Three-dimensional Computed Tomography Scans Research Articles

Three-Dimensional Computed Tomography Scanning Study of the Superior Labial Artery in Chinese Individuals for Assessing Filler Injection Safety.

Lip filler injection is one of the most common minimally invasive cosmetic procedures involving the face; however, vascular complications are not uncommon. The aim of this study was to investigate the anatomy of the superior labial artery (SLA) and provide precise topographic information for dermal filler injection into the lips. Computed tomography (CT) scans of 52 cadaveric heads injected with lead oxide were obtained. We then used Mimics software to construct 3D images of the SLA described by a coordinate system based on the bilateral external auditory canal and the left orbit. This study aimed to classify the SLA in the Han Chinese population, measure its diameter at specific points, and determine the thickness of the lip at those points. Ultimately, we utilized a thermal imaging technique to illustrate the course and depth of the SLA within the lip. The objective of this study was to provide safe guidance for clinical injections. In this study, the SLA was successfully identified in all cadavers. The mean overall diameter of the superior labial arteries was 1.36±0.28 mm. The superior labial artery showed a general course from deep to shallow with an average depth of 5.68±1.68 mm from the oral commissure to the midline. There are anatomical differences in the superior labial arteries among Chinese people. Furthermore, 3D CT images can digitally elucidate the exact positions of the superior labial artery via a coordinate system, improving the safety of upper lip filler injections in clinical settings. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Validating the Supraorbital Notch-Nasion-Supraorbital Notch Angle as a Marker for Metopic Craniosynostosis Severity.

Metopic craniosynostosis (MCS) can be difficult to differentiate from metopic ridge (MR) or normal frontal morphology. This study assess whether the supraorbital notch-nasion-supraorbital notch (SNS) angle can help identify MCS. Records of 212 patients with preoperative three-dimensional computed tomography scans were examined. The SNS angles, surgeon craniofacial dysmorphology rankings, and CranioRate metopic severity scores (MSSs) were compared with the Spearman rank correlation coefficient. Receiver operating characteristic (ROC) curves with Youden J-statistic and cross-validation of regression models assessed the ability of these measures to predict surgery. A total of 212 patients were included, consisting of 78 MCS, 37 MR, and 97 controls. Both the mean SNS angle (MCS: 111.7 ± 10.7 degrees, MR: 126.0 ± 8.2 degrees, controls: 130.7 ± 8.8 degrees P < 0.001) and MSS (MCS: 5.9 ± 2.0, MR: 1.4 ± 1.9, controls: 0.2 ± 1.9, P < 0.001) were different among the cohorts. The mean SNS angle (111.5 ± 10.7 versus 129.1 ± 8.8, P < 0.001) was lower in those who had surgery and CranioRate score (5.9 ± 2.1 versus 0.8 ± 2.2, P < 0.001) was higher in those who underwent surgery. SNS angles were positively correlated with surgeon craniofacial dysmorphology rankings ( r = 0.41, P < 0.05) and CranioRate MSS ( r = 0.54, P < 0.05). The ROC curve requiring high sensitivity revealed an SNS angle of 124.8 degrees predicted surgery with a sensitivity of 88.7% and a specificity of 71.3%. A ROC curve using the CranioRate MCC values ≥3.19 predicted surgery with 88.7% sensitivity and 94.7% specificity. Orbital dysmorphology in patients with MCS is well captured by the supraorbital-nasion angle. Both the SNS angle and CranioRate MSS scores accurately predict surgical intervention.

Laparoscopic Colectomy for Cecal Cancer and Intestinal Malrotation: A Case Report.

Intestinal malrotation (IM) often remains undetected until adulthood, being discovered during testing or surgery for other comorbidities. Preoperative understanding of this anatomical abnormality is crucial. An 80-year-old woman presented with cecal cancer. Three-dimensional computed tomography (CT) revealed that the cecum was located at the midline of the abdominal cavity, the duodenum did not cross the midline, and the ileocolic vein ran to the left. Clinically diagnosed with stage IVc cecal cancer complicated by IM, the patient underwent laparoscopic surgery. The ascending colon and cecum were not fixed to the retroperitoneum. The duodenum lacked the second, third, and fourth portions and the small bowel was distributed on the left and right sides of the abdominal cavity. Adhesions had shortened the mesentery, which were released close to their normal positions. Although laparoscopic surgery is superior to open surgery in terms of securing the field of view in a narrow space, providing a magnifying effect, and minimal invasiveness, it has a limited field of view and is inferior in terms of grasping the overall anatomy, which may be disadvantageous in cases of anatomical abnormalities. Colorectal cancer with IM is rare; however, the rate of preoperative diagnosis seems to be increasing thanks to improvements in diagnostic imaging, such as three-dimensional CT scans. In this study, we also reviewed 49 cases of colorectal cancer associated with IM.

