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1
Verstraete, Frank J. Μ., Philip H. Kass, and Cheryl H. Terpak. "Diagnostic value of full-mouth radiography in dogs." American Journal of Veterinary Research 59, no. 6 (1998): 686. http://dx.doi.org/10.2460/ajvr.1998.59.06.686.
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Abstract Objective To determine the diagnostic value of full-mouth radiography in dogs. Sample Population Prospective series of 226 dogs referred for dental treatment without previous full-mouth radiographic views being available. Procedure In a prospective nested case-control analysis of multiple outcomes in a hospital cohort of dogs presented for dental treatment, full-mouth radiographic views were obtained prior to oral examination and charting. After treatment, clinical and radiographic findings were compared, with reference to presenting problems, main clinical findings, additional information obtained from the radiographs, and unexpected radiographic findings. The importance of the radiographic findings in therapeutic decision-making was assessed. Results The main clinical findings were radiographically confirmed in all dogs. Selected presenting problems and main clinical findings yielded significantly increased odds ratios for a variety of other conditions, either expected or unexpected. Radiographs of teeth without clinical lesions yielded incidental or clinically important findings in 41.7 and 27.8% of dogs, respectively, and were considered of no clinical value in 30.5%. Radiographs of teeth with clinical lesions merely confirmed the findings in 24.3% of dogs, yielded additional or clinically essential information in 50.0 and 22.6%, respectively, and were considered of no value in 3.1%. Older dogs derived more benefit from full-mouth radiography than did younger dogs. Incidental findings were more common in larger dogs. Clinical Relevance Diagnostic yield of full-mouth radiography in new canine patients referred for dental treatment is high, and the routine use of such radiographs is justifiable. (Am J Vet Res 1998;59:686-691)
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Meyer, Maximilian A., Timothy S. Leroux, David M. Levy, et al. "Flexion Posteroanterior Radiographs Affect Both Enrollment for and Outcomes After Injection Therapy for Knee Osteoarthritis." Orthopaedic Journal of Sports Medicine 5, no. 5 (2017): 232596711770669. http://dx.doi.org/10.1177/2325967117706692.
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Background: Knee injection therapy is less effective for severe osteoarthritis (OA), specifically Kellgren-Lawrence (KL) grade 4. Patient selection for knee injection trials has historically been based on extension anteroposterior (AP) radiographic evaluation; however, emerging evidence suggests that KL grading using a flexion posteroanterior (PA) radiograph more accurately and reproducibly predicts disease severity. The impact of radiographic view on patient selection and outcome after knee injection therapy remains unknown. Hypothesis: A 45° flexion PA radiograph will reveal more advanced knee OA in certain patients. These patients will report worse pre- and postinjection outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: Four raters independently graded extension AP and flexion PA radiographs from 91 patients previously enrolled in a knee injection trial. Patients determined to have KL grade 4 OA by any rater on extension AP radiographs were excluded. Among included patients, those upgraded to KL grade 4 on flexion PA radiographs by at least 2 raters constituted group 2, while all remaining patients constituted group 1. Demographic data and patient-reported outcome scores before injection and at 6 weeks, 3 months, 6 months, and 12 months postinjection were compared between groups. Results: Overall, 64 patients met the inclusion criteria, of which 19 patients (30%) constituted group 2. Compared with group 1, patients in group 2 were older (58.7 vs 52.3 years, P = .02), had worse visual analog scale pain scores before (6.6 vs 5.3, P = .03) and 6 months after injection (5.3 vs 3.5, P = .01), had less improvement in both Lysholm (8.5 vs 20.5, P = .02) and Short Form–12 physical component (–2.2 vs 1.7, P = .03) scores from preinjection to 6 months postinjection, and had less improvement in both Lysholm (1.6 vs 13.1, P = .03) and Knee injury and Osteoarthritis Outcome Score sport subscale (–2.1 vs 16, P = .01) scores from preinjection to 12 months postinjection. Conclusion: One in 3 patients considered to have mild to moderate knee OA on extension AP radiography is upgraded to severe knee OA (KL grade 4) on flexion PA radiography. These patients report worse preinjection outcomes, worse pain scores at short-term follow-up, and decreased improvement in knee function scores between 6 months and 1 year postinjection.
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Verstraete, Frank J. Μ., Philip H. Kass, and Cheryl H. Terpak. "Diagnostic value of full-mouth radiography in cats." American Journal of Veterinary Research 59, no. 6 (1998): 692. http://dx.doi.org/10.2460/ajvr.1998.59.06.692.
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Abstract Objective To determine the diagnostic value of full-mouth radiography in cats. Sample Population 115 cats referred for dental treatment without a previous full-mouth radiographic series available. Procedure In a prospective nested case-control analysis of multiple outcomes in a hospital cohort of cats referred for dental treatment, full-mouth radiography was done prior to oral examination and charting. After treatment, the clinical and radiographic findings were compared, with reference to presenting problems, main clinical findings, additional information obtained from radiography and unexpected radiographic findings. Importance of the radiographic findings in therapeutic decision making was assessed. Results The main clinical findings were radiographically confirmed in all cats. Odontoclastic resorption lesions, missed on clinical examination, were diagnosed in 8.7% of cats. Analysis of selected presenting problems and main clinical findings yielded significantly increased odds ratios for a variety of other conditions, either expected or unexpected. Radiographs of teeth without clinical lesions yielded incidental or clinically important findings in 4.8 and 41.7% of cats, respectively, and were considered of no clinical value in 53.6%. Radiographs of teeth with clinical lesions merely confirmed the findings in 13.9% of cats, but yielded additional or clinically essential information in 53.9 and 32.2%, respectively. Clinical Relevance The diagnostic yield of full-mouth radiography in new feline patients referred for dental treatment is high, and routine use of full-mouth radiography is justifiable. (Am J Vet Res 1998;59:692-695)
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Maksymowych, Walter P., Oliver FitzGerald, Mikkel Østergaard, et al. "Outcomes and Findings of the International Rheumatoid Arthritis (RA) BIODAM Cohort for Validation of Soluble Biomarkers in RA." Journal of Rheumatology 47, no. 6 (2019): 796–808. http://dx.doi.org/10.3899/jrheum.190302.
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Objective.The Outcome Measures in Rheumatology Soluble Biomarker Working Group initiated an international, multicenter, prospective study, the Rheumatoid Arthritis (RA) BIODAM cohort, to generate resources for the clinical validation of candidate biomarkers predictive of radiographic progression. This first report describes the cohort, clinical outcomes, and radiographic findings.Methods.Patients with RA from 38 sites in 10 countries starting or changing conventional synthetic disease-modifying antirheumatic drugs and/or starting tumor necrosis factor inhibitors were followed for 2 years. Participating physicians were required to adhere to a treat-to-target strategy. Biosamples (serum, urine) were acquired every 3 months, radiography of hands and feet every 6 months, and ultrasound of hands and feet every 3 months in a subset. Primary endpoint was radiographic progression by the Sharp/van der Heijde score.Results.A total of 571 patients were recruited and 439 (76.9%) completed 2-year followup. At baseline, the majority was female (76%), mean age 55.7 years, and mean disease duration 6.5 years. Patients had a mean of 8.4 swollen and 13.6 tender joints, 44-joint count Disease Activity Score (DAS44) 3.8, 77.7% rheumatoid factor–positive or anticitrullinated protein antibody–positive. Percentage of patients in DAS and American College of Rheumatology remission at 2 years was 52.2% and 27.1%, respectively. Percentage of patients with radiographic progression (> 0.5) at 1 and 2 years was 38.2% and 59.9%, respectively.Conclusion.The RA BIODAM prospective study succeeded in generating an extensive list of clinical, imaging (2343 radiographs), and biosample (4638 sera) resources that will be made available to expedite the identification and validation of biomarkers for radiographic damage endpoints. (Clinicaltrials.gov: NCT01476956, clinicaltrials.gov/ct2/show/NCT01476956)
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Beshtawi, Khaled R., Mogammad T. Peck, and Manogari Chetty. "Review of the radiographic modalities used during dental implant therapy - A narrative." South African Dental Journal 76, no. 2 (2021): 84–90. http://dx.doi.org/10.17159/2519-0105/2021/v76no2a4.
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The introduction of digital x-ray receivers which replaced conventional films was a significant radiographic development that is commonly used in daily dental practice. Dental implant therapy (DIT) is a sought after dental therapeutic intervention and dental radiography is an essential component contributing to the success of treatment. Dental radiographs taken in daily practice are generally conventional two-dimensional images and/or three-dimensional images. Ideally, the choice of radiographic technique should be determined after a thorough clinical examination and comprehensive consideration of the advantages, indications, and drawbacks. Digital three-dimensional modalities that have emerged over the last decade have been incorporated into DIT with the assumption that treatment outcomes will be improved. These modalities are constantly being reassessed and improved but there is a paucity of published information regarding the assessment of variables such as dosages and dimensional accuracy, suggesting that further research in these matters is necessary. This is crucial in order to obtain evidence-based information that may influence future radiographic practices. In this narrative, the authors present the most commonly used dental radiographic modalities currently used in DIT.
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Wollstein, Ronit, Raviv Allon, Yoav Zvi, Alan Katz, Sharon Werech, and Orit Palmon. "Association between Functional Outcomes and Radiographic Reduction Following Surgery for Distal Radius Fractures." Journal of Hand Surgery (Asian-Pacific Volume) 24, no. 03 (2019): 258–63. http://dx.doi.org/10.1142/s2424835519500310.
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Background: Quality of reduction in distal radius fractures (DRF) is assessed using radiographic parameters, however few studies examine the association between radiographic measurements and functional outcomes. Our purpose was to evaluate the relationship between radiographic measurements and clinical outcome measures following surgery for DRF using detailed testing to demonstrate further associations between post-surgical radiographic measurements and function. Methods: Measurements were performed on postoperative radiographs of 38 patients following ORIF of DRF. Measurements included: radial inclination, radial height, ulnar variance, volar tilt, radiocarpal interval (d2/w2), and the intra-articular step-off. Clinical outcome measures included motion, grip strength, functional dexterity testing, Moberg pick-up test, specific activities of daily living, DASH score, pain scale, manual-assessment questionnaire. Results: Different radiographic parameters correlated with different specific tasks. The parameter correlated with most functional tasks was ulnar-variance. Radial inclination, radial-styloid scaphoid distance, and fracture classification correlated with some functions. Intraarticular step-off, and radial height were not associated with functional testing. Conclusions: Surgical radiographic results may affect post-operative function. Detailed task specific testing may enable a better evaluation of surgical outcomes. Further study and refinement of functional assessment may change our surgical goals in DRF.
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Stewart, A., B. Benson, B. Tennent-Brown, J. Foreman, and C. Byron. "Effects of radial extracorporeal shock wave therapy on radiographic and scintigraphic outcomes in horses with palmar heel pain." Veterinary and Comparative Orthopaedics and Traumatology 22, no. 02 (2009): 113–18. http://dx.doi.org/10.3415/vcot-08-04-0037.
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Summary Objective: To investigate the effects of radial extracorporeal shock wave therapy (RESWT) on radiographic and scintigraphic variables in horses with clinical pain referable to the palmar heel. Methods: Eight client-owner horses with palmar heel pain were treated with RESWT for a total of three treatments. Nuclear scintigraphy and radiography were repeated at the beginning and completion of the study. Scintigram region of interest (ROI) density ratios were calculated and compared between treated limbs, untreated limbs, and a population of comparison limbs from eight horses free of lameness. Radiographs were scored for whole navicular bone appearance as well as distal border synovial fossae number and severity. Results: There was not any preversus post-treatment difference in scintigraphic navicular pool phase or delayed phase ROI density ratios in treated limbs, or between treated and untreated limbs. Delayed phase ROI density was increased in the central navicular region in treated limbs compared to comparison limbs from non-lame horses at both time points. Radiographic scores remained unchanged. Clinical significance: RESWT as applied in the present study has no effect on acute palmar heel region scintigraphic or radiographic parameters. Any acute clinical benefit may be due to analgesic effects rather than stimulation of local tissue metabolism.
