To see the other types of publications on this topic, follow the link: Radiography in orthopedia.
Journal articles on the topic 'Radiography in orthopedia'
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 journal articles for your research on the topic 'Radiography in orthopedia.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse journal articles on a wide variety of disciplines and organise your bibliography correctly.
1
Bumbasirevic, Marko, and Aleksandar Lesic. "Physicians founders of orthopedic surgery in Serbia." Srpski arhiv za celokupno lekarstvo 132, no. 5-6 (2004): 198–203. http://dx.doi.org/10.2298/sarh0406198b.
Full textAbstract:
The beginnings of the development of orthopedic surgery in Serbia have been related to the name of Dr Nikola Krstic and his first radiography of the hand in 1908. The foundation of the Orthopedic Ward, led by Dr Nikola Krstic, within the General State Hospital in Belgrade, in 1919, marks the definition of orthopedics as a separate branch of surgery. In addition to Dr Nikola Krstic, Dr Borivoje Lalovic and Temp. Docent Dr Borivoje Gradojevic, who published the first orthopedics textbook in Serbian in 1934, also worked at the orthopedic ward between the two world wars. The work at the orthopedic ward, which grew into a clinic in 1947, was continued by Prof. Dr Milos Simovic, Prof. Dr Svetislav Stojanovic and Prof, dr Ljubisa Boric. Their successors would have high achievements: Prof. Dr Zivojin Bumbasirevic became the only orthopedist who was a regular member of the Serbian Academy of Sciences and Arts, and Chief of Staff Dr Predrag Klisic and Prof. Dr Branko Radulovic provide impetus for further development of orthopedics by founding Specialist Orthopedics Hospital "Banjica".
2
Donovan, Daniel S., Jeremy D. Podolnick, Wayne Reizner, O. Alton Barron, Louis W. Catalano, and Steven Z. Glickel. "Accuracy and Reliability of Radiographic Estimation of Volar Lip Fragment Size in PIP Dorsal Fracture-Dislocations." HAND 14, no. 6 (June 5, 2018): 797–802. http://dx.doi.org/10.1177/1558944718777831.
Full textAbstract:
Background: A cadaveric study was performed to evaluate the accuracy and reliability of radiographic estimation of the volar lip fragment size in proximal interphalangeal joint fracture-dislocations. Methods: Middle phalangeal base volar lip fractures of varying size and morphology were simulated in 18 digits. Radiographs and digital photographs of the middle phalangeal joint surface were obtained pre- and postinjury. Ten orthopedic surgeons of varying levels of training estimated the fracture size based on radiographs. The estimated joint involvement on radiograph was compared with the digitally measured joint involvement. Results: Radiographic estimation underestimated the volar lip fragment size by 9.02%. Estimations possessed high intraobserver (0.76-0.98) and interobserver (0.88-0.97) reliabilities. No differences were detected between levels of surgeon training. Conclusions: The significant underestimation of the volar lip fragment size demonstrates the lack of radiographic estimation accuracy and suggests that surgeons should be mindful of these results when making treatment plans.
3
Mulders, Marjolein A. M., Monique M. J. Walenkamp, Nico L. Sosef, Frank Ouwehand, Romuald van Velde, Carel Goslings, and Niels W. L. Schep. "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 (September 20, 2019): 573–82. http://dx.doi.org/10.1007/s00068-019-01194-2.
Full textAbstract:
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.
4
Akbar, Z., O. A. Al-Juhaishi, T. A. O. Olusa, and H. M. S. Davies. "Radiographic method for evaluation of tarsus morphometry." Comparative Exercise Physiology 15, no. 5 (December 10, 2019): 339–48. http://dx.doi.org/10.3920/cep190016.
Full textAbstract:
The equine tarsus is the most common area of the hind limb associated with lameness. Tarsal function is probably directly related to its conformation. Previous conformational measurement methods and radiological data are either limited or too specific to explain the complex tarsus conformation in different loading conditions. This study aimed to develop a consistent method to evaluate equine tarsal conformation from lateromedial radiographs. Twenty cadaveric hind limbs from 15 adult horses of different breeds were cut at the distal one third of the tibia. Hind limbs mounted in a loading rig and positioned with the metatarsus vertical were digitally radiographed. The zero-degree lateromedial (ZLM) was defined by vertical and horizontal landmarks including overlapping of the lateral and medial trochlea of the talus and a contact point between the dorsal edges of lateral and medial borders of the distal central tarsal bone. Radiographs missing these features were retaken to achieve consistent ZLM views. Specific radiographic features were selected as landmarks to develop tarsal parameters based on their clarity and their being consistently identifiable. The intra-rater repeatability of ten measurable morphometric parameters was evaluated with each radiograph measured twice with an interval of at least one month and Bland-Altman plots developed from this data. Repeat measurements did not differ significantly (Intraclass correlation coefficients (ICC) ranged from 0.731-0.966). This study provides a base for evaluation of the tarsal conformation by radiography.
5
Al-Mohrej, Omar A., Sahar S. Aldakhil, Nouf F. Alsadoun, Fawaz N. Alshaalan, Abdulrahman Alomair, Bashyar Almuqbail, Mohammed S. Alqahtani, et al. "Foot and ankle radiographic angles in a normal saudi population." Journal of Musculoskeletal Surgery and Research 5 (July 2, 2021): 152–58. http://dx.doi.org/10.25259/jmsr_19_2021.
Full textAbstract:
Objectives: Radiographic reference lines, angles, and measures comprise the foundation for accurate evaluation and surgical planning of orthopedic surgeries, especially when it comes to foot and ankle deformities. To date, no study has evaluated the average parameters for foot and ankle radiography in the Saudi population. This study aimed to establish reference values of foot and ankle angles for the general Saudi population. Methods: We included 100 participants (200 feet) in this study, with 50 males and 50 females aged 21–30 years. We recruited subjects who had no history of foot or ankle pain, surgery or fracture, no evidence of ligamentous laxity, and no history of systemic disease. Bilateral anterior-posterior (AP) and lateral weight-bearing radiographs were obtained using standardized angles. A total of 19 angles on AP and 9 angles on lateral radiographs were evaluated. Radiographic parameters were compared between genders. Results: A total of 400 radiographs from 200 normal feet were evaluated. The mean ± SD age of the subjects was 22.7±1.7 years. Statistically significant differences in mean radiographic parameters were found between males and females in both radiographic projections. Conclusion: Significant variation exists between the normal foot and ankle reference angles between the Saudi population included in our study and other ethnicities. Moreover, significant differences are found between genders in our study. Considering the lack of other studies involving the Saudi population, the results of this study can help serve as a reference when evaluating Saudi patients.
6
Younger, Alastair S., Bonita Sawatzky, and Peter Dryden. "Radiographic Assessment of Adult Flatfoot." Foot & Ankle International 26, no. 10 (October 2005): 820–25. http://dx.doi.org/10.1177/107110070502601006.
Full textAbstract:
Background: The accurate measurement of flatfoot on standing radiographs allows correct diagnosis of the condition and evaluation of reconstructive procedures. Method: The standing radiographic measurements of patients with symptomatic, adult flatfoot were compared to controls using blinded observers. Results: On the lateral radiograph, the talar-to-first metatarsal angle, the calcaneal pitch angle, and the medial cuneiform-fifth metatarsal height differed significantly between the patient group and the controls. The difference in the talar-to-first metatarsal angles on lateral radiographs was the most statistically significant (patient group 21.1 ±10.8 degrees and control 7.1 ± 10.7 degrees, p < 0.0001) with good correlation between readings (intraobserver 0.75, interobserver 0.83). On the anteroposterior (AP) radiograph, the talar head uncoverage distance was the most significantly different measurement between these groups. Conclusions: These findings support the hypothesis that the talar-first metatarsal angle is an accurate radiographic identifier of patients with symptomatic, adult flatfoot.
7
Kumar, Dharmendra, Sudhir Singh, and Alok Kumar Yadav. "Ottawa Ankle Rule: An Indian Perspective." Journal of Foot and Ankle Surgery (Asia Pacific) 2, no. 1 (2015): 8–12. http://dx.doi.org/10.5005/jp-journals-10040-1020.
Full textAbstract:
ABSTRACT Introduction Foot and ankle injuries are common clinical conditions treated by orthopedic surgeons accounting for 6 to 12% of the patients seen in emergency. Currently, almost all patients with foot and ankle injuries undergo radiographic examination to exclude fractures; however, fewer than 15% of these patients actually have fractures, thus, most of these radiographs are unnecessary. Unwarranted radiographic examination increases the demands on the healthcare system and also results in prolonged patient waiting times. Ottawa ankle rule (OAR) evolved to reduce the number of radiography and waiting time for patients in emergency department by excluding fractures using only clinical examination. Although, it has good sensitivity but it has not been much popular and not included in medical curriculum. Aim The aim of the study is to implement the OAR in an Indian tertiary care trauma setup with two different levels of clinical examiners (1st year postgraduate junior resident and senior resident) and report the finding. Materials and methods This prospective study was done in the Department of Orthopedics, for a period of 15 months. Clinical examiners were shown and given a video presentation about the Oar and a printed copy of the rules were provided to all. Clinical diagnosis of both levels of clinical examiners were evaluated and analyzed. Results Three hundred cases met our inclusion criteria. In first clinical examination done by junior resident, 115 clinically significant fractures were suspected while senior resident suspected 69 fractures. Radiography showed 5 cases with missed fractures. Accuracy of OAR by JR is 82.33% and by SR is 97.0%. Conclusion Ottawa ankle rule are very effective and can identify all clinically relevant fractures of ankle and foot with increased accuracy and sensitivity when applied by a trauma specialists. Although, these rules can also be applied by general doctors so as to help them to screen patients who need radiography in acute ankle injury, but it is more sensitive when it is applied by specialist doctor. How to cite this article Singh S, Kumar D, Yadav AK. Ottawa Ankle Rule: An Indian Perspective. J Foot Ankle Surg (Asia- Pacific) 2015;2(1):8-12.
8
Park, Byeong Seop, Chin Youb Chung, Moon Seok Park, Ki Hyuk Sung, Young Choi, Chulhee Park, Seungbum Koo, and Kyoung Min Lee. "Inverse Relationship Between Radiographic Lateral Ankle Instability and Osteochondral Lesions of the Talus in Patients With Ankle Inversion Injuries." Foot & Ankle International 40, no. 12 (August 27, 2019): 1368–74. http://dx.doi.org/10.1177/1071100719868476.