A 10-year follow-up study on clinical outcomes of dental implant rehabilitation using surgical guide.

The surgical guide is a static computer-assisted device used for implant surgery planning and guidance. By taking an impression and referring to the patients' three-dimensional computed tomography scan of the desired implant site, a surgical guide can be created. During surgery, the surgical guide aids in achieving the designed implant placement position and direction. We examined and evaluated the long-term clinical outcomes of implant surgery using surgical guides. This study investigated a total of 15 patients with 32 implants that were placed using surgical guides from 2009 to 2011 with a mean follow-up period extended beyond 10 years. Patient demographics and implant survival rates were recorded. We analyzed marginal bone loss (MBL) by assessing the radiographs acquired at installation, three months after installation, and one month, one, two, and five years after prosthesis delivery. The mean patient age was 57.33 years at implant placement. Of the 32 implants, five implants were placed in the anterior region and 27 implants were in the posterior region. Six implants failed and three of them were replaced, resulting in an 81.25% survival rate. The mean follow-up period was 10 years and nine months. Mean MBL compared to post-installation was significantly higher than at three months after installation, and one month, one, two, and five years after prosthesis delivery. Mean MBL at three months after installation, and one month, one year, and two years were significantly higher compared to the previous visit (P<0.05). However, MBL at five years after prosthesis delivery did not differ significantly compared to at two years. In this study, implant rehabilitation assisted by surgical guides exhibited favorable survival rates. With the limitation of the sample amount in this study, further research and more samples are required to evaluate the long-term clinical effectiveness of surgical guides.

The Origin and Course of the Blood Supply to the Lower Eyelid Orbital Fat: Anatomical Study and Clinical Significance.

The aim of this study is to investigate the origin and course of the orbital fat arterial supply in the lower eyelid using traditional anatomy and three-dimensional computed tomography (CT). Twenty-seven cadaver heads were infused with mercury sulfide contrast media through the ophthalmic artery, maxillary artery, transverse facial artery, and facial artery. CT images were obtained after contrast agent injection, three-dimensional CT scans were reconstructed, and the cadaver heads were dissected. Forty-five qualified hemifaces showed that the orbital fat arterial supply in the lower eyelid originates primarily from the inferomedial muscular trunk (IMT) of the ophthalmic artery and the orbital branch of the infraorbital artery. The medial branch of the IMT terminated at the medial fat pad (35.6%) or the orbital floor (64.4%). The lateral branch terminated at the inferior oblique (IO) muscle (28.9%) or the central and lateral fat pads (17.8%). In 53.3%, the lateral branch extended to the anterior part of the lateral fat pad and terminated in the orbital wall or the zygomaticoorbital foramina. The orbital branch of the infraorbital artery coursed between the orbital floor and the orbital fat, providing supply to the IO muscle, inferior rectus (IR) muscle, nasolacrimal duct, and orbital fat. This study elucidated the origin and course of the orbital fat arterial supply in the lower eyelid, which may help to avoid reducing the blood supply of the orbital fat pedicles during surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Relation between spine alignment and scapular position by plain radiograph examination

