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Sample records for fractures plain radiographs

  1. Radiographical measurements for distal intra-articular fractures of the radius using plain radiographs and cone beam computed tomography images

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    Suojaervi, Nora; Lindfors, N. [Helsinki University Central Hospital, Department of Hand Surgery, Helsinki (Finland); Sillat, T.; Koskinen, S.K. [HUS Helsinki Medical Imaging Center, Helsinki University Central Hospital, Department of Radiology, Helsinki (Finland)

    2015-12-15

    Operative treatment of an intra-articular distal radius fracture is one of the most common procedures in orthopedic and hand surgery. The intra- and interobserver agreement of common radiographical measurements of these fractures using cone beam computed tomography (CBCT) and plain radiographs were evaluated. Thirty-seven patients undergoing open reduction and volar fixation for a distal radius fracture were studied. Two radiologists analyzed the preoperative radiographs and CBCT images. Agreement of the measurements was subjected to intra-class correlation coefficient and the Bland-Altman analyses. Plain radiographs provided a slightly poorer level of agreement. For fracture diastasis, excellent intraobserver agreement was achieved for radiographs and good or excellent agreement for CBCT, compared to poor interobserver agreement (ICC 0.334) for radiographs and good interobserver agreement (ICC 0.621) for CBCT images. The Bland-Altman analyses indicated a small mean difference between the measurements but rather large variation using both imaging methods, especially in angular measurements. For most of the measurements, radiographs do well, and may be used in clinical practice. Two different measurements by the same reader or by two different readers can lead to different decisions, and therefore a standardization of the measurements is imperative. More detailed analysis of articular surface needs cross-sectional imaging modalities. (orig.)

  2. Salter-Harris type III fractures of the distal femur: plain radiographs can be deceptive.

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    Lippert, William C; Owens, Richard F; Wall, Eric J

    2010-09-01

    Salter-Harris (SH) III fractures of the distal femur, although rare, can have devastating effects. The purposes of this study were to: (1) compare the intra-articular fracture displacement measured on plain x-ray and magnetic resonance imaging (MRI) or computed tomography (CT) scan and (2) report the outcomes of patients with a SH III fracture of the distal femur. All SH III distal femur fractures treated at a large Children's Hospital with a Level I Pediatric Trauma Center between 1995 and 2006 were retrospectively reviewed. A total of 14 patients (average age: 13 y, 11 mo; range: 7 y, 8 mo to 17 y, 11 mo) with an average follow-up time of 21.50 months (range: 2 to 47 mo) were included in this study. Fracture displacement on plain x-ray was compared with the fracture displacement measured on MRI or CT scan. The average time between the initial plain x-ray and MRI or CT scan was 37.48 days (range: 3 h to 6 mo). Plain x-rays significantly underestimated the displacement of SH III fractures versus MRI or CT scan. Six patients who had both plain x-ray and MRI or CT scan had a measured displacement of 0.42 mm and 2.70 mm, respectively (paired Student t test, P=0.005). Ten of the 14 patients (71%) had no physical limitations and full knee motion at their most recent follow-up visit. The treatment of 4 patients (29%) was changed based on the findings of the additional MRI or CT scan. This study and earlier studies have shown a high rate of poor results with SH III fractures of the distal femur. This type of fracture pattern is extremely unstable and the true displacement is often underestimated by x-rays. Thus, it is strongly recommended that an MRI or CT scan be obtained on every SH III fracture of the distal femur. Moreover, any SH III fracture visible on plain radiographs should be treated with open reduction, internal fixation. Level IV.

  3. Can experts in acetabular fracture care determine hip stability after posterior wall fractures using plain radiographs and computed tomography?

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    Davis, Adrian T; Moed, Berton R

    2013-10-01

    Hip stability status after a posterior wall acetabular fracture involving 20%-50% of the posterior wall is difficult to determine. However, noted experts have professed that hip stability can be accurately determined by careful review of high-quality anteroposterior and oblique plain radiographs and a computed tomography scan. The objective of this investigation was to evaluate the interobserver and intraobserver reliabilities and accuracies in determining hip stability status by fellowship-trained orthopedic traumatologists expert in acetabular fracture care using these studies. Reliability and validation study. Level 1 trauma center. Fifteen patients with isolated unilateral posterior wall (OTA 62-A1) acetabular fractures involving 20%-50% of the posterior acetabular wall and known clinical outcome had undergone dynamic stress fluoroscopy under anesthesia to determine hip stability. High-quality anteroposterior and oblique plain radiographs and axial computed tomography images of 15 fractures involving 20%-50% of the posterior acetabular wall were reviewed in random order by 4 fellowship-trained orthopedic traumatologists specializing in acetabular fracture care in 2 separate sessions. The second session occurred after a minimum 1-month washout period. Determination of hip stability status was made for each fracture at the 2 time points based on the images along with any history of dislocation of the hip at the time of injury. These determinations were compared with the findings of examination under anesthesia, which served as the gold standard. Measurement of agreement using the Kappa statistic. Although intraobserver reliability was good (0.65), interobserver reliability was poor (0.12). In addition, percent correct was only 53% (32/60) for the initial reading and only 52% (31/60) for the second. For the initial reading, sensitivity and specificity were 100% (28/28) and 13% (4/32), respectively. For the second reading, the sensitivity and specificity were 57

  4. Necrotizing fasciitis : plain radiographic and CT findings

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    Lee, Chang Dae; Park, Jeong Hee; Jeon, Hae Jeong; Lim, Jong Nam; Heo, Tae Haeng; Park, Dong Rib [Konkuk Univ. College of Medicine, Seoul (Korea, Republic of)

    1996-11-01

    To evaluate the plain radiographic and CT findings of the necrotizing fasciitis. We retrospectively reviewed the radiologic findings of 4 cases with necrotizing fasciitis. Three cases were proven pathologically. We evaluated pattern and extent of the gas shadows in plain films. CT findings were analysed, with emphasis on : (a) gas pattern, (b) extent, (c) location and involved site, (d) associated focal abscess, and (e) swelling of the adjacent muscles. On plain radiographs, four cases showed streaky or mottled gas densities in the pelvis, three cases in the perineum, one case in the abdomen, and two cases in the thigh. On CT images, gas pattern was mottled and streaky appearance with swelling of the adjacent muscles. Gas shadows located in the extraperitoneal space in four cases, fascial layer in four cases, and subcutaneous layer in four cases. There were gas shadows in pelvic wall, perineum, abdominal wall, buttock, thigh, and scrotum. Focal low density lesion suggestive of focal abscess was not visualized. Plain radiography is useful for early diagnosis of the necrotizing fasciitis and CT is very useful for detection of precise location and extent of the disease. CT is also useful for differentiation of necrotizing fasciitis from focal abscess and cellulitis.

  5. Accuracy of radiographer plain radiograph reporting in clinical practice: a meta-analysis.

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    Brealey, S; Scally, A; Hahn, S; Thomas, N; Godfrey, C; Coomarasamy, A

    2005-02-01

    To determine the accuracy of radiographer plain radiograph reporting in clinical practice. Studies were identified from electronic sources and by hand searching journals, personal communication and checking reference lists. Eligible studies assessed radiographers' plain radiograph reporting in clinical practice compared with a reference standard, and provided accuracy data to construct 2 x 2 contingency tables. Data were extracted on study eligibility and characteristics, quality and accuracy. Summary estimates of sensitivity and specificity and receiver operating characteristic curves were used to pool the accuracy data. Radiographers compared with a reference standard, report plain radiographs in clinical practice at 92.6% (95% CI: 92.0-93.2) and 97.7% (95% CI: 97.5-97.9) sensitivity and specificity, respectively. Studies that compared selectively trained radiographers and radiologists of varying seniority against a reference standard showed no evidence of a difference between radiographer and radiologist reporting accuracy of accident and emergency plain radiographs. Selectively trained radiographers were also found to report such radiographs as accurately as those not solely from accident and emergency, although some variation in reporting accuracy was found for different body areas. Training radiographers improved their accuracy when reporting normal radiographs. This study systematically synthesizes the literature to provide an evidence-base showing that radiographers can accurately report plain radiographs in clinical practice.

  6. Accuracy of radiographer plain radiograph reporting in clinical practice: a meta-analysis

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    Brealey, S. [Department of Health Sciences, University of York (United Kingdom)]. E-mail: sb143@york.ac.uk; Scally, A. [Division of Radiography, University of Bradford (United Kingdom); Hahn, S. [Department of Health Sciences, University of York (United Kingdom); Thomas, N. [Department of X-ray, North Manchester General Hospital (United Kingdom); Godfrey, C. [Department of Health Sciences, University of York (United Kingdom); Coomarasamy, A. [Education Resource Centre, Birmingham Women' s Hospital (United Kingdom)

    2005-02-01

    AIM: To determine the accuracy of radiographer plain radiograph reporting in clinical practice. MATERIALS AND METHODS: Studies were identified from electronic sources and by hand searching journals, personal communication and checking reference lists. Eligible studies assessed radiographers' plain radiograph reporting in clinical practice compared with a reference standard, and provided accuracy data to construct 2x2 contingency tables. Data were extracted on study eligibility and characteristics, quality and accuracy. Summary estimates of sensitivity and specificity and receiver operating characteristic curves were used to pool the accuracy data. RESULTS: Radiographers compared with a reference standard, report plain radiographs in clinical practice at 92.6% and 97.7% sensitivity and specificity, respectively. Studies that compared selectively trained radiographers and radiologists of varying seniority against a reference standard showed no evidence of a difference between radiographer and radiologist reporting accuracy of accident and emergency plain radiographs. Selectively trained radiographers were also found to report such radiographs as accurately as those not solely from accident and emergency, although some variation in reporting accuracy was found for different body areas. Training radiographers improved their accuracy when reporting normal radiographs. CONCLUSION: This study systematically synthesizes the literature to provide an evidence-base showing that radiographers can accurately report plain radiographs in clinical practice.

  7. Clinical diagnostic value of the control application vertebral fractures Plain radiographs and CT%脊椎骨折应用放射平片与CT的临床诊断价值对照

    Institute of Scientific and Technical Information of China (English)

    李岩

    2014-01-01

    Objective To plain radiographs and CT analysis compromise clinical value in the diagnosis of the spine. Methods Se-lect August 2012 to February 2014 in the hospital after surgery in patients diagnosed vertebral fractures, 70 cases underwent pre-operative imaging, radiology plain film row as the control group for the study group underwent CT examination records and analysis of relevant data. Results CT examination of the spinal canal stenosis, bone fragment displacement, canal volume changes and broke into pieces spinal fracture detection rate than the control group, with statistical significance (P<0.05);in column after column of CT and fractures the detection rate of moderate and severe fractures score higher than the control group, there were significant (P<0.05); spinal curvature change between the two methods, the anterior column fracture detection rate and mild fracture score group , the difference was not statistically significant(P<0.05). Conclusion CT scan can clearly show the involvement of the three-column fracture injury, joint Plain radiograph can improve the diagnosis rate of vertebral fractures.%目的:分析放射平片与CT在诊断脊椎骨折中的临床应用价值。方法选取2012年8月-2014年2月在本院经手术确诊为脊椎骨折的患者70例,术前均行影像学检查,将行放射平片检查作对照组,行CT检查作研究组,记录并分析相关数据。结果CT检查的椎管狭窄、骨折片移位、椎管容积改变与骨折片突入椎管诊断符合率均比对照组高,有统计学意义(P<0.05);CT检查的中柱与后柱骨折诊断符合率、中度与重度骨折评分均比对照组高,有统计学意义(P<0.05);两种检查方法的脊柱曲度改变、前柱骨折诊断符合率以及轻度骨折评分组间比较,差异均无统计学意义(P>0.05)。结论 CT扫描可清晰显示三柱受累与骨折损伤程度,联合放射平片可提高脊椎骨折确诊率。

  8. Radiopaque intrahepatic duct stones in plain radiograph: case report

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    Kim, Mi Young; Suh, Chang Hae; Park, Chan Sup; Chung, Won Kyun [College of Medicine, Inha University, Seongnam (Korea, Republic of)

    1994-04-15

    We experienced 3 cases of intrahepatic duct stones detected on plain radiographs. The patients had history of multiple episodes of recurrent cholangitis. Radiographic characteristics of these stones included multiple, round or rectangular radiopaque densities surrounded by calcified rim; these densities showed a branching pattern along the intrahepatic ducts.

  9. Bone and joint changes following electrical burn: plain radiographic findings

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    Kim, Uk Jung; Lee, Eil Seong; Shim, Ya Seong; Kim, Seon Bok; Lee, Shin Ho; Jung, Hae Kyoung; Hwang, Dae Hyun; Kang, Ik Won [Hallym Univ. College of Medicine, Seoul (Korea, Republic of)

    1998-10-01

    To evaluate the plain radiographic findings of bone and joint changes following electrical burn. This study involved 19 patients with 27 bone and joints regions which had suffered electrical injury. The most common input and output sites were, respectively, the hand(7/14) and foot (6/10). Three other sites were involved. Four cases involved osteomyelitis, and in four, amputation was performed. We observed bone and joint changes, changes following osteomyelitis and changes in the amputation stump. We analyzed the difference between input and output changes, and when this was interesting, the average time of onset was assessed. In bone and joint changes following electrical burn, the most frequent radiographic finding was joint contracture(n=3D16). Other findings included osteolysis(n=3D8), articular abnormalites (n=3D6), periostitis(n=3D5), fracture(n=3D5), acro-osteolysis(n=3D2), and heterotopic bone formation(n=3D2). In cases involving osteomyelitis(n=3D4), aggravation of underlying bone changes was noted. In electrical burn, various changes were noted in bone and joints, and input injury was more severe than that of output.=20.

  10. Radiographic features of teriparatide-induced healing of femoral fractures

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    Youngwoo Kim

    2015-12-01

    Full Text Available Teriparatide is a drug that is used to increase bone remodeling, formation, and density for the treatment of osteoporosis. We present three cases of patients with a femoral insufficiency fracture. The patients were administered teripatatide in an attempt to treat severe osteoporosis and to enhance fracture healing. We found several radiographic features around the femoral fractures during the healing period. 1 Callus formation was found at a very early stage in the treatment. Teriparatide substantially increased the unusually abundant callus formation around the fracture site at 2 weeks. Moreover, this callus formation continued for 8 weeks and led to healing of the fracture. 2 Abundant callus formation was found circumferentially around the cortex with a ‘cloud-like’ appearance. 3 Remodeling of the teriparatide-induced callus formation was found to be part of the normal fracture healing process. After 1 year, normal remodeling was observed on plain radiographs. These findings indicate that teriparatide can be used as an adjuvant therapy in the management of femoral insufficiency fractures.

  11. Presence of bias in radiographer plain film reading performance studies

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    Brealey, S.; Scally, A.J.; Thomas, N.B

    2002-11-01

    Purpose To raise awareness of the frequency of bias that can affect the quality of radiographer plain film reading performance studies. Methods Studies that assessed radiographer(s) plain film reading performance were located by searching electronic databases and grey literature, hand-searching journals, personal communication and scanning reference lists. Thirty studies were judged eligible from all data sources. Results A one-way analysis of variance (ANOVA) demonstrates no statistically significant difference (P=0.25) in the mean proportion of biases present from diagnostic accuracy (0.37), performance (0.42) and outcome (0.44) study designs. Pearson's correlation coefficient showed no statistically significant linear association between the proportion of biases present for the three different study designs and the year that the study was performed. The frequency of biases in film and observer selection and application of the reference standard was quite low. In contrast, many biases were present concerning independence of film reporting and comparison of reports for concordance. Conclusions The findings indicate variation in the presence of bias in radiographer plain film reading performance studies. The careful consideration of bias is an essential component of study quality and hence the validity of the evidence-base used to underpin radiographic reporting policy.

  12. Relationships between plain-film radiographic patterns and clinicopathologic variables in AJCC stage II osteosarcoma

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    Kim, Min Suk; Koh, Jae-Soo [Korea Cancer Center Hospital, Department of Pathology, Nowon-gu, Seoul (Korea); Lee, Soo-Yong; Cho, Wan Hyeong; Song, Won Seok; Jeon, Dae-Geun [Korea Cancer Center Hospital, Department of Orthopedic Surgery, Nowon-gu, Seoul (Korea); Lee, Jun Ah [Korea Cancer Center Hospital, Department of Pediatrics, Nowon-gu, Seoul (Korea); Yoo, Ji Young [Korea Cancer Center Hospital, Department of Radiology, Nowon-gu, Seoul (Korea); Jung, Sung Taek [Chonnam National University Medical School, Department of Orthopedic Surgery, Gwangju (Korea)

    2008-11-15

    In this retrospective study, we assessed the plain-film radiographic patterns of American Joint Committee on Cancer (AJCC) stage II osteosarcoma and analyzed the relationship between these patterns and clinicopathologic variables. We retrospectively reviewed 347 patients with AJCC stage II osteosarcoma who were treated at our institute. Patients were divided into three groups based on radiographic patterns, i.e., osteoblastic, osteolytic, and mixed. Fisher's exact chi-square test was performed to analyze correlations between radiographic patterns and clinicopathological variables. One hundred and eighty-eight patients had an osteoblastic tumor, 101 had an osteolytic tumor, and 58 had a mixed tumor. Tumors with an osteoblastic pattern showed a tendency to have the following characteristics: AJCC stage II-B, osteoblastic or chondroblastic subtype, and no pathologic fracture. Conversely, osteolytic tumors were frequently of AJCC stage II-A, had a fibroblastic or rare subtype, and were associated with a pathologic fracture. Finally, mixed tumors were frequently found in men. No survival difference was found according to radiographic pattern. Plain-film radiographic patterns were found to be related with clinicopathological features. We believe that it could be used to provide valuable information for treatment decision-making in cases of high-grade extremity osteosarcoma. (orig.)

  13. Reducing missing fracture clinic radiographs by entrusting them to patients.

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    Calder, Peter R.; Hynes, Matthew C.; Goodier, W. David

    2004-01-01

    BACKGROUND: Missing radiographs in fracture clinics may compromise fracture management and lead to inappropriate use of clerical resources. METHODS: We prospectively compared the number of missing radiographs in two hospitals over a period of two months. In hospital A the radiographs were retained and in hospital B they were entrusted to the patients. RESULTS: At the completion of the study, entrusting patients with their radiographs resulted in statistically less radiographs missing from the...

  14. Acute neuropathic joint in diabetic foot: Plain radiographic findings

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    Yoon, Dae Young; Kang, Heung Sik; Sim, Jung Suk; Yoon, Yong Kyu; Kim, Chu Wan [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1994-05-15

    To determine the plain film findings of acute neuropathic joint in diabetic foot. Acute neuropathic joint in diabetic foot was considered when fragmentation of the articular ends of bone and subluxation of the affected joint developed within eight weeks after clinical onset of diabetic gangrene. Eight toes of six diabetics were satisfactory to our criteria. We analyzed plain radiographic findings of the affected joint and soft tissue, interval changes in followed-up radiographs, and deformities after healing. The time interval between clinical onset of gangrene and bone destruction ranges from 2 weeks to 4 weeks(mean 2.6 weeks). Plane radiographs showed fragmentation of the articular ends, subluxation, and soft tissue swelling of the metatarsophalangeal joint or interphalangeal joint. The significant feature of these patients was rapid progression of the lesions. Clinically, all patients had diabetic gangrene in affected toes, however, there was no evidence of osteomyelitis in our series. Amputation was done in 2 cases, and lesions in 3 of the remaining 4 cases were repaired spontaneously with regression of gangrene, leaving radiological residua such as pointed-end, tapered-end, and ball and socket deformity. Rapid disorganisation of the joint with associated evidence of soft tissue gangrene in plain radiograph is believed to be valuable for the diagnosis of diabetic osteoarthropathy.

  15. Systematic assessment of constipation on plain abdominal radiographs in children

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    Bosch, Maurice van den; Graafmans, Doortje [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Nievelstein, Rutger; Beek, Erik [Wilhelmina Children' s Hospital, Department of Paediatric Radiology, Utrecht (Netherlands)

    2006-03-15

    Constipation in childhood is common and its clinical assessment is often difficult. Plain abdominal radiography is simple and used to quantify constipation. Three scoring systems, those of Barr et al., Leech et al. and Blethyn et al., have been developed to quantify fecal loading on the abdominal radiograph. In order to determine which method is the most useful in clinical practice, we assessed the reproducibility of the three scoring systems. Plain abdominal radiographs from 40 clinically constipated children were retrospectively reviewed by two paediatric radiologists on two separate occasions. The radiographs were scored according to three different systems developed by Barr et al., Leech et al., Blethyn et al. Intraobserver variability and interobserver reproducibility were determined for each system. Kappa coefficients were calculated as indicators of inter- and intraobserver agreement for categorical outcome variables. The Leech score showed the highest reproducibility: the intraobserver agreement was high for both observers ({kappa} values of 0.88 and 1.00, respectively, P<0.05). Furthermore, the interobserver agreement was also high: {kappa} 0.91 in the first round and 0.84 in the second. The Leech score proved to be a highly reproducible tool for assessment of childhood constipation and is of value in clinical practice for systematic assessment of constipation on plain abdominal radiographs in children. (orig.)

  16. Plain abdominal radiographs in children with inflammatory bowel disease

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    Taylor, G.A.; Nancarrow, P.A.; Hernanz-Schulman, M.; Teele, R.L.

    1986-03-01

    The value of plain abdominal radiography in children with inflammatory bowel disease (IBD) has not been ascertained. We reviewed the scout radiographs prior to first barium examination in 100 children with IBD (53 Crohn, 47 ulcerative colitis (UC) and scout films prior to excretory urography in 50 patients who had no clinical evidence of intestinal disease (controls)). The films were reviewed without clinical information, and the abnormalities on each film scored according to severity and location. Criteria included: mural thickening, dilatation and mucosal abnormalities of the small bowel and colon, as well as abnormal quantity and/or distribution of feces in the colon. Eighty percent (40/50) of the films in the control group were interpreted as normal. Abnormalities suggestive of IBD were presented in 73% of the IBD group (76% Crohn and 72% UC). Thirty-one percent of the films in the IBD group had a moderately abnormal score (>=3) or markedly abnormal score (>=5) at presentation. The most reliable radiographic findings were: mucosal abnormality in the colon and small bowel and an abnormal stool pattern (feces completely absent or only present in one colonic segment). The clinical presentation of IBD in childhood is often vague and nonspecific. Abnormalities in plain films of the abdomen are common in these patients and may be helpful in suggesting the presence and, to a great degree, the severity of disease in these children.

  17. Primary radiographic diagnosis of fractures in the mandible.

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    Moilanen, A

    1982-10-01

    A retrospective study was performed to determine the reliability of primary radiography in evaluation of fractures in the mandible. In all, radiographic diagnosis was correct in 77% of 272 fractures. Panoramic tomography (PT) was superior compared with conventional methods (skull films and jaw projections) in the assessment of these fractures. Without PT, the diagnostic error rate increased to 40%, largely due to missed fracture lines. It is recommended that PT be performed in all cases of suspected jaw fractures, initially, when obtainable, or at least once during the treatment of a jaw trauma patient. Fractures in the dento-alveolar and condylar regions, particularly, presented repeated difficulties in initial radiography.

  18. Feasibility and Value of Radiographic Union Score Hip Fracture after Treatment with Intramedullary Nail of Stable Hip Fractures

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    Maiettini, Daniele; Bisaccia, Michele; Caraffa, Auro; Rinonapoli, Giuseppe; Piscitelli, Luigi; Bisaccia, Olga; Rollo, Giuseppe; Meccariello, Luigi; Ceccarini, Paolo; Rebonato, Alberto

    2016-01-01

    Introduction: Given the importance of fracture healing on patient outcome in clinical practice, it is critical to assess fracture healing. Aim: The aim of this study was to evaluate the feasibility of the Radiographic Union Score Hip fracture after treatment with intramedullary nail of stable hip fractures. Patients and Methods: We retrospectively collected the data from the clinical records of our institution of the 47 patientswho had undergone intertrochanteric hip fracture treatment using an intramedullary nail. Pain visual analogic score (VAS) was collected the same day that X-rays were taken. Plain hip X-rays were performed, in two radiographic views, at 40 and 90 days after the surgical procedure. The correlation between the RUSH and VAS score was evaluated. Results: Mean RUSH and VAS scores showed a strong statistical improvement between the 40 and 90 day follow-ups. RUSH value at 40 days fitted an inverse linear regression with VAS, p-value of 0.0063 and r2 of 0.15. At 90 days the regression between RUSH and VAS scores was not significant. Conclusion: RUSH could be proposed as an objective system to evaluate union in hip fractures treated with intramedullary nail. PMID:28077901

  19. Limited magnetic resonance imaging in low back pain instead of plain radiographs: Experience with first 1000 cases

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    McNally, Eugene G.; Wilson, David J.; Ostlere, Simon J

    2001-11-01

    AIM: We report our experience with the first 1000 patients with non-traumatic low back pain (LBP) without radiculopathy undergoing limited sequence magnetic resonance imaging (MRI) instead of plain radiography. METHODS: Between January 1996 and December 1998, 1042 patients with low back pain unresponsive to conservative treatment were examined using a limited MR protocol comprising sagittal T1-weighted and STIR imaging. Plain radiographs were not performed. RESULTS: Malignancy, infection, vertebral fracture, spondylitis, pars defects and cord tumours were detected in 20%. Of the 82 osteoporotic vertebral fractures detected, 51 (62%) were recent and 31 had normal marrow signal indicating that they were old. Eighty pars defects were identified, 45(56%) had spondylolisthesis, 29(37%) were undisplaced and 6 (7%) had pars oedema only. Neoplastic disease was found in 17(8%) of which none was suspected before imaging. Benign neoplastic diseases such as vertebral AVM/haemangiomata were excluded. Twenty-one patients had a variety of disorders including ankylosing spondylitis (7), large vessel aneurysm (3), discitis (2), ovarian cyst (2), sequestered disc (2), sacral insufficiency fracture (2) and one patient each with burst fracture, retroperitoneal haematoma and a previously unsuspected horseshoe kidney. CONCLUSION: The majority of patients with LBP are best assessed clinically and imaging is usually not required. In patients with worrying symptoms, MRI with a limited protocol detects a greater number of abnormalities than previously reported studies using plain radiographs and has replaced plain radiography in our hospital. We report our experience with the first 1000 patients and highlight issues such as protocols, detection rates and communication issues. McNally E.G. et al. (2001)

  20. Quantitative Measurement Method for Possible Rib Fractures in Chest Radiographs

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    Kim, Jaeil; Kim, Sungjun; Kim, Young Jae

    2013-01-01

    Objectives This paper proposes a measurement method to quantify the abnormal characteristics of the broken parts of ribs using local texture and shape features in chest radiographs. Methods Our measurement method comprises two steps: a measurement area assignment and sampling step using a spline curve and sampling lines orthogonal to the spline curve, and a fracture-ness measurement step with three measures, asymmetry and gray-level co-occurrence matrix based measures (contrast and homogeneity). They were designed to quantify the regional shape and texture features of ribs along the centerline. The discriminating ability of our method was evaluated through region of interest (ROI) analysis and rib fracture classification test using support vector machine. Results The statistically significant difference was found between the measured values from fracture and normal ROIs; asymmetry (p rib fracture classifier, trained with the measured values in ROI analysis, detected every rib fracture from chest radiographs used for ROI analysis, but it also classified some unbroken parts of ribs as abnormal parts (8 to 17 line sets; length of each line set, 2.998 ± 2.652 mm; length of centerlines, 131.067 ± 29.460 mm). Conclusions Our measurement method, which includes a flexible measurement technique for the curved shape of ribs and the proposed shape and texture measures, could discriminate the suspicious regions of ribs for possible rib fractures in chest radiographs. PMID:24175118

  1. The cost of screening radiographs after stable fracture fixation

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    Tufescu, Ted

    2017-01-01

    Background Currently up to 58% of Canadian surgeons would forego screening radiographs after stable fracture fixation. It is therefore expected that reducing screening radiographs will be well accepted, provided that patient safety is not compromised, resulting in a cost reduction. The study objective was to measure the savings of a simplified radiographic protocol for well-fixed fractures and establish feasibility for a noninferiority trial that proves patient safety. Methods Patients were randomized after fixation. The control group received screening radiographs immediately after fixation and at 2 weeks. The experimental group received radiographs only when clinically indicated. At 6 weeks all patients received radiographs. The cost of imaging, time spent in clinic and patient satisfaction was measured. A blinded reviewer documented adverse events, either detected or missed. Results Of the 90 patients screened, 39 were randomized and 26 had complete follow-up. The mean cost of radiographs over the first 6 weeks was $44.51 (95% confidence interval [CI] 38.64–50.38) per patient in the experimental group, and $129.23 (95% CI 120.23–138.23) in the control group (p The mean time spent in clinic at 2 weeks was 46 min (95% CI 32–60) per patient for the experimental group and 68 min (95% CI 55–81) for the control group (p = 0.018). Two complications occurred in the experimental group. Both were detected clinically and did not qualify as missed events. Conclusion Implementing a simplified radiography protocol after stable fracture fixation saves time and money. Additionally, no adverse events were missed with the study protocol. Recommendations are made toward a noninferiority trial to establish protocol safety. PMID:28234590

  2. Radiographically Occult and Subtle Fractures: A Pictorial Review

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    Mohamed Jarraya

    2013-01-01

    Full Text Available Radiographically occult and subtle fractures are a diagnostic challenge. They may be divided into (1 “high energy trauma fracture,” (2 “fatigue fracture” from cyclical and sustained mechanical stress, and (3 “insufficiency fracture” occurring in weakened bone (e.g., in osteoporosis and postradiotherapy. Independently of the cause, the initial radiographic examination can be negative either because the findings seem normal or are too subtle. Early detection of these fractures is crucial to explain the patient’s symptoms and prevent further complications. Advanced imaging tools such as computed tomography, magnetic resonance imaging, and scintigraphy are highly valuable in this context. Our aim is to raise the awareness of radiologists and clinicians in these cases by presenting illustrative cases and a discussion of the relevant literature.

  3. Sensitivity and specificity of plain radiographic features of peripheral enthesopathy at major sites in psoriatic arthritis

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    Helliwell, P.S. [University of Leeds, Academic Unit of Musculoskeletal and Rehabilitation Medicine, Leeds (United Kingdom); Porter, G. [Airedale Hospital NHS Trust, Keighley, West Yorkshire (United Kingdom)

    2007-11-15

    It has been proposed that the defining difference between rheumatoid arthritis and spondyloarthropathy (including psoriatic arthritis) is the initial pathological lesion where the emphasis in psoriatic arthritis is on the enthesis and in rheumatoid arthritis on the synovium. Classical radiological descriptions of seronegative spondyloarthropathy include enthesopathy at major entheseal insertions characterised by erosions and exuberant new bone formation. In this study, the plain radiographic features of spondyloarthropathy are compared between psoriatic arthritis, other spondyloarthropathies and rheumatoid arthritis. The CASPAR study collected clinical, radiological and laboratory data on 588 patients with physician diagnosed psoriatic arthritis and 525 controls with other inflammatory arthritis, 70% of which had rheumatoid arthritis. Plain radiographs of the pelvis and heels were part of the study protocol, although radiographs of other potential entheseal sites such as the knee, elbow and shoulder, were interpreted if available. All radiographs were read blind by two observers working in tandem. Significant differences in entheseal erosion and entheseal new bone formation were found between psoriatic arthritis, ankylosing spondylitis, undifferentiated spondyloarthropathy, rheumatoid arthritis and other diagnoses (entheseal erosion, chi-squared 20.8, p = 0.008; entheseal new bone formation, chi-squared 24.5, p = 0.001). These differences were mainly due to a higher proportion of these features in ankylosing spondylitis. No differences in the plain radiographic features of enthesopathy were found between psoriatic arthritis and rheumatoid arthritis except in the case of entheseal new bone formation at sites of attachment of inguinal ligament, sartorius and rectus femoris muscles to the ilium (OR 3.01, 95% CI 1.13-8.02). Very few subjects with symptomatic heel involvement had radiographic changes and minimal differences were found between those with and without

  4. Plain film analysis of acetabular fracture

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Chang Soo; Han, Sang Suk; Yoon, Eu Giene; Cha, Seong Sook; Eun, Tchoong Kie; Chung, Duck Hwan [Inje Medical College Paik Hospital, Pusan (Korea, Republic of)

    1986-02-15

    Acetabular fracture can result in severe limitation of the motion of the hip joint, which supports total weight of human body. Because of different methods of surgical approach according to fracture type, precise interpretation of X-ray films of acetabular fracture is required. We reviewed 38 cases of simple X-ray films showing acetabular fracture. The results were as follows: 1. Almost 60% of the cases-were in their 2nd and 3rd decades. 2. Twenty cases were male, and 18 cases were female. 3. The most common cause of the injury was traffic accident (33 cases, 86.8%), followed by fall down (4 cases, 10.5%), and slip down (1 case, 2.7%). 4. Elementary fractures were 21 cases (55.3%), and associated fractures were 17 cases (44.7%). 5. Among elementary fractures, posterior wall fractures were 9 cases (23.7%), followed by anterior column fractures (8 cases, 21.1%), anterior wall fractures (4 cases, 10.5%). 6. Among associated fractures, T-shaped fractures were 8 cases (21.1%), followed by both column fractures (6 cases, 15.8%), anterior and hemitransverse fractures (3 cases, 7.8%). 7. Other pelvic bone fractures associated with the acetabular fracture were as follows: fractures of contralateral pubic rami (6 cases, 15.8%) contralateral iliac bone (1 case, 2.6%) and ipsilateral iliac bone (1 case, 2.6%). 8. Injuries of other organs adjacent to the acetabulum were as follows: rupture of the bladder (3 cases, 7.9%), urethra (2 cases, 5.3%) and uterus (1 cases, 2.6%)

  5. The role of plain radiographs in patients with acute abdominal pain at the ED

    NARCIS (Netherlands)

    van Randen, Adrienne; Lameris, Wytze; Luitse, Jan S. K.; Gorzeman, Michiel; Hesselink, Erik J.; Dolmans, Dennis E. J. G. J.; Peringa, Jan; van Geloven, Anna A. W.; Bossuyt, Patrick M.; Stoker, Jaap; Boermeester, Marja A.

    2011-01-01

    Objective: The purpose of this study was to evaluate the added value of plain radiographs on top of clinical assessment in unselected patients presenting with acute abdominal pain at the emergency department (ED). Methods: In a multicenter prospective trial, patients with abdominal pain more than 2

  6. The role of plain radiographs in patients with acute abdominal pain at the ED

    NARCIS (Netherlands)

    Randen, A. van; Lameris, W.; Luitse, J.S.; Gorzeman, M.; Hesselink, E.J.; Dolmans, D.E.; Peringa, J.; Geloven, A.A. van; Bossuyt, P.M.; Stoker, J.; Boermeester, M.A.; Gooszen, H.G.

    2011-01-01

    OBJECTIVE: The purpose of this study was to evaluate the added value of plain radiographs on top of clinical assessment in unselected patients presenting with acute abdominal pain at the emergency department (ED). METHODS: In a multicenter prospective trial, patients with abdominal pain more than 2

  7. Evaluation of a method of assessing faecal loading on plain abdominal radiographs in children

    Energy Technology Data Exchange (ETDEWEB)

    Leech, S.C.; Sullivan, P.B. [Dept. of Paediatrics, John Radcliffe Hospital, Oxford (United Kingdom); McHugh, K. [Department of Radiology, John Radcliffe Hospital, Oxford (United Kingdom)

    1999-04-01

    Background. Childhood constipation is common and assessment is often difficult. Plain abdominal radiography is simple and commonly used to assess constipation. The role of radiography with the use of a simple scoring system has not been fully evaluated. Objective. To assess the reliability of scoring faecal loading on plain abdominal radiographs in children with intractable constipation. Materials and methods. Plain abdominal radiographs from 33 constipated and 67 control children were independently assessed by three observers on two separate occasions. A scoring system was devised with scores from 0 (no stool) to 5 (gross faecal loading with bowel dilatation) in three areas of the colon, giving a total score of 0-15. Results. There were significant differences between the scores of the constipated and control radiographs for each observer (P = 0.05). There was no intra-observer variation (P = 0.12-0.69), but significant inter-observer variation was demonstrated (P = 0.00). Conclusions. We have found this scoring system to be a clinically useful and a reproducible tool in assessing childhood constipation. Assessment of faecal loading is subjective and varies between observers, although one observer will consistently score faecal loading on the same radiograph on successive occasions. To limit exposure to ionising radiation, we recommend that radiography be reserved for the investigation of intractable constipation, and its accuracy is improved if all radiographs are scored by the same observer. (orig.) With 2 figs., 1 tab., 14 refs.

  8. Radiographic Measurement of Displacement in Acetabular Fractures: A Systematic Review of the Literature.

    Science.gov (United States)

    Dodd, Andrew; Osterhoff, Georg; Guy, Pierre; Lefaivre, Kelly A

    2016-06-01

    To report methods of measurement of radiographic displacement and radiographic outcomes in acetabular fractures described in the literature. A systematic review of the English literature was performed using EMBASE and Medline in August 2014. Inclusion criteria were studies of operatively treated acetabular fractures in adults with acute (fractures managed >6 weeks from injury, acute total hip arthroplasty, periprosthetic fractures, time frame of radiographic outcomes not stated, missing radiographic outcome data, and non-English language articles. Basic information collected included journal, author, year published, number of fractures, and fracture types. Specific data collected included radiographic outcome data, method of measuring radiographic displacement, and methods of interpreting or categorizing radiographic outcomes. The number of reproducible radiographic measurement techniques (2/64) and previously described radiographic interpretation methods (4) were recorded. One radiographic reduction grading criterion (Matta) was used nearly universally in articles that used previously described criteria. Overall, 70% of articles using this criteria documented anatomic reductions. The current standard of measuring radiographic displacement in publications dealing with acetabulum fractures almost universally lacks basic description, making further scientific rigor, such as testing reproducibility, impossible. Further work is necessary to standardize radiographic measurement techniques, test their reproducibility, and qualify their validity or determine which measurements are important to clinical outcomes. Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  9. Radiographic predictors of compartment syndrome in tibial plateau fractures.

    Science.gov (United States)

    Ziran, Bruce H; Becher, Stephen John

    2013-11-01

    The purpose of this article was to evaluate the relationship of radiographic features of tibial plateau fractures to the development of compartment syndrome. We hypothesized that the direction and degree of initial displacement of the femur on the tibia, and the amount of tibial widening (TW), were correlated with the development of compartment syndrome. Retrospective case-control study. Single level 1 trauma center. Retrospective evaluation of 158 patients with 162 plateau fractures. Grouping with and without compartment syndrome. The following data were obtained: age, sex, Schatzker and OTA/AO classification, open/closed status, TW, and femoral displacement (FD). A univariate statistical and a logistical regression analysis were performed to determine significance. The overall rate of compartment syndrome was 11%. Univariate analysis found both the TW and FD to be significant with respect to development of compartment syndrome (P compartment syndrome. Logistic regression found FD and Schatzker grade to be significant. Our study is the first to identify easily obtained radiographic parameters that correlate to the occurrence compartment syndrome. There may also be a relationship between TW and FD, as noted by regression result. This study helps to assess which patients with a fracture are at higher risk for developing a compartment syndrome. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

  10. MRI of pediatric growth plate injury: correlation with plain film radiographs and clinical outcome

    Energy Technology Data Exchange (ETDEWEB)

    Carey, J.; Spence, L.; Blickman, H.; Eustace, S. [Medical Center, Boston, MA (United States). Dept. of Radiol.

    1998-05-01

    Purpose. To evaluate pediatric growth plate injuries with conventional radiographs and magnetic resonance imaging (MRI). To review potential clinical impact of MRI on subsequent patient management and outcome. Methods. Fourteen patients with known or suspected growth plate injury were studied. Each patient underwent imaging by conventional radiography and MRI within 2 weeks of injury. Findings on conventional radiographs and on MR images were compared and then correlated with subsequent management and outcome at a mean of 12 months. Results. Direct visualization of cartilage afforded by MRI improved evaluation of growth plate injury in each case. MRI changed Salter Harris classification or staging in 2 of 9 patients with fractures visualized on conventional radiographs, allowed the detection of radiographically occult fractures in 5 of 14 cases, and resulted in a physical change in management in 5 of the 14 patients studied. Conclusion. MRI has an important role in the evaluation of acute pediatric growth plate injury, particularly when diagnostic uncertainty persists following the evaluation of conventional radiographs. MRI allows detection of occult fractures, may alter Salter Harris staging, and in the reported study it frequently resulted in a change in patient management. (orig.) With 4 figs., 1 tab., 20 refs.

  11. Ankylosing spondylitis complicated by trauma: MR findings correlated with plain radiographs and CT

    Energy Technology Data Exchange (ETDEWEB)

    Goldberg, A.L. (Dept. of Diagnostic Radiology, Allegheny General Hospital, Pittsburgh, PA (United States) Medical Coll. of Pennsylvania, Pittsburgh, PA (United States)); Keaton, N.L. (Dept. of Diagnostic Radiology, Allegheny General Hospital, Pittsburgh, PA (United States) Medical Coll. of Pennsylvania, Pittsburgh, PA (United States)); Rothfus, W.E. (Dept. of Diagnostic Radiology, Allegheny General Hospital, Pittsburgh, PA (United States) Medical Coll. of Pennsylvania, Pittsburgh, PA (United States)); Daffner, R.H. (Dept. of Diagnostic Radiology, Allegheny General Hospital, Pittsburgh, PA (United States) Medical Coll. of Pennsylvania, Pittsburgh, PA (United States))

    1993-01-01

    Four patients with ankylosing spondylitis sustained a traumatic spinal injury. In three cases, pseudoarthrosis developed at the discovertebral junction, while involvement of the neural arch occurred in the fourth. Although the diagnosis of ankylosing spondylitis was readily established on plain radiographs, magnetic resonance more effectively indentified the complicating injury and in two cases demonstrated the presence of cord compression. Computed tomography was also contributory in delineating bony and ligamentous abnormalities of the neural arch. (orig.)

  12. Prediction models of prevalent radiographic vertebral fractures among older men.

    Science.gov (United States)

    Schousboe, John T; Rosen, Harold R; Vokes, Tamara J; Cauley, Jane A; Cummings, Steven R; Nevitt, Michael C; Black, Dennis M; Orwoll, Eric S; Kado, Deborah M; Ensrud, Kristine E

    2014-01-01

    No studies have compared how well different prediction models discriminate older men who have a radiographic prevalent vertebral fracture (PVFx) from those who do not. We used area under receiver operating characteristic curves and a net reclassification index to compare how well regression-derived prediction models and nonregression prediction tools identify PVFx among men age ≥65 yr with femoral neck T-score of -1.0 or less enrolled in the Osteoporotic Fractures in Men Study. The area under receiver operating characteristic for a model with age, bone mineral density, and historical height loss (HHL) was 0.682 compared with 0.692 for a complex model with age, bone mineral density, HHL, prior non-spine fracture, body mass index, back pain, grip strength, smoking, and glucocorticoid use (p values for difference in 5 bootstrapped samples 0.14-0.92). This complex model, using a cutpoint prevalence of 5%, correctly reclassified only a net 5.7% (p = 0.13) of men as having or not having a PVFx compared with a simple criteria list (age ≥ 80 yr, HHL >4 cm, or glucocorticoid use). In conclusion, simple criteria identify older men with PVFx and regression-based models. Future research to identify additional risk factors that more accurately identify older men with PVFx is needed.

  13. Lateralized odontoid in plain film radiography. Sign of fractures? A comparison study with MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Keller, S.; Bieck, K.; Karul, M.; Schoennagel, B.; Adam, G.; Habermann, C.; Yamamura, J. [University Hospital Hamburg Eppendorf (Germany). Dept. of Diagnostic and Interventional Radiology

    2015-09-15

    To evaluate X-ray standards for the detection of odontoid fractures. Summary of background data: Cervical spine fractures are a common finding in emergency medicine, accounting for 1 - 3 % of injuries. Involvement of the C1 / C2 complex is found in 25 % of cases, affecting the odontoid peg in 55 - 80 %. Regarding the consequences of missed fractures, radiographic techniques built the groundwork for further treatment procedures. As standardized X-ray measurements have not been established, the incidence of unrecognized cervical spine fracture is expected to be up to 20 %. The establishment of X-ray-based guidelines is also limited by the presumed low specificity and sensitivity of distance measurements caused by rotational distortion which leads to a rising popularity of CT. 79 (age 60 ± 26 yrs) patients with lateralization of the odontoid process on conventional plain film radiography (anteroposterior, lateral, and open mouth odontoid process view projection) were examined. The distance between the odontoid process and lateral mass of C1, angles of vertical odontoid line and basis of C2 were measured in the ap view. In the lateral view, dorsal alignment and atlantodental distance were assessed. MDCT examinations were used as a reference. Discriminatory power test was applied to assess significance. 8/79 (10.1 %) odontoid process fractures were found. Diagnosis was achieved on conventional radiographs in 6 patients. Neither distance and angle measurements between odontoid and C1 nor the dorsal alignment of the vertebral bodies differed significantly between healthy and affected patients. Decentralization of the odontoid process is not necessarily an indirect sign for its fracture. In patients with suspected injury of the odontoid process, an MDCT scan might be the method of choice to rule out a fracture.

  14. Reliability of the radiographic union scale in tibial fractures (RUST

    Directory of Open Access Journals (Sweden)

    Fernando Antonio Silva de Azevedo Filho

    Full Text Available ABSTRACT OBJECTIVE: This study aimed to evaluate the inter- and intra observer reproducibility of the radiographic score of consolidation of the tibia shaft fractures. METHODS: Fifty-one sets of radiographs in anteroposterior (AP and profile (P of the tibial shaft treated with intramedullary nail were obtained. The analysis of X-rays was performed in two stages, with a 21-day interval between assessments by a group of nine evaluators. To evaluate the reproducibility of RUST score between the evaluators, the intra-class correlation coefficient (ICC with a 95% confidence interval was used. ICC values range from +1, representing perfect agreement, to -1, complete disagreement. RESULTS: There was a significant correlation among all evaluators: ICC = 0.87 (95% CI 0.81 to 0.91. The intraobserver agreement proved to be substantial with ICC = 0.88 (95% CI 0.85 to 0.91 . CONCLUSION: This study confirms that the RUST scale shows a high degree of reliability and agreement.

  15. Plain radiographic, nuclear medicine and angiographic observations of hepatogenic pulmonary angiodysplasia

    Energy Technology Data Exchange (ETDEWEB)

    Sang Oh, K.; Bender, T.M.; Bowen, A.D.; Ledesma-Medina, J.

    1983-05-01

    Clinical and radiological findings of hepatogenic pulmonary angiodysplasia are reported in two cases. Myriad spidery pulmonary blood vessles are seen on plain radiographs and verified with right to left intrapulmonary shunting on pulmonary angiogram and pulmonary isotopic perfusion scan. Pathophysiology and differential diagnosis are discussed. We propose the medical term ''pulmonary angiodysplasia'' to include: 1) Pulmonary telangiectasia 2) Hereditary hemorrhagic telangiectasia (Osler-Rendu-Weber syndrome) 3) Classical discrete pulmonary arteriovenous fistula 4) Hepatogenic discrete pulmonary angiodysplasia: pulmonary arteriovenous communications with right to left shunting secondary to hepatic cirrhosis.

  16. Radiographic factors and effect of fifth metatarsal Jones and diaphyseal stress fractures on participation in the NFL.

    Science.gov (United States)

    Carreira, Dominic S; Sandilands, Scott M

    2013-04-01

    Jones fracture and proximal diaphyseal stress fracture of the fifth metatarsal have been associated with prolonged healing times and nonunions. We hypothesized that the Jones fracture and proximal diaphyseal stress fracture have a high incidence in elite collegiate football players and that they lead to a decrease in participation in the NFL. Also, we hypothesized that these fractures are associated with a cavovarus foot alignment. The database collected by a single NFL team during the 2004 to 2009 NFL Combines was reviewed to identify players with Jones and proximal diaphyseal fifth metatarsal fractures. A total of 74 fifth metatarsal fractures were identified in 68 players. Subsequent participation data also were collected through the NFL.com website and included games played and years played. Digital plain radiographs and additional imaging studies also were reviewed to determine the extent of healing, types of fixation utilized, and foot alignment. The locations of fractures in the proximal fifth metatarsal were 45 (61%) in the Jones area, 15 (20%) in the proximal diaphyseal area, and 14 (19%) of indeterminate location. The number of patients treated with intramedullary fixation was 55/74 (74%). Of 74 proximal fifth metatarsal fractures, 9 (12.2%) were nonunions at the time of the NFL Combine medical examinations. With the numbers available, the average number of games played in the NFL was not significantly different in the fifth metatarsal fracture group, 16.9, compared to the control group, 24.9 (P > .05). The average number of games started was 7.4 in the fracture group versus 12.1 in the control group (P > .05). No significant differences were noted in the number of years played in the NFL. Except for talonavicular angle measurements, all measurements of coronal plane alignment demonstrated significant differences across groups, but no differences were noted in sagittal plane alignment. No statistically significant difference was noted in participation in

  17. Postoperative radiographs following hip fracture surgery. Do they influence patient management?

    Science.gov (United States)

    Chakravarthy, J; Mangat, K; Qureshi, A; Porter, K

    2007-03-01

    There is still much debate on the appropriateness of taking postoperative radiographs following hip fracture surgery. In our unit, it is routine practice to request postoperative radiographs after hip hemiarthroplasty but not after internal fixation. An audit conducted in our unit highlighted the low acute implant-related complications. This prompted us to conduct a national audit on current UK practice regarding the use of check radiographs following hip fracture surgery. Retrospective case note review of all patients undergoing hip fracture surgery at our hospital, from 2002 to 2004, was performed. Patients undergoing revision surgery in the same admission were identified to determine whether check radiograph influenced the decision. Subsequently a postal performa was sent to 450 randomly chosen UK Orthopaedic Consultants. The performa was designed to determine practice relating to postoperative radiographs. It also attempted to determine whether postoperative radiographs (when requested) influenced the subsequent clinical management of the patient. A total of 1265 hip fractures treated surgically were reviewed locally. Average length of stay was 29.5 days. There were five acute implant-related complications. One revision was performed for a long hip screw which was obvious on the intra-operative image intensifier films. Only one decision to revise (because of incongruous reduction of a hip hemiarthroplasty) was based on a problem identified on a routine check radiograph. All patients undergoing revision were clinically symptomatic. We received 300 responses. Ninety-six per cent routinely took postoperative radiographs following hip hemiarthroplasty of which 83% allowed the patient to mobilise before checking the radiograph. Following dynamic hip screw (DHS)/dynamic condylar screw (DCS) fixation, 61% took check radiographs of which 75% allowed the patient to mobilise prior to reviewing the radiograph. Following cannulated screw (CS) fixation, 58% routinely

  18. Conventional radiographic examination in the evaluation of sequelae after tibial plateau fractures

    Energy Technology Data Exchange (ETDEWEB)

    Jensen, D.B.; Bjerg-Nielsen, A.; Laursen, N.

    1988-07-01

    Seventy patients with 72 conservatively treated tibial plateau fractures were re-examined after an average of 5 3/4 years. Among 55 fractured knees with a primary articular depression of 1-20 mm, the depression was still present radiographically in 47 knees. No correlation existed between the persistent radiographic depression and function of the knee. Moderate to severe osteoarthrosis was found in 10 knees; in five of these the osteoarthrosis was of clinical importance. More than 10 degrees of valgus/varus deformity was present in two knees. In two patients osteotomy had been performed to correct deformity. It is concluded that a persistent radiographic articular depression is of no clinical importance in tibial plateau fractures treated by conservative methods, which include early movement of the knee. The radiographic examination, however is, useful in the evaluation of valgus/varus deformity and osteoarthrosis.

  19. Does sitting versus standing radiographic assessment of odontoid fractures matter? A case report.

    Science.gov (United States)

    Aleem, Ilyas S; Gussous, Yazeed; King, Michael; Fogelson, Jeremy; Nassr, Ahmad; Currier, Bradford L

    2017-06-01

    Fractures of the odontoid are the most common cervical spine injury in the geriatric population. The relationship between odontoid fracture displacement and postural change has not been previously described. We present the first described case of an elderly female patient with thoracic kyphosis and a type II odontoid fracture demonstrating significant fracture displacement with a postural change from sitting to standing. Various radiographic parameters are assessed and discussed in an attempt to characterize and explain this finding. We highlight the importance of regional and global spinal alignment and quantify physiologic odontoid fracture behavior with postural changes in this growing demographic. Upright radiographs in both sitting and standing positions may be considered when concern for odontoid fracture stability is questioned.

  20. The plain beta-angle measured on radiographs in the assessment of femoroacetabular impingement.

    Science.gov (United States)

    Brunner, A; Hamers, A T; Fitze, M; Herzog, R F

    2010-09-01

    The beta-angle is a radiological tool for measuring the distance between the pathological head-neck junction and the acetabular rim with the hip in 90 degrees of flexion in patients with femoroacetabular impingement. Initially it was measured using an open-chamber MRI. We have developed a technique to measure this angle on plain radiographs. Correlation analysis was undertaken to determine the relationship between the range of movement and the beta-angle in 50 patients with femoroacetabular impingement and 50 asymptomatic control subjects. Inter- and intra-observer reliability of the beta-angle was also evaluated. Patients with femoroacetabular impingement had a significantly smaller (p angle (15.6 degrees, 95% confidence interval (CI) 13.3 to 17.7) compared with the asymptomatic group (38.7 degrees, 95% CI 36.5 to 41.0). Correlation between internal rotation and the beta-angle was high in the impingement group and moderate in the asymptomatic group. The beta-angle had excellent inter- and intra-observer reliability in both groups. Our findings suggest that the measurement of the beta-angle on plain radiography may represent a valid, reproducible and cost-effective alternative to open MRI in the assessment of the pathological bony anatomy in patients with cam, pincer and mixed femoroacetabular impingement.

  1. Accuracy of radiographs in assessment of displacement in lateral humeral condyle fractures.

    Science.gov (United States)

    Knutsen, Ashleen; Avoian, Tigran; Borkowski, Sean L; Ebramzadeh, Edward; Zionts, Lewis E; Sangiorgio, Sophia N

    2014-02-01

    Determining the magnitude of displacement in pediatric lateral humeral condyle fractures can be difficult. The purpose of this study was to (1) assess the effect of forearm rotation on true fracture displacement using a cadaver model and to (2) determine the accuracy of radiographic measurements of the fracture gap. A non-displaced fracture was created in three human cadaveric arms. The specimens were mounted on a custom apparatus allowing forearm rotation with the humerus fixed. First, the effect of pure rotation on fracture displacement was simulated by rotating the forearm from supination to pronation about the central axis of the forearm, to isolate the effects of muscle pull. Then, the clinical condition of obtaining a lateral oblique radiograph was simulated by rotating the forearm about the medial aspect of the forearm. Fracture displacements were measured using a motion-capture system (true-displacement) and clinical radiographs (apparent-displacement). During pure rotation of the forearm, there were no significant differences in fracture displacement between supination and pronation, with changes in displacement of <1.0 mm. During rotation about the medial aspect of the forearm, there was a significant difference in true displacements between supination and pronation at the posterior edge (p < 0.05). Overall, true fracture displacement measurements were larger than apparent radiographic displacement measurements, with differences from 1.6 to 6.0 mm, suggesting that the current clinical methods may not be sensitive enough to detect a displacement of 2.0 mm, especially when positioning the upper extremity for an internal oblique lateral radiograph.

  2. Do radiographic indices of distal radius fracture reduction predict outcomes in older adults receiving conservative treatment?

    Energy Technology Data Exchange (ETDEWEB)

    Jaremko, J.L. [Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta (Canada); Lambert, R.G.W. [Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta (Canada); Rowe, B.H. [Department of Emergency Medicine, University of Alberta, Edmonton, Alberta (Canada); Department of Public Health Sciences, University of Alberta, Edmonton, Alberta (Canada); Johnson, J.A. [Department of Public Health Sciences, University of Alberta, Edmonton, Alberta (Canada); Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta (Canada); Majumdar, S.R. [Department of Public Health Sciences, University of Alberta, Edmonton, Alberta (Canada) and Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta (Canada)]. E-mail: me2.majumdar@ualberta.ca

    2007-01-15

    Aim: To investigate whether radiographic deformities suggesting inadequate reduction would be associated with adverse clinical outcomes. Materials and methods: Consecutive patients over 50 years of age (n = 74) with non-operatively managed distal radius fractures were enrolled in a prospective cohort study. They had radiographs at cast removal ({approx}6 weeks) and completed DASH (Disabilities of the Arm, Shoulder and Hand), SF-12 (health-related quality of life), and satisfaction surveys 6-months post-fracture. A reference-standard musculoskeletal radiologist, blinded to outcomes status, measured palmar (dorsal) tilt, radial angle, radial height, ulnar height, and intra-articular step and gap. Radiographic indices were correlated to each other and to the various patient-reported outcomes in univariate and multivariate regression analyses. DASH score was the primary study outcome. Results: Of the cohort studied (n = 74, mean age 68.5 years, primarily white women), 71% had at least one 'unacceptable' radiographic deformity by traditional criteria. Acceptable reduction varied from 60-99% depending on which single index was reported, and 44% of patients had more than two indices reported as unacceptable. Despite these radiographic findings, 6-months post-reduction, self-reported disability was low (DASH = 24 {+-} 17), health-related quality of life was near normal, and 72% were satisfied with their care. No radiographic index of wrist deformity (alone or in combination) was significantly correlated to any of the patient-reported outcomes. Conclusion: Self-reported outcomes in older adults with conservatively managed wrist fractures were not related to the 'acceptability' of radiographic fracture reduction. The proportion of acceptable reductions varied by 40% depending on which index was reported. Consequently, detailed reporting of these indices in older adults with distal radius fracture may be inefficient or perhaps even unnecessary.

  3. A careful evaluation of scout CT lateral radiograph may prevent unreported vertebral fractures

    Energy Technology Data Exchange (ETDEWEB)

    Bazzocchi, Alberto; Spinnato, Paolo [Imaging Division, Clinical Department of Radiological and Histocytopathological Sciences, University of Bologna, Sant’Orsola – Malpighi Hospital, Via Massarenti 9, 40138 Bologna (Italy); Albisinni, Ugo [Department of Radiology, Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136 Bologna (Italy); Battista, Giuseppe [Imaging Division, Clinical Department of Radiological and Histocytopathological Sciences, University of Bologna, Sant’Orsola – Malpighi Hospital, Via Massarenti 9, 40138 Bologna (Italy); Rossi, Cristina [Section of Radiological Sciences, Department of Clinic Sciences, University of Parma, Via Gramsci 14, 43100 Parma (Italy); Guglielmi, Giuseppe, E-mail: g.guglielmi@unifg.it [Department of Radiology, University of Foggia, Viale Luigi Pinto 1, 71100 Foggia (Italy); Department of Radiology, Scientific Institute “Casa Sollievo della Sofferenza” Hospital, Viale Cappuccini 1, 71013 San Giovanni Rotondo, Foggia (Italy)

    2012-09-15

    Objectives: Our purpose was to review scout CT lateral radiographs to reveal osteoporotic vertebral fractures unreported by radiologists and to explore scout CT as a potential diagnostic tool in the detection of vertebral fractures. Methods: We considered 500 patients (303 males, 197 females, age 64.6 ± 13.5 year-old). Our investigation was firstly focused on scout CT lateral images to detect vertebral fractures with a combined semiquantitative and quantitative diagnostic approach. Findings addressed to vertebral fracture were subsequently confirmed by multiplanar sagittal CT reconstructions. Whenever a vertebral fracture was discovered the radiologist report was read and a collection of patient anamnesis followed to understand whether fractures were already known. Results: In 44/500 patients (8.8%) the evaluation on scout CT was incomplete or limited for patient/technical-based conditions, and 15 were excluded from the analysis. In 67/485 patients (13.8%) 99 vertebral fractures were detected. Among 67 fractured patients only 18 (26.9%) were previously diagnosed by radiologists. However, in the clinical history of 32 patients vertebral fractures were already known. Conclusions: The perception and sensibility to vertebral fractures among radiologists are still poor when the assessment of the spine is not the aim of the examination. Short time spent for the evaluation of scout CT lateral radiographs could improve our accuracy.

  4. Reliability of Radiographic Assessments of Adolescent Midshaft Clavicle Fractures by the FACTS Multicenter Study Group.

