Wall Sign Research Articles

Erect weight-bearing pelvic radiographs are superior to supine radiographs for diagnosis of mixed type acetabular retroversion plus developmental dysplasia hip deformity

PurposeThis study focused on the mixed-type deformities of acetabular retroversion (AR) and developmental dysplasia hip deformity (DDH) and aimed to ascertain the changes in pelvic tilt from a supine to a standing position in these cases and identify potential underlying mechanisms. MethodsA retrospective study was conducted on cases with symptomatic DDH from January 1, 2019, to April 30, 2023. DDH was defined as LCEA < 20°. AR was diagnosed by using a crossover index threshold of 0.2 in standing pelvic X-ray. Two observers assessed the supine and weight-bearing pelvic radiographs, along with computed tomography (CT) scans. The evaluated parameters included pelvic tilt (sacrofemoral-pubic angle (SFP), symphysis to sacrococcygeal distance (PSSC), pubic symphysis to sacroiliac (PSSI)), acetabular retroversion (crossover index, posterior wall sign), acetabular coverage (lateral center-edge angle (LCEA), ischial spine sign (ISS)), and axial rotation of the hemipelvis (pelvic width index, obturator index, and ilio-ischial angle). Acetabular orientation and coverage was measured by CT through anterior sector angle (ASA), posterior sector angle (PSA) and acetabular anteversion (AA). Cases with acetabular retroversion plus DDH were defined as the mixed-type deformity. Comparative analyses between mixed-type deformities and DDH cases were performed along with subgroup and correlation analyses within mixed-type cases. Inter-observer and intra-observer reliabilities were assessed using intraclass correlation coefficients. ResultsA total of 85 were included. 26 cases (30.59%) had mixed-type deformity, where transition from the supine to standing position led to an increased posterior pelvic tilt (SFP (supine: 64.35±4.6°, standing: 74.75±4.16°, p<0.001), PSSC (supine: 6.37±2.47, standing: 2.08±1.32, p<0.001) and PSSI (supine: 9.47±1.66, standing: 6.33±1.08, p<0.001)). Compared to cases with DDH, CT examination revealed a significantly greater anterior acetabular coverage and less posterior superior coverage, with smaller posterior sector angle and greater anterior sector angle (ASA) (p<0.05) for cases with AR. The superior iliac wing angle (mixed type: 45.63±9.22°, isolated type: 50.70±8.77°, p=0.013), inferior iliac wing angle(mixed type: 60.77±8.24°, isolated type: 65.24±8.02°, p=0.013), and ischiopubic angle (IPA) (mixed type: 32.27±3.19°, isolated type: 36.71±5.38°, p<0.001) were significantly reduced in AR cases, suggesting external rotation of the hemipelvis. Subgroup analysis showed that cases with a higher crossover index had a significantly higher PSSC and a significantly lower IPA. ConclusionAR was observed in 31% of DDH cases and was associated with a notable posterior pelvic tilt during postural transitions. This tilt appeared to be a compensatory mechanism affecting the AR diagnosis. Key changes in the acetabular coverage, including increased anterior coverage and decreased superior posterior coverage, were also observed. Additionally, external rotation of the hemipelvis in mixed-type cases correlated strongly with the extent of AR and anterior acetabular coverage, suggesting that it may be a key contributor to the underlying mechanism of this mixed-type deformity. Level of evidenceIII, retrospective case series.

Emergency microsurgical trapping, decompression, and revascularization of a middle cerebral artery dissecting aneurysm using a minipterional approach in a pediatric patient: illustrative case.

Pediatric intracranial aneurysms present unique diagnostic and therapeutic challenges due to their rarity and their distinct anatomical and physiological considerations compared with those of adult intracranial aneurysms. The authors present the case of a symptomatic pediatric patient who required emergency microsurgical treatment after a thrombosed dissecting aneurysm was identified in the right M1 segment of the middle cerebral artery. The lesion completely occluded its parent vessel, although distal blood flow was reconstituted through leptomeningeal collaterals. However, aneurysm wall contrast enhancement and signs of early perfusion changes were noticed, which prompted emergency treatment consisting of microsurgical aneurysm trapping, decompression, and extracranial/intracranial revascularization to be successfully performed through a minipterional craniotomy. After 1 year, the bypass occluded, although the patient remained asymptomatic. A slight enlargement of the ipsilateral anterior cerebral artery suggested the possibility of a benign hemodynamic rearrangement. Emergency treatment may be necessary when signs of lesion instability or hemodynamic compromise are present; however, a comprehensive multidisciplinary evaluation is required. Treatment of complex vascular lesions using a minipterional approach is feasible even in pediatric patients, and delayed bypass occlusion may be a benign phenomenon reflecting gradual blood flow reorganization. https://thejns.org/doi/10.3171/CASE24484.

Is Quantitative Radiographic Measurement of Acetabular Version Reliable in Anteverted and Retroverted Hips?