BackgroundBoth scapular dynamics and static scapular position are important in treatment of shoulder dysfunction. This study aimed to create an index that can evaluate scapular position on plain radiographs and evaluate the relation between scapular position and posture accurately. MethodsUsing four fresh frozen cadavers, we developed a glenoid angle grade based on the degree of overlap between the shadow of the coracoid inflection point and the upper edge of the scapula on frontal plain radiographs: grade 1, no overlap; grade 2, overlaps by less than half of the shadow; grade 3, overlaps by more than half. We then performed a retrospective cohort study that included 329 shoulders of 329 patients who underwent spine surgery. Spine alignment parameters (SPAPs), including cervical lordosis (CL), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence, pelvic tilt, sacral slope, and sagittal vertical axis (SVA) were measured on standing lateral plain radiographs. Glenoid anterior tilt (GAT) and glenoid anteversion angle (GAVA) were calculated on frontal radiographs and three-dimensional computed tomography scans. Correlations between SPAPs and each angle were investigated, and independent influencing factors were sought in multivariate analysis. Individual factors, GAT, GAVA, and SPAPs were compared among the grades. ResultsSPAPs associated with GAT were SVA (R = 0.14, p = 0.011), TK (R = 0.12, p = 0.026), and LL (R = -0.11, p = 0.046). Multivariate analysis identified TK and LL as independent influencing factors (TK, p = 0.001; LL, p = 0.008). SPAPs associated with GAVA were CL (R = 0.17, p = 0.002) and TK (R = 0.29, p < 0.001), LL (R = 0.25, p < 0.001). Multivariate analysis identified CL, TK and LL as independent influencing factors (CL, p = 0.01; TK, p = 0.03; LL, p = 0.03). There were 183, 127, and 19 cases categorized as grades 1, 2 and 3. GAT (grade 1, 24.0±7.8; 2, 32.4±7.0; 3, 41.0±7.8), GAVA (1, 29.3±7.6; 2, 33.7±9.5; 3, 31.5±8.3), and TK (1, 30.6±13.6; 2, 35.1±14.2; 3, 43.1±20.4) differed significantly according to grade. ConclusionsWe identified factors that influence scapular position and demonstrated that scapular position can be estimated by a grading system using plain radiographs.

Functional and union outcome of combined column tibial plateau fracture treated with hybrid external fixator.

To determine the combined column tibial plateau fracture treated with a hybrid external fixator in terms of knee functionality, union outcome and complications. The quasi-experimental study was conducted at the Department of Orthopaedic Surgery, Mayo Hospital, Lahore, Pakistan, from July 5, 2019, to December 31, 2021, and comprised patients of either gender aged 20-50 years who presented with 2-column or 3-column fractures of proximal tibia classified according to the 3-column classification system after being diagnosed using radiographs and three-dimensional computed tomography scan. Knee function, union and complications, like neural, vascular, infection, delayed union, nonunion, malunion and implant failure, were evaluated. The Knee Society Score was used to assess knee function, and modified Rasmussen score for the union, while complications were assessed clinically on the 2nd, 6th, 12th, 16th, 24th, 36th weeks and one year post-operatively. Data was analysed using SPSS 26. Of the 113 patients, 91(80.53%) were males and 22(19.47%) were females. The overall mean age was 35.56±9.00 years. From the 12th week to the 24th week 45(39.83%) patients had good and 59(52.21%) patients had excellent functional outcomes. Union outcome in the 16th and 24th week was good in 57(50.44%) patients and excellent in 47(41.59%) patients. No neurovascular injury was observed. Superficial pin tract infection was observed in 21(18.6%) cases that healed with wound debridement and antibiotics. No delayed union, malunion and implant failure was observed. Good to excellent functional and union outcomes with minimum complications were observed with the hybrid external fixator.

Robotic-assisted total knee arthroplasty improved component alignment in the coronal plane compared with navigation-assisted total knee arthroplasty: a comparative study.

The purpose of this study was to directly compare implant placement accuracy and postoperative limb alignment between robotic-assisted total knee arthroplasty and navigation-assisted total knee arthroplasty. This retrospective case-control study included a consecutive series of 182 knees (robotic-assisted group, n = 103 knees; navigation-assisted group, n = 79). An image-free handheld robotic system (NAVIO) or an image-free navigation system (Precision N) was used. Component and limb alignment were evaluated on three-dimensional computed tomography scans and full-length standing anterior-posterior radiographs. We compared the errors between the final intraoperative plan and the postoperative coronal and sagittal alignment of the components and the hip-knee-ankle angle between the two groups. The orientation of the femoral and tibial components in the coronal plane were more accurate in the robotic-assisted group than in the navigation-assisted group (p < 0.05). There was no significant difference in the orientation of the femoral and tibial component in the sagittal plane between the two groups. There were fewer outliers in the tibial coronal plane in the robotic-assisted group (p < 0.05). There was also no significant difference in the frequency of outlying values for coronal or sagittal alignment of the femoral component or sagittal alignment of the tibial component or the hip-knee-ankle angle between the two groups. Robotic-assisted total knee arthroplasty using a handheld image-free system improved component alignment in the coronal plane compared with total knee arthroplasty using an image-free navigation system. Robotic surgery helps surgeons to achieve personalised alignment that may result in better clinical outcomes.