Full textAbstract:
Background: Insufficient or excessive bony constraint surrounding the talus might contribute to the occurrence of ligamentous injury or bone contusion, respectively, at the time of ankle inversion injuries. This study aimed to investigate the relationship between radiographic lateral ankle instability and osteochondral lesions of the talus (OLT) following ankle inversion injuries. Methods: A total of 195 patients (113 men and 83 women; mean age, 38.7 years) with a history of ankle inversion injuries were included in this study. All patients underwent ankle magnetic resonance imaging (MRI) and stress radiography. The tibiotalar tilt angle on varus stress radiograph, anterior translation of the talus on anterior-drawer lateral radiographs, bimalleolar tilt angle, and fibular position were radiographically determined. The radiographic lateral ankle instability was defined as tibiotalar tilt angle ≥10 degrees, and the presence of OLT was confirmed on MR images. The relationship between the radiographic lateral ankle instability and the presence of OLT was statistically analyzed. Results: The presence of radiographic lateral ankle instability (tibiotalar tilt angle ≥10 degrees) showed an inverse relationship with that of OLT in the chi-squared test ( P = .003). An increased tibiotalar tilt angle was associated with lower incidence of OLT ( P = .011) in the multiple regression analysis, and the presence of OLT was associated with a decreased tibiotalar tilt angle ( P = .016) in the binary logistic regression analysis. Conclusions: This study showed an inverse relationship between lateral ankle instability and the development of OLT following ankle inversion injury. The role of bony constraint in the development of sports injuries in the ankle should be considered with these injuries. Level of Evidence: Level III, diagnostic, comparative study.
9
van Gerven, P., S. M. Rubinstein, C. Nederpelt, M. F. Termaat, P. Krijnen, M. W. van Tulder, and I. B. Schipper. "The value of radiography in the follow-up of extremity fractures: a systematic review." Archives of Orthopaedic and Trauma Surgery 138, no. 12 (August 14, 2018): 1659–69. http://dx.doi.org/10.1007/s00402-018-3021-y.
Full textAbstract:
Abstract Background The added value of routine radiography in the follow-up of extremity fractures is unclear. The aim of this systematic review was to create an overview of radiography use in extremity fracture care and the consequences of these radiographs for the treatment of patients with these fractures. Materials and methods Studies were included if they reported on the use of radiography in the follow-up of extremity fractures and on its influence on treatment strategy, clinical outcome, or complications. A comprehensive search of electronic databases (i.e., PubMed, Embase, and Cochrane) was performed to identify relevant studies. Methodological quality was assessed with the Newcastle–Ottawa scale for cohort studies. Level of evidence was assessed using GRADE. The search, quality appraisal, and data extraction were performed independently by two researchers. Results Eleven studies were included. All studies were retrospective cohorts. Of these, only two used a comparative design. Two of the included studies described fractures of both the upper and lower extremities, four studies concerned fractures of the lower extremity only, and five studies focused on fractures of the upper extremity. Pooling of data was not performed because of clinical heterogeneity. Eight studies reported on a change in treatment strategy related to radiography. Percentages ranged from 0 to 2.6%. The overall results indicated that radiographs in the follow-up of extremity fractures seldom alter treatment strategy, that the vast majority of follow-up radiographs are obtained without a clinical indication and that detection of a complication on a radiograph, in the absence of clinical symptoms, is unlikely. All included studies were regarded of a ‘very low’ level using GRADE. Conclusions Based on current literature, the added value of routine radiography in the follow-up of extremity fractures seems limited. Results, however, should be interpreted with care, considering that available evidence is of a low level.
10
Lander, Sarah, Julie Michels, Anne Brayer, Sarah Obudzinski, Taylor D’amore, Mitchel Chess, Derek Wakeman, P. Christopher Cook, and James Sanders. "PEDIATRIC ORTHOPEDIC RADIOGRAPH REDUCTION: A QUALITY IMPROVEMENT INITIATIVE." Orthopaedic Journal of Sports Medicine 8, no. 4_suppl3 (April 1, 2020): 2325967120S0014. http://dx.doi.org/10.1177/2325967120s00149.
Full textAbstract:
Background: Children are more vulnerable to ionizing radiation which increases health risks later in life including cancer. An interdepartmental team developed an algorithm to guide providers ordering extremity radiographs in pediatric patients with musculoskeletal (MSK) injuries. Purpose: Reduce unnecessary pediatric radiation/extremity radiographs through development and implementation of an interdepartmental designed algorithm. Determine utility, safety, and efficacy of the algorithm through retrospective and prospective analysis. Methods: Our study was performed at an academic pediatric trauma center. An interdepartmental committee including pediatric orthopedic surgery, emergency medicine, trauma, and radiology providers created a MSK injury imaging algorithm (Figure 1). We retrospectively validated the algorithm for efficacy and safety through chart review of pediatric patients seen in the ED with MSK extremity injury, identified through CPT code, from 6/24/2016 through 8/31/2016. We determined the number of extra radiographs per patient and identified if injuries would be missed utilizing our protocol. After retrospective validation, guideline implementation was undertaken through multidisciplinary education. The imaging guideline was prospectively implemented in the pediatric ED from 6/24/2018 through 8/31/2018. We continued to prospectively evaluate through selecting one week every month over the following eight months to determine sustainability of the implemented algorithm. Results: Our interdepartmental team in 2016 developed a pediatric MSK radiograph protocol (Figure 1). A retrospective chart and radiograph review of 295 pediatric patients between 6/24/2016 through 8/31/2016 was analyzed correlating physical examination to appropriate radiographs. Utilizing the protocol, the review revealed an average of 2.75 extra radiographs per patient. No injuries were missed. Providers including orthopedic and emergency medicine attendings, mid-levels, and residents were educated through meetings, emails, and having the protocol posted and easily accessible. Our protocol was implemented 6/24/18 and underwent prospective enrollment and review through 8/31/18 which revealed a reduction to 0.72 radiographs per patient (P-value <0.001) (Figure 2). Eight month follow up revealed a sustainable reduction in extra radiographs per patient (Figure 3). Conclusion: Reduction of unnecessary radiation to pediatric patients with MSK extremity injuries was accomplished through development and implementation of a safe and effective imaging algorithm. The multidisciplinary approach combined with widespread education of pediatric providers improved buy-in driving a sustainable system improvement. [Figure: see text][Figure: see text][Figure: see text]
11
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 (April 2, 2019): 155–60. http://dx.doi.org/10.1302/1863-2548.13.180165.
Full textAbstract:
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
12
Ryu, Dong Jin, Kyeu Baek Kwon, Eui Yub Jung, Sung-Sahn Lee, Joo Hwan Kim, Min Chang Jang, and Joon Ho Wang. "Clinically Reliable Knee Flexion Angle Measured on Stress Radiography for Quantifying Posterior Instability in Posterior Cruciate Ligament Injury." Orthopaedic Journal of Sports Medicine 9, no. 3 (March 1, 2021): 232596712198925. http://dx.doi.org/10.1177/2325967121989252.
Full textAbstract:
Background: After posterior cruciate ligament injury, stress radiography is a common method of quantifying posterior instability, defined as the side-to-side difference in posterior tibial displacement (PTD) between the injured knee and contralateral noninjured knee. However, no study has evaluated the reliability of PTD according to knee flexion angle (KFA) measurements on stress radiographs. Purpose: To evaluate the test-retest reliability of stress radiographic measurements of the KFA in the noninjured knee. In addition, we established a reliable range of KFAs to indicate posterior instability by comparing results with the instability measured at 90° KFA, which is considered the gold standard. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: We evaluated patients who had undergone bilateral stress radiographic examinations at least 5 times for ligament injuries between January 2013 and November 2019. All examinations were performed on a Telos device with a 150-N posterior load. A total of 120 knees and 644 stress radiographs were enrolled. We measured the KFA and PTD on stress radiographs and evaluated the reliability of repeated PTD measurement and the correlation between KFA and PTD. Results: The distribution of the actual noninjured knee KFA ranged from 56.9° to 106.7°. Among the 644 radiographs, 155 (24.1%) showed KFAs between 85° and 95°, and 287 (44.6%) showed KFAs between 80° and 85°. A significant correlation was found between KFA and PTD ( P < .001), and the intrapatient intraclass correlation coefficient (ICC) was 0.788. A KFA range of 85° to 92° satisfied the criteria of high ICC (0.885) and nonsignificant correlation between KFA and PTD ( P = .055) and thus was considered a reliable range of KFAs for quantifying posterior instability. We found no significant risk factors for measurement error, including age ( P = .674), sex ( P = .328), height ( P = .957), weight ( P = .248), or body mass index ( P = .257). Conclusion: We found high reproducibility of posterior displacement measurements on Telos stress radiography at a KFA of 85° to 92° in noninjured knees.
13
Ebraheim, Nabil A., Jike Lu, Hua Yang, Anis O. Mekhail, and Richard A. Yeasting. "Radiographic and CT Evaluation of Tibiofibular Syndesmotic Diastasis: A Cadaver Study." Foot & Ankle International 18, no. 11 (November 1997): 693–98. http://dx.doi.org/10.1177/107110079701801103.
Full textAbstract:
Twelve cadaver lower limbs were used for radiographic and CT assessment of the tibiofibular syndesmosis. Plastic spacers were placed in the distal tibiofibular intervals of each specimen in successive 1-mm increments until diastasis could be appreciated on the plain radiographs. All 2- and 3-mm diastases could be noted and clearly identified on CT scans, while the 1-, 2-mm, and half of the 3-mm syndesmotic diastases could not be appreciated with routine radiographs. CT scanning is more sensitive than radiography for detecting the minor degrees of syndesmotic injuries. Therefore, a CT scan can be performed in cases of syndesmotic instability after ankle injuries and for preoperative or postoperative evaluation of the integrity of the distal tibiofibular syndesmosis in cases of doubtful condition of the syndesmosis.
14
Lindsey, Robert, Aaron Daluiski, Sumit Chopra, Alexander Lachapelle, Michael Mozer, Serge Sicular, Douglas Hanel, et al. "Deep neural network improves fracture detection by clinicians." Proceedings of the National Academy of Sciences 115, no. 45 (October 22, 2018): 11591–96. http://dx.doi.org/10.1073/pnas.1806905115.
Full textAbstract:
Suspected fractures are among the most common reasons for patients to visit emergency departments (EDs), and X-ray imaging is the primary diagnostic tool used by clinicians to assess patients for fractures. Missing a fracture in a radiograph often has severe consequences for patients, resulting in delayed treatment and poor recovery of function. Nevertheless, radiographs in emergency settings are often read out of necessity by emergency medicine clinicians who lack subspecialized expertise in orthopedics, and misdiagnosed fractures account for upward of four of every five reported diagnostic errors in certain EDs. In this work, we developed a deep neural network to detect and localize fractures in radiographs. We trained it to accurately emulate the expertise of 18 senior subspecialized orthopedic surgeons by having them annotate 135,409 radiographs. We then ran a controlled experiment with emergency medicine clinicians to evaluate their ability to detect fractures in wrist radiographs with and without the assistance of the deep learning model. The average clinician’s sensitivity was 80.8% (95% CI, 76.7–84.1%) unaided and 91.5% (95% CI, 89.3–92.9%) aided, and specificity was 87.5% (95 CI, 85.3–89.5%) unaided and 93.9% (95% CI, 92.9–94.9%) aided. The average clinician experienced a relative reduction in misinterpretation rate of 47.0% (95% CI, 37.4–53.9%). The significant improvements in diagnostic accuracy that we observed in this study show that deep learning methods are a mechanism by which senior medical specialists can deliver their expertise to generalists on the front lines of medicine, thereby providing substantial improvements to patient care.