    Science.gov (United States)

    Li, Ying; Donohue, Kyna S; Robbins, Christopher B; Pennock, Andrew T; Ellis, Henry B; Nepple, Jeffrey J; Pandya, Nirav; Spence, David D; Willimon, Samuel Clifton; Heyworth, Benton E

    2017-09-01

    There is a recent trend toward increased surgical treatment of displaced midshaft clavicle fractures in adolescents. The primary purpose of this study was to evaluate the intrarater and interrater reliability of clavicle fracture classification systems and measurements of displacement, shortening, and angulation in adolescents. The secondary purpose was to compare 2 different measurement methods for fracture shortening. This study was performed by a multicenter study group conducting a prospective, comparative, observational cohort study of adolescent clavicle fractures. Eight raters evaluated 24 deidentified anteroposterior clavicle radiographs selected from patients 10-18 years of age with midshaft clavicle fractures. Two clavicle fracture classification systems were used, and 2 measurements for shortening, 1 measurement for superior-inferior displacement, and 2 measurements for fracture angulation were performed. A minimum of 2 weeks after the first round, the process was repeated. Intraclass correlation coefficients were calculated. Good to excellent intrarater and interrater agreement was achieved for the descriptive classification system of fracture displacement, direction of angulation, presence of comminution, and all continuous variables, including both measurements of shortening, superior-inferior displacement, and degrees of angulation. Moderate agreement was achieved for the Arbeitsgemeinschaft für Osteosynthesefragen classification system overall. Mean shortening by 2 different methods were significantly different from each other (P < 0.0001). Most radiographic measurements performed by investigators in a multicenter, prospective cohort study of adolescent clavicle fractures demonstrated good-to-excellent intrarater and interrater reliability. Future consensus on the most accurate and clinically appropriate measurement method for fracture shortening is critical.

  5. Outcome after pin fixation of supracondylar humerus fractures in children: postoperative radiographic examinations are unnecessary

    Science.gov (United States)

    Tuomilehto, Noora; Kivisaari, Reetta; Sommarhem, Antti; Nietosvaara, Aarno Y

    2017-01-01

    Background and purpose — The quality of pin fixation of displaced supracondylar humerus fractures in children has not been assessed, and the clinical value of radiographic examinations after pin fixation is unclear. We evaluated pin configuration, quality of osteosynthesis, and outcome in 264 supracondylar fractures. The clinical significance of postoperative radiographs was analyzed. Patients and methods — 252 Gartland-III and 12 flexion-type supracondylar humerus fractures were pin-fixed in the periods 2002–2006 and 2012–2014. During 2012–2014, staff were intructed that postoperative radiographs should not be taken. Quality of reduction was assessed by measuring Baumann and lateral capitellohumeral angles (LCHA) and also by recording the crossing point of the anterior humeral line (AHL) with bony capitellum. Rotatory alignment was registered as normal or abnormal. Pin configuration and quality of osteosynthesis were evaluated. The clinical significance of postoperative radiographs was analyzed. Results — Postoperatively, Baumann angle was normal in 66% of the fractures, AHL crossed the capitellum in 84%, and no malrotation was evident in 85% of the fractures. Crossed pins were used in 89% of the cases. 2 or more pins fixed both fracture fragments in 66%. Radiographic examinations were inadequate for assessment of LCHA in 13%, of Bauman angle in 8%, of AHL in 2%, of rotation in 1%, and of pin fixation in 2% of the cases. Postoperative radiographs did not give useful information except in 1 patient who had corrective osteotomy. All 94 patients with follow-up (97%) who were treated during 2012–2014 were satisfied with the outcome. Interpretation — Despite pin fixation being deemed unsatisfactory in one-third of the cases, significant malunion was rare. Postoperative radiography did not alter management or outcome. PMID:27774833

  6. Radiographic classification for fractures of the fifth metatarsal base

    DEFF Research Database (Denmark)

    Mehlhorn, Alexander T; Zwingmann, Jörn; Hirschmüller, Anja

    2014-01-01

    OBJECTIVE: Avulsion fractures of the fifth metatarsal base (MTB5) are common fore foot injuries. Based on a radiomorphometric analysis reflecting the risk for a secondary displacement, a new classification was developed. MATERIALS AND METHODS: A cohort of 95 healthy, sportive, and young patients ......: Radiomorphometric data may identify fractures at risk for secondary displacement of the MTB5. Based on this, a reliable classification was developed.......OBJECTIVE: Avulsion fractures of the fifth metatarsal base (MTB5) are common fore foot injuries. Based on a radiomorphometric analysis reflecting the risk for a secondary displacement, a new classification was developed. MATERIALS AND METHODS: A cohort of 95 healthy, sportive, and young patients...... (age ≤ 50 years) with avulsion fractures of the MTB5 was included in the study and divided into groups with non-displaced, primary-displaced, and secondary-displaced fractures. Radiomorphometric data obtained using standard oblique and dorso-plantar views were analyzed in association with secondary...

  7. The utility of the plain radiograph ''shunt series'' in the evaluation of suspected ventriculoperitoneal shunt failure in pediatric patients

    Energy Technology Data Exchange (ETDEWEB)

    Desai, Kapil R.; Babb, James S.; Amodio, John B. [New York University School of Medicine, Department of Radiology, Pediatric Radiology Section, New York, NY (United States)

    2007-05-15

    To our knowledge, the sensitivity of plain radiography, known as the shunt series, in diagnosing an etiology of ventriculoperitoneal (VP) shunt malfunction in children has not been previously investigated. To determine the accuracy of plain radiography in diagnosing VP shunt failure in children in whom shunt malfunction is clinically suspected. We retrospectively reviewed the charts of 238 children who had undergone plain radiographic examination for evaluation of clinically suspected VP shunt failure over a 5-year period. The results were compared with those of CT, MRI, and nuclear cisternography. Just 6.72% of patients demonstrated plain radiographic signs of shunt failure. Of patients with normal plain radiographs, 43% demonstrated shunt abnormalities on CT, MRI or cisternography. Statistical analysis indicated that no more than 10.46% (P < 0.05) of plain radiographs showed signs of failure and that the sensitivity of plain radiography for the detection of VP shunt failure is no higher than 31%. Furthermore, there was poor agreement between the results of plain radiography and those of CT, MRI and cisternography. Children with clinically suspected VP shunt failure should proceed directly to cross-sectional or nuclear imaging, as plain radiographic examinations have low sensitivity and significant false-negative rates for detecting shunt abnormalities in all-comers. Use of the shunt series should be limited to patients who specifically have suspected mechanical causes of shunt failure. (orig.)

  8. Fracture of the distal radius: epidemiology and premanagement radiographic characterization.

    Science.gov (United States)

    Porrino, Jack A; Maloney, Ezekiel; Scherer, Kurt; Mulcahy, Hyojeong; Ha, Alice S; Allan, Christopher

    2014-09-01

    Fractures of the distal radius are common and frequently encountered by the radiologist. We review the epidemiology, classification, as well as the concept of instability. Salient qualitative and quantitative features of the distal radius fracture identifiable on the routine radiography series are highlighted. We conclude with a synopsis of descriptors that are of greatest utility to the clinician for treatment planning and that should be addressed in the radiology report. A detailed understanding of the intricacies of the distal radius fracture is necessary for the radiologist to provide a clinically relevant description.

  9. Association of the presence of bone bars on radiographs and hip fracture in postmenopausal Caucasian women.

    Science.gov (United States)

    Sarver, D B; Lopez-Ben, R; Morgan, S L; Rehder, D; Duke, J N; Fineberg, N; Pitt, M J

    2012-09-01

    To determine whether the presence of bone bars (BB) identified on anteroposterior hip radiographs are more prevalent in patients that have had a hip fracture as compared to patients without a fracture. Ninety-two Caucasian women with a unilateral proximal femur fracture were retrospectively evaluated and randomly selected using radiology database records to comprise the investigational group. Ninety-eight age-matched Caucasian women without hip fracture were selected as a control group. Anteroposterior hip radiographs were evaluated for the presence of BBs by two musculoskeletal radiologists. Chi-square tests were used to assess whether fractures were more prevalent in patients with BB than those without BB. The patient population was comprised Caucasian women with a mean age of 79.8 ± 6.4 years in the control group and 79.9 ± 6.6 years in the investigational group. Regardless of the reader, BB were identified in a significantly higher percentage of women with a fracture (75 versus 39%, p fracture. BB are associated with hip fracture. Their presence is a trigger for requesting a dual-energy x-ray absorptiometry (DXA) examination to confirm or refute a diagnosis of low bone mineral density (BMD) and a subsequent increased risk of fracture. Copyright © 2012 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  10. Characteristic plain radiographic and intravenous urographic findings of bladder calculi formed over a hair nidus: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hak Jong; Kim, Seung Hyup [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2000-03-01

    We present the characteristic plain radiographic and intravenous urographic (IVU) findings of calculus formed over a hair. A 66-year-old man who had been quadriplegic for 40 years because of vertebral injury was admitted for further evaluation of frequent urinary tract infection. Plain radiography showed a linear, serpiginous calcification in the lower abdomen, and IVU revealed a round filling defect with linear radiopacity in the bladder, suggesting calculus. The gross appearance of the stone after extraction demonstrated that calcification had formed over a hair.

  11. Radiographic Evaluation During Treatment of Pediatric Forearm Fractures: Implications on Clinical Care and Cost.

    Science.gov (United States)

    Luther, Gaurav; Miller, Patricia; Waters, Peter M; Bae, Donald S

    2016-01-01

    As ≥30% of displaced pediatric forearm fractures demonstrate loss of reduction (LOR) following closed reduction (CR); radiographic follow-up is advocated at 1, 2, 4, and 6 weeks for detection of redisplacement. We hypothesized that there is minimal change in fracture alignment 2 weeks after CR, and consequently, that radiographs at 4 weeks add cost but little value to clinical care. A total of 184 patients enrolled in a prospective study of pediatric forearm fractures including both distal and diaphyseal injuries were evaluated. All were treated with CR, casting, and radiographic evaluation at 1, 2, 4, and 6 weeks postinjury. Primary endpoint was radiographic LOR. Secondary endpoint was need for any intervention. A modified number-needed to treat analysis estimated the utility of the week 4 x-ray in predicting intervention. Relative value unit (RVU) costing, time-derived activity-based costing (TDABC), and billing totals were used for cost analysis. Seventy patients (38%) demonstrated radiographic LOR. Independent predictors of LOR were initial radius displacement >75% (OR=5.40; CI, 2.23-12.60), concomitant ulna fracture (OR=1.71; CI, 1.15-2.54), and dominant arm involvement (OR=2.87; CI, 1.40-5.87). Eighty percent of all LORs occurred within the first 2 weeks. There was no statistically significant change in radiographic alignment after week 2. Of 40 total interventions, all were performed within the first 2 weeks of follow-up. The 4-week x-ray did not influence decision to intervene, and at most, 1 in every 40 patients would require an intervention after week 2. Elimination of the 4-week x-ray would result in a savings of 4.8% (RVU method) to 11.9% (TDABC method) in the overall cost of nonoperative fracture care. There is minimal change in fracture alignment 2 weeks following CR of pediatric forearm fractures, and all interventions are based on early radiographic follow-up. The week 4 x-ray adds little value to clinical decision making, and its elimination

  12. Long-term radiographic follow-up of bisphosphonate-associated atypical femur fractures

    Energy Technology Data Exchange (ETDEWEB)

    Favinger, Jennifer L. [University of Washington, Department of Radiology, 1959 N.E. Pacific Street, Box 357115, Seattle, WA (United States); Hippe, Daniel [University of Washington, Department of Radiology, Seattle, WA (United States); Ha, Alice S. [University of Washington, Department of Radiology, 4245 Roosevelt Way NE, Box 354755, Seattle, WA (United States)

    2016-05-15

    To evaluate the appearance of bisphosphonate-related femur insufficiency fractures on long-term follow-up radiographic studies and to describe the rate of fracture line obscuration and cortical beak healing over time. In this retrospective study, bisphosphonate-related femur fracture radiographs were reviewed by two radiologists for the presence of a fracture line, callus, and the characteristic cortical beak. Kaplan-Meier curves were used to analyze the time to first indication of healing. Femurs were also subdivided into those who underwent early versus late surgical fixation and those who underwent early versus late discontinuation of bisphosphonate. Clinical data including pain level and medication history were collected. Forty-seven femurs with a bisphosphonate-related femur fracture were identified in 28 women. Eighty-five percent took a bisphosphonate for greater than 5 years and 59 % for greater than 10 years. The median time to beak healing was 265 weeks and the median time to fracture line healing was 56 weeks in the 31 femurs with a baseline fracture. No statistically significant difference was identified between surgical fixation and conservative management. Bisphosphonate-related fractures demonstrate notably prolonged healing time on long-term follow-up. (orig.)

  13. Case Report of Multimodality Imaging in Omental Cake: Plain Radiograph, Computed Tomography, and Ultrasonography: A Care-Compliant Article.

    Science.gov (United States)

    Juan, Yu-Hsiang; Cheung, Yun-Chung; Ng, Koon-Kwan; Ng, Shu-Hang; Huang, Jen-Seng; Chang, Liang-Che; Lin, Yu-Ching

    2015-11-01

    The imaging finding of omental cake has been demonstrated in other modalities, such as computed tomography, magnetic resonance imaging, and ultrasonography. However, to the best of our knowledge, the image presentation of omental cake on a routine kidney-ureter-bladder film has not been reported before in the literature. We presented a unique case of a 61-year-old woman, with known advanced cecal colon mucinous adenocarcinoma, presented to our institution with abdominal fullness, poor appetite, and decreased stool passage for 20 days. Physical examination was unremarkable, except distended abdomen. Subsequent study revealed massive post-pigtail catheter drainage ascites with a prominent soft-tissue mass-causing centralization and tethering of focally distended small bowel gas, suggestive of omental cake on plain radiograph. The imaging finding in plain radiograph corresponds to the findings in other imaging modalities, including abdominal sonography and computed tomography. The patient underwent subtotal colectomy and ileostomy during later courses of chemotherapy due to adhesion ileus and possible intraabdominal abscess, and pathologic study confirmed the diagnosis of cecal mucinous adenocarcinoma and peritoneal carcinomatosis. Although the image finding of omental cake on plain radiograph has never been described, this image finding is unique and should be recognized, as it may suggest the presence of omental cake when first identified in the emergency department from patients with abdominal distension and warrant further evaluation to evaluate the underlying cause.

  14. Clinical and radiographic evaluation of biodegradable bone plates in the treatment of mandibular body fractures

    Directory of Open Access Journals (Sweden)

    Sherin Kamal Elhalawany

    2015-01-01

    Full Text Available Background: Many different systems are available for the treatment of fractures ranging from the heavy compression plates for mandibular reconstruction to low profile plates for mid-facial fixation, and are made either from stainless steel, titanium or vitallium. Recently, biodegradable, self-reinforced polylactide plates and screws have been used for the internal fixation of fractures of the mandible with good results. Aim of this study: This study evaluated clinically the biodegradable bone plates for treatment of mandibular body fracture and to evaluate bone healing during the follow-up period using digital radiography. Materials and Methods : Eight patients had been suffered from mandibular body fractures were treated using Inion CPS TM bioresorbable fixation system and the healing process were followed up using digitised panoramic radiography at first week and after 1, 3 and 6 months. Results: Clinical examination of fractured segments revealed stable fixation across the fracture sites while visual and quantitative assessment of radiograph showed healing process was comparable with results previously reported by titanium bone plates. Conclusion: Open reduction and internal fixation of mandibular fractures using bioresorbable fixation system with a brief period of inter-maxillary fixation have evolved to the point where the physical properties are sufficient to withstand the post-operative loads required for fracture repair of mandibular body fractures. The foreign body reaction is a major material-related problem which requires further studies.

  15. Radiographically occult femoral and pelvic fractures are not mutually exclusive: a review of fractures detected by MRI following low-energy trauma

    Energy Technology Data Exchange (ETDEWEB)

    Szewczyk-Bieda, Magdalena; Thomas, Naveena; Oliver, Thomas Barry [Ninewells Hospital and Medical School, Department of Clinical Radiology, Dundee, Scotland (United Kingdom)

    2012-09-15

    The purpose of this study was to review the MRI examinations of a large group of low-energy trauma patients in whom pelvic MRI had detected radiographically occult fractures, in order to characterize prevailing fracture patterns and determine how often co-existing proximal femoral and pelvic fractures were observed. All patients having pelvic MRI over 5 years were identified. Word-search software selected 269 MRI reports containing the term 'fracture'. Further scrutiny identified 168 with diagnosis of fracture. MRI request and imaging record review identified 102 low-energy trauma cases that had MRI for clinical suspicion of fracture despite normal radiographs. Sixty-six cases were excluded for the following reasons: no expressed clinical suspicion of occult fracture; history suggesting high-energy trauma; skeletal co-morbidity hindering acute fracture identification; interval more than 2 weeks between radiographs and MRI. The 102 study MRI examinations, which employed a limited two-sequence protocol, were reviewed. Any fracture that had not been appreciated on radiographs was recorded and characterized as femoral, pelvic, or co-existing femoral and pelvic fractures. The 102 study cases had a median age of 82 years. The median interval between pelvic radiographs and MRI was 3 days. MRI showed undiagnosed femoral fracture in 48/102 cases (47.1%), sacral fracture in 41/102 (40.2%), and pubic fracture in 55/102 (53.9%). In 11/102 cases (10.8%), MRI showed undiagnosed fractures of both proximal femur and pelvic ring (seven sacral, six pubic bone, two other site fractures). In 10/11 cases with co-existing femoral and pelvic fractures, the femoral fracture was incomplete. Limited pelvic MRI found a high prevalence of radiographically occult femoral and pelvic fractures in low-energy trauma patients, with clinical suspicion of fracture despite normal radiographs. Co-existing occult femoral and pelvic ring fractures were commonly observed, and in such cases, the

  16. Prediction of Incident Major Osteoporotic and Hip Fractures by Trabecular Bone Score (TBS) and Prevalent Radiographic Vertebral Fracture in Older Men.

    Science.gov (United States)

    Schousboe, John T; Vo, Tien; Taylor, Brent C; Cawthon, Peggy M; Schwartz, Ann V; Bauer, Douglas C; Orwoll, Eric S; Lane, Nancy E; Barrett-Connor, Elizabeth; Ensrud, Kristine E

    2016-03-01

    Trabecular bone score (TBS) has been shown to predict major osteoporotic (clinical vertebral, hip, humerus, and wrist) and hip fractures in postmenopausal women and older men, but the association of TBS with these incident fractures in men independent of prevalent radiographic vertebral fracture is unknown. TBS was estimated on anteroposterior (AP) spine dual-energy X-ray absorptiometry (DXA) scans obtained at the baseline visit for 5979 men aged ≥65 years enrolled in the Osteoporotic Fractures in Men (MrOS) Study and its association with incident major osteoporotic and hip fractures estimated with proportional hazards models. Model discrimination was tested with Harrell's C-statistic and with a categorical net reclassification improvement index, using 10-year risk cutpoints of 20% for major osteoporotic and 3% for hip fractures. For each standard deviation decrease in TBS, there were hazard ratios of 1.27 (95% confidence interval [CI] 1.17 to 1.39) for major osteoporotic fracture, and 1.20 (95% CI 1.05 to 1.39) for hip fracture, adjusted for FRAX with bone mineral density (BMD) 10-year fracture risks and prevalent radiographic vertebral fracture. In the same model, those with prevalent radiographic vertebral fracture compared with those without prevalent radiographic vertebral fracture had hazard ratios of 1.92 (95% CI 1.49 to 2.48) for major osteoporotic fracture and 1.86 (95% CI 1.26 to 2.74) for hip fracture. There were improvements of 3.3%, 5.2%, and 6.2%, respectively, of classification of major osteoporotic fracture cases when TBS, prevalent radiographic vertebral fracture status, or both were added to FRAX with BMD and age, with minimal loss of correct classification of non-cases. Neither TBS nor prevalent radiographic vertebral fracture improved discrimination of hip fracture cases or non-cases. In conclusion, TBS and prevalent radiographic vertebral fracture are associated with incident major osteoporotic fractures in older men independent of each other

  17. Accuracy of simple plain radiographic signs and measures to diagnose acute scapholunate ligament injuries of the wrist

    Energy Technology Data Exchange (ETDEWEB)

    Dornberger, Jenny E. [Unfallkrankenhaus Berlin, Department of Plastic Surgery and Burn Care, Berlin (Germany); Rademacher, Grit; Mutze, Sven [Unfallkrankenhaus Berlin, Institute of Radiology, Berlin (Germany); Eisenschenk, Andreas [Unfallkrankenhaus Berlin, Department of Hand-, Replantation- and Microsurgery, Berlin (Germany); University Medicine Greifswald, Department of Hand Surgery and Microsurgery, Greifswald (Germany); Stengel, Dirk [Unfallkrankenhaus Berlin, Centre for Clinical Research, Berlin (Germany); Charite Medical University Centre, Julius Wolff Institute, Centre for Musculoskeletal Surgery, Berlin (Germany)

    2015-12-15

    To determine the accuracy of common radiological indices for diagnosing ruptures of the scapholunate (SL) ligament, the most relevant soft tissue injury of the wrist. This was a prospective diagnostic accuracy study with independent verification of index test findings by a reference standard (wrist arthroscopy). Bilateral digital radiographs in posteroanterior (pa), lateral and Stecher's projection were evaluated by two independent expert readers. Diagnostic accuracy of radiological signs was expressed as sensitivity, specificity, positive (PPV) and negative (NPV) predictive values with 95 % confidence intervals (CI). The prevalence of significant acute SL tears (grade ≥ III according to Geissler's classification) was 27/72 (38 %, 95 % CI 26-50 %). The SL distance on Stecher's projection proved the most accurate index to rule the presence of an SL rupture in and out. SL distance on plain pa radiographs, Stecher's projection and the radiolunate angle contributed independently to the final diagnostic model. These three simple indices explained 97 % of the diagnostic variance. In the era of computed tomography and magnetic resonance imaging, plain radiographs remain a highly sensitive and specific primary tool to triage patients with a suspected SL tear to further diagnostic work-up and surgical care. (orig.)

  18. Treatment of proximal humeral fractures using anatomical locking plate: correlation of functional and radiographic results

    Directory of Open Access Journals (Sweden)

    Antonio Carlos Tenor Junior

    2016-06-01

    Full Text Available ABSTRACT OBJECTIVE: To correlate the functional outcomes and radiographic indices of proximal humerus fractures treated using an anatomical locking plate for the proximal humerus. METHODS: Thirty-nine patients with fractures of the proximal humerus who had been treated using an anatomical locking plate were assessed after a mean follow-up of 27 months. These patients were assessed using the University of California Los Angeles (UCLA score and their range of motion was evaluated using the method of the American Academy of Orthopedic Surgeons on the operated shoulder and comparative radiographs on both shoulders. The correlation between radiographic measurements and functional outcomes was established. RESULTS: We found that 64% of the results were good or excellent, according to the UCLA score, with the following means: elevation of 124°; lateral rotation of 44°; and medial rotation of thumb to T9. The type of fracture according to Neer's classification and the patient's age had significant correlations with the range of motion, such that the greater the number of parts in the fracture and the greater the patient's age were, the worse the results also were. Elevation and UCLA score were found to present associations with the anatomical neck-shaft angle in anteroposterior view; fractures fixed with varus deviations greater than 15° showed the worst results (p < 0.001. CONCLUSION: The variation in the neck-shaft angle measurements in anteroposterior view showed a significant correlation with the range of motion; varus deviations greater than 15° were not well tolerated. This parameter may be one of the predictors of functional results from proximal humerus fractures treated using a locking plate.

  19. Evaluation of plain abdominal radiographs in the diagnosis of abdominal pain.

    Science.gov (United States)

    Eisenberg, R L; Heineken, P; Hedgcock, M W; Federle, M; Goldberg, H I

    1983-04-01

    In an effort to develop referral criteria for the ordering of abdominal radiographs for patients presenting with abdominal symptoms, we prospectively studied the relation between clinical data and radiographic abnormalities. Of 1780 examinations, 179 (10.0%) showed some radiographic abnormality. If abdominal radiographs would have been limited to those patients who had moderate or severe abdominal tenderness, or to patients with a high clinical suspicion of bowel obstruction, renal or ureteral calculi, trauma, ischemia, or gallbladder disease, regardless of the degree of tenderness, 956 (53.7%) examinations would not have been done. All radiographic abnormalities reflecting a serious pathologic process would have been identified. Only 33 (3.5%) abnormalities of limited significance, almost all localized or generalized ileus, would have been undetected. The adoption of these referral criteria would result in minimal loss of clinically useful information, large financial savings, and a reduction in radiation exposure.

  20. Measurement of leg length discrepancy after total hip arthroplasty. The reliability of a plain radiographic method compared to CT-scanogram

    Energy Technology Data Exchange (ETDEWEB)

    Kjellberg, Martin [Sundsvall Hospital, Department of Orthopaedics, Sundsvall (Sweden); Al-Amiry, Bariq [Karolinska University Hospital, Huddinge, Department of Radiology, Stockholm (Sweden); Englund, Erling [Vaesternorrland County, Department of Research and Development, Sundsvall (Sweden); Sjoeden, Goeran O.; Sayed-Noor, Arkan S. [Sundsvall Hospital, Department of Orthopaedics, Sundsvall (Sweden); Umeaa University, Department of Surgical and Perioperative Sciences, Umeaa (Sweden)

    2012-02-15

    To measure the interobserver reliability and intraobserver reproducibility of post total hip arthroplasty (THA) leg length discrepancy (LLD) measurement on radiographs as well as to evaluate its accuracy by comparing it with LLD measurement on computed tomographic scanogram (CT-scanogram). In this prospective study, postoperative LLD measurements in ten THA patients were made by four observers on anteroposterior radiographs of the pelvis (inter-teardrop line to the tip of lesser trochanter) and compared to LLD measurements made on CT-scanogram scout views of the lower limb. Two observers repeated the LLD measurements on radiographs 8 weeks after the first measurements. The interobserver reliability of the LLD measurement on plain radiographs was evaluated by comparing the measurements of the four observers and the intraobserver reproducibility by comparing the two repeated measurements made by the two observers. We found excellent interobserver reliability (mean ICC 0.83) and intraobserver reproducibility (ICC 0.90 and 0.88) of the LLD measurements on plain radiographs. There was a moderate to excellent agreement, but with wide variation of measurements among the four observers, when plain radiographic measurement was compared with CT-scanogram (ICC 0.58, 0.60, 0.71, and 0.82). Despite the excellent interobserver reliability and intraobserver reproducibility of LLD measurement on radiographs, clinicians should be aware of its limited accuracy when compared to CT-scanogram. (orig.)

  1. Plain abdominal radiographs in patients with Crohn's disease: radiological findings and diagnostic value.

    LENUS (Irish Health Repository)

    O'Regan, K

    2012-08-01

    To determine the diagnostic yield and clinical value of plain film of the abdomen (PFA) in Crohn\\'s disease (CD) patients and to determine whether performance of PFA yields definitive diagnostic information or whether additional imaging examinations are required.

  2. Diagnostic accuracy of DXA compared to conventional spine radiographs for the detection of vertebral fractures in children

    Energy Technology Data Exchange (ETDEWEB)

    Adiotomre, E. [Sheffield Teaching Hospitals NHS Foundation Trust, Radiology Department, Sheffield, South Yorkshire (United Kingdom); Sheffield Children' s Hospital NHS Foundation Trust, Radiology Department, Sheffield, South Yorkshire (United Kingdom); Summers, L.; Digby, M. [University of Sheffield, Sheffield Medical School, Sheffield, South Yorkshire (United Kingdom); Allison, A.; Walters, S.J. [University of Sheffield, School of Health and Related Research, Sheffield, South Yorkshire (United Kingdom); Broadley, P.; Lang, I. [Sheffield Children' s Hospital NHS Foundation Trust, Radiology Department, Sheffield, South Yorkshire (United Kingdom); Morrison, G. [Sheffield Teaching Hospitals NHS Foundation Trust, Medical Physics, Sheffield, South Yorkshire (United Kingdom); Bishop, N.; Arundel, P. [University of Sheffield, Academic Unit of Child Health, Sheffield, South Yorkshire (United Kingdom); Offiah, A.C. [Sheffield Children' s Hospital NHS Foundation Trust, Radiology Department, Sheffield, South Yorkshire (United Kingdom); University of Sheffield, Academic Unit of Child Health, Sheffield, South Yorkshire (United Kingdom)

    2017-05-15

    In children, radiography is performed to diagnose vertebral fractures and dual energy x-ray absorptiometry (DXA) to assess bone density. In adults, DXA assesses both. We aimed to establish whether DXA can replace spine radiographs in assessment of paediatric vertebral fractures. Prospectively, lateral spine radiographs and lateral spine DXA of 250 children performed on the same day were independently scored by three radiologists using the simplified algorithm-based qualitative technique and blinded to results of the other modality. Consensus radiograph read and second read of 100 random images were performed. Diagnostic accuracy, inter/intraobserver and intermodality agreements, patient/carer experience and radiation dose were assessed. Average sensitivity and specificity (95 % confidence interval) in diagnosing one or more vertebral fractures requiring treatment was 70 % (58-82 %) and 97 % (94-100 %) respectively for DXA and 74 % (55-93 %) and 96 % (95-98 %) for radiographs. Fleiss' kappa for interobserver and average kappa for intraobserver reliability were 0.371 and 0.631 respectively for DXA and 0.418 and 0.621 for radiographs. Average effective dose was 41.9 μSv for DXA and 232.7 μSv for radiographs. Image quality was similar. Given comparable image quality and non-inferior diagnostic accuracy, lateral spine DXA should replace conventional radiographs for assessment of vertebral fractures in children. (orig.)

  3. A computer aided measurement method for unstable pelvic fractures based on standardized radiographs.

    Science.gov (United States)

    Zhao, Jing-Xin; Zhao, Zhe; Zhang, Li-Cheng; Su, Xiu-Yun; Du, Hai-Long; Zhang, Li-Ning; Zhang, Li-Hai; Tang, Pei-Fu

    2015-09-30

    To set up a method for measuring radiographic displacement of unstable pelvic ring fractures based on standardized X-ray images and then test its reliability and validity using a software-based measurement technique. Twenty-five patients that were diagnosed as AO/OTA type B or C pelvic fractures with unilateral pelvis fractured and dislocated were eligible for inclusion by a review of medical records in our clinical centre. Based on the input pelvic preoperative CT data, the standardized X-ray images, including inlet, outlet, and anterior-posterior (AP) radiographs, were simulated using Armira software (Visage Imaging GmbH, Berlin, Germany). After representative anatomic landmarks were marked on the standardized X-ray images, the 2-dimensional (2D) coordinates of these points could be revealed in Digimizer software (Model: Mitutoyo Corp., Tokyo, Japan). Subsequently, we developed a formula that indicated the translational and rotational displacement patterns of the injured hemipelvis. Five separate observers calculated the displacement outcomes using the established formula and determined the rotational patterns using a 3D-CT model based on their overall impression. We performed 3D reconstruction of all the fractured pelvises using Mimics (Materialise, Haasrode, Belgium) and determined the translational and rotational displacement using 3-matic suite. The interobserver reliability of the new method was assessed by comparing the continuous measure and categorical outcomes using intraclass correlation coefficient (ICC) and kappa statistic, respectively. The interobserver reliability of the new method for translational and rotational measurement was high, with both ICCs above 0.9. Rotational outcome assessed by the new method was the same as that concluded by 3-matic software. The agreement for rotational outcome among orthopaedic surgeons based on overall impression was poor (kappa statistic, 0.250 to 0.426). Compared with the 3D reconstruction outcome, the

  4. Radiographic and Computed Tomographic Configuration of Incomplete Proximal Fractures of the Proximal Phalanx in Horses Not Used for Racing.

    Science.gov (United States)

    Brünisholz, Hervé P; Hagen, Regine; Fürst, Anton E; Kuemmerle, Jan M

    2015-10-01

    To characterize the configuration of incomplete proximal fractures of the proximal phalanx (P1) in horses not used for racing and compare radiographic with computed tomography (CT) findings. Historical cohort. Twenty-four horses with incomplete fractures of P1. Medical records of horses not used for racing diagnosed with an incomplete proximal fracture of P1 based on clinical and radiographic examination and confirmed by CT between 2008 and 2013 were retrieved. Radiographs and CT studies of these horses were analyzed using a subjective grading system and by measuring variables that characterized fracture configuration. Twenty-four horses were included (20 Warmbloods) with a mean age of 9.5 years and mean body weight of 574 kg. Fourteen forelimbs and 10 hind limbs were affected. Mean duration of lameness was 8.7 weeks. Computed tomography was superior to radiography in both identifying the fracture and determining fracture size and location. On CT, 92% of fractures were located in the mid-sagittal plane. Mean proximodistal length of the fracture was 13 mm. Fractures were frequently not bicortical. Fractures in forelimbs were located significantly more dorsally than fractures in hind limbs. A distinct fracture pattern with 2 subchondral lines running parallel in close proximity to each other was identified in 54% of cases. Incomplete proximal fractures of P1 have significant variation in their configurations, especially their dorsopalmar/-plantar location. Computed tomography examination allowed clear identification of the fracture configurations and was superior to radiography. © Copyright 2015 by The American College of Veterinary Surgeons.

  5. Radiographic and computed tomography monitoring of a fractured needle fragment in the mandibular branch

    Energy Technology Data Exchange (ETDEWEB)

    De Oliveira e Britto Villalobos, Maria Isabel; Leite, Thaisa Cristina Gomes Ferreira; Barra, Samila Goncalves; Da Cunha Werneche, Daniela Teresa Pinto; Manzi, Flavio Ricardo; E Alves Cardoso, Claudia Assuncao [Dept. of Dentistry, Pontificial Catholic University of Minas Gerais, Belo Horizonte (Brazil)

    2017-03-15

    Some complications can arise with the usage of local anesthesia for dental procedures, including the fracture of needles in the patient. This is a rare incident, usually caused by the patient's sudden movements during anesthetic block. Its complications are not common, but can include pain, trismus, inflammation in the region, difficulty in swallowing, and migration of the object, which is the least common but has the ability to cause more serious damage to the patient. This report describes a case in which, after the fracture of the anesthetic needle used during alveolar nerve block for exodontia of the left mandibular third molar, the fragment moved significantly in the first 2 months, before stabilizing after the third month of radiographic monitoring.

  6. Radiographic and computed tomography monitoring of a fractured needle fragment in the mandibular branch

    Science.gov (United States)

    Leite, Thaisa Cristina Gomes Ferreira; Barra, Samila Gonçalves; Werneche, Daniela Teresa Pinto da Cunha; Manzi, Flavio Ricardo; Cardoso, Claudia Assunção e Alves

    2017-01-01

    Some complications can arise with the usage of local anesthesia for dental procedures, including the fracture of needles in the patient. This is a rare incident, usually caused by the patient's sudden movements during anesthetic block. Its complications are not common, but can include pain, trismus, inflammation in the region, difficulty in swallowing, and migration of the object, which is the least common but has the ability to cause more serious damage to the patient. This report describes a case in which, after the fracture of the anesthetic needle used during alveolar nerve block for exodontia of the left mandibular third molar, the fragment moved significantly in the first 2 months, before stabilizing after the third month of radiographic monitoring. PMID:28361032

  7. Radiographic and computed tomography monitoring of a fractured needle fragment in the mandibular branch.

    Science.gov (United States)

    Villalobos, Maria Isabel de Oliveira E Britto; Leite, Thaisa Cristina Gomes Ferreira; Barra, Samila Gonçalves; Werneche, Daniela Teresa Pinto da Cunha; Manzi, Flavio Ricardo; Cardoso, Claudia Assunção E Alves

    2017-03-01

    Some complications can arise with the usage of local anesthesia for dental procedures, including the fracture of needles in the patient. This is a rare incident, usually caused by the patient's sudden movements during anesthetic block. Its complications are not common, but can include pain, trismus, inflammation in the region, difficulty in swallowing, and migration of the object, which is the least common but has the ability to cause more serious damage to the patient. This report describes a case in which, after the fracture of the anesthetic needle used during alveolar nerve block for exodontia of the left mandibular third molar, the fragment moved significantly in the first 2 months, before stabilizing after the third month of radiographic monitoring.

  8. Acute paediatric ankle trauma: MRI versus plain radiography

    Energy Technology Data Exchange (ETDEWEB)

    Lohman, M. [Helsinki Univ. Central Hospital (Finland). Dept. of Radiology; Radiological Dept., Helsinki University Central Hospital (Finland); Kivisaari, A.; Kivisaari, L. [Helsinki Univ. Central Hospital (Finland). Dept. of Radiology; Kallio, P.; Puntila, J. [Dept. of Paediatric Surgery, Hospital for Children and Adolescents, Helsinki Univ. Central Hospital, Helsinki (Finland); Vehmas, T. [Finnish Institute of Occupational Health, Helsinki (Finland)

    2001-09-01

    Objective: To evaluate the diagnosis of acute physeal ankle fractures on plain radiographs using MRI as the gold standard. Methods: Sixty consecutive children, 29 with a clinical diagnosis of lateral ligament injury and 31 with physeal ankle fractures, were examined using both radiographs and MRI in the acute period. The imaging data were reviewed by three ''masked'' radiologists. The fracture diagnosis and Slater-Harris classification of radiographs were compared with findings on MRI. Results: Plain radiography produced five of 28 (18%) false negative and 12 of 92 (13%) false positive fracture diagnoses compared with MRI. Six of the 12 false positive fractures were due to a misclassification of lateral ligament disruption as SH1 fractures. Altogether a difference was found in 21% of cases in either the diagnosis or the classification of the fractures according to Salter- Harris. All bone bruises in the distal tibia and fibula and 64% of bone bruises in the talus were seen in association with lateral ligament injuries. Talar bone bruises in association with fractures occurred on the same side as the malleolar fracture; talar bone bruises in association with lateral ligament disruption were seen in different locations. The errors identified on radiographs by MRI did not affect the management of the injury. Conclusions: The incidence of false negative ankle fractures in plain radiographs was small and no complex ankle fractures were missed on radiographs. The total extent of complex fractures was, however, not always obvious on radiographs. In an unselected series of relatively mild ankle injuries, we were unable to show a single case where the treatment or prognosis based on plain radiography should have been significantly altered after having done a routine MRI examination. Plain radiography is still the diagnostic cornerstone of paediatric ankle injuries. (orig.)

  9. The Role of Radiographs and Office Visits in the Follow-Up of Healed Intertrochanteric Hip Fractures: An Economic Analysis.

    Science.gov (United States)

    Kempegowda, Harish; Richard, Raveesh; Borade, Amrut; Tawari, Akhil; Howenstein, Abby M; Kubiak, Erik N; Suk, Michael; Horwitz, Daniel S

    2016-12-01

    The purpose of this study was to evaluate the role and the necessity of radiographs and office visits obtained during follow-up of intertrochanteric hip injuries. Retrospective study. Two level I trauma centers. Four hundred sixty-five elderly patients who were surgically treated for an intertrochanteric fracture of the femur at 2 level I trauma centers between January 2009 and August 2014 were retrospectively identified from orthopaedic trauma databases. Analysis of all healed intertrochanteric hip fractures, including demographic characteristics, quality of reduction, time of healing, number of office visits, number of radiographs obtained, and each radiograph for fracture alignment, implant position or any pathological changes. The surgical fixation of 465 fractures included 155 short nails (33%), 232 long nails (50%), 69 sliding hip screw devices (15%), 7 trochanteric stabilizing plates (1.5%), and 2 proximal femur locking plates (0.5%). The average fracture healing time was 12.8 weeks and the average follow-up was 81.2 weeks. Radiographs of any patient obtained after the fracture had healed did not reveal any changes, including fracture alignment or implant position and hardware failure. In 9 patients, pathological changes, including arthritis (3), avascular necrosis (3), and ectopic ossification (3) were noted. The average number of elective office visits and radiographs obtained after the fracture had healed were 2.8 (range: 1-8) and 2.6 (range: 1-8), respectively. According to Medicare payments to the institution, these radiographs and office visits account for a direct cost of $360.81 and $192, respectively, per patient. The current study strongly suggests that there is a negligible role for radiographs and office visits during the follow-up of a well-healed hip fracture when there is documented evidence of radiographic and clinical healing with acceptable fracture alignment and implant position. Implementation of this simple measure will help in reducing

  10. Radiographic diagnosis of sagittal plane rotational displacement in pelvic fractures: a cadaveric model and clinical case study.

    Science.gov (United States)

    Shui, Xiaolong; Ying, Xiaozhou; Kong, Jianzhong; Feng, Yongzeng; Hu, Wei; Guo, Xiaoshan; Wang, Gang

    2015-08-01

    Our objective was to measure the sagittal plane rotational (flexion and extension) displacement of hemipelvis radiologically and analyze the ratio of flexion and extension displacement of unstable pelvic fractures. We used 8 cadaveric models to study the radiographic evidence of pelvic fractures in the sagittal plane. We performed pelvic osteotomy on 8 cadavers to simulate anterior and posterior pelvic ring injury. Radiological data were measured in the flexion and extension group under different angles (5°, 10°, 15°, 20°, and 25°). We retrospectively reviewed 164 patients who were diagnosed with a unilateral fracture of the pelvis. Pelvic ring displacement was identified and recorded radiographically in cadaveric models. The flexion and extension displacement of pelvic fractures was measured in terms of the vertical distance of fracture from the top of iliac crest to the pubic tubercle (CD) or from the top of iliac crest to the lowest point of ischial tuberosity (AB). Fifty-seven pelves showed flexion displacement and 15 showed extension displacement. Closed reduction including internal fixation and external fixation was successfully used in 141 cases (86.0 %). The success rates of closed reduction in flexion and extension displacement groups were 77 and 73 %, respectively, which were lower than in unstable pelvic ring fractures. The sagittal plane rotation (flexion and extension) displacement of pelvic fractures could be measured by special points and lines on the radiographs. Minimally invasive reduction should be based on clearly identified differences between the sagittal plane rotation and the vertical displacement of pelvic fractures.

  11. What is the real angle of deviation of metacarpal neck fractures on oblique views? A radiographic study☆

    Science.gov (United States)

    de Góes Ribeiro, Arthur; Gonçalez, Daniel Hidalgo; Filho, João Manoel Fonseca; da Fonseca, Guilherme Marques; Costa, Antonio Carlos; Chakkour, Ivan

    2016-01-01

    Objective The aim of this study was to establish an indirect, easy-to-use, predictable and safe means of obtaining the true degree of displacement of fractures of the neck of the fifth metacarpal bone, through oblique radiographic views. Methods An anatomical specimen from the fifth human metacarpal was dissected and subjected to ostectomy in the neck region. A 1-mm Kirschner wire was fixed to the base of the fifth metacarpal bone, perpendicular to the longitudinal axis of the bone and parallel to the ground. Another six Kirschner wires of the same diameter were bent over and attached to the ostectomized bone to simulate fracture displacement. Axial rotation of the metacarpus was used to create oblique radiographic views. Radiographic images were generated with different angles and at several degrees of rotation of the bone. Results We deduced a mathematical formula that showed the true displacement of fractures of the neck of the fifth metacarpal bone by means of oblique radiographs. Conclusions Oblique radiographs at 30̊ of supination provided the best view of the bone and least variation from the real value of the displacement of fractures of the fifth metacarpal bone. The mathematical formula deduced was concordant with the experimental model used. PMID:27069882

  12. Retrospective evaluation of exposure index (EI) values from plain radiographs reveals important considerations for quality improvement

    Energy Technology Data Exchange (ETDEWEB)

    Mothiram, Ursula; Brennan, Patrick C; Robinson, John; Lewis, Sarah J [Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Radiation Sciences, Faculty of Health Science, University of Sydney, Sydney (Australia); Moran, Bernadette [Department of Clinical Medicine, Trinity College Dublin, Dublin (Ireland); Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Radiation Sciences, Faculty of Health Science, University of Sydney, Sydney (Australia)

    2013-12-15

    Following X-ray exposure, radiographers receive immediate feedback on detector exposure in the form of the exposure index (EI). To identify whether radiographers are meeting manufacturer-recommended EI (MREI) ranges for routine chest, abdomen and pelvis X-ray examinations under a variety of conditions and to examine factors affecting the EI. Data on 5000 adult X-ray examinations including the following variables were collected: examination parameters, EI values, patient gender, date of birth, date and time of examination, grid usage and the presence of implant or prosthesis. Descriptive statistics were used to summarize each data set and the Mann–Whitney U test was used to determine significant differences, with P < 0.05 indicating significance for all tests. Most examinations demonstrated EI values that were outside the MREI ranges, with significantly higher median EI values recorded for female patient radiographs than those for male patients for all manufacturers, indicating higher detector exposures for all units except for Philips digital radiography (DR), where increased EI values indicate lower exposure (P = 0.01). Median EI values for out of hours radiography were also significantly higher compared with normal working hours for all technologies (P ≤ 0.02). Significantly higher median EI values were demonstrated for Philips DR chest X-rays without as compared to those with the employment of a grid (P = 0.03), while significantly lower median EI values were recorded for Carestream Health computed radiography (CR) chest X-rays when an implant or prosthesis was present (P = 0.02). Non-adherence to MREIs has been demonstrated with EI value discrepancies being dependent on patient gender, time/day of exposure, grid usage and the presence of an implant or prosthesis. Retrospective evaluation of EI databases is a valuable tool to assess the need of quality improvement in routine DR.

  13. What role do plain radiographs have in assessing the skeletally immature acromioclavicular joint?

    Science.gov (United States)

    Lee, Seung Yeol; Kwon, Soon-Sun; Chung, Chin Youb; Lee, Kyoung Min; Park, Moon Seok

    2014-01-01

    Because of incomplete ossification of the coracoid process and acromion, acromioclavicular joint configuration in the skeletally immature patient differs from that of adults. Although comparison to radiographic standards for this joint is critical in the evaluation of acromioclavicular joint injuries, these standards are not well defined for children or adolescents. We therefore sought to determine (1) the reliability of numerous radiographic measurements of the skeletally immature acromioclavicular joint, including the vertical and shortest coracoclavicular interval, and the acromioclavicular joint offset; (2) the timing of ossification of the acromion and coracoid in males and females; and (3) the differences in the values of these radiographic measurements based on age and sex. This study was based on a total of 485 subjects, 8 to 18 years old, who underwent conventional AP view radiographs of both shoulders. The 485 subjects were included to assess normal configuration around the acromioclavicular joint and 466 of these subjects were evaluated for comparison between both sides. The vertical and shortest coracoclavicular interval, coracoclavicular clavicle width ratio, acromioclavicular joint offset, and difference of the coracoclavicular interval of both sides were measured. A reliability test was conducted before obtaining the main measurements. The relationship of measurements with sex, age, and stage of ossification was evaluated. The vertical and shortest coracoclavicular interval showed excellent reliability (intraclass correlation coefficient ([ICC], 0.918 and 0.934). The acromioclavicular joint offset showed low reliability (ICC, 0.543). The ossification centers of the acromion and the coracoid processes appeared and fused earlier in females than in males. The vertical coracoclavicular interval, which was not affected by partial ossification of the coracoid process, was less than 11 mm in the 90% quantile of total subjects in males and 10 mm in the 90

  14. CT classification of acetabular fractures

    Energy Technology Data Exchange (ETDEWEB)

    Marincek, B.; Porcellini, B.; Robotti, G.

    1984-05-01

    The contribution of computed tomography (CT) in classifying acetabular fractures was analysed retrospectively in 33 cases. CT and plain radiography classification agreed in 27 cases (82%). CT revealed more extensive fractures in 6 patients (thereof 5 patients with associated fractures). In 10 patients (thereof 9 patients with associated fractures) CT showed intraarticular fragments; radiographically intraarticular fragments were seen only in 2 patients and suspected in 4. CT is of considerable aid in defining the fracture pattern. It should be used mainly in patients with radiographically difficult interpretable associated fractures in order to assess preoperatively the weight-bearing part of the acetabulum, the degree of displacement and the presence of intraarticular fragments.

  15. How to use a plain abdominal radiograph in children with functional defecation disorders.

    Science.gov (United States)

    Benninga, M A; Tabbers, M M; van Rijn, R R

    2016-08-01

    Defecation-related functional gastrointestinal disorders (FGIDs), such as infant dyschezia, functional constipation and functional non-retentive faecal incontinence, as defined by the Rome IV criteria, are common problems in childhood. The symptomatology varies from relatively mild, such as crying before passage of soft stools or infrequent defecation to severe problems with faecal impaction and the daily involuntary loss of faeces in the underwear. Conventional radiography is widely available, relatively cheap and is non-invasive. The drawback however, is radiation exposure. This review describes and evaluates the value of different existing scoring methods to assess faecal loading on an abdominal radiograph with or without the use of radio-opaque markers, to measure colonic transit time, in the diagnosis of these defecation-related FGIDs. Insufficient evidence exists for a diagnostic association between clinical symptoms of functional constipation or functional nonretentive faecal incontinence and faecal loading on an abdominal radiograph. Furthermore, evidence does not support the routine use of colonic transit studies to diagnose functional constipation. Colonic transit time measurement may be considered in discriminating between functional constipation and functional non-retentive faecal incontinence and in patients in which the diagnosis is not clear such as having an unreliable medical history. In children with the suspicion of defecation-related FGIDs, the diagnosis should be made based on the Rome IV criteria.

  16. Wassel′s Type V Polydactyly with Plain Radiographic and CT Findings

    Directory of Open Access Journals (Sweden)

    Berna Dirim Mete

    2015-01-01

    Full Text Available Duplication of the thumb is the most common polydactyly of the hand. Wassel′s classification is frequently used to classify the polydactyly of the hand. His classification was based on the level of duplication and the number of bones in the thumb, and has seven groups (Types I-VII according to the level of the bifurcation, except for his Type VII. The most common type is the bifurcation at the metacarpophalangeal joint (Type IV. In this paper, we report a very rare case of Type V thumb polydactyly in a 42-year-old man, who presented with swan neck deformity of the radial thumb and discuss the plain radiography and computed tomography (CT findings. Kumar recently reported plain radiography findings in a case of bifid first metacarpal in a 13-year-old girl, who presented with swan neck deformity of the left thumb. To our knowledge, our case is the second presented case that has a swan neck deformity with bifid metacarpal.

  17. WHAT IS THE BEST RADIOGRAPHIC VIEW FOR "DIE PUNCH" DISTAL RADIUS FRACTURES? A CADAVER MODEL STUDY.

    Science.gov (United States)

    Falcochio, Diego Figueira; Crepaldi, Bruno Eiras; Trindade, Christiano Augusto; da Costa, Antonio Carlos; Chakkour, Ivan

    2012-01-01

    the aim of this study is try to show the best view for distal radius fractures so called die-punch fractures. There has been used a human cadaver radius bone from the Salvador Arena Tissue Bank. This bone was cleaned up after removing the soft tissues and osteotomies created displaced lunate fossa fractures of 0, 1, 2, 3 and 5 mm. We have fixed this fragment with adhesive tape. Then the joint deviation were significantly increased with step-offs of 1 mm. Radiographs were then taken into 5 different positions: postero-anterior view, lateral view, oblique views and tangencial view for each of the deviations. The resulting lunate fossa depression in each X-ray film was analyzed by the AutoCAD 2010® software. The tangencial view was the best one to see the 1mm and 3mm bone degrees and the second one view to see the 2mm and 5 mm degrees. The pronated oblique view was the best to see the 2mm degrees and the oblique supinated view wasn't able to see the degrees between 1 and 2mm. The tangencial view was the best one to see the 1mm and 3mm bone degrees and the second one view to see the 2mm and 5 mm degrees.

  18. Salter-Harris I fracture of the distal humerus in a neonate: imaging appearance of radiographs, ultrasound, and arthrography

    Directory of Open Access Journals (Sweden)

    Nicholas M. Beckmann, MD

    2017-09-01

    Full Text Available Neonatal Salter-Harris I fractures of the distal humerus are a rare injury. This injury can be easily mistaken for a posterior elbow dislocation, creating a delay in diagnosis. We present a case of a neonate with a distal humerus Salter-Harris I fracture secondary to trauma during delivery. The patient presented with pseudoparesis of the left arm following birth. Posterior displacement of the elbow was identified on radiographs. Ultrasound of the elbow was performed after a gentle closed reduction of the left elbow was unsuccessful. A transphyseal supracondylar distal humerus fracture was identified on ultrasound. The patient subsequently had an intraoperative left elbow arthrogram to assist in visualization of the supracondylar fracture during closed reduction and percutaneous pinning. At 2-month follow-up, the patient was neurologically intact with full passive range of motion and had normal alignment of the capitellar ossification center and distal humerus on follow-up radiographs.

  19. Salter-Harris I fracture of the distal humerus in a neonate: imaging appearance of radiographs, ultrasound, and arthrography.

    Science.gov (United States)

    Beckmann, Nicholas M; Crawford, Lindsay

    2017-09-01

    Neonatal Salter-Harris I fractures of the distal humerus are a rare injury. This injury can be easily mistaken for a posterior elbow dislocation, creating a delay in diagnosis. We present a case of a neonate with a distal humerus Salter-Harris I fracture secondary to trauma during delivery. The patient presented with pseudoparesis of the left arm following birth. Posterior displacement of the elbow was identified on radiographs. Ultrasound of the elbow was performed after a gentle closed reduction of the left elbow was unsuccessful. A transphyseal supracondylar distal humerus fracture was identified on ultrasound. The patient subsequently had an intraoperative left elbow arthrogram to assist in visualization of the supracondylar fracture during closed reduction and percutaneous pinning. At 2-month follow-up, the patient was neurologically intact with full passive range of motion and had normal alignment of the capitellar ossification center and distal humerus on follow-up radiographs.

  20. A comparison of MRI, radiographic and clinical findings of the position of the TMJ articular disc following open treatment of condylar neck fractures.

    Science.gov (United States)

    Schneider, Alexander; Zahnert, Diana; Klengel, Steffen; Loukota, Richard; Eckelt, Uwe

    2007-10-01

    We examined the position and function of the articular disc after open treatment of condylar fractures by comparing magnetic resonance images (MRI) and radiographs with clinical data. MRI and radiographs were taken after treatment of 28 patients with 33 fractures of the mandibular condyles. In all cases, the disc was located in the fossa after open reduction and internal fixation (ORIF). The MRI, radiographic and clinical findings did not correlate, and damage to the temporomandibular joint (TMJ) could be seen more clearly on MRI than on clinical or radiographic examination. Damage to soft tissues seen on MRI after treatment was more pronounced in dislocated than in displaced fractures.

  1. The Tromsø study: registration of fractures, how good are self-reports, a computerized radiographic register and a discharge register?

    Science.gov (United States)

    Joakimsen, R M; Fønnebø, V; Søgaard, A J; Tollan, A; Størmer, J; Magnus, J H

    2001-12-01

    In order to compare different methods of fracture registration, we sought all nonvertebral fractures suffered during 8 years (1988-95) among 21,441 persons invited to a survey in 1979/80. We registered a total of 54 hip fracture cases through three separate sources (self-report, computer linkage to the local radiographic archives, discharge register), whereas forearm fractures (a total of 291 cases) were registered through two separate sources (self-report, computer linkage to the radiographic archives). The registration of fractures at other sites (a total of 1321 cases) were from one source (computer linkage to the local radiographic archives), and we have compared three ways of obtaining data from this single source (no ascertainment, ascertainment of records coded as fracture, ascertainment of all records). Ninety-three percent of all hip fractures and 97% of all wrist fractures in the entire study population were found by computer linkage to the radiographic archives, whereas the discharge register detected 87% of all the hip fractures. Computer linkage with ascertainment gave no overreporting of fractures. Among the 11,626 persons who answered a follow-up questionnaire in 1994/95, 97% (CI 84-100%) of all hip fractures and 72% (CI 66-78%) of all wrist fractures were self-reported. We conclude that a computerized search of radiographic archives is a viable method of fracture registration.

  2. Radiographic absorptiometry for pre-screening of osteoporosis in patients with low energy fractures

    DEFF Research Database (Denmark)

    Buch, Inge; Oturai, Peter Sandor; Jensen, Lars T

    2010-01-01

    Dual energy X-ray absorptiometry (DEXA) is the most accurate method and thus the method of choice for diagnosing osteoporosis. Due to the limited access to DEXA-scanners, screening of patients with low energy fractures (LEF) for osteoporosis is not routinely performed in Denmark. Pre......-screening with a simple, less expensive device might be able to exclude patients with normal bone mineral density (BMD) from further DEXA-scans. We aimed to determine the frequency of osteoporosis in patients with LEF, and evaluate the diagnostic impact of a radiographic absorptiometry (RA) scanner in the casualty...... department of a major Danish county hospital. In a 5-month period, 136 adult patients with LEF were invited for BMD measurements. In 74 (54%) patients DEXA-scans (spine and femoral neck) and phalangeal RA-scans were performed. A total of 86% of the patients were female and 39% were suffering from...

  3. Digital radiographs displayed on different devices: effect on the detection of vertical root fractures.

    Science.gov (United States)

    Vasconcelos, T V; Santaella, G M; Nascimento, H A R; Rovaris, K; Ambrosano, G M B; Freitas, D Q

    2016-04-01

    To evaluate whether the type of display device affects the detection of vertical root fractures (VRFs) on digital radiographs in unfilled canals and canals with fibreglass posts. Forty single-rooted human teeth were decoronated, and the root canals were prepared. The teeth were divided into 2 groups: controls (20 teeth) and with VRF (20 teeth). The VRFs were induced using an universal testing machine. Periapical radiographs of all teeth, with canal unfilled or with a fibreglass post, were obtained using the parallel technique in 3 directions (ortho-, mesio- and distoradial) on storage phosphor plates (VistaScan®). All images were evaluated and re-evaluated after 30 days by 3 examiners on a 5-point scale using 4 different devices (notebook display with full high definition resolution, desktop display with a standard resolution, 8-inch Android(™) tablet with high definition resolution and a 9.7-inch iPad® tablet with Retina resolution). Areas under ROC curves, sensitivity, specificity and accuracy values were compared by anova. The weighted kappa values for intra- and interobserver reproducibility were 0.55-0.88 and 0.31-0.65, respectively. There was a significant difference (P devices studied. The type of display device did not affect the detection of VRFs. Thus, the detection of VRFs can be performed using different screen sizes and resolutions. © 2015 International Endodontic Journal. Published by John Wiley & Sons Ltd.

  4. Gravity Reduction View: A Radiographic Technique for the Evaluation and Management of Weber B Fibula Fractures

    Directory of Open Access Journals (Sweden)

    Lauren Ehrlichman

    2017-03-01

    Full Text Available Background: While various radiographic parameters and application of manual/gravity stress have been proposed to elucidate instability for Weber B fibula fractures, the prognostic capability of these modalities remains unclear. Determination of anatomic positioning of the mortise is paramount. We propose a novel view, the Gravity Reduction View (GRV, which helps elucidate non-anatomic positioning and reducibility of the mortise.Methods: The patient is positioned lateral decubitus with the injured leg elevated on a holder with the fibula directed superiorly. The x-ray cassette is placed posterior to the heel, with the beam angled at 15˚ of internal rotation to obtain a mortise view. Our proposed treatment algorithm is based upon the measurement of the medial clear space (MCS on the GRV versus the static mortise view (and in comparison to the superior clear space (SCS and is based on reducibility of the MCS. A retrospective review of patients evaluated utilizing the GRV was performed.Results: 26 patients with Weber B fibula fractures were managed according to this treatment algorithm. Mean age was 50.57 years old (range: range:18-81, SD=19. 17 patients underwent operative treatment and 9 patients were initially treated nonoperatively. 2 patients demonstrated late displacement and were treated surgically. Using this algorithm, at a mean follow-up of 26 weeks, all patients had a final MCS that was less than the SCS (final mean MCS 2.86 mm vs. mean SCS of 3.32 indicating effectiveness of the treatment algorithm.Conclusion: The GRV is a novel radiographic view in which deltoid competency, reducibility and initial positioning of the mortise are assessed by comparing a static mortise view with the appearance of the mortise on the GRV. We have developed a treatment algorithm based on the GRV and have found it to be useful in guiding treatment and successful at achieving anatomic mortise alignment.

  5. IMAGING DIAGNOSIS OF THORACOLUMBAR BURST FRACTURES

    Institute of Scientific and Technical Information of China (English)

    Li-yang Dai

    2004-01-01

    Objective To review imaging use in the diagnosis ofthoracolumbar burst fractures and to determine the diagnostic value of different imaging methods.Methods One hundred and fourteen patients with 120 thoracolumbar burst fractures were retrospectively reviewed. Plain radiographs were available in all cases; CT scans and MRI were obtained in 96 and 74 cases, respectively.Results A total of 27 burst fractures were misdiagnosed as other types of fractures on radiographs alone, and accounted for 22.5% of all fractures. The results indicated that plain radiographs often fail to delineate the pathological features of thoracolumbar burst fractures, leading to delay in diagnosis.Conclusion In regard to thoracolumbar injury diagnosis, burst fractures should be differentiated from compression fractures. CT should be routinely indicated and MRI examination, when necessary, may be simultaneously considered.

  6. [Plain radiographs of the spine: static and relationships between spine and pelvis].