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Lee, Christopher J., Barrett S. Boody, Jaclyn Demeter, Joseph D. Smucker, and Rick C. Sasso. "Long-Term Radiographic and Functional Outcomes of Patients With Absence of Radiographic Union at 2 Years After Single-Level Anterior Cervical Discectomy and Fusion." Global Spine Journal 10, no. 6 (2019): 741–47. http://dx.doi.org/10.1177/2192568219874768.
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Study Design: Retrospective radiographic investigation. Objective: To evaluate the long-term radiographic and functional outcomes of patients in whom there is absence of radiographic union at 2 years after single-level anterior cervical discectomy and fusion (ACDF). Methods: Thirty-one patients were evaluated at standard postoperative time intervals per index trial protocol. Plain film radiographic fusion criteria at the arthrodesis level was defined as interspinous motion (ISM) <1 mm with corresponding motion at a non-arthrodesed superjacent level ISM ≥4 mm. Radiographs and functional outcome measures were acquired at each follow-up visit. Delayed union was defined as lack of radiographic union by 24 months. Results: Nine patients demonstrated radiographic evidence of delayed radiographic union at 24 months. Of those 9 patients, 5 patients demonstrated evidence of union during the follow-up period to 72 months. Despite the absence of radiographic union based on our criteria, 3 of the 4 remaining patients reported remarkable improvements in pain scores and functional outcomes. Conclusions: The natural history of delayed union at 24 months after ACDF was still favorable despite the prolonged delay in union. The majority of patients (5 of 9) without radiographic union at 24 months did proceed to radiographic union by final follow-up. In addition, patients that did not meet our criteria for fusion maintained postoperative improvements in patient-reported outcome scores. In summary, our study patients undergoing a single-level ACDF with asymptomatic radiographic delayed union at 24 months can expect maintained improvements in postoperative patient-reported outcomes scores and can still progress to successful radiographic fusion.
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Huish, Eric G., John G. Coury, Mohamed A. Ibrahim, and Marc A. Trzeciak. "Radiographic Outcomes of Dorsal Distraction Distal Radius Plating for Fractures With Dorsal Marginal Impaction." HAND 13, no. 3 (2017): 346–49. http://dx.doi.org/10.1177/1558944717704514.
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Background: The purpose of this study is to compare radiographic outcomes of patients treated with dorsal spanning plates with previously reported normal values of radiographic distal radius anatomy and compare the results with prior publications for both external fixation and internal fixation with volar locked plates. Methods: Patients with complex distal radius fractures including dorsal marginal impaction pattern necessitating dorsal distraction plating at the discretion of the senior authors (M.A.T. and M.A.I.) from May 30, 2013, to December 29, 2015, were identified and included in the study. Retrospective chart and radiograph review was performed on 19 patients, 11 male and 8 female, with mean age of 47.83 years (22-82). No patients were excluded from the study. Results: All fractures united prior to plate removal. The average time the plate was in place was 80.5 days (49-129). Follow-up radiographs showed average radial inclination of 20.5° (13.2°-25.5°), radial height of 10.7 mm (7.5-14 mm), ulnar variance of −0.3 mm (−2.1 to 3.1 mm), and volar tilt of 7.9° (−3° to 15°). One patient had intra-articular step-off greater than 2 mm. Conclusions: Dorsal distraction plating of complex distal radius fractures yields good radiographic results with minimal complications. In cases of complex distal radius fractures including dorsal marginal impaction where volar plating is not considered adequate, a dorsal distraction plate should be considered as an alternative to external fixation due to reduced risk for infection and better control of volar tilt.
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Spaans, A. J., F. J. A. Beek, C. S. P. M. Uiterwaal, J. E. H. Pruijs, and R. J. Sakkers. "Correlation between ultrasonic and radiographic imaging of developmental dysplasia of the hip." Journal of Children's Orthopaedics 13, no. 2 (2019): 155–60. http://dx.doi.org/10.1302/1863-2548.13.180165.
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Purpose The correlation between the degree of developmental hip dysplasia (DDH) measured on ultrasound images compared with that measured on radiographs is not clear. Most studies have compared ultrasonography (US) and radiographic images made at different times of follow-up. In this study the correlation between US images and radiographs of the hip made on the same day was evaluated. Methods US images and radiographs of both hips of 74 infants, who were treated for stable DDH, were reviewed in a retrospective study. Only infants who had an US examination and a radiograph on the same day were included. Results The correlation between α-angle of Graf and femoral head coverage on US was strong (p ≤ 0.0001). Weak correlations were found between the acetabular index of Tönnis on radiographs and α-angle of Graf on US (p = 0.049) and between acetabular index of Tönnis on radiographs and femoral head coverage of Morin on US (p = 0.100). Conclusion This study reports on the correlation between US and radiographic imaging outcomes, both made on the same day in patients for treatment and follow-up of DDH. Level of Evidence IV
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Kohring, Jessica M., Ashlee MacDonald, Steven Karnyski, et al. "Radiographic Outcomes after Flexible Flatfoot Reconstruction with and without Spring Ligament Reconstruction." Foot & Ankle Orthopaedics 5, no. 2 (2020): 2473011420S0000. http://dx.doi.org/10.1177/2473011420s00008.
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Category: Hindfoot Introduction/Purpose: The purpose of this study was to determine postoperative radiographic differences between patients who underwent flexible flatfoot reconstruction and spring ligament repair with a FiberTape suture device versus those who underwent spring ligament reconstruction with suture repair alone or those without reconstruction of the spring ligament for patients with Stage II adult acquired flatfoot deformity (AAFD). Methods: 84 patients with Stage II AAFD met inclusion criteria with 18 undergoing flatfoot reconstruction and spring ligament (SL) repair with a FiberTape suture device (SL+FT), 12 with suture repair alone (SL+suture), and 54 without repair of the SL. Radiographic measurements were made on weight bearing radiographs pre- and postoperatively at an average of 90 ±108 weeks after surgery. The radiographic measurements included tibiotalar tilt (TT), talar-first metatarsal angle (T1M), talar-second metatarsal angle (T2M), talonavicular uncoverage angle (TN), Meary’s angle (MA), calcaneal pitch (CP), medial column height (MCH), and lateral column height (LCH). Statistical analysis was performed using two-way ANOVA. Results: There were no differences in preoperative radiographic measurements between the three groups. Postoperatively, the SL+FT and SL+suture groups had statistically significantly improved radiographic outcomes for T1M, T2M, TN, MA, CP, and LCH when compared to the no SL repair group (p<0.05). There were no differences in any radiographic outcomes between the SL+FT and SL+suture groups ( Figure 1 ). Conclusion: Spring ligament reconstruction with either a FiberTape construct or suture repair alone demonstrates significant improvements in postoperative radiographic outcomes after undergoing flexible flatfoot reconstruction at an average of 2 years after surgery as compared to patients that did not have SL repair. The results of our study support spring ligament repair or reconstruction for patients when performing flexible flatfoot surgery for Stage II AAFD.
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Park, Grace S., Weng Kee Wong, Dinesh Khanna, Richard H. Gold, and Harold E. Paulus. "Examining radiographic outcomes over time." Rheumatology International 34, no. 2 (2013): 271–79. http://dx.doi.org/10.1007/s00296-013-2879-9.
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Mulders, Marjolein A. M., Monique M. J. Walenkamp, Nico L. Sosef, et al. "The Amsterdam Wrist Rules to reduce the need for radiography after a suspected distal radius fracture: an implementation study." European Journal of Trauma and Emergency Surgery 46, no. 3 (2019): 573–82. http://dx.doi.org/10.1007/s00068-019-01194-2.
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Abstract Purpose While most patients with wrist trauma are routinely referred for radiography, around 50% of these radiographs show no fracture. To avoid unnecessary radiographs, the Amsterdam Wrist Rules (AWR) have previously been developed and validated. The aim of the current study was to evaluate the effect of the implementation of the AWR at the Emergency Department (ED). Methods In a before-and-after comparative prospective cohort study, all consecutive adult patients with acute wrist trauma presenting at the ED of four hospitals were included. Primary outcome was the number of wrist radiographs before and after implementation of the AWR. Secondary outcomes were the number of clinically relevant missed fractures, the overall length of stay in the ED, physician compliance regarding the AWR, and patient satisfaction and experience with the care received at the ED. Results A total of 402 patients were included. The absolute reduction in wrist radiographs after implementation was 15% (p < 0.001). One clinically irrelevant fracture was missed. Non-fracture patients without wrist radiography due to the AWR spent 34 min less time in the ED compared with non-fracture patients who had a wrist radiograph (p = 0.015). The physicians adhered to the AWR in 36% of patients. Of all patients who did not receive a radiographic examination of the wrist, 87% were satisfied. Conclusion Implementation of the AWR safely reduces the amount of wrist radiographs in selected patients and consequently reducing the length of stay in the ED.
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Kiwalkar, Sonam, Secia Beier, and Atul Deodhar. "Ixekizumab for treating ankylosing spondylitis." Immunotherapy 11, no. 15 (2019): 1273–82. http://dx.doi.org/10.2217/imt-2019-0094.
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Axial spondyloarthritis (axSpA) is an umbrella term that includes ankylosing spondylitis and nonradiographic axSpA. Presence or absence of definitive sacroiliitis on radiographs differentiates ankylosing spondylitis (also called radiographic axSpA) from nonradiographic axSpA. There is growing evidence that indicates IL-17 pathway is a key contributor to the pathogenesis of axSpA. Ixekizumab (IXE) is an IL-17A inhibitor (IL-17i) with data to support its use in patients with radiographic axSpA. The pharmacologic properties of IXE were reviewed. Data regarding the use and efficacy of IXE in patients with radiographic axSpA were evaluated. Quality life outcomes and safety profiles of IXE were examined as well. By comparison with other chronic inflammatory arthritides, the number of targeted treatment options for axSpA is currently limited to tumor necrosis factor inhibitor (TNFi) and IL-17i secukinumab. IXE has good evidence of improved outcomes in terms of clinical efficacy, patient reported outcomes and imaging outcomes, with an acceptable safety profile in patients with radiographic axSpA. The current results discussed in this article support use of IXE as a treatment option for TNFi naive as well as in subjects with prior inadequate response to or intolerance to TNFi agents.
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Maidman, Samuel, Jason Bariteau, Stephanie Boden, Allison Boden, and Shay Tenenbaum. "Radiographic predictors for improved outcomes after hammertoe correction surgery." Foot & Ankle Orthopaedics 3, no. 3 (2018): 2473011418S0032. http://dx.doi.org/10.1177/2473011418s00329.
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Category: Lesser Toes Introduction/Purpose: Hammertoe deformities are common, often painful deformities of the lesser foot and are known to severely affect daily activities. When patients seek surgical management, x-rays are utilized for diagnosis, evaluation for surgical candidacy, and selection of the operative technique. Postoperatively, radiographs are retaken to assess bone health, healing status, and alignment. Despite the frequent use of radiographs pre- and post-operatively, radiographic results are not necessarily indicative of clinical presentation or surgical outcomes. The aim of this study is to identify specific radiographic parameters that are predictive of improved pain and function after surgical correction of hammertoe deformity. Methods: Prospectively collected data was reviewed on 51 consecutive patients who underwent operative correction of hammertoe deformity. Patient demographics, comorbidities, and post-surgical complications were recorded from their electronic medical records. Clinical outcomes were assessed utilizing preoperative and postoperative Visual Analogue Scale (VAS) and Short Form Health Survey Physical Component (SF-36 PCS) scores with a minimum of six-month follow-up. Radiographs were scored by a foot & ankle fellowship-trained orthopaedic surgeon to assess preoperative severity, postoperative joint fusion, and both pre- and postoperative joint instability and arthritis. Data was examined using a multivariable analysis. Results: Preoperatively, 15.7% (8/51) of patients had a deformity classified radiographically as mild, 37.3% (19/51) as moderate, and 47.1% (24/51) as severe. Additionally, 60.8% (31/51) had joint instability, 17.7% (9/51) had joint dislocation, and 7.8% (4/51) had joint arthritis. Postoperatively, 74.5% had PIP joint fusion, 35.3% (18/51) had joint arthritis, and 9.8% (5/51) had joint instability. A significant association was found between PIP joint fusion and improved SF-36 PCS scores (p=.004). Preoperative anticoagulant therapy was associated with reduced rates of PIP joint fusion (p=0.02). There was no association found between the other demographic or radiographic parameters, and no parameters were associated with improvement in VAS scores. Conclusion: After undergoing surgical correction of hammertoe deformity, postoperative PIP joint fusion was the only variable determined to be indicative of improved physical function. However, pre- and postoperative metatarsophalangeal joint arthritis nor instability was predictive of outcomes. This work informs foot & ankle specialists that healing of the PIP joint is critical to successful hammertoe surgery.