15
Williams, Huw L. M., Gavin E. Bartlett, Mark R. Norton, and Rory G. Middleton. "The posterior acetabular wall (PAW): an aid to acetabular orientation at primary THA." HIP International 28, no. 1 (July 9, 2017): 29–32. http://dx.doi.org/10.5301/hipint.5000531.
Full textAbstract:
Introduction: Incorrect acetabular component positioning during total hip arthroplasty (THA) may lead to dislocation, impingement, wear and revision. Surgeons commonly use the transverse acetabular ligament (TAL) as a landmark for acetabular component orientation. The posterior acetabular wall (PAW) is a structure easily viewed on plain radiography and its position can help guide acetabular component position. In this study, we examine the efficacy of preoperative radiographs in predicting cup position relative to the PAW. Methods: Prospective data was recorded on radiographic findings of the posterior wall (prominent, normal, deficient) on a consecutive series of 200 primary THAs utilising a standardised posterior approach. The final cup position relative to the wall was recorded (prominent, flush, deep). Cup inclination and version were then assessed by postoperative radiography and any instances of dislocation recorded. Results: There were 117 females and 83 males with a mean age of 66.5 years. 154 were recorded as having a normal PAW on radiographs, 152 had the cup positioned in line with the TAL and flush to the PAW. 29 had a deficient PAW and 27 of these had a cup positioned prominently with 17 having a prominent PAW and of these 16 a deep cup position. Postoperative radiographs showed a mean cup version of 20.8° and inclination of 44.7° using this method. There were 21 outliers (10.5%) with no dislocations at a minimum 12-month follow-up. Conclusions: The TAL is a continuation of the posterior labrum. As such, the posterior wall is a useful adjunct to and surrogate landmark for the TAL. It has the added advantage that it is visible on radiographs and so aids surgical planning with respect to cup positioning.
16
Seidel, Angela, Fabian Krause, and Martin Weber. "Weightbearing vs Gravity Stress Radiographs for Stability Evaluation of Supination-External Rotation Fractures of the Ankle." Foot & Ankle International 38, no. 7 (May 16, 2017): 736–44. http://dx.doi.org/10.1177/1071100717702589.
Full textAbstract:
Background: Isolated lateral malleolar fractures may result from a supination-external rotation (SER) injury of the ankle. Stable fractures maintain tibiotalar congruence due to competent medial restraints and can be treated nonoperatively with excellent functional results and long-term prognosis. Stability might be assessed with either stress radiographs or weightbearing radiographs. Methods: A consecutive series of patients with closed SER fractures (presumed AO 44-B1) were prospectively enrolled from 2008 to 2015. Patients with clearly unstable fractures (medial clear space more than 7 mm) on the initial nonweightbearing radiograph were excluded and operated on. All other patients were examined with a gravity stress and a weightbearing anteroposterior radiograph. Borderline instability of the fracture was assumed when the medial clear space was 4 to 7 mm. Those were treated nonoperatively. Results: Of 104 patients with isolated lateral malleolar fractures of the SER type, 14 patients were treated operatively because of clear instability (displacement) on the initial radiographs. Of the nonoperative patients, 44 patients demonstrated borderline instability on the gravity stress but stability on the weightbearing radiograph (“gravity borderline”); the remaining 46 were stable in both tests (“gravity stable”). At an average follow-up of 23 months, no significant differences were seen in the American Orthopaedic Foot & Ankle Society hindfoot score (92 points gravity-borderline group vs 93 points gravity-unstable group), the Foot Functional Index score (11 vs 10 points), the Short Form 36 (SF-36) physical component (86 vs 85 points), and SF-36 mental component (84 vs 81 points). Radiographically, all fractures had healed with anatomic congruity of the ankle. Conclusion: Weightbearing radiographs provided a reliable basis to decide about stability and nonoperative treatment in isolated lateral malleolar fractures of the SER type with excellent clinical and radiographic outcome at short-term follow-up. Gravity stress radiographs appear to overrate the need for operative treatment. Level of Evidence: Level III, prospective comparative study
17
Gotfryd, Alberto Ofenhejm, Felipe de Moraes Pomar, Nicola Jorge Carneiro Neto, Fernando José Franzin, Luciano Miller Reis Rodrigues, and Patricia Rios Poletto. "Reliability analysis of radiographic methods for determination of posterolateral lumbossacral fusion." Einstein (São Paulo) 12, no. 2 (June 2014): 198–203. http://dx.doi.org/10.1590/s1679-45082014ao2964.
Full textAbstract:
Objective To analyze intra and interobserver agreement of two radiographic methods for evaluation of posterolateral lumbar arthrodesis.Methods Twenty patients undergoing instrumented posterolateral fusion were evaluated by anteroposterior and dynamic lateral radiographs in maximal flexion and extension. The images were evaluated initially by 6 orthopedic surgeons, and after 8 weeks, reassessed by 4 of them, totaling 400 radiographic measurements. Intra and interobserver reliability were analyzed using the Kappa coefficient and Landis and Koch criteria.Results Intra and interobserver agreement regarding anteroposterior radiographs were, respectively, 76 and 63%. On lateral views, these values were 78 and 84%, respectively. However, the Kappa analysis showed poor intra and interobserver agreement in most cases, regardless of the radiographic method used.Conclusion There was poor intra and interobserver agreement in the evaluation of lumbosacral fusion by plain film in anteroposterior and dynamic lateral views, with no statistical superiority between the methods.
18
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 (June 2007): 933–35. http://dx.doi.org/10.1177/0363546507299742.
Full textAbstract:
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.
19
Holliday, Charles L., Ryan Martin, and John A. Grant. "Comparing the Efficacy of Kneeling Stress Radiographs and Weighted Gravity Stress Radiographs to Assess Posterior Cruciate Ligament Insufficiency." American Journal of Sports Medicine 49, no. 4 (February 18, 2021): 1017–22. http://dx.doi.org/10.1177/0363546520988114.
Full textAbstract:
Background: Kneeling posterior cruciate ligament (PCL) stress radiographs are commonly used to evaluate PCL laxity. Patients, however, report significant pain, and the method’s reproducibility may be challenged due to its dependence on patient body weight distribution to produce posterior tibial displacement. Weighted gravity stress radiography may offer better reproducibility and comfort than the kneeling technique, but its efficacy has not been studied. Hypothesis: Weighted gravity PCL stress radiographs will be more comfortable and produce similar measurements of side-to-side difference in posterior tibial displacement when compared with the kneeling technique. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: A total of 40 patients with nonoperatively or >6 months postoperatively treated PCL injuries (isolated or multiligamentous) underwent bilateral stress radiographs. Weighted gravity and kneeling stress radiographs were acquired, in random order, for each patient, as well as side-to-side difference in posterior tibial displacement between each knee, patient-reported visual analog scale knee pain (100 mm), time to acquire the images, and patient preference for technique. Paired t tests were used to compare the side-to-side difference, pain score, and time to complete the radiographs. Results: There was no difference between the 2 radiographic methods in the mean side-to-side difference (gravity: 6.45 ± 4.61 mm, kneeling: 6.82 ± 4.60 mm; P = .72), time required to acquire radiographs (kneeling: 307.3 ± 140.5 seconds, gravity: 318.7 ± 151.1 seconds; P = .073), or number of radiographs taken to obtain acceptable images (kneeling: 3.6 ± 1.6, gravity: 3.7 ± 1.7; P = .73). Patients reported significantly less knee pain during the weighted gravity views (kneeling: 31.8 ± 26.6, gravity: 4.0 ± 12.0; P < .0001). Of the patients, 88% preferred the weighted gravity method. Conclusion: Weighted gravity stress radiographs produce similar side-to-side differences in posterior tibial translation compared with the kneeling stress technique, but do not rely on patient weightbearing and provide significantly better patient comfort. Clinicians should therefore consider the use of weighted gravity stress radiographs in clinical practice to minimize the pain associated with stress radiography while allowing for accurate decision making.
20
Miller, Christopher P., Mohammad Ghorbanhoseini, Lauren K. Ehrlichman, Kempland C. Walley, Azadeh Ghaheri, and John Y. Kwon. "High Variability of Observed Weight Bearing During Standing Foot and Ankle Radiographs." Foot & Ankle International 38, no. 6 (March 13, 2017): 690–93. http://dx.doi.org/10.1177/1071100717695361.
Full textAbstract:
Background: Weight-bearing radiographs are a critical component of evaluating foot and ankle pathology. An underlying assumption is that patients are placing 50% of their body weight on the affected foot during image acquisition. The accuracy of weight bearing during radiographs is unknown and, presumably, variable, which may result in uncertain ability of the resultant radiographs to appropriately portray the pathology of interest. Methods: Fifty subjects were tested. The percentage body weight through the foot of interest was measured at the moment of radiographic image acquisition. The subject was then instructed to bear “half [their] weight” prior to the next radiograph. The percentage body weight was calculated and compared to ideal 50% weight bearing. Results: The mean percentage body weight in trial 1 and 2 was 45.7% ± 3.2% ( P = .012 compared to the 50% mark) and 49.2% ± 2.4%, respectively ( P = .428 compared to 50%). The mean absolute difference in percentage weight bearing compared to 50% in trials 1 and 2 was 9.3% ± 2.3% and 5.8% ± 1.8%, respectively ( P = .005). For trial 1, 18/50 subjects were within the “ideal” (45%-55%) range for weight bearing compared to 32/50 on trial 2 ( P = .005). In trial 1, 24/50 subjects had “appropriate” (>45%) weight bearing compared to 39/50 on trial 2 ( P = .002). Conclusions: There was substantial variability in the weight applied during radiograph acquisition. This study raises questions regarding the assumptions, reliability, and interpretation when evaluating weight-bearing radiographs. Level of Evidence: Level III, comparative study.
21
Kumar, A., W. W. Chau, A. L. H. Hung, J. K. T. Wong, B. K. W. Ng, and J. C. Y. Cheng. "Gonadal shield: is it the Albatross hanging around the neck of developmental dysplasia of the hip research?" Journal of Children's Orthopaedics 12, no. 6 (December 2018): 606–13. http://dx.doi.org/10.1302/1863-2548.12.180133.