The acetabular version is crucial for hip function, and its accurate assessment is necessary for treating patients with hip disorders. Current studies reveal discrepancies in the precision of quantitative radiographic measurements versus CT measurements, but there is a lack of focused analysis on anteverted versus retroverted hips. This study aims to fill this gap by directly comparing the reliability of these two methods in assessing varied hip configurations. (1) How reliable are quantitative radiographic and CT methods in measuring the acetabular version angle? (2) Is there any difference in the reliability of acetabular version angle measurements using radiography compared with CT in anteverted and retroverted hips? (3) What is the extent of variation in acetabular version measurements when quantitative radiographic and CT methods are compared in anteverted and retroverted hips? We searched our image archives for patients who had received both radiographs and CT scans between January 2020 and June 2022 and found 84 patients who met the criteria. From these patients, we selected those who presented with hip pain of different causes and who had no previous elective and/or hip trauma surgery, no hip dysplasia, and results from adequate radiographic examinations. Accordingly, 73% (61 of 84) of the patients were included in this study, and angle measurements were performed on both hips of these patients (122 hips). Standardized positioning was meticulously verified for all plain radiographs and CT scans utilized in the measurement process. We measured quantitative angles and assessed qualitative signs of retroversion, including crossover, posterior wall, and ischial spine findings. We considered a hip with at least one of these findings a retroverted hip, and the hips without these findings were included in the anteverted hip group. Three clinicians took measurements independently. Measurement reliability and agreement were examined using intraobserver and interobserver intraclass correlation coefficients (ICCs), with statistical analyses including paired and independent t-tests. To investigate the reliability of quantitative radiographic and CT methods, we assessed both intraobserver and interobserver agreements. To explore the reliability disparities in measuring the acetabular version via radiography and CT in anteverted and retroverted hips, we analyzed the agreement between measurements from both modalities in the hip groups. Furthermore, to evaluate the degree of variation in acetabular version measurements when comparing quantitative radiographic and CT methods in anteverted and retroverted hips, we utilized paired and independent t-tests to examine the measurement differences within these hip categories. The difference between radiographic and CT measurements was also evaluated by Bland-Altman analysis. Quantitative radiographic measurements showed intraobserver and interobserver reliabilities with ICCs of 0.87 (95% CI 0.84 to 0.91) and 0.78 (95% CI 0.75 to 0.82), respectively, and CT measurements demonstrated higher reliabilities with ICCs of 0.92 (95% CI 0.90 to 0.93) and 0.91 (95% CI 0.89 to 0.92), respectively. The reliability of measuring the acetabular version in anteverted hips was moderate, with an ICC of 0.59 (95% CI 0.49 to 0.68). In contrast, retroverted hips showed an ICC of -0.41 (95% CI -1.17 to 0.08), indicating a lack of consistency between quantitative radiographic and CT measurements. Variation in measurement on plain radiographs in anteverted hips was less than that of retroverted hips (mean ± SD absolute difference between anteverted hips and retroverted hips 3° ± 3° versus 6° ± 4°; p = 0.0001), indicating greater variability in the radiographic measurement of retroverted hips. According to Bland-Altman analysis, we observed that the difference between radiographic and CT measurements was well outside the CI, especially in retroverted hips. Although quantitative radiographic measurement demonstrates acceptable intraobserver and interobserver reliabilities, its precision is lower than that of CT-based measurements. Specifically, quantitative radiographic methods are prone to a larger margin of error in retroverted hips. For more precise assessments of acetabular version, especially in retroverted hips, we recommend using CT measurement instead of the radiographic method. Level III, diagnostic study.

Social Life of Zines and Other DIY Micro-Media Constituting American DIY Communities and Scenes

The primary function of zines is often considered to be creative and expressive, and the function of other types of DIY (“do-it-yourself”) micro-media as utilitarian (e.g., flyers as promotion), but all of these media also perform important social roles. DIY micro-media (e.g., zines, flyers, Internet pages, graffiti, wall signs, and “thank you” notes) are in this way embroiled in social lives of their makers and help them constitute themselves culturally and socially. DIY micro-media in this way also acquire their own social lives. Inspired by my ethnographic observations of the social lives of DIY micro-media within particular American DIY houses and music scenes, I examine in this article not only the content of DIY zines and micro-media (i.e., to study them as texts), but primarily the social role of zines and other DIY micro-media in the material, social, and affective constitution of DIY and music communities and scenes (i.e., to study them as social agents). Therefore, I show how these micro-media operate as material and media objects that are simultaneously shaped by and shaping human and social relations. By combining zine and micro-media studies with anthropology and material culture studies, I offer in this article a nuanced micro perspective, both ethnographic and emic, of the social processes implicated in the social and economic mutual constitution between media objects and music/art communities and scenes.

Chronic kidney disease activates the HDAC6-inflammatory axis in the heart and contributes to myocardial remodeling in mice: inhibition of HDAC6 alleviates chronic kidney disease-induced myocardial remodeling.

