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Acta Orthopaedica Et Traumatologica... Nov 2023This study aimed to biomechanically compare the maximum rotational, axial movements, and compression forces between fracture fragments before and after 1-4 mm fracture...
OBJECTIVE
This study aimed to biomechanically compare the maximum rotational, axial movements, and compression forces between fracture fragments before and after 1-4 mm fracture site resorption among interlocking nails, compression nails, and newly designed compressive anti-resorption (CARES) nails compressed with tube and coil spring.
METHODS
We determined the maximum axial/rotational movements and interfragmentary compression loads between fragments on 10 interlocking nails, 10 compression nails, and 10 CARES nails with 30 composite femurs. Using a compression-distraction testing device, 6 N·m external and internal torques were applied, and we evaluated the maximum rotational and axial displacement between fragments after 1-4 mm fracture site resorption.
RESULTS
When 6 N·m of internal-external rotation torque was applied after 2 mm fracture site resorption, the maximum rotational displacement between fragments in the CARES nail was 3 ± 0.52 mm, 101% less than the 6.03 ± 0.83 value in the compression nail and 100% less than the 6 ± 1 mm value measured in the interlocking nail (P=.000). The compression between fragments was 298 ± 72 N in the CARES nail after 1 mm of resorption, while this value was measured as 0 in the other nails. There was a significant difference in rotational, axial stability, and interfragment compression among the different femoral nails after 1-4 mm fracture site resorption.
CONCLUSION
The CARES nail having additional coil springs seems significantly biomechanically superior to compression nails and interlocking nails, providing maximum rotational, axial stability, and interfragment compression after fracture site resorption.
Topics: Humans; Bone Nails; Femoral Fractures; Fracture Fixation, Intramedullary; Biomechanical Phenomena; Femur
PubMed: 38454216
DOI: 10.5152/j.aott.2023.23055 -
Foot and Ankle Surgery : Official... Oct 2023Post-operative alignment is the most critical indicator for a successful total ankle arthroplasty (TAA). Total ankle malrotation is associated with an increased risk for...
BACKGROUND
Post-operative alignment is the most critical indicator for a successful total ankle arthroplasty (TAA). Total ankle malrotation is associated with an increased risk for polyethylene wear and medial gutter pain. Currently, there is no consensus on the correct way to measure the alignment of the tibial and talar component rotations in the axial plane. In the current study, the post-operative analysis system was assessed using weight-bearing computer tomography and a three-dimensional (3D) model. The purpose of the study was to assess the inter-observer and intra-observer agreement of this system.
MATERIAL AND METHOD
Four angles were measured by two raters independently in two separate readings: posterior tibial component rotation angle (PTIRA), posterior talar component rotation angle (PTARA), tibia talar component axial angle (TTAM), and tibial component to the second metatarsal angle (TMRA). Agreement analysis was quantified according to the interclass coefficient.
RESULTS
Sixty TAAs across 60 patients were evaluated. A good inter-observer agreement and intra-observer agreement when measuring the PTIRA, PTARA, and TTAM angles was observed along with an excellent inter-observer agreement and intra-observer agreement when measuring the TMRA angle.
CONCLUSION
In conclusion, the current 3D model-based measurement system demonstrates good to excellent inter and intra-agreement. According to these results, 3D modelling can be reliably used to measure and assess the axial rotation of TAA components.
LEVEL OF EVIDENCE
Level 3 retrospective study.
Topics: Humans; Ankle; Retrospective Studies; Arthroplasty, Replacement, Ankle; Tibia; Tomography, X-Ray Computed; Weight-Bearing
PubMed: 37193615
DOI: 10.1016/j.fas.2023.05.001 -
The Journal of Rheumatology Nov 2023Axial spondyloarthritis (axSpA) is associated with decreased function and mobility of patients as a result of inflammation and radiographic damage. The Epionics SPINE...
OBJECTIVE
Axial spondyloarthritis (axSpA) is associated with decreased function and mobility of patients as a result of inflammation and radiographic damage. The Epionics SPINE device (ES), an electronic device that objectively measures spinal mobility, including range of motion (RoM) and speed (ie, range of kinematics [RoK]) of movement, has been clinically validated in axSpA. We investigated the performance of the ES relative to radiographic damage in the axial skeleton of patients with axSpA.