Full textAbstract:
Purpose Prospective randomized controlled trials and long-term studies are essential future directions for building evidence-based practices in developmental dysplasia of the hip (DDH), however, sufficient attrition in data (> 20%) can introduce bias deteriorating research quality. Pelvic radiography is synonymous with DDH assessment and so are Gonadal Shield (GS) recommendations with pelvic radiography. Nonetheless, losses to diagnostic information and inadequate protection have been increasingly implicated to GS usage, with significantly worse implications in female patients. Understandably for DDH, a disease with 80% female prevalence, the impact of GS usage on quality of radiographs and readability of radiological data may be drastic. This study aims to objectively define the implications of GS recommendations in DDH patients. Methods Pelvis radiographs of all DDH patients under the hip surveillance programme at a tertiary care hospital with a written protocol for GS usage were evaluated. Images were reviewed for gender, GS presence, adequate gonadal protection and obstruction of essential anatomical landmarks for pelvic indices. Results In all, 131 pelvis radiographs with DDH diagnoses (age: 1.25 to 6 years; 107 female, 24 male pelvises) were reviewed. Only 42.67% (56) of pelvis radiographs used GS despite the presence of a clear protocol. Useful anatomical landmarks were obstructed in 58.9% of radiographs with GS present. Lost diagnostic information was more common in female patients than male patients (68.1% versus 11.1%, p < 0.01). GS was ineffective at gonadal protection in 73.2% (41) of the pelvises with worse protection in female patients (78.7% vs 44.4%; p = 0.03). Conclusions Ironically, essential anatomy was obstructed in all the adequately protected female pelvises. Routine GS usage results in substantial attrition of radiographic data in DDH patients. Level of Evidence III
22
Yaprakci, Mustafa Volkan, Marek Galanty, and Katarzyna Siewruk. "Clinical Comparative Evaluation of the V-Cut Pelvic Ostectomy in the Management of Canine Hip Dysplasia." Bulletin of the Veterinary Institute in Pulawy 57, no. 2 (June 1, 2013): 243–47. http://dx.doi.org/10.2478/bvip-2013-0043.
Full textAbstract:
Abstract The operational method (V-cut pelvic ostectomy) was applied on seven dogs. Pubic symphysis was cut in an inverted “V” fashion and a bone gap occurred between pelvic halves. The gap was reduced by contracting both sides of the pelvis. A new pubic symphysis developed. Results were evaluated with radiographs and different clinical and orthopedic tests. Radiographic measures between mutual parts of pelvic bone showed a marked increase in Norberg angles and diminishing in Bardens, Barlow, and Ortolani orthopedic tests after operations. Principal conclusion: V-cut pelvic ostectomy was found to be a successful operation technique in treatment of canine hip dysplasia.
23
Lee, Chang-Yk, Byeong-Mun Park, Tae-Woo Kim, and Seung-Hwan Lee. "Clinical Implication of Mid-Range Dynamic Instability in Lumbar Degenerative Spondylolisthesis." Asian Spine Journal 14, no. 4 (August 31, 2020): 507–12. http://dx.doi.org/10.31616/asj.2020.0087.
Full textAbstract:
Study Design: Retrospective evaluation.Purpose: To determine the prevalence of mid-range dynamic instability in patients with degenerative spondylolisthesis (DS) and to evaluate the clinical implication of mid-range instability (MI).Overview of Literature: Instability is identified by measuring vertebral body anterior–posterior translation on static end-range flexion and extension lateral radiographs. Mid-range kinematics could evince occult dynamic instability in which motion is not appreciated at the terminal-range of motion.Methods: In this study, 30 patients with DS with checked standing dynamic radiographs of the lumbar spine in Gwangmyeong Sungae Orthopedic Clinic were recruited. Standing lateral radiographs were evaluated in extension, 45° of flexion (mid-range) and 90° of flexion (terminal-range) of the lumbar spine. Instability was defined as sagittal translation greater than 3 mm from the extension position. Patients were divided into three groups: a control group, an MI group, and a terminal-range instability (TI) group. Radiographic outcome (stenosis grade) and clinical outcome were compared between the three groups.Results: The average sagittal translation of the lumbar spine was 5.2 mm in extension, 6.6 mm in mid-range, and 7.2 mm in endrange. MI was observed in eight patients (26.2%) and TI was seen in 12 patients (40%). Of eight patients with MI, three patients did not have instability at terminal-range (occult patients) and five patients had instability at terminal-range (typical patients). Body weight and body mass index (BMI) was significantly higher in the MI group as compared to the control group. BMI was positively correlated with slippage to mid-range. There was no significant difference in stenosis grade, Visual Analog Scale, and Oswestry Disability Index. In the TI group, there was no significant difference in radiographic clinical parameters as compared to the control group.Conclusions: MI was demonstrated in 25% of DS patients. Mid-range motion was increased with BMI. Mid-range lateral radiography can reveal occult instability in patients with DS, particularly in obese patients.
24
Seo, Hajime, Masatoshi Naito, Yoshinari Nakamura, Koichi Kinoshita, Tomohiro Nomura, So Minokawa, Tomohiko Minamikawa, and Takuaki Yamamoto. "New Cross-Table Lateral Radiography Method for Measuring Acetabular Component Anteversion in Total Hip Arthroplasty: A Prospective Study of 93 Primary THA." HIP International 27, no. 3 (January 31, 2017): 293–98. http://dx.doi.org/10.5301/hipint.5000456.
Full textAbstract:
Introduction Various methods have been described for measuring acetabular component anteversion. However, accurate measurement of anteversion is difficult. We herein propose a new method using cross-table lateral (CL) radiography performed with the contralateral hip flexed to 45° (45° flexed CL radiography). The main purpose of this study was to evaluate the reliability and validity of this new method. Methods The study group included 93 patients who underwent total hip arthroplasty (THA). All hips were evaluated with computed tomography (CT) and both standard and 45° flexed CL radiographs to measure acetabular component anteversion the week after THA. The intraobserver and interobserver reliability of each measurement was assessed. Plain radiography measurements were compared with reference CT measurements to evaluate their validity. Results All measurements had excellent intraobserver and interobserver reliability, and plain radiography measurements correlated well with CT measurements. The mean measurements were 21.9° (3°-39°) with CT, 24.9° (7°-47°; p<0.001) with standard CL radiographs, and 22.5° (7°-43°; p = 0.112) with 45° flexed CL radiographs. Discussion The anteversion values measured with our new method were closer to the CT values used as a reference standard than those with standard CL radiographs. Our new method appears to be reliable and valid for measuring acetabular component anteversion.
25
Choi, Ji Hye, Kug Jin Choi, Chin Youb Chung, Moon Seok Park, Ki Hyuk Sung, and Kyoung Min Lee. "Consistency and Reliability of Ankle Stress Radiography in Patients With Chronic Lateral Ankle Instability." Orthopaedic Journal of Sports Medicine 9, no. 5 (May 1, 2021): 232596712110040. http://dx.doi.org/10.1177/23259671211004099.
Full textAbstract:
Background: Ankle stress radiographs are important tools for evaluating chronic lateral ankle instability. The consistency of a patient’s ankle condition as it affects the reliability of ankle stress radiographs has never been evaluated. Purpose: To investigate the consistency and reliability of ankle stress radiographs in patients with chronic lateral ankle instability without an ankle injury during the study period. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Included were patients with chronic lateral ankle instability who underwent 2 repeated ankle stress radiographs between January 2014 and July 2019; those with an ankle injury during the study period were excluded. The tibiotalar tilt angle on varus stress radiographs and anterior translation of the talus on anterior drawer stress radiographs were measured at initial presentation and final follow-up examination. Interobserver reliability and consistency of ankle stress radiographs were analyzed using the intraclass correlation coefficient (ICC). Results: A total of 45 patients (mean ± standard deviation age, 36.4 ± 13.4 years; 18 men and 27 women; follow-up duration, 9.1 ± 3.2 months) were included. The mean ± standard deviation tibiotalar tilt angle and anterior talar translation at initial presentation were 10.8° ± 5.2° and 6.9 ± 2.7 mm, respectively. The interobserver reliabilities of the tibiotalar tilt angle and anterior talar translation were excellent (ICC = 0.926 [95% CI, 0.874-0.959] and 0.911 [95% CI, 0.766-0.961], respectively). The consistency between the initial and final radiographs was good for tibiotalar tilt angle (ICC = 0.763 [95% CI, 0.607-0.862]) and poor for anterior talar translation (ICC = 0.456 [95% CI, 0.187-0.660]). Conclusion: Although the interobserver reliability of the radiographic measurements was excellent, the consistency of the ankle stress radiographs was not as acceptable. Surgeons need to be cautious when deciding whether to operate on a patient with chronic lateral ankle instability based on a single ankle stress radiograph.
26
Prissel, Mark A., Gregory C. Berlet, Ryan T. Scott, Justin L. Daigre, Patrick E. Bull, Kyle S. Peterson, Christy L. Collins, and Christopher F. Hyer. "Radiographic Assessment of a Medullary Total Ankle Prosthesis." Foot & Ankle Specialist 9, no. 6 (July 18, 2016): 486–93. http://dx.doi.org/10.1177/1938640016656785.
Full textAbstract:
Total ankle replacement (TAR) is a viable alternative to ankle fusion in certain patients with end-stage ankle arthritis. Despite the importance of understanding alignment and movement of the prosthesis, there is no standardized radiographic method for evaluating the position and movement of the INBONE 2 prosthesis. The aims of this study were to describe a radiographic measurement protocol for INBONE 2 for clinical practice and research while determining the interobserver and intraobserver reliability using standard weightbearing radiographs. Fifteen patients were randomly selected with operative dates from January 2011 to January 2014 who underwent primary TAR using the INBONE 2 prosthesis. Most recent preoperative and first postoperative weightbearing anteroposterior and lateral radiographs were pulled and deidentified. Three foot and ankle surgeons blinded from the patient selection and deidentification, measured the described measurements on separate occasions. Intraobserver reliability: surgeon 1 had acceptable reliability for 9 of 13 continuous radiographic measurements (69.2%), surgeon 2 had acceptable reliability for 8 of 13 measurements (61.5%), and surgeon 3 had acceptable reliability for 12 of 13 measurements (92.3%). Interobserver reliability: among the first measurements, 6 of 13 continuous radiographic measurements (46.2%) had acceptable reliability. Among the second measurements, 7 of 13 measurements (53.8%) had acceptable reliability. Among the first and second measurements combined, 7 of 13 measurements (53.8%) had acceptable reliability. This study promotes the need for meticulous evaluation of annual radiographic findings following TAR in an effort to avoid catastrophic failure and represents moderate agreement can be obtained by employing the proposed measurements for surveillance of INBONE 2 TAR at annual postoperative visits. Measurements on the anteroposterior radiograph appear to demonstrate more consistent results for surveillance than lateral measurements. The intraobserver reliability results were somewhat superior to the interobserver reliability, implying more relevance for a single surgeon applying these measurements annually for postoperative surveillance. Levels of Evidence: Diagnostic, Level III
27
Farber, Daniel C., James K. DeOrio, and Maxwell W. Steel. "Goniometric Versus Computerized Angle Measurement in Assessing Hallux Valgus." Foot & Ankle International 26, no. 3 (March 2005): 234–38. http://dx.doi.org/10.1177/107110070502600309.