Chronic kidney disease (CKD) adversely affects the heart. The underlying mechanism and the interplay between the kidney and the heart are still obscure. We examined the cardiac effect using the unilateral ureteral obstruction (UUO)-induced CKD pre-clinical model in mice. Echocardiography, histopathology of the heart, myocardial mRNA expression of ANP and BNP, the extent of fibrotic (TGF-β, α-SMA, and collagen I) and epigenetic (histone deacetylases, namely HDAC3, HDAC4, and HDAC6) proteins, and myocardial inflammatory response were assessed. Six weeks of post-UUO surgery, we observed a compromised left-ventricular wall thickness and signs of cardiac hypertrophy, accumulation of fibrosis associated, and inflammatory proteins in the heart. In addition, we observed a perturbation of epigenetic proteins, especially HDAC3, HDAC4, and HDAC6, in the heart. Pharmacological inhibition of HDAC6 using ricolinostat (RIC) lessened cardiac damage and improved left-ventricular wall thickness. The RIC treatment substantially restored the serum cardiac injury markers, namely creatine kinase-MB and lactate dehydrogenase (LDH) activities, ANP and BNP mRNA expression, and heart histological changes. The extent of myocardial fibrotic proteins, phospho-NF-κB (p65), and pro-inflammatory cytokines (TNF-α, IL-18, and IL-1β) were significantly decreased in the RIC treatment group. Further findings revealed the CKD-induced infiltration of CD3, CD8a, CD11c, and F4/80 positive inflammatory cells in the heart. Treatment with RIC substantially reduced the myocardial infiltration of these inflammatory cells. From these findings, we believe that CKD-induced myocardial HDAC6 perturbation has a deteriorative effect on the heart, and inhibition of HDAC6 can be a promising approach to alleviate CKD-induced myocardial remodeling.

MENINGOTHELIOID NODULES COEXISTING WITH PULMONARY HYDATID CYST:A RARE CASE REPORT

Meningothelioid nodules are rare and usually benign pulmonary nodules. We present this case report because it represents the first reported case of an association between meningothelioid nodules and a pulmonary hydatid cyst. A 48-year-old Turkish female patient presented with a cough and hemoptysis lasting for a week. Chest computed tomography images revealed a well-circumscribed, unilocular cystic lesion in the left lower lobe of the lung, displaying the typical “double- wall sign” of a hydatid cyst. It was decided that the patient would undergo thoracoscopic wedge resection of the hydatid cyst in the left lower lobe. Microscopic examination revealed multiple perivenular nodules composed of epithelioid cells with round to oval nuclei, a moderate amount of eosinophilic cytoplasm, and finely granular chromatin in hematoxylin-eosin sections. Whorling of tumor cells was observed focally in most areas. Some cells exhibited pseudonuclear inclusions. The surrounding lung parenchyma contained hydatid cysts. Based on these histopathological and immunohistochemistry findings, a diagnosis of a meningothelioid nodule and a hydatid cyst was made. We encountered a rare case of coexisting meningothelioid nodules and a pulmonary hydatid cyst. Careful pathological, clinical, and radiological examination are required for the definitive diagnosis of meningothelioid nodules, and they can provide an excellent prognosis with surgery.

How Does Radiographic Acetabular Morphology Change Between the Supine and Standing Positions in Asymptomatic Volunteers?

The radiographic appearance of the acetabulum differs between the supine and standing positions in patients with hip conditions. The pelvis undergoes a change in tilt when transitioning between positions, resulting in variations in version and acetabular coverage. However, the extent of these variations in well-functioning volunteers without compensatory patterns caused by pain is unknown. We performed this study to (1) quantify differences in radiographic acetabular measurements when transitioning between supine and standing among asymptomatic, well-functioning volunteers; (2) assess differences in pelvic tilt between positions; and (3) test whether individual anatomic parameters are associated with the change in tilt. This was a prospective, single-center study performed at an academic referral center. One hundred volunteers (students, staff, and patients with upper limb injuries) with well-functioning hips (Oxford hip score ≥ 45) were invited to participate. A total of 45% (45) of them were female, their mean age was 37 ± 14 years, and their mean BMI was 25 ± 2 kg/m 2 . Supine and standing AP pelvic radiographs were analyzed to determine numerous acetabular parameters including the lateral center-edge angle (LCEA), acetabular index (AI), anterior wall index (AWI), posterior wall index (PWI), crossover sign (COS), crossover ratio (COR), posterior wall sign (PWS), ischial spine sign (ISS), and femoroepiphyseal acetabular roof index (FEAR), as well as pelvic parameters including the sacrofemoral-pubic angle (SFP). Spinopelvic parameters were measured from lateral standing spinopelvic radiographs. Radiographic measurements were performed by one hip preservation research fellow and a fellowship-trained staff surgeon. Differences in parameters were determined, and correlations between postural differences and morphological parameters were tested. Clinically important differences were defined as a difference greater than 3° for acetabular angle measurements and 0.03 for acetabular ratio measurements, based on previous studies. Lateral coverage angles did not show a clinically important difference between positions. AWI decreased when standing (0.47 ± 0.13 versus 0.41 ± 0.14; p < 0.001), whereas acetabular retroversion signs were more pronounced when supine (COS: 34% [34 of 100], PWS: 68% [68 of 100], and ISS: 34% [34 of 100] versus COS: 19% [19 of 100], PWS: 38% [38 of 100], and ISS: 14% [14 of 100]; all p values < 0.05). Pelvic tilt increased by a mean of 4° ± 4° when standing, but the range of change was from -15° to 7°. The change in AWI (ρ = 0.47; p < 0.001), PWI (ρ = -0.45; p < 0.001), and COR (ρ = 0.52; p < 0.001) between positions correlated with ΔSFP. Volunteers with spinal imbalance (pelvic incidence lumbar lordosis > 10°) demonstrated greater change in pelvic tilt (ΔSFP) (-7° ± 3° versus -4° ± 4°; p = 0.02) and a greater reduction in AWI (by 10%). These volunteers demonstrated reduced standing lumbar lordosis angles (45° ± 11° versus 61° ± 10°; p = 0.001). Acetabular version increases from supine to standing because of an increase in pelvic tilt. The change in pelvic tilt between positions exhibited substantial variability. Individuals with reduced lumbar lordosis for a given pelvic incidence value demonstrated greater pelvic mobility. No features on supine radiographs were associated with the change in tilt. Performing standing radiographs in addition to supine views can help identify aberrant physiologic patterns in patients with diagnostic dilemmas and might thus help with management. Normative data of pelvic tilt change can help clinicians identify patients who demonstrate excessive change in tilt that contributes to abnormal hip pathomechanics.