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Kim, Myoung Kyoung, Tae Yeon Jeon, Kyunga Kim, et al. "Clinical Outcome of Ultrasound-Detected Perforated Necrotizing Enterocolitis without Radiographic Pneumoperitoneum in Very Preterm Infants." Journal of Clinical Medicine 12, no. 5 (2023): 1805. http://dx.doi.org/10.3390/jcm12051805.
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Objectives: To investigate the clinical outcomes of ultrasound (US)-detected perforated necrotizing enterocolitis (NEC) without radiographic pneumoperitoneum in very preterm infants. Methods: In this single-center retrospective study, very preterm infants who underwent a laparotomy for perforated NEC during their neonatal intensive care unit stay were classified into two groups according to the absence or presence of pneumoperitoneum on radiographs (the case versus the control groups). The primary outcome was death before discharge, and the secondary outcomes included major morbidities and body weight at 36 weeks postmenstrual age (PMA). Results: Of the 57 infants with perforated NEC, 12 (21%) had no pneumoperitoneum on the radiographs and were diagnosed with perforated NEC on the US. In the multivariable analyses, the primary outcome of death before discharge was significantly lower in infants with perforated NEC without radiographic pneumoperitoneum than in those with perforated NEC and radiographic pneumoperitoneum (8% [1/12] vs. 44% [20/45]; adjusted odds ratio [OR], 0.02; 95% confidence interval [CI], 0.00–0.61; p = 0.025). The secondary outcomes (short bowel syndrome, total parenteral nutrition dependence for 3 months or more, the length of their hospital stay, a bowel stricture requiring surgery, sepsis after the laparotomy, acute kidney injury after the laparotomy, and body weight at 36 weeks PMA) did not differ significantly between the two groups. Conclusions: Very preterm infants with US-detected perforated NEC without radiographic pneumoperitoneum had a lower risk of death before discharge than those with perforated NEC and radiographic pneumoperitoneum. Bowel USs may have a potential role in surgical decision-making in infants with advanced NEC.
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Mehta, Vishal M., Liz W. Paxton, Stefan X. Fornalski, Rick P. Csintalan, and Donald C. Fithian. "Reliability of the International Knee Documentation Committee Radiographic Grading System." American Journal of Sports Medicine 35, no. 6 (2007): 933–35. http://dx.doi.org/10.1177/0363546507299742.
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Background The International Knee Documentation Committee (IKDC) forms are commonly used to measure outcomes after anterior cruciate ligament (ACL) reconstruction. The knee examination portion of the IKDC forms includes a radiographic grading system to grade degenerative changes. The interrater and intrarater reliability of this radiographic grading system remain unknown. Hypothesis We hypothesize that the IKDC radiographic grading system will have acceptable interrater and intrarater reliability. Study Design Case series (diagnosis); Level of evidence, 4. Methods Radiographs of 205 ACL-reconstructed knees were obtained at 5-year follow-up. Specifically, weightbearing posteroanterior radiographs of the operative knee in 35° to 45° of flexion and a lateral radiograph in 30° of flexion were used. The radiographs were independently graded by 2 sports medicine fellowship—trained orthopaedic surgeons using the IKDC 2000 standard instructions. One surgeon graded the same radiographs 6 months apart, blinded to patient and prior IKDC grades. The percentage agreement was calculated for each of the 5 knee compartments as defined by the IKDC. Interrater reliability was evaluated using the intraclass correlation coefficient (ICC) 2-way mixed effect model with absolute agreement. The Spearman rank-order correlation coefficient (rs) was applied to evaluate intrarater reliability. Results The interrater agreement between the 2 surgeons was 59% for the medial joint space (ICC = 0.46; 95% confidence interval [CI] = 0.35-0.56), 54% for the lateral joint space (ICC = 0.45; 95% CI = 0.27-0.58), 49% for the patellofemoral joint (ICC = 0.40; 95% CI = 0.26-0.52), 63% for the anterior joint space (ICC = 0.20; 95% CI = 0.05-0.34), and 44% for the posterior joint space (ICC = 0.28; 95% CI = 0.15-0.40). The intrarater agreement was 83% for the medial joint space (rs = .77, P < .001), 86% for the lateral joint space (rs = .76, P < .001), 81% for the patellofemoral joint (rs = .79, P < .001), 91% for the anterior joint space (rs = .48, P < .001), and 69% for the posterior joint space (rs = .64, P < .001). Conclusions While intrarater reliability was acceptable, interrater reliability was poor. These findings suggest that multiple raters may score the same radiographs differently using the IKDC radiographic grading system. The use of a single rater to grade all radiographs when using the IKDC radiographic grading system maximizes reliability.
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Cody, Elizabeth A., Kristin Caolo, Scott J. Ellis, and A. Holly Johnson. "Early Radiographic Outcomes of Minimally Invasive Chevron Bunionectomy Compared to the Modified Lapidus Procedure." Foot & Ankle Orthopaedics 7, no. 3 (2022): 247301142211121. http://dx.doi.org/10.1177/24730114221112103.
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Background: Minimally invasive (MIS) bunion surgery has become increasingly popular. Although early reports on outcomes have been encouraging, no study to date has compared outcomes from the MIS chevron and Akin procedures to the modified Lapidus procedure. Our primary aim was to compare early radiographic outcomes of the MIS chevron and Akin osteotomies to those of the modified Lapidus procedure in patients with comparable deformities, and secondarily to compare clinical outcomes. Methods: Patients were retrospectively reviewed for inclusion from a prospectively collected foot and ankle registry. Patients were eligible if they underwent either the MIS bunionectomy or modified Lapidus procedure and had preoperative and minimum 5-month postoperative weightbearing radiographs. Forty-one patients who underwent MIS bunionectomy were matched to 41 patients who underwent Lapidus bunionectomy based on radiographic parameters. Demographics, radiographic parameters, complications, reoperations, and PROMIS scores were compared between groups. Results: Both groups achieved similar radiographic correction. There was no significant difference in pre- or postoperative PROMIS scores between groups. Procedure duration was significantly faster in the MIS group ( P < .001). Bunion recurrence (hallux valgus angle ≥20 degrees) occurred in 1 MIS patient and 2 Lapidus patients, with all patients asymptomatic. The most common reason for reoperation was removal of hardware (4 patients in the MIS group, 2 patients in the Lapidus group). Conclusion: This is the first study to our knowledge to compare early radiographic outcomes between MIS bunionectomy and the modified Lapidus procedure in patients matched for bunion severity. We found that patients with similar preoperative deformities experience similar radiographic correction following MIS chevron and Akin osteotomies vs modified Lapidus bunionectomy. Further research is needed to investigate satisfaction differences between the procedures, longer-term outcomes, and which deformities are best suited to each procedure. Level of Evidence: Level III, Retrospective case control study.
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Lewis, T., P. W. Robinson, R. Ray, et al. "FIVE-YEAR FOLLOW-UP OF THIRD-GENERATION PERCUTANEOUS CHEVRON AND AKIN OSTEOTOMIES (PECA) FOR HALLUX VALGUS." Orthopaedic Proceedings 106-B, SUPP_11 (2024): 20. http://dx.doi.org/10.1302/1358-992x.2024.11.020.
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BackgroundRecent large studies of third-generation minimally invasive hallux valgus surgery (MIS) have demonstrated significant improvement in clinical and radiological outcomes. It remains unknown whether these clinical and radiological outcomes are maintained in the medium to long-term. The aim of this study was to investigate the five-year clinical and radiological outcomes following third-generation MIS hallux valgus surgery.MethodsA retrospective observational single surgeon case series of consecutive patients undergoing primary isolated third-generation percutaneous Chevron and Akin osteotomies (PECA) for hallux valgus with a minimum 60 month clinical and radiographic follow up. Primary outcome was radiographic assessment of the hallux valgus angle (HVA) and intermetatarsal angle (IMA) pre-operatively, 6 months and ≥60 months following PECA. Secondary outcomes included the Manchester-Oxford Foot Questionnaire, patient satisfaction, Euroqol-5D Visual Analogue Scale and Visual Analogue Scale for Pain.ResultsBetween 2012 and 2014, 126 consecutive feet underwent isolated third-generation PECA. The mean follow up was 68.8±7.3 (range 60–88) months. There was a significant improvement in radiographic deformity correction; IMA improved from 13.0±3.0 to 6.0±2.6, (p < 0.001) and HVA improved from 27.5±7.6 to 7.8±5.1. There was a statistically significant but not clinically relevant increase of 1.2±2.6° in the HVA between 6 month and ≥60 month radiographs. There was an increase in IMA of 0.1±1.6º between 6 month and ≥60 month radiographs which was not statistically or clinically significant. MOXFQ Index score at ≥follow up was 10.1±17.0. The radiographic recurrence rate was 2.6% at final follow up. The screw removal rate was 4.0%.ConclusionRadiological deformity correction following third-generation PECA is maintained at a mean follow up of 68.8 months with a radiographic recurrence rate of 2.6%. Clinical PROMs and patient satisfaction levels are high and comparable to other third-generation studies with shorter duration of follow up.
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Dos Santos Barroco, Rui, Bruno Rodrigues de Miranda, Leticia Zaccaria Prates de Oliveira, Mahmoud Beerens Abdul Ghani Abdul Ghani, Antonio Candido de Paula Neto, and Douglas Hideki Ikeuti. "PO 18271 - New method for the radiographic evaluation of metatarsal rotation in hallux valgus." Scientific Journal of the Foot & Ankle 13, Supl 1 (2019): 60S. http://dx.doi.org/10.30795/scijfootankle.2019.v13.1055.
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Introduction: Hallux valgus involves, in addition to I/II intermetatarsal angle deviation, a rotational deformity of the first metatarsal bone and its sesamoids in relation to the ground. The correction of the rotation is the objective of new and recently developed surgical techniques. Objective: To describe a radiographic method that can help predict changes resulting from metatarsal rotational correction and facilitate surgical planning. Methods: We acquired radiographs in a weight-bearing anteroposterior position in patients with flexible hallux valgus while asking the patient to actively extend the toes. We compared the weight-bearing radiographs with and without the toe extension maneuver. In addition to radiography, we performed computed tomography (CT) of the nonweight-bearing active toe extension maneuver using a support platform. To measure the changes, we used the classification of Coughlin and Smith et al. Results: We observed clinical and radiographic correction, both angular and rotational, by measuring the intermetatarsal angle and sesamoid position. The changes were confirmed by CT, which showed improvement in the intermetatarsal angle, sesamoid position and metatarsophalangeal range. Discussion: The toe extension maneuver was described as a peroneus longus tendon activation test by Klemola et al., who used it to demonstrate rotational clinical correction of hallux valgus. Here, we described a radiographic method based on this principle to observe the correction power of and factors involved in metatarsal derotation using a preoperative radiographic technique. Conclusion: The method clearly demonstrated the capacity for the correction of preoperative hallux derotation in various planes, thus helping to predict the clinical, angular and rotational outcomes of surgical treatment.
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Day, Jonathan, Jaeyoung Kim, Martin J. O’Malley, et al. "Radiographic and Clinical Outcomes of the Salto Talaris Total Ankle Arthroplasty." Foot & Ankle International 41, no. 12 (2020): 1519–28. http://dx.doi.org/10.1177/1071100720947030.