Full textAbstract:
Background: Digital workstations with high-resolution monitors are replacing standard radiographs for image evaluation and interpretation. Radiographic angles in the foot have been evaluated for interobserver and intraobserver reliability with plain films, but use of digital workstations has not been validated. Because the 1-2 intermetatarsal (IM) and hallux valgus (HV) angles help determine the most appropriate bunion procedure, the reliability of these measurements is important. Methods: The HV and 1-2 IM angles were evaluated on preoperative radiographs of 25 patients who subsequently underwent bunion procedures. A standardized technique using a film marker and goniometer on plain film was compared with use of a mouse and computerized angle measurement software at a digital workstation. Three foot and ankle surgeons conducted these measurements at various intervals. Completion of three readings of each radiograph in each format by each observer totaled 1,800 measurements. Results: Computerized measurement gave better overall reliability. For the HV angle, inter-observer agreement (measurements within 2 degrees) improved from 66% with plain films to 81% with the digital workstation (p < 0.001). Intraobserver agreement increased from 72% to 80%. The 1-2 IM angle was similarly reliable with both methods for inter- and intraobserver agreement. Conclusions: This study validates the use of computer-assisted angle measurement on digital radiographs for assessment of HV and 1-2 IM angles. Computerized measurement may result in more reliable readings because it eliminates the error inherent with use of a goniometer and facilitates adjustment of radiographic lines on the computer to ensure correct alignment.
28
Barrett, Matthew C., Eve E. Robertson-Waters, Michael R. Whitehouse, Ashley W. Blom, and James R. Berstock. "Trochanteric spurs and surface irregularities on plain radiography are not predictive of greater trochanteric pain syndrome." HIP International 30, no. 2 (March 11, 2019): 176–80. http://dx.doi.org/10.1177/1120700019835641.
Full textAbstract:
Purpose: Surface irregularities of the greater trochanter have been described as a potential radiographic sign of greater trochanteric pain syndrome (GTPS). We report a diagnostic accuracy study to evaluate the clinical usefulness of trochanteric surface irregularities on plain radiographs in the diagnosis of GTPS. Methods: We retrospectively identified the anteroposterior pelvic radiographs of a consecutive group of 38 patients (representing a 27.5% series prevalence) diagnosed with GTPS (mean age 69.5 years ± 16.1 [standard deviation], 27 females, 11 males) based on clinical symptoms and a positive response to a local anaesthetic and steroid injection. A control group consisted of 100 patients (mean age 73 years ± 17.1 [standard deviation], 67 females, 33 males) with either hip osteoarthritis listed for hip arthroplasty ( n = 50), or with an intracapsular neck of femur fracture ( n = 50) both presenting between January and July 2017. Radiographs were cropped to blind observers to the presence of hip osteoarthritis or intracapsular fracture but included the trochanteric region. The radiograph sequence was randomised and separately presented to 3 orthopaedic surgeons to evaluate the presence of trochanteric surface irregularities. Results: The inter-observer correlation coefficient agreement was acceptable at 0.75 (95% CI, 0.60–0.84). Trochanteric surface irregularities including frank spurs protruding ⩾2 mm were associated with a 24.7% positive predictive value, 64.0% sensitivity, 25.7% specificity, 74.3% false-positive rate, 36.0% false-negative rate, and a 65.3% negative predictive value for clinical GTPS. Conclusion: Surface irregularities of the greater trochanter are not reliable radiographic indicators for the diagnosis of greater trochanteric pain syndrome.
29
Adams, WM, RT Dueland, J. Meinen, RT O'Brien, E. Giuliano, and EV Nordheim. "Early detection of canine hip dysplasia: comparison of two palpation and five radiographic methods." Journal of the American Animal Hospital Association 34, no. 4 (July 1, 1998): 339–47. http://dx.doi.org/10.5326/15473317-34-4-339.
Full textAbstract:
Hip joint laxity was evaluated in four breeds (i.e., greyhound, Labrador retriever, Irish setter, hound mixed-breed) of puppies (n=32) by Ortolani's and Bardens' maneuvers, by subjective assessment of radiographs (Orthopedic Foundation for Animals [OFA] method), and by four radiographic measurement indices. Puppies were studied at four, six-to-10, 16-to-18, and 52 weeks of age. The purpose of this study was to compare palpation and radiographic methods of hip laxity detection in puppies for predicting the development of degenerative joint disease (DJD) by one year of age. Twenty-seven (42%) hips developed DJD. Ortolani's method was not a reliable predictor of hip dysplasia at six-to-10 weeks; it was significantly predictive at 16-to-18 weeks but had a high incidence of false negatives. Bardens' and subjective (OFA) assessment methods were not reliable at six-to-10 or 16-to-18 weeks. Radiographic measurements taken with femurs in a neutral position and hips distracted (distraction index [DI] and Norberg angle) and measurements taken with femurs extended in OFA position (Norberg angle) of six- to 10-week-old puppies accurately predicted DJD occurrence by one year of age (p less than 0.01). Distraction index measurement (PennHIP method) was the most accurate in predicting the development of DJD (p less than 0.001). Distraction index radiography in puppies six-to-10 and 16-to-18 weeks of age was the most reliable predictor of hip dysplasia. Norberg angle measurement was more reliable during hip distraction than when hips were measured in the OFA position in 16- to 18-week-old puppies, but had similar reliability in six- to 10-week-old puppies.
30
Sugino, Yuki, Ichiro Yoshimura, Tomonobu Hagio, Masaya Nagatomo, and Takuaki Yamamoto. "Reliability of Evaluating Methods using Weightbearing Radiograph of the Foot in Lisfranc Injuries." Foot & Ankle Orthopaedics 5, no. 4 (October 1, 2020): 2473011420S0046. http://dx.doi.org/10.1177/2473011420s00462.
Full textAbstract:
Category: Trauma; Midfoot/Forefoot Introduction/Purpose: Lisfranc ligament is a strong interosseous ligament located between the medial cuneiform (C1) and base of the second metatarsal (M2). Lisfranc injuries occur in approximately 0.2% of all fractures and are often overlooked or misdiagnosed. Weightbearing radiograph of the foot has been used as a diagnostic method for Lisfranc injuries; however, there is no study to evaluate the reliability of the measurement techniques on weightbearing radiographs. While several measurement techniques on weightbearing radiograph have been proposed for evaluating Lisfranc injuries, it remains unclear which measurement is the most reliable. This study aimed to evaluate the intra- and inter-observer reliability of the measurement techniques using weightbearing radiographs. Methods: Seventeen patients who were diagnosed with Lisfranc injuries using weightbearing radiographs and were treated with open reduction and internal fixation in our hospital between January 2013 and April 2019 were included in this study. Patients with multiple fractures were excluded. Four observers were selected, of which two were orthopedic specialists with more than six years of experience, while the remaining two were orthopedic surgeons with less than five years of experience. Observers evaluated the intra- and inter-observer reliability of the five measurement points on weightbearing radiographs on the affected and unaffected sides. The measurement points included the proximal, middle, and distal C1-M2 distance and parallel distance of C1-M2 and C1- the medial cuneiform (C2). Results: The proximal, middle, and distal C1-M2 distance and parallel distance of C1-M2 of The affected sides were wider than those of the unaffected sides with significant difference (p<0.01). The middle C1-M2 distance of the affected sides showed the highest intra-observer reliability (0.92) and the second highest inter-observer reliability (0.8). Other measurements of the affected sides showed comparable intra- (0.76-0.91) and inter-observer reliability (0.62-0.84). In addition, the middle C1-M2 distance of the unaffected sides showed the highest intra- (0.76) and inter-observer reliability (0.64); however, all measurements of the unaffected sides showed lower reliability than all measurements of the affected sides. Conclusion: The most reliable measurement point on the weightbearing radiograph was the middle distance of C1-M2. This result may help avoid overlooking or misdiagnosis of Lisfranc injuries.
31
Lau, L. C. M., A. L. H. Hung, W. W. Chau, Z. Hu, A. Kumar, T. P. Lam, W. C. W. Chu, and J. C. Y. Cheng. "Sequential spine-hand radiography for assessing skeletal maturity with low radiation EOS imaging system for bracing treatment recommendation in adolescent idiopathic scoliosis: a feasibility and validity study." Journal of Children's Orthopaedics 13, no. 4 (August 2019): 385–92. http://dx.doi.org/10.1302/1863-2548.13.190007.
Full textAbstract:
Purpose The EOS-imaging system is increasingly adopted for clinical follow-up in scoliosis with the advantages of simultaneous biplanar imaging of the spine in an erect position. Skeletal maturity assessment using a hand radiograph is an essential adjunct to spinal radiography in scoliosis follow-up. This study aims at testing the feasibility and validity of a newly proposed EOS workflow with sequential spine-hand radiography for skeletal maturity assessment and bracing recommendation. Methods EOS spine-hand radiographs from patients with diagnosis of idiopathic scoliosis, including both sexes and an age range of ten to 14 years, were scored using the Thumb Ossification Composite Index (TOCI), Sanders and Risser methods. Intraclass correlation coefficients (ICCs) were calculated for inter/intraobserver agreement and were tested with Cronbach’s alpha values. Results In all, 60 EOS-spine hand radiographs selected from subjects with diagnosis of adolescent idiopathic scoliosis (AIS), including 32 male patients (mean age 11.53 years; 10 to 14) and 28 female patients (mean age 11.50 years; 10 to 13) who underwent sequential spine-hand low dose EOS imaging were generated for analysis. The overall interobserver (ICC = 0.997) and intraobserver agreement (α > 0.9) demonstrated excellent agreement for TOCI staging; ICC > 0.994 for both TOCI and Sanders staging comparing traditional digital versus EOS hand radiography; ICC ≥ 0.841 for agreement on bracing recommendation among TOCI versus the Risser and Sanders system. Conclusion With the proposed new EOS workflow it was feasible to produce high image quality for skeletal maturity assessment with excellent reliability and validity to inform consistent bracing recommendation in AIS. The workflow is applicable for busy daily clinic settings in tertiary scoliosis centres with reduced time cost, improved efficiency and throughput of the radiology department. Level of evidence III
32
Plint, Amy C., Jeffrey J. Perry, and Jennifer L. Y. Tsang. "Pediatric wrist buckle fractures: Should we just splint and go?" CJEM 6, no. 06 (November 2004): 397–401. http://dx.doi.org/10.1017/s1481803500009386.