    Science.gov (United States)

    Morvan, G; Wybier, M; Mathieu, P; Vuillemin, V; Guerini, H

    2008-05-01

    Man, with his erect posture, evolves in a world subject to the laws of gravity. His spine reflects these constraints. The morphology and static of human spine and biomechanical relationships between spine and pelvis are in direct relation with bipedia. Owing to this position the pelvis widened and straightened, characteristic sagittal spinal curves appeared and the perispinal muscles were deeply reorganized. Each pelvis is characterized by an important anatomical landmark: the pelvic incidence that reflects the sagittal morphology of the pelvis. Based on this anatomical characteristic, a chain of reactions determines the more efficient equilibrium of the whole body in the sagittal plane in term of energy consumption. Incidence affects the sacral slope, which determines lumbar lordosis, which itself influences pelvic tilt, thoracic kyphosis, and even hip and knee position. All these landmarks can easily be studied on a sagittal radiograph. Knowledge of these functional relationships is essential to understand the origin of low back pain, sagittal imbalance and above all before surgical treatment of spine disorders especially when arthrodesis is considered.

  7. Quantitative local topological texture properties obtained from radiographs of the proximal femur in patients with pertrochanteric and transcervical hip fractures

    Science.gov (United States)

    Boehm, H. F.; Lutz, J.; Koerner, M.; Notohamiprodjo, M.; Reiser, M.

    2009-02-01

    The incidence of osteoporosis and associated fractures becomes an increasingly relevant issue for the public health institutions of industrialized nations. Fractures of the hip represent the worst complication of osteoporosis with a significantly elevated rate of mortality. Prediction of fracture risk is a major focus of osteoporosis research and, over the years, has been approched from different angles. There exist two distinct subtypes of transcervical and pertrochanteric hip fracture that can be distinguished on the basis of the anatomical location of the injury. While the epidemiology of hip fractures has been well described, typically, little or no distinction is made between the subtypes. The object of this study was to determine whether local topological texture properties based on the Minkowski Functionals (MF) obtained from standard radiographs of the proximal femur in patients with hip fracture can be used to differentiate between the two types of fracture pattern. The texture features were extracted from standardized regions of interest (femoral head, neck, and pertrochanteric region) in clinical radiographs of the hip obtained from 90 post-menopausal women (69.8 +/- 7.9 yrs). 30 of the women had sustained pertrochanteric fractures, 30 had transcervical hip fractures and 30 were age-matched controls. We determined an optimized topological parameter MF2Dloc using an integrative filtering procedure based on a sliding-windows algorithm. Statistical relationship between the fracture type (pertrochanteric/transcervical) and the value of MF2Dloc was assessed by receiver-operator characteristic (ROC) analysis. Depending on the anatomical location of the region of interest for texture analysis correct classification of tanscervial and pertrochanteric fractures ranged from AUC = 0.79 to 0.98. In conclusion, quantitative texture properties of trabecular bone extracted from radiographs of the hip can be used to identify patients with hip fracture and to distinguish

  8. Plain abdominal radiographs in patients with Crohn's disease: Radiological findings and diagnostic value

    Energy Technology Data Exchange (ETDEWEB)

    O' Regan, K.; O' Connor, O.J.; O' Neill, S.B.; Mc Laughlin, P.D. [Department of Radiology, Cork University Hospital and University College Cork, Cork (Ireland); Desmond, A. [Department of Medicine (Gastroenterology), Cork University Hospital and University College Cork, Cork (Ireland); McWilliams, S.R. [Department of Radiology, Cork University Hospital and University College Cork, Cork (Ireland); Quigley, E.M.M.; Shanahan, F. [Department of Medicine (Gastroenterology), Cork University Hospital and University College Cork, Cork (Ireland); Maher, M.M., E-mail: M.Maher@ucc.ie [Department of Radiology, Cork University Hospital and University College Cork, Cork (Ireland)

    2012-08-15

    Aim: To determine the diagnostic yield and clinical value of plain film of the abdomen (PFA) in Crohn's disease (CD) patients and to determine whether performance of PFA yields definitive diagnostic information or whether additional imaging examinations are required. Materials and methods: One hundred and seventy-seven CD patients underwent 643 PFAs during the period September 1992 to August 2008. Two radiologists blinded to the clinical details independently evaluated individual PFAs and/or their reports for abnormal findings using the following criteria: normal, small bowel (SB) findings; colonic findings, acute CD complications, extra-colonic findings; global assessment/impression. The results of additional imaging studies performed within 5 days of PFA were recorded and findings were analysed. Results: A mean of 3.6 (range 1-22) PFAs was performed per patient during the study period. Almost 70% of films were normal (n = 449). SB abnormalities were detected in 21.8% (n = 140) PFAs; most commonly dilated loops (18.8%, n = 121) and mucosal oedema (5%, n = 32). Colonic abnormalities were present in 11.4% (n = 73); most commonly mucosal oedema (7.5%, n = 48) and dilated loops (5%, n = 32). Four cases of pneumoperitoneum were detected. There was no case of toxic megacolon. There was one case in which intra-abdominal abscess/collection was suspected and two cases of obstruction/ileus. Extracolonic findings (renal calculi, sacro-iliitis, etc.) were identified in 7.5% (n = 48). PFAs were followed by additional abdominal imaging within 5 days of PFA in 273/643 (42.5%) of cases. Conclusion: Despite the high rates of utilization of PFA in CD patients, there is a low incidence of abnormal findings (32.5%). Many of the findings are non-specific and clinically irrelevant and PFA is frequently followed by additional abdominal imaging examinations.

  9. Comparison of the fracture process of the rubberized concrete and plain concrete under bending load

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    Acoustic emission (AE) technique is employed to investigate the damage process of the notched plain concrete and rubberized concrete specimens under 3-point bending load.AE signals in the fracture process of notched specimens are illustrated by analyzing the distribution of amplitude and hit rate of AE signals.AE signals in the rubberized concrete have lower activity and amplitude than in the plain concrete.By AE location analysis,it is found that the high energy events mainly are distributed near the notch tip.According to AE energy,the fracture process zone (FPZ) is determined.By comparing the FPZ of both concretes,it is found that the incorporation of rubber particles in concrete can greatly alleviate the damage process of concrete specimens and the damage zone in the rubberized concrete is much smaller than in the plain concrete.The moment tensor is also used to analyze the type of cracks and it is found that tensile cracks dominate the early period of loading,while shear cracks become dominant with propagation of cracks in late load period.

  10. 强直性脊柱炎的X线平片和CT诊断%X-ray plain radiographs and CT diagnosis of ankylosing spondylitis

    Institute of Scientific and Technical Information of China (English)

    段常青

    2016-01-01

    目的:探讨X线平片和CT检查对强直性脊柱炎的诊断价值。方法:收治强直性脊柱炎患者70例作为研究对象,分别给予X线平片检查和CT检查。结果:CT检查确诊率100.0%,明显高于X线平片检查,差异有统计学意义(P<0.05)。结论:CT检查对强直性脊柱炎的诊断率高,且能发现微小病变,灵敏度高。%Objective:To investigate the diagnosis value of X-ray plain radiographs and CT for ankylosing spondylitis.Methods:70 cases of patients with ankylosing spondylitis were as the research object and were given X-ray plain radiographs and CT.Results:The diagnosis rate of CT was 100%,which was significantly higher than that of X-ray plain radiographs,and the difference was statistically significant(P<0.05).Conclusion:The diagnosis rate of CT examination for ankylosing spondylitis was high.It could detect small lesions and it had high sensitivity.

  11. Assessment of the level of agreement in the interpretation of plain radiographs of lumbar spondylosis among clinical physiotherapists in Ghana.

    Science.gov (United States)

    Bello, Ajediran I; Ofori, Eric K; Alabi, Oluwasegun J; Adjei, David N

    2014-03-29

    Objective physical assessment of patients with lumbar spondylosis involves plain film radiographs (PFR) viewing and interpretation by the radiologists. Physiotherapists also routinely assess PFR within the scope of their practice. However, studies appraising the level of agreement of physiotherapists' PFR interpretation with radiologists are not common in Ghana. Forty-one (41) physiotherapists took part in the cross-sectional survey. An assessment guide was developed from findings of the interpretation of three PFR of patients with lumbar spondylosis by a radiologist. The three PFR were selected from a pool of different radiographs based on clarity, common visible pathological features, coverage body segments and short post production period. Physiotherapists were required to view the same PFR after which they were assessed with the assessment guide according to the number of features identified correctly or incorrectly. The score range on the assessment form was 0-24, interpreted as follow: 0-8 points (low), 9-16 points (moderate) and 17-24 points (high) levels of agreement. Data were analyzed using one sample t-test and fisher's exact test at α = 0.05. The mean score of interpretation for the physiotherapists was 12.7 ± 2.6 points compared to the radiologist's interpretation of 24 points (assessment guide). The physiotherapists' levels were found to be significantly associated with their academic qualification (p = 0.006) and sex (p = 0.001). However, their levels of agreement were not significantly associated with their age group (p = 0.098), work settings (p = 0.171), experience (p = 0.666), preferred PFR view (p = 0.088) and continuing education (p = 0.069). The physiotherapists' skills fall short of expectation for interpreting PFR of patients with lumbar spondylosis. The levels of agreement with radiologist's interpretation have no link with year of clinial practice, age, work settings and continuing education. Thus

  12. Anterior cervical surgery methods for central cord syndrome without radiographic spinal fracture-dislocation

    Institute of Scientific and Technical Information of China (English)

    Chengwei JING; Qin FU; Xiaojun XU

    2009-01-01

    This study was aimed to explore the anterior cervical surgery methods to treat central cord syndrome without radiographic spinal fracture-dislocation (CCSWORFD), retrospectively analyze the cases of CCSWORFD, and evaluate the curative effect of anterior cervical surgery methods for CCSWORFD. Twenty four cases of CCSWORFD (19 males and 5 females), all suffering from cervical hyperextension injury, between 45-68 (average 59) years old, were operated on by anterior cervical surgery methods. Among these, 18 cases had been followed up for 6-24 (average 15) months; 18 cases, who had anterior decompression and plate fixation with titanium mesh bone grafting or iliac bone grafting achieved reliable effects based on the Japanese Orthopedics Association (JOA) evaluation (improved scores of cases with titanium mesh bone grafting, t = 2.800, P0.05). Most of these cases had degeneration of cervical vertebra. The decompression which relieves the oppression to the spinal cord can help lessen edema of the spinal cord, and early fixation for stability of cervical vertebra is better for the recovery of spinal cord injury. Anterior operation with titanium mesh bone grafting or iliac bone grafting are both reliable curative methods for CCSWORFD, and titanium mesh bone grafting can avoid the trauma of the supplying graft. Mesh bone grafting can also shorten hospital stay.

  13. Two-Dimensional Image Fusion of Planar Bone Scintigraphy and Radiographs in Patients with Clinical Scaphoid Fracture: An Imaging Study

    DEFF Research Database (Denmark)

    Henriksen, O.M.; Lonsdale, M.N.; Jensen, T.D.

    2008-01-01

    experienced nuclear medicine physicians. In addition to the diagnosis, the degree of diagnostic confidence was scored in each case. Results: The addition of fusion images changed the interpretation of each of the three observers in seven, four, and two cases, respectively, reducing the number of positive....... Bone scintigraphy is highly sensitive for the detection of fractures, but exact localization of scintigraphic lesions may be difficult and can negatively affect diagnostic accuracy. Purpose: To investigate the influence of image fusion of planar bone scintigraphy and radiographs on image interpretation...... in patients with suspected scaphoid fracture. Material and Methods: In 24 consecutive patients with suspected scaphoid fracture, a standard planar bone scintigraphy of both hands was supplemented with fusion imaging of the injured wrist. Standard and fusion images were evaluated independently by three...

  14. Two-dimensional fusion imaging of planar bone scintigraphy and radiographs in patients with clinical scaphoid fracture: an imaging study

    DEFF Research Database (Denmark)

    Henriksen, Otto Mølby; Lonsdale, Markus Georg; Jensen, T D

    2009-01-01

    experienced nuclear medicine physicians. In addition to the diagnosis, the degree of diagnostic confidence was scored in each case. RESULTS: The addition of fusion images changed the interpretation of each of the three observers in seven, four, and two cases, respectively, reducing the number of positive....... Bone scintigraphy is highly sensitive for the detection of fractures, but exact localization of scintigraphic lesions may be difficult and can negatively affect diagnostic accuracy. PURPOSE: To investigate the influence of image fusion of planar bone scintigraphy and radiographs on image interpretation...... in patients with suspected scaphoid fracture. MATERIAL AND METHODS: In 24 consecutive patients with suspected scaphoid fracture, a standard planar bone scintigraphy of both hands was supplemented with fusion imaging of the injured wrist. Standard and fusion images were evaluated independently by three...

  15. Two-Dimensional Image Fusion of Planar Bone Scintigraphy and Radiographs in Patients with Clinical Scaphoid Fracture: An Imaging Study

    DEFF Research Database (Denmark)

    Henriksen, O.M.; Lonsdale, M.N.; Jensen, T.D.

    2008-01-01

    experienced nuclear medicine physicians. In addition to the diagnosis, the degree of diagnostic confidence was scored in each case. Results: The addition of fusion images changed the interpretation of each of the three observers in seven, four, and two cases, respectively, reducing the number of positive....... Bone scintigraphy is highly sensitive for the detection of fractures, but exact localization of scintigraphic lesions may be difficult and can negatively affect diagnostic accuracy. Purpose: To investigate the influence of image fusion of planar bone scintigraphy and radiographs on image interpretation...... in patients with suspected scaphoid fracture. Material and Methods: In 24 consecutive patients with suspected scaphoid fracture, a standard planar bone scintigraphy of both hands was supplemented with fusion imaging of the injured wrist. Standard and fusion images were evaluated independently by three...

  16. Radiographic Outcomes of Percutaneous Pinning for Displaced Extra-Articular Fractures of the Distal Radius: A Time Course Study

    Science.gov (United States)

    Yang, Tien-Yu; Shen, Shih-Hsun

    2014-01-01

    Introduction. Although not all malunited distal radius fractures are symptomatic, the goal of treatment for displaced extra-articular fractures of the distal radius should be to restore and to maintain the radial geometry until bone healing. However, the time course change after surgery for these fractures is unclear. Methods. We, therefore, performed a retrospective cohort study on patients who sustained such fractures treated with percutaneous pinning. The main outcome measures in this study included four radiographic measurements: radial height, radial inclination, radial tilt, and ulnar variance. Results. Assessment of the monthly changes in these measurements revealed that early fracture collapse with loss of the reduced radial tilt occurred. Besides, among the 4 measurements, the normal radial tilt was the most difficult to be achieved when repositioning and pinning the fractured fragments. Conclusions. Even though the modified Kapandji technique provided a superior ability to maintain the reduced position until bone healing over the Willenegger method, we recommended that refinement of surgical techniques and postoperative hand care program may be necessary to fulfill the treatment objectives of stable surgical fixation and early joint motion. PMID:24883316

  17. Radiographic Outcomes of Percutaneous Pinning for Displaced Extra-Articular Fractures of the Distal Radius: A Time Course Study

    Directory of Open Access Journals (Sweden)

    Tien-Yu Yang

    2014-01-01

    Full Text Available Introduction. Although not all malunited distal radius fractures are symptomatic, the goal of treatment for displaced extra-articular fractures of the distal radius should be to restore and to maintain the radial geometry until bone healing. However, the time course change after surgery for these fractures is unclear. Methods. We, therefore, performed a retrospective cohort study on patients who sustained such fractures treated with percutaneous pinning. The main outcome measures in this study included four radiographic measurements: radial height, radial inclination, radial tilt, and ulnar variance. Results. Assessment of the monthly changes in these measurements revealed that early fracture collapse with loss of the reduced radial tilt occurred. Besides, among the 4 measurements, the normal radial tilt was the most difficult to be achieved when repositioning and pinning the fractured fragments. Conclusions. Even though the modified Kapandji technique provided a superior ability to maintain the reduced position until bone healing over the Willenegger method, we recommended that refinement of surgical techniques and postoperative hand care program may be necessary to fulfill the treatment objectives of stable surgical fixation and early joint motion.

  18. Two-Dimensional Image Fusion of Planar Bone Scintigraphy and Radiographs in Patients with Clinical Scaphoid Fracture: An Imaging Study

    Energy Technology Data Exchange (ETDEWEB)

    Henriksen, O.M.; Lonsdale, M.N.; Jensen, T.D.; Weikop, K.L.; Holm, O.; Duus, B.; Friberg, L. (Dept. of Clinical Physiology/Nuclear Medicine, Glostrup Hospital, Glostrup (Denmark))

    2009-01-15

    Background: Although magnetic resonance imaging (MRI) is now considered the gold standard in second-line imaging of patients with suspected scaphoid fracture and negative radiographs, bone scintigraphy can be used in patients with pacemakers, metallic implants, or other contraindications to MRI. Bone scintigraphy is highly sensitive for the detection of fractures, but exact localization of scintigraphic lesions may be difficult and can negatively affect diagnostic accuracy. Purpose: To investigate the influence of image fusion of planar bone scintigraphy and radiographs on image interpretation in patients with suspected scaphoid fracture. Material and Methods: In 24 consecutive patients with suspected scaphoid fracture, a standard planar bone scintigraphy of both hands was supplemented with fusion imaging of the injured wrist. Standard and fusion images were evaluated independently by three experienced nuclear medicine physicians. In addition to the diagnosis, the degree of diagnostic confidence was scored in each case. Results: The addition of fusion images changed the interpretation of each of the three observers in seven, four, and two cases, respectively, reducing the number of positive interpretations of two of the observers from 11 and nine cases to six and seven cases, respectively. The degree of diagnostic confidence increased significantly in two observers, and interobserver agreement increased in all three pairs of observers from 0.83, 0.57, and 0.73 to 0.89, 0.8, and 0.9, respectively. Conclusion: Image fusion of planar bone scintigrams and radiographs has a significant influence on image interpretation and increases both diagnostic confidence and interobserver agreement

  19. Defining the lateral and accessory views of the patella: an anatomic and radiographic study with implications for fracture treatment.

    Science.gov (United States)

    Berkes, Marschall B; Little, Milton T M; Pardee, Nadine C; Lazaro, Lionel E; Helfet, David L; Lorich, Dean G

    2013-12-01

    The majority of orthopaedic surgeons rely on a lateral fluoroscopic image to assess reduction during patella fracture osteosynthesis. However, a comprehensive radiographic description of the lateral view of the patella has not been performed previously, and no accessory views to better visualize specific anatomic features have been developed. The purpose of this study was to provide a detailed anatomic description of all radiographic features of the true lateral of the patella, describe reproducible accessory views for assessing specific features of the patella, and demonstrate their utility in a fracture model. Twelve cadaver knee specimens free of patellofemoral pathology were used, and imaging was performed using standard C-arm fluoroscopy. For each specimen, a true lateral radiographic projection of the patella was obtained and distinct features were noted. Next, an arthrotomy was made and steel wire was contoured and fixed to various anatomic regions of the patella so as to obliterate the radiographic densities on the true lateral projection, thus confirming their anatomic correlation. Ideal views of the lateral and medial facets themselves were determined using radiographic markers and varying amounts of internal or external rotation of the specimen. Last, a transverse osteotomy was created in each patella and the ability of the true lateral and accessory views to detect malreduction was assessed. The true lateral projection of the patella was obtained with the limb in neutral alignment. Constant radiographic features of the lateral view of the patella include the articular tangent, a secondary articular density of variable length, and a dorsal cortical density. The articular tangent was produced by the central ridge between the medial and lateral facets in all specimens. The secondary articular density was created by a confluence of the edge of the lateral and edge of the medial facets in 5 patellas, a confluence of the edge of the lateral facet and the

  20. Routine radiographs at time of pin removal after closed reduction and percutaneous pinning for type 2 supracondylar humerus fractures do not change management: a retrospective cohort study.

    Science.gov (United States)

    Garg, Sumeet; Bloch, Nikki; Cyr, Micaela; Carry, Patrick

    2016-08-01

    Radiographs are usually taken on day of pin removal for children treated with closed reduction and percutaneous pinning (CRPP) of type 2 supracondylar humerus fractures. The purpose of this study was to determine whether radiographs taken at time of pin removal for patients recovering uneventfully alter management. After IRB approval, billing records identified 1213 patients aged 1-10 years who underwent elbow surgery between 2007 and 2013 at our institution for a supracondylar humerus fracture. Of these patients, 389 met inclusion criteria. Clinical charts were reviewed for demographics, operative details, and clinical follow-up, focusing on clinical symptoms present at pin removal. Radiographs taken at time of pin removal and subsequent visits were assessed for healing and fracture alignment. In no case was pin removal delayed based on radiographs. One hundred and nineteen (31 %) patients had radiographs taken following pin removal; in no case was loss of reduction found among these patients. No cases of neurologic or vascular injury, re-fracture, or loss of reduction occurred. Infection occurred in 12 patients (3 %). Pins were kept in place for 23.8 ± 4.4 days. Eighty-six patients (22 %) had additional intervention after pin removal (cast application in all cases). Of 389 patients, 75 (19 %) had no documented reason for extended casting, four (1 %) were extended based on physician evaluation of radiographs, and seven (2 %) were extended for other reasons. Elimination of radiographs at time of pin removal should be considered. If continuing to obtain radiographs at pin removal, we recommend removing pins before taking radiographs to reduce patient fear and anxiety from visualizing percutaneous pins.

  1. An investigation of thoracic and lumbar cancellous vertebral architecture using power-spectral analysis of plain radiographs.

    Science.gov (United States)

    Buck, A M; Price, R I; Sweetman, I M; Oxnard, C E

    2002-05-01

    The internal architecture of the vertebral bodies spanning the levels T1 to L5 in seven male columns was studied using mammographic-resolution radiographs of 2.5-mm-thick planar parasagittal slices. The overlapping radiographic shadows of vertebral trabeculae combined in the image to form a series of 'elements', broadly representative of the cancellous structure. The orientations and sizes of these elements were analysed by applying the Fast Fourier transform (FFT) to the digitized radiographic images. Elements aligned in the 'vertical' orientation, along the long axis of the column, were the most prominent for all vertebral levels. The relative prominence of horizontal to vertical elements was generally constant along the column below T5. In contrast, the relative prominence of oblique to vertical elements declined in the cranio-caudal direction, particularly in individuals aged > or = 60 years. The ratio of 'large' (x > 0.3 mm) to 'small' (0.15 mm or = 60 years, large elements increased in relative prominence in the caudal direction. These results suggest that a basic orthogonal pattern of trabeculae is found along the male human spine, regardless of differences in vertebral body size. Power-spectral analysis is shown to yield information summarizing the predominant orientations and sizes of radiographically rendered architectural elements of vertebral cancellous bone, to define the effects of ageing on architecture, and to identify broad structural differences between vertebral levels in the adult male spine.

  2. Fractures of the Sacrum After Chemoradiation for Rectal Carcinoma: Incidence, Risk Factors, and Radiographic Evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Han Jo [Department of Orthopedic Surgery, Washington University, St. Louis, Missouri (United States); Boland, Patrick J. [Department of Surgery, Orthopaedic Service, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Meredith, Dennis S. [Hospital for Special Surgery, Department of Orthopaedic Surgery, New York, New York (United States); Lis, Eric [Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Zhang Zhigang; Shi Weiji [Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Yamada, Yoshiya J. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Goodman, Karyn A., E-mail: goodmank@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

    2012-11-01

    Purpose: Sacral insufficiency fractures after adjuvant radiation for rectal carcinoma can present similarly to recurrent disease. As a complication associated with pelvic radiation, it is important to be aware of the incidence and risk factors associated with sacral fractures in the clinical assessment of these patients. Methods and Materials: Between 1998 and 2007, a total of 582 patients with locally advanced rectal carcinoma received adjuvant chemoradiation and surgical excision. Of these, 492 patients had imaging studies available for review. Hospital records and imaging studies from all 492 patients were retrospectively evaluated to identify risk factors associated with developing a sacral insufficiency fracture. Results: With a median follow-up time of 3.5 years, the incidence of sacral fractures was 7.1% (35/492). The 4-year sacral fracture free rate was 0.91. Univariate analysis showed that increasing age ({>=}60 vs. <60 years), female sex, and history of osteoporosis were significantly associated with shorter time to sacral fracture (P=.01, P=.004, P=.001, respectively). There was no significant difference in the time to sacral fracture for patients based on stage, radiotherapy dose, or chemotherapy regimen. Multivariate analysis showed increasing age ({>=}60 vs. <60 years, hazard ratio [HR] = 2.50, 95% confidence interval [CI] = 1.22-5.13, P=.01), female sex (HR = 2.64, CI = 1.29-5.38, P=.008), and history of osteoporosis (HR = 3.23, CI = 1.23-8.50, P=.02) were independent risk factors associated with sacral fracture. Conclusions: Sacral insufficiency fractures after pelvic radiation for rectal carcinoma occur more commonly than previously described. Independent risk factors associated with fracture were osteoporosis, female sex, and age greater than 60 years.

  3. Radiographic evaluation of acute distal radius fracture stability: A comparative cadaveric study between a thermo-formable bracing system and traditional fiberglass casting.

    Science.gov (United States)

    Santoni, Brandon G; Aira, Jazmine R; Diaz, Miguel A; Kyle Stoops, T; Simon, Peter

    2017-08-01

    Distal radius fractures are common musculoskeletal injuries and many can be treated non-operatively with cast immobilization. A thermo-formable brace has been developed for management of such fractures, but no data exist regarding its comparative stabilizing efficacy to fiberglass casting. A worst-case distal radius fracture was created in 6 cadaveric forearms. A radiolucent loading fixture was created to apply cantilever bending/compression loads ranging from 4.5N to 66.7N across the simulated fracture in the: (1) non-stabilized, (2) braced; and (3) casted forearms, each forearm serving as its own control. Fracture fragment translations and rotations were measured radiographically using orthogonal radiographs and a 2D-3D, CT-based transformation methodology. Under 4.5N of load in the non-stabilized condition, average sagittal plane rotation and 3D center of mass translation of the fracture fragment were 12.3° and 5.3mm, respectively. At the 4.5N load step, fragment rotation with the brace (avg. 0.0°) and cast (0.1°) reduced sagittal plane rotation compared to the non-stabilized forearm (Pdifferences in measured sagittal plane fracture fragment rotations or 3D fragment translations between the brace or cast at any of the four load steps (4.5N, 22.2N, 44.5N, and 66.7N, P≥0.138). In this in vitro radiographic study utilizing 6 cadaveric forearms with simulated severe-case, unstable and comminuted distal radius fractures, the thermo-formable brace stabilized the fracture in a manner that was not radiographically or biomechanically different from traditional fiberglass casting. Study results support the use of the thermo-formable brace clinically. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. Computed tomography of the acetabular fractures

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Ho Young; Suh, Jin Suck; Park, Chang Yun; Lee, Kil Woo [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1986-04-15

    In a retrospective study of 21 patients, in whom the acetabular fractures were suspected on initial radiographs, we compared and analysed the computed tomographic findings and plain radiographic findings. The results were as follow: 1. In patients with multiple trauma, no further change in position was required during CT examinations. 2. CT showed intraarticular loose bodies, which were invisible on plain radiographs. 3. CT was useful in detecting the fractures of acetabular rims, medial wall of acetabulum, and femoral head. 4. CT permitted better evaluation of shape, extent, and degree of separation of fracture fragments. 5. CT was helpful in detecting the associated fractures and soft tissue injuries. 6. CT also demonstrated the adequacy of reduction, the position of metallic fixation devices, and the presence or absence of remaining intraarticular osseous fragments after surgery.

  5. A rare case of 'blow-up' fracture of the orbit in a child

    Energy Technology Data Exchange (ETDEWEB)

    Patel, Preena N.; Kenney, Ian J. [Royal Alexandra Hospital for Sick Children, Radiology Department, Brighton (United Kingdom)

    2009-08-15

    We present a case of blow-out fracture of the superomedial orbital wall in a 6-year-old boy. The initial plain radiograph showed an intact orbital margin and opacification of the ethmoid sinus. A fine-cut CT scan of the facial bones revealed a complex fracture of the medial orbital wall extending into the orbital roof, with migration of fracture fragments into the anterior cranial fossa. Suspicion for unusual orbital fractures is crucial when assessing a child for orbital trauma, especially when plain radiographs do not display the typical signs. (orig.)

  6. Impact of degenerative radiographic abnormalities and vertebral fractures on spinal bone density of women with osteoporosis

    Directory of Open Access Journals (Sweden)

    Lúcia Costa Paiva

    2002-01-01

    Full Text Available CONTEXT: Measurements of bone density taken by dual-energy x-ray absorptiometry are the most accurate procedure for the diagnosis of osteoporosis. This procedure has the disadvantage of measuring the density of all mineral components, including osteophytes, vascular and extra vertebral calcifications. These alterations can influence bone density results and densitometry interpretation. OBJECTIVE: To correlate radiography and densitometry findings from women with osteoporosis, analyzing the influence of degenerative processes and vertebral fractures on the evaluation of bone density. DESIGN: Retrospective study. SETTING: Osteoporosis outpatients' clinic at Hospital das Clínicas, Universidade Estadual de Campinas. PARTICIPANTS: Ninety-six postmenopausal women presenting osteoporosis diagnosed by bone density. MAIN MEASUREMENTS: Bone mineral density of the lumbar spine and femoral neck were measured by the technique of dual-energy x-ray absorptiometry, using a LUNAR-DPX densitometer. Fractures, osteophytes and aortic calcifications were evaluated by simple x-rays of the thoracic and lumbar spine. RESULTS: The x-rays confirmed vertebral fractures in 41.6%, osteophytes in 33.3% and calcifications of the aorta in 30.2%. The prevalence of fractures and aortic calcifications increased with age. The mean bone mineral density was 0.783g/cm² and the mean T-score was --3.47 DP. Neither fractures nor aortic calcifications had significant influence on bone mineral density (P = 0.36 and P = 0.09, respectively, despite the fractured vertebrae having greater bone mineral density (P < 0.02. Patients with lumbar spine osteophytes showed greater bone mineral density (P = 0.04. Osteophytosis was associated with lumbar spine bone mineral density after adjustment for fractures and aortic calcifications by multiple regression (P = 0.01. CONCLUSION: Osteophytes and lumbar spine fractures can overestimate bone density interpretation. The interpretation of densitometry

  7. Radiographic absorptiometry for pre-screening of osteoporosis in patients with low energy fractures

    DEFF Research Database (Denmark)

    Buch, Inge; Oturai, Peter S; Jensen, Lars T

    2010-01-01

    Dual energy X-ray absorptiometry (DEXA) is the most accurate method and thus the method of choice for diagnosing osteoporosis. Due to the limited access to DEXA-scanners, screening of patients with low energy fractures (LEF) for osteoporosis is not routinely performed in Denmark. Pre...

  8. Radiographic evaluation of fracture healing after rigid plate fixation. Experiments in the rabbit

    Energy Technology Data Exchange (ETDEWEB)

    Paavolainen, P.; Karaharju, E.; Slaetis, P.; Waris, P. (Helsinki Univ. Central Hospital (Finland). Meilahti Clinic)

    1981-01-01

    Experimental osteotomies were made in 35 rabbit tibio-fibular bones and fixed with rigid stainless steel osteosynthesis plates (DCP/ASIF). The radiographic and histopathologic appearances in the healing osteotomies and adjacent bone were analysed at intervals from 3 up to 24 weeks postoperatively. Radiologically the osteotomy had closed at 9 weeks and microscopically this could be confirmed as longitudinal orientation of the cutter heads across the osteotomy gap with longitudinal orientation of the bone structure. The healing of the osteotomy was accompanied by gross structural changes in the adjacent cortical bone with loss of intracortical and subendosteal osteons, cementing lines and intermediate tissue between the osteons. This was characterized by decreasing attenuation of the cortical bone after healing of the osteotomy and should clinically be regarded as an indication for removal of the implant.

  9. Spinal cord injury without radiographic abnormality

    Directory of Open Access Journals (Sweden)

    Singh Anil

    2006-01-01

    Full Text Available Spinal cord injury without radiological abnormality is rare in adults. Below we present a case report of 20 yrs old male with isolated cervical cord injury, without accompanying vertebral dislocation or fracture involving the spinal canal rim. He fell down on plain and smooth ground while carrying 40 kg weight overhead and developed quadriparesis with difficulty in respiration. Plain radiographs of the neck revealed no fractures or dislocations. MRI showed bulky spinal cord and an abnormal hyper intense signal on the T2W image from C2 vertebral body level to C3/4 intervertebral disc level predominantly in the anterior aspect of the cord The patient was managed conservatively with head halter traction and invasive ventilatory support for the initial 7 days period in the ICU. In our patient recovery was good and most of the neurological deficit improved over 4 weeks with conservative management.

  10. Introduction of an alternative standardized radiographic measurement method to evaluate volar angulation in subcapital fractures of the 5th metacarpal

    Energy Technology Data Exchange (ETDEWEB)

    Hoffelner, Thomas; Resch, Herbert; Moroder, Philipp; Korn, Gundobert; Steinhauer, Felix [University of Salzburg, Department of Traumatology and Sports Injuries, Salzburg (Austria); Atzwanger, Joerg [University of Salzburg, Department of Radiology, Salzburg (Austria); Minnich, Bernd [University of Salzburg, Department of Organismic Biology, Salzburg (Austria); Tauber, Mark [Shoulder and Elbow Surgery ATOS Clinic Munich, Munich (Germany)

    2012-10-15

    The purpose of the present study was to compare the intra- and interobserver reliability of two different measurement methods for volar angulation of the 5th metacarpal (MC) in an attempt to establish a new standard measurement method to reduce interobserver discrepancies for therapeutic decisions. Twenty patients with subcapital fractures of the 5th MC were radiologically investigated. Imaging consisted of a radiographs in antero-posterior and precise lateral view in addition to a CT scan of the 5th MC. Measurement of volar angulation was accomplished using the conventional and the shaft articular surface (SAS) method. The measurements of five investigators were exported to a spreadsheet for statistical analysis to evaluate the intra-and interobserver reliability. The conventional technique showed large differences among the investigators and poor interobserver reliability (W = 0.328 and 0.307) both at injury (p = 0.001) and at follow-up (p = 0.189). The intraobserver concordance of all investigators showed better results with the SAS than with the conventional technique. With the SAS technique, no statistically significant difference among the investigators could be detected at either the time of injury (p = 0.418) or at follow-up (p = 0.526) with excellent interobserver reliability (W = 0.051 and W = 0.041). Evaluation of volar angulation at follow-up using CT scans did not show any statistically significant difference between the techniques with better correlation among the observers with the SAS technique (p = 0.838). The interobserver correlation of volar angulation with lateral radiographs using the conventional technique was insufficient. Therefore, we recommend the use of the novel SAS technique as standardized measurement method which showed higher accuracy and interobserver reliability in order to facilitate the choice of adequate treatment option. (orig.)

  11. Stochastic Model of Fracture Frequency Heterogeneity in a Welded Tuff EGS reservoir, Snake River Plain, Idaho, USA

    Science.gov (United States)

    Moody, A.; Fairley, J. P., Jr.

    2014-12-01

    In light of recent advancements in reservoir enhancement and injection tests at active geothermal fields, there is interest in investigating the geothermal potential of widespread subsurface welded tuffs related to caldera collapse on the Snake River Plain (SRP). Before considering stimulation strategies, simulating heat extraction from the reservoir under in-situ fracture geometries will give a first-order estimation of extractable heat. With only limited deep boreholes drilled on the SRP, few analyses of the bulk hydrologic properties of the tuffs exist. Acknowledging the importance of the spatial heterogeneity of fractures to the permeability and injectivity of reservoirs hosted in impermeable volcanic units, we present fracture distributions from ICDP hole 5036-2A drilled as a part of Project HOTSPOT. The core documents more than 1200 m of largely homogeneous densely welded tuff hosting an isothermal warm-water reservoir at ~60˚ C. Multiple realizations of a hypothetical reservoir are created using sequential indicator algorithms that honor the observed vertical fracture frequency statistics. Results help form criteria for producing geothermal energy from the SRP.

  12. Occult spinous process fractures associated with interspinous process spacers.

    Science.gov (United States)

    Kim, David H; Tantorski, Mark; Shaw, Jeremy; Martha, Juli; Li, Ling; Shanti, Nael; Rencu, Tal; Parazin, Stephen; Kwon, Brian

    2011-07-15

    Prospective observational study. To provide a more accurate estimate of the rate of acute spinous process fractures associated with IPS surgery. Biomechanical cadaveric studies have suggested adequate spinous process strength to support placement of interspinous process spacers (IPS). Postoperative spinous process fractures have been reported in one%-to 5.8% of patients in previous series based on routine biplanar radiographic evaluation. However, most fractures occur between the base and midportion of the spinous process in an area that is typically difficult to visualize on plain radiographs due to device design. All patients underwent preoperative biplanar plain radiographs and computed tomography (CT) of the lumbar spine to confirm anatomy favorable for IPS placement and rule out fracture or spondylolysis. Postoperatively, all patients underwent repeat CT imaging within six months of surgery, biplanar radiographs at two weeks, six weeks, three months, six months, and one year. All studies were reviewed independently by a neuroradiologist and two orthopedic spine surgeons. Fifty implants (38 L4-5, 12 L3-4) were placed in 38 patients who completed follow-up and were included in final analysis. Three IPS designs were included (34 Medtronic X-STOP titanium, 8 X-STOP PEEK, 8 Lanx Aspen). Postoperative CT revealed 11 nondisplaced spinous process fractures in 11 patients (28.9% of patients, 22% of levels). Five fractures were associated with mild to moderate lumbar back pain and six fractures were asymptomatic. No patient reported a traumatic incident. No fracture was identifiable on plain radiographs. One fracture displaced during follow-up evaluation. Three patients underwent IPS removal and laminectomy. Three fractures healed by CT in one year. Overall, patients with fractures tended toward poorer outcomes by Zurich Claudication Questionnaire (ZCQ) (28.5% vs. 34.8% improvement in symptom severity, P = 0.496; 21.4% vs. 30.7% improvement in physical function, P = 0

  13. Paired maximum inspiratory and expiratory plain chest radiographs for assessment of airflow limitation in chronic obstructive pulmonary disease

    Energy Technology Data Exchange (ETDEWEB)

    Kinoshita, Takashi, E-mail: tkino@med.kurume-u.ac.jp [Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume (Japan); Kawayama, Tomotaka, E-mail: kawayama_tomotaka@med.kurume-u.ac.jp [Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume (Japan); Imamura, Youhei, E-mail: mamura_youhei@med.kurume-u.ac.jp [Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume (Japan); Sakazaki, Yuki, E-mail: sakazaki@med.kurume-u.ac.jp [Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume (Japan); Hirai, Ryo, E-mail: hirai_ryou@kurume-u.ac.jp [Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume (Japan); Ishii, Hidenobu, E-mail: shii_hidenobu@med.kurume-u.ac.jp [Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume (Japan); Suetomo, Masashi, E-mail: jin_t_f_c@yahoo.co.jp [Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume (Japan); Matsunaga, Kazuko, E-mail: kmatsunaga@kouhoukai.or.jp [Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume (Japan); Azuma, Koichi, E-mail: azuma@med.kurume-u.ac.jp [Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume (Japan); Fujimoto, Kiminori, E-mail: kimichan@med.kurume-u.ac.jp [Department of Radiology, Kurume University School of Medicine, Kurume (Japan); Hoshino, Tomoaki, E-mail: hoshino@med.kurume-u.ac.jp [Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume (Japan)

    2015-04-15

    Highlights: •It is often to use computed tomography (CT) scan for diagnosis of chronic obstructive pulmonary disease. •CT scan is more expensive and higher. •A plane chest radiography more simple and cheap. Moreover, it is useful as detection of pulmonary emphysema, but not airflow limitation. •Our study demonstrated that the maximum inspiratory and expiratory plane chest radiography technique could detect severe airflow limitations. •We believe that the technique is helpful to diagnose the patients with chronic obstructive pulmonary disease. -- Abstract: Background: The usefulness of paired maximum inspiratory and expiratory (I/E) plain chest radiography (pCR) for diagnosis of chronic obstructive pulmonary disease (COPD) is still unclear. Objectives: We examined whether measurement of the I/E ratio using paired I/E pCR could be used for detection of airflow limitation in patients with COPD. Methods: Eighty patients with COPD (GOLD stage I = 23, stage II = 32, stage III = 15, stage IV = 10) and 34 control subjects were enrolled. The I/E ratios of frontal and lateral lung areas, and lung distance between the apex and base on pCR views were analyzed quantitatively. Pulmonary function parameters were measured at the same time. Results: The I/E ratios for the frontal lung area (1.25 ± 0.01), the lateral lung area (1.29 ± 0.01), and the lung distance (1.18 ± 0.01) were significantly (p < 0.05) reduced in COPD patients compared with controls (1.31 ± 0.02 and 1.38 ± 0.02, and 1.22 ± 0.01, respectively). The I/E ratios in frontal and lateral areas, and lung distance were significantly (p < 0.05) reduced in severe (GOLD stage III) and very severe (GOLD stage IV) COPD as compared to control subjects, although the I/E ratios did not differ significantly between severe and very severe COPD. Moreover, the I/E ratios were significantly correlated with pulmonary function parameters. Conclusions: Measurement of I/E ratios on paired I/E pCR is simple and

  14. A Radiographic Study on the Associations of Age and Prevalence of Vertebral Fractures with Abdominal Aortic Calcification in Japanese Postmenopausal Women and Men

    Directory of Open Access Journals (Sweden)

    Jun Iwamoto

    2010-01-01

    Full Text Available The purpose of the present study was to determine the associations of age and history of non- and low-traumatic fractures with the severity of abdominal aortic calcification in Japanese postmenopausal women and men. Four hundred and one Japanese persons (24 men and 377 postmenopausal women, mean age: 73.8 years for whom thoracic and lumbar spine radiographs had been obtained to evaluate their posture prior to patient participation in a fall-prevention exercise program were enrolled. The associations of sex, age, history of hip fracture, prevalence of vertebral fracture, and spondylosis grade (the Nathan degree with the severity of abdominal aortic calcification (length of calcification, as evaluated according to the number of vertebral bodies were analyzed. Nine subjects (2.2% had a history of hip fracture, and 221 (55.1% had at least one prevalent vertebral fracture. Two hundred and sixty-seven subjects (66.6% had first-degree spondylosis. Age and the number of prevalent vertebral fractures, but not sex, history of hip fracture, or spondylosis grade, were significantly associated with the severity of abdominal aortic calcification. The present study confirmed that age and the number of vertebral fractures were associated with the severity of abdominal aortic calcification in Japanese postmenopausal women and men.

  15. Genome-wide Association Study for Radiographic Vertebral Fractures: A Potential Role for the 16q24 BMD Locus versus Lessons Learned from Challenging Phenotype Definition.

    Science.gov (United States)

    Oei, Ling; Estrada, Karol; Duncan, Emma L; Christiansen, Claus; Liu, Ching-Ti; Langdahl, Bente L; Obermayer-Pietsch, Barbara; Riancho, José A; Prince, Richard L; van Schoor, Natasja M; McCloskey, Eugene; Hsu, Yi-Hsiang; Evangelou, Evangelos; Ntzani, Evangelia; Evans, David M; Alonso, Nerea; Husted, Lise B; Valero, Carmen; Hernandez, Jose L; Lewis, Joshua R; Kaptoge, Stephen K; Zhu, Kun; Cupples, L Adrienne; Medina-Gómez, Carolina; Vandenput, Liesbeth; Kim, Ghi Su; Lee, Seung Hun; Castaño-Betancourt, Martha C; Oei, Edwin H G; Martinez, Josefina; Daroszewska, Anna; van der Klift, Marjolein; Mellström, Dan; Herrera, Lizbeth; Karlsson, Magnus K; Hofman, Albert; Ljunggren, Osten; Pols, Huibert A P; Stolk, Lisette; van Meurs, Joyce B J; Ioannidis, John P A; Zillikens, M Carola; Lips, Paul; Karasik, David; Uitterlinden, André G; Styrkarsdottir, Unnur; Brown, Matthew A; Koh, Jung-Min; Richards, J Brent; Reeve, Jonathan; Ohlsson, Claes; Ralston, Stuart H; Kiel, Douglas P; Rivadeneira, Fernando

    2013-10-25

    Vertebral fracture risk is a heritable complex trait. The aim of this study was to identify genetic susceptibility factors for osteoporotic vertebral fractures applying a genome-wide association study (GWAS) approach. The GWAS discovery was based on the Rotterdam Study, a population-based study of elderly Dutch individuals aged >55years; and comprising 329 cases and 2,666 controls with radiographic scoring (McCloskey-Kanis) and genetic data. Replication of one top-associated SNP was pursued by de-novo genotyping of 15 independent studies across Europe, the United States, Australia and one Asian study. Radiographic vertebral fracture assessment was performed using McCloskey-Kanis or Genant semi-quantitative definitions. SNPs were analyzed in relation to vertebral fracture using logistic regression models corrected for age and sex. Fixed effects inverse variance and Han-Eskin alternative random effects meta-analyses were applied. Genome-wide significance was set at P 1.25) may still be consistent with an effect size definitions are needed to confirm or reject the involvement of this locus on the risk for vertebral fractures. © 2013.

  16. Cortical Marrow Ratio in Plain X-rays of Femoral Neck Fractures

    DEFF Research Database (Denmark)

    Viberg, Bjarke; Severin Gråe Harbo, Frederik; Ryg, Jesper

    2016-01-01

    Objectives: The purpose of this study is to evaluate Cortical Marrow Ratio (CMR) for reliability and relation to low Bone Mineral Density (BMD) in patients with femoral neck fractures. Methods: A total of 132 consecutive femoral neck fracture patients (median age 81.2 years, IQR 70.6-86.1) were a...

  17. Transphyseal Distal Humerus Fracture.

    Science.gov (United States)

    Abzug, Joshua; Ho, Christine Ann; Ritzman, Todd F; Brighton, Brian

    2016-01-01

    Transphyseal distal humerus fractures typically occur in children younger than 3 years secondary to birth trauma, nonaccidental trauma, or a fall from a small height. Prompt and accurate diagnosis of a transphyseal distal humerus fracture is crucial for a successful outcome. Recognizing that the forearm is not aligned with the humerus on plain radiographs may aid in the diagnosis of a transphyseal distal humerus fracture. Surgical management is most commonly performed with the aid of an arthrogram. Closed reduction and percutaneous pinning techniques similar to those used for supracondylar humerus fractures are employed. Cubitus varus caused by a malunion, osteonecrosis of the medial condyle, or growth arrest is the most common complication encountered in the treatment of transphyseal distal humerus fractures. A corrective lateral closing wedge osteotomy can be performed to restore a nearly normal carrying angle.

  18. Relative Frequency of Maxillofacial Fracture in CT-Scan Radiographs in Shahid Sadoghi and Shahid Rahnemoun Emergency Departments in Yazd from 2007 Till 2010

    Directory of Open Access Journals (Sweden)

    Ezoddini Ardakan

    2012-02-01

    Full Text Available Introduction: Technologic improvement and increased production of car and motorcycle have led to the increased incidence of maxillofacial trauma all around the world. Injuries of maxillofacial region include fractures of mandible, maxilla, zygoma, orbit and nasal bone, which is due to different etiologic factors such as motor vehicle accidents, quarreling, fall, and sport-related and work- related accidents. The Purpose of this study was to evaluate the frequency of maxillofacial fracture in CT-scan radiographs in Shahid Sadoghi and Shahid Rahnemon emergency departments in Yazd from 2007 till 2010. Methods: In this retrospective study we assessed the medical files of all patients with maxillofacial traumawho were admitted at Shahid Sadoughi and Shahid Rahnemoun hospitals in ENT and surgery wards during a 4-year period. The information from patients' medical file and CT scan radiographs were recorded. At last 372 patients were evaluated. Results: In this study the age of patients showed to be between 20 and 29. Eighty six and fourteen percent of patients were males and females, respectively. Among all fractures, mandible fracture was the most frequent one (50.8%. The most frequent etiologic factor was accident (59% and the most frequent outcome was partial recovery (46.4% and death was observed in 0.8% of individuals. Conclusion: Results of this study showed that the most frequent etiologic factor of trauma to maxillofacial region is motor vehicle accident similar to other developing countries.

  19. Qualitative and quantitative assessment of relationship between mandibular third molar and angle fracture on North Indian population: A clinico-radiographic study.

    Science.gov (United States)

    Yadav, Suresh; Tyagi, Shallu; Puri, Naveen; Kumar, Prince; Kumar, Puneet

    2013-04-01

    To assess the relationship between impacted mandibular third molar presence and the risk for mandibular angle fracture with the effect of various positions of mandibular third molar and the risk of mandibular angle fracture. In the North Indian territory, a total of 289 patients with mandibular angle fractures were studied and evaluated for the possible relationship with impacted third molar on the basis of clinical and panoramic radiographical findings. Results that confirmed the highest risk for mandibular angle fracture was associated with mesioangular angulations (45.42%) followed by vertical (26.34%), distoangular in sequence and least risk was found with bucco-version angulations (2.67%) according to Winter's classification. Additionally, the highest risk of mandibular angle fracture was reported with partially erupted third molar (47.75%), followed by erupted (23.53%) and unerupted third molar (19.38%). The risk for mandibular angle fracture is not only affected by status of eruption, angulations, position, number of roots present in third molar but also by the distance of mandibular third molar from inferior border of mandible and the percentage of remaining amount of bone at the mandibular angle region.

  20. False negative rate of syndesmotic injury in pronation-external rotation stage IV ankle fractures

    Directory of Open Access Journals (Sweden)

    Kwang-Soon Song

    2013-01-01

    Full Text Available Background: To investigate false negative rate in the diagnosis of diastasis on initial static anteroposterior radiograph and reliability of intraoperative external rotational stress test for detection of concealed disruption of syndesmosis in pronation external rotation (PER stage IV (Lauge-Hansen ankle fractures. Materials and Methods: We prospectively studied 34 PER stage IV ankle fractures between September 2001 and September 2008. Twenty (59% patients show syndesmotic injury on initial anteroposterior radiographs. We performed an intraoperative external rotation stress test in other 14 patients with suspicious PER stage IV ankle fractures, which showed no defined syndesmotic injury on anteroposterior radiographs inspite of a medial malleolar fracture, an oblique fibular fracture above the syndesmosis and fracture of the posterior tubercle of the tibia. Results: All 14 fractures showed different degrees of tibiofibular clear space (TFCS and tibiofibular overlapping (TFO on the external rotation stress test radiograph compared to the initial plain anteroposterior radiograph. It is important to understand the fracture pattern characterstic of PER stage IV ankle fractures even though it appears normal on anteroposterior radiographs, it is to be confirmed for the concealed syndesmotic injury through a routine intraoperative external rotational stress radiograph.

  1. Pediatric elbow fractures: MRI evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Beltran, J. (Dept. of Radiology, Hospital for Joint Diseases, New York, NY (United States)); Rosenberg, Z.S. (Dept. of Radiology, Hospital for Joint Diseases, New York, NY (United States)); Kawelblum, M. (Dept. of Orthopaedic Surgery, Hospital for Joint Diseases, New York, NY (United States)); Montes, L. (Dept. of Radiology, Beth Israel Medical Center, New York, NY (United States)); Bergman, A.G. (Dept. of Radiology, Stanford Univ., School of Medicine, CA (United States)); Strongwater, A. (Dept. of Orthopaedic Surgery, Hospital for Joint Diseases, New York, NY (United States))

    1994-05-01

    Magnetic resonance imaging (MRI) was performed in eight patients under the age of 8 years who suffered elbow fractures, to assess possible fracture extension into the distal nonossified epiphysis of the humerus in seven cases and to determine the displacement and location of the radial head in one case. MRI allowed accurate depiction of the fracture line when it extended into the cartilaginous epiphysis. In four cases, MRI findings were confirmed at surgery. In five cases, surgery was obviated because no articular extension of the fracture was seen on MRI (4 cases) or because no displacement was noted (1 case). In one patient, the plain film diagnosis of a Salter type II fracture was changed to Salter type IV on the basis of the MRI findings. It is concluded that MRI might play a role in the preoperative evaluation of pediatric patients presenting with elbow trauma when extension of the fracture cannot be determined with routine radiographic studies. (orig.)

  2. Diagnostic value of abdominal free air detection on a plain chest radiograph in the early postoperative period: a prospective study in 648 consecutive patients who have undergone abdominal surgery.

    Science.gov (United States)

    Milone, Marco; Di Minno, Matteo Nicola Dario; Bifulco, Giuseppe; Maietta, Paola; Sosa Fernandez, Loredana Maria; Musella, Mario; Iaccarino, Vittorio; Buccelli, Claudio; Nappi, Carmine; Milone, Francesco

    2013-09-01

    To the best of our knowledge, this is the first study to evaluate the predictive value of free air (on a plain radiograph) for bowel perforation in a large prospective cohort of surgical patients. All consecutive patients undergoing abdominal surgery between January 2011 and June 2012 were screened for this study. We performed an upright chest radiograph on the second and third postoperative day. Thereafter, additional radiographic evaluations were performed every 2 days until the disappearance of abdominal free air. Of the 648 subjects enrolled in our study, free abdominal air was found in 65 subjects on the first radiographic evaluation (2 days after surgery), 51 on the second (3 days after surgery), three on the third (5 days after surgery), and none on the fourth (7 days after surgery). The presence of free abdominal air was associated with an increased risk of gastrointestinal perforation. The presence of free air was associated with a hazard ratio (HR) of 21.54 (95% CI 9.66-48.01, pSensitivity, specificity, positive predictive value, and negative predictive value were 70, 93, 33, and 98%, respectively, at 2 days after surgery, and similar results were confirmed at 3 days after surgery. We believe that the presence of free air at 3 days after surgery should not be considered a common finding. Here, we demonstrate that the detection of free air has a remarkable predictive value for gastrointestinal perforation, which has been overestimated in previous experience.

  3. The Role of Computed Tomography in Evaluating Intra-Articular Distal Humerus Fractures.

    Science.gov (United States)

    Nolan, Betsy M; Sweet, Stephan J; Ferkel, Eric; Udofia, Aniebet-Abasi; Itamura, John

    2015-09-01

    Computed tomography (CT) is often used to evaluate intra-articular distal humerus fracture patterns, but it increases radiation exposure and cost. We conducted a study to determine the effect of adding CT evaluation to plain radiographic evaluation on the classification of, and treatment plans for, intra-articular distal humerus fractures. Nine blinded orthopedic surgeons evaluated 30 consecutive fractures for classification and surgical approach. Evaluations were performed first using plain radiographs and then again using the same radiographs plus CT images. Statistical analysis was performed using the κ correlation coefficient and Cramer V testing. We hypothesized that adding CT images to plain radiographs would change the classification and treatment of these fractures and would improve interobserver agreement on classification and treatment. Intraobserver reliability (Cramer V) was fair (.393) for classification and moderate (.426) for treatment. Interobserver reliability (Cohen κ) did not improve with CT: For classification, κ was .21 without CT and .20 with CT; for treatment, κ was .28 without CT and .27 with CT. When classifying the fractures, attending surgeons chose the multiplanar fracture pattern 25.6% of the time without CT, and remained consistent at 23.3% with CT. Trainees chose this fracture pattern much less often without CT than with CT. Use of CT changed the treatment for multiplanar fractures (73.7% lateral approach vs 51.9% posterior approach with olecranon osteotomy). When added to plain radiographic evaluation, CT evaluation changes classification and treatment plans. Interobserver reliability did not improve. Less experienced surgeons were more likely to identify multiplanar fracture patterns with use of CT. We recommend performing CT for all intra-articular distal humerus fractures.

  4. MR of physeal fractures of the adolescent knee

    Energy Technology Data Exchange (ETDEWEB)

    Close, B.J.; Strouse, P.J. [Section of Pediatric Radiology, C. S. Mott Children' s Hospital, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI (United States)

    2000-11-01

    The aim of this study was to assess physeal fractures of the pediatric knee identified by MR imaging and to describe the MR findings of such fractures. The authors reviewed 315 consecutive pediatric knee MR examinations done to assess for traumatic injury. The MR images were reviewed for evidence of physeal fracture. Fractures were classified by the Salter-Harris system, and associated findings and injuries were noted. Plain radiographs and medical records were reviewed. Seven distal femoral physeal fractures (Salter II, n = 6; Salter III, n = 1) and two proximal tibia physeal fractures (Salter III, n = 1; complex Salter IV, n = 1) were identified. Magnetic resonance demonstrated widening of a portion of the physis with visualization of a metaphyseal/epiphyseal fracture line. Periosteal elevation was observed in six cases. Four patients had associated ligamentous or meniscal injuries. Plain radiographs were available for review in eight patients. Bone abnormalities suggesting fracture were evident in six of eight patients; however, the fracture was fully delineated in only one patient. The diagnosis or confirmation of fracture by MR changed clinical management in seven of eight patients in whom follow-up was available. Physeal fractures of the pediatric knee are occasionally diagnosed by MR. Magnetic resonance provides improved delineation of non-displaced physeal fractures of the knee, while simultaneously allowing for evaluation of soft tissue structures. (orig.)

  5. Usefulness of MR imaging in pathologic fracture of long bone

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Hyo Soon; Park, Jin Gyoon; Song, Jae Min; Chung, Tae Woong; Yoon, Woong; Kang, Heoung Kyun [Chonnam University Hospital, Kwangju (Korea, Republic of)

    2002-08-01

    The purpose of this study was to evaluate the usefulness of MR imaging of pathologic fractures of the long bones. In 18 patients aged between four and 75 (mean, 25.8) years with histologically confirmed pathologic fractures of the long bones, plain radiographs and MR images were retrospectively analyzed. The former were examined with regard to location and type of fracture, and the presence or absence of underlying disease causing fracture; and the latter in terms of underlying disease, extraosseous mass formation, and soft tissue change. The long bones involved were the femur in nine patients, the humerus in six, and the tibia in three. Underlying diseases were metastatic tumor (n=6), benign bone tumor (n=5), primary malignant bone tumor (n=4), osteomyelitis (n=2), and eosinophilic granuloma (n=1). Plain radiographs showed the fracture site as the metaphysis in ten cases, the disphysis in five, and the metadisphysis in one. Fractures were either transverse (n=10), oblique (n=3), spiral (n=1), vertical (n=1), or telescopic (n=1). In two cases, the fracture line was not visible. MR images revealed underlying diseases in all cases. Two benign bone tumors took the form of a cystic mass, hematoma was seen in three cases. Where pathologic fracture of a long bone had occurred, or a pathologic fracture in which the findings of plain radiography were equivocal, MR imaging was useful for evaluating the pattern and extent of an underlying lesion.

  6. Stress Fracture of the Proximal Fibula in Military Recruits

    OpenAIRE

    Hong, Seoung Hwan; Chu, In Tak

    2009-01-01

    Background We wanted to report on stress fracture of the proximal fibula and to suggest the pathomechanism of this fracture. Methods Between April 2004 through April 2005, the military recruits who complained of leg pain during the 6 weeks basic training in the Republic of Korea Marine Corps education and training group were evaluated according to their clinical manifestations and plain radiographs. Results Twelve recruits of 635 recruits who complained leg pain were diagnosed as having fibul...

  7. Texture analysis of clinical radiographs using radon transform on a local scale for differentiation between post-menopausal women with and without hip fracture

    Science.gov (United States)

    Boehm, Holger F.; Körner, Markus; Baumert, Bernhard; Linsenmaier, Ulrich; Reiser, Maximilian

    2011-03-01

    Osteoporosis is a chronic condition characterized by demineralization and destruction of bone tissue. Fractures associated with the disease are becoming an increasingly relevant issue for public health institutions. Prediction of fracture risk is a major focus research and, over the years, has been approched by various methods. Still, bone mineral density (BMD) obtained by dual-energy X-ray absorptiometry (DXA) remains the clinical gold-standard for diagnosis and follow-up of osteoporosis. However, DXA is restricted to specialized diagnostic centers and there exists considerable overlap in BMD results between populations of individuals with and without fractures. Clinically far more available than DXA is conventional x-ray imaging depicting trabecular bone structure in great detail. In this paper, we demonstrate that bone structure depicted by clinical radiographs can be analysed quantitatively by parameters obtained from the Radon Transform (RT). RT is a global analysis-tool for detection of predefined, parameterized patterns, e.g. straight lines or struts, representing suitable approximations of trabecular bone texture. The proposed algorithm differentiates between patients with and without fractures of the hip by application of various texture-metrics based on the Radon-Transform to standard x-ray images of the proximal femur. We consider three different regions-of-interest in the proximal femur (femoral head, neck, and inter-trochanteric area), and conduct an analysis with respect to correct classification of the fracture status. Performance of the novel approach is compared to DXA. We draw the conclusion that performance of RT is comparable to DXA and may become a useful supplement to densitometry for the prediction of fracture risk.