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Background: The Salto Talaris is a fixed-bearing implant first approved in the US in 2006. While early surgical outcomes have been promising, mid- to long-term survivorship data are limited. The aim of this study was to present the survivorship and causes of failure of the Salto Talaris implant, with functional and radiographic outcomes. Methods: Eighty-seven prospectively followed patients who underwent total ankle arthroplasty with the Salto Talaris between 2007 and 2015 at our institution were retrospectively identified. Of these, 82 patients (85 ankles) had a minimum follow-up of 5 (mean, 7.1; range, 5-12) years. The mean age was 63.5 (range, 42-82) years and the mean body mass index was 28.1 (range, 17.9-41.2) kg/m2. Survivorship was determined by incidence of revision, defined as removal/exchange of a metal component. Preoperative, immediate, and minimum 5-year postoperative AP and lateral weightbearing radiographs were reviewed; tibiotalar alignment (TTA) and the medial distal tibial angle (MDTA) were measured to assess coronal talar and tibial alignment, respectively. The sagittal tibial angle (STA) was measured; the talar inclination angle (TIA) was measured to evaluate for radiographic subsidence of the implant, defined as a change in TIA of 5 degrees or more from the immediately to the latest postoperative lateral radiograph. The locations of periprosthetic cysts were documented. Preoperative and minimum 5-year postoperative Foot and Ankle Outcome Score (FAOS) subscales were compared. Results: Survivorship was 97.6% with 2 revisions. One patient underwent tibial and talar component revision for varus malalignment of the ankle; another underwent talar component revision for aseptic loosening and subsidence. The rate of other reoperations was 21.2% ( n = 18), with the main reoperation being exostectomy with debridement for ankle impingement ( n = 12). At final follow-up, the average TTA improved 4.4 (± 3.8) degrees, the average MDTA improved 3.4 (± 2.6) degrees, and the average STA improved 5.3 (± 4.5) degrees. Periprosthetic cysts were observed in 18 patients, and there was no radiographic subsidence. All FAOS subscales demonstrated significant improvement at final follow-up. Conclusions: We found the Salto Talaris implant to be durable, consistent with previous studies of shorter follow-up lengths. We observed significant improvement in radiographic alignment as well as patient-reported clinical outcomes at a minimum 5-year follow-up. Level of Evidence: Level IV, retrospective case series.
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Johnson, Mitchell A., Kunbo Park, Divya Talwar, Kathleen J. Maguire, and J. Todd R. Lawrence. "Predicting Outcomes of Talar Osteochondritis Dissecans Lesions in Children." Orthopaedic Journal of Sports Medicine 9, no. 11 (2021): 232596712110517. http://dx.doi.org/10.1177/23259671211051769.
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Background: Reports detailing the rates of radiographic healing after treatment of talar osteochondritis dissecans (TOCD) remain scarce. There is also a paucity of data characterizing treatment outcomes and the risk factors associated with poor outcomes in children with TOCD. Purpose: To identify factors associated with healing, assess treatment outcomes, and develop a clinically useful nomogram for predicting healing of TOCD in children. Study Design: Case-control study; Level of evidence, 3. Methods: This was a retrospective review of all patients ≤18 years of age with TOCD from a single pediatric institution over a 12-year period. Surgical treatment was left to the discretion of the treating surgeon based on standard treatment techniques. Medical records and radiographs were reviewed for patient and clinical data, lesion characteristics, and skeletal maturity. Radiographic healing was evaluated at the 1-year follow-up, and patients with complete versus incomplete healing were compared using multivariable logistic regression models to examine the predictive value of the variables. Results: The authors analyzed 92 lesions in 74 patients (mean age, 13.1 ± 2.7 years [range, 7.1-18.0 years]; 61% female). Of these, 58 (63%) lesions were treated surgically (drilling, debridement, microfracture, bone grafting, or loose body removal), and the rest were treated nonoperatively. Complete radiographic healing was seen in 43 (47%) lesions. In bivariate analysis, patients with complete healing were younger ( P = .006), were skeletally immature ( P = .013), and had a lower body mass index (BMI; P < .001) versus those with incomplete healing. In a multivariate regression model, the factors that correlated significantly with the rate of complete healing were age at diagnosis, BMI, and initial surgical treatment. The lesion dimensions were not significantly associated with the likelihood of healing. A nomogram was developed using the independent variables that correlated significantly with the likelihood of complete radiographic healing. Conclusion: Complete radiographic healing of TOCD lesions was more likely in younger patients with a lower BMI. The effect of initial surgical treatment on potential healing rate was greater in older patients with a higher BMI.
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Akhbari, Bardiya, Kalpit N. Shah, Amy M. Morton, et al. "Total Wrist Arthroplasty Alignment and Its Potential Association with Clinical Outcomes." Journal of Wrist Surgery 10, no. 04 (2021): 308–15. http://dx.doi.org/10.1055/s-0041-1725172.
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Abstract Purpose There is a lack of quantitative research that describes the alignment and, more importantly, the effects of malalignment on total wrist arthroplasty (TWA). The main goal of this pilot study was to assess the alignment of TWA components in radiographic images and compare them with measures computed by three-dimensional analysis. Using these measures, we then determined if malalignment is associated with range of motion (ROM) or clinical outcomes (PRWHE, PROMIS, QuickDash, and grip strength). Methods Six osteoarthritic patients with a single type of TWA were recruited. Radiographic images, computed tomography images, and clinical outcomes of the wrists were recorded. Using posteroanterior and lateral radiographs, alignment measurements were defined for the radial and carpal components. Radiographic measurements were validated with models reconstructed from computed tomography images using Bland–Altman analysis. Biplanar videoradiography (<1mm and <1 degree accuracy) was used to capture and compute ROM of the TWA components. Linear regression assessed the associations between alignment and outcomes. Results Radiographic measures had a 95% limit-of-agreement (mean difference ± 1.96 × SD) of 3 degrees and 3mm with three-dimensional values, except for the measures of the carpal component in the lateral view. In our small cohort, wrist flexion–extension and radial–ulnar deviation were correlated with volar–dorsal tilt and volar–dorsal offset of the radial component and demonstrated a ROM increase of 3.7 and 1.6 degrees per degree increase in volar tilt, and 10.8 and 4.2 degrees per every millimeter increase in volar offset. The carpal component's higher volar tilt was also associated with improvements in patient-reported pain. Conclusions We determined metrics describing the alignment of TWA, and found the volar tilt and volar offset of the radial component could potentially influence the replaced wrist's ROM. Clinical Relevance TWA component alignment can be measured reliably in radiographs, and may be associated with clinical outcomes. Future studies must evaluate its role in a larger cohort.
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Kim, Do-Hyoung, Seung-Jae Hyun, Chang-Hyun Lee, and Ki-Jeong Kim. "The Last Touched Vertebra on Supine Radiographs Can Be the Optimal Lower Instrumented Vertebra in Adolescent Idiopathic Scoliosis Patients." Neurospine 19, no. 1 (2022): 236–43. http://dx.doi.org/10.14245/ns.2143224.612.
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Objective: To determine whether the last touched vertebra (LTV) on supine radiographs is suitable for the lower instrumented vertebra (LIV) in adolescent idiopathic scoliosis (AIS) correction surgery.Methods: In total, 57 patients were included in the study following posterior instrumentation and fusion. The average follow-up period was 2.2 years. Patients were classified into 4 groups according to the relationship of the location of LIV, LTV, and the last substantially touched vertebra (LSTV) on upright radiographs and the LTV on supine radiographs. In group 1, the upright LTV and supine LTV were the same. Group 1 was subdivided into group 1A and group 1B according to whether the LTV and LSTV were different or the same, respectively. In group 2, the upright LTV was selected as the LIV, whereas in group 3, the supine LTV was selected as the LIV. The baseline characteristics and the preoperative and postoperative radiographic/clinical outcomes of the groups were analyzed.Results: No differences were found in the preoperative clinical and radiographic baseline characteristics of the 4 groups except the LIV-central sacral vertical line distance. The immediate, 6-month, 1-year, and 2-year postoperative outcomes were not significantly different among the 4 groups. One patient (4.3%) in group 1A experienced radiographic addingon without clinical symptoms. No patients underwent revision surgery.Conclusion: The group in whom the LIV was selected as the LTV on supine x-rays showed similar postoperative radiographic and clinical results to other groups. The LTV on preoperative supine radiographs is acceptable as the LIV in AIS surgery to maximize motion segments.
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Marshall, William G., Cristina Gonzalez-Garcia, Sara Trujillo, et al. "Bioengineering an Osteoinductive Treatment for Bone Healing Disorders: A Small Animal Case Series." VCOT Open 06, no. 01 (2023): e41-e51. http://dx.doi.org/10.1055/s-0043-1762900.
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AbstractThe aim of this article was to study clinical and radiographic outcomes following treatment of bone healing disorders with a novel osteoinductive system that utilizes poly (ethyl acrylate), fibronectin and an ultra-low concentration of recombinant human bone morphogenetic protein-2. A case series of nine dogs and two cats were treated, and clinical records and radiographs were reviewed. Radiographs were scored by two blinded observers using the modified Radiographic Union Score for Tibial Fractures. Long-term follow-up was obtained using the Canine Orthopaedic Index and Feline Musculoskeletal Pain Index. Follow-up data were available for 11 treatments (10 cases). Complications: three minor, three major, one catastrophic (non-union requiring amputation). Lameness median 320 (range: 42–1,082) days postoperatively: ‘sound’ (three cases), ‘subtle’ (two), ‘mild’ (three), ‘moderate’ (one), and ‘non-weightbearing’ (one). The attending clinician judged 9 of 11 treatments achieved radiographic union; modified Radiographic Union Score for Tibial Fractures observers 1 and 2 agreed with the clinician in 8/9 and 5/9 treatments respectively. Long-term Canine Orthopaedic Index scores for five dogs median 650 (range: 544–1,724) days postoperatively: 15/64 (median) for four dogs with acceptable outcomes, 30/64 in one dog with a poor outcome. Feline Musculoskeletal Pain Index scores for two cats 433 and 751 days postoperatively: 48/60 and 60/60. Eight of 10 cases were sound or showed subtle or mild lameness in the short- or long-term, and radiographic union occurred in the majority of treatments.
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Park, Mi So, Won Hee Seo, Bo-Kyung Je, Dae Jin Song, and Jung Hyun Kwon. "Outcome prediction of pediatric drowning." Pediatric Emergency Medicine Journal 8, no. 2 (2021): 66–72. http://dx.doi.org/10.22470/pemj.2021.00304.
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Purpose: Despite the well-known mortality of pediatric drowning, there is a paucity of evidence on the implications of an initial evaluation on the relevant outcome of drowning. This study aimed to investigate the association of initial clinical findings with outcome of children undergoing drowning.Methods: This retrospective study was conducted using the medical records of 56 children undergoing drowning who visited 3 Korean academic hospitals from January 2000 through May 2020. We analyzed information regarding the prehospital resuscitation, drowning time, a 4-tiered chest radiographic grade, and the baseline characteristics. The grade was defined based on the findings of initial chest radiographs. The poor outcomes were defined as the need for intensive care unit care or death aftercare. We analyzed the association of the prehospital resuscitation, submersion time, and the radiographic grade with the poor outcomes using binary logistic regression.Results: Among the 56 children, 31 (55.4%) were aged 1-4 years. Prehospital resuscitation and 1-5 minutes of submersion time were noted in the 25 (44.6%) and 30 children (53.6%), respectively. The chest radiographic grades 1 through 4 accounted for 17 (30.4%), 20 (35.7%), 12 (21.4%), and 3 children (5.4%), respectively. Poor outcomes occurred in 17 children (30.4%), including 3 deaths (5.4%). The association with the poor outcomes was noted in the submersion time of longer than 5 minutes (adjusted odds ratio, 21.49; 95% confidence interval, 1.11-415.73; compared with < 1 minute) while not in the submersion time and chest radiographic grade.Conclusion: This study confirms that submersion time is an outcome predictor of drowning.