Full textAbstract:
ABSTRACT: Objectives: The objective of this study was to evaluate the utility of circumferential casting in the emergency department (ED), orthopedic follow-up visits, and radiographic follow-up in the management of children with wrist buckle fractures. Methods: We performed a retrospective medical record review of all children < 18 years of age who presented to our tertiary care children’s hospital between July 1, 2000, and June 30, 2001, and were diagnosed with a fracture of the wrist, radius or ulna. Based on the radiology reports, we identified buckle fractures of the distal radius, the distal ulna, or both bones. We excluded children who had other types of fractures. Results: We identified 840 children with fractures of the wrist, radius, or ulna. Of these, 309 met our inclusion criteria. The median age of our study cohort was 9.2 years. Emergency physicians immobilized 269 of these fractures in circumferential casts; of these, 30 (11%) had cast complications. Of the 276 subjects who had orthopedic follow-up visits and radiographs, 184 (67%) had multiple visits and 127 (46%) had multiple radiographs performed. No subjects had fracture displacement identified on follow-up. Conclusions: Orthopedic follow-up visits and radiographic follow-up may have minimal utility in the treatment of pediatric wrist buckle fractures. ED casting may pose more risk than benefit for these children. Splinting in the ED with primary care follow-up appears to be a reasonable management strategy for these fractures. A prospective study comparing ED splinting and casting for pediatric wrist buckle fractures is needed.
33
Segundo, Saulo de Tarso de Sá Pereira, Edgar Santiago Valesin Filho, Mario Lenza, Durval do Carmo Barros Santos, Laercio Alberto Rosemberg, and Mario Ferretti. "Interobserver reproducibility of radiographic evaluation of lumbar spine instability." Einstein (São Paulo) 14, no. 3 (September 2016): 378–83. http://dx.doi.org/10.1590/s1679-45082016ao3489.
Full textAbstract:
ABSTRACT Objective: To measure the interobserver reproducibility of the radiographic evaluation of lumbar spine instability. Methods: Measurements of the dynamic radiographs of the lumbar spine in lateral view were performed, evaluating the anterior translation and the angulation among the vertebral bodies. The tests were evaluated at workstations of the organization, through the Carestream Health Vue RIS (PACS), version 11.0.12.14 Inc. 2009© system. Results: Agreement in detecting cases of radiographic instability among the observers varied from 88.1 to 94.4%, and the agreement coefficients AC1 were all above 0.8, indicating excellent agreement. Conclusion: The interobserver analysis performed among orthopedic surgeons with different levels of training in dynamic radiographs of the spine obtained high reproducibility and agreement. However, some factors, such as the manual method of measurement and the presence of vertebral osteophytes, might have generated a few less accurate results in this comparative evaluation of measurements.
34
Li, Ryan T., Raymond W. Liu, Mithun Neral, Heath Gould, Emily Hu, Shane Nho, and Michael J. Salata. "Use of the False-Profile Radiographic View to Measure Pelvic Incidence." American Journal of Sports Medicine 46, no. 9 (July 2018): 2089–95. http://dx.doi.org/10.1177/0363546518780938.
Full textAbstract:
Background: Pelvic incidence (PI) is an important variable in assessing spinopelvic balance that is associated with hip pathology. A lateral radiograph of the pelvis can be used to measure PI, but this view is not routinely performed in the clinical setting during evaluation of hip pain. The false-profile (FP) radiographic view of the hip is commonly obtained to measure acetabular coverage. Purpose: To evaluate the tolerance of PI measurements to pelvic rotation and assess the feasibility of using an FP radiograph to obtain an accurate measurement of PI. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A mathematical model was developed to predict the change in PI with rotation. Fluoroscopic images were obtained of 6 reconstructed cadaveric adult pelvis and femur specimens at varying degrees of rotation, including a perfect lateral and FP image. PI was measured with the midpoint between the centers of the femoral heads as a reference point. The findings were confirmed clinically by retrospectively reviewing FP radiographs and computed tomography (CT) scans of 40 clinical patients. PI was measured on FP radiographs and CT scans by 2 independent reviewers. Results: With dry cadaveric pelvis specimens, the discrepancy in PI measured between fluoroscopic FP and lateral views was 1.6° (95% CI, 0.7°-2.4°). There was excellent agreement between CT and FP radiographs with regard to measurement of PI (intraclass correlation coefficient = 0.92; 95% CI, 0.78-0.98). Mean discrepancy in PI measured between the 40 clinical FP radiographs and CT scans was 2.8° (range, 0.1°-9.1°). Conclusion: Increased rotation from a lateral view results in greater error in measuring PI, although relatively nominally with a 2.8° error with the 25° of rotation in clinical true FP views. These data demonstrate that FP radiographs can be used to measure PI with reasonable accuracy.
35
Vittetoe, David A., Charles L. Saltzman, James C. Krieg, and Thomas D. Brown. "Validity and Reliability of the First Distal Metatarsal Articular Angle." Foot & Ankle International 15, no. 10 (October 1994): 541–47. http://dx.doi.org/10.1177/107110079401501004.
Full textAbstract:
A laboratory study was undertaken to quantify the validity, the intra- and interobserver reliability, and the effect of first metatarsal orientation on the distal metatarsal articular angle (DMAA). First metatarsals from six cadavers were isolated by sharp dissection and attached to a custom-made triplanar protractor. This allowed controlled positioning of the first metatarsal in the three cardinal planes. Each specimen was moved through a stepwise sequence of first metatarsal orientation changes. Radiographs were taken at each position. The distal (metatarsophalangeal) articular surface of the first metatarsal was then circumscribed with metallic paint and the radiographic series was repeated. DMAA measurements were made on each radiograph multiple times by two measurers blinded to the parameters of variation. The difference between the standard (clinical) radiographic technique for estimating the DMAA and the metallic paint DMAA averaged −0.9° (SD = 2.4°). Longitudinal rotation ( P < .0001) and varus deviation (P < .02 at 10°) of the first metatarsal had a significant effect on the radiographic determination of the DMAA. Although intraobserver reliability for DMAA measurement was high, interobserver reliability for the clinical technique of measurement was poor (pooled intraclass correlation coefficient = 0.14).
36
Dekhne, Mihir S., Isabelle D. Kocher, Zaamin B. Hussain, Aliya G. Feroe, Saritha Sankarankutty, Kathryn A. Williams, Benton E. Heyworth, Matthew D. Milewski, and Mininder S. Kocher. "Tibial Tubercle Apophyseal Stage to Determine Skeletal Age in Pediatric Patients Undergoing ACL Reconstruction: A Validation and Reliability Study." Orthopaedic Journal of Sports Medicine 9, no. 9 (September 1, 2021): 232596712110368. http://dx.doi.org/10.1177/23259671211036897.
Full textAbstract:
Background: Anterior cruciate ligament (ACL) injuries demand individualized treatments based on an accurate estimation of the child’s skeletal age. Wrist radiographs, which have traditionally been used to determine skeletal age, have a number of limitations, including cost, radiation exposure, and inconvenience. Purpose: To evaluate the reliability and validity of a radiographic staging system using tibial apophyseal landmarks as hypothetical proxies for skeletal age to use in the preoperative management of pediatric ACL tears. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: The study included children younger than 16 years of age who underwent ACL reconstruction between July 2008 and July 2018 and received both skeletal age radiography and knee radiography within 3 months of each other. Skeletal age was calculated from hand and wrist radiographs using the Greulich and Pyle atlas. Tibial apophyseal staging was categorized into 4 stages: cartilaginous stage (stage 1), apophyseal stage (stage 2), epiphyseal stage (stage 3), and bony/fused stage (stage 4). Data were collected by 2 independent assessors. The analysis was repeated 1 month later with the same assessors. We calculated descriptive statistics, measures of agreement, and the correlation between skeletal age and apophyseal stage. Results: The mean chronological age of the 287 patients included in the analysis was 12.9 ± 1.9 years; 164 (57%) of the patients were male. The overall Spearman r between skeletal age and tibial apophyseal staging was 0.69 (0.77 in males; 0.60 in females). The interrater reliability for the tibial apophyseal staging was substantial (Cohen κ = 0.66), and the intrarater reliability was excellent (Cohen κ = 0.82). The interrater reliability for skeletal age was excellent (intraclass correlation coefficient [ICC] = 0.93), as was the intrarater reliability (ICC = 0.97). Conclusion: The observed correlation between skeletal age and tibial apophyseal staging as well as observed intra- and interrater reliabilities demonstrated that tibial apophyseal landmarks on knee radiographs may be used to estimate skeletal age. This study supports the validity of knee radiographs in determining skeletal age and provides early evidence in certain clinical presentations to simplify the diagnostic workup and operative management of pediatric knee injuries, including ACL tears.
37
Talbot, Kyle D., and Charles L. Saltzman. "Assessing Sesamoid Subluxation: How Good Is the AP Radiograph?" Foot & Ankle International 19, no. 8 (August 1998): 547–54. http://dx.doi.org/10.1177/107110079801900808.
Full textAbstract:
Subluxation of the metatarsosesamoid joints frequently occurs with the development of hallux valgus deformity, and the restoration of a normal metatarsosesamoid articulation has been proposed as essential for achieving a biomechanically sound operative result. The position of the sesamoid bones on the AP radiograph is used often to assess the pre- and postoperative relationship between the hallucal sesamoids and the metatarsal sulci. We evaluated the validity of this approach. Thirty subjects with hallux valgus and 30 control subjects participated in this study by undergoing both AP and tangential weightbearing radiographs. The sesamoid station on the AP radiographs was compared with the position of the sesamoids on tangential radiographs, using a new continuous measure to estimate subluxation. In approximately half of the cases, we found a difference between the apparent sesamoid station on the AP radiograph and the true position on the tangential one. Increased metatarsal rotation was associated with misclassification of the sesamoid station on the AP radiograph. We conclude that the standard method for measuring the sesamoid station on the AP radiograph is not valid. Surgeons wishing to evaluate the metatarsosesamoid joint should obtain weightbearing tangential radiographs.
38
Raj, Manish, Ashish Jaiman, and Rajesh Kumar Chopra. "Evaluation of version of acetabular component following total hip replacement on conventional radiograph and computed tomography." Journal of Orthopaedics, Trauma and Rehabilitation 27, no. 2 (August 11, 2020): 179–85. http://dx.doi.org/10.1177/2210491720942887.