  8. Distal tibial fracture treated by minimally invasive plate osteosynthesis after external fixation Retrospective clinical and radiographic assessment

    Directory of Open Access Journals (Sweden)

    Al. Șerban

    2014-02-01

    Full Text Available Fractures of the horizontal surface of the distal tibia are known commonly as pylon or plafond fractures, and represent 1-5% of lower extremity fractures, 7-10% of all tibial fractures. The protocol consisted of immediate (within eight to 24 hours open reduction and internal fixation of the fibula, using a fibular plate or one third tubular plate and application of an external fixator spanning the ankle joint. In the second stage, the treatment of proximal and distal tibial fractures with close reduction and MIPPO technique can preserve soft tissue, simplify operative procedure and decrease wound, obtain rigid internal fixation and guarantee early function exercises of ankle joint. In this study we evaluated 22 patients treated in Clinical Emergency Hospital Constanta between April 2012 - July 2013 diagnosed with multifragmentary fractures of the distal tibia. This study evaluates the treatment of complex fractures of distal tibia with locked plate after external fixation. There were 17 males and 5 females of mean age 51,7 years (31-68. The mean follow-up period was 14 weeks. (Ranging from 9-16 weeks. All patients were fully weight bearing at 16 weeks (ranging 9-16 weeks showing radiological union. There were no cases of failures of fixation, or rotational misalignment. No significant complication was observed in our patients. MIPO is an effective method of treatment for distal tibial fractures, reduce surgical trauma and maintain a more biologically favorable environment for fracture healing, reducing risks of infection and nonunion.

  9. Relationship between mandibular angle fracture and state of eruption of mandibular third molar: A digital radiographic study

    Directory of Open Access Journals (Sweden)

    Mahesh Kumar Talkad Subbaiah

    2015-01-01

    Full Text Available Objectives: The purpose of this study was to assess the relationship between mandibular angle fracture and the status of eruption of the mandibular third molars. Materials and Methods: The sample consisted of 50 mandibular angle fracture cases with or without the presence of mandibular third molars, inclusive of both genders in the age group 18 years and above. The mandibular angle fractures were assessed by taking an orthopantomograph for each case following strict radiation protection protocol after an informed consent was obtained. The captured image was assessed and traced for the presence of mandibular angle fracture, angulation, and status of mandibular third molar by using Windows Trophy DICOM and Master View 3.0 software. Pell and Gregory′s and Winter′s classifications were followed. Results: We observed the following: Increased incidence of angle fractures in the presence of mandibular third molar, male predominance, the mean average age being 29 years, and the most common cause of angle fractures was road traffic accident; the fractures were observed more on the left side. In the total sample, mandibular third molar was present in 90% of the cases with angle fracture; of this, 73% of the teeth were impacted. Increased incidence of mandibular angle fracture was observed in position A, class II, and mesioangular impaction of third molar, which were statistically significant. Conclusion: The presence of mandibular third molar was in strong association with mandibular angle fracture and there was an increased incidence of position A, class II, and mesioangular impaction, when compared with other positions. This study concludes that there is a direct relationship between the presence and status of impacted third molars with increased risk of mandibular angle fracture.

  10. Role of computed tomography in the classification and management of pediatric pelvic fractures.

    Science.gov (United States)

    Silber, J S; Flynn, J M; Katz, M A; Ganley, T J; Koffler, K M; Drummond, D S

    2001-01-01

    In adults, pelvic computed tomography (CT) scanning plays an important role in the treatment of pelvic fractures; however, the role of CT scanning in the management of pediatric pelvic fractures is unclear. The purpose of this study was to investigate the efficacy of CT scanning in the management of pelvic fractures in children. One hundred three consecutive patients were identified. All patients underwent anteroposterior plain radiographic evaluation; CT scans were performed in 62. Three orthopaedic surgeons independently reviewed the plain radiographs and determined fracture classification and management. Subsequently, each observer was shown corresponding CT scans and again determined classification and management. Interobserver agreement was calculated using Kappa statistics. After the addition of CT scans, the mean changes in classification were nine (15%) and in management two (3%). Plain radiographs alone reliably predicted the need and type of operative intervention. Kappa statistics demonstrated "excellent" agreement for classification and management without and with CT scans. We reliably determined fracture classification and management based on plain radiographs alone.

  11. MODE II FRACTURE PARAMETERS FOR VARIOUS SIZES OF BEAMS IN PLAIN CONCRETE

    Directory of Open Access Journals (Sweden)

    Darsigunta Seshaiah

    2015-11-01

    Full Text Available Blended aggregate in concrete and arriving at the structural properties of blended aggregate concrete is a thrust area. Pumice is very light and porous igneous rock that is formed during volcanic eruptions.Cinder is a waste material obtained from steel manufacturing units. Shear strength is a property of major significance for wide range of civil engineering materials and structures. Shear and punching shear failures particularly in deep beams, in corbels and in concrete flat slabs are considered to be more critical and catastrophic than other types of failures. This area has received greater attention in recent years. For investigating shear type of failures, from the literature it is found that double central notched (DCN specimen geometry proposed by Prakash Desai and V.Bhaskar Desai is supposed the best suited geometry. In this present experimental investigation an attempt is made to study the Mode-II fracture property of light weight blended aggregate cement concrete combining both the pumice and cinder in different proportions, and making use of DCN test specimen geometry . By blending the pumice and cinder in different percentages of 0, 25, 50, 75 and 100 by volumeof concrete, a blended light weight aggregate concrete is prepared. By using this the property such as in plane shear strength is studied. Finally an analysis is carried out regarding Mode-II fracture properties of blended concrete. It is concluded that the Ultimate load in Mode-II is found to decrease continuously with the percentage increase in Pumice aggregate content. It is also observed that the ultimate stress in Mode II is found to increase continuously with percentage increase in cinder aggregate content.

  12. Radiographic results after plaster cast fixation for 10 days versus 1 month in reduced distal radius fractures: a prospective randomised study.

    Science.gov (United States)

    Christersson, Albert; Larsson, Sune; Östlund, Bengt; Sandén, Bengt

    2016-11-21

    The aim of this study was to examine whether reduced distal radius fractures can be treated with early mobilisation without affecting the radiographic results. In a prospective randomised study, 109 patients (mean age 65.8 (range 50-92)) with moderately displaced distal radius fractures were treated with closed reduction and plaster cast fixation for about 10 days (range 8-13 days) followed by randomisation to one of two groups: early mobilisation (n = 54, active group) or continued plaster cast fixation for another 3 weeks (n = 55, control group). For three patients in the active group (6%), treatment proved unsuccessful because of severe displacement of the fracture (n = 2) or perceived instability (n = 1). From 10 days to 1 month, i.e. the only period when the treatment differed between the two groups, the active group displaced significantly more in dorsal angulation (4.5°, p < 0.001), radial angulation (2.0°, p < 0.001) and axial compression (0.5 mm, p = 0.01) compared with the control group. However, during the entire study period (i.e. from admission to 12 months), the active group displaced significantly more than the controls only in radial angulation (3.2°, p = 0.002) and axial compression (0.7 mm, p = 0.02). Early mobilisation 10 days after reduction of moderately displaced distal radius fractures resulted in both an increased number of treatment failures and increased displacement in radial angulation and axial compression as compared with the control group. Mobilisation 10 days after reduction cannot be recommended for the routine treatment of reduced distal radius fractures. ClinicalTrail.gov, NCT02798614 . Retrospectively registered 16 June 2016.

  13. Clinical and radiographic predictors of acute compartment syndrome in the treatment of tibial plateau fractures: a retrospective cohort study.

    Science.gov (United States)

    Gamulin, Axel; Lübbeke, Anne; Belinga, Patrick; Hoffmeyer, Pierre; Perneger, Thomas V; Zingg, Matthieu; Cunningham, Gregory

    2017-07-18

    The aim of the study was to evaluate the relation between demographic, injury-related, clinical and radiological factors of patients with tibial plateau fractures and the development of acute compartment syndrome. All consecutive adult patients with intra-articular tibial plateau fractures admitted in our urban academic medical centre between January 2005 and December 2009 were included in this retrospective cohort study. The main outcome measurement was the development of acute compartment syndrome. The charts of 265 patients (mean age 48.6 years) sustaining 269 intra-articular tibial plateau fractures were retrospectively reviewed. Acute compartment syndrome occurred in 28 fractures (10.4%). Four patients presented bilateral tibial plateau fractures; of them, 2 had unilateral, but none had bilateral acute compartment syndrome. Non-contiguous tibia fracture or knee dislocation and higher AO/OTA classification (type 41-C) were statistically significantly associated with the development of acute compartment syndrome in multivariable regression analysis, while younger age (compartment syndrome seemed unlikely during initial assessment. However, larger studies are mandatory to confirm and refine both factors in predicting the occurrence of acute compartment syndrome.

  14. Do we need to follow up an early normal ultrasound with a later plain radiograph in children with a family history of developmental dysplasia of the hip?

    Science.gov (United States)

    Tafazal, Suhayl; Flowers, Mark J

    2015-10-01

    We routinely perform a pelvic radiograph between 6 and 12 months of age for children with a family history of developmental dysplasia of hip (DDH). We conducted this study to determine whether children with a family history of DDH and a normal hip ultrasound after birth require any further radiological follow-up. We identified all children referred to our hip-screening clinic in a 3-year period between August 2008 and August 2011 with a family history of DDH and a normal hip ultrasound after birth. A total of 119 patients with a normal hip ultrasound after birth had a pelvic radiograph at a median age of 6.6 months. Six patients had residual dysplasia (acetabular index >30°) on the initial radiograph; five of these had resolved spontaneously by age 12 months, and the remaining patient had a normal radiograph at 21 months of age and was discharged. We have found no cases of residual hip dysplasia requiring treatment in children with a family history of DDH and a normal hip ultrasound after birth. We have therefore changed our practice accordingly and no longer routinely followed up such cases. Diagnostic study, Level II.

  15. Atraumatic femoral neck fracture secondary to prolonged lactation induced osteomalacia

    Directory of Open Access Journals (Sweden)

    Dhammapal Sahebrao Bhamare

    2013-01-01

    Full Text Available Presenting a case of atraumatic fracture neck femur secondary to 2 years of prolonged lactation. A 26-year-old lactating mother presented with pain in left hip from last 12 months. She was apparently alright before and during pregnancy. Plain radiograph showed a complete undisplaced fracture of femoral neck. Osteomalacia was diagnosed by radiological and serological investigations. The fracture was fixed using AO type cannulated cancellous screws. The fracture showed good clinical and radiological union at 3 months. Literature review shows that this is a first case of atraumatic fracture of neck femur due to prolonged lactational osteomalacia. It showed that even apparently healthy Indians are susceptible to osteomalacia, more so during pregnancy and lactation and can be presented as atraumatic fracture. Although considered relatively stable, a compression type incomplete fracture neck femur may progress to a complete fracture if not treated in time.

  16. Salter-Harris type III fracture of the lateral femoral condyle with a ruptured posterior cruciate ligament: an uncommon injury pattern.

    Science.gov (United States)

    Rafee, Asan; Kumar, A; Shah, S V

    2007-01-01

    We report a case of an obscure injury to the distal femoral epiphysis with an uncommon pattern in a 12-year-old boy following a road traffic accident. Initial plain radiographs of the knee were inconclusive. Further investigation with magnetic resonance imaging revealed Salter-Harris type III fracture of the lateral femoral condyle with a gap at the fracture site associated with avulsion of the posterior cruciate ligament. This potentially serious injury can be underestimated on plain radiographs and therefore any suspected injury to the distal femoral epiphysis should be thoroughly assessed and investigated to institute appropriate treatment and minimise the risk of long-term complications.

  17. Numerical simulation of groundwater level in a fractured porous medium and sensitivity analysis of the hydrodynamic parameters using grid computing: application of the plain of Gondo (Burkina Faso

    Directory of Open Access Journals (Sweden)

    Wenddabo Olivier Sawadogo

    2012-01-01

    Full Text Available The use of mathematical modeling as a tool for decision support is not common in Africa in solving development problems. In this article we talk about the numerical simulation of groundwater level of the plain of Gondo (Burkina Faso and the sensitivity analysis of the hydrodynamic parameters. The domain has fractures which have hydraulic coefficients lower than those of the rock. Our contribution is to bring brief replies to the real problem posed in the thesis of Mr. KOUSSOUBE [1]. Namely that what causes the appearance of the piezometric level observed and impact of surface water on the piezometry. The mathematical model of the flow was solved by programming the finite element method on FreeFem++[2]. A local refinement of the mesh at fracture was used. We then conduct a sensitivity analysis to see which hydrodynamic parameters influences much of the solution. The method used for the sensitivity analysis is based on the calculation of the gradient by the adjoint equation and requires great computational power. To remedy this, we used a technique of distributed computing and we launched our application to the Moroccan grid (magrid. This allowed us to reduce the computation time. The results allowed to highlight the role of fractures and contributions of surface water on the evolution of the piezometric level of the plain of Gondo and identified the parameters that greatly influence the piezometric level.

  18. The Bristol Hip View: Its Role in the Diagnosis and Surgical Planning and Occult Fracture Diagnosis for Proximal Femoral Fractures

    Directory of Open Access Journals (Sweden)

    J. Harding

    2013-01-01

    Full Text Available Aim. To evaluate whether a modified radiographic view of the femoral neck improves the diagnosis of occult proximal femoral. Materials and Methods. Prospective study of patients presenting with clinically suspected proximal femoral fractures or who underwent traditional plain radiographic views and the Bristol hip view (a 30-degree angled projection. Six blinded independent observers assessed the images for presence of a fracture, anatomical level, and displacement. Results. 166 consecutive patients presenting with the clinical diagnosis of a proximal femoral fracture, of which 61 sustained a fracture. Six of these were deemed occult due to negative plain and had proven fractures on subsequent cross-sectional imaging. The Bristol hip view demonstrated five of these six fractures. It performed better than the traditional lateral hip view to identify the injury. The Bristol hip view predicted correctly the fracture type and displacement in all cases and missed only one of the occult fractures. Conclusion. The Bristol hip view is more sensitive and clearer than a lateral projection for patients. It adds useful diagnostic information and performs better than the traditional views in occult fractures. Its use may prevent the need for further cross sectional imaging and subsequent surgical delay.

  19. Proximal femoral bone geometry in osteoporotic hip fractures in Thailand.

    Science.gov (United States)

    2015-01-01

    A number of different bone geometries have been reported to be correlated with osteoporosis, bone mineral density and fractures. Those correlations are used for diagnosis, treatment and prediction of fracture risk in osteoporosis cases. However there have been no studies of significant bone parameters predicting osteoporosis and hip fracture in Thailand To evaluate the correlation between geometric parameters of the proximal femur and both the Singh index and bone mineral density as well as to investigate the relationship between those two metrics and osteoporotic hip fracture in the Thai population. Forty-four Thai patients with osteoporotic hip fractures andforty-five healthy Thai people matched for age and gender were included in the present study. Bone mineral density and bone geometry from plain hip radiographs of non-fracture sites in the fracture group and proximal femur radiographs of the same site in the healthy group were measured That data were analyzed to determine levels of correlation. Bone geometries were also analyzed to determine hip fracture predictive capacity. Correlation between the Singh index and bone mineral density was significant (p hip fracture (p = 0.014 and p = 0.035, respectively). Each 1 mm reduction in the width of the femoral medial neck cortex increased the osteoporotic hip fracture risk by a factor of 2.7 (OR = 0.37, 95% CI = 0.15-0.93). In the Thai population, bone geometry from plain radiographs can help predict the risk of osteoporotic hip fracture. Osteoporosis is correlated with a low Singh index value. The width of the femoral medial neck cortex is a reliable predictor of hip fracture risk.

  20. Multidetector Computed Tomography of Cervical Spine Fractures in Ankylosing Spondylitis

    Energy Technology Data Exchange (ETDEWEB)

    Koivikko, M.P.; Kiuru, M.J.; Koskinen, S.K. [Helsinki Univ. Central Hospital, Toeoeloe Trauma Center (Finland). Dept. of Radiology

    2004-11-01

    Purpose: To analyze multidetector computed tomography (MDCT) cervical spine findings in trauma patients with advanced ankylosing spondylitis (AS). Material and Methods: Using PACS, 2282 cervical spine MDCT examinations requested by emergency room physicians were found during a period of 3 years. Of these patients, 18 (16 M, aged 41-87, mean 57 years) had advanced AS. Primary imaging included radiography in 12 and MRI in 11 patients. Results: MDCT detected one facet joint subluxation and 31 fractures in 17 patients: 14 transverse fractures, 8 spinous process fractures, 2 Jefferson's fractures, 1 type I and 2 type II odontoid process fractures, and 1 each: atlanto-occipital joint fracture and C2 laminar fracture plus isolated transverse process and facet joint fractures. Radiographs detected 48% and MRI 60% of the fractures. MRI detected all transverse and odontoid fractures, demonstrating spinal cord abnormalities in 72%. Conclusion: MDCT is superior to plain radiographs or MRI, showing significantly more injuries and yielding more information on fracture morphology. MRI is valuable, however, in evaluating the spinal cord and soft-tissue injuries. Fractures in advanced AS often show an abnormal orientation and are frequently associated with spinal cord injuries. In these patients, for any suspected cervical spine injuries, MDCT is therefore the imaging modality of choice.

  1. Degenerative disc disease as a cause of back pain in the thalassaemic population: a case-control study using MRI and plain radiographs

    Energy Technology Data Exchange (ETDEWEB)

    Desigan, S.; Hall-Craggs, M.A.; Ho, C.-P. [Department of Imaging, University College London Hospitals NHS Foundation Trust, London (United Kingdom); Eliahoo, J. [University College London Hospitals NHS Trust, Research and Development Directorate, London (United Kingdom); Porter, J.B. [University College Hospital, Department of Haematology, University College London Hospitals NHS Trust, London (United Kingdom)

    2006-02-15

    The aim of this study was to test our observation that back pain in thalassemic patients could be caused by premature and extensive lumbar degenerative disc disease, when compared to non-thalassemic patients with back pain. Sixteen thalassemic patients with their sex- and age-matched controls were recruited into the study, 12 with thalassemia major, and 4 with thalassemia intermedia. Both the thalassemia patients and control subjects suffered from back pain, which was subjective rather than measured/pain scored. All subjects underwent magnetic resonance (MR) imaging of the lumbar spine, and 11 of the cases and 8 controls had lumbar spine radiographs. Each lumbar disc was scored for radiographic appearances and MR features of disc degeneration and disc protrusion. Proportion values for these parameters and median scores were derived at each disc level, and were analyzed and compared. There was a statistically-significant difference between proportion values of cases and controls for the MR features (P value=0.01, n=16) and the radiographic features (P value=0.01, n=11 cases, n=8 controls) of disc degeneration. The median disc level scores for the thalassemic group were uniformly high across all lumbar discs, and at all levels except at L 4/5. The control group conversely demonstrated a predilection for disc degeneration at L4/5 level. The distribution of lumbar disc degeneration in thalassemic patients with back pain is more extensive, severe and multi-level in nature compared to matched controls, and disc degeneration should be considered as a significant cause of back pain in this population group. (orig.)

  2. Radiographic bone texture analysis is correlated with 3D microarchitecture in the femoral head, and improves the estimation of the femoral neck fracture risk when combined with bone mineral density

    Energy Technology Data Exchange (ETDEWEB)

    Ollivier, Matthieu [Aix-Marseille Université, CNRS, ISM UMR 7287, 13284 Marseille (France); APHM, Hôpital Sainte Marguerite, Orthopedic Surgery Department, 13009 Marseille (France); Le Corroller, Thomas, E-mail: Thomas.LeCorroller@ap-hm.fr [Aix-Marseille Université, CNRS, ISM UMR 7287, 13284 Marseille (France); APHM, Hôpital Sainte Marguerite, Radiology Department, 13009 Marseille (France); Blanc, Guillaume [APHM, Hôpital Sainte Marguerite, Orthopedic Surgery Department, 13009 Marseille (France); Parratte, Sébastien [Aix-Marseille Université, CNRS, ISM UMR 7287, 13284 Marseille (France); APHM, Hôpital Sainte Marguerite, Orthopedic Surgery Department, 13009 Marseille (France); Champsaur, Pierre [Aix-Marseille Université, CNRS, ISM UMR 7287, 13284 Marseille (France); APHM, Hôpital Sainte Marguerite, Radiology Department, 13009 Marseille (France); Chabrand, Patrick [Aix-Marseille Université, CNRS, ISM UMR 7287, 13284 Marseille (France); Argenson, Jean-Noël [Aix-Marseille Université, CNRS, ISM UMR 7287, 13284 Marseille (France); APHM, Hôpital Sainte Marguerite, Orthopedic Surgery Department, 13009 Marseille (France)

    2013-09-15

    Purpose: Femoral neck fracture is a major public health problem in elderly persons, representing the main source of osteoporosis-related mortality and morbidity. In this study, we aimed at comparing radiographic texture analysis with three-dimensional (3D) microarchitecture in human femurs, and at evaluating whether bone texture analysis improved the assessment of the femoral neck fracture risk other than that obtainable by bone mineral density (BMD). Materials and methods: Thirteen osteoporotic femoral heads from patients who fractured their femoral neck and twelve non-fractured femoral heads from osteoarthritic patients were studied using respectively (1) a new high-resolution digital X-ray device (BMA™, D3A Medical Systems) allowing for bone texture analysis with fractal parameter Hmean, and (2) a micro-computed tomograph (CT) for 3D microarchitecture. BMD was measured postoperatively by DXA in all patients in the contralateral femur. Results: In these femoral heads, we found that fractal parameter Hmean was correlated with 3D microarchitecture parameters: bone volume fraction (BV/TV), trabecular number (Tb.N), trabecular separation (Tb.Sp) and fractal dimension (FD) respectively (p < 0.05). Then, fractal parameter Hmean was significantly lower in the femoral heads from the fractured group than from the non-fractured group (p < 0.01). Finally, multiple regression analysis showed that combining bone texture analysis and total hip BMD significantly improved the estimation of the femoral neck fracture risk from adjusted r{sup 2} = 0.46 to adjusted r{sup 2} = 0.67 (p < 0.05). Conclusion: Radiographic bone texture analysis was correlated with 3D microarchitecture parameters in the femoral head, provided accurate discrimination between the femoral heads from the fractured and non-fractured groups, and significantly improved the estimation of the femoral neck fracture risk when combined with BMD.

  3. Performance of computed tomography of the head to evaluate for skull fractures in infants with suspected non-accidental trauma

    Energy Technology Data Exchange (ETDEWEB)

    Culotta, Paige A.; Tran, Quynh-Anh; Donaruma-Kwoh, Marcella [Texas Children' s Hospital, Section of Public Health Pediatrics, Baylor College of Medicine, Houston, TX (United States); Crowe, James E.; Jones, Jeremy Y.; Mehollin-Ray, Amy R.; Tran, H.B.; Dodge, Cristina T. [Texas Children' s Hospital, The Edward B. Singleton, MD, Department of Pediatric Radiology, Baylor College of Medicine, Houston, TX (United States); Camp, Elizabeth A. [Texas Children' s Hospital, Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX (United States); Cruz, Andrea T. [Texas Children' s Hospital, Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX (United States); Texas Children' s Hospital, Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, TX (United States)

    2017-01-15

    Young children with suspected abusive head trauma often receive skull radiographs to evaluate for fractures as well as computed tomography (CT) of the head to assess for intracranial injury. Using a CT as the primary modality to evaluate both fracture and intracranial injury could reduce exposure to radiation without sacrificing performance. To evaluate the sensitivity of CT head with (3-D) reconstruction compared to skull radiographs to identify skull fractures in children with suspected abusive head trauma. This was a retrospective (2013-2014) cross-sectional study of infants evaluated for abusive head trauma via both skull radiographs and CT with 3-D reconstruction. The reference standard was skull radiography. All studies were read by pediatric radiologists and neuroradiologists, with ten percent read by a second radiologist to evaluate for interobserver reliability. One hundred seventy-seven children (47% female; mean/median age: 5 months) were included. Sixty-two (35%) had skull fractures by radiography. CT with 3-D reconstruction was 97% sensitive (95% confidence interval [CI]: 89-100%) and 94% specific (CI: 87-97%) for skull fracture. There was no significant difference between plain radiographs and 3-D CT scan results (P-value = 0.18). Kappa was 1 (P-value <0.001) between radiologist readings of CTs and 0.77 (P = 0.001) for skull radiographs. CT with 3-D reconstruction is equivalent to skull radiographs in identifying skull fractures. When a head CT is indicated, skull radiographs add little diagnostic value. (orig.)

  4. Fracture of an uncemented tantalum patellar component

    Directory of Open Access Journals (Sweden)

    Nathan L. Grimm, MD

    2016-06-01

    Full Text Available A 62-year-old man presented with the acute, atraumatic onset of pain 3 years after uncemented right total knee arthroplasty. He complained of new mechanical locking with the knee held in extension on examination and unable to flex the knee. On the plain radiographs, the patellar component peg was fractured and the plate was dislocated. The knee was immobilized, and revision to a cemented 3-peg component was performed. Fracture of a single-peg, tantalum-backed uncemented patellar component has not been described. Clinical suspicion for this should be given in the setting of acute locking. We recommend revision with a cemented polyethylene component.

  5. Plain radiologic findings and chronological changes of incipient phase osteosarcoma overlooked by primary physicians.

    Science.gov (United States)

    Song, Won Seok; Jeon, Dae-Geun; Cho, Wan Hyeong; Kong, Chang-Bae; Cho, Sang Hyun; Lee, Jung Wook; Lee, Soo-Yong

    2014-06-01

    We assessed the plain radiographic characteristics of 10 cases of osteosarcomas during the initial painful period that had been overlooked by a primary physician. In addition, we evaluated chronologic changes in radiographic findings from initial symptomatic period to the time of accurate diagnosis. The clinical records were reviewed for clinical parameters including age, sex, location, presenting symptoms, initial diagnosis, duration from initial symptoms to definite diagnosis, and initial and follow-up plain radiographic findings of the lesion. Initial clinical diagnoses included a sprain in 6, growing pain in 2, stress fracture in 1, and infection in 1 patient. Initial plain radiographic findings were trabecular destruction (100%), cortical disruption (60%), periosteal reaction (60%), and soft tissue mass (10%). Intramedullary matrix changes were osteosclerosis in 6 and osteolysis in 4 patients. On progression, 4 cases with minimal sclerosis changed to osteoblastic lesion in 3 patients and osteolytic lesion in 1. Four cases with faint osteolytic foci transformed into osteolytic lesion in 3 and mixed pattern in 1. Notable plain radiologic findings of incipient-stage osteosarcoma include trabecular disruption along with faint osteosclerosis or osteolysis. In symptomatic patients with trabecular destruction, additional imaging study including magnetic resonance imaging should be performed to exclude osteosarcoma in the incipient phase, even without radiologic findings suggesting malignant tumor, such as cortical destruction or periosteal reaction.

  6. Diagnostic value of CT in pelvic fracture by trauma

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Kyung Sook; Kang, Hyun Il; Suh, Myung Ok; Lee, Yul; Chung, Soo Young; Bae, Sang Hoon; Yoon, Jong Sup [College of Medicine Hallym University, Choonchun (Korea, Republic of)

    1987-06-15

    In order to determine the diagnostic value of CT in pelvic trauma, esp. acetabular fracture, we analysed 32 cases of pelvic trauma with conventional radiographic and computed tomographic findings. The results were as follows : 1. There were 26 males and 6 female and peak age span was 4th decade. 2. In 32 cases of acetabular fractures, single column fracture were diagnosed in 20 cases and two column fracture in 12 cases by CT. Among single column fractures, anterior column fractures were 12 cases and posterior column fractures were 8 cases. Complex fracture was most common type in two column fractures. 3. In 32 cases of acetabular fractures diagnosed by CT, 18 cases could be detected by plain X-ray. 4. Intraarticular bony fragments were detected on CT in 11 cases and on plain X-ray in 2 cases. 5. Combined soft issue injuries were 13 cases of pelvic hematoma, 1 case of retroperitoneal hematoma and 2 cases of hemarthrosis. 6. CT was useful in acetabular injury to delineated the extent and type of fracture, localized intraarticular bony fragments, characterize joint dislocation and detect the combined soft tissue injury.

  7. Inter- and intraobserver reliability of the MTM-classification for proximal humeral fractures

    DEFF Research Database (Denmark)

    Bahrs, Christian; Schmal, Hagen; Lingenfelter, Erich

    2008-01-01

    tool. METHODS: Three observers classified plain radiographs of 22 fractures using both a simple version (fracture displacement, number of parts) and an extensive version (individual topographic fracture type and morphology) of the MTM classification. Kappa-statistics were used to determine reliability....... RESULTS: An acceptable reliability was found for the simple version classifying fracture displacement and fractured main parts. Fair interobserver agreement was found for the extensive version with individual topographic fracture type and morphology. CONCLUSION: Although the MTM-classification covers...... a wide spectrum of fracture types, our results indicate that the precise topographic and morphological description is not delivering reproducible results. Therefore, simplicity in fracture classification may be more useful than extensive approaches, which are not adequately reliable to address current...

  8. Two and three-dimensional computed tomography for the classification and management of distal humeral fractures - Evaluation of reliability and diagnostic accuracy

    NARCIS (Netherlands)

    J. Doornberg; A. Lindenhovius; P. Kloen; C.N. van Dijk; D. Zurakowski; D. Ring

    2006-01-01

    Background: Complex fractures of the distal part of the humerus can be difficult to characterize on plain radiographs and two-dimensional computed tomography scans. We tested the hypothesis that three-dimensional reconstructions of computed tomography scans improve the reliability and accuracy of fr

  9. Radiographic arthrosis after elbow trauma: interobserver reliability.

    NARCIS (Netherlands)

    Lindenhovius, A.; Karanicolas, P.J.; Bhandari, M.; Ring, D.; Kampen, A. van

    2012-01-01

    PURPOSE: This study measured observer variation in radiographic rating of elbow arthrosis. METHODS: Thirty-seven independent orthopedic surgeons graded the extent of elbow arthrosis in 20 consecutive sets of plain radiographs, according to the Broberg and Morrey rating system (grade 0, normal joint;

  10. Correlating first- and second-rib fractures noted on spine computed tomography with major vessel injury.

    Science.gov (United States)

    Khosla, Ankaj; Ocel, Joseph; Rad, Arash Ehteshami; Kallmes, David F

    2010-11-01

    First- and second-rib fractures diagnosed on plain radiographs have been associated with traumatic aortic injury. We examined whether such fractures diagnosed on computed tomography (CT), which is of greater sensitivity than plain radiograms for rib fractures, are associated with traumatic vascular injury. We identified 1,894 patients who had undergone a chest CT angiogram with indication of trauma between 2005 and 2008. Among these, 185 patients were selected at random. The main mechanism of injury was motor vehicle accident or a fall. The patients were divided into two groups: patients with first- and/or second-rib fractures and those without. Proportions of patients with major vessel injury noted on CT angiography were compared between groups. Information regarding displacement of the fracture, location of the fracture, detection upon plain film, and gender of the patients was also evaluated and correlated with incidence of major vessel injury. Fisher's test and χ2 analysis were used to determine significance of the data. Incidence of major vessel injury was similar between patients with and without first- and/or second-rib fractures (7% vs. 9%, respectively; p = 0.59). No subset of type of rib fracture was associated with greater incidence of aortic injury. First- and second-fractures are not associated with greater incidence of aortic injury. Thus, the previous axiom that first- and second-rib fractures should result in increased examination for aortic injury may not hold true.

  11. 曲面体层X线、CT和MRI在髁突骨折诊断中的应用比较%The value of paronamic radiograph, CT and MRI for the diagnosis of condylar fracture

    Institute of Scientific and Technical Information of China (English)

    黄国伟; 郑吉驷; 张善勇; 杨驰

    2014-01-01

    Objective To retrospectively analyze the advantages and disadvantages of radiographic methods commonly used for diagnostic of condylar fractures.Methods From Jan 2002 to Nov 2013,290 patients (405 condylars) in the temporomandibular joint (TMJ) division of Ninth People's Hospital Shanghai Jiao Tong University School of Medicine were diagnosed as condylar fractures.Panoramic films and CT were taken in all patients to check and count the amount of condylar fractures,including intracapsular condyle fracture (type A,B,C and M),condylar neck fracture and subcondylar fracture.MRI was also taken in 119 patients with 174 condylar fractures to check the position of TMJ disc.The data were analyzed and compared among the three examinations in the diagnosis of the condylar fractures.Results Panoramic films showed 79.8% (323/405) condylar fractures.Among condylar fractures,intracapsular condylar fractures,condylar neck fractures and subcondylar fractures accounted for 48.9%(198/405),20.3%(82/405) and 10.6%(43/405)respectively.CT showed 64.0% (259/405) intracapsular condylar fractures,24.0% (97/405) condylar neck fractures and 12.1%(49/405) subcondylar fractures.Among intracapsular condylar fractures,Type A fracture was the most common type of ICF,which accounted for 48.7%(126/259),followed by Type B fracture,which accounted for 30.9%(80/259) and Type M fracture,12.4%(32/259).Type C fracture was the least type which accounted for 8.1% (21/259).According to the diagnostic criteria of CT,there were 10 condylar neck fractures misdiagnosed with intracapsular condylar fractures.MRI showed 94.9% (129/136) TMJ disc displacement in intracapsular condylar fractures,53.6% (15/28) in condylar neck fractures and 60.0% (6/10) in subcondylar fractures.Among intracapsular condylar fractures,there were 95.3%(61/64) TMJ disc displacement in type A,95.2%(40/42) in type B,89.0%(8/9) in type C,and 95.2%(20/21) in type M.There was significant difference of TMJ

  12. Radiographic Test

    Energy Technology Data Exchange (ETDEWEB)

    Lee, H.J; Yang, S.H. [Korea Electric Power Research Institute, Taejon (Korea)

    2002-07-01

    This report contains theory, procedure technique and interpretation of radiographic examination and written for whom preparing radiographic test Level II. To determine this baseline of technical competence in the examination, the individual must demonstrate a knowledge of radiography physics, radiation safety, technique development, radiation detection and measurement, facility design, and the characteristics of radiation-producing devices and their principles of operation. (author) 98 figs., 23 tabs.

  13. Radiographic tales

    DEFF Research Database (Denmark)

    Mussmann, Bo Redder

    2007-01-01

    . Methods The study is designed as an observational study with a narrative approach. The participant observations took place in a Danish radiological department and involved 20 examinations followed up by three semi-structured interviews. Conclusions Through emergent narratives radiographers construct...... of their narrative alertness. Errors and failure to keep the time schedule can, however, lead the radiographers to a change of perspective that makes them displace man from the scene of radiography by playing on the premises of technology....

  14. Visual search behaviour in skeletal radiographs: a cross-speciality study

    Energy Technology Data Exchange (ETDEWEB)

    Leong, J.J.H.; Nicolaou, M. [Royal Society/Wolfson Foundation Medical Image Computing Laboratory, Imperial College London, London (United Kingdom); Department of Biosurgery and Surgical Technology, Imperial College London, St Mary' s Hospital, London (United Kingdom); Emery, R.J.; Darzi, A.W. [Department of Biosurgery and Surgical Technology, Imperial College London, St Mary' s Hospital, London (United Kingdom); Yang, G.-Z. [Royal Society/Wolfson Foundation Medical Image Computing Laboratory, Imperial College London, London (United Kingdom)], E-mail: g.z.yang@imperial.ac.uk

    2007-11-15

    Aim: To determine whether experience improves the consistency of visual search behaviour in fracture identification in plain radiographs, and the effect of specialization. Material and methods: Twenty-five observers consisting of consultant radiologists, consultant orthopaedic surgeons, orthopaedic specialist registrars, orthopaedic senior house officers, and accident and emergency senior house officers examined 33 skeletal radiographs (shoulder, hand, and knee). Eye movement data were collected using a Tobii 1750 eye tracker with levels of diagnostic confidence collected simultaneously. Kullback-Leibler (KL) divergence and Gaussian mixture model fitting of fixation distance-to-fracture were used to calculate the consistency and the relationship between discovery and reflective visual search phases among different observer groups. Results: Total time spent studying the radiograph was not significantly different between the groups. However, the expert groups had a higher number of true positives (p < 0.001) with less dwell time on the fracture site (p < 0.001) and smaller KL distance (r = 0.062, p < 0.001) between trials. The Gaussian mixture model revealed smaller mean squared error in the expert groups in hand radiographs (r 0.162, p = 0.07); however, the reverse was true in shoulder radiographs (r -0.287, p < 0.001). The relative duration of the reflective phase decreases as the confidence level increased (r = 0.266, p = 0.074). Conclusions: Expert search behaviour exhibited higher accuracy and consistency whilst using less time fixating on fracture sites. This strategy conforms to the discovery and reflective phases of the global-focal model, where the reflective search may be implicated in the cross-referencing and conspicuity of the target, as well as the level of decision-making process involved. The effect of specialization appears to change the search strategy more than the effect of the length of training.

  15. Visual search behaviour in skeletal radiographs: a cross-specialty study.

    Science.gov (United States)

    Leong, J J H; Nicolaou, M; Emery, R J; Darzi, A W; Yang, G-Z

    2007-11-01

    To determine whether experience improves the consistency of visual search behaviour in fracture identification in plain radiographs, and the effect of specialization. Twenty-five observers consisting of consultant radiologists, consultant orthopaedic surgeons, orthopaedic specialist registrars, orthopaedic senior house officers, and accident and emergency senior house officers examined 33 skeletal radiographs (shoulder, hand, and knee). Eye movement data were collected using a Tobii 1750 eye tracker with levels of diagnostic confidence collected simultaneously. Kullback-Leibler (KL) divergence and Gaussian mixture model fitting of fixation distance-to-fracture were used to calculate the consistency and the relationship between discovery and reflective visual search phases among different observer groups. Total time spent studying the radiograph was not significantly different between the groups. However, the expert groups had a higher number of true positives (p<0.001) with less dwell time on the fracture site (p<0.001) and smaller KL distance (r=0.062, p<0.001) between trials. The Gaussian mixture model revealed smaller mean squared error in the expert groups in hand radiographs (r=0.162, p=0.07); however, the reverse was true in shoulder radiographs (r=-0.287, p<0.001). The relative duration of the reflective phase decreases as the confidence level increased (r=0.266, p=0.074). Expert search behaviour exhibited higher accuracy and consistency whilst using less time fixating on fracture sites. This strategy conforms to the discovery and reflective phases of the global-focal model, where the reflective search may be implicated in the cross-referencing and conspicuity of the target, as well as the level of decision-making process involved. The effect of specialization appears to change the search strategy more than the effect of the length of training.

  16. Does bone mineral density affect hip fracture severity?

    Science.gov (United States)

    Spencer, Simon J; Blyth, Mark J G; Lovell, Frances; Holt, Graeme

    2012-06-01

    The association between hip fracture and reduced bone mineral density is well documented, with reduced bone mineral density predisposing to fracture. However, it is unknown whether an association exists between the magnitude of bone density lost and the severity of the hip fracture sustained. One hundred forty-two patients (96 women, 46 men) with a mean age of 74 years (range, 49-92 years) who sustained a hip fracture following a simple ground-level fall and were treated for this injury were reviewed. All patients had undergone dual-energy x-ray absorptiometry bone scanning of the contralateral hip and lumbar spine. Fractures were classified as intra- or extracapsular or subtrochanteric and then subclassified by degree of severity as simple (stable) or multifragmentary (unstable) fracture patterns.Although a low hip bone mineral density (T- or Z score fracture (P=.025) compared with other fracture types, no association existed between bone mineral density and the severity of the resultant hip fracture. Although an association exists between bone mineral density and the risk of fragility fractures, the results of the current study suggest that the severity of hip fractures does not follow this correlation. Therefore, no assumption can be made about bone mineral density of the proximal femur based on the severity of the fracture observed on plain radiographs. Copyright 2012, SLACK Incorporated.

  17. Occipital condyle fracture as a rare cause of shoulder pain

    Directory of Open Access Journals (Sweden)

    Anil Yalcin

    2015-06-01

    Full Text Available Occipital condyle fractures (OCFs usually occur due to high energy trauma and are often associated with serious injuries, particularly in the brain. Because it is difficult to determine this fracture on plain radiographs, it can easily be misdiagnosed. In this report, we present a patient admitted to our emergency department with one and only complaint of shoulder pain following a motor vehicle accident. We aimed to underline the importance of physician’s elaboration and attention in the diagnosis of this rare entity.

  18. Diagnosis and Rehabilitation of a Middle Cuneiform Fracture in a Hockey Player.

    Science.gov (United States)

    Hensley, Craig P; Dirschl, Douglas R

    2016-07-01

    Isolated cuneiform fractures are rare and are often missed on plain radiographs, leading to delayed diagnosis and delayed return to sport. The authors of this study present a 32-year-old male ice hockey player who sustained trauma to his dorsal midfoot from a slap shot. Radiographs were negative for fracture. After inability to wean out of the controlled ankle movement boot, magnetic resonance imaging was ordered, demonstrating a middle cuneiform fracture. The patient was seen in physical therapy, where aquatic therapy, strength training, and cardiovascular conditioning were progressed. He was able to wean out of the controlled ankle movement boot at 7 weeks after injury and return to playing ice hockey. Here, we outline rehabilitation and a diagnostic and rehabilitative algorithm for those who sustain trauma to the dorsal midfoot with suspected fracture.

  19. Are L5 fractures an indicator of metastasis?

    Energy Technology Data Exchange (ETDEWEB)

    Lo, L.D.; Schweitzer, M.E.; Juneja, V.; Shabshin, N. [Thomas Jefferson Univ., Philadelphia, PA (United States). Dept. of Radiology

    2000-08-01

    Objective. To determine whether L5 vertebral body fractures are an indicator of malignancy.Design and patients. A retrospective study of L5 vertebral body fractures was carried out using plain radiographs, CT, and/or MRI. Over a 5-year period, 51 patients with L5 vertebral body fractures were seen at our institution. Since L1 vertebral body fractures are common, 51 age- and gender-matched (20 men, 31 women; mean age 60 years) patients with L1 fractures were utilized as the control group. The frequency of neoplastic infiltration of the vertebrae was compared between these two populations to determine whether pathologic fracture was more frequent at L5.Results. Twelve (24%) of the L5 fractures were pathologic compared with four (8%) of the L1 fractures (chi-square test, P<0.05). Neoplasm types included multiple myeloma (n=4), prostate (n=3), breast (n=2), lung (n=2), melanoma (n=2), bladder, colon, and leukemia (each n=1).Conclusion. Although most L5 fractures are not pathologic, there is an increased incidence of pathologic fractures in this location compared with L1. Therefore, a fracture of L5 should raise the suspicion of metastasis. (orig.)

  20. Stress fractures of ankle and wrist in childhood: nature and frequency

    Energy Technology Data Exchange (ETDEWEB)

    Oestreich, Alan E. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Bhojwani, Nicholas [University of Cincinnati College of Medicine, Cincinnati, OH (United States)

    2010-08-15

    Stress fractures of many etiologies are found not infrequently in various tarsal bones but are less commonly recognized in carpal bones. To assess the distribution of tarsal and carpal stress fractures. During the last three decades, the senior author collected locations of tarsal and carpal bone stress fracture callus seen on plain radiographs. 527 children with tarsal and carpal stress fractures were identified (88 children had multiple bones involved). The totals were: calcaneus 244, cuboid 188, talus 121, navicular 24, cuneiforms 23, capitate 18, lunate 1, and scaphoid 1. Stress fractures were more frequently seen once we became aware each particular bone could be involved. Tarsal and carpal stress fractures in children are not rare. Careful perusal of these bones is urged in all susceptible children with limping or wrist pain. (orig.)

  1. Subtrochanteric stress fractures in patients on oral bisphosphonate therapy: an emerging problem.

    LENUS (Irish Health Repository)

    Murphy, Colin G

    2012-01-31

    The emergence of a new variant of subtrochanteric stress fractures of the femur, affecting patients on oral bisphosphonate therapy, has only recently been described. This fracture is often preceded by pain and distinctive radiographic changes (lateral cortical thickening), and associated with a characteristic fracture pattern (transverse fracture line and medial cortical spike). A retrospective review (2007-2009) was carried out for patients who were taking oral bisphosphonates and who sustained a subtrochanteric fracture after a low velocity injury. Eleven fractures were found in 10 patients matching the inclusion criteria outlined. All were females, and taking bisphosphonates for a mean of 43 years. Five of the 10 patients mentioned prodromal symptoms, for an average of 9.4 months before the fracture. Although all fractures were deemed low velocity, 5 of 11 were even atraumatic. Two patients had previously sustained contralateral subtrochanteric fractures. Plain radiographs of two patients showed lateral cortical thickening on the contralateral unfractured femur; the bisphosphonate therapy was stopped and close surveillance was started. Patients taking oral bisphosphonates may be at risk of a new variant of stress fracture of the proximal femur. Awareness of the symptoms is the key to ensure that appropriate investigations are undertaken.

  2. Subtrochanteric stress fractures in patients on oral bisphosphonate therapy: an emerging problem.

    Science.gov (United States)

    Murphy, Colin G; O'Flanagan, Shay; Keogh, Peter; Kenny, Patrick

    2011-10-01

    The emergence of a new variant of subtrochanteric stress fractures of the femur, affecting patients on oral bisphosphonate therapy, has only recently been described. This fracture is often preceded by pain and distinctive radiographic changes (lateral cortical thickening), and associated with a characteristic fracture pattern (transverse fracture line and medial cortical spike). A retrospective review (2007-2009) was carried out for patients who were taking oral bisphosphonates and who sustained a subtrochanteric fracture after a low velocity injury. Eleven fractures were found in 10 patients matching the inclusion criteria outlined. All were females, and taking bisphosphonates for a mean of 43 years. Five of the 10 patients mentioned prodromal symptoms, for an average of 9.4 months before the fracture. Although all fractures were deemed low velocity, 5 of 11 were even atraumatic. Two patients had previously sustained contralateral subtrochanteric fractures. Plain radiographs of two patients showed lateral cortical thickening on the contralateral unfractured femur; the bisphosphonate therapy was stopped and close surveillance was started. Patients taking oral bisphosphonates may be at risk of a new variant of stress fracture of the proximal femur. Awareness of the symptoms is the key to ensure that appropriate investigations are undertaken.

  3. Lethal injuries following building collapse: comparison between autopsy and radiographic findings.

    Science.gov (United States)

    Guglielmi, G; Sica, G; Palumbo, L; D'Errico, S; Pomara, C; Fineschi, V; Scaglione, M

    2011-09-01

    The aim of this study was to evaluate the impact of conventional radiology on the assessment of causes of death of human beings after a building collapse and to establish whether the radiographic approach is useful and justifiable. Eight victims of a building collapse were subjected to autopsy, toxicology and radiographic examinations of the entire body. The autopsy findings, classified into three groups according to the New Injury Severity Score (NISS), were compared with radiographic findings. The death of the three individuals in group 1 was ascribed to mechanical asphyxia. Costal fractures, pneumothorax and subcutaneous emphysema were detected in one case only. The three individuals in group 2 died of mechanical asphyxia associated with cerebral injuries in all cases, abdominal injuries in two and cardiac injuries in one. Plain films showed skull fracture in one case, air within the cardiac chambers in another and diaphragmatic injuries in the third. The two individuals in group 3 died of injuries not compatible with life at the cardiac and abdominal level in both cases and at the cerebral level in one. Radiography showed multiple fractures of the cranium associated with diaphragmatic injuries in one case only. No significant pleuropulmonary radiographic findings were detected in any of the eight victims. Paralytic ileus, identified in all patients, is not strictly correlated to abdominal injuries. Skeletal injuries were all confirmed at conventional radiography. Conventional radiography allows for the overall assessment of skeletal injuries. Radiographic findings provide limited information about the causes of death, whereas findings related to the concomitant causes of death are more frequent. Conventional radiography should be considered inadequate, especially if the potential of the modern software tools available on current computed tomography and magnetic resonance images is considered.

  4. A case report of missed femoral neck stress fracture

    Directory of Open Access Journals (Sweden)

    Onibere Oruaro Adebayo

    2015-01-01

    Full Text Available Femoral neck stress fracture (FNSF is an uncommon but potentially serious orthopaedic problem. This is a case report on missed femoral neck stress fracture in a 62-year-old female who was initially treated as early-onset coxarthrosis. She later presented to us with a displaced intra-capsular neck of left femur fracture and underwent total hip replacement. This case illustrates that causes other than osteoarthritis should be taken into consideration in patients presenting with anterior hip pain where symptoms are disproportionate to clinical and radiological findings. More advanced investigations such as MRI scan or regular follow up with plain radiographs should be performed. A delay in diagnosis can lead to secondary displacement of the femoral neck stress fracture.

  5. Total elbow arthroplasty: a radiographic outcome study

    Energy Technology Data Exchange (ETDEWEB)

    Bai, Xue Susan [University of Washington, Department of Radiology, Box 357115, Seattle, WA (United States); Petscavage-Thomas, Jonelle M. [Penn State Hershey Medical Center, Department of Radiology, Hershey, PA (United States); Ha, Alice S. [University of Washington, Department of Radiology, Box 354755, Seattle, WA (United States)

    2016-06-15

    Total elbow arthroplasty (TEA) is becoming a popular alternative to arthrodesis for patients with end-stage elbow arthrosis and comminuted distal humeral fractures. Prior outcome studies have primarily focused on surgical findings. Our purpose is to determine the radiographic outcome of TEA and to correlate with clinical symptoms such as pain. This is an IRB-approved retrospective review from 2005 to 2015 of all patients with semiconstrained TEA. All available elbow radiographs and clinical data were reviewed. Data analysis included descriptive statistics and Kaplan-Meier survival curves for radiographic and clinical survival. A total of 104 total elbow arthroplasties in 102 patients were reviewed; 75 % were in women and the mean patient age was 63.1 years. Mean radiographic follow-up was 826 days with average of four radiographs per patient. Seventy TEAs (67 %) developed radiographic complications, including heterotopic ossification (48 %), perihardware lucency (27 %), periprosthetic fracture (23 %), hardware subluxation/dislocation (7 %), polyethylene wear (3 %), and hardware fracture/dislodgement (3 %); 56 patients (55 %) developed symptoms of elbow pain or instability and 30 patients (30 %) underwent at least one reoperation. In patients with radiographic complications, 66 % developed elbow pain, compared to 19 % of patients with no radiologic complications (p = 0.001). Of the patients with radiographic complications, 39 % had at least one additional surgery compared to 0 % of patients without radiographic complications (p = 0.056). Radiographic complications are common in patients after total elbow arthroplasty. There is a strong positive association between post-operative radiographic findings and clinical outcome. Knowledge of common postoperative radiographic findings is important for the practicing radiologist. (orig.)

  6. Hip and pelvis diseases on lumbar AP radiographs including both hip joints

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Hyun Soo; Juhng, Seon Kwan; Kim, Eun A; Kim, Jeong Ho; Song, Ha Heon; Shim, Dae Moo [Wonkwang University School of Medicine, Iksan (Korea, Republic of)

    2002-12-01

    To determine the frequency of disease, and to evaluate the methods used for lumbar spine radiography in Korea. Sixty university and training hospitals were randomly selected and asked to describe the projections, film size and radiographic techniques employed for routine radiography in patients with suspected disease of the lumbar spine. Plain radiographs of 1215 patients, taken using 14x17 inch film and depicting both hip joints and the lumbar region, were analysed between March 1999 and February 2000. In 15 patients (1.2%), the radiographs revealed hip or pelvic lesion, confirmed as follows: avascular necrosis of the femoral head (n=11, with bilateral lesion in four cases); sustained ankylosing spondylitis (n=2); acetabular dysplasia (n=1); and insufficiency fracture of the pubic rami secondary to osteoporosis (n=1). In 11 or the 20 hospitals which responded, 14{sup x}17{sup f}ilm was being used for lumbar radiography, while in the other nine, film size was smaller. Plain radiography of the lumbar spine including both hip joints, may be a useful way to simultaneously evaluate lesions not only of the lumbar spine but also of the hip and/or pelvis.

  7. Pediatric cervical spine in emergency: radiographic features of normal anatomy, variants and pitfalls

    Energy Technology Data Exchange (ETDEWEB)

    Adib, Omar; Berthier, Emeline; Loisel, Didier; Aube, Christophe [University Hospital of Angers, Department of Radiology, Angers (France)

    2016-12-15

    Injuries of the cervical spine are uncommon in children. The distribution of injuries, when they do occur, differs according to age. Young children aged less than 8 years usually have upper cervical injuries because of the anatomic and biomechanical properties of their immature spine, whereas older children, whose biomechanics more closely resemble those of adults, are prone to lower cervical injuries. In all cases, the pediatric cervical spine has distinct radiographic features, making the emergency radiological analysis of it difficult. Such features as hypermobility between C2 and C3, pseudospread of the atlas on the axis, pseudosubluxation, the absence of lordosis, anterior wedging of vertebral bodies, pseudowidening of prevertebral soft tissue and incomplete ossification of synchondrosis can be mistaken for traumatic injuries. The interpretation of a plain radiograph of the pediatric cervical spine following trauma must take into account the age of the child, the location of the injury and the mechanism of trauma. Comprehensive knowledge of the specific anatomy and biomechanics of the childhood spine is essential for the diagnosis of suspected cervical spine injury. With it, the physician can, on one hand, differentiate normal physes or synchondroses from pathological fractures or ligamentous disruptions and, on the other, identify any possible congenital anomalies that may also be mistaken for injury. Thus, in the present work, we discuss normal radiological features of the pediatric cervical spine, variants that may be encountered and pitfalls that must be avoided when interpreting plain radiographs taken in an emergency setting following trauma. (orig.)

  8. Amyloidoma of the skull: pain radiographs, CT and MRI

    Energy Technology Data Exchange (ETDEWEB)

    Hidalgo, F. [Dept. of Neuroradiology, Ciutat Sanitaria i Univ. de Bellvitge, Barcelona (Spain); Aguilera, C. [Inst. de Diagnostic per la Imatge (IDI), Centre Bellvitge, Hospital Duran i Reynals, Barcelona (Spain); Monford, J.L. [Dept. of Neuroradiology, Ciutat Sanitaria i Univ. de Bellvitge, Barcelona (Spain); Rene, M. [Dept. of Neuroradiology, Ciutat Sanitaria i Univ. de Bellvitge, Barcelona (Spain); Muntane, A. [Dept. of Neuroradiology, Ciutat Sanitaria i Univ. de Bellvitge, Barcelona (Spain); Pons, L.C. [Inst. de Diagnostic per la Imatge (IDI), Centre Bellvitge, Hospital Duran i Reynals, Barcelona (Spain)

    1996-01-01

    Amyloidomas involving bone are rare. The 67-year-old man reported here had a large amyloidoma of the left frontal, parietal, sphenoid (greater wing) and temporal bones causing neural compression. Plain radiographs CT and MRI are shown. (orig.)

  9. Fixation of complex proximal humeral fractures in elderly patients with a locking plate: A retrospective analysis of radiographic and clinical outcome and complications

    Institute of Scientific and Technical Information of China (English)

    Fabio Rodia; Emmanouil Theodorakis; Georgios Touloupakis; Angelo Ventura

    2016-01-01

    Purpose:The optimal surgical treatment of displaced type B and C fractures of the proximal humerus in the elderly remains controversial.Good clinical results have been reported by plating these fractures as well as a high rate of complications.Our retrospective study aims to evaluate clinical recovery and complications using the S3 locking plate in elderly patients.Methods:Fifty-one patients older than 65 years of age,with a complex proximal humeral fracture type B or C (AO classification system),were included.Patients have been followed up for a minimum of 12 months.We assessed callus formation,radiological results,clinical outcome (according to the Constant Shoulder Score System) and complications.Any difference in the clinical recovery among the 2 types of fracture pattern (B and C) was investigated.Results:The mean time of fracture healing was 12.4 weeks.The mean Constant score at 3,6 and 12 months was 68,73 and 75 respectively.No statistically significant difference in the clinical outcome was observed between the B and C fracture patterns (p > 0.05).We noticed an overall of 5 complications (9.8%).There was no need to revision any of the implants.Conclusion:Anatomic reduction and proper plate positioning are essential for minimizing implantrelated complications.In our experience the S3 angular stability system offers a proper osteosyntesis and a good clinical recovery with a low rate of complications.

  10. Radiographers and trainee radiologists reporting accident radiographs

    DEFF Research Database (Denmark)

    Buskov, L; Abild, A; Christensen, A

    2013-01-01

    To compare the diagnostic accuracy and clinical validity of reporting radiographers with that of trainee radiologists whom they have recently joined in reporting emergency room radiographs at Bispebjerg University Hospital.......To compare the diagnostic accuracy and clinical validity of reporting radiographers with that of trainee radiologists whom they have recently joined in reporting emergency room radiographs at Bispebjerg University Hospital....

  11. T-condylar fracture delayed for 10 days in a 5-year-old boy: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Kantharajanna Shashidhar B

    2013-02-01

    Full Text Available 【Abstract】 T-condylar fracture is rare in paediatric age group, especially in skeletally immature children less than 9 years old, with very few cases reported in available literature. We present such a case in a 5 year old child that was initially managed as a supracondylar fracture at an-other centre before referral to us, 10 days after the injury. The child was diagnosed as having a displaced T-condylar fracture on plain radiograph. Open reduction and internal fixation with K-wires was performed. At 2 years follow-up, the child had good range of motion at elbow with 5 o of cubi-tus varus. With this background we discuss the pertinent principles of management of T-condylar fractures in skele-tally immature children. Key words: Humeral fractures; Fracture fixation; Fracture healing; Child

  12. Anterior superior iliac spine avulsion fracture presenting as meralgia paraesthetica in an adolescent sprinter.

    Science.gov (United States)

    Hsu, Chia-Yu; Wu, Chu-Ming; Lin, Shih-Wei; Cheng, Kui-Lin

    2014-02-01

    We report here a rare case of anterior superior iliac spine avulsion fracture that presented initially as meralgia paraesthetica. A 14-year-old male sprinter presented with anterior superior iliac spine avulsion fracture, which was not observed on initial plain radiograph of the hip, but was diagnosed by ultrasound. Both clinical presentations and electrophysiological studies indicated meralgia paraesthetica. The lateral femoral cutaneous nerve of the thigh was probably compressed by an inguinal haematoma resulting from sartorius muscle strain, which was detected on musculoskeletal ultrasound. Computed tomography of the pelvis confirmed anterior superior iliac spine avulsion fracture. Meralgia paraesthetica in adolescents can be due to anterior superior iliac spine avulsion fracture. Sonography is a valuable tool for screening for muscular haematoma and occult fractures, which may allow clinicians to diagnose the nature of the muscle injury, and thus guide the most appropriate therapeutic strategy.

  13. Epithelioid hemangioma of the distal humerus with pathologic fracture.

    Science.gov (United States)

    Kleck, Christopher J; Seidel, Matthew J

    2012-01-16

    Epithelioid hemangioma is a rare tumor that can have bone involvement. Its clinically and radiographically aggressive appearance mimics a malignant neoplasm. Although epitheliod hemangioma has been described as having an aggressive appearance on magnetic resonance imaging (MRI) and plain radiographs, this is the first reported case of pathologic fracture associated with this lesion to our knowledge. This article describes a case of epithelioid hemangioma involving the distal humerus, which initially presented with progressive pain and fracture of the lateral condyle. The aggressive appearance on plain radiographs and MRI suggested a malignant bone tumor. This preliminary diagnosis was confirmed due to the presence of local lymph node spread on positron emission tomography/computed tomography. After a core needle biopsy revealed nondiagnostic tissue, rather than performing a wide resection based on a presumptive malignant diagnosis, we followed the standard diagnostic algorithm and performed an open biopsy with temporary internal stabilization. The tissue sample was adequate and revealed a diagnosis of epithelioid hemangioma. Based on this finding, we were able to proceed with surgical management, including curettage of the lesion, placement of a bone graft, and internal fixation, rather than a wide resection with elbow joint replacement. This article emphasizes the need for careful adherence to the diagnostic algorithm for musculoskeletal tumors. In doing so, a definitive diagnosis was reached, and our patient was able to resume his occupation as a laborer without the restrictions that would have accompanied elbow arthroplasty.

  14. Transverse Stress Fracture of the Proximal Patella

    Science.gov (United States)

    Atsumi, Satoru; Arai, Yuji; Kato, Ko; Nishimura, Akinobu; Nakazora, Shigeto; Nakagawa, Shuji; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Sudo, Akihiro; Kubo, Toshikazu

    2016-01-01

    Abstract Among stress fractures associated with sports activities, patellar stress fracture is rare. Regarding patella stress fractures, so far only distal transverse or lateral longitudinal fractures have been reported, but there are no reports of transverse fractures occurring in the proximal patella. We describe an extremely rare case of transverse stress fracture of proximal patella in a 9-year-old athlete. A 9-year old boy, who participated in sports (sprints and Kendo) presented with left knee pain without any external injury. In plain radiographs, a fracture line was observed in the proximal 1/3 of the left patella, and a patella stress fracture was diagnosed. For treatment, because 7 months of conservative therapy showed no improvement, internal fixation was carried out using Acutrak screws, and bone union was thus achieved. Three months after the operation, he was able to return to his previous level of athletic sports activity. Regarding the mechanism of onset, it is believed that the causes are longitudinal traction force and patellofemoral contact pressure. On the other hand, the contact region of the patella with the femur changes with the flexion angle of the knee. In the current case, the fracture occurred at a site where the patella was in contact with the femur at a flexion angle of >90°, so it is believed that it occurred as a clinical condition from being subjected to repeated longitudinal traction force and patellofemoral contact pressure at a flexion angle of >90°, during the sports activities of sprints and Kendo. The nonunion of the transverse stress fracture of his proximal patella was successfully treated with internal fixation using Acutrak screws. PMID:26871789

  15. Conjoint bicondylar Hoffa fracture in an adult

    Directory of Open Access Journals (Sweden)

    Rehan Ul Haq

    2013-01-01

    Full Text Available Conjoint bicondylar Hoffa fracture is an extremely rare injury. Only one case has been reported previously in the pediatric age group. We describe this injury in a 17-year-old male who presented following a fall with direct impact on his semiflexed right knee. Plain radiographs were inadequate to define the exact pattern of injury. Computed tomographic (CT scans demonstrated the coronal fracture involving both the femoral condyles which were joined by a bridge of intact bone. The patient was treated with open reduction and internal fixation using swashbuckler (modified anterior approach. Union occurred within 3 months and at final followup (at 18 months the patient had a good clinical outcome. The possible mechanism of injury is discussed.