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Ray, Justin, Jennifer Koay, and Robert Santrock. "Early Clinical Outcomes of Triplanar Modified Lapidus Arthrodesis with Immediate Weight Bearing." Foot & Ankle Orthopaedics 3, no. 3 (2018): 2473011418S0039. http://dx.doi.org/10.1177/2473011418s00397.
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Category: Bunion Introduction/Purpose: There are numerous corrective procedures for hallux valgus deformity. The majority of procedures prioritize correction in the transverse plane based on anteroposterior (AP) radiographs. Long-term results demonstrate high recurrence rates ranging from 8-78% with various metatarsal osteotomy techniques. Recent evidence suggests that hallux valgus is a multi-planar deformity with significant contributions from the sagittal and frontal planes. Correction of hallux valgus at the first tarsometatarsal joint (modified Lapidus) offers a powerful method to restore anatomic alignment in all three planes and correct hallux valgus at the apex of the deformity. The purpose of this study is to investigate early clinical and radiographic outcomes and complications of triplanar tarsometatarsal (TMT) arthrodesis with immediate weight-bearing. Methods: After receiving IRB approval, charts and radiographs were retrospectively reviewed for 37 patients (30 female, age 54.8 years) undergoing triplanar tarsometatarsal (TMT) arthrodesis for hallux valgus deformity correction at our institution between June 2016 and June 2017. All patients were allowed immediate weight-bearing as tolerated in a boot walker. Radiographic imaging at 4 months and 12 months was compared to pre-operative imaging. Clinical outcomes were evaluated using the American Academy of Orthopaedic Surgeons Foot and Ankle questionnaire (AAOS FAQ), Quality of Life 12 (QOL-12), and the patient-reported outcomes measurement information system 10 (PROMIS 10). Demographics included age, gender, body mass index, and medical comorbidities. The time in days to weight-bearing, wearing athletic shoes, and return to full activity were noted. Any complications were recorded. For statistical analysis, t-tests were performed for continuous variables and chi-square tests were performed for categorical variables using JMP 11.0.0 (SAS Institute Inc., Cary, NC). Results: Although improvements were noted in the AAOS FAQ and PROMIS 10 at 3 and 6 months post-operative, these results were not significantly different compared to baseline scores (Table 1). From the time of procedure, average time to weight-bearing was 2.75 ± 7.2 days. Patients returned to wearing athletic shoes an average of 48.3 ± 12.1 days after the procedure. Return to full activity without restrictions was 130.9 ± 37.0 days from surgery. Radiographic results demonstrated significant improvement in IMA and HVA at final follow-up (p < 0.001). 35 patients (94.6%) demonstrated evidence of radiographic union by final follow-up. Regarding complications, one patient (2.7%) required hardware removal for soft-tissue irritation, and there were three cases (8.1%) of hardware failure that did not require re-operation. Conclusion: In this study, early clinical and radiographic outcomes of triplanar tarsometatarsal corrective arthrodesis (modified Lapidus) with immediate weight-bearing were promising with low complication rates. Patients were able to return to normal shoe wear approximately 7 weeks after the procedure and return to full activity a little more than 4 months after surgery. Radiographic results demonstrated high union rates, low recurrence rates, and significant improvements in HVA and IMA at final follow-up. Longer follow-up is necessary to determine the long-term radiographic and clinical outcomes of triplanar tarsometatarsal arthrodesis to correct hallux valgus deformity.
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Reddy, Michael S., and I.-Chung Wang. "Radiographic Determinants of Implant Performance." Advances in Dental Research 13, no. 1 (1999): 136–45. http://dx.doi.org/10.1177/08959374990130010301.
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This paper reviews and compares the strengths and weaknesses of radiographic techniques including periapical, occlusal, panoramic, direct digital, motion tomography, and computed tomography. Practical considerations for each method, including availability and accessibility, are discussed. To date, digital subtraction radiography is the most versatile and sensitive method for measuring boss loss. It can detect both bone height and bone mass changes on root-form or blade-form dental implants. Criteria for implant success have changed substantially over the past two decades. In clinical trials of dental implants, the outcomes require certain radiographic analyses to address the hypothesis or clinical question adequately. Radiographic methods best suited to the objective assessment of implant performance and hypothesis were reviewed.
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Mesfin, Addisu, Wajeeh R. Bakhsh, Tapanut Chuntarapas, and K. Daniel Riew. "Cervical Scoliosis: Clinical and Radiographic Outcomes." Global Spine Journal 6, no. 1 (2015): 7–13. http://dx.doi.org/10.1055/s-0035-1554776.
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Delman, Connor, Christopher Kreulen, Trevor Shelton, Brent Roster, Robert Boutin, and Eric Giza. "Radiographic Outcomes of Lisfranc Injuries Treated with a Suture Button Device." Foot & Ankle Orthopaedics 4, no. 4 (2019): 2473011419S0016. http://dx.doi.org/10.1177/2473011419s00162.
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Category: Midfoot/Forefoot Introduction/Purpose: Controversy exists regarding the optimal treatment of Lisfranc injuries of the midfoot. There has been increasing interest in using a suture button device in lieu of traditional screw fixation. Biomechanical studies comparing screw fixation with suture button devices have demonstrated conflicting results. This study evaluates the radiographic outcomes of patients with Lisfranc injuries treated with a suture button device or a hybrid technique with supplemental fixation. Methods: Forty-three patients with a Lisfranc injury were treated operatively with either a suture button device (Tightrope, Arthrex, Naples, FL) or a hybrid technique with supplemental hardware fixation. The distances between the first and second metatarsal (M1-M2) and the medial cuneiform and second metatarsal (C1-M2) were measured on weightbearing radiographs. These measurements were used to assess the accuracy of reduction, maintenance of reduction, and magnitude of reduction. The accuracy of reduction was determined by comparing weightbearing AP radiographs of the uninjured foot with weightbearing radiographs of the operatively treated foot at 6 weeks postoperatively. The magnitude of reduction was assessed via a comparison of weightbearing AP radiographs of the injured foot preoperatively to the operatively treated foot at 6 weeks postoperatively. The maintenance of reduction was determined by comparing radiographic measurements at 6 weeks postoperatively to measurements taken at 12 weeks postoperatively. Results: An accurate reduction was obtained in both treatment groups with no significant difference in the M1-M2 and C1-M2 measurements at 6 weeks postoperatively compared to the uninjured foot. The magnitude of reduction was greater and statistically significant for the hybrid fixation group but was not maintained (Hybrid fixation M1-M2 magnitude of reduction: -1.39, p < .001; C1-M2 magnitude of reduction: -1.77, p < .001). The suture button treatment group attained a satisfactory reduction that was maintained with no statistically significant difference in the M1-M2 and C1-M2 distances at 6 weeks and 12 weeks postoperatively (Tightrope M1-M2 maintenance of reduction: 0.04, p=0.88; C1-M2 maintenance of reduction: 0.39, p=0.21). Conclusion: After open reduction of Lisfranc injuries, the suture button device appears to adequately maintain the reduction when patients have returned to full activity. Based on radiographic parameters, the suture button construct provides an effective alternative to traditional screw fixation for the treatment of Lisfranc injuries.
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Cherian, Roshan, Soudha Hidayath, Aparna M. Krishnakumari, Akshay D. Shetty, U. Hemavathi, and Chouduri S. Swaroop. "Postoperative Paresthesia: A Spanner in the Works? Topographic Analysis of Inferior Alveolar Nerve to Predict Its Incidence Following Surgical Excision of Mandibular Third Molar—A Prospective Study." Journal of Pharmacy and Bioallied Sciences 17, Suppl 1 (2025): S538—S540. https://doi.org/10.4103/jpbs.jpbs_1958_24.
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ABSTRACT Objective: This study aimed to analyze the relationship between impacted lower third molars (ILTMs) and the inferior alveolar nerve (IAN), identify radiographic predictors of neurosensory disturbances, and assess their impact on patients’ quality of life. Materials and Methods: A prospective study was conducted on 350 patients (20–50 years) undergoing surgical extraction of ILTMs between May 2022 and May 2023. Panoramic radiographs were evaluated for seven radiographic signs based on Rood and Shehab criteria. Neurosensory deficits were assessed postoperatively on days 3 and 7, and monitored for up to one year. Quality of life was evaluated using the OHIP questionnaire. Surgical parameters, operator experience, and patient outcomes were analyzed. Results: Postoperative neurosensory disturbances occurred in 10.9% (38/350) of patients, with 2.3% (8/350) persisting at one year. Mesioangular impactions were most common (47.4%), and radiographic features such as deflected roots and interruption of the white line were strongly associated with neurosensory deficits. Senior surgeons achieved better outcomes with fewer complications and shorter surgical times. Patients aged late 20s to early 30s had higher neurosensory disturbance rates, likely due to fully formed roots. Mental health conditions negatively influenced recovery and quality of life. Conclusion: Panoramic radiographs are valuable for preoperative risk assessment of IAN injury during ILTM surgeries. Radiographic features, like deflected roots and white line interruption, are strong predictors of neurosensory deficits. Surgeon experience and mental health significantly impact outcomes, emphasizing the need for careful preoperative planning and psychological support. Larger, multicenter studies with advanced imaging techniques are recommended for further validation.
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Ray, Justin, Jennifer Koay, Paul Dayton, Daniel Hatch, W. Bret Smith, and Robert Santrock. "Multicenter Early Radiographic Outcomes of Triplanar Modified Lapidus Arthrodesis with Immediate Weight-Bearing." Foot & Ankle Orthopaedics 3, no. 3 (2018): 2473011418S0009. http://dx.doi.org/10.1177/2473011418s00099.
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Category: Bunion Introduction/Purpose: Hallux valgus is a complex positional deformity of the first ray. Traditional correction methods for hallux valgus prioritize correction in the transverse plane based on anteroposterior (AP) radiographs. However, only addressing the transverse plane component of hallux valgus is a potential factor resulting in poor outcomes and high long-term recurrence rates ranging from 8%-78%. Recent evidence suggests that hallux valgus is a multi-planar deformity with significant contributions from the sagittal and frontal planes. The triplanar tarsometatarsal arthrodesis (modified Lapidus, Figure 1) uses a multi-planar approach to evaluate and correct the deformity associated with hallux valgus in all three anatomical planes. The purpose of this study is to investigate early radiographic outcomes and complications of triplanar tarsometatarsal (TMT) arthrodesis with immediate weight-bearing. Methods: After receiving IRB approval, radiographs and charts were retrospectively reviewed for 101 patients (age 41.9 ± 17.9 years) undergoing triplanar tarsometatarsal arthrodesis (modified Lapidus) for hallux valgus deformity correction at four institutions between June 2016 and June 2017. Patients were allowed immediate weight-bearing as tolerated after the procedure. Radiographic imaging at 4 months and 12 months was reviewed and compared to pre-operative imaging. Radiographic measures included hallux valgus angle (HVA), intermetatarsal angle (IMA), tibial sesamoid position (TSP), metatarsus adductus angle, evidence of metatarsal pronation, and radiographic first TMT union. Demographics included age, gender, body mass index, medical comorbidities, and smoking status. Time (days) to weight-bearing, wearing athletic shoes, and return to full activity were also noted. Any complications were recorded. For statistical analysis, t-tests were performed for continuous variables and chi-square tests were performed for categorical variables using JMP 11.0.0 (SAS Institute Inc., Cary, NC). Results: Radiographic results demonstrated significant improvements in IMA, HVA, and TSP at final follow-up. IMA was 5.9 ± 3.2 degrees at final follow-up compared to 15.0 ± 3.1 degrees pre-operatively (p < 0.001). At final follow-up, HVA was 8.3 ± 5.5 degrees compared to 23.7 ± 10.1 degrees pre-operatively (p < 0.001). TSP was also significantly improved at final follow-up (2.0 ± 0.9) compared to pre-operatively (5.1 ± 1.2; p < 0.001). Lateral round sign was present in 5 patients (4.9%) at final follow-up compared to 88 patients (87.1%) prior to corrective surgery. Four patients (4.0%) demonstrated evidence of radiographic non-union at final follow-up. Regarding complications, there were four cases (3.9%) of hardware removal for either soft-tissue irritation or hardware failure. Conclusion: In this study, early radiographic outcomes of triplanar tarsometatarsal arthrodesis (modified Lapidus) with immediate weight-bearing were promising with low complication rates. These results demonstrate that this procedure is able to reliably achieve anatomic correction in all three planes for hallux valgus deformity. The triplanar tarsometatarsal arthrodesis technique also demonstrated high union rates and low recurrence rates at final follow-up. Longer follow-up is necessary to determine the long-term survivorship, outcomes, and complications of this new technique to correct hallux valgus deformity.