Justification of geodetic monitoring methodology of the retaining walls on the example of the embankment in Kremenchuk

Purpose. Development of a methodology for analyzing the results of geodetic measurements according to which it is possible to use the materials of past years for the needs of geodetic monitoring on the example of a retaining wall in the conditions of the city’s recreational area. Methodology. A technological scheme of geodetic monitoring of retaining walls has been developed with four main stages: analysis of initial data, design of geodetic monitoring, periodic observations, processing and analysis of geodetic monitoring results. The conditions of the recreational areas of the city determine the specifics of geodetic monitoring, limit the possibilities of choosing a scheme of the geodetic network and methods of measurements. In this regard, it is proposed to develop models of the development of deformation processes already at the first stage of geodetic monitoring, which will allow geodetic monitoring to be carried out with greater reliability in the future and avoid possible forecasting errors. Findings. The results of the analysis of geodetic measurements in the geodetic networks of Kremenchuk (coordinates and heights of wall signs) show the presence of horizontal and vertical displacements of the retaining wall. In the horizontal plane the retaining wall has shifted in the south-western direction, towards the Dnipro River. In the vertical plane, the retaining wall has subsided. The displacements of different parts of the retaining wall are uneven. The average annual rate of both horizontal and vertical displacements is equivalent and is approximately 1 mm/year. The values of absolute displacement vectors of wall signs in the horizontal plane exceed the accuracy of geodetic measurements and normative tolerances. Originality. Modeling of displacements of retaining walls in the conditions of recreational areas of the city is already underway, taking into account the analysis of the results of geodetic measurements of past years. Practical value. The data of the analysis of the results of geodetic measurements carried out in the geodetic densification networks of Kremenchuk indicate the presence of deformation processes and justify the need for their control through geodetic monitoring. The suggested models can be used as the comparative and combined analysis of future forecast changes based on previous and current results of measurements, which is a topic for another research.

Three-Dimensional Computed Tomography Reconstructions May Detect Pincer Lesions With Higher Sensitivity Than Radiographs in Patients With Femoroacetabular Impingement Syndrome

To assess the diagnostic capability of radiographs (XRs) to detect pincer lesions compared with 3-dimensional (3D) computed tomography scans in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS). We performed a retrospective review of all patients who underwent hip arthroscopy for FAIS between September 1, 2020, and October 2, 2022. Preoperative imaging was reviewed. Pincer lesions were defined as a lateral center-edge angle greater than 40°; a Tönnis angle greater than 0°; the presence of the ischial spine, crossover, or posterior wall sign; and the presence of overcoverage greater than 80%. Under "select criteria," patients were classified as having a pincer lesion on XRs and 3D computed tomography reconstructions (CTRs) based on the lateral center-edge angle or Tönnis angle alone, whereas "all criteria" added the presence of the crossover sign and coverage percentage. Statistical analysis was performed to determine the diagnostic accuracy of XRs compared with 3D CTRs. A total of 69 patients met the inclusion criteria. There were 21 male patients (30.4%) and 48 female patients (69.6%). The mean age was 33 ± 13.5 years. χ2 Analysis for select criteria found that 3D CTR was more likely than XRs to detect a pincer lesion. χ2 Analysis for all criteria found that 3D CTR was more likely than XRs to detect a pincer lesion. χ2 Analysis further showed that when using XRs, a pincer lesion was more likely to be detected under all criteria than under select criteria. Likewise, when using 3D CTR, a pincer lesion was more likely to be detected under all criteria than under select criteria. In this study, we found that 3D CTR detected pincer lesions in patients undergoing hip arthroscopy for FAIS with significantly higher sensitivity than XRs alone. Level III, retrospective cohort study.

IDIOPATIC SCLEROSING ENCAPSULATING PERITONITIS

ABSTRACT Introduction: Sclerosing Encapsulating Peritonitis (SEP) is a rare syndrome characterized by a chronic inflammatory process that leads to the formation of a thick fibrocollagenous membrane that surrounds and entraps intra-abdominal organs. As a result, although some cases may be asymptomatic, patients commonly develop symptoms of intestinal obstruction, and the diagnosis is often made incidentally during intra-abdominal surgeries. Case report: A 37-year-old male patient, a chronic alcoholic, was admitted with severe abdominal pain for seven days associated with abdominal distension, anorexia, and fever. Abdominal examination revealed signs of peritoneal irritation. Chest X-ray and abdominal computed tomography showed pneumoperitoneum and a large fluid collection, with signs of wall thickening extending through the pelvic cavity, parietocolic gutters, anterior abdominal cavity, and hepatodiaphragmatic space, causing compression of the hepatic parenchyma and displacement of intestinal loops. Due to these findings, the patient underwent an emergency exploratory laparotomy, in which a fibrocollagenous membrane, extensive bowel obstruction, and an abscess were identified. A total of 4.5 liters of purulent secretion were drained, the fibrous membrane was excised, the abdominal cavity was copiously washed, and a drain was placed in the upper right quadrant. He had a satisfactory resolution of the condition, without postoperative complications, and was discharged 11 days after the procedure. Conclusion: Initially, conservative management should be prioritized due to the technical difficulty of surgery and possible complications. However, in case of greater the level of peritoneal involvement and tissue adhesion, there is a higher chance of failure of conservative management, and surgical intervention may become necessary. Keywords: Peritonitis. Fibrosis Peritoneal. Intestinal Obstruction.