  16. Isolated syndesmotic injury in acute ankle trauma: Comparison of plain film radiography with 3 T MRI

    Energy Technology Data Exchange (ETDEWEB)

    Schoennagel, B.P., E-mail: b.schoennagel@uke.uni-hamburg.de [Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg (Germany); Karul, M.; Avanesov, M.; Bannas, P.; Gold, G. [Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg (Germany); Großterlinden, L.G. [Department of Trauma-, Hand- and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg (Germany); Rupprecht, M. [Department of Pediatric Orthopedics, Children' s Hospital Hamburg-Altona, Bleickenallee 38, 22763 Hamburg (Germany); Adam, G.; Yamamura, J. [Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg (Germany)

    2014-10-15

    Highlights: • Isolated syndesmotic injury is a frequent finding after acute ankle trauma. • Cut-off values and accuracy of plain film radiograph measurements were determined. • The TFCS and the MCS have the potential to detect isolated syndesmotic injury. • Appropriate cut-off values allow detection of isolated syndesmotic injury. • Only MRI reveals severity of isolated syndesmotic injury and concomitant injuries. - Abstract: Objectives: To determine cut-off values and the accuracy of plain film measurements for the detection of isolated syndesmotic injury after acute ankle trauma and to investigate MRI findings of concomitant ankle injury. Methods: Eighty-four consecutive patients with absent fracture in plain film radiographs were prospectively evaluated for isolated syndesmotic injury after acute ankle trauma. The tibiofibular clear space (TFCS), the tibiofibular overlap (TFO), and the medial clear space (MCS) were independently assessed in plain radiographs by two readers. MRI performed at 3 T within 24 h served as the reference standard. MRI was evaluated for syndesmotic injury, using a four-scale grading system (0 = normal syndesmosis, 1a = periligamentous edema, 1b = intraligamentous edema, 2 = partial rupture, 3 = complete rupture), and for concomitant ankle injury. Inter-observer variability for x-ray measurements was assessed using Bland–Altman diagrams. ROC analyses were performed to determine cut-off values and sensitivity and specificity for TFCS, TFO, and MCS. Results: Eleven of 84 patients (13.1%) revealed syndesmotic injury (Grade 2 or 3) according to MRI. Between patients with and without syndesmotic injury significantly different measurements were obtained for TFCS (p = 0.003) and MCS (p = 0.04). ROC derived cut-off values were 5.3 mm for TFCS, 2.8 mm for TFO, and 2.8 mm for MCS. Sensitivity and specificity was 82% and 75% for TFCS, 36% and 78% for TFO, and 73% and 59% for MCS. The bias and limits of agreement were −0.04 mm and [−1

  17. GI Radiographic Tests

    Science.gov (United States)

    ... Topic / Radiographic Tests in GI Radiographic Tests in GI Basics Commonly Performed Radiographic Tests in Gastroenterology Gastroenterologists ... January 2009. Updated December 2012. Return to Top GI Health Centers Colorectal Cancer Hepatitis C Inflammatory Bowel ...

  18. Use of computed tomography scout film and Hounsfield unit of computed tomography scan in predicting the radio-opacity of urinary calculi in plain kidney, ureter and bladder radiographs

    Directory of Open Access Journals (Sweden)

    Michael E. Chua

    2014-01-01

    Conclusion: Urolithiases identified on the CT-scout film were also seen as radiopaque on the KUB radiograph while those stones not visible on the CT-scout film, but above the optimal HU cut-off value of 630 are also likely to be radiopaque.

  19. Clinical and Radiographic Outcomes of Unipolar and Bipolar Radial Head Prosthesis in Patients with Radial Head Fracture: A Systemic Review and Meta-Analysis.

    Science.gov (United States)

    Chen, Hongwei; Wang, Ziyang; Shang, Yongjun

    2017-09-13

    To compare clinical outcomes of unipolar and bipolar radial head prosthesis in the treatment of patients with radial head fracture. Medline, Cochrane, EMBASE, Google Scholar databases were searched until April 18, 2016 using the following search terms: radial head fracture, elbow fracture, radial head arthroplasty, implants, prosthesis, unipolar, bipolar, cemented, and press-fit. Randomized controlled trials, retrospective, and cohort studies were included. The Mayo elbow performance score (MEPS), disabilities of the arm, shoulder, and hand (DASH) score, radiologic assessment, ROM, and grip strength following elbow replacement were similar between prosthetic devices. The pooled mean excellent/good ranking of MEPS was 0.78 for unipolar and 0.73 for bipolar radial head arthroplasty, and the pooled mean MEPS was 86.9 and 79.9, respectively. DASH scores for unipolar and bipolar prosthesis were 19.0 and 16.3, respectively. Range of motion outcomes were similar between groups, with both groups have comparable risk of flexion arc, flexion, extension deficit, rotation arc, pronation, and supination (p values bipolar prosthesis). However, bipolar radial head prosthesis was associated with an increased chance of heterotopic ossification and lucency (p values ≤0.049) while unipolar prosthesis was not (p values ≥0.088). Both groups had risk for development of capitellar osteopenia or erosion/wear (p values ≤0.039). Unipolar and bipolar radial head prostheses were similar with respect to clinical outcomes. Additional comparative studies are necessary to further compare different radial head prostheses used to treat radial head fracture.

  20. "Nutcracker Fracture" in a Ballet Dancer Performing in The Nutcracker.

    Science.gov (United States)

    Carsen, Sasha; Quinn, Bridget J; Beck, Elizabeth; Southwick, Heather; Micheli, Lyle J

    2015-09-01

    A 26-year-old female professional dancer sustained an acute injury to her mid-foot during a performance of The Nutcracker. An intra-articular, comminuted, minimally displaced fracture of the cuboid was found. The patient was treated non-operatively with cast and boot immobilization, modified weightbearing, and progressive rehabilitation. She was able to return to professional dance at 6 months post-injury and continues to dance professionally over 1 year out from injury without issue. The unique demands of classical ballet, especially dancing en pointe, increase the risk for mid-foot fractures, and clinicians should have a high-index of suspicion in dancers suffering an acute injury to the foot and ankle with greater than expected pain or swelling. Multiple imaging modalities can be used to make the diagnosis, to include plain film radiographs, MRI, and CT scan. Fracture characteristics and patient-specific factors should be taken into account when deciding on a treatment plan.

  1. Conventional versus virtual radiographs of the injured pelvis and acetabulum

    Energy Technology Data Exchange (ETDEWEB)

    Bishop, Julius A.; Rao, Allison J.; Pouliot, Michael A.; Bellino, Michael [Stanford University School of Medicine, Department of Orthopaedic Surgery, Stanford, CA (United States); Beaulieu, Christopher [Stanford University School of Medicine, Department of Radiology, Stanford, CA (United States)

    2015-09-15

    Evaluation of the fractured pelvis or acetabulum requires both standard radiographic evaluation as well as computed tomography (CT) imaging. The standard anterior-posterior (AP), Judet, and inlet and outlet views can now be simulated using data acquired during CT, decreasing patient discomfort, radiation exposure, and cost to the healthcare system. The purpose of this study is to compare the image quality of conventional radiographic views of the traumatized pelvis to virtual radiographs created from pelvic CT scans. Five patients with acetabular fractures and ten patients with pelvic ring injuries were identified using the orthopedic trauma database at our institution. These fractures were evaluated with both conventional radiographs as well as virtual radiographs generated from a CT scan. A web-based survey was created to query overall image quality and visibility of relevant anatomic structures. This survey was then administered to members of the Orthopaedic Trauma Association (OTA). Ninety-seven surgeons completed the acetabular fracture survey and 87 completed the pelvic fracture survey. Overall image quality was judged to be statistically superior for the virtual as compared to conventional images for acetabular fractures (3.15 vs. 2.98, p = 0.02), as well as pelvic ring injuries (2.21 vs. 1.45, p = 0.0001). Visibility ratings for each anatomic landmark were statistically superior with virtual images as well. Virtual radiographs of pelvic and acetabular fractures offer superior image quality, improved comfort, decreased radiation exposure, and a more cost-effective alternative to conventional radiographs. (orig.)

  2. Pulmonary edema: radiographic differential diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Yoo, Dong Soo; Choi, Young Hi; Kim, Seung Cheol; An, Ji Hyun; Lee, Jee Young; Park, Hee Hong [Dankook Univ. College of Medicine, Chonan (Korea, Republic of)

    1997-04-01

    To evaluate the feasibility of using chest radiography to differentiate between three different etiologies of pulmonary edema. Plain chest radiographs of 77 patients, who were clinically confirmed as having pulmonary edema, were retrospectively reviewed. The patients were classified into three groups : group 1 (cardiogenic edema : n = 35), group 2 (renal pulmonary edema : n = 16) and group 3 (permeability edema : n = 26). We analyzed the radiologic findings of air bronchogram, heart size, peribronchial cuffing, septal line, pleural effusion, vascular pedicle width, pulmonary blood flow distribution and distribution of pulmonary edema. In a search for radiologic findings which would help in the differentiation of these three etiologies, each finding was assessed. Cardiogenic and renal pulmonary edema showed overlapping radiologic findings, except for pulmonary blood flow distribution. In cardiogenic pulmonary edema (n=35), cardiomegaly (n=29), peribronchial cuffing (n=29), inverted pulmonary blood flow distribution (n=21) and basal distribution of edema (n=20) were common. In renal pulmonary edema (n=16), cardiomegaly (n=15), balanced blood flow distribution (n=12), and central (n=9) or basal distribution of edema (n=7) were common. Permeability edema (n=26) showed different findings. Air bronchogram (n=25), normal blood flow distribution (n=14) and peripheral distribution of edema (n=21) were frequent findings, while cardiomegaly (n=7), peribronchial cuffing (n=7) and septal line (n=5) were observed in only a few cases. On plain chest radiograph, permeability edema can be differentiated from cardiogenic or renal pulmonary edema. The radiographic findings which most reliably differentiated these two etiologies were air bronchogram, distribution of pulmonary edema, peribronchial cuffing and heart size. Only blood flow distribution was useful for radiographic differentiation of cardiogenic and renal edema.

  3. 螺旋CT及X线平片在腕骨隐匿性骨折诊断中的比较分析%Spiral CT and X-ray plain film in the diagnosis of carpal bone occult fracture

    Institute of Scientific and Technical Information of China (English)

    宋春华

    2015-01-01

    Objective To study the carpal bone occult fracture characteristics of spiral CT and X-ray plain film. Methods A retrospective analysis of 46 carpal bone occult fracture cases X-ray films, CT data. Including the review of the data. Results X-ray, suspicious 19 cases of fracture and CT examination all positive, typically characterized by bone cortex lifted, interruption of trabecular bone. Conclusion CT has important significance in avoiding misdiagnosis and carpal bone occult fracture.%目的 探讨螺旋CT及X线平片在腕骨隐匿性骨折检查中的特点.方法 回顾性分析46例腕骨隐匿性骨折的X线片、CT资料. 结果 X线检查阳性1例, 可疑骨折19例,CT阳性后复核X线阳性2例,CT检查44例阳性,典型表现为骨皮质掀起,骨小梁中断.结论 CT检查在避免腕骨隐匿性骨折漏诊中有重要作用,CT阴性应引起重视.

  4. Utilising magnetic resonance imaging as the gold-standard in management of suspected scaphoid fractures in the emergency department setting

    LENUS (Irish Health Repository)

    Ramasubbu, B

    2017-02-01

    Scaphoid fractures are the most common carpal bone fracture. Up to 40% of scaphoid fractures can be missed at initial presentation and investigation. Follow-up plain film radiograph has overall poor sensitivity and reliability. MRI has been shown to have an almost 100% sensitivity and specificity and so is the gold standard in scaphoid fracture diagnosis. Additionally, early specialist involvement is recommended. We proposed that following a designated pathway, there would be no significant increase in MRI requests. Following implementation of a pathway for the management of suspected scaphoid fractures in St James’s Hospital in 2012 re-auditing demonstrated that management changed to either MRI directly after initial x-ray (16\\/145, 11%), MRI after second x-ray (9\\/28, 32%) or orthopaedic follow-up (19\\/28, 68%). The number of MRIs requested was consistent with our predictors of demand. Thus, our new protocol maximises diagnostics, cost effectiveness and quality of patient care.

  5. MRI assessment of the posterior acetabular wall fracture in traumatic dislocation of the hip in children

    Energy Technology Data Exchange (ETDEWEB)

    Rubel, Ivan F.; Kloen, Peter; Helfet, David L. [Department of Orthopaedic Surgery, Weill Medical College of Cornell University, New York, NY (United States); Potter, Hollis G. [MRI Department, Diagnostic Radiology, Hospital for Special Surgery, New York (United States)

    2002-06-01

    Traumatic hip dislocations associated with posterior wall fractures of the acetabulum in the pediatric population are in general a consequence of high-energy trauma. After expeditious reduction, instability mandates for further diagnosis and intervention. Plain radiographs or computerized tomography (CT) scans can misjudge the involvement of the posterior wall of the acetabulum due to the partially calcified nature of the pediatric bone. We present two cases of pediatric traumatic hip dislocation associated with posterior wall fractures of the acetabulum. In both cases, obvious postreduction instability was noted without conclusive findings of etiology on plain X-rays or CT scans. Magnetic resonance imaging (MRI) disclosed an extensive posterior wall traumatic involvement in both cases and helped to decide in favor of open reduction of the hip and internal fixation of the posterior wall fragment. (orig.)

  6. Fratura toracolombar explosão: análise radiográfica diferencial entre A e B de Margerl Thoracolumbar burst fracture: radiographic evaluation on differences between Magerl's A and B

    Directory of Open Access Journals (Sweden)

    Carlos Alberto Almeida de Assunção Filho

    2012-01-01

    Full Text Available OBJETIVOS: Verificar nos pacientes com fratura toracolombar explosão de Denis a incidência de fratura tipo A e B de Margerl segundo examinadores independentes. MÉTODOS: De acordo com a abertura radiográfica dos processos espinhosos do arco vertebral posterior na radiografia ântero-posterior, três examinadores independentes dividiram os pacientes internados de 2000 a 2009 com fratura toracolombar explosão (Denis em fraturas tipo A3 e B1.2 de Margerl. A avaliação estatística foi descritiva e pelo método de Kappa. RESULTADOS: Dos 72 pacientes, a fratura foi classificada B em 11 pacientes de acordo com o primeiro examinador 1; 10 pelo segundo e 17 pelo terceiro. A concordância entre os examinadores da presença de comprometimento posterior nestas fraturas (B1.2 foi satisfatória (boa,κ=0,7. CONCLUSÃO: 14 a 24% de pacientes com fratura toracolombar explosão (Denis apresentam comprometimento posterior (B1.2 de acordo com critérios radiográficos. Nível de evidencia III, Estudo Diagnostico, Investigação de Teste diagnosticoObjectives: Evaluate incidence of Magerl's A and B group in thoracolumbar burst fracture (Denis according to independent examiners. Method: According to the posterior spinous process split on the anteroposterior radiography, three independent examiners have analyzed the patients admitted from 2000 to 2009 with thoracolumbar burst fractures (according to Denis to differenciate between Magerl's type A3 and B1.2. Statistical evaluation was descriptive and by using Kappa's method. Results: From the 72 patients, 11 patients compose the Magerl's type B group according to examiner 1; 10 according to examiner 2; and 17 according to examiner 3. Posterior lesion concordance was satisfactory (good,κ=0,7 between the examiners. Conclusion: 14 to 24% patients with thoracolumbar fractures show posterior lesion (B1.2 by using radiographic criteria. Level of evidence III, Diagnostic Studies Investigating a Diagnostic Test.

  7. Comparison of application value between spiral CT and DR plain film in diagnosis of acetabulum fracture%对比螺旋 CT 与 DR 平片在髋臼骨折诊断中的应用价值

    Institute of Scientific and Technical Information of China (English)

    刘金全; 海忠; 崔凌; 郭锐

    2015-01-01

    目的:对比螺旋 CT 与 DR 平片在髋臼骨折诊断中的应用价值。方法58例髋臼骨折患者作为研究对象。所有患者均经手术证实为髋臼骨折,术前行螺旋 CT 与 DR 摄影,其中螺旋 CT 采用多平面重建(MPR)、三维表面重建(SSD)、容积重建(VR)等三维重建技术进行图像后处理,对比两种检查方案的诊断结果。结果CT 确诊髋臼骨折55例,高疑骨折3例, DR 确诊骨折42例,高疑8例,无骨折8例,两组确诊结果比较,差异有统计学意义(P<0.05);CT 诊断准确率更高。结论螺旋 CT 三维重建技术具有扫描快速、成像清晰的特点,在髋臼骨折诊断中具有重要的应用价值,较常规 DR 平片具有更高的确诊率,同时可有效评估患者骨折病情,为手术治疗方案提供指导。%Objective To compare the application value between spiral CT and DR plain film in diagnosis of acetabulum fracture. Methods There were 58 patients with acetabulum fracture as study subjects, and they were all diagnosed by operation. They received spiral CT and DR filming before operation. 3D reconstruction by multiple planar reconstruction (MPR), surface shading display (SSD), and volume reconstruction (VR) were applied for image postprocessing in spiral CT. Diagnosis results of the two examination methods were compared. Results CT showed 55 diagnosed acetabulum fracture cases and 3 highly suspected fracture cases. DR showed 42 diagnosed fracture cases, 8 highly suspected cases, and 8 cases without fracture. The difference between diagnosis results of the two groups had statistical significance (P<0.05). CT provided more accuracy in diagnosis. Conclusion Spiral CT 3D reconstruction method has advantages of quick scanning and clear imaging, and it contains important application value in diagnosis of acetabulum fracture. It provides higher diagnosis rate than common DR plain film with effective assessment of fracture condition, and it can

  8. Plain film emergency radiology of child abuse: a strategy; Die akute Roentgendiagnostik der Kindesmisshandlung: Eine Strategie

    Energy Technology Data Exchange (ETDEWEB)

    Oestreich, A.E. [Children`s Hospital Medical Center, Cincinnati OH (United States). Dept. of Radiology

    1998-04-01

    A strategy is proposed for the dedicated interpretation of possible radiographic plain film signs that are suspicious for indicating child abuse. For each sign, the features `PRO` raise the question of abuse, while radiographic or clinical findings `CON` suggest an alternate explanation. Birth trauma, oesteogenesis imperfecta, rescue trauma, and metastatic neuroblastoma are among the many entities cited. A triad of situations may lead a radiologist to look systematically for changes from abuse; a triad of resolutions may result from the search. Periosteal reaction is the major factor in dating of fractures; physiologic periosteal reaction of infancy and periosteal reaction from previous fracture must be considered when so dating fractures. (orig.) [Deutsch] Es wird eine Strategie fuer die genaue Interpretation roentgenologischer Befunde, die auf eine Kindesmisshandlung hindeuten koennen, vorgeschlagen. Fuer jeden Befund werfen die unter `PRO` aufgefuehrten Merkmale die Frage nach einer Kindesmisshandlung auf, waehrend radiologische und klinische Befunde unter `CON` andere Erklaerungen nahelegen. Geburtstrauma, Osteogenesis imperfecta, Rettungstrauma und metastasierendes Neuroblastom sind unter den vielen zitierten Differentialdiagnosen. Drei moegliche Situationen koennen den Radiologen dazu veranlassen, systematisch nach Zeichen einer Kindesmisshandlung zu suchen, 3 moegliche Loesungen koennen aus dieser Suche hervorgehen. Eine Periostreaktion ist ein Kardinalbefund zur Datierung von Frakturen. Physiologische Periostreaktionen im fruehen Kindesalter und Periostreaktionen durch fruehere Frakturen muessen bei einer solchen Datierung von Frakturen mitbedacht werden. (orig.)

  9. 3D pose estimation of fracture femur based on bi-planar digital radiographs%基于双平面DR的骨折股骨三维姿态估计

    Institute of Scientific and Technical Information of China (English)

    张斌; 孙金玮; 孙绍滨

    2013-01-01

    针对骨折股骨DR缺少三维模态下空间信息的问题,提出一种基于双平面DR进行2D-3D非刚性配准的姿态估计方法,实现骨外科手术术前骨折股骨的三维可视化.本文提出的方法相比于单纯的DR或CT成像诊断方式,具有成本低、成像快、有害辐射小、精度高等优点.该方法首先利用正、侧位骨折股骨DR获得与通用模型投影轮廓的二维配准参数;然后利用基于针孔相机模型的标定法确定二维平面到三维空间的变换关系,最后将通用模型分成骨折的两段,确定每段的姿态,获得患者股骨个体化骨折姿态.实验结果为平均旋转误差小于1.5°,平均平移误差小于2 mm,配准成功率大于90%,表明该方法具有较高的精度和鲁棒性,可为骨外科手术的术前诊断及手术计划制定提供更为有效的三维影像信息.%Aiming at the problem that the digital radiography of fracture femur lacks space information in 3D modality, a pose estimation method based on 2D-3D non-rigid registration using bi-planar digital radiographs is proposed to realize preoperative 3D pose visualization of fracture femur model. Compared with simple DR or CT diagnosis methods , the proposed method has the advantages of low cost, fast imaging speed, little radiation to the patients and high precision. Firstly, the 2D registration parameters between the projected contours of generic model and DR image contours of fracture femur from frontal and lateral views are obtained. Secondly, the transform relationship from 2D plane to 3 D space is determined by using the calibration method based on pinhole camera model. Finally, the generic model is divided into two fracture parts and the pose of each part is determined. Then the individual fracture posture of patient femur is acquired. Experiment results indicate that the proposed method possesses high precision and good robustness; the average rotation and translation errors are less than 1.5and 2

  10. A simple technique to position patients with bilateral above-knee amputations for operative fixation of intertrochanteric fractures of the femur: a case report

    Directory of Open Access Journals (Sweden)

    Dramis Asterios

    2010-11-01

    Full Text Available Abstract Introduction Intertrochanteric fractures of the femur are common fractures in the elderly, and management includes operative fixation after patient positioning on the fracture table. Patients with bilateral above-knee amputations are challenging in terms of positioning on the table. We describe a simple technique to overcome this special problem. Case presentation A 75-year-old wheelchair-bound Caucasian man with bilateral above-knee amputations presented to our hospital after a fall. Plain radiographs showed an intertrochanteric fracture of the femur, and operative fixation with a dynamic hip screw was planned. His positioning on the table posed a particular problem, and therefore we developed a technique to overcome this problem. Conclusion Positioning of patients for fixation of intertrochanteric fractures of the femur poses a particular problem that can be solved by using our simple technique.

  11. Radiographic distinction of degenerative slippage (spondylolisthesis and retrolisthesis) from traumatic slippage of the cervical spine

    Energy Technology Data Exchange (ETDEWEB)

    Lee, C.; Woodring, J.H.; Rogers, L.F.; Kim, K.S.

    1986-08-01

    In a review of 42 cases of degenerative arthritis of the cervical spine and 22 cases of cervical spine trauma with an observed anterior slip-page (spondylolisthesis) or posterior slippage (retrolisthesis) of the vertebral bodies of 2 mm or more, characteristic features were observed which allowed distinction between degenerative and traumatic slippage of the cervical spine. In degenerative slippage the shape of the articular facets and width of the facet joint space may remain normal; however, in most cases the articular facets become 'ground-down' with narrowing of the facet joint space and the articular facets themselves becoming thinned or ribbon-like. In traumatic slippage the articular facets will either be normally shaped or fractured and the facet joint space will be abnormally widened. Plain radiographs will usually allow this distinction to be made; however, in difficult cases polytomography may be required.

  12. Acetabular stress fractures in military endurance athletes and recruits: incidence and MRI and scintigraphic findings

    Energy Technology Data Exchange (ETDEWEB)

    Williams, T.R. [Portsmouth Naval Medical Center, Radiology Department, Charette Health Care Center, Portsmouth, VA (United States); Puckett, M.L.; Shin, A.Y.; Gorman, J.D. [Naval Medical Center San Diego, Radiology Department, San Diego, CA (United States); Denison, G. [US Naval Hospital Guam (United States)

    2002-05-01

    Objective: To evaluate the incidence and the MRI and scintigraphic appearance of acetabular stress (fatigue) fractures in military endurance athletes and recruits. Design and patients: One hundred and seventy-eight active duty military endurance trainees with a history of activity-related hip pain were evaluated by both MRI and bone scan over a 2-year period. Patients in the study ranged in age from 17 to 45 years. They had hip pain related to activity and had plain radiographs of the hip and pelvis that were interpreted as normal or equivocal. The study was originally designed to evaluate the MRI and scintigraphic appearance of femoral neck stress fractures. Patients had scintigraphy and a limited MRI examination (coronal imaging only) within 48 h of the bone scan. Twelve patients demonstrated imaging findings compatible with acetabular stress fractures. Results: Stress fractures are common in endurance athletes and in military populations; however, stress fracture of the acetabulum is uncommon. Twelve of 178 patients (6.7%) in our study had imaging findings consistent with acetabular stress fractures. Two patterns were identified. Seven of the 12 (58%) patients had acetabular roof stress fractures. In this group, two cases of bilateral acetabular roof stress fractures were identified, one with a synchronous tensile sided femoral neck stress fracture. The remaining five of 12 (42%) patients had anterior column stress fractures, rarely occurring in isolation, and almost always occurring with inferior pubic ramus stress fracture (4 of 5, or 80%). One case of bilateral anterior column stress fractures was identified without additional sites of injury. Conclusions: Stress fractures are commonplace in military populations, especially endurance trainees. Acetabular stress fractures are rare and therefore unrecognized, but do occur and may be a cause for activity-related hip pain in a small percentage of military endurance athletes and recruits. (orig.)

  13. Giant colonic diverticulum: radiographic and MDCT characteristics.

    Science.gov (United States)

    Zeina, Abdel-Rauf; Mahamid, Ahmad; Nachtigal, Alicia; Ashkenazi, Itamar; Shapira-Rootman, Mika

    2015-12-01

    Giant colonic diverticulum (GCD), defined as a diverticulum larger than 4 cm, is a rare entity that is generally a manifestation of colonic diverticular disease. Because of its rarity and its variable and non-specific presentation, the diagnosis of GCD depends mainly on imaging findings. Knowledge of the spectrum of radiographic and CT features of the GCD is important in making the correct diagnosis and potentially preventing complications. This review focuses on imaging findings characteristic of GCD as well as its complications and radiographic mimics. Teaching points • Giant colonic diverticulum is a rare complication of diverticulosis.• The most common symptom is abdominal pain presenting in approximately 70 % of patients.• Diagnosis is based on imaging findings with plain abdominal radiographs and MDCT.• Treatment consists of en bloc resection of the diverticulum and affected adjacent colon.

  14. Transverse Stress Fracture of the Proximal Patella: A Case Report.

    Science.gov (United States)

    Atsumi, Satoru; Arai, Yuji; Kato, Ko; Nishimura, Akinobu; Nakazora, Shigeto; Nakagawa, Shuji; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Sudo, Akihiro; Kubo, Toshikazu

    2016-02-01

    Among stress fractures associated with sports activities, patellar stress fracture is rare. Regarding patella stress fractures, so far only distal transverse or lateral longitudinal fractures have been reported, but there are no reports of transverse fractures occurring in the proximal patella. We describe an extremely rare case of transverse stress fracture of proximal patella in a 9-year-old athlete.A 9-year old boy, who participated in sports (sprints and Kendo) presented with left knee pain without any external injury. In plain radiographs, a fracture line was observed in the proximal 1/3 of the left patella, and a patella stress fracture was diagnosed. For treatment, because 7 months of conservative therapy showed no improvement, internal fixation was carried out using Acutrak screws, and bone union was thus achieved. Three months after the operation, he was able to return to his previous level of athletic sports activity.Regarding the mechanism of onset, it is believed that the causes are longitudinal traction force and patellofemoral contact pressure. On the other hand, the contact region of the patella with the femur changes with the flexion angle of the knee. In the current case, the fracture occurred at a site where the patella was in contact with the femur at a flexion angle of >90°, so it is believed that it occurred as a clinical condition from being subjected to repeated longitudinal traction force and patellofemoral contact pressure at a flexion angle of >90°, during the sports activities of sprints and Kendo. The nonunion of the transverse stress fracture of his proximal patella was successfully treated with internal fixation using Acutrak screws.

  15. Fracture of posterior margin of lumbar vertebral body

    Directory of Open Access Journals (Sweden)

    Krishnan Ajay

    2005-01-01

    Full Text Available Background: Avulsion or fracture of posterior ring apophysis of lumbar vertebra is not a common clinical entity and is missed often. These fractures are mostly traumatic lesions typically seen in adolescents and young adults, because fusion in this area is not complete until the age of 18 to 25 years. These fractures are occult on plain radiographs and are frequently missed due to unfamiliarity with the entity. But, CT scanning and MR imaging shows characteristic picture. Methods: We had 21 cases of fracture of posterior margin of a lumbar vertebral body from 1991 to 2002. Fracture in all patients were classified according to CT imaging, into the three types described by Takata et al. Out of these, 8 patients were of type I, 4 patients of type II and 9 patients of type III respectively. Focal deficit / muscle weakness was present in only three patients. No fractures of type IV (Epstein et al was found. Twelve patients were treated conservatively and 9 patients were treated by posterior decompression with total laminectomy and removal of retropulsed fragment and discectomy. Results: The mean follow-up period was of 42 months. Conventional radiography could locate the fracture in only 6 cases and CT scan was required in all cases for stamping the diagnosis and classification. Though it is uncommon, high index of suspicion is required to diagnose it, in especially adolescent patients. All the 21 patients had good outcome following the management. Conclusion: Avulsion or fracture of posterior margin of lumbar vertebral body is not so rare entity. In children and young adults diagnosed as having lumbar disc herniation, this lesion may be the proper diagnosis. These fractures need to be accurately diagnosed because as compared to simple disc herniations these fractures require more extensive exposure and resection to relieve the nerve impingent.

  16. Calculation of rotational deformity in pediatric supracondylar humerus fractures

    Energy Technology Data Exchange (ETDEWEB)

    Henderson, Eric R.; Egol, Kenneth A.; Bosse, Harold J.P. van; Schweitzer, Mark E.; Pettrone, Sarah K. [NYU Hospital for Joint Diseases, New York, NY (United States); Feldman, David S. [NYU Hospital for Joint Diseases, New York, NY (United States); NYU Hospital for Joint Diseases, Pediatric Orthopaedic Surgery, Center for Children, New York, NY (United States)

    2007-03-15

    Supracondylar humerus fractures (SCHF) are common in the pediatric population. Cubitus varus deformity (CVD) is the most common long-term complication of SCHFs and may lead to elbow instability and deficits in throwing or extension. Distal fragment malrotation in the axial plane disposes to fragment tilt and CVD; however, no simple method of assessing fracture malrotation exists. This study tested a mathematical method of measuring axial plane malrotation in SCHFs based on plain radiographs. A pediatric SCHF model was made, and x-rays were taken at known intervals of rotation. Five independent, blinded observers measured these films. Calculated rotation for each data set was compared to the known rotation. The identical protocol was performed for an aluminum phantom. The reliability and agreement of the rotation values were good for both models. This method is a reliable, accurate, and cost-effective means of calculating SCHF distal fragment malrotation and warrants clinical application. (orig.)

  17. [Epithelioid hemangioendothelioma of bone complicated by femoral fracture].

    Science.gov (United States)

    Charfi, L; Mrad, K; Karray, S; Sassi, S; Driss, M; Abbes, I; Ben Romdhane, K

    2005-12-01

    A 54-year-old man was seen with a fracture of the left femur. Plain radiographs revealed a 40-mm lytic centromedullary lesion. Magnetic resonance T1- and T2-weighted sequences showed high and low signals. After stabilization of the fracture, the tumor was removed followed by reconstruction with a vascularized fibula. The pathological examination demonstrated proliferation of non atypical CD34 and CD31 positive epithelioid cells with few lumens, accompanied by abundant fibrous stroma, sometimes masking tumor cells. Satisfactory motion was achieved with no recurrence at 20 months follow-up. Bone hemangioendothelioma can simulate metastasis and must be distinguished by immunohistochemistry. Prognosis is a subject of debate as the tumor is considered to exhibit intermediate malignancy by some authors while other consider it to be a malignant tumor.

  18. Ultrasonography as a diagnostic tool in assessing deltoid ligament injury in supination external rotation fractures of the ankle.

    LENUS (Irish Health Repository)

    Henari, Shwan

    2011-10-01

    The medial deltoid ligament is the primary stabilizing structure in the ankle joint following lateral malleolar fracture. However, medial deltoid ligament ruptures are difficult to diagnose using current imaging modalities. We hypothesized that ultrasonography can be used to accurately allow early clinical assessment of ankle fracture stability, thereby negating the need to perform plain film stress views of the acutely injured ankle. This prospective study included 12 patients (age range, 18-72) with supination external rotation fractures requiring operative fixation. Following induction of anesthesia, ultrasonography examination was performed, followed by an arthrogram under fluoroscopic screening. Radiographs, ultrasonography, and arthrographic findings were compared. There was 100% correlation between ultrasonography and arthrogram findings. Ultrasonography accurately diagnosed medial deltoid rupture with a sensitivity of 100% and specificity of 100%. Plain film radiographs of the ankle had a sensitivity of 57.1% and a specificity of 60%. The difference between these was significant (χ(2)=.0091). This study demonstrates diagnostic ultrasonography to be an accurate diagnostic modality in assessing medial deltoid ligament integrity in patients with supination external rotation fractures. It offers the same sensitivity and specificity as arthrography without the need for additional invasive procedures. Its relative ease of use and lack of ionizing radiation make it a potentially useful tool, particularly in a busy trauma service.

  19. Multiplanar and 3D CT of acetabular fractures

    Energy Technology Data Exchange (ETDEWEB)

    Haveri, M.; Suramo, I.; Laehde, S. [Oulu Univ., Dept. of Diagnostic Radiology (Finland); Junila, J. [Oulu Univ., Dept. of Orthopaedic Surgery (Finland)

    1998-05-01

    Purpose: To establish a standard protocol for the multiplanar (MPR) and 3D shaded surface display (SSD) reconstruction of CT data on acetabular fractures, and to assess the usefulness of these reformats. Material and Methods: Acetabular fractures in 15 patients were imaged by means of plain radiographs, transaxial CT, MPR reformats, and SSD reformats. Results: The classification of the acetabular fracture was revised in 7/15 cases when the transaxial CT images were read after the plain radiographs. Although the MPR and SSD reformats did not alter the classification, they did add to the degree of confidence in the diagnosis in 9/15 cases. In 2 patients, the MPR and SSD reformats indicated operative instead of conservative treatment. In the MPR reformats, the following views were considered essential in all cases: (a) along the anterior column; (b) along the posterior column; and (c) along both columns and the inferior ramus. In the SSD reformats, the following views were considered essential in all cases: (d) the latero-caudal en face view into the acetabulum; and 180 opposite to this, (e) the medio-cranial view (facing the quadrilateral plate). In 10/15 cases, these views were all that was needed for classification. It was, however, essential to remove the femur from the images before reconstructing the SSD views. Conclusion: Complex acetabular fractures with displacement should be evaluated by means of transaxial CT and additional MPR and SSD reformats. The use of appropriate standard MPR and SSD views shortens the time required to produce the reformats and thereby maximizes the benefit gained. (orig.).

  20. Primary Hyperparathyroidism with Extensive Brown Tumors and Multiple Fractures in a 20-Year-Old Woman

    Science.gov (United States)

    Choi, Ju Hee; Kim, Kyoung Jin; Lee, Ye Jin; Kim, Sun Hwa; Kim, Sin Gon; Jung, Kwang Yoon; Choi, Dong Seop

    2015-01-01

    A brown tumor is a benign fibrotic, erosive bony lesion caused by localized, rapid osteoclastic turnover, resulting from hyperparathyroidism. Although brown tumors are one of the most pathognomonic signs of primary hyperparathyroidism, they are rarely seen in clinical practice. In this report, we present a case of 20-year-old woman with recurrent fractures and bone pain. Plain digital radiographs of the affected bones revealed multiple erosive bone tumors, which were finally diagnosed as brown tumors associated with primary hyperparathyroidism due to a parathyroid adenoma. This case shows that multiple, and clinically severe form of brown tumors can even occur in young patients. PMID:26354493

  1. Primary Hyperparathyroidism with Extensive Brown Tumors and Multiple Fractures in a 20-Year-Old Woman

    Directory of Open Access Journals (Sweden)

    Ju Hee Choi

    2015-12-01

    Full Text Available A brown tumor is a benign fibrotic, erosive bony lesion caused by localized, rapid osteoclastic turnover, resulting from hyperparathyroidism. Although brown tumors are one of the most pathognomonic signs of primary hyperparathyroidism, they are rarely seen in clinical practice. In this report, we present a case of 20-year-old woman with recurrent fractures and bone pain. Plain digital radiographs of the affected bones revealed multiple erosive bone tumors, which were finally diagnosed as brown tumors associated with primary hyperparathyroidism due to a parathyroid adenoma. This case shows that multiple, and clinically severe form of brown tumors can even occur in young patients.

  2. Value of 3-D CT in classifying acetabular fractures during orthopedic residency training.

    Science.gov (United States)

    Garrett, Jeffrey; Halvorson, Jason; Carroll, Eben; Webb, Lawrence X

    2012-05-01

    The complex anatomy of the pelvis and acetabulum have historically made classification and interpretation of acetabular fractures difficult for orthopedic trainees. The addition of 3-dimensional (3-D) computed tomography (CT) scan has gained popularity in preoperative planning, identification, and education of acetabular fractures given their complexity. Therefore, the authors examined the value of 3-D CT compared with conventional radiography in classifying acetabular fractures at different levels of orthopedic training. Their hypothesis was that 3-D CT would improve correct identification of acetabular fractures compared with conventional radiography.The classic Letournel fracture pattern classification system was presented in quiz format to 57 orthopedic residents and 20 fellowship-trained orthopedic traumatologists. A case consisted of (1) plain radiographs and 2-dimensional axial CT scans or (2) 3-D CT scans. All levels of training showed significant improvement in classifying acetabular fractures with 3-D vs 2-D CT, with the greatest benefit from 3-D CT found in junior residents (postgraduate years 1-3).Three-dimensional CT scans can be an effective educational tool for understanding the complex spatial anatomy of the pelvis, learning acetabular fracture patterns, and correctly applying a widely accepted fracture classification system.

  3. Stress fractures in runners.

    Science.gov (United States)

    McCormick, Frank; Nwachukwu, Benedict U; Provencher, Matthew T

    2012-04-01

    Stress fractures are a relatively common entity in athletes, in particular, runners. Physicians and health care providers should maintain a high index of suspicion for stress fractures in runners presenting with insidious onset of focal bone tenderness associated with recent changes in training intensity or regimen. It is particularly important to recognize “high-risk” fractures, as these are associated with an increased risk of complication. A patient with confirmed radiographic evidence of a high-risk stress fracture should be evaluated by an orthopedic surgeon. Runners may benefit from orthotics, cushioned sneakers, interval training, and vitamin/calcium supplementation as a means of stress fracture prevention.

  4. Fractures in infants and toddlers with rickets

    Energy Technology Data Exchange (ETDEWEB)

    Chapman, Teresa; Done, Stephen [Seattle Children' s Hospital, Department of Radiology, Seattle, WA (United States); Sugar, Naomi; Feldman, Kenneth [Seattle Children' s Hospital, Children' s Protection Program, Seattle, WA (United States); Marasigan, Joanne; Wambold, Nicolle [University of Washington, College of Arts and Sciences, Seattle, WA (United States)

    2010-07-15

    Rickets affects young infants and toddlers. However, there is a paucity of literature regarding the types of fractures that occur in rachitic patients. To evaluate the age of patients at which radiographically evident rickets occurs, and to characterize the age incidence and fractures that are observed in infants and toddlers with radiographically evident rickets. A retrospective study of children younger than 24 months was performed. Clinical data and radiographs were reviewed. Radiographs obtained within 1 month of the diagnosis were evaluated for the presence or absence of osteopenia, presence or absence of fraying-cupping, and presence and characterization of fractures. After exclusion criteria were applied, 45 children were included in the study. Children with rickets evident by radiograph were in the age range of 2-24 months. Fractures were present in 17.5% of the study group, exclusively in mobile infants and toddlers. Fracture types included transverse long bone fractures, anterior and anterior-lateral rib fractures, and metaphyseal fractures. All fractures occurred exclusively in patients with severe, overtly evident rickets. Fractures occur in older infants and toddlers with overt rickets and can be seen by radiograph. Fractures do not resemble high-risk non-accidental trauma fractures. (orig.)

  5. Fractures of the proximal femur: correlates of radiological evidence of osteoporosis

    Energy Technology Data Exchange (ETDEWEB)

    Patel, Salil H.; Murphy, Kieran P. [Johns Hopkins School of Medicine, Radiology, Baltimore, Maryland (United States)

    2006-04-15

    Fractures of the proximal femur are common sequelae of osteoporosis, and are responsible for significant morbidity and mortality in elderly patients worldwide. Plain film radiographic assessment methods to assess for fracture risk may be of particular value. The authors present the results of biomechanical testing, radiographic imaging, and histologic exam of 20 embalmed human bone specimens, with implications for clinical correlation of radiologic findings. Authors assessed bone architecture using the Singh Index, using a blinded 3-rater system to reduce bias and measure intra-observer reliability. After loading to failure with ultimate tensile strength (UTS), bone specimens were assessed by fracture location type and by trabecular bone volume (TBV). Singh scoring was performed with Inter-Class Correlation of 0.80 (F=0.24, by ICC Portney Model 2). A statistically-significant difference among the UTS distributions was noted for UTS by Fracture Site (F=4.49, p=0.026, by ANOVA). No significant association of Singh Index with TBV, or TBV with UTS, was observed, although a trend toward greater UTS with higher Singh grade was observed. The authors propose that the Singh Index is a valuable and reliable indicator which may reflect structural integrity in trabecular bone. Fracture site along the femur is associated with tensile strength. The authors, in the light of these findings, address the promise and potential impact of prophylactic hip augmentation in populations at risk for femoral neck pathology. (orig.)

  6. Lower thoracic rib stress fractures in baseball pitchers.

    Science.gov (United States)

    Gerrie, Brayden J; Harris, Joshua D; Lintner, David M; McCulloch, Patrick C

    2016-01-01

    Stress fractures of the first rib on the dominant throwing side are well-described in baseball pitchers; however, lower thoracic rib fractures are not commonly recognized. While common in other sports such as rowing, there is scant literature on these injuries in baseball. Intercostal muscle strains are commonly diagnosed in baseball pitchers and have a nearly identical presentation but also a highly variable healing time. The diagnosis of a rib stress fracture can predict a more protracted recovery. This case series presents two collegiate baseball pitchers on one team during the same season who were originally diagnosed with intercostal muscle strains, which following magnetic resonance imaging (MRI) were found to have actually sustained lower thoracic rib stress fractures. The first sustained a stress fracture of the posterior aspect of the right 8th rib on the dominant arm side, while the second presented with a left-sided 10th rib stress fracture on the nondominant arm side. In both cases, MRI was used to visualize the fractures as plain radiographs are insensitive and commonly negative early in patient presentation. Patients were treated with activity modification, and symptomatic management for 4-6 weeks with a graduated return to throwing and competition by 8-10 weeks. The repetitive high stresses incurred by pitching may cause either dominant or nondominant rib stress fractures and this should be included in the differential diagnosis of thoracic injuries in throwers. It is especially important that athletic trainers and team physicians consider this diagnosis, as rib fractures may have a protracted course and delayed return to play. Additionally, using the appropriate imaging techniques to establish an accurate diagnosis can help inform return-to-play decisions, which have important practical applications in baseball, such as roster management and eligibility.

  7. Are routine pelvic radiographs in major pediatric blunt trauma necessary?

    Energy Technology Data Exchange (ETDEWEB)

    Lagisetty, Jyothi [Memorial Hermann Medical Center, Emergency Medicine Department, Houston, TX (United States); Slovis, Thomas [Wayne State University School of Medicine, Department of Radiology, Pediatric Imaging, Children' s Hospital of Michigan, Detroit, MI (United States); Thomas, Ronald [Children' s Hospital of Michigan, Wayne State University of Medicine, Department of Pediatrics, Detroit, MI (United States); Knazik, Stephen; Stankovic, Curt [Wayne State University of Medicine, Division of Emergency Medicine, Children' s Hospital of Michigan, Detroit, MI (United States)

    2012-07-15

    Screening pelvic radiographs to rule out pelvic fractures are routinely used for the initial evaluation of pediatric blunt trauma. Recently, the utility of routine pelvic radiographs in certain subsets of patients with blunt trauma has been questioned. There is a growing amount of evidence that shows the clinical exam is reliable enough to obviate the need for routine screening pelvic radiographs in children. To identify variables that help predict the presence or absence of pelvic fractures in pediatric blunt trauma. We conducted a retrospective study from January 2005 to January 2010 using the trauma registry at a level 1 pediatric trauma center. We analyzed all level 1 and level 2 trauma victims, evaluating history, exam and mechanism of injury for association with the presence or absence of a pelvic fracture. Of 553 level 1 and 2 trauma patients who presented during the study period, 504 were included in the study. Most of these children, 486/504 (96.4%), showed no evidence of a pelvic fracture while 18/504 (3.6%) had a pelvic fracture. No factors were found to be predictive of a pelvic fracture. However, we developed a pelvic fracture screening tool that accurately rules out the presence of a pelvic fracture P = 0.008, NPV 99, sensitivity 96, 8.98 (1.52-52.8). This screening tool combines eight high-risk clinical findings (pelvic tenderness, laceration, ecchymosis, abrasion, GCS <14, positive urinalysis, abdominal pain/tenderness, femur fracture) and five high-risk mechanisms of injury (unrestrained motor vehicle collision [MVC], MVC with ejection, MVC rollover, auto vs. pedestrian, auto vs. bicycle). Pelvic fractures in pediatric major blunt trauma can reliably be ruled out by using our pelvic trauma screening tool. Although no findings accurately identified the presence of a pelvic fracture, the screening tool accurately identified the absence of a fracture, suggesting that pelvic radiographs are not warranted in this subset of patients. (orig.)

  8. Galeazzi fracture.

    Science.gov (United States)

    Atesok, Kivanc I; Jupiter, Jesse B; Weiss, Arnold-Peter C

    2011-10-01

    Galeazzi fracture is a fracture of the radial diaphysis with disruption at the distal radioulnar joint (DRUJ). Typically, the mechanism of injury is forceful axial loading and torsion of the forearm. Diagnosis is established on radiographic evaluation. Underdiagnosis is common because disruption of the ligamentous restraints of the DRUJ may be overlooked. Nonsurgical management with anatomic reduction and immobilization in a long-arm cast has been successful in children. In adults, nonsurgical treatment typically fails because of deforming forces acting on the distal radius and DRUJ. Open reduction and internal fixation is the preferred surgical option. Anatomic reduction and rigid fixation should be followed by intraoperative assessment of the DRUJ. Further intraoperative interventions are based on the reducibility and postreduction stability of the DRUJ. Misdiagnosis or inadequate management of Galeazzi fracture may result in disabling complications, such as DRUJ instability, malunion, limited forearm range of motion, chronic wrist pain, and osteoarthritis.

  9. Plains Traveler

    Science.gov (United States)

    2006-01-01

    10 April 2006 This Mars Global Surveyor (MGS) Mars Orbiter Camera (MOC) image shows a dust devil traveling across a plain west-southwest of Schiaparelli Crater, in far eastern Sinus Meridiani. The dust devil is casting a shadow toward the northeast, just south (below) of an egg-shaped crater. Location near: 6.4oS, 349.3oW Image width: 3 km (1.9 mi) Illumination from: lower left Season: Southern Summer

  10. Utopia Plain

    Science.gov (United States)

    2006-01-01

    5 March 2006 This Mars Global Surveyor (MGS) Mars Orbiter Camera (MOC) image shows a dark-toned, cratered plain in southwest Utopia Planitia. Large, light-toned, windblown ripples reside on the floors of many of the depressions in the scene, including a long, linear, trough. Location near: 30.3oN, 255.3oW Image width: 3 km (1.9 mi) Illumination from: lower left Season: Northern Winter

  11. Radiographic constant exposure technique

    DEFF Research Database (Denmark)

    Domanus, Joseph Czeslaw

    1985-01-01

    The constant exposure technique has been applied to assess various industrial radiographic systems. Different X-ray films and radiographic papers of two producers were compared. Special attention was given to fast film and paper used with fluorometallic screens. Radiographic image quality...... was tested by the use of ISO wire IQI's and ASTM penetrameters used on Al and Fe test plates. Relative speed and reduction of kilovoltage obtained with the constant exposure technique were calculated. The advantages of fast radiographic systems are pointed out...

  12. Clinical value of weight-bearing lateral radiographs in evaluation of ankle fracture restoration%负重X线侧位片评估踝关节骨折复位情况的价值分析

    Institute of Scientific and Technical Information of China (English)

    杨勇; 陈维毅; 易兴彪

    2016-01-01

    Objective To discuss the clinical value of L-value measured in weight -bearing lateral radio-graphs in evaluation of ankle fracture restoration .Methods Totally 45 cases of ankle joint fracture treated in our hospital from Jan.2011 to Jan.2014 had been used as samples of a retrospective analysis .According to whether they had a joint pain,movement limitation and other complications after treatment ,the patients were divided into group A (n=27) and group B(n=18).The two groups were compared to find out whether there was a significant difference in L-value.Patients in group B needed to restore fracture by operation and the L-value in the process was decreased and the curative effect before and after operation was compared .Results L-value of group A was (1.26 ±1.4)mm, and was(2.43 ±2.0)mm in group B.The difference was statistically significant (t=2.312,P<0.05).Group B con-tained 18 cases of malunited ankle fracture .After the surgery,they were followed up for an average of (17.1 ±7.3) months.All fractures healed well.AOFAS score was (43.1 ±15.9) before surgery,and (83.3 ±11.8) after surgery. The change of AOFAS score was statistically significant (t=8.614,P<0.05).Conclusion Since L-value can be used as a standard to accurately evaluate ankle joint replacement ,it has both clinical and practical value .%目的:探讨负重X线侧位片“距骨中心胫骨中轴距”L值对于评估踝关节骨折复位的临床价值。方法笔者以2011年1月~2014年1月收治的45例踝关节骨折患者为样本进行回顾性分析,根据有无复位后关节疼痛、活动受限等并发症将患者分为A组(27例)和B组(18例),对比A、B组负重X线侧位片L值有无统计学差异;对于需要进行重建手术的B组,通过手术干预,减小L值,对比手术前后的疗效。结果 A、B组患者L值分别为(1.26±1.4)mm、(2.43±2.0)mm,两者对比有统计学意义(t=2.312,P<0.05);B组18例踝关节

  13. Surgical Management of 3 and 4-Part Proximal Humerus Fractures with Locking Plates in Elderly

    Directory of Open Access Journals (Sweden)

    Emrah Kovalak

    2017-05-01

    Full Text Available Aim: Proximal humeral fractures are approximately 5% of all fractures and, %15-20 is displaced and unstable. By the introduction of locking plates there used to be a substantial rise in the osteosynthesis of the 3 and 4-part proximal humeral fractures. But there is still a lack of consensus for the optimal treatment of these complex fractures. In this retrospective study, we aimed to evaluate the functional outcomes and prognostic factors of 3 and 4-part proximal humerus fractures treated with locking plate osteosynthesis in elderly. Material and Method: 53 patients with displaced 3 and 4-part proximal humeral fractures treated with locking plate osteosynthesis between 2010 and 2015 were included. The fractures were classified according to Neer classification system. Outcomes were assessed by Constant-Murley scoring system (CMS, visual analog pain scale and plain radiographs. In reference to range of motion, forward elevation and abduction of the arm were measured.Results: No statistically significant differences found between the 3- part and 4- part fractures in CMS, forward elevation and, abduction (p>0.05. Pain was significantly higher in 4-part fractures (p=0.035. CMS, forward elevation, and abduction were inversely correlated with age and delay in surgery. There was statistical significance between the patients had complications and those not in terms of CMS, forward elevation and, abduction (p=0.029, p=0.017 and p=0.024. Discussion: Functional outcomes of locking plate fixation of proximal humerus fractures are associated with patient related factors, fracture pattern, surgeon and, the implant. When indications are carefully selected, locking plate osteosynthesis yield good outcomes in surgical treatment of 3 or 4-part proximal humerus fractures.

  14. T-condylar fracture delayed for 10 days in a 5-year-old boy: a case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    Shashidhar B Kantharajanna; Vijay Goni; Pebam Sudesh; Nirmal Raj Gopinathan

    2013-01-01

    T-condylar fracture is rare in paediatric age group,especially in skeletally immature children less than 9 years old,with very few cases reported in available literature.We present such a case in a 5 year old child that was initially managed as a supracondylar fracture at another centre before referral to us,10 days after the injury.The child was diagnosed as having a displaced T-condylar fracture on plain radiograph.Open reduction and internal fixation with K-wires was performed.At 2 years follow-up,the child had good range of motion at elbow with 5°of cubitus varus.With this background we discuss the pertinent principles of management of T-condylar fractures in skeletally immature children.

  15. Thoracic fractures and dislocations in motorcyclists

    Energy Technology Data Exchange (ETDEWEB)

    Daffner, R.H.; Deeb, Z.L.; Rothfus, W.E.

    1987-06-01

    Motorcyclists who are involved in accidents generally suffer severe multiple injuries, some of which are not readily apparent on initial examination. One such subtle injury is fracture, with or without dislocation, in the upper thoracic spine. The severe spinal cord damage produced by the injury is often overshadowed by cerebral or cervical injury. Proper diagnosis is further hampered by the fact that the upper thoracic region is difficult to examine radiographically on plain films, particularly when using portable equipment. Of a group of 14 motorcyclists having 26 fractures and/or dislocations in the thoracic region, 12 had 24 injuries between T3 and T8. These 24 injuries represented 56% of the fractures and/or dislocations encountered in a larger study of trauma to the thoracic vertebral column. All of these were flexion injuries, suffered when the individual was thrown from the motorcycle and struck a large, solid object. In three cases, the diagnosis was delayed as much as 48 h because proper films were not obtained initially. Because of the serious consequences of delayed treatment, we recommended that all motorcyclists who have sustained severe trauma be examined by overpenetrated film of the upper thoracic region.

  16. Magnetic Resonance Imaging in Pediatric Elbow Fractures

    Energy Technology Data Exchange (ETDEWEB)

    Pudas, T.; Hurme, T.; Mattila, K.; Svedstroem, E. [Univ. of Turku, (Finland). Depts. of Radiology and Pediatric Surgery

    2005-10-01

    Purpose: Magnetic resonance imaging (MRI) evaluation of pediatric elbow trauma with or without a visible fracture on radiography. Material and Methods: MRI was performed in the acute phase in 25 children with an elbow injury. Nine patients with an elbow effusion only on radiographs and 16 with a fracture or luxation seen on radiographs underwent subsequent MRI. No sedation was used. Results: MRI revealed eight occult fractures (89%) in seven out of nine patients who had only an effusion on radiographs. Based on MRI findings, septic arthritis was suspected in one patient. Two patients out of five with a supracondylar fracture on the radiograph had a cartilage lesion in the humerus. MRI depicted a 3-mm gap on the articular surface in two patients with a lateral condyle fracture, a more accurate fracture location in two patients than the radiographs, and an additional occult fracture in two patients. MRI showed a fracture not seen on radiographs in two of three patients with prior luxation. Conclusion: MRI is a sensitive and accurate method in the diagnosis of pediatric elbow injuries, especially when only an effusion is present on radiographs. Occult fractures are more common in pediatric patients with elbow injury than reported earlier.

  17. Bilateral periprosthetic stress fractures in a juvenile chronic arthritis patient secondary to bilateral genu valgum.

    Science.gov (United States)

    Al-Khateeb, H; Meir, A; Singer, G C

    2007-01-01

    Lateral insufficiency fractures following total hip replacement have been reported with the femoral stems positioned in varus, together with osteopenia of the lateral femoral cortex. Any abnormal alignment of the lower limbs, such as genu valgum, will alter the load distribution across the femoral cortices, and repetitive loading during walking will predispose the bones to stress fractures at any stress riser point, such as the tip of a femoral component. Bilateral femoral stress fractures post total hip replacements have not been previously described. We present a 55-year-old woman, diagnosed with juvenile idiopathic arthritis, who had undergone bilateral total hip replacements and bilateral knee replacements. The knees 15 years postoperatively were in valgus and the left knee was extremely stiff, flexing to just 5. The patient presented with bilateral thigh pain, with plain radiographs confirming bilateral periprosthetic fractures of the femur at the tip of well-fixed femoral components. There was no history of injury and her hips were functioning well up to this time. The patient required revision of both hips to long-stem uncemented components, bypassing the fractures, and revision of both knees to stemmed semi-constrained implants, thereby correcting the alignment of both lower limbs. Both fractures healed and the patient is currently pain-free and mobile with walking aids. Surgeons must remain aware that when implants are in situ, abnormal alignments will lead to abnormal forces, and stress fractures are likely to occur at any stress riser around the implant. Avoiding malalignment will avoid this complication.

  18. Acromioclavicular Joint Dislocation with Ipsilateral Mid Third Clavicle, Mid Shaft Humerus and Coracoid Process Fracture - A Case Report.

    Science.gov (United States)

    Sharma, Naveen; Mandloi, Avinash; Agrawal, Ashish; Singh, Shailendra

    2016-01-01

    The clavicle, humerus and acromioclavicular (AC) joint separately are very commonly involved in traumatic injuries around the shoulder. Acromioclavicular joint dislocation with distal clavicle fracture is a well recognized entity in clinical practice. AC joint dislocation with mid shaft clavicle fracture is uncommon and only few cases have been reported in literature. However, to the best of our knowledge, this is the first case report to describe an acromioclavicular dislocation with ipsilateral mid shaft clavicle, mid shaft humerus and coracoid process fracture. Fractures of the humerus and clavicle along with the acromioclavicular joint dislocation were fixed at the same setting. A 65-year-old male met with a high velocity road traffic accident. Plain radiographs showed displaced mid third clavicle fracture with acromioclavicular joint dislocation with mid shaft humerus fracture. Surgical fixation was planned for humerus with interlocking nail, clavicle with locking plate and acromioclavicular joint with reconstruction of coracoclavicular ligaments. Intraoperatively, coracoid process was found to have a comminuted fracture. The operative plan had to be changed on table as coracoclavicular fixation was not possible. So acromioclavicular joint fixation was done using tension band wiring and the coracoclavicular ligament was repaired using a 2-0 ethibond. The comminuted coracoid fracture was managed conservatively. K wires were removed at 6 weeks. Early mobilization was started. In acromioclavicular joint injuries, clavicle must be evaluated for any injury. Although it is more commonly associated with distal clavicle fractures, it can be associated with middle third clavicle fractures. As plain radiographs, AP view are most of the times insufficient for viewing integrity of coracoid process, either special views like Stryker notch or CT scan may help in diagnosing such concealed injuries. When associated with fractures of the humerus and clavicle, anatomical

  19. Artificial intelligence for analyzing orthopedic trauma radiographs.

    Science.gov (United States)

    Olczak, Jakub; Fahlberg, Niklas; Maki, Atsuto; Razavian, Ali Sharif; Jilert, Anthony; Stark, André; Sköldenberg, Olof; Gordon, Max

    2017-07-06

    Background and purpose - Recent advances in artificial intelligence (deep learning) have shown remarkable performance in classifying non-medical images, and the technology is believed to be the next technological revolution. So far it has never been applied in an orthopedic setting, and in this study we sought to determine the feasibility of using deep learning for skeletal radiographs. Methods - We extracted 256,000 wrist, hand, and ankle radiographs from Danderyd's Hospital and identified 4 classes: fracture, laterality, body part, and exam view. We then selected 5 openly available deep learning networks that were adapted for these images. The most accurate network was benchmarked against a gold standard for fractures. We furthermore compared the network's performance with 2 senior orthopedic surgeons who reviewed images at the same resolution as the network. Results - All networks exhibited an accuracy of at least 90% when identifying laterality, body part, and exam view. The final accuracy for fractures was estimated at 83% for the best performing network. The network performed similarly to senior orthopedic surgeons when presented with images at the same resolution as the network. The 2 reviewer Cohen's kappa under these conditions was 0.76. Interpretation - This study supports the use for orthopedic radiographs of artificial intelligence, which can perform at a human level. While current implementation lacks important features that surgeons require, e.g. risk of dislocation, classifications, measurements, and combining multiple exam views, these problems have technical solutions that are waiting to be implemented for orthopedics.