METHODS
A total of 103 patients with axSpA, 31 with nonradiographic axSpA (nr-axSpA) and 72 with radiographic axSpA (r-axSpA), were consecutively examined. Conventional radiographs of the spine (including presence, number, and location of syndesmophytes) and the sacroiliac joints (SIJs; rated by the modified New York criteria) were analyzed with the ES. Function and mobility were assessed using analyses of covariance and Spearman correlation.
RESULTS
The number of syndesmophytes correlated positively with Bath Ankylosing Spondylitis Metrology Index scores ( 0.38, = 0.02) and correlated negatively with chest expansion ( -0.39, = 0.02) and ES measurements (-0.53 ≤ ≤ -0.34, all < 0.03), except for RoM and RoK regarding rotation and RoK for extension of the lumbar and thoracic spines. In the radiographic evaluation of the SIJs, the extent of damage correlated negatively with ES scores and metric measurements (-0.49 ≤ ≤ -0.33, all < 0.001). Patients with r-axSpA, as compared to those with nr-axSpA, showed significantly worse ES scores for RoM, RoK, and chest expansion.
CONCLUSION
The ES scores, in accordance with mobility measurements, correlated well with the presence and extent of radiographic damage in the spine and the SIJs. As expected, patients with r-axSpA had more severe impairments than those with nr-axSpA.
Topics: Humans; Spondylarthritis; Non-Radiographic Axial Spondyloarthritis; Clinical Relevance; Spondylitis, Ankylosing; Sacroiliac Joint
PubMed: 37061230
DOI: 10.3899/jrheum.2022-1240 -
The Journal of Contemporary Dental... Sep 2023The study aimed to analyze the morphological and anatomical variations of the nasopalatine canal (NPC) using cone-beam computed tomography (CBCT) images and their...
AIM
The study aimed to analyze the morphological and anatomical variations of the nasopalatine canal (NPC) using cone-beam computed tomography (CBCT) images and their association with age and gender among the subpopulation of the Qassim region of Saudi Arabia.
MATERIALS AND METHODS
The CBCT records of 401 patients referred to the Department of Radiology between January 2020 and July 2023 were randomly selected in the retrospective cross-sectional study. The anatomical characteristics such as the length of the NPC, and the superior and inferior width of the canal, were analyzed. In the sagittal and axial planes, the morphological variants of the shape of the NPC were also investigated. The Statistical Package for the Social Sciences (SPSS) software was used for statistical analyses at a 5% significance level.
RESULTS
The study examined the CBCT images of 219 females (54.6%) and 182 males (45.4%) with an overall mean age of 40.17 ± 2.31 years. The overall length of the NPC and superior and inferior canal width were 13.86 ± 2.68 mm, 3.4 ± 1.42 mm, and 4.07 ± 2.06 mm, respectively. Independent -test revealed that the males had a statistically significant larger superior (3.62 ± 1.78 mm) and inferior canal width (4.33 ± 1.79 mm). In terms of gender, the Chi-square test revealed a statistically significant association ( < 0.01) between the morphological shape of the NPC in the axial and sagittal planes. The heart-shaped (51.4%) and cone-shaped canals (34.2%) were the most frequently recorded NPC in the axial and sagittal planes, respectively. Pearson's correlation found a statistically significant positive relationship ( < 0.05) between the superior and inferior canal width and the canal length. Spearman's correlation revealed a statistically highly significant correlation between the NPC shape in the sagittal plane and gender ( < 0.001).
CONCLUSION
The study findings revealed a statistically significant difference in the anatomical and morphological traits of the NPC in the axial and sagittal planes based on gender. The effect of age and gender was found to exhibit significant differences with the NPC parameters. The heart-shaped canal in the axial plane and the cone-shaped canal in the sagittal plane were more prevalent in the study sample. A three-dimensional (3D) examination of the NPC will be crucial to avert challenging circumstances prior to surgical treatments in the anterior maxilla.