Patient positioning during the radiographic procedure affects the radiological signs of acetabular retroversion - A systematic review.

Young adults presenting with non-traumatic hip pain may suffer from acetabular retroversion (AR). The previous studies have suggested that patient positioning during the radiographic procedure, that is, pelvic tilt and/or rotation may alter the appearance of the acetabulum. The purpose of this systematic review was to explore and collate existing literature on the correlation between pelvic positioning in weight-bearing anterior-posterior radiographs and the radiographic signs of AR, namely, the ischial spine sign (ISS) the cross-over sign (COS) and posterior wall sign (PWS). The preferred reporting items for systematic reviews and meta-analysis guidelines were followed. MEDLINE, EMBASE, PubMed, The Cochrane Library, and CINAHL were searched. The search string included the following keywords: Pelvic, tilt, rotation, positioning, inclination, incidence, AR, ISS, COS, PWS, and acetabular version. Two authors independently screened the studies identified in the search, extracted data, and critically assessed included studies for quality using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. In total, 2289 publications were screened. Fifteen articles were found eligible for full-text screening, and four articles met the inclusion criteria. Although the studies varied methodologically, all reported that pelvic positioning impacted radiographic signs of AR investigated. One study suggested that more than 9° of pelvic inclination would result in positive COS. No other benchmark values on the degree of pelvic tilt and rotation that would compromise the diagnosis of AR, that is, the detection of ISS, COS, and PWS were reported. At present, literature reporting on the correlation between patient positioning and AR is sparse. Four studies met the inclusion criteria, and they all reported a link between pelvic positioning and the radiographic appearance of AR.

Global Acetabular Retroversion Is Not Associated With Differences in Outcomes After Primary Hip Arthroscopy Among Patients With Femoroacetabular Impingement Syndrome: A Matched Cohort Study With Minimum 5-Year Follow-Up

To compare hip survivorship and patient-reported outcome measures (PROMs) after primary hip arthroscopy at 5-year follow-up between patients with femoroacetabular impingement syndrome (FAIS) with radiographic signs of global acetabular retroversion and those without. A retrospective matched-cohort study was conducted using a single-surgeon hip arthroscopy database. Patients were included if they underwent primary hip arthroscopy for treatment of FAIS, had preoperative hip x-rays, and had a minimum 5-year follow-up. Global retroversion was defined as the presence of ischial spine sign, posterior wall sign, and crossover sign on anteroposterior view. Patients with FAIS with global retroversion were matched 1:1 on age, sex, and body mass index to FAIS controls. The modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS) were administered preoperatively and at follow-up. Hip survivorship and PROMs were compared between the 2 groups using the paired t test, Wilcoxon signed rank test, and/or Cochran-Mantel-Haenszel test as appropriate. P values <.05 were considered significant. Thirty-eight patients with global retroversion (mean age 40.6 ± 10.8 years, 60.5% female) were matched to 38 controls (mean age 41.3 ± 13.6 years, 60.5% female). Reoperation rates were the same in both groups (5.3%). On average, both groups reported significant pre- to postoperative improvement in mHHS (P < .001) and NAHS (P < .001), and there was no significant intergroup differences in the change in mHHS (P= .86) or NAHS (P= .90). Achievement rates for the patient acceptable symptom state on the mHHS were higher among males compared to females (P= .04) in both the global retroversion group (93.3% vs 73.9%) and the control group (93.3% vs 73.9%). Patients with FAIS with and without global acetabular retroversion had no significant difference in outcomes after primary hip arthroscopy at a minimum 5-year minimum follow-up. Level III, retrospective comparative prognostic trial.

Poster 232: Clinical Outcomes Among Individuals with Global Acetabular Retroversion who Underwent Hip Arthroscopy for FAI with Minimum 5-Year Follow-Up