Identification Based on Height, Age, and Gender Estimation Using the Measured Parameters of the T10 and T11 Vertebrae in Three-Dimensional Computed Tomography Scan Among the Iranian Population

: The present study aimed to estimate the age, gender, and height of the Iranian population based on the characteristics of the 10th and 11th thoracic vertebrae for identification. This cross-sectional study measured the T10 and T11 indices in axial, sagittal, and coronal computed tomography (CT) scan images. The measured indices included vertebral length (VL), endplate depth (EPD), endplate width (EPW), foramen diameter (FD), foramen width (FW), transverse process distance (TDm), spinal process height (SPH), spinal process length (SPL), vertebral body height (VBH), pedicle height (PH), pedicle width (PW), articular process height inferior (APHi), articular process height superior (APHs), and maximum distance between articular processes (ADm). The mean differences of the T10 and T11 indices between the two groups of men and women, except FW, FD, and APHi, were higher in men, which were statistically significant (P &lt; 0.006). VL, EPD, EPW, FW, TDm, VBH, PH, and ADm in men, and VL, EPD, EPW, TDm, SPH, SPL, PH, APHs, and ADm in women were significantly correlated with height in the T10 vertebra (P &lt; 0.05). Moreover, FD in T10 was found to be negatively correlated with women’s height (P = 0.04). In addition, in the T11, the VL, EPD, EPW, FW, FD, TDm, and VBH indices in men and the VL, EPW, TDm, SPL, PH, APHs, and PW in women were significantly correlated with height (P &lt; 0.05). Moreover, VL, EPD, TDm, SPH, SPL, and APHi in women and VL in men were significantly and positively correlated with age in T10 (P &lt; 0.05), similar to the T11 APHs correlation with age in men and VL, EPW, EPD, SPL, and APHi in women. The current study showed that the T10 and L11 vertebral indices were significantly correlated with gender, height, and age.

Long-Term Outcomes and Growth Analysis of Costochondral Grafts for Hemifacial Microsomia: 24-Year Experience of a Single Surgeon.

Costochondral grafts (CCGs) can be used in mandibular reconstruction of Kaban-Pruzansky IIB/III hemifacial microsomia (HFM). Their growth is variable, occasionally necessitating secondary surgery. This study examined one surgeon's 24-year experience to better quantify long-term outcomes and surgical care required in CCG reconstruction of HFM mandibles. Serial three-dimensional computed tomography scans, from preoperative to most recent, were analyzed in patients with minimum four years of clinical follow-up following CCG reconstruction. Graft/ramus height, length, volume, bilateral mandibular body length, and chin deviation were measured. Changes in measurements were analyzed at preoperative, immediate postoperative, most recent imaging prior to secondary surgery, and most recent imaging overall. Growth rates per measure were calculated utilizing scans after CCG, but before secondary surgery. Thirteen patients were analyzed. Median clinical follow-up was 10.0 (5.1) years. One patient developed temporomandibular joint ankylosis secondary to stacked-graft malposition, which was repaired without further complications. CCG reconstruction led to immediate improvement in graft/ramus height (p=0.03), length (p=0.002), and volumetric symmetry (p=0.02). No difference was found between graft and native ramus height (p=0.4) and length measures (p=0.5), while graft volume and affected mandibular body grew significantly more slowly. By latest imaging, 63% of patients required secondary surgery, including distraction osteogenesis and/or orthognathic surgery due to differential graft/hemimandible growth behavior. By most recent clinical follow-up, this proportion increased to 93%. CCGs provide significant short-term mandibular and facial symmetry improvement in HFM IIB/III. Long-term analysis reveals frequent undergrowth requiring secondary intervention to promote and maintain symmetry.

Three-dimensional Computed Tomography Scan of the Pelvic Bone in Isolated Epispadias: Analysis Before Surgical Correction