  20. Unexpected Salter-Harris type II fracture of the proximal phalanx of the second toe: a chiropractic perspective.

    Science.gov (United States)

    Murdock, Mark

    2015-12-01

    To discuss the diagnosis and management of a Salter-Harris type II fracture in a nine-year-old girl who was managed conservatively. A nine-year-old girl fell while playing in bare feet in the grass. She experienced pain when she walked or moved her toe. There was minor swelling and bruising. Plain film radiographs revealed a Salter-Harris type II fracture of the 2(nd) proximal phalanx. Her toe was stabilized and she was referred to an orthopedist. Orthopedic management involved a taping procedure. After three weeks, her fracture healed and she was pain free. Chiropractors may consider radiography of post-traumatic injury sites even with equivocal examination findings despite histories suggesting seemingly innocuous mechanisms of injury.

  1. Bilateral atypical femoral subtrochanteric fractures in a premenopausal patient receiving prolonged bisphosphonate therapy: evidence of severely suppressed bone turnover.

    Science.gov (United States)

    Kondo, Naoki; Yoda, Takuya; Fujisawa, Junichi; Arai, Katsumitsu; Sakuma, Mayumi; Ninomiya, Hiroshi; Sano, Hiroshige; Endo, Naoto

    2015-01-01

    We report a case of bilateral atypical femoral fractures that occurred in a patient who had been taking bisphosphonate long-term. A 36-year-old premenopausal female diagnosed with systemic lupus erythematosus and dermatomyositis had been treated with glucocorticoid and alendronate (5 mg/day) to prevent glucocorticoid-induced osteoporosis. She was taken to our hospital because she could not walk immediately after falling down from the standing position. A plain radiograph showed a subtrochanteric fracture of the left femur. Four months later, she fell again and sustained a contralateral subtrochanteric fracture. For each fracture, a femoral intramedullary nail was inserted. Delayed union was detected in both sides, and revision surgery with an iliac bone graft was required for implant breakage in the right side. Histomorphometric findings for the ilium revealed remarkably decreased osteoid volume with no osteoclasts and a minimally eroded surface, suggesting that bone turnover was severely suppressed. However, histology of the delayed union site revealed callus formation and some osteoclast appearance, suggesting that fracture healing was occurring. In total, it took 29 months (left) and 24 months (right) until fracture healing was achieved, showing delayed union. This case is extremely rare in that patient who presented with atypical femoral fractures in spite of her premenopausal status. The bone histomorphometric findings from this case suggest that severely suppressed bone turnover is associated with atypical femoral subtrochanteric fracture and can cause delayed union in patients treated with alendronate long-term.

  2. Bilateral atypical insufficiency fractures of the proximal tibia and a unilateral distal femoral fracture associated with long-term intravenous bisphosphonate therapy: a case report

    Directory of Open Access Journals (Sweden)

    Imbuldeniya Arjuna

    2012-02-01

    Full Text Available Abstract Introduction Atypical insufficiency fractures of the femur in patients on long-term bisphosphonate therapy have been well described in recent literature. The majority of cases are associated with minimal or no trauma and occur in the subtrochanteric or diaphyseal region. Case presentation We describe the case of a 76-year-old British Caucasian woman who presented initially to an emergency department and then to her primary care physician with a long-standing history of bilateral knee pain after minor trauma. Plain radiographs showed subtle linear areas of sclerosis bilaterally in her proximal tibiae. Magnetic resonance imaging confirmed the presence of insufficiency fractures in these areas along with her left distal femur. There are very few reports of atypical insufficiency fractures involving the tibia in patients on long-term bisphosphonate therapy and this appears to be the only documented bilateral case involving the metaphyseal regions of the proximal tibia and distal femur. Conclusion In addition to existing literature describing atypical fractures in the proximal femur and femoral shaft, there is a need for increased awareness that these fractures can also occur in other weight-bearing areas of the skeleton. All clinicians involved in the care of patients taking long-term bisphosphonates need to be aware of the growing association between new onset lower limb pain and atypical insufficiency fractures.

  3. Revisiting Plain Language.

    Science.gov (United States)

    Mazur, Beth

    2000-01-01

    Discusses the plain language movement and its origins. Reviews past and current resources related to plain language writing. Examines criticism of the movement while examining past and current plain language literature, with particular attention to the information design field. (SR)

  4. [Fractures of carpal bones].

    Science.gov (United States)

    Lögters, T; Windolf, J

    2016-10-01

    Fractures of the carpal bones are uncommon. On standard radiographs fractures are often not recognized and a computed tomography (CT) scan is the diagnostic method of choice. The aim of treatment is to restore pain-free and full functioning of the hand. A distinction is made between stable and unstable carpal fractures. Stable non-displaced fractures can be treated conservatively. Unstable and displaced fractures have an increased risk of arthritis and non-union and should be stabilized by screws or k‑wires. If treated adequately, fractures of the carpal bones have a good prognosis. Unstable and dislocated fractures have an increased risk for non-union. The subsequent development of carpal collapse with arthrosis is a severe consequence of non-union, which has a heterogeneous prognosis.

  5. Radiographic features of desmoplastic ameloblastoma: report of 3 cases

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Da Hye; Huh, Kyung Hoe; Moon, Je Woon; Yi, Won Jin; Heo, Min Suk; Lee, Sam Sun; Choi, Soon Chul [Seoul National Univ., Seoul (Korea, Republic of); Park, Kwan Soo [Inje Univ., Kimhae (Korea, Republic of)

    2006-03-15

    Desmoplastic ameloblastoma is a rare histologic variant of ameloblastoma. It shows important differences in distribution, histologic appearance, and radiographic findings compared with the general type of ameloblastoma. It is histologically characterized by an abundance of densely collagenous stroma and radiographically a mixed radiolucent-radiopaque lesion. We present three cases of desmoplastic ameloblastoma. All patients complained on buccal swelling with or without pain and the sites of occurrence were the anterior and premolar region. Plain radiographs showed mixed radiopaque-radiolucent lesion with ill-defined or diffuse margin and no external root resorption. Additionally, CT scans revealed buccal expansion and relatively margin of the lesions. The clinical and radiographic features of the presented cases were compared with those of the desmoplastic ameloblastoma in the previous literatures.

  6. Radiographic artefact due to a faulty lead rubber shield

    Energy Technology Data Exchange (ETDEWEB)

    Kumar, G. E-mail: gunasekarankumar@hotmail.com; Kamath, V.; Murali, S.R.; Temperley, D

    2003-05-01

    Radiographic examination is one of the commonest investigations performed in the field of Orthopaedics. There are several pitfalls to be kept in mind while interpreting radiographs in Orthopaedics. Bony or soft tissue lesions can be mimicked by anatomical variations, superimposition of soft tissues, inappropriate radiographic exposure and presence of external radio-opaque substances, to name a few. We present a case, where a faulty lead rubber shield mimicked a fracture of distal end of humerus. Early identification of these abnormalities can avoid distress to and unnecessary investigations of the patient.

  7. Fractures of the acetabulum in elderly patients: an update.

    Science.gov (United States)

    Guerado, E; Cano, J R; Cruz, E

    2012-12-01

    The incidence of acetabular fractures in elderly patients is increasing. Poor bone quality and concomitant diseases are the main features of these patients. Fracture patterns are marked by a high degree of variability in terms of patient and fracture characteristics. Preoperative planning with plain radiographs and computed tomography, including 3-dimensional reconstructions, is recommended. Treatment remains challenging because of precarious general health, severe osteopenia, comminution, and associated femoral head damage. Treatment options available include closed management, open reduction with internal fixation, percutaneous fixation in situ, and acute or staged total hip arthroplasty (THA) whether alone or combined with osteosynthesis. In the case of significant destruction of the articular cartilage, primary THA may provide the best solution. Whichever surgical method is chosen, the objective is rapid mobilisation of the patient on a walker or crutches. Late local complications that may occur after nonoperative or operative treatment include posttraumatic arthritis, nonunion, malunion, wound infection, dislocation, intrusive hardware, nerve palsy, and heterotopic bone formation. In this article an overview of the current trends in the management of acetabulum fractures in the elderly is presented.

  8. Pulpal healing following acute dental trauma: clinical and radiographic review.

    Science.gov (United States)

    Andreasen, F M

    2001-05-01

    Successful treatment of tooth luxations, crown fractures, and root fractures is often compromised by the emergency nature of the injury. Precise radiographic and clinical evaluation is required to facilitate healing and treatment selection. While traditional treatment protocols indicate that dental injuries implying pulpal ischemia require immediate endodontic therapy to avoid healing complications, the clinical investigations discussed herein suggest that a variety of etiologies for pulp survival/pulp necrosis exist. This article discusses the long-term prognosis of pulp necrosis following traumatic dental injuries, and clinical and radiographic criteria for its diagnosis.

  9. Floating shoulders: Clinical and radiographic analysis at a mean follow-up of 11 years

    Directory of Open Access Journals (Sweden)

    ReÌ gis Pailhes

    2013-01-01

    Full Text Available Context: The floating shoulder (FS is an uncommon injury, which can be managed conservatively or surgically. The therapeutic option remains controversial. Aims: The goal of our study was to evaluate the long-term results and to identify predictive factors of functional outcomes. Settings and Design: Retrospective monocentric study. Materials and Methods: Forty consecutive FS were included (24 nonoperated and 16 operated from 1984 to 2009. Clinical results were assessed with Simple Shoulder Test (SST, Oxford Shoulder Score (OSS, Single Assessment Numeric Evaluation (SANE, Short Form-12 (SF12, Disabilities of the Arm Shoulder and Hand score (DASH, and Constant score (CST. Plain radiographs were reviewed to evaluate secondary displacement, fracture healing, and modification of the lateral offset of the gleno-humeral joint (chest X-rays. New radiographs were made to evaluate osteoarthritis during follow-up. Statistical Analysis Used: T-test, Mann-Whitney test, and the Pearson′s correlation coefficient were used. The significance level was set at 0.05. Results: At mean follow-up of 135 months (range 12-312, clinical results were satisfactory regarding different mean scores: SST 10.5 points, OSS 14 points, SANE 81%, SF12 (50 points and 60 points, DASH 14.5 points and CST 84 points. There were no significant differences between operative and non-operative groups. However, the loss of lateral offset influenced the results negatively. Osteoarthritis was diagnosed in five patients (12.5% without correlation to fracture patterns and type of treatment. Conclusions: This study advocates that floating shoulder may be treated conservatively and surgically with satisfactory clinical long-term outcomes. However, the loss of gleno-humeral lateral offset should be evaluated carefully before taking a therapeutic option.

  10. [Clinical application of the combination of postural reduction and kyphoplasty for traumatic thoracolumbar spine fractures].

    Science.gov (United States)

    Huang, Hong-bin; Bao, Feng; Ji, Xiang-rong; Fan, Shun-wu; Chen, Hong-wei

    2008-09-01

    To determine the efficacy and feasibility of the combination of postural reduction and percutaneous kyphoplasty for traumatic thoracolumbar spine fractures. Thirty-seven patients with single level traumatic thoracolumbar spine fractures were included in this study. There are 28 males and 9 females, with an average age of 48 years (range 24 to 79 years). Patients were treated with postural reduction and then percutaneous vertebroplasty with Calcium Phosphate Cement (CPC) were performed on the fractured vertebra. The results were quantitatively evaluated, according to the concept of estimated vertebral height loss and kyphotic angle of the vertebral fractures by preoperative and postoperative plain standing lateral radiographs. Visual analog scale (VAS) and the fracture vertebra shape changes were recorded. Patients were followed up for 9 to 24 months (average 13 months), pain was significantly relieved compared with the preoperative, VAS was reduced averagely from 7.6 +/- 2.5 to 1.8 +/- 1.5, the anterior and middle vertebral height was restored and kyphotic angle was corrected. During the period of follow up, outcomes were satisfactory, without notable correction loss. If the indications are correctly handled, the combination of postural reduction and percutaneous kyphoplasty for the treatment of traumatic thoracolumbar spine fractures can provide significant pain relieve and restore the vertebral height and kyphotic angle.

  11. Hollow-Bone-Graft Dynamic Hip Screw Can Fix and Promote Bone Union after Femoral Neck Fracture: an Experimental Research

    Directory of Open Access Journals (Sweden)

    Jia-zuo SHEN, Jian-fei YAO, Da-sheng LIN, Ke-jian LIAN, Zhen-qi DING, Bin LIN, Zhi-min GUO, Ming-hua ZHANG, Qiang LI, Lin LI, Peng QI

    2012-01-01

    Full Text Available Background: Delayed bone union, nonunion or osteonecrosis often occur after femoral neck fractures in young adults. Secondary bone healing requires strong internal fixation, intramedullary pressure reduction and early functional exercise.Objective: To compare bone healing of femoral neck fractures treated with hollow-bone-graft dynamic hip screws (Hb-DHS and standard dynamic hip screws (DHS in an animal model.Design: Testing of specifically designed fixation devices in a pig animal model.Interventions/Methods: We designed Hb-DHS and DHS devices appropriate to the femoral neck and head of experimental animals and used them in eight pigs (4-month-old, male or female, 30-40 kg/each. Under anesthesia, we induced medium neck type, Garden III type femoral neck fractures in each pig with fracture gaps of 0.5 mm and then fixed each left femur with Hb-DHS and each right femur with DHS. We assessed the animals radiographically and by postmortem visual appraisal of evidence of bone healing 8 and 16 weeks postoperatively.Results: There were significant differences in radiographic and general findings between the Hb-DHS and DHS groups at weeks 8 and 16 postoperatively. We found statistically significant differences between the Hb-DHS and DHS groups in bone healing scores, trabecular bone volume percentage and bone mineral density as assessed on plain radiographs and computed tomography images (P < 0.05. There were also significant differences between the Hb-DHS and DHS groups in postmortem visually assessed indicators of bone healing at both 8 and 16 weeks postoperatively.Conclusions: The Hb-DHS device promotes femoral neck bone union, stimulates trabecular bone formation, increases BMD and has advantages over DHS for internal fixation of femoral neck fractures. This animal experiment will contribute to developing optimal treatment for femoral neck fractures in young adults.

  12. Imaging of insufficiency fractures

    Energy Technology Data Exchange (ETDEWEB)

    Krestan, Christian [Department of Radiology, Medical University of Vienna, Vienna General Hospital, Waehringerstr. 18-20, 1090 Vienna (Austria)], E-mail: christian.krestan@meduniwien.ac.at; Hojreh, Azadeh [Department of Radiology, Medical University of Vienna, Vienna General Hospital, Waehringerstr. 18-20, 1090 Vienna (Austria)

    2009-09-15

    This review focuses on the occurrence, imaging and differential diagnosis of insufficiency fractures. Prevalence, the most common sites of insufficiency fractures and their clinical implications are discussed. Insufficiency fractures occur with normal stress exerted on weakened bone. Postmenopausal osteoporosis is the most common cause of insufficiency fractures. Other conditions which affect bone turnover include osteomalacia, hyperparathyroidism, chronic renal failure and high-dose glucocorticoid therapy. It is a challenge for the radiologist to detect and diagnose insufficiency fractures, and to differentiate them from other bone lesions. Radiographs are still the most widely used imaging method for identification of insufficiency fractures, but sensitivity is limited, depending on the location of the fractures. Magnetic resonance imaging (MRI) is a very sensitive tool to visualize bone marrow abnormalities associated with insufficiency fractures. Thin section, multi-detector computed tomography (MDCT) depicts subtle fracture lines allowing direct visualization of cortical and trabecular bone. Bone scintigraphy still plays a role in detecting fractures, with good sensitivity but limited specificity. The most important differential diagnosis is underlying malignant disease leading to pathologic fractures. Bone densitometry and clinical history may also be helpful in confirming the diagnosis of insufficiency fractures.

  13. Bilateral non-traumatic acetabular and femoral neck fractures due to pregnancy-associated osteoporosis.

    Science.gov (United States)

    Aynaci, Osman; Kerimoglu, Servet; Ozturk, Cagatay; Saracoglu, Metehan

    2008-03-01

    Pregnancy-associated osteoporosis is a rare disorder and its pathophysiology remains unknown. We report a case of pregnancy-associated osteoporosis in a 27-year-old primiparous patient who revealed bilateral hip pain during early postnatal period. The plain radiographs and computerized tomography showed bilateral femoral neck and acetabular fractures. The diagnosis of osteoporosis was established by bone mineral density. Diagnostic work-up excluded a secondary osteoporosis. The case was treated successfully by bilateral cementless total hip arthroplasty. Bone mineral density increased after 2 years of treatment with calcium-vitamin D, calcitriol and alendronate. Diagnosis of pregnancy-associated osteoporosis should be suspected when hip pain occurs during pregnancy or in the post-partum period as it can lead to acetabular and femoral neck fractures.

  14. Radiographic Assessment for Back Pain

    Science.gov (United States)

    Radiographic Assessment for Back Pain What are Radiographic Assessments? When Should I get an X-ray for Low Back Pain? Other Reasons for Having an X-ray What ... What are Radiographic Assessments? Radiographic assessments for low back pain involve the use of X-rays to determine ...

  15. Percutaneous vertebroplasty compared to conservative treatment in patients with painful acute or subacute osteoporotic vertebral fractures.Three months follow up in a clinical randomised study

    DEFF Research Database (Denmark)

    Rousing, Rikke

    2008-01-01

    ) were included from January 2001 until January 2008. Patients with acute (weeks) and subacute (between 2 and 8 weeks) osteoporotic fractures were included and randomised to either PVP or conservative treatment. Pain was assessed with a visual analogue scale and physical and mental outcome were...... assessed by validated questionnaires and tests. Tests, questionnaires, and plain radiographs were performed at the inclusion and after 3 months. Results. Reduction in pain from initial visit to 3 months follow up was comparable in the two groups (p=0.22) from approximate VAS 8.0 to VAS 2.0, intra group...... difference was significant (phours after the procedure (p

  16. Plain film diagnosis in meconium plug syndrome, meconium ileus and neonatal Hirschsprung's disease - A scoring system

    NARCIS (Netherlands)

    S.M. Hussain (Shahid); M. Meradji (Morteza); S.G.F. Robben (Simon); W.C.J. Hop (Wim)

    1991-01-01

    textabstractAbdominal plain films of 133 neonates, with 82 cases of meconium plug syndrome (MPS), 27 cases of meconium ileus (MI) and 24 cases of neonatal Hirschsprung's disease (HD), were reviewed to assess the value of such radiographs for diagnosis. The radiographs were examined according to a li

  17. CT examinations of healing fractures

    Energy Technology Data Exchange (ETDEWEB)

    Nutz, V.; Uexkuell-Gueldenband, V. v.

    1988-10-01

    The CT appearances of healing fractures were studied following tibial osteotomy in a dog. Traditional radiological investigations and CT were carried out until healing was complete; CT showed callus on the ninth day, whereas radiographs only showed it after 19 days. After 32 days, callus filled nearly the entire medullary cavity. Similar observations were made in several human situations. CT demonstrates interposed material in the fracture very clearly, even if there is marked callus formation within the fracture.

  18. Acute avulsion fractures of the pelvis in adolescent competitive athletes: prevalence, location and sports distribution of 203 cases collected

    Energy Technology Data Exchange (ETDEWEB)

    Rossi, F.; Dragoni, S. [Sports Science Inst., Rome (Italy)

    2001-03-01

    Objective. To describe the prevalence, location and sports distribution of pelvic avulsion fractures in adolescent competitive athletes. Design and patients. One thousand two hundred and thirty-eight radiographs of the pelvis taken for focal traumatic symptoms in athletes with an age range of 11-35 years over a period of 22 years were reviewed. Results. One hundred and ninety-eight adolescent athletes were affected by 203 avulsion fractures of the pelvic apophyses (five cases presented multiple locations). The localisation was the ischial tuberosity (IT) in 109 cases, anterior inferior iliac spine (AIIS) in 45 cases, anterior superior iliac spine (ASIS) in 39 cases, superior corner of pubic symphysis (SCPS) in 7 cases and iliac crest (IC) in 3 cases. Soccer (74 cases) and gymnastics (55 cases) were the sports with the highest number of avulsion fractures documented. Conclusions. Apophyseal avulsion fractures of the pelvis in adolescent competitive athletes are most common in soccer and gymnastics. The lesions are usually the consequence of sudden and forceful muscle-tendon contractions during sport activities. Plain radiographs, are determinant for the diagnosis. (orig.)

  19. Association of Ipsilateral Rib Fractures With Displacement of Midshaft Clavicle Fractures.

    Science.gov (United States)

    Stahl, Daniel; Ellington, Matthew; Brennan, Kindyle; Brennan, Michael

    2017-04-01

    To determine whether the presence of ipsilateral rib fractures affects the rate of a clavicle fracture being unstable (>100% displacement). A retrospective review from 2002-2013 performed at a single level 1 trauma center evaluated 243 midshaft clavicle fractures. Single Level 1 trauma center. These fractures were subdivided into those with ipsilateral rib fractures (CIR; n = 149) and those without ipsilateral rib fractures (CnIR; n = 94). The amount of displacement was measured on the initial injury radiograph and subsequent follow-up radiographs. Fractures were classified into either 100% displacement, based on anteroposterior radiographs. Ipsilateral rib fractures were recorded based on which number rib was fractured and the total number of fractured ribs. One hundred sixteen (78%) of the CIR group and 51 (54%) of the CnIR group were found to have >100% displacement at follow-up (P = 0.0047). Seventy-two percent of the CIR group demonstrated progression from 100% displacement of the fracture compared with only 54% of the CnIR group (P 100% was 4.08 (P = 0.000194) when ribs 1-4 were fractured and not significant for rib fractures 5-8 or 9-12. The presence of concomitant ipsilateral rib fractures significantly increases the rate of midshaft clavicle fractures being >100% displaced. In addition, a fracture involving the upper one-third of the ribs significantly increases the rate of the clavicle fracture being >100% displaced on early follow-up. Clavicle fractures with associated ipsilateral rib fractures tend to demonstrate an increased amount of displacement on follow-up radiographs compared with those without ipsilateral rib fractures. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

  20. Incidence and risk factors for the development of radiographic arthrosis after traumatic elbow injuries

    NARCIS (Netherlands)

    T.G. Guitton; D. Zurakowski; N.C. van Dijk; D. Ring

    2010-01-01

    Radiographic arthrosis is a common sequela of elbow trauma. Few studies have addressed risk factors for radiographic arthrosis after elbow injury, especially in the long term. Data from multiple long-term follow-up studies of patients with surgically treated elbow fractures provided us with an oppor

  1. New finding in the radiographic diagnosis of Achilles tendon rupture

    Energy Technology Data Exchange (ETDEWEB)

    Newmark, H.; Mellon, W.S. Jr.; Malhotra, A.K.; Olken, S.M.; Halls, J.

    1982-06-01

    The authors describe a new radiographic sign of rupture of the Achilles tendon system. It is a fracture, with separation through an osteophyte at the insertion of this tendon. Previously reported signs are also discussed as well as the present case report.

  2. Comparison Of Digital Radiographic Units

    Science.gov (United States)

    Wang, Yen

    1986-06-01

    A total PACS will be inevitable for radiology practice within several years. To achieve a total PACS for radiology, a satisfactory digital radiographic unit is required, because approximately 65% of digital data for PACS comes from digital radiographs. There are several possibilities for producing digital radiographs, and 3 - 4 companies have been marketing digital radiographic devices. Some data regarding the digital radiographic units on the market are compared. It will aid in assessing the current status and availability of this aspect of development, as well as providing a summary of further development of digital radiographic technology.

  3. Trichobezoars Detected and Treated Based on Plain Radiography.

    Science.gov (United States)

    Barrows, Amy; Vachon, Tyler; Campin, Richard C; Ignacio, Romeo C

    2015-10-01

    Bezoars are conglomerations of indigestible material that become trapped in the gastrointestinal tract. We present a case of an 8-year-old female child diagnosed with a gastric bezoar solely on plain radiography and treated with abdominal surgical exploration and removal. In addition, traditional characteristic radiographic findings and treatment options for bezoars found in the current literature are reviewed.

  4. A transepiphyseal fracture of the femoral neck in a child with 2 widely displaced Salter-Harris III fragments of the capital femoral epiphysis.

    Science.gov (United States)

    Lee, Dae-Hee; Park, Jong-Woong; Lee, Soon-Hyuck

    2010-02-01

    To our knowledge, this is the first report of a transphyseal fracture of the femoral neck with a fracture of the capital femoral epiphysis involving 2 widely displaced Salter-Harris III fragments in a child. Preoperative surgical lateral radiographs of the hip of a 14-year-old boy clearly showed an anteriorly dislocated femoral head fragment. However, the overlapping ischium, soft tissue, and an anteriorly dislocated femoral head fragment caused a posteriorly dislocated fragment of the split femoral head to be overlooked on the radiographs. The emergent nature of the injury resulted in the performance of an open reduction without further imaging studies. Based on the initial evaluation, an anterior iliofemoral approach was chosen, which made it difficult to locate the posteriorly dislocated main fragment of the split femoral head. This case highlights that plain radiographs do not always provide adequate information for such injuries. Computed tomography or magnetic resonance imaging should be employed to enable accurate diagnosis and appropriate treatment for fracture-dislocations of the pediatric hip.

  5. Radiographic evaluation of common pediatric elbow injuries

    Directory of Open Access Journals (Sweden)

    Steven F. DeFroda

    2017-02-01

    Full Text Available Normal variations in anatomy in the skeletally immature patient may be mistaken for fracture or injury due to the presence of secondary centers of ossification. Variations in imaging exist from patient to patient based on sex, age, and may even vary from one extremity to the other on the same patient. Despite differences in the appearance of the bony anatomy of the elbow there are certain landmarks and relationships, which can help, distinguish normal from abnormal. We review common radiographic parameters and pitfalls associated in the evaluation of pediatric elbow imaging. We also review common clinical diagnoses in this population.

  6. Coracoclavicular stabilization using a suture button device for Neer type IIB lateral clavicle fractures.

    Science.gov (United States)

    Cho, Chul-Hyun; Jung, Jae-Hoon; Kim, Beom-Soo

    2017-05-01

    The purpose of this study was to evaluate the radiologic and clinical outcomes of coracoclavicular (CC) stabilization using a suture button device for Neer type IIB lateral clavicle fractures. Eighteen consecutive patients with Neer type IIB fractures were treated with CC stabilization using a TightRope device (Arthrex, Naples, FL, USA). The mean follow-up period was 46.6 months (range, 24-75 months). Radiologic outcomes were assessed using serial plain radiographs. Clinical outcomes were evaluated using the visual analog scale pain score; University of California, Los Angeles score; American Shoulder and Elbow Surgeons score; and subjective shoulder value. Intraoperative and postoperative complications were also evaluated. Of the 18 cases, 17 (94.4%) showed complete bony union. The mean final visual analog scale pain score was 1.1; University of California, Los Angeles score, 31.3; American Shoulder and Elbow Surgeons score, 88.6; and subjective shoulder value, 88.5%. Four complications were observed: (1) intraoperative coracoid process fracture, (2) nonunion, (3) delayed union, and (4) shoulder stiffness. The case with a coracoid process fracture during coracoid tunnel generation was converted to the K-wire tension band technique. CC stabilization using a suture button device for Neer type IIB lateral clavicle fractures yielded satisfactory radiologic and clinical outcomes. The major advantage of this technique is that implant removal is not required. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  7. Primary total elbow arthroplasty in complex fractures of the distal humerus

    DEFF Research Database (Denmark)

    Sørensen, Brian Weng; Brorson, Stig; Olsen, Bo Sanderhoff

    2014-01-01

    ), plain radiographs, complications and overall satisfaction. The indications for surgery were 1: AO type B3 or C3 or Sheffield type 3 fracture and age above 65 or 2: fracture and severe rheumatoid arthritis. Mean follow-up time was 21 mo. RESULTS: Twenty patients were followed up. Four patients, of which......AIM: To evaluate short- to medium term outcome of total elbow arthroplasty (TEA) in complex fractures of the distal humerus. METHODS: A consecutive series of 24 complex distal humerus fractures operated with TEA in the period 2006-2012 was evaluated with the Mayo Elbow Performance score (MEPS...... 3 had died, were lost to follow up. According to the AO classification there were 17 C3, 1 B2 and 2 A2 fractures. Mean follow-up was 21 months (range 4-54). Mean MEPS was 94 (range 65-100). Mean flexion was 114 degrees (range 80-140). According to MEPS there were 15 excellent, 4 good and 1 fair...

  8. Radiographic features of bisphosphonate therapy in pediatric patients

    Energy Technology Data Exchange (ETDEWEB)

    Grissom, L.E.; Theodore Harcke, H. [Dept. of Medical Imaging, Alfred I. duPont Hospital for Children, Nemours Children' s Clinic, Wilmington, DE (United States)

    2003-04-01

    Background: Pediatric patients are being treated with bisphosphonates for low bone mineral density. Skeletal radiographic findings have been described with bisphosphonates given orally and intravenously. Objective: To determine and describe the radiographic findings of cyclic intravenous bisphosphonate therapy in the growing skeleton. Materials and methods: Retrospective review of radiographs of 32 patients with osteogenesis imperfecta or cerebral palsy treated with intravenous bisphosphonates on a quarterly schedule. Results: Principal observations were metaphyseal bands and increased bone mineral density. The bands varied in spacing according to the age of the patient, rate of growth, and the location of the metaphysis. Fractures continued to be seen in patients with osteogenesis imperfecta. Conclusion: Cyclic bisphosphonate therapy results in distinctive radiographic findings in the growing skeleton. (orig.)

  9. Periprosthetic Occult Fractures of the Acetabulum Occur Frequently During Primary THA.

    Science.gov (United States)

    Hasegawa, Kazuhiro; Kabata, Tamon; Kajino, Yoshitomo; Inoue, Daisuke; Tsuchiya, Hiroyuki

    2017-02-01

    Periprosthetic fractures of the acetabulum occurring during primary THA are rare. Periprosthetic occult fractures are defined as those not identified by the surgeon during the procedure which might be missed on a routine postoperative radiograph. However, it is unclear how frequently these fractures occur and whether their presence affects functional recovery. In this study, using routine CT scans that were obtained as part of another primary hip arthroplasty study protocol, we retrospectively assessed (1) the prevalence of occult fractures of the acetabulum occurring during primary THA, (2) the location of occult fractures of the acetabulum during THA, and (3) risk factors contributing to such occult fractures. Between 2004 and 2013, our institute performed 585 primary THAs (cementless or hybrid) in 494 patients with DICOM pre- and postoperative CT; during the period in question, all patients undergoing THA underwent CT before and after surgery. Preoperative CT images were taken as part of a CT-based three-dimensional templating software and navigation system. Postoperative CT images were taken an average of 1 week after surgery as part of a different protocol to evaluate cup position, restoration of leg length and offset, volume of postoperative hematoma to assess anticoagulation effects after THA, and fractures that were not found on routine postoperative radiographs (which we defined as occult fractures). Patients with a history of prior pelvic osteotomy, trauma, and infection were excluded (88 patients/99 hips); 406 patients (102 males and 304 females; 486 hips) form the basis of this report. The mean age of the patients was 60 ± 11 years, with a mean BMI of 23 ± 4 kg/m(2). The mean followup of the patients with periprosthetic fracture of the acetabulum was 58 ± 28 months (range, 12-131 months). Potential risk factors for occult acetabular fracture including age, sex, BMI, preoperative diagnosis, additional dome screw fixation, composition and size of each

  10. Scaphoid Waist Internal Fixation for Fractures Trial (SWIFFT) protocol: a pragmatic multi-centre randomised controlled trial of cast treatment versus surgical fixation for the treatment of bi-cortical, minimally displaced fractures of the scaphoid waist in adults.

    Science.gov (United States)

    Dias, Joseph; Brealey, Stephen; Choudhary, Surabhi; Cook, Liz; Costa, Matthew; Fairhurst, Caroline; Hewitt, Catherine; Hodgson, Stephen; Jefferson, Laura; Jeyapalan, Kanagaratnam; Keding, Ada; Leighton, Paul; Rangan, Amar; Richardson, Gerry; Rothery, Claire; Taub, Nicholas; Thompson, John; Torgerson, David

    2016-06-04

    A scaphoid fracture is the most common type of carpal fracture affecting young active people. The optimal management of this fracture is uncertain. When treated with a cast, 88 to 90 % of these fractures unite; however, for the remaining 10-12 % the non-union almost invariably leads to arthritis. The alternative is surgery to fix the scaphoid with a screw at the outset. We will conduct a randomised controlled trial (RCT) of 438 adult patients with a "clear" and "bicortical" scaphoid waist fracture on plain radiographs to evaluate the clinical effectiveness and cost-effectiveness of plaster cast treatment (with fixation of those that fail to unite) versus early surgical fixation. The plaster cast treatment will be immobilisation in a below elbow cast for 6 to 10 weeks followed by mobilisation. If non-union is confirmed on plain radiographs and/or Computerised Tomogram at 6 to 12 weeks, then urgent surgical fixation will be performed. This is being compared with immediate surgical fixation with surgeons using their preferred technique and implant. These treatments will be undertaken in trauma units across the United Kingdom. The primary outcome and end-point will be the Patient Rated Wrist Evaluation (a patient self-reported assessment of wrist pain and function) at 52 weeks and also measured at 6, 12, 26 weeks and 5 years. Secondary outcomes include an assessment of radiological union of the fracture; quality of life; recovery of wrist range and strength; and complications. We will also qualitatively investigate patient experiences of their treatment. Scaphoid fractures are an important public health problem as they predominantly affect young active individuals in the more productive working years of their lives. Non-union, if untreated, can lead to arthritis which can disable patients at a very young age. There is a rapidly increasing trend for immediate surgical fixation of these fractures but there is insufficient evidence from existing RCTs to support

  11. Opportunistic Identification of Vertebral Fractures.

    Science.gov (United States)

    Adams, Judith E

    2016-01-01

    Vertebral fractures are powerful predictors of future fracture, so, their identification is important to ensure that patients are commenced on appropriate bone protective or bone-enhancing therapy. Risk factors (e.g., low bone mineral density and increasing age) and symptoms (back pain, loss of height) may herald the presence of vertebral fractures, which are usually confirmed by performing spinal radiographs or, increasingly, using vertebral fracture assessment with dual-energy X-ray absorptiometry scanners. However, a large number (30% or more) of vertebral fractures are asymptomatic and do not come to clinical attention. There is, therefore, scope for opportunistic (fortuitous) identification of vertebral fractures from various imaging modalities (radiographs, computed tomography, magnetic resonance imaging, and radionuclide scans) performed for other clinical indications and which include the spine in the field of view, with midline sagittal reformatted images from computed tomography having the greatest potential for such opportunistic detection. Numerous studies confirm this potential for identification but consistently find underreporting of vertebral fractures. So, a valuable opportunity to improve the management of patients at increased risk of future fracture is being squandered. Educational training programs for all clinicians and constant reiteration, stressing the importance of the accurate and clear reporting of vertebral fractures ("you only see what you look for"), can improve the situation, and automated computer-aided diagnostic tools also show promise to solve the problem of this underreporting of vertebral fractures. Copyright © 2016. Published by Elsevier Inc.

  12. Radiographic Evaluation of the Ankle Mortise

    Directory of Open Access Journals (Sweden)

    Hamid Mirbagheri

    2010-05-01

    Full Text Available The ankle joint is the most frequently injured joint in adults. Decisions on management are usually based on clinical examination and interpretation of the x-rays. Stability of the ankle mortise relies on the configuration of the osseous structures and the ligaments. A basic radiographic examination consists of a mortise-view and a lateral view. Some add the AP-view. The Mortise view is an AP-view with 15-25 degrees endorotation of the foot. "nThe view clearly demonstrates both lateral and medial joint spaces. On a true AP-view the talus overlaps a portion of the lateral malleolus obscuring the lateral aspect of the ankle joint. However, the AP-view will give you an extra view on both malleoli from a different angle. The lateral radiograph of the ankle should include the base of the fifth metatarsal because of the frequency of fractures at this side that clinically mimic a fracture of the ankle.

  13. Fracture of the L-4 vertebral body after use of a stand-alone interbody fusion device in degenerative spondylolisthesis for anterior L3-4 fixation.

    Science.gov (United States)

    Kwon, Yoon-Kwang; Jang, Ju-Hee; Lee, Choon-Dae; Lee, Sang-Ho

    2014-06-01

    Many studies attest to the excellent results achieved using anterior lumbar interbody fusion (ALIF) for degenerative spondylolisthesis. The purpose of this report is to document a rare instance of L-4 vertebral body fracture following use of a stand-alone interbody fusion device for L3-4 ALIF. The patient, a 55-year-old man, had suffered intractable pain of the back, right buttock, and left leg for several weeks. Initial radiographs showed Grade I degenerative spondylolisthesis, with instability in the sagittal plane (upon 15° rotation) and stenosis of central and both lateral recesses at the L3-4 level. Anterior lumbar interbody fusion of the affected vertebrae was subsequently conducted using a stand-alone cage/plate system. Postoperatively, the severity of spondylolisthesis diminished, with resolution of symptoms. However, the patient returned 2 months later with both leg weakness and back pain. Plain radiographs and CT indicated device failure due to anterior fracture of the L-4 vertebral body, and the spondylolisthesis had recurred. At this point, bilateral facetectomies were performed, with reduction/fixation of L3-4 by pedicle screws. Again, degenerative spondylolisthesis improved postsurgically and symptoms eased, with eventual healing of the vertebral body fracture. This report documents a rare instance of L-4 vertebral body fracture following use of a stand-alone device for ALIF at L3-4, likely as a consequence of angular instability in degenerative spondylolisthesis. Under such conditions, additional pedicle screw fixation is advised.

  14. An olecranon chondral flap and osteochondral coronoid fracture in a spontaneously reduced elbow dislocation in a child.

    Science.gov (United States)

    Quick, Tom J; Gibbons, Paul; Smith, Nick

    2013-09-01

    Elbow injuries in children are very common and radiographs are often difficult to interpret because of the radiolucency of the cartilaginous anlage and the progressive appearance of multiple secondary ossification centres. Elbow dislocations are rare injuries in children. Coronoid fractures can occur during dislocation or relocation of the elbow and can be the only hallmark of a severe injury. The understanding of the mechanics of these injuries has undergone considerable evolution over the past decade. Intra-articular chondral flap fractures are a traumatic elevation of the hyaline cartilage from the subchondral bone. They are also rare injuries in children but should be included in the differential when examining an injured joint. The infrequency of these injuries provides little opportunity to become accustomed to the radiographic signs. We present a case report of a 4-year-old boy with both an olecranon chondral flap and coronoid cartilaginous fracture after a joint dislocation. We present his plain radiography and MRI with illustrated photographic records of the operative findings. This injury has been little described in the literature and never with such imaging to aid understanding of both the pathology and the injury mechanism.

  15. Peritoneal tuberculosis: radiographic diagnosis

    Directory of Open Access Journals (Sweden)

    Carolina Ospina-Moreno

    2014-12-01

    Full Text Available Peritoneal tuberculosis (TB is an extrapulmonary form of presentation of tuberculosis. HIV infection is a primary risk factor for this condition. Diagnosis requires microbiological or histopathological confirmation in addition to supporting radiological imaging studies. Abdominal ultrasonography and CT are useful to obtain a radiographic diagnosis, with typical findings including diffuse peritoneal thickening, presence of ascites in varying volumes, adenopathies, and caseating nodes. We report 2 cases of patients with ascites and nodular peritoneal thickening on diagnostic images, as well as high CA-125 levels in laboratory tests. In both patients, a diagnosis of peritoneal tuberculosis was reached following a US-guided peritoneal biopsy.

  16. Subperiosteal osteoid osteoma: radiographic and pathologic manifestations

    Energy Technology Data Exchange (ETDEWEB)

    Shankman, S. [Department of Radiology, Hospital for Joint Diseases/OI, 301 East 17th Street, New York, NY 10003 (United States); Desai, P. [Department of Pathology, Hospital for Joint Diseases/OI, 301 East 17th Street, New York, NY 10003 (United States); Beltran, J. [Department of Radiology, Hospital for Joint Diseases/OI, 301 East 17th Street, New York, NY 10003 (United States)

    1997-08-01

    Objective.To demonstrate the radiologic and pathologic manifestations of osteoid osteoma arising beneath the periosteum, on the surface of the bone. Design. One hundred and sixty osteoid osteomas were seen over a 30-year period. The radiologic, pathologic and operative findings of those that were subperiosteal were reviewed. Patients. Eleven patients with subperiosteal osteoid osteoma were reviewed. The patients ranged in age from 13 to 36 years with a mean of 24 years. Eight were male and three were female. Results and conclusion. Eleven subperiosteal lesions were studied. The reactive periostitis of four lesions was atypical and misleading. Four lesions had features similar to the more common intracortical variety. Three lesions occurring within the joint like other intra-articular lesions were barely seen on plain radiographs. Bone scan and CT scan were virtually diagnostic. The histopathology of these lesions was also atypical though not misleading. In conclusion, subperiosteal osteoid osteoma is a rare lesion with atypical radiographic and histopathologic features. The unusual reactive periostitis seen in several extra-articular cases may suggest other diagnoses. (orig.). With 4 figs., 2 tabs.

  17. Paediatric talus fracture.

    LENUS (Irish Health Repository)

    Byrne, Ann-Maria

    2012-01-01

    Paediatric talus fractures are rare injuries resulting from axial loading of the talus against the anterior tibia with the foot in dorsiflexion. Skeletally immature bone is less brittle, with higher elastic resistance than adult bone, thus the paediatric talus can sustain higher forces before fractures occur. However, displaced paediatric talus fractures and those associated with high-energy trauma have been associated with complications including avascular necrosis, arthrosis, delayed union, neurapraxia and the need for revision surgery. The authors present the rare case of a talar neck fracture in a skeletally immature young girl, initially missed on radiological review. However, clinical suspicion on the part of the emergency physician, repeat examination and further radiographic imaging revealed this rare paediatric injury.

  18. Reliability analysis of radiographic methods for determination of posterolateral lumbossacral fusion

    Energy Technology Data Exchange (ETDEWEB)

    Gotfryd, Alberto Ofenhejm; Moraes Pomar, Felipe de; Carneiro, Nicola Jorge Neto; Franzin, Fernando José [Santa Casa da Misericórdia de Santos, Santos, SP (Brazil); Rodrigues, Luciano Miller Reis [Faculdade de Medicina do ABC, Santo André, SP (Brazil); Poletto, Patricia Rios [Universidade Federal de São Paulo, Santos, SP (Brazil)

    2014-07-01

    To analyze intra and interobserver agreement of two radiographic methods for evaluation of posterolateral lumbar arthrodesis. 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. 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. 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.

  19. Digital x-ray radiogrammetry identifies women at risk of osteoporotic fracture: results from a prospective study

    DEFF Research Database (Denmark)

    Bach-Mortensen, Pernille; Hyldstrup, Lars; Appleyard, Merete;

    2006-01-01

    Using digital X-ray radiogrammetry (DXR) on hand radiographs from a large population-based study, 1,370 postmenopausal women were evaluated in a prospective fashion; fracture occurrence was compared with DXR measurements of historic radiographs. Further, the aim of the study was to evaluate factors...... suffered a fracture. Odds ratios (ORs) per 1 standard deviation decline in DXR-BMD were statistically significant for fracture in the groups of wrist fractures, proximal humerus fractures, vertebral fractures, and other fractures as well as in the total fracture group. In the hip fracture group, the P...

  20. Posterior malleolar fracture: technique and clinical ex-perience of the posterolateral approach

    Directory of Open Access Journals (Sweden)

    HUANG Ruo-kun

    2012-04-01

    Full Text Available 【Abstract】Objective: To introduce the postero-lateral surgical approach to the posterior malleolar fracture and report its clinical outcomes in 32 cases. Methods: This study consisted of 32 cases, 22 males and 10 females with the mean age of 48 years (range, 21-63 years, suffering from posterior malleolar fracture. All cases were treated with the posterolateral surgical approach to the ankle. The average follow-up period was 28 months (range, 24-35 months. The clinical outcomes of these cases were evaluated on the basis of the Olerud-Molander Ankle (OMA score and plain radiographs. Results: All cases showed radiological evidence of bony union at follow-up. The average OMA score was 82 points; 21 cases had excellent scores (90-100 points, 9 good (61-90 points, and 2 fair (31-60 points. The excellent-to-good rate was 93.8%. Although most cases did not show any wound dehiscence or necrosis, one patient had a su-perficial infection which healed after using antibiotic dress-ing and one had sural cutaneous nerve injury that under-went spontaneous remission without any treatment after three months. In addition, one presented with mild symp-toms of peroneal tendonitis that disappeared after plate removal. Conclusion: The posterolateral approach offers an effective technique for fracture reduction and fixation of large posterior malleolar fragments. Key words: Ankle injuries; Dislocations; Fracture fixation, internal

  1. Misdiagnosis of sacral stress fracture: an underestimated cause of low back pain in pregnancy?

    Science.gov (United States)

    Deschamps Perdomo, Ambar; Tome-Bermejo, Felix; Piñera, Angel R; Alvarez, Luis

    2015-02-06

    Sacral stress fracture during pregnancy is an uncommon condition with unclear pathophysiology, presenting with non-specific symptoms and clinical findings. To date, few cases have been published in the literature describing the occurrence of sacral stress fracture during pregnancy. We report a 28-year-old primigravid patient who developed lumbosacral pain at the end of the second trimester. Symptoms were overlooked throughout pregnancy and the postpartum period, resulting in the development of secondary chronic gait and balance problems. Stress fracture of the sacrum should be included in the differential diagnosis of low back and sacral pain during pregnancy. Its prevalence is probably underestimated because of the lack of specificity of the symptoms. Plain radiographs are not appropriate due to radiation exclusion; magnetic resonance is the only method that can be applied safely. There is limited information on natural history but many patients are expected to have a benign course. However, misdiagnosis may lead to prolonged morbidity and the development of secondary gait abnormalities. Stress fracture of the sacrum should be included in the differential diagnosis of low back and sacral pain during pregnancy. A high index of suspicion is necessary to establish an early diagnosis and appropriate treatment.

  2. One strategy for arthroscopic suture fixation of tibial intercondylar eminence fractures using the Meniscal Viper Repair System

    Directory of Open Access Journals (Sweden)

    Ochiai Satoshi

    2011-08-01

    Full Text Available Abstract Background Principles for the treatment of tibial intercondylar eminence fracture are early reduction and stable fixation. Numerous ways to treatment of this fracture have been invented. We designed a simple, low-invasive, and arthroscopic surgical strategy for tibial intercondylar eminence fracture utilizing the Meniscal Viper Repair System used for arthroscopic meniscal suture. Methods We studied 5 patients, who underwent arthroscopic suture fixation that we modified. The present technique utilized the Meniscal Viper Repair System for arthroscopic suture of the meniscus. With one handling, a high-strength ultra-high molecular weight polyethylene(UHMWPE suture can be passed through the anterior cruciate ligament (ACL and the loops for suture retrieval placed at both sides of ACL. Surgical results were evaluated by the presence or absence of bone union on plain radiographs, postoperative range of motion of the knee joint, the side-to-side differences measured by Telos SE, and Lysholm scores. Results The reduced position achieved after surgery was maintained and good function was obtained in all cases. The mean distance of tibia anterior displacement and assessment by Lysholm score showed good surgical results. Conclusion This method simplified the conventional arthroscopic suture fixation and increased its precision, and was applicable to Type II fractures that could be reduced, as well as surgically indicated Types III and IV. The present series suggested that our surgical approach was a useful surgical intervention for tibial intercondylar eminence fracture.

  3. Core competencies of radiographers working in rural hospitals of KwaZulu-Natal, South Africa.

    Science.gov (United States)

    Mung'omba, Bernard; Botha, Annali D H

    2017-08-31

    Rural radiographers require, over and above traditional radiographic expertise, additional competencies which to a certain degree are unique however not limited to rural practice. Previous studies, however, have focused more attention primarily on other rural health professionals such as doctors and nurses leaving a research need in this field. This article focuses on the additional competencies that may be required for rural radiographers. To investigate and identify additional core competencies required by radiographers working in rural hospitals of KwaZulu-Natal in order to propose a continuous professional development strategy aimed at rural radiographers. An exploratory sequential design was utilised with qualitative (Phase I) and quantitative (Phase II) strands involving seven participants and 109 respondents, respectively. Only radiographers working in rural KwaZulu-Natal hospitals were included in the study. The four major themes and categories identified in Phase I were used to develop data collection instrument for Phase II of the study. Collectively, the results revealed that there were a number of additional core competencies such as, but not limited to, teamwork, ability to do basic obstetric ultrasound scans, leadership, management and reporting on plain radiographs, all of which are required by rural radiographers. In 2014 when these competencies were checked against a single curriculum, it was found that majority of them were either partially covered or not at all covered. The study provides additional information on context specific core competencies and, therefore, may act as a catalyst to influence the future of radiographers working in rural areas of South Africa.

  4. Double segmental tibial fractures - an unusual fracture pattern

    Directory of Open Access Journals (Sweden)

    Bali Kamal

    2012-02-01

    Full Text Available 【Abstract】A case of a 50-year-old pedestrian who was hit by a bike and suffered fractures of both bones of his right leg was presented. Complete clinical and radiographic assessment showed double segmental fractures of the tibia and multisegmental fractures of the fibula. Review of the literature revealed that this fracture pattern was unique and only a single case was reported so far. Moreover, we discussed the possible mechanisms which can lead to such an injury. We also discussed the management of segmental tibial fracture and the difficulties encountered with them. This case was managed by modern osteosynthesis tech- nique with a pleasing outcome. Key words: Fracture, bone; Tibia; Fibula; Nails

  5. Radiographic study of ameloblastoma

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Jong Sub; You, Dong Soo [Dept. of Oral Radiology, College of Dentistry, Seoul National University, Seoul (Korea, Republic of)

    1982-11-15

    The purpose of this study is to obtain some information for the differential diagnosis of ameloblastoma from dentigerous cyst by analysis of the radiographic findings of these lesions. The author studied age and sex distribution, the site of the lesion, tooth behavior and several radiographic features of ameloblastoma and dentigerous cyst. The material consisted of 65 patients of ameloblastoma and 37 patients of dentigerous cyst. The results were obtained as followings. 1) The incidence was highest in 2nd decade (29.2%) and total 65 cases consists of 35 males (53.8%) and 30 females (46.2%) in ameloblastoma. 62 cases were found in lower jaw (95.4%) and the highest site of occurrence of ameloblastoma was mandibular molar region 27 cases.(41.5%) 2) In 65 cases of ameloblastoma, 18 cases were seen in association with tooth and 15 cases (83.2%) out of those were associated with mandibular molar teeth. Mandibular molar were most frequently involved in dentigerous cyst (11/37 cases, 29.7%). 3) (a) 23 cases (35.3%) of tooth resorption were found in ameloblastoma and 11 cases (29.7%) of tooth resorption were found in dentigerous cyst. (b) 15 cases (23.1%) of tooth migration were found in ameloblastoma and 10 cases (27.0%) of tooth migration were found in dentigerous cyst. 4) Several radiographic features. (a) Monolocular type ameloblastoma were seen in 23 cases (35.4) and multilocular type of ameloblastoma were seen in 42 cases (64.6%). Monolocular type of dentigerous cyst were seen in 33 cases (89.2%) and multilocular type was seen in 4 cases. (b) Monolocular type ameloblastoma showed 20 cases (87.0%) of scalloped border but 32 cases (97.0%) of dentigerous cyst showed smooth border. (c) 34 cases (81.0%) of ameloblastoma showed honey-comb appearance, soap-bubble appearance or mixed appearance. But all 4 cases of dentigerous cyst showed multicystic appearance. (d) 12 cases (52.2%) of monolocular type ameloblastoma showed slightly increased radiopacity in surrounding bone

  6. 胫骨下段螺旋型骨折合并后踝骨折的诊断与治疗%Diagnosis and treatment of the distal spiral tibial shaft fracture associated with posterior mal-leolar fracture

    Institute of Scientific and Technical Information of China (English)

    张正廉; 王士波; 高迪; 郑杰; 赵廷虎; 高彦军; 张勇

    2015-01-01

    Objective To explore the cause of leak diagnosis, injury mechanism and treatment strategy of the distal 1/3 spiral tibial shaft fracture associated with occult posterior malleolar fracture. Methods 81 patients with distal third spiral tibia shaft fracture associated posterior malleolar fractures were treated by surgery. The radiology detected 38 posterior malleolar fracture. The rest fractures were determined by CT scan. All cases were fixed with tibial intr-amedulary nailing at the supination foot and the internal-rotation tibia. The posterior malleolar fractures were fixed with ø 4. 5 mm cannulated screws. All cases of distal 1/2 fibular fractures were fixed with plates or Kirschner wires. All of proximal fibular fractures were not fixed. Results 81 cases were all followed up from 4 months to 11 months. 68 cases of posterior malleolar fractures were fixed with cannulated screws, which can prevent displacement during in-tramedullary nailing of tibia shaft fractures, and all showed radiographic evidence of healing. 13 cases were not fixed for small and no displacement fractures. 79 cases of spiral tibial shaft fracture were healed according to plain radio-graphs standard. 2 cases were ununion for excessive gap between fractures and later healed with bone grafting. 1 case occurred ankle traumatic arthritis. The wounds were not contaminated and no osteomyelitis occurred. According to Johner-Wruhs evaluation standard, the results were excellent in 67 cases, good in 10, fair in 3 and poor in 1;the ex-cellent and good rate was 95%. Conclusions Distal spiral tibia shaft fractures are associated with ipsilateral posteri-or malleolar fractures, which plain radiographs are often insufficient for detecting. Using a preoperative CT protocol for spiral tibial shaft fractures can significantly improve the ability to diagnose associated posterior malleolar fractures that may not be evident on plain radiographs. Injury mechanism is the supination foot and the internal

  7. Rotator cuff tears: clinical, radiographic, and US findings.

    Science.gov (United States)

    Moosikasuwan, Josh B; Miller, Theodore T; Burke, Brian J

    2005-01-01

    Rotator cuff tears are a common cause of shoulder pain. Clinical and radiographic findings can suggest the presence of a rotator cuff tear. The most sensitive clinical findings are impingement and the "arc of pain" sign. Radiographic findings are usually normal in the acute setting, although the "active abduction" view may show decreased acromiohumeral distance. In more chronic cases, an outlet view may show decreased opacity and decreased size of the supraspinatus muscle due to atrophy. In late cases, the humeral head may become subluxated superiorly, and secondary degenerative arthritis of the glenohumeral joint may ensue. Ultrasonography (US), with over 90% sensitivity and specificity, can help confirm the diagnosis in clinically or radiographically equivocal cases. US can also reveal the presence of other abnormalities that may mimic rotator cuff tear at clinical examination, including tendinosis, calcific tendinitis, subacromial subdeltoid bursitis, greater tuberosity fracture, and adhesive capsulitis.

  8. Computer assisted measurement of femoral cortex thickening on radiographs

    Science.gov (United States)

    Yao, Jianhua; Liu, Yixun; Chen, Foster; Summers, Ronald M.; Bhattacharyya, Timothy

    2013-03-01

    Radiographic features such as femoral cortex thickening have been frequently observed with atypical subtrochanteric fractures. These features may be a valuable finding to help prevent fractures before they happen. The current practice of manual measurement is often subjective and inconsistent. We developed a semi-automatic tool to consistently measure and monitor the progress of femoral cortex thickening on radiographs. By placing two seed points on each side of the femur, the program automatically extracts the periosteal and endosteal layers of the cortical shell by active contour models and B-spline fitting. Several measurements are taken along the femur shaft, including shaft diameter, cortical thickness, and integral area for medial and lateral cortex. The experiment was conducted on 52 patient datasets. The semi-automatic measurements were validated against manual measurements on 52 patients and demonstrated great improvement in consistency and accuracy (p<0.001).

  9. Traumatic posterior atlantoaxial dislocation without related fractures of C1-C2

    Directory of Open Access Journals (Sweden)

    Maruti Kambali

    2013-01-01

    Full Text Available Posterior dislocation without any associated fracture of odontoid is exceedingly rare and only 11 cases have been reported so far. A 32 year old male presented with pain, stiffness in neck, difficulty in breathing, associated lacerations on face and deformity of mandible and inability to open mouth. His plain radiographs, CT scan, MRI demonstrated a posterior dislocation of the atlas with respect of axis and a flake of bone from odontoid process on CT scan. He was successfully managed by closed reduction, C1C2 lateral mars pedicular screw stabilization and inter facetal fusion with synthetic bone graft substitute. At 10 months followup he had lost only 30° cervical rotation. The case is reported in view of rarity and to discuss the treatment rationale.

  10. Iloprost inhibits fracture repair in rats

    Institute of Scientific and Technical Information of China (English)

    Ali Do(g)an; Fatih Duygun; A.Murat Kalender; Irfan Bayram; Ibrahim Sungur

    2014-01-01

    Background Previous studies have shown that prostaglandins (PGs) dramatically stimulate healing processes in bone.However,the effect of prostaglandin l2 (PGI2) on fracture healing remains unclear.To investigate the effect of PGI2,a study on fracture healing process in closed tibia fractures was designed.Methods Thirty-six Sprague-Dawley male rats were randomized into two groups.On the first day,their right tibias were fractured by three-point bending technique.The study group (n=18) received a single injection of 10 μg/kg iloprost for 5 days,while the control group (n=18) received saline solution in the same way.On the 7th,14th and 28th days following the fracture,six rats were sacrificed and their right legs were harvested in each group.The progression of fracture healing was assessed for each specimen by the scores of radiography (by Lane-Sandhu) and histology (by Huo et al).Results On the 7th day,the radiographic and histologic scores were equal.On the 14th day radiographic total score was 6 and histologic total score was 23 in the iloprost group,whereas radiographic total score was 11 and histologic total score was 33 in the control group.On the 14th day radiographic and histologic scores were significantly decreased in the iloprost group compared to the control group (P <0.05).On the 28th day radiographic total score was 12 and histologic total score was 37 in the iloprost group,whereas radiographic total score was 15 and histologic total score was 40 in the control group.On the 28th day although there was a decrease in radiographic and histologic scores of the iloprost group acording to control group,it was not statistically significant (P >0.05).Conclusion Iloprost delays fracture healing in early stage in rats.

  11. Diagnostic ability of panoramic radiography for mandibular fractures

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ji Hyun; Jung, Yun Hoa; Cho Bong Hae; Hwang, Dae Seok [School of Dentistry, Pusan National University, Pusan (Korea, Republic of)

    2010-03-15

    The purpose of this study was to evaluate the diagnostic efficacy of panoramic radiographs for detection of mandibular fractures. The sample was comprised of 65 patients (55 fractured, 10 non-fractured) with 92 fracture sites confirmed by multi-detector computed tomography (CT). Panoramic radiographs were evaluated for mandibular fractures by six examiners; two oral and maxillofacial radiologists (observer A and B), two oral and maxillofacial surgeons (observer C and D), and two general dentists (observer E and F). Sensitivity of panoramic radiography for mandibular fractures was 95.7% in observer A and B, 93.5% in observer C and D and 80.4% in observer E and F. The lowest sensitivity was shown in symphyseal/parasymphyseal areas, followed by subcondylar/condylar regions. Panoramic radiography is adequate for detection of mandibular fractures. However, additional multidetector CT is recommended to ascertain some indecisive fractures of symphysis and condyle, and in complicated fractures.