Full textAbstract:
Background/Purpose: Total hip replacement (THR) is considered as one of the most successful orthopedic procedures. However, improperly placed components can lead to instability and accelerated wear. Acetabular cup inclination can be very well accessed by anteroposterior pelvis X-rays; for acetabular version assessment, computed tomography (CT) scan is the gold standard. CT scan is not readily available at many centers and the surgeon has to rely on X-ray methods for evaluation of acetabular version to audit results and to predict behavior of the surgical intervention. This prospective study was undertaken to compare Woo and Morrey’s and ischiolateral methods of assessment of acetabular version on cross-table lateral radiographs with CT assessment and to assess the validity of radiographic methods with respect to CT scan method. Material and methods: A prospective follow-up study was conducted for 18 months’ duration (October 2016 to March 2018) on 30 adult patients who underwent THR surgery. Cross-table lateral radiograph was obtained at 3 and 6 weeks in the postoperative period. Two observers made each observation at two different points of time. CT scan was performed at 3 weeks. Version as measured by radiographs and CT scan was recorded. Results: The major overlap in the distribution of the values of the Woo and Morrey method suggests that there is no significant difference between the observations. Distribution of the values of the ischiolateral view and the CT scan value distributions have a very small overlap and hence suggest a strong significant difference between the two. Conclusion: In this study, Woo and Morrey’s method and ischiolateral method of assessment of acetabular version were compared with CT assessment. We found that in Woo and Morrey’s method, values were comparable to CT scan values, when put on regression line. However, in situation of change in patient positioning, namely hip stiffness in contralateral hip, measurement of component changed in series of radiography due to differences in pelvis tilt. So, in these circumstances, we can use ischiolateral method which can give consistent measurement. But it will not be in concordance with CT scan values and Woo and Morrey values, as represented in regression line. The high intra-class correlation coefficients for both intra- and inter-observer reliability indicated that the angle measured with these methods is consistent and reproducible for multiple observers. CT, however, be considered as gold standard for measurement owing to control over pelvic rotation and/or tilt/patient positioning.
39
Frazao, Paulo J. R., Rodrigo Crispim, Cesar A. M. Pereira, Mariana B. Selim, Lara L. Facó, Ana Carolina B. C. Fonseca Pinto, Stefano C. F. Hagen, and André L. V. Zoppa. "CORRELATION STUDY BETWEEN BONE MINERAL DENSITY DETERMINED BY RADIOGRAPHIC ABSORPTIOMETRY AND BONE RESISTANCE OF EQUINE THIRD METACARPAL BONE SUBMITTED TO BIOMECHANICAL TESTING." Journal of Musculoskeletal Research 15, no. 01 (March 2012): 1250007. http://dx.doi.org/10.1142/s0218957712500078.
Full textAbstract:
Knowledge about non-invasive methods for early diagnostics in equine orthopedic disorders is economically important and has been widely studied. In this study, bone mineral density determined by radiographic absorptiometry was correlated to bone resistance of the equine third metacarpal bone submitted to biomechanical testing. Thirty pairs of third metacarpal bone of adult horses were collected, dissected, radiographed, analyzed by the radiographic absorptiometry technique, and submitted to tomographic study and biomechanical testing. No significant linear correlation between radiographic bone density values and measured biomechanical properties was observed. Therefore, bone mineral density of the third metacarpal bone determined by radiographic absorptiometry does not predict bone capacity to resist compression and flexion loads. Further studies should be developed to establish which techniques are reliably capable of giving such predictive information.
40
Lind, Anna, Ehsan Akbarian, Simon Olsson, Hans Nåsell, Olof Sköldenberg, Ali Sharif Razavian, and Max Gordon. "Artificial intelligence for the classification of fractures around the knee in adults according to the 2018 AO/OTA classification system." PLOS ONE 16, no. 4 (April 1, 2021): e0248809. http://dx.doi.org/10.1371/journal.pone.0248809.
Full textAbstract:
Background Fractures around the knee joint are inherently complex in terms of treatment; complication rates are high, and they are difficult to diagnose on a plain radiograph. An automated way of classifying radiographic images could improve diagnostic accuracy and would enable production of uniformly classified records of fractures to be used in researching treatment strategies for different fracture types. Recently deep learning, a form of artificial intelligence (AI), has shown promising results for interpreting radiographs. In this study, we aim to evaluate how well an AI can classify knee fractures according to the detailed 2018 AO-OTA fracture classification system. Methods We selected 6003 radiograph exams taken at Danderyd University Hospital between the years 2002–2016, and manually categorized them according to the AO/OTA classification system and by custom classifiers. We then trained a ResNet-based neural network on this data. We evaluated the performance against a test set of 600 exams. Two senior orthopedic surgeons had reviewed these exams independently where we settled exams with disagreement through a consensus session. Results We captured a total of 49 nested fracture classes. Weighted mean AUC was 0.87 for proximal tibia fractures, 0.89 for patella fractures and 0.89 for distal femur fractures. Almost ¾ of AUC estimates were above 0.8, out of which more than half reached an AUC of 0.9 or above indicating excellent performance. Conclusion Our study shows that neural networks can be used not only for fracture identification but also for more detailed classification of fractures around the knee joint.
41
Williams, Jamie. "Orthopedic radiography in exotic animal practice." Veterinary Clinics of North America: Exotic Animal Practice 5, no. 1 (January 2002): 1–22. http://dx.doi.org/10.1016/s1094-9194(03)00043-4.
Full text
42
Wall, Eric J., Matthew D. Milewski, James L. Carey, Kevin G. Shea, Theodore J. Ganley, John D. Polousky, Nathan L. Grimm, et al. "The Reliability of Assessing Radiographic Healing of Osteochondritis Dissecans of the Knee." American Journal of Sports Medicine 45, no. 6 (April 11, 2017): 1370–75. http://dx.doi.org/10.1177/0363546517698933.
Full textAbstract:
Background: The reliability of assessing healing on plain radiographs has not been well-established for knee osteochondritis dissecans (OCD). Purpose: To determine the inter- and intrarater reliability of specific radiographic criteria in judging healing of femoral condyle OCD. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: Ten orthopedic sports surgeons rated the radiographic healing of 30 knee OCD lesions at 2 time points, a minimum of 1 month apart. First, raters compared pretreatment and 2-year follow-up radiographs on “overall healing” and on 5 subfeatures of healing, including OCD boundary, sclerosis, size, shape, and ossification using a continuous slider scale. “Overall healing” was also rated using a 7-tier ordinal scale. Raters then compared the same 30 pretreatment knee radiographs in a stepwise progression to the 2-, 4-, 7-, 12-, and 24-month follow-up radiographs on “overall healing” using a continuous slider scale. Interrater and intrarater reliability were assessed using intraclass correlations (ICC) derived from a 2-way mixed effects analysis of variance for absolute agreement. Results: Overall healing of the OCD lesions from pretreatment to 2-year follow-up radiographs was rated with excellent interrater reliability (ICC = 0.94) and intrarater reliability (ICC = 0.84) when using a continuous scale. The reliability of the 5 subfeatures of healing was also excellent (interrater ICCs of 0.87-0.89; intrarater ICCs of 0.74-0.84). The 7-tier ordinal scale rating of overall healing had lower interrater (ICC = 0.61) and intrarater (ICC = 0.68) reliability. The overall healing of OCD lesions at the 5 time points up to 24 months had interrater ICCs of 0.81-0.88 and intrarater ICCs of 0.65-0.70. Conclusion: Interrater reliability was excellent when judging the overall healing of OCD femoral condyle lesions on radiographs as well as on 5 specific features of healing on 2-year follow-up radiographs. Continuous scale rating of OCD radiographic healing yielded higher reliability than the ordinal scale rating. Raters showed substantial to excellent agreement of OCD overall radiographic healing measured on a continuous scale at 2, 4, 7, 12, and 24 months after starting treatment.
43
Swami, Vimarsha G., Lei Liu, Myles Mabee, and Jacob L. Jaremko. "Normal Values and Variation of Radiographic and CT Infant Lateral Iliac Wall Angles in Normal and Dysplastic Hips." HIP International 26, no. 6 (October 15, 2016): 602–7. http://dx.doi.org/10.5301/hipint.5000393.
Full textAbstract:
Purpose Indices from 3-D ultrasound may have a role in developmental dysplasia of the hip (DDH) assessment, but require a way to determine spatial orientation relative to body axes. The lateral iliac wall angle is a potentially suitable reference axis in 3-D ultrasound. We sought to quantify normal values and variations of the infant iliac wall angle on radiography, and compare with computed tomography (CT). Methods Acetabular and lateral iliac angles were measured on frontal pelvic radiographs of 200 patients (400 hips, 183 with DDH) and coronal CT of 20 patients (40 hips) aged 0-12 months. Relationships among morphologic indices and demographics were assessed using linear regression, Welch's t-test, Pearson's correlation coefficient (r) and coefficients of variance (CoV). Reliability was assessed using intra-class correlation coefficients (ICC). Results The radiographic iliac angle averaged 53.0° ± 7.7° (mean ± standard deviation; 95% CI, 38°-68°) in DDH vs. 56.2° ± 6.7° (95% CI, 43°-69°) in normal hips (p<0.001), correlated weakly with age (r = 0.25), and showed no inter-sex differences (p = 0.79). Inter-reader and intra-reader reliability were ICC = 0.946 and 0.965. CT iliac angle had mean difference 5.8° ± 6.2° (p<0.01), CoV = 10% and r = 0.68 vs. corresponding radiographs. Conclusions The radiographic infant lateral iliac wall angle has mean value 53-56° in dysplastic and normal hips with consistent range of variation approximately ±15°, was measured with high reliability, does not differ by sex, and is only slightly lower in the youngest infants. The iliac wall angle is an unbiased reference axis that may be suitable to establish general spatial orientation of 3-D hip ultrasound images.
44
Nishikino, Shoichi, Hiroshi Koyama, Hiroki Furuhashi, Hironobu Hoshino, and Yukihiro Matsuyama. "Validation of a new 2.5D radiographic index evaluating acetabular coverage using ACX software." HIP International 30, no. 1 (January 3, 2019): 16–21. http://dx.doi.org/10.1177/1120700018820883.