CLINICAL SIGNIFICANCE
The NPC is a long, narrow canal that can take up to 58% of the buccal bone plate width, and an accurate 3D anatomic illustration of the NPC allows for reliable surgical planning and dental implant placement.
Topics: Male; Female; Humans; Adult; Retrospective Studies; Cross-Sectional Studies; Cone-Beam Computed Tomography; Maxilla; Research Design
PubMed: 38152939
DOI: 10.5005/jp-journals-10024-3561 -
European Spine Journal : Official... Jan 2024To present the clinical features and treatment strategy of degenerative atlantoaxial subluxation (DAAS).
PURPOSE
To present the clinical features and treatment strategy of degenerative atlantoaxial subluxation (DAAS).
METHODS
Patients with DAAS treated in our institution from 2003 to 2020 were retrospectively reviewed. We utilized the Japanese Orthopedic Association (JOA) scale to evaluate the neurologic status and distance of Ranawat et al. (DOR) to measure vertical migration.
RESULTS
We recruited 40 patients with > 2 years of follow-up and an average age of 62.3 ± 7.7 years. All the patients had myelopathy; only one patient had moderate trauma before exacerbation of symptoms, and the duration of symptoms was 34 ± 36 months. The most frequent radiological features were vertical migration of C1 (100%), sclerosis (100%), and narrowing of the atlantoaxial lateral mass articulations (100%). Two patients underwent transoral release combined with posterior reduction and fusion, and 38 patients underwent posterior reduction and fusion with C1 lateral mass screws-C2 pedicle screws and plate systems only. Forty cases (100%) achieved a solid atlantoaxial fusion, and 38 cases (95%) achieved anatomic atlantoaxial reduction. The JOA score increased from 9.3 ± 2.6 to 14.8 ± 2.1 (P < 0.01). DOR increased from 14.5 ± 2.5 to 17.8 ± 2.2 mm at the final follow-up (P < 0.01). Loosening of the locking caps was detected in one case, bony fusion was achieved, and harvest-site pain was reported in five patients.
CONCLUSION
DAAS differs from other types of AAS and presents with anterior subluxation combined with vertical subluxation arising from degenerative changes in the atlantoaxial joints. We recommend anatomic reduction as an optimal strategy for DAAS.
Topics: Humans; Middle Aged; Aged; Retrospective Studies; Joint Dislocations; Pedicle Screws; Bone Plates; Atlanto-Axial Joint; Neck Injuries; Spinal Cord Diseases; Spinal Fusion; Bone Marrow Diseases; Treatment Outcome
PubMed: 37659971
DOI: 10.1007/s00586-023-07860-9 -
Journal of Morphology Oct 2023The neck is a critical portion of the avian spine, one that works in tandem with the beak to act as a surrogate forelimb and allows birds to manipulate their... (Review)
Review
The neck is a critical portion of the avian spine, one that works in tandem with the beak to act as a surrogate forelimb and allows birds to manipulate their surroundings despite the lack of a grasping capable hand. Birds display an incredible amount of diversity in neck morphology across multiple anatomical scales-from varying cervical counts down to intricate adaptations of individual vertebrae. Despite this morphofunctional disparity, little is known about the drivers of this enormous variation, nor how neck evolution has shaped avian macroevolution. To promote interest in this system, I review the development, function and evolution of the avian cervical spine. The musculoskeletal anatomy, basic kinematics and development of the avian neck are all documented, but focus primarily upon commercially available taxa. In addition, recent work has quantified the drivers of extant morphological variation across the avian neck, as well as patterns of integration between the neck and other skeletal elements. However, the evolutionary history of the avian cervical spine, and its contribution to the diversification and success of modern birds is currently unknown. Future work should aim to broaden our understanding of the cervical anatomy, development and kinematics to include a more diverse selection of extant birds, while also considering the macroevolutionary drivers and consequences of this important section of the avian spine.
Topics: Animals; Forelimb; Cervical Vertebrae; Neck; Beak; Birds
PubMed: 37708511
DOI: 10.1002/jmor.21638 -
Clinical Radiology Oct 2023To evaluate the difference in computed tomography (CT) attenuation value of different planes of the 7th thoracic vertebra and investigate the efficacy of axial and...