Objectives: The purpose of this study was to compare functional outcomes and clinical threshold achievement rates of patients with radiographic signs of global acetabular retroversion who underwent hip arthroscopy for FAI with minimum follow-up of 5 years. Methods: Patients were identified from a single-surgeon prospectively-collected database who underwent primary hip arthroscopy for treatment of FAI. Patients completed patient-reported outcome (PRO) surveys at both baseline and at 5-year follow-up. Demographic data was collected including age, sex, BMI at time of surgery, and patient-reported symptom length. Intraoperative findings were recorded, including the Outerbridge grade, presence of labral tears, chondral delamination, subspine impingement, cam lesions, pincer lesions, and mixed-type FAI. Global acetabular retroversion was assessed on AP view using three radiographic signs: ischial spine, posterior wall, and crossover signs. Other radiographic measures included alpha angle measured on three view (AP, 45° Dunn, 90° Dunn), lateral center edge angle (LCEA), and Tönnis grade. Results: We identified 124 primary hip arthroscopy patients who had minimum 5-year follow-up with adequate imaging and complete 5-year PROs. Preoperative X-rays demonstrated presence of ischial spine sign in 65 patients (52.4%), posterior wall sign in 61 patients (49.2%), and crossover sign in 75 patients (60.5%). Mean alpha angle was highest on AP view (62.2°), followed by 45° Dunn view (55.9°) and 90° Dunn view (50.9°) and mean LCEA was 38.5°. A baseline comparison demonstrated no significant differences between groups in age, sex, BMI, preoperative symptom length, Tönnis grade, Outerbridge grade, and preoperative mHHS or NAHS (p&gt;0.05). At 5-year follow-up, patients reported significant improvement in both mHHS (mean 50.4 to 82.7, p&lt;0.001) and NAHS (49.4 to 85.5, p&lt;0.001). Achievement rates were high for MCID (90.3%), SCB (80.7%), and PASS (79.0%) for the mHHS. Three-way frequency comparison of acetabular retroversion signs found that all three signs tended to be present together (40 patients, 32.3%) or absent together (31 patients, 25.0%). Pairwise comparisons with tetrachoric correlation testing found all three signs to be significantly correlated with one another: ischial spine sign versus posterior wall (rtet=0.65, corrected p&lt;0.001), ischial spine sign versus crossover sign (rtet=0.74, corrected p&lt;0.001), and posterior wall sign versus crossover sign (rtet=0.51, corrected p&lt;0.001). Multivariable analysis did not find any of the three signs to be significant independent predictors of 5-year improvement in mHHS or NAHS (p&gt;0.05). Posterior wall sign was associated with lower odds of achieving the MCID (OR = 0.62, 95% CI [0.06 to 1.09]) but this did not achieve significance (χ2=3.39, p=0.07). Overall, achievement rates for MCID, SCB, and PASS did not significantly differ between the cohorts with respect to each sign (p&gt;0.05). Conclusions: Clinical outcomes and achievement rates at 5-year follow-up demonstrated no significant differences among patients with respect to each sign of acetabular retroversion based on mHHS, NAHS, MCID, SCB and PASS. Surgeons should be reassured that these patients regain function at a rate similar to the greater FAI population.

WHAT IS THE CONTEMPORARY MANAGEMENT OF ACETABULAR RETROVERSION?

Acetabular retroversion (ARV) is a cause of femoroacetabular impingement leading to hip pain and reduced range of motion. We aimed to describe the radiological criteria used for diagnosing ARV in the literature and report on the outcomes of periacetabular osteotomy (PAO) and hip arthroscopy (HA) in its management.A systematic review using PRISMA guidelines was conducted on the MEDLINE, CINAHL, EMBASE, COCHRANE database in December 2022. English-language studies reporting outcomes of PAO, or open or arthroscopic interventions for ARV were included.From an initial 4203 studies, 21 non-randomised studies met the inclusion criteria.Eleven studies evaluated HA for ARV, with average follow-up ranging from 1 to 5 years, for a cumulative number of 996 patients. Only 3/11 studies identified ARV using AP standardized pelvic radiographs. The most frequent signs describing ARV identified were: Ischial Spine Sign (98% of patients), Posterior Wall Sign (PWS, 94%) and Crossover Sign (COS, 64%); with mean Acetabular Retroversion Index (ARI) ranging from 33% to 35%. 39% of HA patients had all three radiographic signs. Clinically significant outcomes were reached by 33–78% of patients.Eight studies evaluated PAO for ARV, with a follow-up ranging from 2 to 10 years, for a cumulative number of 379 patients. Five of the eight studies identified ARV using standardized radiographs. ISS, COS and PWS were positive in 54%, 97% and 81% of patients, respectively with 52% of PAO patients having all three radiographic signs. Mean ARI ranged from 36–41%. Clinically significant results were reported in 71%–78% of patients.The diagnostic criteria for ARV is poorly defined in the literature, and the quality of evidence is low. Studies on HA are more likely to have used lenient diagnostic criteria. It remains difficult to recommend which cases maybe more suitable for treatment by HA rather than PAO.

The influence of lumbo-sacral transitional vertebrae in developmental dysplasia of the hip: a matched pair analysis

Lumbo-sacral transitional vertebrae (LSTV) are the most common congenital alteration of the lumbo-sacral junction and known to significantly influence pelvic anatomy. However, the influence of LSTV on dysplasia of the hip (DDH) and the surgical treatment by periacetabular osteotomy (PAO) remains unknown. We retrospectively examined standardized standing anterior–posterior pelvic radiographs of 170 patients in 185 PAO procedures. Radiographs were examined for LSTV, lateral-central-edge-angle (LCEA), Tönnis-angle (TA), femoral-head-extrusion index (FHEI), and anterior-wall-index (AWI) and posterior-wall-index (PWI). Patients with LSTV were compared to an age- and sex-matched control group. Patient-reported outcome measurements (PROMs) were evaluated pre- and in the mean 63.0 months (range 47–81 months) postoperatively. 43 patients (25.3%) had LSTV. Patients with LSTV had significantly greater PWI (p = 0.025) compared to the matched control group. No significant differences were seen in AWI (p = 0.374), LCEA (p = 0.664), TA (p = 0.667), and FHEI (p = 0.886). Between the two groups, no significant differences were detected in pre- or postoperative PROMs. Due to the increased dorsal femoral head coverage in patients with LSTV and DDH compared to patients with sole DDH, a more pronounced ventral tilting might be performed in those patients with prominent posterior wall sign to avoid anterior undercoverage, which is a significant predictor for premature conversion to hip arthroplasty after PAO. However, anterior overcoverage or acetabular retroversion must be avoided due to the risk of femoroacetabular impingement. Patients with LSTV reported similar functional outcomes and activity after PAO as the control group. Therefore, even for patients with concomitant LSTV, which are frequent with one-fourth in our cohort, PAO is an efficient treatment option to improve clinical symptoms caused by DDH.