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Ou-Yang, Li-Wei, Pei-Ching Chang, Li-Chuan Chuang, Hsiu-Ting Yu, and Aileen I. Tsai. "Treatment Outcomes of Pulpectomy in Primary Maxillary Incisors Filled with ZOE and Metapex: A Two-year Retrospective Study." Journal of Clinical Pediatric Dentistry 45, no. 2 (2021): 83–89. http://dx.doi.org/10.17796/1053-4625-45.2.3.
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Objectives: To address a literature gap by evaluating, in a larger set of samples, the clinical and radiographic outcomes of pulpectomy in primary maxillary incisors using ZOE and calcium hydroxide/iodoform paste. To also identify the predisposing factors for treatment outcomes. Study design: Medical charts of 124 patients (aged 16 to 60 months) and radiographs of their incisors (309 incisors) were reviewed (128 with ZOE and 181 with Metapex). All incisors were restored with composite resin crowns. Results: The radiographic success rates for ZOE and Metapex were: 85.9% and 82.9% at the 12-month recall, and 69.2% and 64% at the 24-month recall, with no statistically significant difference between the two groups. Clinical failures occurred more frequently in the Metapex group (P = 0.006), as clinical signs of pain and soft tissue pathosis were found in 6.2% of the Metapex cases at 24 months but none in the ZOE group. Significant predisposing factors for radiographic success were type of tooth, degree of obturation at recalls, and preoperative root resorption. Conclusions. The radiographic success rates are comparable between the ZOE and Metapex groups. Clinical pathological manifestations such as pain and soft tissue pathosis are seen in the Metapex group at recalls, but none in the ZOE group. Predisposing factors such as type of incisor, preoperative root resorption, and extent of filling at recalls are associated with the radiographic success rate.
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Finney, Lydia J., Vijay Padmanaban, Samuel Todd, Nadia Ahmed, Sarah L. Elkin, and Patrick Mallia. "Validity of the diagnosis of pneumonia in hospitalised patients with COPD." ERJ Open Research 5, no. 2 (2019): 00031–2019. http://dx.doi.org/10.1183/23120541.00031-2019.
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RationaleExacerbations of chronic obstructive pulmonary disease (COPD) and pneumonia are two of the most common reasons for acute hospital admissions. Acute exacerbations and pneumonia present with similar symptoms in COPD patients, representing a diagnostic challenge with a significant impact on patient outcomes. The objectives of this study were to compare the prevalence of radiographic consolidation with the discharge diagnoses of hospitalised COPD patients.MethodsCOPD patients admitted to three UK hospitals over a 3-year period were identified. Participants were included if they were admitted with an acute respiratory illness, COPD was confirmed by spirometry and a chest radiograph was performed within 24 h of admission. Pneumonia was defined as consolidation on chest radiograph reviewed by two independent observersResultsThere were 941 admissions in 621 patients included in the final analysis. In 235 admissions, consolidation was present on chest radiography and there were 706 admissions without consolidation. Of the 235 admissions with consolidation, only 42.9% had a discharge diagnosis of pneumonia; 90.7% of patients without consolidation had a discharge diagnosis of COPD exacerbation. The presence of consolidation was associated with increased rate of high-dependency care admission, increased mortality and prolonged length of stay. Inhaled corticosteroid use was associated with recurrent pneumonia.ConclusionsPneumonia is underdiagnosed in patients with COPD. Radiographic consolidation is associated with worse outcomes and prolonged length of stay. Incorrect diagnosis could result in inappropriate use of inhaled corticosteroids. Future guidelines should specifically address the diagnosis and management of pneumonia in COPD.
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England, Devon, Lauren Newsom, Constance White, and Erica McKenzie. "Retrospective radiographic myelogram measurements and long-term outcomes in horses undergoing cervical interbody fusion surgery: 22 cases." PLOS One 20, no. 5 (2025): e0323083. https://doi.org/10.1371/journal.pone.0323083.
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Site selection for cervical stabilization surgery in horses with spinal ataxia frequently relies on measurements derived from radiographic myelography. A variety of measurement criteria exist and can provide conflicting results. The main objectives of this study were to assess the correlation between two commonly used myelographic measures, dorsal contrast column reduction (DCCR) and dural diameter reduction (DDR), and their association with previously selected operative sites in a population of horses operated at a tertiary clinic. Secondary objectives were to determine if articular process joint (APJ) atrophy occurred in a subset of operated horses with radiographic follow-up, and to describe complications of cervical stabilization surgery and long term outcomes. The study was primarily cross-sectional using previously recorded medical information and images from horses operated between 2008 and 2022: three masked raters assessed previously acquired pre-operative myelograms obtained in neutral, flexed and extended neck positions from horses that had subsequently undergone stabilization surgery consisting of cervical interbody fusion via a Kerf-cut cylinder technique at one or two sites. A veterinary radiologist evaluated changes in APJ in radiographs obtained in a subset of horses re-evaluated >18 months after surgery. DCCR was unremarkable at nearly all articulations in all horses, while DDR met reduction criteria at over 50% of articulations in flexed position. Neither DCCR nor DDR distinguished operated from non-operated sites at most intervertebral junctions, except at the C6-7 articulation in neutral and extended position. The two measures were also poorly correlated at most sites and in most positions. Surgical complications included a high incidence of laryngeal hemiplegia. Comparison of operated to non-operated sites within individuals radiographed years later showed consistent, mildly reduced APJ opacity at most operated sites without a consistent decrease in APJ height or area ratios. Our results suggest that DCCR and DDR measures did not reliably predict surgical site selection in this surgical cohort except at C6-7, and that the two measures yielded conflicting diagnostic classification at many sites and positions. Complication rates from stabilization surgery were high; and predictable reduction in APJ height or area after surgery was not demonstrated by radiography in this study.
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Ahrend, Marc-Daniel, Luise Kühle, Stephan Riedmann, Sonja D. Bahrs, Christian Bahrs, and Patrick Ziegler. "Radiographic parameter(s) influencing functional outcomes following angular stable plate fixation of proximal humeral fractures." International Orthopaedics 45, no. 7 (2021): 1845–52. http://dx.doi.org/10.1007/s00264-021-04945-2.
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Abstract Purpose Radiographic parameters which correlate with poor clinical outcome after proximal humeral fractures could be helpful indicators to answer the question which patients should be followed up closer. Moreover, during surgery, radiographic parameters correlating with unfavourable outcome should be avoided. The primary aim of the study was to compare radiographic measurements between the injured and the contralateral, uninjured shoulder. The secondary aim was to correlate these radiographic parameters with post-operative shoulder function. Methods Fifty-eight patients (age: 55.6 ± 14.4 years, age at surgery) following angular stable plate fixation of a proximal humeral fracture (2-part fractures according to Neer: 24, 3-part: 25, 4-part: 9) were included in this retrospective cohort study. All patients were followed up at least six years (7.9 ± 1.4 after surgical intervention). During follow-up examination, the Constant score (CS) was assessed, and radiographs of both shoulders were taken. Radiographs were analyzed regarding lateral humeral offset, distance between tuberculum and head apex, head diameter, head height, perpendicular height, perpendicular center, vertical height, and angles between head and humeral shaft (CCD and HSA). These parameters were compared between the injured and uninjured shoulder. The cohort was divided in two groups: patients with a CS category of excellent/good and satisfying/worse. Both groups were tested regarding differences of demographic and radiographic parameters. Results The distance between tuberculum and head apex (2.6 ± 3.4 mm vs. 4.3 ± 2.1 mm; p = 0.0017), the CCD (123.1 ± 12.9° vs. 130.1 ± 7.3°; p = 0.0005), and the HSA (33.1 ± 12.8° vs. 40.1 ± 7.3°; p = 0.0066) were significantly smaller on the treated shoulder compared to the uninjured side. Patients reached a Constant score of 80.2 ± 17.4 (95% CI 75.6–84.8) points. Regarding outcome categories of the Constant score, 46 patients had a good to excellent outcome, and 12 patients had a satisfying or bad outcome. The comparison of these groups revealed that patients with inferior outcome in the long-term follow-up were older, female, had a more complex fracture type (AO classification), smaller lateral humeral offset, smaller head diameter and height, lower perpendicular height, and lower CCD and HSA angles. Conclusion If the abovementioned parameters cannot be restored sufficiently during surgery, (reversed) shoulder arthroplasty might be a better solution to reach good post-operative outcome. Moreover, patients presenting these radiographic characteristics in the follow-up, older patients, and patients with a more complex fracture type should be followed up closer to possibly prevent poor shoulder function. Trial registration: 83 250/2011BO2
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Almhdie-Imjabbar, Ahmad, Hechmi Toumi, and Eric Lespessailles. "Radiographic Biomarkers for Knee Osteoarthritis: A Narrative Review." Life 13, no. 1 (2023): 237. http://dx.doi.org/10.3390/life13010237.
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Conventional radiography remains the most widely available imaging modality in clinical practice in knee osteoarthritis. Recent research has been carried out to develop novel radiographic biomarkers to establish the diagnosis and to monitor the progression of the disease. The growing number of publications on this topic over time highlights the necessity of a renewed review. Herein, we propose a narrative review of a selection of original full-text articles describing human studies on radiographic imaging biomarkers used for the prediction of knee osteoarthritis-related outcomes. To achieve this, a PubMed database search was used. A total of 24 studies were obtained and then classified based on three outcomes: (1) prediction of radiographic knee osteoarthritis incidence, (2) knee osteoarthritis progression and (3) knee arthroplasty risk. Results showed that numerous studies have reported the relevance of joint space narrowing score, Kellgren–Lawrence score and trabecular bone texture features as potential bioimaging markers in the prediction of the three outcomes. Performance results of reviewed prediction models were presented in terms of the area under the receiver operating characteristic curves. However, fair and valid comparisons of the models’ performance were not possible due to the lack of a unique definition of each of the three outcomes.
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Lin, Sung-Yen, Cheng-Jung Ho, Wen-Chih Liu, et al. "Predicting the Poor Clinical and Radiographic Outcomes after the Anatomical Reduction and Internal Fixation of Posterior Wall Acetabular Fractures: A Retrospective Analysis." Journal of Clinical Medicine 11, no. 11 (2022): 3244. http://dx.doi.org/10.3390/jcm11113244.
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Anatomical reduction is the fundamental principle of hip function restoration after posterior acetabular wall fractures (PWFs). Some patients exhibit poor outcomes despite anatomical reduction, and the prognostic factors leading to poor outcomes remain elusive. This study aimed to investigate the clinical and radiographic outcomes in patients with PWFs who had undergone anatomical reduction and internal fixation and to identify the predictors that impair clinical and radiologic outcomes. The clinical records of 60 patients with elementary PWFs who had undergone anatomical reduction and internal fixation between January 2005 and July 2015 were reviewed retrospectively. The Harris hip score (HHS) and modified Merle d’Aubigné clinical hip scores (MMAS) were used to evaluate the clinical outcome. Preoperative and final follow-up radiographs were cross checked to identify poor radiographic outcomes that included the presence of advanced osteoarthritis and osteonecrosis, as well as the need for conversion to total hip arthroplasty. Acetabular dome comminution was assessed from computerized tomography, and the outcomes were further evaluated according to the involvement of fragment comminution. The fracture comminution and age were negatively correlated with functional outcomes (correlation coefficients were −0.41 and −0.39 in HHS and MMAS, respectively) and were significantly related to the severity of osteoarthritis and osteonecrosis as well as the need for total hip arthroplasty. Regarding the radiographic factors, significantly worse post-operative HHS and MMAS were found in the fracture comminution group. In the subanalysis of the status of fracture comminution, patients with fragment comminution involving the acetabular dome had significantly lower functional scores than those with other fracture patterns. In conclusion, age, fracture comminution, and dome comminution were the prognostic indicators of advanced osteoarthritis and poor functional scores after the anatomical reduction and internal fixation of PWFs. We emphasized the relevance of acetabular dome comminution as an important contributing factor to clinical and radiographic outcomes.