AIM
To evaluate the difference in computed tomography (CT) attenuation value of different planes of the 7th thoracic vertebra and investigate the efficacy of axial and sagittal vertebral CT measurements in predicting osteoporosis.
MATERIALS AND METHODS
Patients who underwent routine chest CT and dual-energy X-ray absorptiometry (DXA) within 1 month were included in this retrospective study. The CT attenuation values of different planes were compared. Logistic regression and receiver operating characteristic (ROC) were used to analyse the difference of each plane in the diagnosis of osteoporosis.
RESULTS
The study included 1,338 patients (mean age of 61.9±11.9; 54% female). The CT attenuation values decreased successively in the normal group, osteopenia group, and osteoporosis group. The paired t-test results showed that the mid-axial measurements were greater than mid-sagittal measurements, with a mean difference of 9 HU, the difference was statistically significant (p<0.001, 95% confidence interval [CI] = 7.8-10.1). For each one-unit reduction in mid-sagittal CT attenuation value, the risk of osteopenia or osteoporosis increased by 3.6%. To distinguish osteoporosis from non-osteoporosis (osteopenia + normal), the sensitivity was 90% and the specificity was 52.4% at the mid-sagittal threshold of 113.7 HU.
CONCLUSIONS
The CT attenuation values of mid-sagittal plane have higher diagnostic efficacy than axial planes in predicting osteoporosis. For patients with a sagittal CT attenuation value of <113.7 HU in the T7, further DXA examination is warranted.
Topics: Humans; Female; Middle Aged; Aged; Male; Bone Density; Thoracic Vertebrae; Retrospective Studies; Lumbar Vertebrae; Osteoporosis; Bone Diseases, Metabolic; Tomography, X-Ray Computed; Absorptiometry, Photon
PubMed: 37573241
DOI: 10.1016/j.crad.2023.07.006 -
Neuro-Chirurgie May 2024An in-depth understanding of the anatomy of the craniocervical junction (CCJ) is indispensable in skull base neurosurgery. In this paper, we discuss the osteology of the... (Review)
Review
An in-depth understanding of the anatomy of the craniocervical junction (CCJ) is indispensable in skull base neurosurgery. In this paper, we discuss the osteology of the occipital bone, the atlas (C1) and axis (C2), the ligaments and the muscle anatomy of the CCJ region and their relationships with the vertebral artery. We will also discuss the trajectory of the vertebral artery and review the anatomy of the jugular foramen and lower cranial nerves (IX to XII). The most important surgical approaches to the CCJ, including the far lateral approach, the anterolateral approach of Bernard George and the endoscopic endonasal approach, will be discussed to review the surgical anatomy.
Topics: Humans; Skull Base; Cervical Atlas; Occipital Bone; Atlanto-Occipital Joint; Vertebral Artery; Neurosurgical Procedures; Cervical Vertebrae; Atlanto-Axial Joint; Cranial Nerves; Axis, Cervical Vertebra
PubMed: 38277861
DOI: 10.1016/j.neuchi.2023.101511 -
World Neurosurgery Dec 2023Results of C4-C6 laminoplasty with C3 laminectomy and C3-C6 laminoplasty were compared retrospectively.
STUDY DESIGN
Results of C4-C6 laminoplasty with C3 laminectomy and C3-C6 laminoplasty were compared retrospectively.
OBJECTIVES
To clarify the difference between C3 laminectomy and C3 laminoplasty in cervical laminoplasty.
SUMMARY OF BACKGROUND DATA
Intraoperative damage to the semispinalis cervicis has been shown to lead to postoperative axial symptoms and reduced range of motion (ROM). To prevent this event, C3 laminectomy in cervical laminoplasty is considered superior to C3 laminoplasty.
METHODS
A total of 36 patients were included in this study: 20 patients (GroupA) of C3 laminectomy, C4-C6 laminoplasty compared with 16 patients (GroupB) of C3-C6 laminoplasty. We collected patient's background data, operative time, Japanese Orthopaedic Association (JOA) score, VAS score, and radiologic findings such as C2-C7 Cobb angle, ROM, C2 inter-spinous angle, and use of postoperative PRN medication were compared.