  12. Pediatric elbow fractures: a new angle on an old topic

    Energy Technology Data Exchange (ETDEWEB)

    Emery, Kathleen H.; Anton, Christopher G. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Zingula, Shannon N. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); Salisbury, Shelia R. [Cincinnati Children' s Hospital Medical Center, Biostatistics and Epidemiology, Cincinnati, OH (United States); Tamai, Junichi [Cincinnati Children' s Hospital Medical Center, Department of Pediatric Orthopedics, Cincinnati, OH (United States)

    2016-01-15

    The three most common elbow fractures classically reported in pediatric orthopedic literature are supracondylar (50-70%), lateral condylar (17-34%), and medial epicondylar fractures (10%), with fractures of the proximal radius (including but not limited to fractures of the radial neck) being relatively uncommon (5-10%). Our experience at a large children's hospital suggests a different distribution. Our goals were (1) to ascertain the frequency of different elbow fracture types in a large pediatric population, and (2) to determine which fracture types were occult on initial radiographs but detected on follow-up. Review of medical records identified 462 children, median age 6 years and interquartile range for age of 4-8 years (range 0.8-18 years), who were diagnosed with elbow fractures at our institution over a 10-month period. Initial and follow-up radiographs were reviewed in blinded fashion independently by two experienced pediatric musculoskeletal radiologists to identify fracture types on initial and follow-up radiographs. The most common fractures included supracondylar (n = 258, 56%), radial neck (n = 80, 17%), and lateral condylar (n = 69, 15%). Additional fractures were seen on follow-up exams in 32 children. Of these, 25 had a different fracture type than was identified on initial radiographs. The most common follow-up fractures were olecranon (n = 23, 72%), coronoid process (n = 4, 13%) and supracondylar (n = 3, 9%). Olecranon fractures were significantly more common on follow-up radiographs than they were on initial radiographs (n = 33, 7%; P <.0001). Twenty-six children had more than one fracture type on the initial radiograph. The most common fracture combinations were radial neck with olecranon (n = 9) and supracondylar with lateral condylar (n = 9). Supracondylar fractures are the most frequent elbow fracture seen initially, followed by radial neck, lateral condylar, and olecranon fractures in a distribution different from what has been

  13. RELATIONSHIP BETWEEN J-INTEGRAL AND FRACTURE SURFACE AVERAGE PROFILE

    Institute of Scientific and Technical Information of China (English)

    Y.G. Cao; S.F. Xue; K.Tanaka

    2007-01-01

    To investigate the causes that led to the formation of cracks in materials, a novel method that only considered the fracture surfaces for determining the fracture toughness parameters of J-integral for plain strain was proposed. The principle of the fracture-surface topography analysis (FRASTA) was used. In FRASTA, the fracture surfaces were scanned by laser microscope and the elevation data was recorded for analysis. The relationship between J-integral and fracture surface average profile for plain strain was deduced. It was also verified that the J-integral determined by the novel method and by the compliance method matches each other well.

  14. Spontaneous rib fractures.

    Science.gov (United States)

    Katrancioglu, Ozgur; Akkas, Yucel; Arslan, Sulhattin; Sahin, Ekber

    2015-07-01

    Other than trauma, rib fracture can occur spontaneously due to a severe cough or sneeze. In this study, patients with spontaneous rib fractures were analyzed according to age, sex, underlying pathology, treatment, and complications. Twelve patients who presented between February 2009 and February 2011 with spontaneous rib fracture were reviewed retrospectively. The patients' data were evaluated according to anamnesis, physical examination, and chest radiographs. The ages of the patients ranged from 34 to 77 years (mean 55.91 ± 12.20 years), and 7 (58.4%) were male. All patients had severe cough and chest pain. The fractures were most frequently between 4th and 9th ribs; multiple rib fractures were detected in 5 (41.7%) patients. Eight (66.7%) patients had chronic obstructive pulmonary disease, 2 (16.7%) had bronchial asthma, and 2 (16.7%) had osteoporosis. Bone densitometry revealed a high risk of bone fracture in all patients. Patients with chronic obstructive pulmonary disease or bronchial asthma had been treated with high-dose steroids for over a year. Spontaneous rib fracture due to severe cough may occur in patients with osteoporosis, chronic obstructive pulmonary disease, or bronchial asthma, receiving long-term steroid therapy. If these patients have severe chest pain, chest radiography should be performed to check for bone lesions. © The Author(s) 2015.

  15. Application of spiral CT image 3D reconstruction in severe talar neck fracture

    Institute of Scientific and Technical Information of China (English)

    HE Fei; HUANG He; DENG Ya-min; Wang Bing; ZHANG Chun-qiang; ZHAO Zhi; TANG Xi-zhang; ZHOU Zhao-wen; ZHAO Xue-ling

    2007-01-01

    Objective:To explore the application of the spiral computerized tomography (CT) image three-dimensional(3D ) reconstruction technique associated with the conventional radiography in the diagnosis and treatment of severe talar neck fracture. Methods:Using the multi-slice spiral CT image 3D reconstruction technique,we analysed 11 cases of talar neck fracture.The fractures were reduced and fixed through a minimal incision and internal fixation with titanium cannulated lag screws. Results:In the 11 cases,the results of CT image 3D reconstruction were in concordance with plain radiograph in 6 case of Hawkins type H.And the remaining 5 cases of Hawkins types Ⅲ and Ⅳ could not be classified exactly only by radiographs,one of whom was misdiagnosed.After using the CT image 3D reconstruction,the 5 cases were classified exactly before osteosynthesis.The classifications of these 11 cases were confirmed finally by surgical findings.The duration of operation were 45-140 min,averaging 81min (including the duration of C-arm fluoroscopy).X-ray exposure time was 6-58 seconds,averaging 22 seconds.The blood loss was less than 100 ml.The fracture union was achieved in 3 months. No nonunion, talus avascular necrosis or joint surface collapse occurred.Postoperative follow-up was from 1 to 25 months.According to Hawkins score,excellent result was found in 6 type Ⅱ cases and 1type Ⅲ case;good result in 1 type Ⅲ case with both medial and lateral malleolar fracture,1 type Ⅲ with medial malleolus fractures and 1 open type Ⅲ;fair result in 1 open type Ⅳ with lateral malleolus fracture. Conclusions:By using the multi-slice spiral CT image 3D reconstruction associated with radiography to diagnose and treat severe talar neck fractures,the accuracy of diagnosis can be improved obviously. Based on this technique,more consummate operational plan can be designed and performed so as to achieve a better therapeutic effect.

  16. Recognizing the elbow prosthesis on conventional radiographs.

    Science.gov (United States)

    Oflazoglu, Kamilcan; Koenrades, Nienke; Somford, Matthijs P; van den Bekerom, Michel P J

    2016-11-01

    The objective of this study was to make an overview that can be useful in determining which type and brand of prosthesis a patient has when visiting the emergency department or outpatient clinic with a periprosthetic fracture, dislocation, or implant failure. The commonly used prostheses in Europe are opted for this list. The radiographs used for this list are obtained either from the company or from our own patients. This list contains the Coonrad/Morrey total elbow prosthesis, the Nexel total elbow prosthesis, the GSB III Elbow Prosthesis, the iBP Total Elbow System, the Discovery Elbow System, the NESimplavit Elbow System, the Latitude Elbow prosthesis, the Solar Elbow, and the Souter-Strathclyde total elbow. The characteristics of each prosthesis are described.

  17. Recognizing the elbow prosthesis on conventional radiographs

    Directory of Open Access Journals (Sweden)

    Kamilcan Oflazoglu

    2016-09-01

    Full Text Available Abstract The objective of this study was to make an overview that can be useful in determining which type and brand of prosthesis a patient has when visiting the emergency department or outpatient clinic with a periprosthetic fracture, dislocation, or implant failure. The commonly used prostheses in Europe are opted for this list. The radiographs used for this list are obtained either from the company or from our own patients. This list contains the Coonrad/Morrey total elbow prosthesis, the Nexel total elbow prosthesis, the GSB III Elbow Prosthesis, the iBP Total Elbow System, the Discovery Elbow System, the NESimplavit Elbow System, the Latitude Elbow prosthesis, the Solar Elbow, and the Souter–Strathclyde total elbow. The characteristics of each prosthesis are described.

  18. Detection of tibial condylar fractures using 3D imaging with a mobile image amplifier (Siemens ISO-C-3D): Comparison with plain films and spiral CT; Frakturdiagnostik am Kniegelenk mit einem neuen mobilen CT-System (ISO-C-3D): Vergleich mit konventionellem Roentgen und Spiral-CT

    Energy Technology Data Exchange (ETDEWEB)

    Kotsianos, D.; Rock, C.; Wirth, S.; Linsenmaier, U.; Brandl, R.; Fischer, T.; Pfeifer, K.J.; Reiser, M. [Klinikum der Universitaet Muenchen-Innenstadt, Muenchen (Germany). Inst. fuer Klinische Radiologie; Euler, E.; Mutschler, W. [Klinikum der Universitaet Muenchen-Innenstadt, Muenchen (Germany). Chirurgische Klinik und Poliklinik

    2002-01-01

    Purpose: To analyze a prototype mobile C-arm 3D image amplifier in the detection and classification of experimental tibial condylar fractures with multiplanar reconstructions (MPR). Method: Human knee specimens (n=22) with tibial condylar fractures were examined with a prototype C-arm (ISO-C-3D, Siemens AG), plain films (CR) and spiral CT (CT). The motorized C-arm provides fluoroscopic images during a 190 orbital rotation computing a 119 mm data cube. From these 3D data sets MP reconstructions were obtained. All images were evaluated by four independent readers for the detection and assessment of fracture lines. All fractures were classified according to the Mueller AO classification. To confirm the results, the specimens were finally surgically dissected. Results: 97% of the tibial condylar fractures were easily seen and correctly classified according to the Mueller AO classification on MP reconstruction of the ISO-C-3D. There is no significant difference between ISO-C and CT in detection and correct classification of fractures, but ISO-CD-3D is significant by better than CR. (orig.) [German] Zielsetzung: Ziel der vorliegenden Studie war es, die diagnostischen Moeglichkeiten und Grenzen der Erkennbarkeit und Klassifizierung von Frakturen mit multiplanaren Rekonstruktionen (MPR) aus 3D-Datensaetzen eines fahrbaren C-Bogengeraetes an Kniegelenken zu pruefen. Methodik: Kniegelenke von Verstorbenen (n=22) mit Tibiakopffrakturen wurden an einem Prototyp eines mobilen C-Bogen Schnittbild-/Durchleuchtungsgeraets (ISO-C-3D, Siemens AG Erlangen) untersucht. Das Geraet erzeugt waehrend einer einmaligen 190-Grad-Rotation 100 Projektionsaufnahmen, aus denen ein 3D-Volumendatensatz gewonnen wird. Aus diesem werden Hochkontrastschnittbilder als MP-Rekonstruktionen in allen drei Raumebenen errechnet und visualisiert. Die Kniegelenke wurden von 4 unabhaengigen Befundern hinsichtlich Frakturerkennbarkeit, Frakturart und -ausmass unter Verwendung der MP

  19. Herpes simplex virus 1 pneumonia: conventional chest radiograph pattern

    Energy Technology Data Exchange (ETDEWEB)

    Umans, U.; Golding, R.P.; Duraku, S.; Manoliu, R.A. [Dept. of Radiology, Academic Hospital ' ' Vrije Universiteit' ' , Amsterdam (Netherlands)

    2001-06-01

    The aim of this study was to describe the findings on plain chest radiographs in patients with herpes simplex virus pneumonia (HSVP). The study was based on 17 patients who at a retrospective search have been found to have a monoinfection with herpes simplex virus. The diagnosis was established by isolation of the virus from material obtained during fiberoptic bronchoscopy (FOB) which also included broncho-alveolar lavage and tissue sampling. Fourteen patients had a chest radiograph performed within 24 h of the date of the FOB. Two radiographs showed no abnormalities of the lung parenchyma. The radiographs of the other 12 patients showed lung opacification, predominantly lobar or more extensive and always bilateral. Most patients presented with a mixed airspace and interstitial pattern of opacities, but 11 of 14 showed at least an airspace consolidation. Lobar, segmental, or subsegmental atelectasis was present in 7 patients, and unilateral or bilateral pleural effusion in 8 patients, but only in 1 patient was it a large amount. In contradiction to the literature which reports a high correlation between HSVP and acute respiratory distress syndrome (ARDS), 11 of 14 patients did not meet the pathophysiological criteria for ARDS. The radiologist may suggest the diagnosis of HSVP when bilateral airspace consolidation or mixed opacities appear in a susceptible group of patients who are not thought to have ARDS or pulmonary edema. The definite diagnosis of HSV pneumonia can be established only on the basis of culture of material obtained by broncho-alveolar lavage. (orig.)

  20. Radiographic features of tuberculous osteitis in greater trochanter and lschium

    Energy Technology Data Exchange (ETDEWEB)

    Hahm, So Hee; Lee, Ye Ri [Hanil Hospital Affiliated to KEPCO, Seoul (Korea, Republic of); Kim, Dong Jin; Sung, Ki Jun [Yonsei Univ. Wonju College of Medicine, Wonju (Korea, Republic of); Lim, Jong Nam [Konkuk Univ. College of Medicine, Seoul (Korea, Republic of)

    1996-11-01

    To evaluate, if possible, the radiographic features of tuberculous osteitis in the greater trochanter and ischium, and to determine the cause of the lesions. We reterospectively reviewed the plain radiographic findings of 14 ptients with histologically proven tuberculous osteitis involving the greater trochanter and ischium. In each case, the following were analyzed:morphology of bone destruction, including cortical erosion;periosteal reaction;presence or abscence of calcific shadows in adjacent soft tissue. On the basis of an analysis of radiographic features and correlation of the anatomy with adjacent structures we attempted to determine causes. Of the 14 cases evaluated, 12 showed varrious degrees of extrinsic erosion on the outer cortical bone of the greater trochanter and ischium ; in two cases, bone destruction was so severe that the radiographic features of advanced perforated osteomyelitis were simulated. In addition to findings of bone destruction, in these twelve cases, the presence of sequestrum or calcific shadows was seen in adjacent soft tissue. Tuberculous osteitis in the greater trochanter and ischium showed the characteristic findings of chronic extrinsic erosion. On the basis of these findings we can suggest that these lesions result from an extrinsic pathophysiologic cause such as adjacent bursitis.

  1. 儿童及青少年单侧髁突骨折保守治疗的影像及咀嚼生理学疗效评估%Radiographic and masticatory physiologic evaluation after conservative treatment of condylar fractures in children and adolescents

    Institute of Scientific and Technical Information of China (English)

    全星宇; 秦满; 康艳凤; 张益; 赵玉鸣

    2016-01-01

    Objective To evaluate the developmental and functional outcome of condylar fractures in children and adolescents after conservative treatment.Methods Eight children and adolescents with unilateral condylar fracture, aged 5-13 were included.A removable occlusal splint, the thickness of which was determined according to the age, the developmental stage of the dentition, the level of the fracture and the degree of dislocation, worn for 1-3 months, and the patients were asked to perform functional exercises.The patients were followed up by clinical observation, panoramic radiograph, temporomandibular joint(TMJ) cone beam computed tomography(CBCT), and surface electromyography(sEMG) of masticatory muscles (superficial masseter, anterior temporalis, and anterior digastric muscles).Ramus height and body length of mandible were measured on panoramic radiograph.The patients were asked to return for follow-up visits at 1, 3, and 6 months after treatment, and then once a year.The patients underwent clinical examination at each follow-up visit, and radiological examinations at 6 months and then annually.Results All the patients showed clinically satisfactory results.CBCT showed smooth and continuous cortex.Panoramic X-ray revealed that the ramus height was shorter in the fractured side than in the contralateral side, while body length was longer.The mean asymmetry index(AI, (x) ± s) for ramus height and body length were (3.29±2.68)% and (4.01 ± 2.54)%.sEMG showed either hypertension or hypotension in the masticatory muscles of the fractured side and asymmetries were obvious.The mean AI for sEMG activity of the anterior temporalis, masseter, and anterior digastric muscle were masseter: (15.0 ± 16.9)%;anterior temporalis: (21.5 ± 15.9)%;anterior digastric muscles: (11.9 ± 10.7)%.Conclusions Conservative treatment of condylar fracture in children and adolescents had clinically satisfactory results, while mandibular development was slightly interrupted

  2. Function impairment and pain after closed treatment of fractures of the mandibular condyle

    NARCIS (Netherlands)

    Dijkstra, P.U.; Stegenga, B.; de Bont, L.G.; Bos, R.R.

    2005-01-01

    Background: To determine the prognosis of fractures of the mandibular condyle after closed treatment. Methods: Patients (n = 144) with a fracture of the mandibular condyle, all treated closed, were included in the study. Fracture types and position of the fracture parts were determined on radiograph

  3. Chest radiographic findings of leptospirosis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Mee Hyun; Jung, Hee Tae; Lee, Young Joong; Yoon, Jong Sup [Hallym University College of Medicine, Seoul (Korea, Republic of)

    1986-04-15

    1. A study on chest radiographic findings of 54 cases with pneumonia like symptoms was performed. Of 54 cases, 8 cases were confirmed to be leptospirosis and 7 cases were leptospirosis combined with Korean hemorrhagic fever. 2. Of 8 cases of leptospirosis, 4 cases showed abnormal chest radiographic findings: acinar nodular type 2, massive confluent consolidation type 2. Of 7 cases of leptospirosis combined with Korean hemorrhagic fever: acinar nodular type 3, massive confluent consolidation type 1, and increased interstitial markings type 1 respectively. 3. It was considered to be difficult to diagnose the leptospirosis on chest radiographic findings alone, especially the case combined with Korean hemorrhagic fever.

  4. Early history of scapular fractures.

    Science.gov (United States)

    Bartoníček, Jan; Kozánek, Michal; Jupiter, Jesse B

    2016-01-01

    The first to use the term Scapula was Vesalius (1514-1564) and thus it has remained ever since. Probably the oldest injured scapula, from 250 million years ago, was described by Chinese authors of a skeletal examination of a fossilised remains of a dinosaur Yangchuanosaurus hepingensis. In humans, the oldest known scapular fractures date back to the prehistoric and early historic times. In ancient times, a fracture of acromion was described in the treatises of Hippocrates. Early modern history of the treatment of scapular fractures is closely interlinked with the history of the French surgery. The first to point out the existence of these fractures were Petit, Du Verney and Desault in the 18th century. The first study devoted solely to scapular fractures was published by Traugott Karl August Vogt in 1799. Thomas Callaway published in 1849 an extensive dissertation on injuries to the shoulder girdle, in which he discussed a number of cases known at that time. The first radiograph of a scapular fracture was published by Petty in 1907. Mayo Robson (1884), Lambotte (1913) and Lane (1914) were pioneers in the surgical treatment of these fractures, followed in 1923 by the French surgeons Lenormat, Dujarrier and Basset. The first internal fixation of the glenoid fossa, including a radiograph, was published by Fischer in 1939.

  5. Imaging of ceramic liner fractures in total hip arthroplasty: the value of CT

    Energy Technology Data Exchange (ETDEWEB)

    Endo, Yoshimi; Mintz, Douglas N. [Hospital for Special Surgery, Department of Radiology and Imaging, New York, NY (United States); Renner, Lisa; Schmidt-Braekling, Tom; Boettner, Friedrich [Hospital for Special Surgery, Adult Reconstruction and Joint Replacement Division, New York, NY (United States)

    2015-08-15

    Fracture of a ceramic liner of a total hip arthroplasty is rare and is radiographically occult if not displaced. We report on two patients in whom ceramic liner fracture was radiographically occult but was diagnosed on subsequent CT scan through appropriate windowing. (orig.)

  6. The use of {sup 18}F-fluoride and {sup 18}F-FDG PET scans to assess fracture healing in a rat femur model

    Energy Technology Data Exchange (ETDEWEB)

    Hsu, W.K.; Feeley, B.T.; Krenek, L.; Stout, D.B.; Chatziioannou, A.F. [David Geffen School of Medicine at UCLA, Center for Health Sciences, Department of Orthopaedic Surgery, Los Angeles, CA (United States); Lieberman, J.R. [University of Connecticut Health Center, The Musculoskeletal Institute, Department of Orthopaedic Surgery, Farmington, CT (United States)

    2007-08-15

    Currently available diagnostic techniques can be unreliable in the diagnosis of delayed fracture healing in certain clinical situations, which can lead to increased complication rates and costs to the health care system. This study sought to determine the utility of positron emission tomography (PET) scanning with {sup 18}F-fluoride ion, which localizes in regions of high osteoblastic activity, and {sup 18}F-fluorodeoxyglucose (FDG), an indicator of cellular glucose metabolism, in assessing bone healing in a rat femur fracture model. Fractures were created in the femurs of immunocompetent rats. Animals in group I had a fracture produced via a manual three-point bending technique. Group II animals underwent a femoral osteotomy with placement of a 2-mm silastic spacer at the fracture site. Fracture healing was assessed with plain radiographs, {sup 18}F-fluoride, and {sup 18}F-FDG PET scans at 1, 2, 3, and 4-week time points after surgery. Femoral specimens were harvested for histologic analysis and manual testing of torsional and bending strength 4 weeks after surgery. All fractures in group I revealed abundant callus formation and bone healing, while none of the nonunion femurs were healed via assessment with manual palpation, radiographic, and histologic evaluation at the 4-week time point. {sup 18}F-fluoride PET images of group I femurs at successive 1-week intervals revealed progressively increased signal uptake at the union site during fracture repair. In contrast, minimal tracer uptake was seen at the fracture sites in group II at all time points after surgery. Data analysis revealed statistically significant differences in mean signal intensity between groups I and II at each weekly interval. No significant differences between the two groups were seen using {sup 18}F-FDG PET imaging at any time point. This study suggests that {sup 18}F-fluoride PET imaging, which is an indicator of osteoblastic activity in vivo, can identify fracture nonunions at an early time

  7. Maisonneuve-hyperplantarflexion variant ankle fracture.

    Science.gov (United States)

    Hinds, Richard M; Tran, Wesley H; Lorich, Dean G

    2014-11-01

    Maisonneuve fractures are rare ankle injuries, accounting for up to 7% of all ankle fractures. They consist of a proximal third fibula fracture, syndesmotic disruption, and medial ankle injury (either a deltoid ligament disruption or a medial malleolus fracture), and are often successfully managed with nonoperative treatment of the proximal fibula fracture and open reduction and internal fixation (ORIF) of the medial ankle injury and syndesmotic disruption. The hyperplantarflexion variant ankle fracture comprises approximately 7% of all ankle fractures and features dual posterior tibial lip fractures featuring a posterolateral fragment and a posteromedial fragment. Good functional results have been reported in the literature after ORIF of both the posterolateral and posteromedial fragments of this variant fracture that is not described by the Lauge-Hansen classification. In this report, the authors present the unique case of an isolated ankle fracture demonstrating characteristics of both a Maisonneuve fracture and a hyperplantarflexion variant ankle fracture. They also highlight the diagnostic imaging characteristics, including magnetic resonance imaging (MRI) and preoperative radiograph findings, surgical treatment, and postoperative clinical outcome for this patient with a Maisonneuve-hyperplantarflexion variant ankle fracture. To the authors' knowledge, this unique fracture pattern has not been reported previously in the literature. The authors conclude that although good results were seen postoperatively in this case, the importance of ORIF of both the posteromedial and posterolateral fragments of variant fractures cannot be overstated. They also found MRI to be a particularly helpful adjunct in formulating the correct diagnosis and treatment plan.

  8. CT of pelvic fractures

    Energy Technology Data Exchange (ETDEWEB)

    Falchi, Marco E-mail: marcofalchi@yahoo.it; Rollandi, Gian Andrea

    2004-04-01

    Although magnetic resonance imaging has become the dominant modality for cross-sectional musculo-skeletal imaging, the widespread availability, speed, and versatility of computed tomography (CT) continue to make it a mainstay of emergency room (ER) diagnostic imaging. Pelvic ring and acetabular fractures occur as the result of significant trauma secondary to either a motor vehicle accident or a high-velocity fall. These injuries are correlated with significant morbidity and mortality, both from the complications of pelvic ring fractures and from commonly associated injuries. The most commonly used classification of pelvic and acetabular fractures has been based on conventional radiographs that are, in the majority of cases, sufficient to determine the type of injury. However, because of the complexity of pelvic and acetabular fractures, precise pathological anatomy is not easily demonstrated by routine radiographs and in many cases details of fractures are not visible. Moreover, the insufficient co-operation of the patient or the difficulty of maintaining special positions can be overcome by using computed tomography. Spiral computed tomography provides information regarding the extent of the fractures and is complementary to radiography for ascertaining the spatial arrangement of fracture fragments. Spiral computed tomography is an effective tool for understanding complex fracture patterns, particularly when combined with multi-planar reconstruction two-dimensional (MPR 2D) reformatted images or three-dimensional images (3D) images. Including these techniques of reconstruction in routine pelvic imaging protocols can change management in a significant number of cases. Subtle fractures, particularly those oriented in the axial plane, are better seen on MPR images or 3D volume-rendered images. Complex injuries can be better demonstrated with 3D volume-rendered images, and complicated spatial information about the relative positions of fracture fragments can be easily

  9. Use of a long distally fixed intramedullary stem to treat a periprosthetic femoral fracture following total hip arthroplasty using a thrust plate hip prosthesis: A case report.

    Science.gov (United States)

    Hatanaka, Hiroyuki; Motomura, Goro; Ikemura, Satoshi; Sonoda, Kazuhiko; Kubo, Yusuke; Utsunomiya, Takeshi; Yamamoto, Takuaki; Nakashima, Yasuharu

    2017-01-01

    The thrust plate hip prosthesis (TPP; Zimmer, Winterthur, Switzerland) is a hip prosthesis that is no longer in production. Few reports have focused on periprosthetic fractures following total hip arthroplasty (THA) with the use of a TPP. We report a 57-year-old woman with a periprosthetic femoral fracture 13 years after THA with the use of a TPP. A plain radiograph showed a displaced subtrochanteric fracture of the right femur just below the distal tip of the lateral plate without implant loosening. She underwent revision surgery with a long distally fixed intramedullary stem in conjunction with a plate and cable system. Three months after surgery, bone union was confirmed using radiography and the patient was clinically asymptomatic. We encountered three major problems while planning surgical treatment, these being, discontinuation of the TPP system, loss of proximal femoral cancellous bone, and difficulties with the type of subtrochanteric fracture. After considering these problems, we planned revision surgery using a long distally fixed intramedullary stem in conjunction with a plate and cable system. This case shows that sufficient implant preparation based on precise preoperative planning is necessary to obtain good clinical results for the surgical treatment of periprosthetic femoral fractures following THA with the use of a TPP. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  10. Radiographic analysis of treatment of inter-trochanteric fractures using proximal femoral nails%股骨近端髓内钉治疗股骨粗隆间骨折的影像学分析

    Institute of Scientific and Technical Information of China (English)

    赵晶鑫; 苏秀云; 赵喆; 张里程; 张立海; 唐佩福

    2015-01-01

    Objective:To establish a reliable approach for measuring proximal femoral 3 dimensional anatomy, and to compare post-operative differences of proximal femoralanatomy in the inter-trochanter fractures with two kinds of antegrade nailings.Methods: Some computer assisted design ( CAD ) soft-wares, e.g.Mimics, were used to establish a reliable approach for measuring proximal femoral 3 dimen-sional (3D) anatomy.Intra-class correlation coefficient ( ICC) was used to test the reliability of intra-and inter-observers.The post-operative pelvic CT data of 19 cases of inter-trochanter fracture patients treated with InterTAN nailing and 21 cases of inter-trochanter fracture patients treated with proximal femo-ral nail anti-rotation ( PFNA) were retrospectively analysed and used to measure bilateral proximal femo-ral anatomical parameters, including 2D and 3D femoral neck-shaft ( NS) angle and femoral neck ante-version (NA) angle, and 2D and 3D anteversion angles of the intramedullary (IM) nailings.ICC was used to test the consistency of the NA angles in the different groups, and the paired student T-test was used to test the differences of the paired quantitative data.Results:The established measurement method hasdexcellent consistency within the intra-and inter-observers, with all the ICCs higher than 0.9.The paired student T-test showed no significant difference between the post-operative bilateral 2D or 3D NA angles.The ICCs results showed that there were no consistency between the post-operative bilateral 2D or 3D NA angles (P values were 0.099 and 0.055, respectively), but the excellent consistency between the 2D injured side NA angle and 2D IM nailing’ s NA angle, or between the 3D injured side NA angle and 3D IM nailing’s NA angle (the ICCs were 0.81 and 0.8, respectively, P values <0.001).In PF-NA group, 57%of the differences between the 2D post-operative injured side’s and intact side’s NA an-gles were higher than 15°, which was more than 15.78%in Inter

  11. Iloprost inhibits fracture repair in rats.

    Science.gov (United States)

    Doğan, Ali; Duygun, Fatih; Kalender, A Murat; Bayram, Irfan; Sungur, Ibrahim

    2014-01-01

    Previous studies have shown that prostaglandins (PGs) dramatically stimulate healing processes in bone. However, the effect of prostaglandin I2 (PGI2) on fracture healing remains unclear. To investigate the effect of PGI2, a study on fracture healing process in closed tibia fractures was designed. Thirty-six Sprague-Dawley male rats were randomized into two groups. On the first day, their right tibias were fractured by three-point bending technique. The study group (n = 18) received a single injection of 10 µg/kg iloprost for 5 days, while the control group (n = 18) received saline solution in the same way. On the 7th, 14th and 28th days following the fracture, six rats were sacrificed and their right legs were harvested in each group. The progression of fracture healing was assessed for each specimen by the scores of radiography (by Lane-Sandhu) and histology (by Huo et al). On the 7th day, the radiographic and histologic scores were equal. On the 14th day radiographic total score was 6 and histologic total score was 23 in the iloprost group, whereas radiographic total score was 11 and histologic total score was 33 in the control group. On the 14th day radiographic and histologic scores were significantly decreased in the iloprost group compared to the control group (P iloprost group, whereas radiographic total score was 15 and histologic total score was 40 in the control group. On the 28th day although there was a decrease in radiographic and histologic scores of the iloprost group acording to control group, it was not statistically significant (P > 0.05). Iloprost delays fracture healing in early stage in rats.

  12. Automatic orientation correction for radiographs

    Science.gov (United States)

    Luo, Hui; Luo, Jiebo; Wang, Xiaohui

    2006-03-01

    In picture archiving and communications systems (PACS), images need to be displayed in standardized ways for radiologists' interpretations. However, for most radiographs acquired by computed radiography (CR), digital radiography (DR), or digitized films, the image orientation is undetermined because of the variation of examination conditions and patient situations. To address this problem, an automatic orientation correction method is presented. It first detects the most indicative region for orientation in a radiograph, and then extracts a set of low-level visual features sensitive to rotation from the region. Based on these features, a trained classifier based on a support vector machine is employed to recognize the correct orientation of the radiograph and reorient it to a desired position. A large-scale experiment has been conducted on more than 12,000 radiographs covering a large variety of body parts and projections to validate the method. The overall performance is quite promising, with the success rate of orientation correction reaching 95.2%.

  13. Radiographic findings in liveborn triploidy

    Energy Technology Data Exchange (ETDEWEB)

    Silverthorn, K.G.; Houston, C.S.; Newman, D.E.; Wood, B.J.

    1989-05-01

    The detailed radiographic features of triploidy, a fatal congenital disorder with 69 chromosomes, have not previously been reported. Radiographs of ten liveborn infants with chromosomally confirmed triploidy showed six findings highly suggestive of this diagnosis: Harlequin orbits, small anterior fontanelle, gracile ribs, diaphyseal overtubulation of long bones, upswept clavicles and antimongoloid pelvis. Sixteen other less specific findings showed many similarities to those found in trisomy 18.

  14. Radiographic findings in liveborn triploidy.

    Science.gov (United States)

    Silverthorn, K G; Houston, C S; Newman, D E; Wood, B J

    1989-01-01

    The detailed radiographic features of triploidy, a fatal congenital disorder with 69 chromosomes, have not previously been reported. Radiographs of ten liveborn infants with chromosomally confirmed triploidy showed six findings highly suggestive of this diagnosis: harlequin orbits, small anterior fontanelle, gracile ribs, diaphyseal overtubulation of long bones, upswept clavicles and antimongoloid pelvis. Sixteen other less specific findings showed many similarities to those found in trisomy 18.

  15. Film holder for radiographing tubing

    Science.gov (United States)

    Davis, Earl V.; Foster, Billy E.

    1976-01-01

    A film cassette is provided which may be easily placed about tubing or piping and readily held in place while radiographic inspection is performed. A pair of precurved light-impervious semi-rigid plastic sheets, hinged at one edge, enclose sheet film together with any metallic foils or screens. Other edges are made light-tight with removable caps, and the entire unit is held securely about the object to be radiographed with a releasable fastener such as a strip of Velcro.

  16. Radiographic study of mandibular asymmetry

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Yeon Hwa; Cho, Bong Hae [Dept. of Oral and Maxillofacial Radiology, College of Dentistry, Pusan National University, Pusan (Korea, Republic of)

    1998-02-15

    The purpose of this study was to perform the radiographic measurements and temporomandibular joint evaluation in mandibular asymmetry. For this study, thirty-two patients who have mandibular asymmetry were selected and submentovertex, panoramic and lateral corrected tomographic radiographs were taken. Horizontal and vertical analysis using various landmarks on these radiographs were performed. Also radiographic and clinical evaluation of temporomandibular joint were obtained. The results were as follows: 1. On the submentovertex radiograph, the mean distance of Pogonion to midline was 5.0 {+-} 3.8 mm. 2. The mean distance of Pogonion to Gonion between the deviated and the contra-lateral side (p<0.001). 3. The distance difference of Pogonion to Gonion between the deviated and the contra-lateral side was significantly related to the degree of asymmetry (p<0.001). 4. On panoramic radiograph,the condylar height of the contral-lateral side was significantly longer than the one of the deviated side (p<0.001). 5. On lateral corrected tomogram, bony of temporomandibular joint was observed in 11 condyles of the deviated side and 9 condyles of the contra-lateral side. Erosion and ostephyte were the most common changes in both the deviated and the contra-lateral sides.

  17. The Plains of Venus

    Science.gov (United States)

    Sharpton, V. L.

    2013-12-01

    Volcanic plains units of various types comprise at least 80% of the surface of Venus. Though devoid of topographic splendor and, therefore often overlooked, these plains units house a spectacular array of volcanic, tectonic, and impact features. Here I propose that the plains hold the keys to understanding the resurfacing history of Venus and resolving the global stratigraphy debate. The quasi-random distribution of impact craters and the small number that have been conspicuously modified from the outside by plains-forming volcanism have led some to propose that Venus was catastrophically resurfaced around 725×375 Ma with little volcanism since. Challenges, however, hinge on interpretations of certain morphological characteristics of impact craters: For instance, Venusian impact craters exhibit either radar dark (smooth) floor deposits or bright, blocky floors. Bright floor craters (BFC) are typically 100-400 m deeper than dark floor craters (DFC). Furthermore, all 58 impact craters with ephemeral bright ejecta rays and/or distal parabolic ejecta patterns have bright floor deposits. This suggests that BFCs are younger, on average, than DFCs. These observations suggest that DFCs could be partially filled with lava during plains emplacement and, therefore, are not strictly younger than the plains units as widely held. Because the DFC group comprises ~80% of the total crater population on Venus the recalculated emplacement age of the plains would be ~145 Ma if DFCs are indeed volcanically modified during plains formation. Improved image and topographic data are required to measure stratigraphic and morphometric relationships and resolve this issue. Plains units are also home to an abundant and diverse set of volcanic features including steep-sided domes, shield fields, isolated volcanoes, collapse features and lava channels, some of which extend for 1000s of kilometers. The inferred viscosity range of plains-forming lavas, therefore, is immense, ranging from the

  18. Interobserver error in interpretation of the radiographs for degeneration of the lumbar spine.

    Science.gov (United States)

    Madan, Sanjeev S; Rai, Am; Harley, John M

    2003-01-01

    We examined 114 segments in 23 patients' lumbar spine plain radiographs affected by disc degeneration. Two consultant orthopaedic surgeons, two consultant radiologists, and one spine nurse practitioner made independent observations on the radiographs. MRI scan films of the corresponding 114 segments were used as a gold standard. Kappa coefficients were used to evaluate the interobserver error, and the error between the independent observers and the MRI scanning reports. The systematic differences between the observers for the diagnosis of the disc degeneration at each segment level was recorded. There was significant interobserver error between the independent observers. The pairwise interobserver agreement ranged from fair to substantial on the plain radiograph observations [Weighted kappa coefficient, mean: 0.517 (CI=0.388-0.646)]. The pairwise interobserver agreement between the independent observers and the MRI scan ranged from fair to moderate [Weighted kappa coefficient, mean: 0.388 (CI=0.259-0.518)]. There is significant error in interpretation of the plain radiographs for the diagnosis of lumbar disc degeneration. MRI may be more accurate in the diagnosis of lumbar disc degeneration.

  19. [Stress fractures of the distal fibula in an osteoporotic woman].

    Science.gov (United States)

    Schwartz, Frederik; Heerfordt, Ida Marie

    2014-08-04

    We report a case of an 81-year-old osteoporotic woman, who suffered stress fractures of the distal fibula on both sides within a two-year period. The risk factors for stress fractures are reviewed and the importance of a high index of suspicion for stress fractures is emphasized. When a stress fracture is suspected it should lead to plain radiography and treatment with protected weight-bearing with crutches or a brace.

  20. Osteosarcoma; clinical aspects and significance of conventional radiographs

    Energy Technology Data Exchange (ETDEWEB)

    Suh, Jin Suck; Kim, Eung Jo; Park, Chang Yun [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1988-12-15

    The clinical features of 141 patients with osteosarcoma were analysed and conventional radiographs of 92 patients out of 141 patients were reviewed retrospectively in order to assess the distribution of the age, sex, locations and to evaluate the predominant radiographic features. The incidence of tumors occurring in the extremities is 90 percent of total 141 patients. The majority of tumors were located in the metaphases of the long tubular bones. About sixty percent of the patients were in the second decade of life. The increment of the level of serum alkaline phosphatase was observed in 76 (67%) out of 114 patients. It is considered that thoracic CT scan might be helpful for the evaluation of metastases to lungs, because the detection rate of lung metastasis was 20 percent among 30 cases by CT, being disclosed higher than by conventional radiographs. Of the 92 patients available for radiographic analysis, predominantly osteolytic lesions were disclosed in 17 cases (19%). Preoperative radiographic impression was not the osteosarcoma in 8 out of 17 patients with purely osteolytic osteosarcoma. It was meant that the radiographic diagnosis was difficult in each case of predominantly osteolytic lesions. The patterns of periosteal reaction were variable, and there was no evidence of periosteal reaction in seventeen patients (18%). Both the cortical destruction and, the intralesional calcification were observed in 85 percent of 92 patients with osteosarcoma. Extraskeletal tumor shadow was observed in 79 percent of 92 patients with osteosarcoma, but either the calcification of ossification was detected in only 55 patients among 73 patients with soft tissue tumor shadows. Only 7 patients had a pathologic fracture, all in the femur.

  1. THE CORRELATION OF RADIOLOGICAL EXAMINATION AND VOLITIONAL VOIDING IN THORACO - LUMBAR FRACTURES AND SPINAL INJURY

    Directory of Open Access Journals (Sweden)

    Mathangi Santhosh

    2015-04-01

    Full Text Available BACKGROUND: Spinal Cord Injury (SCI is a devastating medical condition which results in paraplegia with decreased bladder and bowel control. Investigation used to predict volitional voiding in persons with acute SCI include clinical examination, X - rays of the spine, CT scan, MRI, even though the later ones are not available in every medical center and all cannot afford. AIM: To determine if those with a mild narrowing of the vertebral canal have a better prognosis for volitional voiding. SETTINGS AND DESIGN: Prospective study of 20 consecutive patients with thoracolumbar fractures and spinal injury, admitted in the Department of Physical Medicine Rehabilitation, Christian Medical College, and Vellore within three weeks of injury, were recruited into the study. METHODS AND MATERIALS: Initial neurological examination was performed on admission and final between 16 - 20 weeks after the injury. Lateral and anteroposterior X - rays of the spine were done to measure the antero - posterior and transverse diameters of the spinal canal as well as the canal - body ratio at the level of the lesion. Bladder function was assessed between 16 - 20 weeks following the injury by Urodynamic study. The bladder outcome was divided into first category was assisted bladder emptying, which included intermittent catheterization, indwelling catheterization and second category was with volitional voiding. STATISTICAL ANALYSIS: D ata collection was subjected to statistical analysis using SPSS Version 11.0. Fisher’s exact test, Independent t - test and Mann - Whitney test were used. RESULTS AND CONCLUSIONS: The level of fracture did not correspond to the type of bladder. The use of Canal body ratio at the level of vertebral fracture on plain radiographs was not useful in prediction of volitional voiding. (P> 0.05. Therefore plain radiography was not found to be a good predictor of bladder function in persons with spinal injuries.

  2. Classification of subtrochanteric femoral fractures.

    Science.gov (United States)

    Loizou, C L; McNamara, I; Ahmed, K; Pryor, G A; Parker, M J

    2010-07-01

    A review of the literature identified 15 different classification methods for subtrochanteric femoral fractures. Only eight of those classifications defined the area of bone, which constituted a subtrochanteric fracture. The actual length of femur defined as the subtrochanteric zone varied from 3 cm up to the level of the femoral isthmus. There was no agreement between the different classifications regarding the proximal and distal border or for those fractures, which traverse anatomical boundaries. In the various classifications, fractures were subdivided into 2-15 subgroups. The majority of the identified studies were unable to find the classifications useful in either determining treatment or predicting the outcome after treatment. We subdivided subtrochanteric fractures into three types based on the degree of fracture comminution. We examined the inter- and intra-observer agreement of our recommended classification. One orthopaedic consultant, one specialist hip fracture surgeon, two trainee registrar orthopaedic surgeons and one specialty trainee in orthopaedics, on two different occasions, 8 weeks apart, independently classified the radiographs of 20 patients with a subtrochanteric fracture. The mean kappa value for inter- and intra-observer variation was 0.71 and 0.79, respectively, with both showing substantial agreement and, therefore, this simpler classification is recommended. Based on the review of previous classification methods, we also recommend that the subtrochanteric zone be defined as the one in which the fracture line crossing the femur is predominantly within the area of bone extending 5 cm below the lower border of the lesser trochanter.

  3. Requesting wrist radiographs in emergency department triage: developing a training program and diagnostic algorithm.

    Science.gov (United States)

    Streppa, Joanna; Schneidman, Valerie; Biron, Alain D

    2014-01-01

    Crowding is extremely problematic in Canada, as the emergency department (ED) utilization is considerably higher than in any other country. Consequently, an increase has been noted in waiting times for patients who present with injuries of lesser acuity such as wrist injuries. Wrist fractures are the most common broken bone in patients younger than 65 years. Many nurses employed within EDs are requesting wrist radiographs for patients who present with wrist complaints as a norm within their working practice. Significant potential advantages can ensue if EDs adopt a triage nurse-requested radiographic protocol; patients can benefit from a significant time-saving of 36% in ED length of stay (M. Lindley-Jones & B. J Finlayson, 2000)— when nurses initiated radiographs in triage. In addition, the literature suggests that increased rates of patient and staff satisfaction may be achieved, without compromising quality of radiographic request or quality of service (W. Parris,S. McCarthy, A. M. Kelly, & S. Richardson, 1997). Studies have shown that nurses are capable of requesting appropriate radiographs on the basis of a preset protocol. As there are no standardized set of rules for assessing patients, presenting with suspected wrist fractures, a training program as well as a diagnostic algorithm was developed to prepare emergency nurses to appropriately request wrist radiographs. The triage nurse-specific training program includes the following topics: wrist anatomy and physiology, commonly occurring wrist injuries, mechanisms of injury, physical assessment techniques, and types of radiographic images required. The triage nurse algorithm includes the clinical decision-making process. Providing triage nurses with up-to-date evidence-based educational material not only allowed triage nurses to independently assess and request wrist radiographs for patients with potential wrist fractures but also strengthening the link between competent nursing care and better patient

  4. Stress fracture injury in young military men and women.

    Science.gov (United States)

    Armstrong, David W; Rue, John-Paul H; Wilckens, John H; Frassica, Frank J

    2004-09-01

    Approximately 5% of all military recruits incur stress fracture injuries during intense physical training, predominately in the lower extremity. We compared young men and women with stress fracture injury (subjects) to a matched group of uninjured volunteers (controls) during a summer training program at the United States Naval Academy to identify possible risk factors for stress fracture injury. The subject group was composed of 13 female and 18 male plebes with training-induced stress fracture injury verified by plain radiographs and/or nuclear bone scan. The control group was composed of 13 female and 18 male plebes who remained without injury during plebe summer training but who were matched with the 31 injured plebes for the Initial Strength Test (1-mi run time, means: women, 7.9 min; men, 6.4 min) and body mass index (means: women, 23.4; men, 23.8). We found that the subjects lost significant body weight (mean, 2.63 +/- 0.54 kg) between Day 1 and the date of their diagnosis of a stress fracture (mean, Day 35) and that they continued to lose weight until the date of their DEXA scan (mean, Day 49). Among female plebes, there was no evidence of the female athlete triad (eating disorders, menstrual dysfunction, or low bone density). Thigh girth was significantly smaller in female subjects than in female controls and trended to be lower in male subjects than in male controls. Total body bone mineral content was significantly lower in the male subjects than in male controls. Bone mineral density of the distal tibia and femoral neck were not significantly different between the groups. DEXA-derived structural geometric properties were not different between subjects and controls. Because, on average, tibias were significantly longer in male subjects than in male controls, the mean bone strength index in male subjects was significantly lower than that of male controls. We conclude that significant, acute weight loss combined with regular daily physical training among

  5. Decreasing Complications of Quadricepsplasty for Knee Contracture after Femoral Fracture Treatment with an External Fixator: Report of Four Cases

    Directory of Open Access Journals (Sweden)

    Naoya Kashiwagi

    2013-01-01

    Full Text Available Introduction: In performing quadricepsplasty for contracture that develops after application of an external fixator for femoral fractures, surgeons must be aware of the potential risk for re-fracture and pin-related problems. The purpose of this report is to highlight these not well-detailed complications and to discuss specific findings and treatment suggestions.Case Report: 4 men (mean age, 40 years presenting with secondary to contracture that developed after application of an external fixator for femoral fractures were included in this study. The radiographs showed union across the fracture site however two of these patients couldn't stand on one leg raising suspicion about the union status. A computed tomographic image indeed demonstrated limited continuity of the cortex. Bone grafting was performed prior to quadricepsplasty. The mean extension and flexion before the quadricepsplasty were 0o and 570 , respectively. At the final follow-up examination, the mean active flexion of the knee had increased to 98o.Results: The incidence of re-fracture during and after quadricepsplasty has been reported to be between 10 and 25%. There are 2 preoperative features that may mislead surgeons into believing that complete union of the fractures has been attained: one is the patient's ability to stand on a single leg, and the other is the fact that plain radiographs may lend themselves to different interpretations. In such cases, computed tomography will provide evidence of the continuity of the cortical bone. Bone grafting in 2 of our patients is thought to have prevented the postoperative complications of re-fracture. Complications at pin sites induce contracture at surrounding structures. When extreme tightness of the skin is noted, a tension-releasing procedure such as a skin graft should be performed.Conclusion: In conclusion, re-fracture or pin-site contracture should be carefully managed before quadricepsplasty, because the patients who need a

  6. Insufficient bilateral femoral subtrochanteric fractures in a patient receiving imatinib mesylate.

    Science.gov (United States)

    Yang, Kyu-Hyun; Park, Si-Young; Park, Sang-Won; Lee, Soon-Hyuck; Han, Seung-Beom; Jung, Woong-Kyo; Kim, Suk-Jin

    2010-11-01

    We present a case of insufficient bilateral femoral subtrochanteric fractures in a patient who was treated with imatinib mesylate, an anticancer drug, for 1 year after a diagnosis of chronic myelogenous leukemia (CML). A 60-year-old woman presented with bilateral thigh pain for 6 months. A plain radiograph revealed bilateral progressive insufficient fractures on the subtrochanteric areas of the femurs. MRI of the femurs revealed incomplete stress fractures and no evidence of bone metastasis on either femur. Bone densitometry showed normal T-scores around the hip joint and spine. The patient had normal serum levels of calcium, vitamin D derivatives, and thyroid hormones. Serum phosphate levels were decreased, and parathyroid hormone levels were increased. Serum osteocalcin and urinary N-telopeptide of collagen cross-links (NTx) were both decreased. A bone biopsy demonstrated normocellular marrow without leukemic cells. A histomorphometric evaluation of her bones revealed reduced bone turnover despite secondary hyperparathyroidism. The serum markers for bone metabolism and histomorphometric evaluations in this patient suggest that the drug may have an effect on bone metabolism. These effects could be seen for both bone formation and resorption: this could result in impaired bone mineralization, a severely suppressed bone turnover rate, insufficient fractures, and bone necrosis, which are sometimes seen with long-term use of bisphosphonates. To our knowledge, this is the first case of an insufficient bilateral femoral shaft fracture that is potentially related to the use of imatinib mesylate in a patient with CML. Careful examination of bone metabolism should be performed in patients with CML because imatinib mesylate treatment is a lifelong process.

  7. Hip Fracture

    Science.gov (United States)

    Diseases and Conditions Hip fracture By Mayo Clinic Staff A hip fracture is a serious injury, with complications that can be life-threatening. The risk of hip fracture rises with age. Older people are at a ...

  8. Modelling localised fracture of reinforced concrete structures

    OpenAIRE

    Liao, F; Huang, Z.

    2015-01-01

    This paper presents a robust finite element procedure for simulating the localised fracture of reinforced concrete members. In this new model the concrete member is modelled as an assembly of plain concrete, reinforcing steel bar and bond-link elements. The 4-node quadrilateral elements are used for 2D modelling of plain concrete elements, in which the extended finite element method is adopted to simulate the formation and growth of individual cracks. The reinforcing steel bars are modelled b...

  9. Carpal pseudoerosions: a plain X-ray interpretation pitfall

    Energy Technology Data Exchange (ETDEWEB)

    Wawer, Richard [Univ. Catholique de Lille (France). Service d' Imagerie Medicale; Budzik, Jean Francois [Univ. Catholique de Lille (France). Service d' Imagerie Medicale; Univ. Nord de France, Boulogne sur Mer (France). Unite de Recherche EA 4490, Physiopathologie des Maladies Osseuses Inflammatoires; Demondion, Xavier [Univ. Lille 2 (France). Service d' Imagerie Musculosquelettique; CHRU Lille (France). Lab. d' Anatomie; Forzy, Gerard [Univ. Catholique de Lille, Lomme (France). Lab. de Biologie; Cotten, Anne [Univ. Lille 2 (France). Service d' Imagerie Musculosquelettique; Univ. Nord de France, Boulogne sur Mer (France). Unite de Recherche EA 4490, Physiopathologie des Maladies Osseuses Inflammatoires

    2014-10-15

    To examine in detail images of pseudoerosion of the wrist and hand on plain radiographs. The study was conducted with 28 cadaver wrists. During a single imaging session three techniques - plain radiography, tomosynthesis, and computed tomography - were used to visualize the wrist and hand specimens. For each technique, 20 radio-ulno-carpo-metacarpal sites known to present bone erosions in rheumatoid arthritis were analyzed by two radiologists using a standard system to score the cortical bone: normal, pseudoerosion, true erosion, or other pathology. Cohen's concordance analysis was performed to determine inter-observer and intra-observer (for the senior radiologist) agreement by site and by technique. Serial sections of two cadaver specimens were examined to determine the anatomical correlation of the pseudoerosions. On the plain radiographs, the radiologists scored many images as pseudoerosion (7.3 %), particularly in the distal ulnar portion of the capitate, the distal radial portion of the hamate, the proximal ulnar portion of the base of the third metacarpal, the proximal radial portion of the base of the fourth metacarpal, the distal ulnar portion of the hamate, and the proximal portion of the base of the fifth metacarpal. The computed tomography scan revealed that none of these doubtful images corresponded to true erosions. The anatomical correlation study showed that these images could probably be attributed to ligament insertions, thinner lamina, and enhanced cortical bone transparency. Knowledge of the anatomical carpal localizations where pseudoerosions commonly occur is a necessary prerequisite for analysis of plain radiographs performed to diagnose or monitor rheumatoid arthritis. (orig.)

  10. Avaliação biomecânica das fraturas intra-articulares do calcâneo e sua correlação clínica radiográfica Biomechanical evaluation of intra articular calcaneal fracture and clinical radiographic correlation

    Directory of Open Access Journals (Sweden)

    Marcos Emilio Kuschnaroff Contreras

    2004-06-01

    Full Text Available O presente estudo teve o objetivo de oferecer uma avaliação clínica, radiográfica e biomecânica de pacientes com fratura intraarticular de calcâneo, submetidos à redução aberta e fixação interna. A amostra consistiu em 22 pacientes, 20 do sexo masculino e dois do sexo feminino, com idade média de 40,95 (± 11,63 anos. Os autores realizaram avaliações radiográficas do ângulo de Böhler e Gissane, no pré e no pós-operatório, além de utilizarem a tomografia computadorizada para avaliação da classificação de Sanders. A avaliação da Distribuição da Pressão Plantar foi realizada pelo sistema F-scan. Os resultados clínicos encontrados foram satisfatórios apresentando, pontuação média de 75,5 no critério da AOFAS.. A redução cirúrgica resultou em uma melhora dos ângulos de Böhler e Gissane. O estudo mostrou diferenças estatisticamente significantes entre o antepé o retropé fraturados no que tange sobre a área de contato, pressão e força de reação do solo. Os valores encontrados para estes parâmetros foram maiores no retropé que no antepé fraturados. A trajetória de Pressão (COP foi menor no pé fraturado que no pé normal. Encontrou-se correlação entre o Ângulo de Gissane após a redução e o Segundo Pico de Força, indicando que quanto melhor a redução deste ângulo , melhor a impulsão. Também encontrou-se a correlação entre a pontuação AOFAS e o Primeiro Pico de Força, mostrando que quanto melhor o resultado clínico melhor o apoio do retropé.The present study had an objective to perfom a clinical, radiographic and biomechanical evaluation in patients with calcaneal fractures submitted to open reduction with internal fixation. The sample consisted of 22 patients - 20 male and 2 female with an average age of 40,95 (±11,63 years old. The authors have done radiographic evaluation of the pre and post operatory of Böchler and Gissane angles; furthermore, they used a CT scanning for Sander

  11. Prognosis of teeth in the line of jaw fractures.

    Science.gov (United States)

    Aulakh, Kamaldeep K; Gumber, Tejinder Kaur; Sandhu, Sumeet

    2017-04-01

    The decision as to whether teeth in the line of jaw fractures should be extracted or retained remains a controversial issue. The aim of this study was to assess the prognosis of teeth directly in the line of, and adjacent to, jaw fracture sites. The study consisted of 50 patients with facial fractures in the dentate region, the diagnosis of which was made on the basis of clinical and radiographic examinations. A total of 124 teeth were present in 69 fracture sites (50 patients), of which 89 teeth were evaluated both, clinically (tooth mobility, pocket depth, pulp sensibility) and with periapical radiographs (degree of fracture displacement, marginal bone loss, root resorption). The results revealed that 61.9% of teeth in directly in the line of fractures showed no response to electric pulp testing compared with 48.9% teeth adjacent to fractures. The maximum frequency of non-responsive teeth was observed in Type I fractures followed by Type II fractures. Response to pulp tests was highly significant at postoperative 3- and 6-month periods (Wilcoxon's test). There was continuous reduction in the measurement for mean pocket depth at both test and control sites of teeth. The measurement of marginal bone levels of teeth in the line of fractures revealed a significant reduction (P jaw fractures should not be removed on a prophylactic basis and should be followed up clinically and radiographically to determine any treatment needs. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. Qual a melhor incidência radiográfica para avaliar o desvio das fraturas tipo die-punch? Estudo em cadáver What is the best radiographic view for "die punch" distal radius fractures? A cadaver model study

    Directory of Open Access Journals (Sweden)

    Diego Figueira Falcochio

    2012-02-01

    Full Text Available OBJETIVO: Avaliar qual a melhor incidência radiográfica para diagnosticar os desvios da fratura tipo die-punch da extremidade distal do rádio. MÉTODOS: Utilizou-se um rádio do Banco de Tecidos Salvador Arena. Após limpeza e retirada de partes moles, realizou-se osteotomia da região dorsoulnar da superfície articular com microsserra, osteótomo e martelo. Fixou-se o fragmento distal com fita adesiva, nos degraus articulares de 1, 2, 3 e 5mm. A peça foi submetida a radiografias nas incidências frente, perfil, oblíqua semipronada, oblíqua semissupinada e tangencial (75º com o plano da mesa. Em uma segunda etapa, avaliou-se o desvio da fratura em cada radiografia, com auxílio do software AutoCAD 2010®. RESULTADOS: A incidência tangencial foi a melhor para identificar os desvios de 1 e 3mm e a segunda melhor nos desvios de 2 e 5mm. No desvio de 2mm a melhor incidência foi a oblíqua semipronada e no de 5mm a oblíqua semissupinada, sendo que não se consegue identificar os desvios de 1 e 2mm na oblíqua semissupinada. CONCLUSÃO: A incidência tangencial foi superior na avaliação do degrau articular de 1mm e 3mm e a segunda melhor quando houve degrau de 2mm e 5mm.OBJECTIVE: the aim of this study is try to show the best view for distal radius fractures so called die-punch fractures. METHODS: There has been used a human cadaver radius bone from the Salvador Arena Tissue Bank. This bone was cleaned up after removing the soft tissues and osteotomies created displaced lunate fossa fractures of 0, 1, 2, 3 and 5 mm. We have fixed this fragment with adhesive tape. Then the joint deviation were significantly increased with step-offs of 1 mm. Radiographs were then taken into 5 different positions: postero-anterior view, lateral view, oblique views and tangencial view for each of the deviations. The resulting lunate fossa depression in each X-ray film was analyzed by the AutoCAD 2010® software. RESULTS: The tangencial view was the best one

  13. Monitoring Radiographic Brain Tumor Progression

    Directory of Open Access Journals (Sweden)

    John H. Sampson

    2011-03-01

    Full Text Available Determining radiographic progression in primary malignant brain tumors has posed a significant challenge to the neuroncology community. Glioblastoma multiforme (GBM, WHO Grade IV through its inherent heterogeneous enhancement, growth patterns, and irregular nature has been difficult to assess for progression. Our ability to detect tumor progression radiographically remains inadequate. Despite the advanced imaging techniques, detecting tumor progression continues to be a clinical challenge. Here we review the different criteria used to detect tumor progression, and highlight the inherent challenges with detection of progression.

  14. The future for the radiographer

    DEFF Research Database (Denmark)

    Mussmann, Bo Redder

    2007-01-01

    implemented reporting as a part of the radiographers line of work. They report on peripheral skeleton and ultrasoundexaminations which they have done for quite some time now, and the next move will be the pelvis and the vertebral column. The implementation of the reporting radiographers has contributed...... with higher quality images and more efficiency in the workload. It has also resulted in quicker replies for the patients. I greet this development welcome since it gives even more variation in our profession. However there is also reason to maintain a critical attitude towards the sliding of competences. We...

  15. Radiographic parameters of the hip joint from birth to adolescence

    Energy Technology Data Exchange (ETDEWEB)

    Than, P.; Kranicz, J.; Bellyei, A. [Dept. of Orthopaedics, Univ. of Pecs, Medical Faculty, Ifjusag utja (Hungary); Sillinger, T. [Dept. of Orthopaedics, Szt Gyorgy County Hospital, Szekesfehervar (Hungary)

    2004-03-01

    Background: Various qualitative and quantitative radiological geometrical parameters can be of great help when assessing dysplasia of the hip joint and in understanding developmental processes of the infant hip. There are few data on the normal values of the hip joint at different ages. Objective: To perform radiographic measurements on hip joints considered to be anatomically normal and to provide data for each age group, thus describing features of the radiographic development of the hip. Materials and methods: Radiographs were examined from 355 children (age 0-16 years) undergoing examination for scoliosis (long film), urography or plain abdominal radiography. Qualitative and quantitative signs were observed and measured, focusing on the Hilgenreiner, Wiberg and Idelberger angles and the decentric distance. Results: Before the age of 9 years measurable data from neighbouring age groups differed significantly, indicating typical radiological changes of the joint. For the same age range, qualitative changes could also be observed. After 9 years of age, radiological development of the normal hip joint during childhood is much slower. (orig.)

  16. Reverse LISS plating for intertrochanteric Hip Fractures in elderly patients

    Directory of Open Access Journals (Sweden)

    Chen SB

    2010-07-01

    Full Text Available Abstract Background Fractures of the intertrochanteric hip are common and the treatment of unstable fractures generally requires an operative approach. In elderly patients, osteoporosis makes internal fixation problematic and frequently contributes to failed fixation and poor clinical results. We have attempted to apply the Less Invasive Stabilization System (LISS in reverse position for the repair of intertrochanteric hip fractures in elderly patients with osteoporotic bones. A retrospective review is presented of the cases of 28 elderly patients with stable and unstable fractures of the intertrochanteric hip treated using the reverse LISS. Methods We treated 28 elderly patients with a mean age of 82.3 years. According to the Evens classification, there were 2 Type I fractures, 2 Type II fractures, 3 Type III fractures, 13 Type IV fractures, 6 Type V fractures and 2 Type R fractures. All fractures were treated using the reverse LISS. Radiographic and clinical evidence of functional outcome and complications were evaluated. Results Mean perioperative blood loss was 92.4 milliliters (range 35 to 245 milliliters, and the mean postoperative hospital stay was 8.7 days (range 3 to 14 days. Complications included one minor wound hematoma. Radiographically, no collapses, screw cutouts, or head penetrations were seen. All surviving patients (28 of 28; 100 percent had uneventful fracture healing with union achieved by six months in all patients. Conclusions Use of the Reverse LISS plating for intertrochanteric hip fractures resulted in event-free fracture healing.