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Malik, Mateusz, Jakub Kwiatkowski, Artur Gądek, Agnieszka Lechowska-Liszka, and Henryk Liszka. "Utility of Weight-Bearing Computed Tomography in the Postoperative Assessment of Ankle Fractures." Diagnostics 15, no. 6 (2025): 750. https://doi.org/10.3390/diagnostics15060750.
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Background: Ankle fractures are among the most common injuries requiring surgical intervention. Standard radiographs are typically used for postoperative assessment; however, some patients continue to experience residual symptoms despite satisfactory radiographic outcomes. Weight-bearing computed tomography (WBCT), though not yet widely integrated into clinical practice, offers potential advantages in evaluating lower-limb deformities, injuries, and arthritis. This study explores the utility of WBCT for the midterm assessment following ankle fracture fixation and compares its findings with those obtained from standard radiographs. Methods: In this retrospective case study, we analyzed the correlations between the functional outcome scores approximately one year post-surgery and parameters assessed using WBCT. Pearson’s correlation coefficient was used to evaluate these correlations, and a t-test was performed to assess their statistical significance, with a threshold p-value of 0.05. Additionally, Spearman’s rank correlation coefficient was calculated as a supplementary descriptive measure, without significance testing. These correlations were then compared with those obtained from standard ankle radiographic views (anteroposterior, lateral, and mortise). Results: Several correlations were identified between WBCT parameters and functional scales, with certain parameters demonstrating high statistical significance (p < 0.05). Overall, the correlations observed for WBCT were stronger than those for standard radiographs. Conclusions: Although the study cohort was limited, the findings suggest that WBCT may provide additional insights beyond conventional radiography. Further research with larger patient groups is needed to establish its clinical relevance.
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Bloomer, Ainsley K., R. Randall McKnight, Nicholas R. Johnson, et al. "Screws-Only Primary Subtalar Arthrodesis for Calcaneus Fractures." Foot & Ankle International 43, no. 4 (2022): 509–19. http://dx.doi.org/10.1177/10711007211058689.
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Background: The management of displaced intraarticular calcaneus fractures (DIACFs) is a difficult problem with disappointing results from open reduction internal fixation (ORIF). Alternatively, ORIF with primary subtalar arthrodesis (PSTA) has gained increasing popularity. The purpose of this study is to review patient-centered and radiographic outcomes of ORIF plus PSTA using only screws through a sinus tarsi approach. Methods: A retrospective study of patients who underwent ORIF+PSTA for DIACFs was conducted. The same surgical technique was used in all cases consisting of only screws; no plates were used. Delayed surgeries past 8 weeks were excluded. Demographic and radiographic data were collected including worker’s compensation claims. Plain radiographs were used to characterize injuries and review outcomes. Results: Seventy-nine DIACFs underwent PSTA with a median follow-up of 200 days (n = 69 patients). Median time to weightbearing was 57.5 days postoperatively. Ten fractures were documented as Sanders II, 36 as Sanders III, and 32 as Sanders IV. Sixty-eight fractures (86.1%) achieved fusion on radiographs at a median of 126.5 (range, 54-518) days. Thirty-nine fractures (57.3%) demonstrated radiographic fusion in all 3 predefined locations. Nine of the 14 worker’s compensation patients returned to work within the period of observation. There were 8 complications: 3 requiring a secondary operation. Eleven of 79 fractures treated did not go on to achieve radiographic union. Conclusion: In this retrospective case series, we found that screws-only primary subtalar arthrodesis for the treatment of DIACFs through a sinus tarsi approach was associated with relatively high rates of return to work and radiographic fusion. Level of Evidence: Level IV, retrospective case series.
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Pedersen, Marie, Hege Grindem, Bjørnar Berg, et al. "Low Rates of Radiographic Knee Osteoarthritis 5 Years After ACL Reconstruction or Rehabilitation Alone: The Delaware-Oslo ACL Cohort Study." Orthopaedic Journal of Sports Medicine 9, no. 8 (2021): 232596712110275. http://dx.doi.org/10.1177/23259671211027530.
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Background: Patients and clinicians often struggle to choose the optimal management strategy for posttraumatic knee osteoarthritis (OA) after an anterior cruciate ligament (ACL) injury. An evaluation of radiographic outcomes after a decision-making and treatment algorithm applicable in clinical practice can help to inform future recommendations and treatment choices. Purpose: To describe and compare 5-year radiographic outcomes and knee pain in individuals who had gone through our decision-making and treatment algorithm and chosen (1) early (<6 months) ACL reconstruction (ACLR) with pre- and postoperative rehabilitation, (2) delayed (>6 months) ACLR with pre- and postoperative rehabilitation, or (3) progressive rehabilitation alone. Study Design: Cohort study; Level of evidence, 2. Methods: We included 276 patients with unilateral ACL injury from a prospective cohort study. Patients chose management using a shared decision-making process and treatment algorithm, and 5-year postoperative radiographs of the index and contralateral knees were assessed using the Kellgren and Lawrence (K&L) classification and minimum joint space width measurements. We defined radiographic tibiofemoral OA as K&L grade ≥2 and knee pain as a Knee injury and Osteoarthritis Outcome Score for Pain ≤72. To further explore early radiographic changes, we included alternative cutoffs for radiographic knee OA using K&L grade ≥2/osteophyte (definite osteophyte without joint space narrowing) and K&L grade ≥1. Results: At 5 years, 64% had undergone early ACLR; 11%, delayed ACLR; and 25%, progressive rehabilitation alone. Radiographic examination was attended by 187 patients (68%). Six percent of the cohort had radiographic tibiofemoral OA (K&L grade ≥2) in the index knee; 4%, in the contralateral knee. Using the alternative cutoffs at K&L grade ≥2/osteophyte and K&L grade ≥1, the corresponding numbers were 20% and 33% in the index knee and 18% and 29% in the contralateral knee. Six percent had a painful index knee. There were no statistically significant differences in any radiographic outcomes or knee pain among the 3 management groups. Conclusion: There were no statistically significant differences in any 5-year radiographic outcomes or knee pain among the 3 management groups. Very few of the patients who participated in our decision-making and treatment algorithm had knee OA or knee pain at 5 years.
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Fraser, Tyler W., Anish R. Kadakia, and Jesse F. Doty. "Complications and Early Radiographic Outcomes of Flatfoot Deformity Correction With Metallic Midfoot Opening Wedge Implants." Foot & Ankle Orthopaedics 4, no. 3 (2019): 247301141986897. http://dx.doi.org/10.1177/2473011419868971.
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Background: Forefoot varus is a common component of flatfoot deformity that is often surgically addressed. Multiple options exist to plantarflex the medial column, with midfoot fusion and the Cotton osteotomy being the most common. This study analyzes radiographic outcomes and complications when a titanium wedge is used for structural support in a dorsal opening wedge Cotton osteotomy of the medial cuneiform. Methods: Between December 2016 and May 2018, 32 feet in 31 patients were treated with medial column titanium wedges for residual forefoot varus in association with flatfoot corrections. All participants had preoperative and weight-bearing postoperative radiographs examined for analysis of radiographic correction. The average age of the patients was 41.1 (range: 12-70). The average follow-up time for patients was 12.2 months (8-24). Results: All radiographic parameters were statistically significantly improved from preoperative to postoperative ( P < .05). There were no instances of nonunion of the medial cuneiform osteotomy. There was 1 implant that loosened and was revised to a larger implant that healed uneventfully. No wedges were removed for continued pain at the osteotomy site. Conclusion: This study suggests that metal wedges are both safe and effective for use in medial column correction based on early follow-up data. Future studies comparing titanium wedges versus traditional bone grafting for Cotton osteotomies may provide further analysis of radiographic correction, operative time, procedure cost, and outcomes. There were no instances of pain over the titanium wedge site. Radiographic outcomes are similar to those reported for opening wedge Cotton osteotomies including bone grafting and wedge plates with screws. Future studies will help determine the long-term maintenance of correction and hardware survivorship. Level of Evidence: Level IV, case series.
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Stamatos, Nicholas J., Marlon J. Murasko, Kyle Richardson, et al. "Radiographic Outcomes of Titanium Augment vs Bone Graft in Lateral Column Lengthening for Adult-Acquired Flatfoot Deformity." Foot & Ankle Orthopaedics 8, no. 2 (2023): 247301142311765. http://dx.doi.org/10.1177/24730114231176554.
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Background: Lateral column lengthening (LCL) is a surgical procedure used to manage forefoot abduction and, in theory, also increases the longitudinal arch by plantarflexion of the first ray through tensioning the peroneus longus for patients with stage IIB adult acquired flatfoot deformity (AAFD). This procedure utilizes an opening wedge osteotomy of the calcaneus, which is then filled with autograft, allograft, or a porous metal wedge. The primary aim of this study was to compare the radiographic outcomes of these different bone substitutes following LCL for stage IIB AAFD. Methods: We conducted a retrospective review of all patients who underwent LCL from October 2008 until October 2018. Preoperative weightbearing radiographs, initial postoperative radiographs, and 1-year weightbearing radiographs were reviewed. The following radiographic measurements were recorded: incongruency angle, talonavicular coverage angle (TNCA), talar–first metatarsal angle (T-1MT), and calcaneal pitch. Results: A total of 44 patients were included in our study. The mean age of the cohort was 54 (range, 18-74). The study cohort was divided into 2 groups. There were 17 (38.7%) patients who received a titanium metal wedge and 27 (61.5%) that received autograft or allograft. Patients that underwent LCL with the autograft/allograft group were significantly older (59 vs 47 years old, P = .006). Patients who underwent LCL with a titanium wedge had a significantly higher preoperative talonavicular angle (32 vs 27 degrees, P = .013). There were no significant differences in postoperative TNCA, incongruency angle, or calcaneal pitch at 6 months or 1 year. Conclusion: At 6 months and 1 year, no radiographic differences were found between autograft/allograft bone substitutes vs titanium wedge in LCL. Level of Evidence: Level III, retrospective cohort study.
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JORDAN, JOANNE M., CHARLES G. HELMICK, JORDAN B. RENNER, et al. "Prevalence of Hip Symptoms and Radiographic and Symptomatic Hip Osteoarthritis in African Americans and Caucasians: The Johnston County Osteoarthritis Project." Journal of Rheumatology 36, no. 4 (2009): 809–15. http://dx.doi.org/10.3899/jrheum.080677.
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Objective.To report contemporary estimates of the prevalence of hip-related osteoarthritis (OA) outcomes in African Americans and Caucasians aged ≥ 45 years.Methods.Weighted prevalence estimates and their corresponding 95% confidence intervals for hip symptoms, radiographic hip OA, symptomatic hip OA, and severe radiographic hip OA were calculated using SUDAAN® for age, race, and sex subgroups among 3068 participants (33% African Americans, 38% men) in the baseline examination (1991–97) of The Johnston County Osteoarthritis Project, a population-based study of OA in North Carolina. Radiographic hip OA was defined as Kellgren-Lawrence radiographic grade ≥ 2, moderate/severe radiographic hip OA as grades 3 and 4, and symptomatic hip OA as hip symptoms in a hip with radiographic OA.Results.Hip symptoms were present in 36%; 28% had radiographic hip OA; nearly 10% had symptomatic hip OA; and 2.5% had moderate/severe radiographic hip OA. Prevalence of all 4 outcomes was higher in older individuals; most outcomes were higher for women and African Americans.Conclusion.African Americans in this population do not have a lower prevalence of hip-related OA outcomes as previous studies suggested. Increasing public and health system awareness of the relatively high prevalence of these outcomes, which can be disabling, may help to decrease their effects and ultimately prevent them.
