude the final decision matrix regarding surgical management of intertrochanteric fractures based on parameters assessed on plain radiographs and CT scan. We have retrospectively evaluated 55 patients with intertrochanteric fractures presented to our institute after informed consent with radiographs and CT scans between July 2017 to July 2018. Assessment of various parameters regarding fracture geometry and classification as well as measurement was done. Mean lateral wall thickness in present study was 20.76mm. Incidence of coronal fragments was 90.9% and absence of coronal fragment in 5 patients. We noted the cases with anterior comminution had also a posterior comminution rendered the fracture unstable in almost 20 % cases. Better understanding of fracture geometry by combined used of radiograph and CT scan enhanced preoperative planning, choice of suitable implant, helps in reduction manoeuvre and improving quality of osteosynthesis.

Relative lateral wall thickness is an improved predictor for postoperative lateral wall fracture after trochanteric femoral fracture osteosynthesis

Lateral wall thickness is a known predictor for postoperative stability of trochanteric femoral fractures and occurrence of secondary lateral wall fractures. Currently, the AO/OTA classification relies on the absolute lateral wall thickness (aLWT) to distinguish between stable A1.3 and unstable A2.1 fractures that does not take interpersonal patient differences into account. Thus, a more individualized and accurate measure would be favorable. Therefore, we proposed and validated a new patient-specific measure—the relative lateral wall thickness (rLWT)—to consider individualized measures and hypothesized its higher sensitivity and specificity compared with aLWT. First, in 146 pelvic radiographs of patients without a trochanteric femoral fracture, the symmetry of both caput-collum-diaphyseal angle (CCD) and total trochanteric thickness (TTT) was assessed to determine whether the contralateral side can be used for rLWT determination. Then, data of 202 patients were re-evaluated to compare rLWT versus previously published aLWT. Bilateral symmetry was found for both CCD and TTT (p ≥ 0.827), implying that bone morphology and geometry of the contralateral intact side could be used to calculate rLWT. Validation revealed increased accuracy of the rLWT compared with the gold standard aLWT, with increased specificity by 3.5% (Number Needed to Treat = 64 patients) and sensitivity by 1% (Number Needed to Treat = 75 patients). The novel rLWT is a more accurate and individualized predictor of secondary lateral wall fractures compared with the standard aLWT. This study established the threshold of 50.5% rLWT as a reference value for predicting fracture stability in trochanteric femoral fractures.

Cut-Through versus Cut-Out: No Easy Way to Predict How Single Lag Screw Design Cephalomedullary Nails Used for Intertrochanteric Hip Fractures Will Fail?

This study aims to compare patients in whom fixation failure occurred via cut-out (CO) or cut-through (CT) in order to determine patient factors and radiographic parameters that may be predictive of each mechanism. This retrospective cohort study includes 18 patients with intertrochanteric (IT) hip fractures (AO/OTA classification 31A1.3) who underwent treatment using a single lag screw design intramedullary nail in whom fixation failure occurred within one year. All patients were reviewed for demographics and radiographic parameters including tip-to-apex distance (TAD), posteromedial calcar continuity, neck-shaft angle, lateral wall thickness, and others. Patients were grouped into cohorts based on the mechanism of failure, either lag screw CO or CT, and a comparison was performed. No differences in demographics, injury details, fracture classifications, or radiographic parameters were observed between CO/CT cohorts. Of note, a similar rate of post-reduction TAD>25 mm (P=0.936) was observed between groups. A higher rate of DEXA (dual energy X-ray absorptiometry) confirmed osteoporosis (25.0% vs. 60.0%) was observed in the CT group, but without significance. The mechanism of CT failure during intramedullary nail fixation of an IT fracture did not show an association with clinical data including patient demographics, reduction accuracy, or radiographic parameters. As reported in previous biomechanical studies, the main predictive factor for patients in whom early failure might occur via the CT effect mechanism may be related to bone quality; however, conduct of larger studies will be required in order to determine whether there is a difference in bone quality.