To determine intrapelvic angles and distances in pure epispadias patients and compare them to normal values. Using three-dimensional computed tomography, 17 intrapelvic dimensions (8 angles and 9 distances) were measured in 26 patients with pure epispadias (21 boys and 5 girls). These values were compared to normal values obtained from 6 patients (5 boys and 1 girl) who underwent either pelvic or abdominopelvic computed tomography for purposes unrelated to their bony pelvis. Significant differences were observed in five angles (sacroiliac joint angle, S1 tilt angle, sacral curvature, superior-inferior rotation of the pelvis, and pubococcygeal angle; P-value=.016, .044, .011, .020, and .001, respectively); these show less sacral rotation toward the axial plane, more sacral curvature, inferior rotation of the pelvis, and sacroiliac joints' rotation toward the coronal plane in epispadias compared to controls. Also, two distances (pubic diastasis and anterior segment length of the pelvis; P-value=.002 and .012, respectively) had significant differences, showing wider pubic diastasis and shorter anterior segment in epispadias. However, the differences between other intrapelvic angles and distances were not statistically significant between the two groups. In addition to the explanations hypothesized for the embryology of the exstrophy-epispadias complex, there can be other etiologies for both epispadias and bladder exstrophy to explain the differences between bony anatomies of the pelvis in these patients.

Estimation of Gender and Age Based on Three-dimensional Computed Tomography Scan Indices of the Twelfth Thoracic Vertebrae and the First and Fifth Lumbar Vertebrae in Iranian Adults

Background: Gender identification is a crucial starting point in creating a biological profile for human skeletal remains because it reduces the number of possible matches by 50%. The vertebrae (especially the chest and back) can also be some of the best-preserved skeletal elements in some areas of forensics and archeology. In the present study, gender and age were assessed based on the measurement of three-dimensional computed tomography (CT) scan indices of the Twelfth thoracic (T12) vertebrae and the first and fifth lumbar (L1 and L5) vertebrae in Iranian adults. Methods: The present study was a descriptive study carried out on 200 participants over 18 years of age in 2020. Individuals measuring thoracic and lumbar vertebrae diameters (T12 and first and fifth lumbar vertebrae) by three-dimensional computed tomography (CT) scan (Toshiba, Japan, 16-Slice) with multiplanar reconstruction (MPR) and volume rendering were placed in two sagittal and horizontal sections. Results: The mean age of male and female participants was 34.62±9.63 years and 34.10±9.70 years, respectively, which were not significantly different (P=0.789). The present study showed that the mean indices for T12, L1 and L5 vertebrae were significantly higher in males (P&gt;0.05). The results also showed that T12, L1, and L5 indices of nuts are not good predictors for age estimation. Conclusion: Based on the results, the indices of the T12 vertebrae and the L1, and L5 vertebrae can be used to determine gender, but these indices are not a good criterion to estimate age and do not have the necessary accuracy to predict the age variable.

Assessment of two entry points for S2 alar-iliac screw in a Japanese cohort using three-dimensional computed tomography scan

Lumbosacral fusion supplemented with sacropelvic fusion has recently been increasingly employed for correcting spinal deformity and is associated with lower incidence of pseudarthrosis and implant failure. To date, few studies have evaluated anatomical parameters and technical feasibility between different entry points for S2 alar-iliac screws. To compare anatomical parameters and technical feasibility of two entry points for the S2 alar-iliac screw (S2AIS) in a Japanese cohort using three-dimensional (3D) computed tomography (CT). Retrospective cohort study. Fifteen men and 15 women aged 50-79 years who underwent pelvic CT at our hospital in 2013. Screw length, lateral angulation, caudal angulation, angle range, distance from the entry point to the sacroiliac joint, distance from the S2AIS to the acetabular roof, distance from the S2AIS to the sciatic notch, and insertion difficulty. We used 30 pelvic CT images (15 men and 15 women). We selected two entry points from previous studies: one was 1 mm distal and 1 mm lateral to the S1 dorsal foramen (A group) and the other was the midpoint between the S1 and S2 dorsal foramen (B group). We resliced the plane in which the pelvis was sectioned obliquely from these entry points to the anterior inferior iliac spine in the sagittal plane. We placed the shortest and longest virtual S2AISs bilaterally in this plane using a 4-mm margin. We measured screw length, lateral angulation, caudal angulation, angle range, distance from the entry point to the sacroiliac joint, distance from the S2AIS to the acetabular roof, distance from the S2AIS to the sciatic notch, and insertion difficulty. These measurements were compared between Groups A and B. In group A, the angle in the sagittal plane was significantly smaller and the distance from the entry point to the sciatic notch was significantly longer than in group B. Group B demonstrated a significantly longer screw length, longer distance from the entry point to the sacroiliac joint, and longer distance from the entry point to the acetabular roof than group A. The rate of insertion difficulty of S2AIS was much higher in group A. Insertion of S2AIS from the midpoint between the S1 and S2 dorsal foramen compared with the entry at distal and lateral to S1 foramen enables insertion of longer screws with low insertion difficulty.