"When the medium massages perceptions: Personal (vs. public) displays of information reduce crowding perceptions and outsider mistreatment of frontline staff": Correction.

Reports an error in "When the medium massages perceptions: Personal (vs. public) displays of information reduce crowding perceptions and outsider mistreatment of frontline staff" by Jean-Nicolas Reyt, Dorit Efrat-Treister, Daniel Altman, Chen Shapira, Arie Eisenman and Anat Rafaeli (Journal of Occupational Health Psychology, 2022[Feb], Vol 27[1], 164-178). In the original article, changes were needed to the labels under the images in the Appendix. Personal media were mistakenly labeled as public and vice versa. The four legends, from left to right, top to bottom, should be "Low crowding, public medium," "Low crowding, personal medium," "High crowding, public medium," and "High crowding, personal medium." The results and conclusions are unchanged. The online version of this article has been corrected. (The following abstract of the original article appeared in record 2022-30403-003). Crowded waiting areas are volatile environments, where seemingly ordinary people often get frustrated and mistreat frontline staff. Given that crowding is an exogenous factor in many industries (e.g., retail, healthcare), we suggest an intervention that can "massage" outsiders' perceptions of crowding and reduce the mistreatment of frontline staff. We theorize that providing information for outsiders to read while they wait on a personal medium (e.g., a leaflet, a smartphone) reduces their crowding perceptions and mistreatment of frontline staff, compared to providing the same information on a public medium (e.g., poster, wall sign). We report two studies that confirm our theory: A field experiment in Emergency Departments (n = 939) and an online experiment simulating a coffee shop (n = 246). Theoretical and managerial implications are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

John Charnley Award: A Quantitative Fluoroscopic Tool Improves Acetabular Fragment Positioning in Periacetabular Osteotomy

BackgroundRadiographic assessment of acetabular fragment positioning during periacetabular osteotomy (PAO) has been linked to hip survivorship. Intraoperative plain radiographs are time and resource intensive, while fluoroscopy can introduce image distortion affecting measurement accuracy. Our purpose was to determine whether intraoperative fluoroscopy-based measurements with a distortion correcting fluoroscopic tool improved PAO measurement targets. MethodsWe retrospectively reviewed 570 PAOs; 136 PAOs utilized a distortion correcting fluoroscopic tool, and 434 PAOs performed with routine fluoroscopy, prior to this technology. Lateral center-edge angle (LCEA), acetabular index (AI), posterior wall sign (PWS), and anterior center-edge angle (ACEA) were measured on preoperative standing radiographs, intraoperative fluoroscopic images, and postoperative standing radiographs. Defined target zones of correction were AI: 0-10°, ACEA: 25-40°, LCEA: 25-40°, PWS: negative. Postoperative correction in zones and patient-reported outcomes were compared using chi-square tests and paired t-tests, respectively. ResultsThe average difference between postcorrection fluoroscopic measurements and 6-week postoperative radiographs was 0.21° for LCEA, 0.01° for ACEA, and −0.07° for AI (all P < .01). The PWS agreement was 92%. The percentages of hips meeting target goals overall improved with the new fluoroscopic tool: 74%-92% for LCEA (P < .01), 72%-85% for ACEA (P < .01), and 69 versus 74% for AI (P = .25), though there was no improvement in PWS (85 versus 85%, P = .92). All patient-reported outcomes except PROMIS Mental Health were significantly improved at most recent follow-up. ConclusionsOur study demonstrated improved PAO measurements and target goals with the use of a distortion correcting quantitative fluoroscopic real-time measuring device. This value-additive tool gives reliable quantitative measurements of correction without interfering with surgical workflow.

Bile duct penetrating duodenal wall sign: a novel computed tomography finding of common bile duct stone impaction into duodenal major papilla.

Impacted common bile duct stones cause severe acute cholangitis. However, the early and accurate diagnosis, especially iso-attenuating stone impaction, is still challenging. Therefore, we proposed and validated the bile duct penetrating duodenal wall sign (BPDS), which shows the common bile duct penetrating the duodenal wall on coronal reformatted computed tomography (CT), as a novel sign of stone impaction. Patients who underwent urgent endoscopic retrograde cholangiopancreatography (ERCP) for acute cholangitis due to common bile duct stones were retrospectively enrolled. Stone impaction was defined by endoscopic findings as a reference standard. Two abdominal radiologists blinded to clinical information interpreted CT images to record the presence of the BPDS. The diagnostic accuracy of the BPDS to diagnose stone impaction was analyzed. Clinical data related to the severity of acute cholangitis were compared between patients with and without the BPDS. A total of 40 patients (mean age 70.6years; 18 female) were enrolled. The BPDS was observed in 15 patients. Stone impaction occurred in 13/40 (32.5%) cases. Overall accuracy, sensitivity, and specificity were 34/40 (85.0%), 11/13 (84.6%), and 23/27 (85.2%), respectively; 14/16 (87.5%), 5/6 (83.3%), and 9/10 (90.0%) for iso-attenuating stones; and 20/24 (83.3%), 6/7 (85.7%), and 14/17 (82.4%) for high-attenuating stones. Interobserver agreement of the BPDS was substantial (κ = 0.68). In addition, the BPDS was significantly correlated with the number of factors in the systemic inflammatory response syndrome (P = 0.03) and total bilirubin (P = 0.04). The BPDS was a unique CT imaging finding to identify common bile duct stone impaction regardless of stone attenuation with high accuracy.