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Park, Jae Hyun, Sang Hyun Kim, Noh Sung Hyun, and Pyung Goo Cho. "Role of Supine and Standing Radiography in Vertebroplasty for Osteoporotic Compression Fractures”." Nerve 7, no. 2 (2021): 41–48. http://dx.doi.org/10.21129/nerve.2021.7.2.41.
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Objective: To confirm the benefits of vertebroplasty (VP) in selected patients with acute vertebral compression fracture (VCF) and analyze whether the study of a weight dynamic plain lateral radiograph would help in making decisions to perform VP. Using retrospective analysis, we aimed to determine the radiological characteristics of patients benefiting from VP.Methods: Data were collected from 54 patients (age, 56-97 years) diagnosed with osteoporosis and compression fractures between December 2013 and January 2018. Each patient was hospitalized with ≥2 weeks of absolute bed rest (ABR) and treated for osteoporosis. Plain lateral supine radiography of the fractured spine was performed prior to diagnosis, and both supine and standing spinal radiographs were taken 1 and 2 weeks after ABR. Patients were categorized into the VP and non-VP groups 2 weeks after ABR.Results: Although patients with worse pain and functional progress were selected to undergo VP, patients in the VP group presented better outcomes in the fourth week of evaluation than those in the non-VP group. In a retrospective analysis of the radiographic study, changes in the compression rate between supine and standing (weight-bearing) X-rays (ΔCR), showed a statistically significant correlation with the patient’s outcome in the second week.Conclusion: VP was found to be an effective management option for patients with VCF. A weightbearing radiographic study of VCFs provided valuable information on patient selection for VP. Therefore, patient selection based on subjective surveys and radiological studies to determine the benefits of VP could be a beneficial management strategy.
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Hoang Anh, Dao, and Nhung Nguyen Thi Thu. "EVALUATION OF ENDODONTIC TREATMENT OUTCOMES OF VERTICAL CONDENSATION TECHNIQUE USING TOUCH’N HEAT DEVICE." Volume 8 Issue 5 8, no. 5 (2018): 7–13. http://dx.doi.org/10.34071/jmp.2018.5.1.
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Background: One of the key factors in successful endodontic therapy is to adequately fill the root canals. Vertical condensation technique is regarded as a high probability of three-dimensional filling of root canal space which is required to achieve long-term success. Aim: To evaluate the endodontic treatment outcomes of vertical condensation technique using Touch’N Heat device. Subjects and methods: A prospective, descriptive study was conducted across two hospitals in Hue city from 11/2016 to 5/2017. All teeth were instrumented by manual Protaper files and obturated by the vertical condensation technique with Touch’N Heat device. The radiographic evaluation for initial assessment of obturation quality was performed. Evaluation of endodontic treatment outcomes in terms of clinical symptoms and radiographic assessment were recorded after 3-month follow-up. Results: A sample of 30 patients (with 39 incisors) from 13 to 73 years old was recruited. The principal reasons for visiting were pain (30.8%), decay (20.5%) or trauma (20.5%). Most patients seeked treatment at chronic stage of diseases with chronic pulpitis (38.4%) and chronic periapical periodontitis (30.8%). In radiographical quality of obturation, there were 27 (69.3%) fulllength obturated teeth, 8 (20.5%) overfilled teeth (sealer). The percentage of homogeneity of root canal filling was 82.1%. Over 82% patients (25 patients with 32 teeth) presented after there-months followup. Clinical assessment yeiled 30 (93.7%) “adequate” teeth, 2 (6.3%) “poor” teeth. Refer to radiographical assessment, the teeth were defined as “success”, “questionable” and “failure” (29 teeth (90.6%), 3 teeth (9.4%) and zero, respectively). Conclusions: The vertical condensation using Touch’N Heat device ensure the full-length obturation, high homogenetious root canal filling, and sucessful prognosis in clinical and radiographic outcomes. Key words: vertical condensation,Touch’N Heat, endodontic outcomes
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Ray, Justin J., Jennifer Koay, Paul D. Dayton, Daniel J. Hatch, Bret Smith, and Robert D. Santrock. "Multicenter Early Radiographic Outcomes of Triplanar Tarsometatarsal Arthrodesis With Early Weightbearing." Foot & Ankle International 40, no. 8 (2019): 955–60. http://dx.doi.org/10.1177/1071100719847700.
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Background:Hallux valgus is a multiplanar deformity of the first ray. Traditional correction methods prioritize the transverse plane, a potential factor resulting in high recurrence rates. Triplanar first tarsometatarsal (TMT) arthrodesis uses a multiplanar approach to correct hallux valgus in all 3 anatomical planes at the apex of the deformity. The purpose of this study was to investigate early radiographic outcomes and complications of triplanar first TMT arthrodesis with early weightbearing.Methods:Radiographs and charts were retrospectively reviewed for 57 patients (62 feet) aged 39.7 ± 18.9 years undergoing triplanar first TMT arthrodesis at 4 institutions between 2015 and 2017. Patients were allowed early full weightbearing in a boot walker. Postoperative radiographs were compared with preoperative radiographs for hallux valgus angle (HVA), intermetatarsal angle (IMA), tibial sesamoid position (TSP), and lateral round sign. Any complications were recorded.Results:Radiographic results demonstrated significant improvements in IMA (13.6 ± 2.7 degrees to 6.6 ± 1.9 degrees), HVA (24.2 ± 9.3 degrees to 9.7 ± 5.1 degrees), and TSP (5.0 ± 1.3 to 1.9 ± 0.9) from preoperative to final follow-up ( P < .001). Lateral round sign was present in 2 of 62 feet (3.2%) at final follow-up compared with 52 of 62 feet (83.9%) preoperatively. At final follow-up, recurrence was 3.2% (2/62 feet), and the symptomatic nonunion rate was 1.6% (1/62 feet). Two patients required hardware removal, and 2 patients required additional Akin osteotomy.Conclusion:Early radiographic outcomes of triplanar first TMT arthrodesis with early weightbearing were promising with low recurrence rates and maintenance of correction.Level of Evidence:Level IV, retrospective case series.
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Chang, Bong-Soon, Jong-Hun Jung, Sang-Min Park, Seung Hoo Lee, Choon-Ki Lee, and Hyoungmin Kim. "Structural Femoral Shaft Allografts for Anterior Spinal Column Reconstruction in Osteoporotic Spines." BioMed Research International 2016 (2016): 1–9. http://dx.doi.org/10.1155/2016/8681957.
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This study was to investigate the clinical and radiographical outcomes of anterior spinal column reconstruction using structural femoral shaft allografts in osteoporotic patients. Retrospective analyses of medical records, radiographic parameters, and postoperative complications were performed in twenty-one patients who underwent anterior spinal column reconstruction surgery for osteoporotic vertebral collapse or nonunion. Surgical invasiveness, clinical outcomes, postoperative complications, and radiographic outcomes were evaluated. Ambulatory status and back pain significantly improved. The Cobb’s angle of segmental kyphosis significantly improved immediately after surgery with slight progression at the final follow-up. There were two cases of failed reconstruction with marked progression of kyphosis; both were related to loosening of screws rather than subsidence of the graft. Anterior spinal column reconstruction using femoral shaft allografts improved kyphosis and resulted in minimal subsidence and therefore is recommended as an effective treatment option for dealing with osteoporotic vertebral collapse and kyphotic deformity.
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Kakihana, Masataka, Yuki Tochigi, Takayuki Yamazaki, Masanori Ohashi, and Satoru Ozeki. "Suture anchor stabilization of symptomatic accessory navicular in adolescents: Clinical and radiographic outcomes." Journal of Orthopaedic Surgery 28, no. 2 (2020): 230949902091894. http://dx.doi.org/10.1177/2309499020918949.
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Background: Screw fixation used in modified Kidner procedures to treat persistent symptomatic accessory navicular in adult cases is often challenging in adolescent cases with a small accessory fragment. The present study aimed to document the clinical effect of a suture anchor stabilization technique applicable to such cases where osteosynthesis is considered an ideal outcome. Methods: Consecutive clinical cases who received this surgical treatment from 2009 to 2016 were retrospectively reviewed. The focus of interest included radiographic union of the accessory bone, changes in symptoms evaluated using a validated clinical outcome scale introduced by the Japanese Society for Surgery of the Foot, and changes in the medial arch bony alignment measured in lateral weight-bearing plain radiographs. Results: Twenty-two feet in 15 individuals (11 females and 4 males, age at surgery 10–16 years) were identified. In 14 feet (64%), radiographic bone union was confirmed within 8 weeks postoperatively. At the final follow-up ranging 12–51 months postoperation, the clinical scores have significantly improved ( p < 0.001) to 96 ± 5.71 (mean ± standard deviation, range 87–100), from 54 preoperatively. Radiographic measurements revealed significant postoperative increase of the sagittal talar tilt angle ( p < 0.001, increment 4 ± 3°, range 0–11) and the talo-first metatarsal angle ( p < 0.001, increment 5 ± 4°, range 0–12). No significant changes were identified in the calcaneal pitch angle, first metatarsal tilt angle, calcaneo-navicular angle, and the navicular height. Conclusion: Despite the modest bone union rate, the clinical outcomes suggest distinct symptom-relieving effect, at least in the short- to midterm, while the radiographic measurements suggest positive biomechanical effects. The present suture-anchor stabilization concept appears to be a promising treatment option for persistent symptomatic accessory navicular in adolescent cases.
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Maidman, Samuel D., Amalie A. Erwood, James Brodsky, et al. "Radiographic Predictors for Adverse Outcomes Following Surgical Correction of Hammertoe Deformity." Foot & Ankle Orthopaedics 4, no. 4 (2019): 2473011419S0028. http://dx.doi.org/10.1177/2473011419s00287.
Full textAbstract:
Category: Lesser Toes Introduction/Purpose: Hammertoe deformities are common, often painful deformities of the lesser foot and are known to severely affect physical function. When patients seek surgical management, x-ray imagining is utilized for diagnosis, evaluation for surgical candidacy, and selection of the operative technique. Postoperatively, radiographs are retaken to assess bone health, healing status, and alignment. Despite their frequent use, no previous data support particular X-ray findings as being indicative of clinical presentation nor surgical outcomes. The aim of this study is to identify specific radiographic parameters that are predictive of pain and function outcomes after surgical correction of hammertoe deformity. Methods: Prospectively collected data was reviewed on 116 patients who underwent hammertoe correctional surgery. Patient demographics, comorbidities, and postsurgical complications were recorded from their electronic medical records. Clinical outcomes were assessed utilizing preoperative and postoperative pain Visual Analogue Scale (VAS) and Short Form Health Survey Physical Component (SF-36 PCS) scores with 1-year follow-up. Radiographs were scored by a foot & ankle fellowship-trained orthopaedic surgeon to assess preoperative severity, postoperative joint fusion, and both pre- and postoperative joint instability. Data was examined using chi-squared, t-test, and ANOVA analyses. Results: Preoperatively, 14.7% of patients had a deformity classified radiographically as mild, 37.1% as moderate, and 48.3% as severe. X-rays prior to surgery showed that 65.5% had MTP joint instability, 9.5% had joint dislocation, and 18.1% had joint arthritis. Postoperatively, 78.5% had PIP joint fusion, 38.8% had MTP joint arthritis, and 17.2% had MTP joint instability. A significant association was found between postoperative MTP joint instability and a lower 1-year SF-36 PCS (p=0.0032). There were no associations found between the other radiographic findings and postoperative outcomes, and no parameters were associated with pain VAS scores. Conclusion: After undergoing surgical correction of hammertoe deformity, the postoperative radiographic finding of MTP joint instability was determined to be predictive of physical function. However, neither metatarsophalangeal joint arthritis nor PIP fusion were predictive of outcomes. This work informs foot and ankle specialists that proper joint alignment and stabilization is critical to ensuring success in hammertoe surgery.