Multimodal imaging assessment of mitral valve area after transcatheter mitral valve implantation: A three-dimensional echocardiographic and CT scan study

The assessment of mitral bioprosthetic area remains a technical challenge, and its calculation by the continuity equation using transthoracic echocardiography (TTE) may be invalidated in several situations, especially after transcatheter mitral valve implantation (TMVI). This study aims to develop a new technique to measure the mitral valve area after a TMVI using a multimodal three-dimensional echocardiographic and computed tomography (CT) approach. Among the patients hospitalized for TMVI at Bichat Hospital between June 2017 and February 2021, we selected 24 who had both a transesophageal echocardiography (TEE) and a cardiac CT after TMVI and before discharge. We performed two area measurements by planimetry: the geometric orifice area (GOA) corresponding to the area delimited by the edges of the open valve leaflets after alignment in the plane of the proximal coaptation point of the bioprosthesis leaflets; and the smallest valve area (SVA) defined by the smallest measurable area of the open prosthesis, at the free edges of the leaflets. In our cohort, the GOA was 1.73 ± 0.41 cm2 on 3D TEE and 1.75 ± 0.42 cm2 on CT. The SVA was 1.40 ± 0.31 cm2 on 3D TEE and 1.49 ± 0.37 cm2 on CT. There was a good agreement between the two techniques for GOA and SVA (ICC > 0.6, P < 0.01) and a good correlation between the two measurements on 3D TEE as well as on CT (Pearson 0.88 and 0.91 respectively, P < 0.001). Our work suggests a new approach to multimodal assessment of prosthetic mitral valve area after TMVI, using 3D TEE and CT scan. Further studies are needed to complete our results, especially to confirm the feasibility and reproducibility of the measurements. It would also be interesting to correlate these area measurements with the clinical prognosis of patients after TMVI. Agreement between 3D TEE and CT measurements (Fig. 1).

Morphometric variations of the suprascapular notch using three-dimensional computed tomography scans in a group of Jordanian population

Morphometric variations of the suprascapular notch using three-dimensional computed tomography scans in a group of Jordanian population

Introduction of Spring-Assisted Cranioplasty for Bicoronal Synotosis in India: Description of First Case and Our Learning Experience.

Various surgical techniques for cranial reconstruction of patients with bicoronal synostosis have been suggested. The outcome is, however, still often suboptimal. In a 5-month-old child with apert syndrome, following a craniotomy incision, lambdoid suturotomy was done bilaterally. Two springs were implanted bilaterally over the lambdoid sutures. Cephalic index was obtained from three-dimensional computed tomography scans, and photographs were analyzed for aesthetic evaluation. The preoperative calvarial shape was hyperbrachycephalic. The CI improved from 92 to 83 units. Duration of surgery was 1 h 45 min, blood loss was 30 mL, and total hospital stay was 3 days. No major complications were observed. Spring removal was done at 6 months postoperatively and frontoorbital advancement performed. Spring-assisted cranioplasty for bicoronal synostosis is a safe and elegant technique, is less invasive than many other cranioplasties, and results in marked improvement in the calvarial shape.

A simple method for calculating acetabular posterior wall fracture fragment percentages on three-dimensional computed tomography scan reconstruction images

A simple method for calculating acetabular posterior wall fracture fragment percentages on three-dimensional computed tomography scan reconstruction images

Fracture Line Morphology of Greater Tuberosity Fragments of Neer Three- and Four-Part Proximal Humerus Fractures.