Retrotilt of the Pelvis During Periacetabular Osteotomy: How to Avoid a Systematic Error Resulting in Acetabular Retroversion and Possible Femoroacetabular Impingement

Background: Pelvic tilt directly influences acetabular version on radiographs. Changes of pelvic tilt potentially affect acetabular reorientation after periacetabular osteotomy (PAO). Purpose: (1) To compare the ratio of the pubic symphysis height to the sacroiliac width (PS-SI) between hips with dysplasia and acetabular retroversion, uni- and bilateral PAO, and male and female patients. (2) To evaluate pelvic tilt (quantified using the PS-SI ratio) in patients after PAO by tracking it from preoperative to intra- and postoperative and short- and middle-term follow-up. Study Design: Case series; Level of evidence, 4. Methods: A retrospective and radiographic study was conducted evaluating pelvic tilt in 124 patients (139 hips) with dysplasia and 46 patients (57 hips) with acetabular retroversion who were undergoing PAO (January 2005–December 2019). Patients were excluded if they had insufficient radiographic data, previous or concomitant hip surgery, posttraumatic or pediatric deformities, or combined dysplasia and retroversion (90 patients, 95 hips). Dysplasia was defined as a lateral center-edge angle <23°; retroversion was defined by simultaneous appearance of a retroversion index 30% and positive ischial spine and posterior wall signs. Anteroposterior pelvic radiographs were taken in the supine position preoperatively, during PAO, postoperatively, and at short- and middle-term follow-up (mean ± SD [range]; 9 ± 3 weeks [5-23 weeks] and 21 ± 21 weeks [6-125 months]). The PS-SI ratio was calculated at 5 observation periods (preoperatively to middle-term follow-up) for different subgroups (dysplasia vs retroversion, uni- vs bilateral surgery, male vs female) and validated with intra- and interobserver agreement (intraclass correlation coefficients, 0.984 (95%CI, 0.976-0.989) and 0.991 (95% CI, 0.987-0.994), respectively). Results: The PS-SI ratio differed between dysplasia and retroversion at all observation periods (P = .041 to P < .001). Male dysplastic hips had a lower PS-SI ratio when compared with female dysplastic hips at all observation periods (P < .001 to P = .005). In hips with acetabular retroversion, the PS-SI ratio was lower in men than women at short- and middle-term follow-up (P = .024 and .003). No difference was found between uni- and bilateral surgery (P = .306 to P = .905) except for short-term follow-up in dysplasia (P = .040). The PS-SI ratio decreased in all subgroups preoperatively to intra- or postoperatively (P < .001 to P = .031). At short- and middle-term follow-up, the PS-SI ratio increased as compared with intraoperatively (P < .001 to P = .044) and did not differ from preoperatively in all subgroups (P = .370 to P = .795). Conclusion: A lower PS-SI ratio was found for male or dysplastic hips. In all subgroups, the PS-SI ratio decreased during surgery, indicating retrotilt of the pelvis. Correct pelvic orientation during surgery is crucial for accurate acetabular reorientation. Retrotilt during surgery results in underestimation of acetabular version and iatrogenic retroversion of the acetabulum at follow-up, with the pelvis in the correct and more forward-tilted orientation. Not taking into account retrotilt during PAO potentially results in femoroacetabular impingement. Therefore, we changed our intraoperative setting with adjustment of the central beam to compensate for retrotilt of the pelvis.

A Study of the Association Between Carotid Artery Curvature and Intracranial Aneurysms.

Carotid artery curvature is considered a sign of a weak vessel wall, and we hypothesize that a weak vascular wall under the effect of hemodynamics may cause intracranial aneurysms. The general data of 534 patients with aneurysms and 473 control patients were retrospectively analyzed in a case-control study. Carotid artery curvature was characterized as none, tortuosity, kinking, and coiling by computed tomography angiography images. Univariate analysis was performed to determine the degree of carotid artery tortuosity and to analyze the general data between the aneurysm group and the control group, and then, multivariate statistical logistic regression analysis was used to analyze the statistical significance of the univariate analysis. Finally, the correlation between aneurysm-related features and carotid artery curvature was analyzed. Univariate analysis showed that kinking was significantly related to the occurrence of intracranial aneurysms (P=0.009). The results of multivariate regression analysis showed that kinking was an independent risk factor for the occurrence of aneurysms (odds ratio: 1.942; 95% confidence interval: 1.387-2.720 for model 1; odds ratio: 1.995; 95% confidence interval: 1.419-2.805 for model 2). In the analysis of the correlation between the characteristics of intracranial aneurysms and the curvature of the internal carotid artery, there was no correlation between the curvature of the internal carotid artery and the size, location or number of aneurysms, or whether the intracranial aneurysm was ruptured. Intracranial aneurysms are associated with carotid artery curvature. Kinking of the internal carotid artery may indicate a higher risk for aneurysm formation.