Full textAbstract:
Background: Several radiographic signs have been described to assess acetabular coverage. However, plain radiographs only have 2 dimensions (2D) and cannot accurately show acetabular coverage. Questions/purposes: We developed the ACX Dynamics software to calculate the radial centre-edge angle (RCEA), which represents the acetabular coverage of the femoral head at each acetabular edge point on the radial plane. This study validated the accuracy of the RCEA, as calculated by ACX Dynamics, as a quantitative parameter for acetabular coverage. Patients and methods: We reviewed the anteroposterior (AP) pelvic radiographs and computed tomography (CT) of 650 hips from 325 patients who presented with chief complaint of symptoms at the hip joint. Of 109 hip radiographs (68 patients) that satisfied the criteria, 50 randomised, blinded AP pelvic radiographs were chosen. We determined the absolute RCEA difference (°) [= RCEA ACX (°) – RCEA CT (°)], determined the correlation between RCEA ACX (°) and RCEA CT (°), and examined the RCEA’s intra-observer and inter-observer reliability in 50 hips. Results: The absolute RCEA difference from A45° to P75° was 1.9–3.1°. The correlation between the RCEA ACX (°) and RCEA CT (°) was > 0.7 in all lesions ( p < 0.001). Using the intraclass correlation coefficient, the intra-observer reliability of the RCEA was 0.83–0.97 in the whole range, which is a highly reproducible and reasonable parameter, and the inter-observer reliability was > 0.80 in A45°–P0°. Conclusions: The RCEA ACX (°) can be used as a simple quantitative parameter for assessing acetabular coverage using AP pelvic radiograph.
45
Aryana, Gusti Ngurah Wien, Febyan, and Agus Eka Wiradiputra. "Posterior Shoulder Dislocation: A Rare Case Report and Review of the Literature." European Journal of Medical and Health Sciences 3, no. 3 (May 31, 2021): 55–57. http://dx.doi.org/10.24018/ejmed.2021.3.3.872.
Full textAbstract:
Posterior shoulder dislocation is a unique finding in the orthopedics field. Although it is rarely found, this condition is one that must be considered in the presence of acute shoulder pain. Most clinicians often miss this diagnosis on initial examination; therefore, imaging radiographs are often needed to confirm the diagnosis. Unfortunately, insufficient radiographic assessment can be the greatest pitfall in establishing an accurate diagnosis. Multiple radiographic projections, including anteroposterior view, scapular Y view, and the axillary view, are important to achieve an accurate diagnosis. In this study, we present a middle-aged patient with a pain and trauma history on the shoulder. Anteroposterior radiographic examination revealed an atypical finding. Fortunately, additional radiographic projections were successful in establishing the proper diagnosis of posterior shoulder dislocation. This study also presents a comprehensive review of the keys in the recognition and treatment of the injury.
46
Schlichte, Lindsay M., Peter D. Fabricant, Christine Goodbody, and Daniel W. Green. "USE CAUTION WHEN ASSESSING PRE-OPERATIVE LEG LENGTH DISCREPANCY IN PEDIATRIC PATIENTS WITH ANTERIOR CRUCIATE LIGAMENT INJURIES." Orthopaedic Journal of Sports Medicine 8, no. 4_suppl3 (April 1, 2020): 2325967120S0028. http://dx.doi.org/10.1177/2325967120s00284.
Full textAbstract:
Background: Pre- and post-operative standing hip to ankle radiography is critical for monitoring potential post-operative growth arrest and resultant length and angular deformities after pediatric anterior cruciate ligament (ACL) reconstruction. During acquisition of pre-operative standing alignment radiographs, it is possible that patients are lacking full extension, not weight bearing comfortably, or leaning resulting in inaccurate measurements. Purpose: This study aims to assess both pre- and post-operative radiographic measurements to assess if the standing pre-operative x-ray is a accurate and reliable source for baseline measurements. Methods: We retrospectively reviewed prospectively collected pre-operative and first post-operative full-length hip-to-ankle radiographs in a cohort of skeletally immature athletes who presented with an acute ACL injury and underwent subsequent surgical reconstruction. Initially, leg length discrepancy for 25 patients was measured by 3 orthopedic surgeons (top of femoral head to center of tibial plafond). The intraclass correlation was almost perfect (ICC (2,1) = .996) therefore, 1 surgeon measured the remaining 94 radiographs. Measurements for both the injured and uninjured legs were obtained for comparison and surgeons were blinded to the injured side. Results: A total of 119 pediatric patients (mean age 13.4, range 7-14 years) were included (83 males and 36 females). Patient were categorized as either having ≥5mm, ≥10mm, or ≥15mm LLD on pre-operative standing x-ray. Sixty-two patients (52%) were found to have a pre-operative LLD ≥ 5mm. Forty-one (66%) of these patients tore their ACL on the limb measuring shorter. At 6 month post-operative standing x-ray, 35 patients (56%) resolved to ≤5mm LLD. Eighteen patients had a pre-operative LLD of ≥ 10mm. At 6 month post-operative standing x-ray, 13 (72%) patients resolved to ≤5mm LLD. Five patients had a pre-operative LLD of ≥ 15mm. At 6 month post-operative standing x-ray, 4 (80%) resolved ≤5mm. All patients with a pre-operative LLD of ≥ 13mm had sustained an ACL injury on the limb measuring shorter Conclusion: Of the pediatric ACL patients initially presenting with a pre-operative LLD of ≥ 10mm, 72% demonstrated apparent correction of their LLD on their 6 month standing x-ray. This high rate of LLD pre-operatively but not post operatively calls into question the accuracy of pre-operative standing alignment radiographs for patients after an ACL tear. Surgeons and radiology technicians should be aware of injured patients potentially lacking full extension, leaning, or not weight bearing comfortably, and should consider delaying preoperative radiographic length and alignment analysis until after the patient is able to fully straighten the injured knee and weight bear comfortably.
47
DelSole, Edward M., and John J. Mercuri. "Utility of Upright Weight-bearing Imaging in Total Hip Arthroplasty." Seminars in Musculoskeletal Radiology 23, no. 06 (November 19, 2019): 603–8. http://dx.doi.org/10.1055/s-0039-1697935.
Full textAbstract:
AbstractPlanning for total hip arthroplasty (THA) has traditionally been performed using static supine anteroposterior radiographs of the pelvis. Recent advances in imaging technology and the understanding of human spinopelvic kinematics have made weight-bearing radiography an important adjunct to supine imaging. Hip surgeons can use weight-bearing imaging to optimize THA component position to prevent hip instability and early component wear. The goal of this narrative review is to delineate the fundamentals of spinopelvic kinematics, the benefits of surgical planning using weight-bearing radiography, and the underpinnings of upright full-body stereoradiography as a useful adjunct to traditional supine radiographs.
48
ten Berg, Paul W. L., Tessa Drijkoningen, Thierry G. Guitton, and David Ring. "Does a Comparison View Improve the Reliability of Staging Wrist Osteoarthritis?" HAND 12, no. 5 (November 10, 2016): 439–45. http://dx.doi.org/10.1177/1558944716677541.
Full textAbstract:
Background: Radiological grading of wrist osteoarthritis associated with scaphoid nonunion advanced collapse (SNAC) can be difficult. A comparison radiograph of the contralateral healthy wrist and an educational training in the various SNAC stages may improve reliability. Our purposes were to evaluate the difference in the reliability: (1) between observers who rate SNAC wrists with and without a comparison radiograph; and (2) between observers who receive training prior to ratings and those who do not. Methods: In this cross-sectional survey study, 82 fully trained orthopedic or hand surgeons rated anteroposterior radiographs of 19 patient wrists following a scaphoid nonunion based on SNAC stages 0 to 4. Observers were randomized online in 4 groups: one group rated unilateral views without training, a second group unilateral views with training, a third group bilateral views without training, and a fourth group bilateral views with training. Training included a 1-page clarification of the SNAC stages. Interobserver agreement was calculated using kappa statistics. Results: There was no significant difference between agreement between observers who rated unilateral radiographs (κ = 0.55) and who rated bilateral radiographs (κ = 0.58) ( P = .14), nor between agreement between observers who received training (κ = 0.59) and who did not (κ = 0.54) ( P = .058). Conclusions: The use of an additional comparison view and/or training does not seem to be clinically relevant in SNAC staging. There is room for improvement in the way we assess patients with SNAC wrists.
49
Fraenkel, Liana, Lisa Suter, Lawrence Weis, and Gillian A. Hawker. "Variability in Recommendations for Total Knee Arthroplasty Among Rheumatologists and Orthopedic Surgeons." Journal of Rheumatology 41, no. 1 (December 1, 2013): 47–52. http://dx.doi.org/10.3899/jrheum.130762.
Full textAbstract:
Objective.The most rapidly growing population of patients undergoing total knee arthroplasty (TKA) is under the age of 65. The objective of our study was to gain insight into the factors influencing physicians’ recommendations for persons in this age group with moderate osteoarthritis (OA).Methods.Rheumatologists and orthopedic surgeons attending national meetings were asked to complete a survey including a standardized scenario of a 62-year-old person with knee OA who has moderate knee pain limiting strenuous activity despite medical management. We used an experimental 2 × 2 × 2 design to examine the effects of sex, employment status, and severity of radiographic OA on physicians’ recommendations. Each physician was asked to rate a single scenario.Results.The percentage of physicians recommending TKA varied from 30% to 55% for scenarios describing a patient with mild radiographic OA, and from 39% to 71% for scenarios describing a patient with moderate radiographic OA. Surgeons were less likely to recommend TKA for women compared to men of the same age, employment status, symptom severity, and functional status, and radiographs. Rheumatologists practicing in academic settings were more likely to recommend TKA compared to those practicing in nonacademic settings, and American surgeons were more likely to recommend TKA compared to their European counterparts.Conclusion.Orthopedic surgeons and rheumatologists vary significantly in their recommendations for patients with moderate knee pain and functional limitations. Both patient and physician characteristics influence physicians’ recommendations, and rheumatologists and orthopedic surgeons display different patterns of decision making.
50
Alassaf, Nabil. "Acute presentation of Sinding-Larsen-Johansson disease simulating patella sleeve fracture: A case report." SAGE Open Medical Case Reports 6 (January 2018): 2050313X1879924. http://dx.doi.org/10.1177/2050313x18799242.
Full textAbstract:
Objectives: Diagnosis of Sinding-Larsen-Johansson disease may not be an easy task. Several sport-related conditions affect the distal pole of the patella in the adolescent, and treatment varies considerably. The article describes a patient that had radiographic features of Sinding-Larsen-Johansson disease associated with an atypical acute presentation. Methods: Case report and literature review. Results: A 10-year-old boy presented with a sudden pain after a noncontact soccer injury. He had tenderness and swelling over the patella. Radiographs showed minimally displaced distal patellar ossicle. Magnetic resonance imaging excluded sleeve cartilaginous injury and documented Sinding-Larsen-Johansson disease. The knee was immobilized briefly. There was complete healing of the injury in 4-week follow-up radiographs. Conclusion: Emergency physicians, radiologists, and orthopedic surgeons should be aware of the acute presentation of Sinding-Larsen-Johansson disease after knee injuries.