RESULTS
There was no statistically significant difference in the C2-C7 Cobb angles between the 2 groups before and after surgery (P = 0.315). In ROM, there was a 17.7% decrease from 31.5 preoperatively to 25.9 postoperatively in Group A, and a 6.1% decrease from 29.3 preoperatively to 27.5 postoperatively in Group B. There was no statistically significant difference in ROM (P = 0.683). Postoperative neck pain (VAS) was significantly lower in Group A than in Group B both at 1 week (P = 0.015) and 1 month (P = 0.035) after surgery. The C2 inter-spinous angle was statistically significantly smaller in Group A than in Group B (P = 0.004). Clinical outcomes and surgical outcomes did not differ significantly between groups.
CONCLUSIONS
If the C2 interspinous angle is wide and intraoperative semispinalis capitis damage can be minimized, it is worth trying C3 laminoplasty, but if the C2 inter-spinous angle is narrow, C3 laminectomy is recommended from the beginning.
Topics: Humans; Cervical Vertebrae; Treatment Outcome; Laminoplasty; Retrospective Studies; Range of Motion, Articular; Laminectomy; Pain, Postoperative
PubMed: 37793608
DOI: 10.1016/j.wneu.2023.09.118 -
The Journal of Bone and Joint Surgery.... Nov 2023Radiographic evaluation plays an important role in detecting and grading hip dysplasia. Acetabular sector angles (ASAs) measure the degree of femoral head coverage...
BACKGROUND
Radiographic evaluation plays an important role in detecting and grading hip dysplasia. Acetabular sector angles (ASAs) measure the degree of femoral head coverage provided by the acetabulum on computed tomographic (CT) scans. In this study, we aimed to determine ASA values at different axial levels in a control cohort with asymptomatic, high-functioning hips without underlying hip pathology and a study group with symptomatic, dysplastic hips that underwent periacetabular osteotomy (PAO), thereby defining the ASA thresholds for hip dysplasia.
METHODS
This was a cross-sectional study evaluating a control group of 51 patients (102 hips) and a study group of 66 patients (72 hips). The control group was high-functioning and asymptomatic, with an Oxford Hip Score of >43, did not have osteoarthritis (Tönnis grade ≤1), underwent a pelvic CT scan, had a mean age (and standard deviation) of 52.1 ± 5.5 years, and was 52.9% female. The study group had symptomatic hip dysplasia treated with PAO, had a mean age of 29.5 ± 7.3 years, and 83.3% was female. Anterior ASA (AASA) and posterior ASA (PASA) were measured at 3 axial CT levels to determine equatorial, intermediate, and proximal ASA. The thresholds for dysplasia were determined using receiver operating characteristic (ROC) curve analysis, including the area under the curve (AUC).
RESULTS
Patients with dysplasia had significantly smaller ASAs compared with the control group; the differences were most pronounced for proximal AASAs and proximal and intermediate PASAs. The control group had a mean proximal PASA of 162° ± 17°, yielding a threshold for dysplasia of 137° (AUC, 0.908). The mean intermediate PASA for the control group was 117° ± 11°, yielding a threshold of 107° (AUC, 0.904). The threshold for anterior dysplasia was 133° for proximal AASA (AUC, 0.859) and 57° for equatorial AASA (AUC, 0.868). The threshold for posterior dysplasia was 102° for intermediate PASA (AUC, 0.933).
CONCLUSIONS
Measurement of ASA is a reliable tool to identify focal acetabular deficiency with high accuracy, aiding diagnosis and management. A proximal PASA of <137° or an intermediate PASA of <107° should alert clinicians to the presence of dysplasia.
LEVEL OF EVIDENCE
Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence.
Topics: Humans; Female; Young Adult; Adult; Middle Aged; Male; Acetabulum; Cross-Sectional Studies; Hip Dislocation; Hip Dislocation, Congenital; Aspirin
PubMed: 37486985
DOI: 10.2106/JBJS.23.00022