In complicated Neer three- and four-part proximal humerus fracture (PHF), greater tuberosity (GT) fragments are often comminuted, and the currently widely used locking plate may not fix GT fragments effectively. A further understanding of morphological characteristics of the GT fragments may help explore new fixation devices. This study aimed to determine the fracture line morphology of the GT fragment of Neer three- or four-part PHF and analyze the location relationship between the locking plate and the GT fragment. Seventy-one three-dimensional computed tomography scans of Neer three- and four-part PHF were retrospectively reviewed between January 2014 and June 2019. Fracture fragments were reconstructed and virtually reduced in the Mimics software, and fracture lines of GT fragments were depicted on a humerus template in the 3-matic software and then were superimposed altogether. The common sites of the GT fracture were identified, and the location relationship between the locking plate and GT fragments was analyzed in a computer-simulated scenario. The fracture line morphology of GT fragments was similar between Neer three- and four-part PHF. The overall morphology of GT fragments was in a fan shape, which could be summarized as anterior, superior, posterior, and middle lines. Of these, we identified 51 split and 29 avulsion type GT fragments based on the Mutch classification, and they could occur simultaneously in a PHF. The overall morphology of split type fragments was in a fan shape, and avulsion type fragments showed a quite distinguishable distribution pattern. A GT fragment could be classified as anterior-split, posterior-split, complete-split, anterior -avulsion, and posterior-avulsion type based on its morphology and location. The median percentage of fragment area covered by the plate was 32.3% in all of the fragments, and it was 69.4%, 23.0%, 37.2%, 21.8%, 0.0% in anterior-split, posterior-split, complete-split, anterior-avulsion, and posterior-avulsion type GT fragments. We defined the posterior-split, anterior-avulsion, and posterior-avulsion type GT fragments as the risky GT fragments, and they occurred in 43 (60.6%) Neer three- and four-part PHFs. The fracture line morphology of GT fragments of Neer three- and four-part PHF was in a fan shape. GT fragments could be classified based on their location and morphology. The extent of GT fragment coverage provided by the locking plate differed in various fragment types, and we identified the anterior-avulsion, posterior-avulsion, and posterior-split type fragments as the risky GT fragments with a high incidence rate in Neer three- and four-part PHFs.

Long-Term Changes in Thecal Sac Compression and Decreased Cerebrospinal Fluid Space Following Paddle Lead Spinal Cord Stimulation at T9: A Long-Term Follow-Up via Three-Dimensional Myelographic Computed Tomography

ObjectivesTo investigate the long-term changes in thecal sac compression following T9 paddle lead spinal cord stimulation (SCS) using three-dimensional myelographic computed tomography (CT). Materials and MethodsSeventeen patients with five-column paddle lead SCS at T9 underwent three-dimensional myelographic CT scans preoperatively, immediately after surgery, and after an average of 11 months. The cross-sectional areas of thecal sac and spinal cord and the widths of anterior and posterior cerebrospinal fluid (CSF) spaces were repeatedly measured and compared. The contact angle of the lead with long-term pain relief was assessed. ResultsThe cross-sectional areas of thecal sac and spinal cord decreased significantly after lead placement (30.47 ± 9.21% and 4.71 ± 9.84%, respectively). Even after 11 months, a significant reduction was found with the preoperative values (17.97 ± 12.32% and 2.88 ± 7.09%). The widths of anterior and posterior CSF spaces decreased significantly after surgery (43.53 ± 13.17% and 57.13 ± 13.17%, respectively) and the severe decrease persisted long-term (29.13 ± 21.54% and 50.99 ± 16.07%). The average pain relief was 42.27 ± 17.50% with no correlation between the rate of reduction in cross-sectional areas of thecal sac and the widths of CSF spaces. ConclusionsSignificant early reduction and late partial restoration occurred in the thecal sac and spinal cord and the width of the anterior and posterior CSF spaces in the T9 5-column paddle lead SCS. Thecal sac compromise was expected to some extent after paddle lead implantation, but the degree is significant, and the cross-sectional area of the spinal cord as well as the thecal sac is affected. Fortunately, these anatomical changes did not cause any clinical problems except for intercostal root irritation. The shape and flat contours of the five-column paddle leads clearly affected the results.

Eagle’s syndrome (Elongated styloid process) an unrecognized rare cause of neck pain: A case illustration

Eagle syndrome is a rare condition characterized by an abnormally elongated styloid process with or without abnormal direction and/or ossification of the styloid ligament. 45-year-old men with the complaint of left-sided neck pain below the ear for 3 years. The diagnosis of cervical arthrosis was made and physiotherapy was advised for 2 years. Three-dimensional Computed tomography scan revealed bilateral elongated styloid processes: both styloid processes were found to be longer than normal. No vascular compression was documented. Surgery was advised but the patient has refused. The management was conservative with non-steroid analgesics and antalgics. These symptoms are not specific because the symptoms related to this condition can be confused with those attributed to a wide variety of disorders including facial neuralgias, oral, otologic, and spinal diseases. Diagnosis is made with appropriate radiological examination specially cranial 3D CT scan. The treatment of Eagle's syndrome is primarily surgical. The styloid process can be shortened through an intraoral or external approach. Neurosurgeons, Otolaryngologists, and dental surgeons should be aware of the existence and incidence of this clinical entity, which is associated with reduced quality of life.