  17. Use of point-of-care ultrasound in long bone fractures: a systematic review and meta-analysis.

    Science.gov (United States)

    Chartier, Lucas B; Bosco, Laura; Lapointe-Shaw, Lauren; Chenkin, Jordan

    2017-03-01

    Long bone fractures (LBFs) are among the most frequent traumatic injuries seen in emergency departments. Reduction and immobilization is the most common form of treatment for displaced fractures. Point-of-care ultrasound (PoCUS) is a promising technique for diagnosing LBFs and assessing the success of reduction attempts. This article offers a comprehensive review of the use of PoCUS for the diagnosis and reduction of LBFs. Data source MEDLINE and EMBASE databases were searched through July 19, 2015. Study selection We included prospective studies that assessed test characteristics of PoCUS in 1) the diagnosis or 2) the reduction of LBFs. The methodological quality of the included studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Data extraction Thirty studies met inclusion criteria (n=3,506; overall fracture rate 48.0%). Test characteristics of PoCUS for the diagnosis of LBFs were as follows: sensitivity 64.7%-100%, specificity 79.2%-100%, positive likelihood ratio (LR) 3.11-infinity, and negative LR zero-0.45. Sensitivity and specificity for the adequate reduction of LBFs with PoCUS were 94%-100% and 56%-100%, respectively. PoCUS diagnosis of pediatric forearm fractures in 10 studies showed a pooled sensitivity of 93.1% (95% confidence interval [CI], 87.2%-96.4%) and specificity of 92.9% (95% CI, 86.6%-96.4%), and PoCUS diagnosis of adult ankle fractures in four studies showed a pooled sensitivity of 89.5% (95% CI, 77.0%-95.6%) and specificity of 94.2% (95% CI, 86.1%-97.7%). PoCUS demonstrates good diagnostic accuracy in all LBFs studied, especially in pooled results of diagnosis of pediatric forearm and adult ankle fractures. PoCUS is an appropriate adjunct to plain radiographs for LBFs.

  18. Radiographic findings in type 3 b Gaucher disease

    Energy Technology Data Exchange (ETDEWEB)

    Hill, S.C. [Diagnostic Radiology Department, National Institutes of Health, Bethesda, MD (United States); Damaska, B.M. [Diagnostic Radiology Department, National Institutes of Health, Bethesda, MD (United States); Tsokos, M. [Laboratory of Pathology, National Institutes of Health, Bethesda, MD (United States); Kreps, C. [Developmental and Metabolic Neurology Branch, National Institutes of Health, Bethesda, MD (United States); Brady, R.O. [Developmental and Metabolic Neurology Branch, National Institutes of Health, Bethesda, MD (United States); Barton, N.W. [Developmental and Metabolic Neurology Branch, National Institutes of Health, Bethesda, MD (United States)

    1996-12-01

    The purpose of this paper is to describe the radiographic findings in type 3 b Gaucher disease, a chronic neuronopathic form of the illness with severe systemic manifestations. Between 1980 and 1985 17 consecutive patients were evaluated with radiography of the chest, long bones and spine, CT of the head and chest, abdominal sonography, and MRI of the head, abdomen and spine. Clinical manifestations were severe, and led to death from hepatic, pulmonary or cardiac failure in nine patients. Type 3 b Gaucher disease shares the same spectrum of radiographic findings observed in type 1 disease, but the systemic manifestations are more severe. Pulmonary infiltrates, thoracic lymph node enlargement, vertebral compression fractures and osteonecrosis of the long bones occur much more frequently in patients with type 3 b disease. (orig.). With 7 figs., 2 tabs.

  19. Mountain-Plains Curriculum.

    Science.gov (United States)

    Mountain-Plains Education and Economic Development Program, Inc., Glasgow AFB, MT.

    The document lists the Mountain-Plains curriculum by job title (where applicable), including support courses. The curriculum areas covered are mathematics skills, communication skills, office education, lodging services, food services, marketing and distribution, welding support, automotive, small engines, career guidance, World of Work, health…

  20. RADIOGRAPHIC MEASUREMENTS OF THE HEIGHTS OF VERTEBRAL BODIES IN THORACIC AND LUMBAR SPINE

    Institute of Scientific and Technical Information of China (English)

    戴力扬

    1996-01-01

    Radiographic measurements was performed on 124 normal adults for anterior, posterior and middle heights of the vertebral bodies in thoracic and lumbar spine. The normal ratios of vertebral height in one vertebral body and one with the adjacent bodies were presented. The method for measurement and its diagnostic value to osteoporodc vertebral fractures were discussed.

  1. Radiographic condition in a digital system

    Energy Technology Data Exchange (ETDEWEB)

    Higashida, Yoshiharu (Kumamoto Univ. (Japan). Coll. of Medical Science)

    1993-12-01

    This paper deals with the optimum radiographic condition in digital radiographic systems. Radiographic conditions for chest and bone radiography with the computed radiographic (CR) system were reviewed. The effect of incident exposure on the detectability of various abnormalities including nodule, pneumothorax, asbestosis, fine pulmonary line and other abnormalities were also discussed. Radiographic conditions for radiography with portable X-ray unit and CR system were investigated at several institutions. Chest and abdominal examinations with the CR system were performed under the same exposure conditions as those of screen-film systems. However, large fluctuations in the radiographic condition were found by some technologists. (author).

  2. Core competencies of radiographers working in rural hospitals of KwaZulu-Natal, South Africa

    Directory of Open Access Journals (Sweden)

    Bernard Mung'omba

    2017-01-01

    Full Text Available Introduction: Rural radiographers require, over and above traditional radiographic expertise, additional competencies which to a certain degree are unique however not limited to rural practice. Previous studies, however, have focused more attention primarily on other rural health professionals such as doctors and nurses leaving a research need in this field. This article focuses on the additional competencies that may be required for rural radiographers.Aim: To investigate and identify additional core competencies required by radiographers working in rural hospitals of KwaZulu-Natal in order to propose a continuous professional development strategy aimed at rural radiographers.Methods: An exploratory sequential design was utilised with qualitative (Phase I and quantitative (Phase II strands involving seven participants and 109 respondents, respectively. Only radiographers working in rural KwaZulu-Natal hospitals were included in the study. The four major themes and categories identified in Phase I were used to develop data collection instrument for Phase II of the study.Results: Collectively, the results revealed that there were a number of additional core competencies such as, but not limited to, teamwork, ability to do basic obstetric ultrasound scans, leadership, management and reporting on plain radiographs, all of which are required by rural radiographers. In 2014 when these competencies were checked against a single curriculum, it was found that majority of them were either partially covered or not at all covered.Conclusion: The study provides additional information on context specific core competencies and, therefore, may act as a catalyst to influence the future of radiographers working in rural areas of South Africa.

  3. Thoracic kyphosis and rate of incident vertebral fractures: the Fracture Intervention Trial

    Science.gov (United States)

    Vittinghoff, E.; Kado, D. M.; Lane, N. E.; Ensrud, K. E.; Shipp, K.

    2016-01-01

    Summary Biomechanical analyses support the theory that thoracic spine hyperkyphosis may increase risk of new vertebral fractures. While greater kyphosis was associated with an increased rate of incident vertebral fractures, our analysis does not show an independent association of kyphosis on incident fracture, after adjustment for prevalent vertebral fracture. Excessive kyphosis may still be a clinical marker for prevalent vertebral fracture. Introduction Biomechanical analyses suggest hyperkyphosis may increase risk of incident vertebral fracture by increasing the load on vertebral bodies during daily activities. We propose to assess the association of kyphosis with incident radiographic vertebral fracture. Methods We used data from the Fracture Intervention Trial among 3038 women 55–81 years of age with low bone mineral density (BMD). Baseline kyphosis angle was measured using a Debrunner kyphometer. Vertebral fractures were assessed at baseline and follow-up from lateral radiographs of the thoracic and lumbar spine. We used Poisson models to estimate the independent association of kyphosis with incident fracture, controlling for age and femoral neck BMD. Results Mean baseline kyphosis was 48° (SD = 12) (range 7–83). At baseline, 962 (32 %) participants had a prevalent fracture. There were 221 incident fractures over a median of 4 years. At baseline, prevalent fracture was associated with 3.7° greater average kyphosis (95 % CI 2.8–4.6, p < 0.0005), adjusting for age and femoral neck BMD. Before adjusting for prevalent fracture, each 10° greater kyphosis was associated with 22 % increase (95 % CI 8–38 %, p = 0.001) in annualized rate of new radiographic vertebral fracture, adjusting for age and femoral neck BMD. After additional adjustment for prevalent fracture, estimated increased annualized rate was attenuated and no longer significant, 8 % per 10° kyphosis (95 % CI −4 to 22 %, p = 0.18). Conclusions While greater kyphosis increased the rate of

  4. Case Report: Nonoperative Treatment of an Unstable Jefferson Fracture Using a Cervical Collar

    OpenAIRE

    Haus, Brian M.; Harris, Mitchel B.

    2008-01-01

    The treatment of unstable burst fractures of the atlas (Jefferson fractures) is controversial. Unstable Jefferson fractures have been managed successfully with either immobilization, typically halo traction or halo vest, or surgery. We report a patient with an unstable Jefferson fracture treated nonoperatively with a cervical collar, frequent clinical examinations, and flexion-extension radiographs. Twelve months after treatment, the patient achieved painless union of his fracture. The succes...

  5. Hip fracture: diagnosis, treatment, and secondary prevention.

    Science.gov (United States)

    LeBlanc, Kim Edward; Muncie, Herbert L; LeBlanc, Leanne L

    2014-06-15

    Hip fractures cause significant morbidity and are associated with increased mortality. Women experience 80% of hip fractures, and the average age of persons who have a hip fracture is 80 years. Most hip fractures are associated with a fall, although other risk factors include decreased bone mineral density, reduced level of activity, and chronic medication use. Patients with hip fractures have pain in the groin and are unable to bear weight on the affected extremity. During the physical examination, displaced fractures present with external rotation and abduction, and the leg will appear shortened. Plain radiography with cross-table lateral view of the hip and anteroposterior view of the pelvis usually confirms the diagnosis. If an occult hip fracture is suspected and plain radiography is normal, magnetic resonance imaging should be ordered. Most fractures are treated surgically unless the patient has significant comorbidities or reduced life expectancy. The consulting orthopedic surgeon will choose the surgical procedure. Patients should receive prophylactic antibiotics, particularly against Staphylococcus aureus, before surgery. In addition, patients should receive thromboembolic prophylaxis, preferably with low-molecular-weight heparin. Rehabilitation is critical to long-term recovery. Unless contraindicated, bisphosphonate therapy should be used to reduce the risk of another hip fracture. Some patients may benefit from a fall-prevention assessment.

  6. Short-term Results of Muscle-Pedicle Bone Grafting with Tensor Fascia Lata for Delayed Femoral Neck Fractures; Case Series and Literature Review

    Directory of Open Access Journals (Sweden)

    Kuldip Salgotra

    2016-04-01

    Full Text Available Neglected, untreated and delayed femur neck fractures are commonly encountered and the treatment dilemma arises especially when the patient is physiologically young and osteosynthesis is the preferred option. Controversy exists in the current literature as the various head salvage surgeries like valgus subtrochanteric osteotomy, non-vascularized fibular bone grafting, muscle pedicle bone grafting (Tensor fascia lata and Quadratus femoris graft and vascularized bone grafting do not have clear lines of indications. The current study is a case series of 7 patients with femur neck fractures with delayed presentation beyond the vascular emergency period who were treated with osteosynthesis with muscle pedicle bone graft (MPBG using tensor fascia lata muscle pedicle graft. Patients were followed clinical and radiologically at 6 weeks, 3 and 6 months, 1 year and 3 years and patients were regularly followed. The mean age of the patients was 47 ± 1.1 ranging from 38 to 55 years. There were 6 (85.7% men and 1 (14.3% women among the patients. Overall 5 (71.5% patients had transcervical and 2 (28.5% had subcapital fractures. At the end of 6 months, 6 (85.7% patients were pain free and on plain radiographs fracture union was noted. One (14.3% patient developed collapse and persistent nonunion. Younger group less than 50 years presenting with neglected fracture neck femur should always be give an option of head salvage surgery in selected cases. Muscle pedicle bone grafting has been proven although inconsistently as a valid option for fracture neck femur. We encourage osteosynthesis with the use of tensor fascia lata muscle pedicle grafting along with cancellous cannulated screws as a first option in selected cases of neglected femur neck fractures.

  7. Optimizing bone surveys performed for suspected non-accidental trauma with attention to maximizing diagnostic yield while minimizing radiation exposure: utility of pelvic and lateral radiographs

    Energy Technology Data Exchange (ETDEWEB)

    Jha, Priyanka; Stein-Wexler, Rebecca; Seibert, Anthony; Wootton-Gorges, Sandra L. [University of California Davis Medical Center, Department of Radiology, Sacramento, CA (United States); Coulter, Kevin [University of California Davis Medical Center, Department of Pediatrics, Sacramento, CA (United States); Li, Chin-Shang [University of California Davis Medical Center, Division of Biostatistics, Department of Public Health Sciences, Sacramento, CA (United States)

    2013-06-15

    Skeletal surveys for non-accidental trauma (NAT) include lateral spinal and pelvic views, which have a significant radiation dose. To determine whether pelvic and lateral spinal radiographs should routinely be performed during initial bone surveys for suspected NAT. The radiology database was queried for the period May 2005 to May 2011 using CPT codes for skeletal surveys for suspected NAT. Studies performed for skeletal dysplasia and follow-up surveys were excluded. Initial skeletal surveys were reviewed to identify fractures present, including those identified only on lateral spinal and/or pelvic radiographs. Clinical information and MR imaging was reviewed for the single patient with vertebral compression deformities. Of the 530 children, 223 (42.1%) had rib and extremity fractures suspicious for NAT. No fractures were identified solely on pelvic radiographs. Only one child (<0.2%) had vertebral compression deformities identified on a lateral spinal radiograph. This infant had rib and extremity fractures and was clinically paraplegic. MR imaging confirmed the vertebral body fractures. Since no fractures were identified solely on pelvic radiographs and on lateral spinal radiographs in children without evidence of NAT, nor in nearly all with evidence of NAT, inclusion of these views in the initial evaluation of children for suspected NAT may not be warranted. (orig.)

  8. Fractures of the proximal humerus involving the intertubercular groove

    Energy Technology Data Exchange (ETDEWEB)

    Ahovuo, J.; Paavolainen, P.; Bjoerkenheim, J.M. (Helsinki Univ. Central Hospital (Finland). Dept. of Radiology; Helsinki Univ. Central Hospital (Finland). Div. of Traumatology and Orthopaedic Surgery)

    The purpose of this study was to analyse the involvement of the gliding surface of the biceps tendon in fractures of the proximal humerus. Fifteen patients had a fracture of the proximal humerus verified with antero-posterior and axillary radiographs. Tangential radiographs of the intertubercular groove, obtained from the shoulder joint, showed involvement of the intertubercular groove in 13 patients (87%), which could not be shown with other projections. Groove radiographs revealed in 3 patients a dislocation of the fragments of the greater tuberosity large enough to require surgical treatment, but which had not been found using conventional techniques. Therefore, a groove radiograph should be used to precise fractures of the proximal humerus. (orig.).

  9. Longitudinal stress fracture of the femur: A rare presentation

    Science.gov (United States)

    Bilreiro, Carlos; Bahia, Carla; Castro, Miguel Oliveira e

    2016-01-01

    We present the case of an 80 year old woman with hip pain, caused by a longitudinal femoral insufficiency stress fracture, depicted with radiographs, CT and MR. This type of fracture is very rare, with only a few cases reported. We conducted a literature review and compared the findings with the present case. PMID:27069976

  10. Medial supracondylar stress fracture in an adolescent pitcher

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Eric Y.; Chung, Christine B. [VA San Diego Healthcare System, San Diego, CA (United States); University of California, San Diego Medical Center, San Diego, CA (United States); Fronek, Jan [Scripps Healthcare, La Jolla, CA (United States)

    2014-01-15

    We report the occurrence of a medial supracondylar stress fracture in an adolescent pitcher. To our knowledge, this fracture has not been described in the literature, and awareness of this entity allows initiation of therapy and precludes further unnecessary work-up. The radiographic, computed tomography, and magnetic resonance imaging appearances are reviewed and the mechanism of injury is discussed. (orig.)

  11. Appearance of the weight-bearing lateral radiograph in retrocalcaneal bursitis

    Science.gov (United States)

    Muller, Bart; Maas, Mario; Sierevelt, Inger N; van Dijk, C Niek

    2010-01-01

    Background and purpose A retrocalcaneal bursitis is caused by repetitive impingement of the bursa between the Achilles tendon and the posterosuperior calcaneus. The bursa is situated in the posteroinferior corner of Kager's triangle (retrocalcaneal recess), which is a radiolucency with sharp borders on the lateral radiograph of the ankle. If there is inflammation, the fluid-filled bursa is less radiolucent, making it difficult to delineate the retrocalcaneal recess. We assessed whether the radiographic appearance of the retrocalcaneal recess on plain digital (filmless) radiographs could be used in the diagnosis of a retrocalcaneal bursitis. Methods Whether or not there was obliteration of the retrocalcaneal recess (yes/no) on 74 digital weight-bearing lateral radiographs of the ankle was independently assessed by 2 observers. The radiographs were from 24 patients (25 heels) with retrocalcaneal bursitis (confirmed on endoscopic calcaneoplasty); the control group consisted of 50 patients (59 heels). Results The sensitivity of the test was 83% for observer 1 and 79% for observer 2. Specificity was 100% and 98%, respectively. The kappa value of the interobserver reliability test was 0.86. For observer 1, intraobserver reliability was 0.96 and for observer 2 it was 0.92. Interpretation On digital weight-bearing lateral radiographs of a retrocalcaneal bursitis, the retrocalcaneal recess has a typical appearance. PMID:20450438

  12. A clinical decision rule for the use of plain radiography in children after acute wrist injury: development and external validation of the Amsterdam Pediatric Wrist Rules

    Energy Technology Data Exchange (ETDEWEB)

    Slaar, Annelie; Maas, Mario; Rijn, Rick R. van [University of Amsterdam, Department of Radiology, Academic Medical Centre, Meibergdreef 9, 1105, AZ, Amsterdam (Netherlands); Walenkamp, Monique M.J.; Bentohami, Abdelali; Goslings, J.C. [University of Amsterdam, Trauma Unit, Department of Surgery, Academic Medical Centre, Amsterdam (Netherlands); Steyerberg, Ewout W. [Erasmus MC - University Medical Centre, Department of Public Health, Rotterdam (Netherlands); Jager, L.C. [University of Amsterdam, Emergency Department, Academic Medical Centre, Amsterdam (Netherlands); Sosef, Nico L. [Spaarne Hospital, Department of Surgery, Hoofddorp (Netherlands); Velde, Romuald van [Tergooi Hospitals, Department of Surgery, Hilversum (Netherlands); Ultee, Jan M. [Sint Lucas Andreas Hospital, Department of Surgery, Amsterdam (Netherlands); Schep, Niels W.L. [University of Amsterdam, Trauma Unit, Department of Surgery, Academic Medical Centre, Amsterdam (Netherlands); Maasstadziekenhuis Rotterdam, Department of Surgery, Rotterdam (Netherlands)

    2016-01-15

    In most hospitals, children with acute wrist trauma are routinely referred for radiography. To develop and validate a clinical decision rule to decide whether radiography in children with wrist trauma is required. We prospectively developed and validated a clinical decision rule in two study populations. All children who presented in the emergency department of four hospitals with pain following wrist trauma were included and evaluated for 18 clinical variables. The outcome was a wrist fracture diagnosed by plain radiography. Included in the study were 787 children. The prediction model consisted of six variables: age, swelling of the distal radius, visible deformation, distal radius tender to palpation, anatomical snuffbox tender to palpation, and painful or abnormal supination. The model showed an area under the receiver operator characteristics curve of 0.79 (95% CI: 0.76-0.83). The sensitivity and specificity were 95.9% and 37.3%, respectively. The use of this model would have resulted in a 22% absolute reduction of radiographic examinations. In a validation study, 7/170 fractures (4.1%, 95% CI: 1.7-8.3%) would have been missed using the decision model. The decision model may be a valuable tool to decide whether radiography in children after wrist trauma is required. (orig.)

  13. Radiographic findings in late-presenting congenital diaphragmatic hernia: helpful imaging findings

    Energy Technology Data Exchange (ETDEWEB)

    Muzzafar, Sofia; Swischuk, Leonard E.; Jadhav, Siddharth P. [University of Texas Medical Branch, Department of Pediatric Radiology, Galveston, TX (United States)

    2012-03-15

    Imaging findings in delayed presentation of congenital diaphragmatic hernia can be confusing and misleading, resulting in a delay in diagnosis. To evaluate the often puzzling plain film findings of late-presenting CDH in an effort to determine whether any of the findings could be helpful in arriving at an early diagnosis. We reviewed and documented the plain film findings and clinical data in eight patients seen during the last 20 years with late-presenting CDH. IRB exempt status was obtained in this study. There were five boys and three girls. The age range was 4 months to 12 years with a mean of 2.4 years. Five children presented with acute respiratory problems while three presented with acute abdominal pain. Two children presented with both respiratory and abdominal findings and one also presented with hematemesis. Two children had radiographic findings that were not difficult to analyze while the remaining six had findings that posed initial diagnostic problems. Although not common, late-presenting CDH can result in confusing plain film radiographic findings and a delay in diagnosis. We found that the most important finding in analyzing these radiographs is in evaluating the location and position of the gastric bubble with the more common left-side hernias. (orig.)

  14. Weber B Distal Fibular Fracture Diagnosed by Point of Care Ultrasound in the Emergency Department

    OpenAIRE

    Makinen, James

    2016-01-01

    We report the case of a 45 year-old woman who presented to the Emergency Department (ED) after an acute ankle inversion injury. After history and physical exam suggested a potential fracture, point of care (POC) ultrasound demonstrated a cortical defect of the distal fibula, consistent with fracture. Plain radiography failed to demonstrate a fracture. Later, the fracture was identified as a Weber B distal fibular fracture by stress-view radiography. This case reviews the evaluation of acute a...

  15. Rib Fracture Diagnosis in the Panscan Era.

    Science.gov (United States)

    Murphy, Charles E; Raja, Ali S; Baumann, Brigitte M; Medak, Anthony J; Langdorf, Mark I; Nishijima, Daniel K; Hendey, Gregory W; Mower, William R; Rodriguez, Robert M

    2017-05-27

    With increased use of chest computed tomography (CT) in trauma evaluation, traditional teachings in regard to rib fracture morbidity and mortality may no longer be accurate. We seek to determine rates of rib fracture observed on chest CT only; admission and mortality of patients with isolated rib fractures, rib fractures observed on CT only, and first or second rib fractures; and first or second rib fracture-associated great vessel injury. We conducted a planned secondary analysis of 2 prospectively enrolled cohorts of the National Emergency X-Radiography Utilization Study chest studies, which evaluated patients with blunt trauma who were older than 14 years and received chest imaging in the emergency department. We defined rib fractures and other thoracic injuries according to CT reports and followed patients through their hospital course to determine outcomes. Of 8,661 patients who had both chest radiograph and chest CT, 2,071 (23.9%) had rib fractures, and rib fractures were observed on chest CT only in 1,368 cases (66.1%). Rib fracture patients had higher admission rates (88.7% versus 45.8%; mean difference 42.9%; 95% confidence interval [CI] 41.4% to 44.4%) and mortality (5.6% versus 2.7%; mean difference 2.9%; 95% CI 1.8% to 4.0%) than patients without rib fracture. The mortality of patients with rib fracture observed on chest CT only was not statistically significantly different from that of patients with fractures also observed on chest radiograph (4.8% versus 5.7%; mean difference -0.9%; 95% CI -3.1% to 1.1%). Patients with first or second rib fractures had significantly higher mortality (7.4% versus 4.1%; mean difference 3.3%; 95% CI 0.2% to 7.1%) and prevalence of concomitant great vessel injury (2.8% versus 0.6%; mean difference 2.2%; 95% CI 0.6% to 4.9%) than patients with fractures of ribs 3 to 12, and the odds ratio of great vessel injury with first or second rib fracture was 4.4 (95% CI 1.8 to 10.4). Under trauma imaging protocols that commonly

  16. Neglected hangman fracture

    Directory of Open Access Journals (Sweden)

    Sudhir Kumar Srivastava

    2015-01-01

    Full Text Available Acute management of hangman fracture is well described; however the surgical management of neglected hangman fracture has not been described in literature. We report the surgical management of an untreated hangman′s fracture. A 30-year-old male had fallen from a tree 12 weeks back. Patient presented with cervical myelopathy and restricted neck movements. Radiographs and computed tomography (CT scan revealed fracture of pars interarticularis of axis with Grade III C2-C3 spondylolisthesis with localized kyphosis of 33°. Gentle reduction under general anesthesia (GA failed to improve the alignment. Patient was operated in three stages in a single setting. In Stage I, release of contracted anterior structures and C2-C3 discectomy was done in supine position followed by C2-C3 posterior fixation and fusion in Stage II. C2-C3 interbody bone grafting and anterior plating completed the third stage. C2-C3 interbody fusion was seen at 5 months and a CT scan at 18 months postoperative confirmed fusion and maintenance of alignment. The satisfactory outcome in our patient leads us to believe that anterior-posterior-anterior is the appropriate surgical approach for treatment of such patients.

  17. CT outperforms radiographs at a comparable radiation dose in the assessment for spondylolysis

    Energy Technology Data Exchange (ETDEWEB)

    Fadell, Michael F.; Stewart, Jaime R.; Harned, Roger K.; Ingram, James D.; Miller, Angie L.; Strain, John D.; Weinman, Jason P. [Children' s Hospital Colorado, Department of Radiology, Aurora, CO (United States); University of Colorado Hospital, Department of Radiology, Aurora, CO (United States); Gralla, Jane [University of Colorado Denver, Department of Pediatrics, Aurora, CO (United States); Bercha, Istiaq [Children' s Hospital Colorado, Department of Radiology, Aurora, CO (United States)

    2015-07-15

    Lumbar spondylolysis, a unilateral or bilateral fracture at pars interarticularis, is a common cause of low back pain in children. The initial imaging study in the diagnosis of lumbar spondylolysis has historically been lumbar spine radiographs; however, radiographs can be equivocal or false-negative. Definitive diagnosis can be achieved with computed tomography (CT), but its use has been limited due to the dose of ionizing radiation to the patient. By limiting the z-axis coverage to the relevant anatomy and optimizing the CT protocol, we are able to provide a definitive diagnosis of fractures of the pars interarticularis at comparable or lower radiation dose than commonly performed lumbar spine radiographs. As there is no gold standard for the diagnosis of spondylolysis besides surgery, we compared interobserver agreement and degree of confidence to determine which modality is preferable. Sixty-two patients with low back pain ages 5-18 years were assessed for the presence of spondylolysis. Forty-seven patients were evaluated by radiography and 15 patients were evaluated by limited field-of-view CT. Both radiographic and CT examinations were assessed anonymously in random order for the presence or absence of spondylolysis by six raters. Agreement was assessed among raters using a Fleiss Kappa statistic for multiple raters. CT provided a significantly higher level of agreement among raters than radiographs (P < 0.001). The overall Kappa for rater agreement with radiographs was 0.24, 0.34 and 0.40 for 2, 3 or 4 views, respectively, and 0.88 with CT. Interobserver agreement is significantly greater using limited z-axis coverage CT when compared with radiographs. Radiologist confidence improved significantly with CT compared to radiographs regardless of the number of views. (orig.)

  18. Screening panoramic radiographs in a group of patient visiting a health promotion center

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jae Seo; Kang, Byung Cheol [Chonnam National University College of Medicine, Gwangju (Korea, Republic of)

    2005-12-15

    To report the incidence of radiological findings from screening panoramic radiograph and verify the validity of the panoramic radiography for screening purposes. Six thousand one hundred and sixty panoramic radiographs taken from the patients visiting the Health Promotion Center of CNUH were selected for this retrospective study. Panoramic radiographs were examined into the following pathologic conditions : the presence of periodontal bone loss, dental caries, peri apical radiolucencies, retained roots, impacted supernumerary teeth, impacted third molars, odontoma, cystic lesions other than radicular cyst, sialoliths, and mixed radiolucent-radiopaque lesions. Number of pathologic conditions and Prevalence values were recorded. The prevalence of pathologic conditions were 72.9% of periodontal bone loss, 32.2% of dental caries, 11.9% of peri apical radiolucencies, 10.8% of retained roots, 0.4% of root fracture, 1.0% of impacted supernumerary teeth, 1.0% of impacted third molars, 0.06% of odontoma, 0.08% of cystic lesion other than radicular cyst, 0.2% of prolonged retention of deciduous tooth, 0.1% of sialolith, and 0.04% of mixed radiopaque and radiolucent lesion. Although the panoramic radiograph should not be used to replace intraoral radiographic and clinical examinations, this study showed that many dental pathologic conditions could be detected on panoramic radiographs. The panoramic radiograph might serve as a diagnostic aid in dental health evaluation programs.

  19. Computed tomographic evaluation of the proximal femur: A predictive classification in displaced femoral neck fracture management

    Directory of Open Access Journals (Sweden)

    Narender Kumar Magu

    2014-01-01

    Full Text Available Background: Femoral neck fracture is truly an enigma due to the high incidence of avascular necrosis and nonunion. Different methods have been described to determine the size of the femoral head fragment, as a small head has been said to be associated with poor outcome and nonunion due to inadequate implant purchase in the proximal fragment. These methods were two dimensional and were affected by radiography techniques, therefore did not determine true head size. Computed tomography (CT is an important option to measure true head size as images can be obtained in three dimensions. Henceforth, we subjected patients to CT scan of hip in cases with displaced fracture neck of femur. The study aims to define the term "small head or inadequate size femoral head" objectively for its prognostic significance. Materials and Methods: 70 cases of displaced femoral neck fractures underwent CT scan preoperatively for proximal femoral geometric measurements of both hips. Dual energy X-ray absorptiometry scan was done in all cases. Patients were treated with either intertrochanteric osteotomy or lag screw osteosynthesis based on the size of the head fragment on plain radiographs. Results: The average femoral head fragment volume was 57 cu cm (range 28.3-84.91 cu cm; standard deviation 14 cu cm. Proximal fragment volume of >43 cu cm was termed adequate size (type I and of ≤43 cu cm as small femoral head (type II. Fractures which united (n = 54 had a relatively large average head size (59 cu cm when compared to fractures that did not (n = 16, which had a small average head size (49 cu cm and this difference was statistically significant. In type I fractures union rate was comparable in both osteotomy and lag screw groups (P > 0.05. Lag screw fixation failed invariably, while osteotomy showed good results in type II fractures (P < 0.05. Conclusion: Computed tomography scan of the proximal femur is advisable for measuring true size of head fragment. An objective

  20. Ischial apophyseal fracture in an abused infant

    Energy Technology Data Exchange (ETDEWEB)

    Bixby, Sarah D.; Kleinman, Paul K. [Boston Children' s Hospital, Department of Radiology, Boston, MA (United States); Wilson, Celeste R. [Boston Children' s Hospital, Child Protection Program, Department of Pediatrics, Boston, MA (United States); Barber, Ignasi [Hospital Vall d' Hebron, Department of Pediatric Radiology, Barcelona (Spain)

    2014-09-15

    We report a previously healthy 4-month-old who presented to the hospital with leg pain and swelling and no history of trauma. Radiographs demonstrated a comminuted left femur fracture. Given the concern for child abuse, skeletal survey was performed and revealed four vertebral compression deformities. Although abuse was suspected, the possibility of a lytic lesion associated with the femur fracture and multiple spinal abnormalities raised the possibility of an underlying process such as Langerhans cell histiocytosis. Subsequently 18F-NaF positron emission tomographic (PET) scintigraphy revealed increased tracer activity in the ischium, and MRI confirmed an ischial apophyseal fracture. Pelvic fractures, particularly ischial fractures, are extremely rare in the setting of child abuse. This case report describes the multimodality imaging findings of an ischial fracture in an abused infant. (orig.)

  1. Neglected isolated fracture of the trochlea humeri

    Institute of Scientific and Technical Information of China (English)

    Ajay Pal Singh; Ish Kumar Dhammi; Anil Kumar Jain; Saurabh Jain

    2010-01-01

    A 15 years old girl was found to have isolated trochlea fracture 10 weeks after an injury caused by a fall on her left elbow. Movement of the elbow was severely restricted. Radiographs showed a half moon-shaped and anterosuperiorly displaced osteochondral fragment. Medial approach capsulotomy of the elbow and excision of the intraarticular adhesions were done to expose the isolated trochlea fracture. Headless screws were used for fixation,combined with bone grafting. The follow-up showed union and excellent functional recovery of the elbow. Isolated trochlea fracture in adults is rare and usually associated with capitellar fractures and/or elbow dislocations. A neglected trochlea fracture is rarely reported in the English language literature to the best of our knowledge. Recognition of isolated trochlea fracture is vital to apprehend the pathomechanics of the injury and to devise a suitable treatment approach.

  2. Atypical subtrochanteric and diaphyseal femoral fractures

    DEFF Research Database (Denmark)

    Shane, Elizabeth; Burr, David; Abrahamsen, Bo

    2014-01-01

    Bisphosphonates (BPs) and denosumab reduce the risk of spine and nonspine fractures. Atypical femur fractures (AFFs) located in the subtrochanteric region and diaphysis of the femur have been reported in patients taking BPs and in patients on denosumab, but they also occur in patients...... with no exposure to these drugs. In this report, we review studies on the epidemiology, pathogenesis, and medical management of AFFs, published since 2010. This newer evidence suggests that AFFs are stress or insufficiency fractures. The original case definition was revised to highlight radiographic features...... that distinguish AFFs from ordinary osteoporotic femoral diaphyseal fractures and to provide guidance on the importance of their transverse orientation. The requirement that fractures be noncomminuted was relaxed to include minimal comminution. The periosteal stress reaction at the fracture site was changed from...

  3. Comparison of Computed Tomography and Chest Radiography in the Detection of Rib Fractures in Abused Infants

    Science.gov (United States)

    Wootton-Gorges, Sandra L.; Stein-Wexler, Rebecca; Walton, John W.; Rosas, Angela J.; Coulter, Kevin P.; Rogers, Kristen K.

    2008-01-01

    Purpose: Chest radiographs (CXR) are the standard method for evaluating rib fractures in abused infants. Computed tomography (CT) is a sensitive method to detect rib fractures. The purpose of this study was to compare CT and CXR in the evaluation of rib fractures in abused infants. Methods: This retrospective study included all 12 abused infants…

  4. 21 CFR 892.1840 - Radiographic film.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Radiographic film. 892.1840 Section 892.1840 Food... DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1840 Radiographic film. (a) Identification. Radiographic film is a device that consists of a thin sheet of radiotransparent material coated on one or...

  5. Early Clinical and Radiographic Results of Minimally Invasive Anterior Approach Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Tamara Alexandrov

    2014-01-01

    consecutive patients with 43 total hip arthroplasties performed through an anterior muscle sparing minimally invasive approach. We found the early complication rates and radiographic outcomes comparable to those reported from arthroplasties performed via traditional approaches. Complications included dislocation (2%, femur fracture (2%, greater trochanteric fracture (12%, postoperative periprosthetic intertrochanteric fracture (2%, femoral nerve palsy (5%, hematoma (2%, and postoperative iliopsoas avulsion (2%. Radiographic analysis revealed average cup anteversion of 19.6°±6.6, average cup abduction angle of 48.4°±7, stem varus of 0.9°±2, and a mean leg length discrepancy of 0.7 mm. The anterior approach to the hip is an attractive alternative to the more traditional approaches. Acceptable component placement with comparable complication rates is possible using a muscle sparing technique which may lead to faster overall recovery.

  6. HADES, A Radiographic Simulation Code

    Energy Technology Data Exchange (ETDEWEB)

    Aufderheide, M.B.; Slone, D.M.; Schach von Wittenau, A.E.

    2000-08-18

    We describe features of the HADES radiographic simulation code. We begin with a discussion of why it is useful to simulate transmission radiography. The capabilities of HADES are described, followed by an application of HADES to a dynamic experiment recently performed at the Los Alamos Neutron Science Center. We describe quantitative comparisons between experimental data and HADES simulations using a copper step wedge. We conclude with a short discussion of future work planned for HADES.

  7. Ball-thrower's fracture of the humerus

    Energy Technology Data Exchange (ETDEWEB)

    Callaghan, Eric B.; Bennett, D. Lee; El-Khoury, Georges Y.; Ohashi, Kenjirou [Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, IA 52242, Iowa City (United States)

    2004-06-01

    A relatively rare case of ball-thrower's fracture of the humerus is presented. Severe muscular action is an uncommon cause of humeral fractures but has been well documented in the orthopedic literature. To our knowledge, this fracture has not been described in the radiology literature, and awareness of this entity could preclude further unnecessary workup. The mechanism of injury and its typical radiographic appearance is described. (orig.)

  8. A Radiographic Study of Odontoma

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kyung Ho; Choi, Karp Shik [Dept. of Dental Radiology, College of Dentistry, Kyungpook National University, Daegu (Korea, Republic of)

    1998-02-15

    The purpose of this study was to obtain information on the clinical and radiographic features of the odontomas in the jaws. For this study, the authors examined and analyzed the clinical records and radiographs of 119 patients who had lesion of odontoma diagnosed by clinical and radiographic examinations. The obtained results were as follows: 1. Odontoma occurred the most frequently in the 2nd decade (45.4%) and occurred more frequently in males (60.5%) than in females (39.5%). 2. The most common clinical symptom was the delayed eruption of the teeth (34.2%). 3. The type of lesions was mainly observed as compound odontoma (80.8%), and internal pattern of the complex odontoma was unevenly radiopaque (73.9%). 4. The compound odontoma frequently occurred in anterior portion of the maxilla (57.7%) and mandible (30.9%), and complex odontoma frequently occurred in anterior portion of maxilla (34.8%) and posterior portion of mandible (30.5%). 5. The effects on adjacent teeth were impaction of teeth (71.7%) and prolonged retention of deciduous teeth (31.7%). 6. The impaction of the teeth occurred in anterior portion of maxilla (44.2%) amd mandible (19.2%), but root resorption of the adjacent teeth were not seen. 7. The boundary to adjacent structure was well-defined , the lesions appear as radiopaque mass with radiolucent rim.

  9. 鲁西平原济宁市北部裂隙岩溶地下水补给机理研究%Study on Recharge Mechanism of Fracture Karst Groundwater in North Jining of Luxi Plain

    Institute of Scientific and Technical Information of China (English)

    李占琪; 李元仲; 孟令兴

    2011-01-01

    鲁西平原地区赋存较丰富的岩溶地下水,埋深一般在80~200m,其中济宁市北部的岩溶水已被当地政府纳入综合开发利用规划.但该岩溶水系统的补给机理一直是水文地质工作者们关心的问题,这为准确评价该地区岩溶地下水水资源量增加了一定的难度.传统观点认为,济宁北深层岩溶水的主要补给来源是南部裸露山区的降水人渗补给,但笔者经计算,发现南部裸露区降水入渗补给量远远不能满足现状开采量,这说明该岩溶地下水系统还有其它补给途径.该文通过对地下水位动态、水化学特征、水中铀同位素组成特征及抽水试验资料的分析,认为上覆孔隙水的越流补给才是该岩溶水系统最主要的补给来源.%The Luxi plain is rich in kaist groundwater and its buried depth is generally 80 ~ 200m.The karst water in north Jinning has been brought into the comprehensive development plan by local government. But the recharge mechanism of karst water system has been the concerned problem of hydrogeologist, and it adds to the difficulty to evaluate the karst groundwater resource volume in the area. According to traditional view, the main recharge source in the area is precipitation infiltration recharge from its south bare mountain. However, the author discovers that the source is not far enough to meet the current groundwater extraction volume, which means that the area has other recharge sources. Based on the groundwater dynamic level, hydrochemical characteristics , water uranium isotope characteristics and the analysis of pumping test, it shows that the leakage recharge from its upper pore water is the main recharge source of the karst water system.

  10. Double segmental tibial fractures——an unusual fracture pattern

    Institute of Scientific and Technical Information of China (English)

    Kamal Bali; Vishal Kumar; Sandeep Patel; Sameer Aggarwal

    2011-01-01

    A case of a 50-year-old pedestrian who was hit by a bike and suffered fractures of both bones of his right leg was presented. Complete clinical and radiographic assessment showed double segmental fractures of the tibia and multisegmental fractures of the fibula. Review of the literature revealed that this fracture pattern was unique and only a single case was reported so far. Moreover, we discussed the possible mechanisms which can lead to such an injury. We also discussed the management of segmental tibial fracture and the difficulties encountered with them. This case was managed by modern osteosynthesis tech nique with a pleasing outcome.

  11. Isolated Fracture of the Coracoid Process

    Directory of Open Access Journals (Sweden)

    Ali Güleç

    2014-01-01

    Full Text Available Coracoid fractures are rarely seen fractures. In the shoulder girdle, coracoid process fractures generally accompany dislocation of the acromioclavicular joint or glenohumeral joint, scapula corpus, clavicula, humerus fracture, or rotator cuff tear. Coracoid fractures can be missed and the treatment for coracoid process fractures is still controversial. In this paper, a 34-year-old male manual labourer presented to the emergency department with complaints of pain and restricted movement in the left shoulder following a traffic accident. On direct radiographs and computerised tomography images a fragmented fracture was observed on the base of the coracoid process. In addition to the coracoid fracture, a mandibular fracture was determined. The patient was admitted for surgery on both fractures. After open reduction, fixation was made with a 3.5 mm cannulated screw and washer. At the postoperative 6th week, bone union was determined. The patient returned to his previous occupation pain-free and with a full range of joint movement. In conclusion, in the current case of isolated fragmented coracoid process fracture showing minimal displacement in a patient engaged in heavy manual work, surgery was preferred as it was thought that nonunion might be encountered particularly because of the effect of forces around the coracoid.

  12. Mandibular symphysis fracture associated with the displacement of a fractured genial segment: An unusual case report with review

    OpenAIRE

    Krishnaveni Buduru; Dalsingh Vankudoth; Darpan Bhargava; Murali Mohan Thota

    2015-01-01

    Fractures and displacement of fragments involving the genial tubercles due to trauma are rarely seen in patients with a full complement of teeth although spontaneous fractures of the genial tubercles in edentulous atrophic mandible are not uncommon. These are usually displaced and may be missed during routine clinical and radiographic examinations owing to superimposition of the features of a fractured mandible. Very few cases have been reported till date. Their implications lie in functional...

  13. Automatic hanging protocol for chest radiographs

    Science.gov (United States)

    Luo, Hui; Hao, Wei; Cornelius, Craig

    2005-04-01

    Chest radiography is one of the most widely used techniques in diagnostic imaging. It makes up at least one third of all conventional diagnostic radiographic procedures in hospitals. However, in both film-screen and computed radiography, images are often digitized with the view and orientation unknown or mislabeled, which causes inefficiency in displaying them in the picture archive and communication system (PACS). Hence, the goal of this work is to provide a robust, efficient, and automatic hanging protocol for chest radiographs. To achieve it, the method star ts with recognition by extracting a set of distinctive features from chest radiographs. Next, a well-defined probabilistic classifier is used to train and classify the radiographs. Identifying the orientation of the radiographs is performed by an efficient algorithm which locates the neck, heart, and abdomen positions in radiographs. The initial experiment was performed on radiographs collected from daily routine chest exams in hospitals, and it has shown promising results.

  14. [Atlas fractures].

    Science.gov (United States)

    Schären, S; Jeanneret, B

    1999-05-01

    Fractures of the atlas account for 1-2% of all vertebral fractures. We divide atlas fractures into 5 groups: isolated fractures of the anterior arch of the atlas, isolated fractures of the posterior arch, combined fractures of the anterior and posterior arch (so-called Jefferson fractures), isolated fractures of the lateral mass and fractures of the transverse process. Isolated fractures of the anterior or posterior arch are benign and are treated conservatively with a soft collar until the neck pain has disappeared. Jefferson fractures are divided into stable and unstable fracture depending on the integrity of the transverse ligament. Stable Jefferson fractures are treated conservatively with good outcome while unstable Jefferson fractures are probably best treated operatively with a posterior atlanto-axial or occipito-axial stabilization and fusion. The authors preferred treatment modality is the immediate open reduction of the dislocated lateral masses combined with a stabilization in the reduced position using a transarticular screw fixation C1/C2 according to Magerl. This has the advantage of saving the atlanto-occipital joints and offering an immediate stability which makes immobilization in an halo or Minerva cast superfluous. In late instabilities C1/2 with incongruency of the lateral masses occurring after primary conservative treatment, an occipito-cervical fusion is indicated. Isolated fractures of the lateral masses are very rare and may, if the lateral mass is totally destroyed, be a reason for an occipito-cervical fusion. Fractures of the transverse processes may be the cause for a thrombosis of the vertebral artery. No treatment is necessary for the fracture itself.

  15. Imaging of the elbow in children with wrist fracture: an unnecessary source of radiation and use of resources?

    Energy Technology Data Exchange (ETDEWEB)

    Golding, Lauren P. [Wake Forest University Baptist Health, Department of Radiology, Winston-Salem, NC (United States); Triad Radiology Associates, Winston-Salem, NC (United States); Yasin, Yousef; Singh, Jasmeet; Anthony, Evelyn [Wake Forest University Baptist Health, Department of Radiology, Winston-Salem, NC (United States); Gyr, Bettina M. [Wake Forest University Baptist Health, Department of Orthopedic Surgery, Winston-Salem, NC (United States); Gardner, Alison [Wake Forest University Baptist Health, Department of Pediatric Emergency Medicine, Winston-Salem, NC (United States)

    2015-08-15

    Anecdotally accepted practice for evaluation of children with clinically suspected or radiographically proven wrist fracture in many urgent care and primary care settings is concurrent imaging of the forearm and elbow, despite the lack of evidence to support additional images. These additional radiographs may be an unnecessary source of radiation and use of health care resources. Our study assesses the necessity of additional radiographs of the forearm and elbow in children with wrist injury. We reviewed electronic medical records of children 17 and younger in whom wrist fracture was diagnosed in the emergency department. We identified the frequency with which additional radiographs of the proximal forearm and distal humerus demonstrated another site of acute injury. We identified 214 children with wrist fracture. Of those, 129 received additional radiographs of the elbow. Physical examination findings proximal to the wrist were documented in only 16 (12%) of these 129 children. A second injury proximal to the wrist fracture was present in 4 (3%) of these 129 children, all of whom exhibited physical examination findings at the elbow. No fractures were documented in children with a negative physical examination of the elbow. Although elbow fractures occasionally complicate distal forearm fractures in children, our findings indicate that a careful physical evaluation of the elbow is sufficient to guide further radiographic investigation. Routine radiographs of both the wrist and elbow in children with distal forearm fracture appear to be unnecessary when an appropriate physical examination is performed. (orig.)

  16. Amyloidoma, an Unusual Cause of Fracture

    Directory of Open Access Journals (Sweden)

    Frank Verhoeven

    2014-01-01

    Full Text Available We report a case of a spontaneous hip fracture in a context of dysglobulinemia. The bone histologic examination found amyloidoma. Amyloidoma is an overload pathology and an unusual cause of fracture. In most of the cases, it is associated with myeloma and the difference between bone invasion of myeloma and amyloidoma in an osteolytic radiographic picture is not easy but is of importance because prognosis and treatment may be totally different. Thus, in the context of dysglobulinemia, one must keep in mind that spontaneous bone fracture may be due to amyloidoma with another prognosis.

  17. Radiographic findings of gastrointestinal anisakiasis: clinical and pathologic correlation

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Tae Woong; Kang, Heoung Keun; Jeong, Yong Yeon [Medical School, Chonnam University, Kwangju (Korea, Republic of); And Others

    2000-08-01

    To evaluate the radiographic findings of gastrointestinal anisakiasis with clinical and pathologic correlation. In ten patients, findings were retrospectively analysed. There were two cases of the gastric variety of gastrointestinal anisakiasis and eight of the intestinal, and they were diagnosed during gastroscopy, by resection during surgery, and on the basis of typical clinical findings. All ten patients underwent both plain radiography and CT scanning of the abdomen. US was performed in five patients and an upper gastrointestinal series in one. Clinical data were evaluated with regard to a history of raw fish ingestion, time from ingestion of raw fish to onset of symptoms, location of abdominal pain, and laboratory data. Radiologic findings were analysed in terms of wall thickening and appearance, mesenteric infiltration, bowel dilatation proximal to lesion, and ascites. All patients had a history of recent ingestion of raw fish and complained of severe abdominal pain that occurred approximately 7-48 hours later. Pain occurred in the lower abdomen in five patients, the epigastrium in four, and the right lower abdomen in two. Laboratory test disclosed the leukocytosis in eight patients and eosinophilia in three. In all cases of intestinal anisakiasis, ileus was demonstrated on plain radiographs of the abdomen, while the upper gastrointestinal series showed mucosal thickening and multiple filling defects. US findings were bowel thickening and dilation, and on CT images, wall thickening revealed a target sign. Mesenteric infiltration and ascites were seen in seven patients. In four who underwent surgery, a cross-section through the lesion revealed submucosal eosinophilic granuloma with anisakis larva. Although the CT findings are non-specific, taken in conjunction with characteristic clinical findings, they may be helpful in the diagnosis of gastrointestinal anisakiasis. (author)

  18. Root fractures

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Christensen, Søren Steno Ahrensburg; Tsilingaridis, Georgios

    2012-01-01

    The purpose of this study was to analyze tooth loss after root fractures and to assess the influence of the type of healing and the location of the root fracture. Furthermore, the actual cause of tooth loss was analyzed.......The purpose of this study was to analyze tooth loss after root fractures and to assess the influence of the type of healing and the location of the root fracture. Furthermore, the actual cause of tooth loss was analyzed....

  19. Type IIA Monteggia Fracture Dislocation with Ipsilateral Distal Radius Fracture in Adult – A Rare Association

    Science.gov (United States)

    James, Boblee

    2016-01-01

    Monteggia fracture constitutes about 5-10% of the forearm fractures. Monteggia fracture by definition is proximal ulnar fracture with disruption of proximal radioulnar joint. Bado classified Monteggia fracture dislocation into four types and Jupiter subclassified type II Bado’s fractures into four types. The associated injury in the form of distal radial fractures and distal humerus fractures are rare though many cases of distal radial physeal injuries have been reported in paediatric population. Hereby we report a rare association of type IIA Monteggia fracture dislocation with ipsilateral distal radius fracture in an adult patient. This case report also highlights on proper examination and full length radiographs of forearm to avoid missing injury at wrist in cases of elbow injuries. Management of such complex injuries included open reduction and internal fixation of olecronon fracture, distal radius fracture and radial head resection. Functional outcome at six months was good at wrist whereas at elbow, stiffness was a major concern with elbow range of movement from 40°-110°. PMID:27656518

  20. Stress Fractures

    Science.gov (United States)

    Stress fractures Overview Stress fractures are tiny cracks in a bone. They're caused by repetitive force, often from overuse — such as repeatedly jumping up and down or running long distances. Stress fractures can also arise from normal use of ...

  1. Galeazzi fractures: Is DRUJ instability predicted by current guidelines?

    Science.gov (United States)

    Tsismenakis, Tony; Tornetta, Paul

    2016-07-01

    Clinically significant distal radioulnar joint (DRUJ) injuries can occur with radial shaft fractures. Several radiographic methods of diagnosis, such as radial shortening of >5mm or fracture line within 7.5cm from the lunate facet, have been proposed but not clinically validated. The purpose of this study was to compare radiographic measurements of radial shaft fractures associated with and without clinically significant DRUJ injury (i.e., true Galeazzi fracture-dislocation) in order to evaluate the predictive value of reported parameters of DRUJ injury. A retrospective record and radiographic review was performed of 66 consecutive skeletally mature patients with isolated radial shaft fractures from 2004 to 2014 treated at one level 1 academic trauma center. Intraoperatively determined DRUJ instability after radial shaft fixation was used as the gold standard for diagnosis of a Galeazzi fracture-dislocation. Average age was 34 years old (range: 18-90). By thirds, there were 10 proximal (15%), 27 middle (41%), and 29 distal (44%) fractures. 13 (20%) had an associated ulnar styloid fracture. 7 (11%) patients had DRUJ instability after radial fixation. Radial shortening averaged 4.4±5.2mm (-2.6-22), and 21 had shortening of >5mm. Twenty-six (39%) fractures were within 7.5cm of the wrist joint. Previous guidelines were only moderately accurate. Even greater shortening did not predict instability (3/7 patients with >10mm shortening had a true injury). Four out of 7 cases with instability had ulnar styloid fractures (p=0.02). Using a larger data set than has historically been evaluated, previously reported radiographic guidelines are only moderately accurate. The presence of an ulnar styloid fracture can be helpful. Surgeons should be aware of these associations but rely primarily on intraoperative assessment of the DRUJ after radial fixation to determine treatment. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Fragility Fractures in Patients with Psoriatic Arthritis.

    Science.gov (United States)

    Del Puente, Antonio; Esposito, Antonella; Costa, Luisa; Benigno, Carla; Del Puente, Aurora; Foglia, Francesca; Oriente, Alfonso; Bottiglieri, Paolo; Caso, Francesco; Scarpa, Raffaele

    2015-11-01

    Psoriatic arthritis (PsA) can have peculiar effects on bone, including mechanisms of bone loss such as erosions, but also of bone formation, such as ankylosis or periostitis. The aim of the present study was to describe the prevalence of fractures in patients with PsA as compared to healthy controls and to investigate determinants of fractures among cases. For both cases and controls, radiographs were read to identify vertebral fractures (VF), and the presence of femoral neck or other nonvertebral fractures was obtained from patients' medical history. The prevalence of fragility fractures on radiographic readings did not differ between cases and controls. The number of subjects showing a VF was 33 (36%) among PsA patients and 36 (36%) among controls, with a prevalence of severe VF of 8% among cases and 4% among controls. Controlling for covariates in a logistic model, the only variables showing a significant correlation with the presence of nonvertebral fractures (NVF) were disease duration (p=0.02), age (p=0.03), and bone mineral density at femoral neck (inverse correlation, p=0.04). Fractures should be carefully considered when evaluating the global picture of the patient with PsA for their contribution to the "fragility" profile.

  3. Stress fractures in the lower extremity

    Energy Technology Data Exchange (ETDEWEB)

    Berger, Ferco H. [Academic Medical Center, University of Amsterdam, Department of Radiology, Meibergdreef 9, 1105 AZ Amsterdam (Netherlands); Jonge, Milko C. de [Academic Medical Center, University of Amsterdam, Department of Radiology, Meibergdreef 9, 1105 AZ Amsterdam (Netherlands); Maas, Mario [Academic Medical Center, University of Amsterdam, Department of Radiology, Meibergdreef 9, 1105 AZ Amsterdam (Netherlands)]. E-mail: m.maas@amc.uva.nl

    2007-04-15

    Stress fractures are fatigue injuries of bone usually caused by changes in training regimen in the population of military recruits and both professional and recreational athletes. Raised levels of sporting activity in today's population and refined imaging technologies have caused a rise in reported incidence of stress fractures in the past decades, now making up more than 10% of cases in a typical sports medicine practice. Background information (including etiology, epidemiology, clinical presentation and treatment and prevention) as well as state of the art imaging of stress fractures will be discussed to increase awareness amongst radiologists, providing the tools to play an important role in diagnosis and prognosis of stress fractures. Specific fracture sites in the lower extremity will be addressed, covering the far majority of stress fracture incidence. Proper communication between treating physician, physical therapist and radiologist is needed to obtain a high index of suspicion for this easily overlooked entity. Radiographs are not reliable for detection of stress fractures and radiologist should not falsely be comforted by them, which could result in delayed diagnosis and possibly permanent consequences for the patient. Although radiographs are mandatory to rule out differentials, they should be followed through when negative, preferably by magnetic resonance imaging (MRI), as this technique has proven to be superior to bone scintigraphy. CT can be beneficial in a limited number of patients, but should not be used routinely.

  4. Accuracy of Digital Subtraction Radiography in the Detection of Vertical Root Fractures.

    Science.gov (United States)

    Queiroz, Polyane Mazucatto; Nascimento, Helena Aguiar Ribeiro; da Paz, Thais Diniz Jacome; Anacleto, Felipe Nogueira; Freitas, Deborah Queiroz

    2016-06-01

    The objective of this study was to evaluate the accuracy of digital subtraction radiography in the diagnosis of vertical root fractures (VRFs). Twenty decoronated uniradicular human teeth were placed in the alveoli of a dry mandible and radiographed twice, first without (unfilled roots) and then with (filled roots) a gutta-percha cone placed into the root canal. Roots were then removed from the dry mandible, and vertical fractures were created with the aid of a universal testing machine. The fractured roots were repositioned in the mandibular alveoli and again radiographed twice. Radiographic images were subtracted by using the Regeemy software in 3 test situations: group 1, initial radiographic images of unfilled roots and images of fractured or non-fractured unfilled roots; group 2, initial radiographic images of unfilled roots and images of fractured or non-fractured filled roots; and group 3, initial radiographic images of filled roots and images of fractured or non-fractured filled roots. Three examiners evaluated all the original digital radiographs, as well as the subtracted images, for the presence or absence of VRFs. Numerical data were subject to statistical analysis with the use of receiver operator characteristic (ROC) curves. The areas under the ROC curve for groups 1, 2, and 3 were 0.86, 0.73, and 0.66, respectively. For the original digital radiographs, areas under the ROC curve were 0.80 (without gutta-percha) and 0.73 (with gutta-percha). No statistically significant differences were found between subtracted and original images. Digital subtraction radiography could be considered as an alternative tool for the investigation of VRFs because of its comparable diagnostic accuracy to existing methods. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  5. Material identification with multichannel radiographs

    Science.gov (United States)

    Collins, Noelle; Jimenez, Edward S.; Thompson, Kyle R.

    2017-02-01

    This work aims to validate previous exploratory work done to characterize materials by matching their attenuation profiles using a multichannel radiograph given an initial energy spectrum. The experiment was performed in order to evaluate the effects of noise on the resulting attenuation profiles, which was ignored in simulation. Spectrum measurements have also been collected from various materials of interest. Additionally, a MATLAB optimization algorithm has been applied to these candidate spectrum measurements in order to extract an estimate of the attenuation profile. Being able to characterize materials through this nondestructive method has an extensive range of applications for a wide variety of fields, including quality assessment, industry, and national security.

  6. Radiographic survey of perlite workers.

    Science.gov (United States)

    Cooper, W C

    1975-05-01

    Chest roentgenograms of 240 perlite workers employed for 1 to 23 years in the industry, showed no evidence of pneumoconiosis associated with perlite exposures. One individual, found to have simple pneumoconiosis, and one found to have complicated pneumoconiosis, had formerly been diatomaceous earth workers. Since only 28 of the men had been in the industry over 15 years and only seven for 20 years or more, continued surveillance is essential to make sure that there are no effects with more prolonged exposures. Studies of pulmonary function of the individuals who have had relatively long exposures are needed to supplement radiographic evidence.

  7. 3-dimensional analysis of scaphoid fracture angle morphology.

    Science.gov (United States)

    Luria, Shai; Schwarcz, Yonatan; Wollstein, Ronit; Emelife, Patrick; Zinger, Gershon; Peleg, Eran

    2015-03-01

    Scaphoid fractures are classified according to their 2-dimensional radiographic appearance, and transverse waist fractures are considered the most common. Our hypothesis was that most scaphoid fractures are not perpendicular to the longitudinal axis of the scaphoid (ie, not transverse). Computerized 3-dimensional analyses were performed on 124 computed tomography scans of acute scaphoid fractures. Thirty of the fractures were displaced and virtually reduced. The angle between the scaphoid's first principal axis (longitudinal axis) and the fracture plane was analyzed for location and displacement. The distal radius articular surface was used to depict the volar-dorsal vector of the wrist. There were 86 fractures of the waist, 13 of the distal third, and 25 of the proximal third. The average angle between the scaphoid longitudinal axis and the fracture plane was 53° for all fractures and 56° for waist fractures, both differing significantly from a 90°, transverse fracture. The majority of fracture planes were found to have a volar distal to dorsal proximal (horizontal oblique) inclination relative to the volar-dorsal vector. Most waist fractures were horizontal oblique and not transverse. According to these findings, fixation of all fractures along the longitudinal axis of the scaphoid may not be the optimal mode of fixation for most. A different approach may be needed in accordance with the fracture plane. Diagnostic II. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  8. Epidemiology of tibial shaft fractures

    Directory of Open Access Journals (Sweden)

    Grecco Marco Aurélio Sertório

    2002-01-01

    Full Text Available In this work an epidemiological analysis on tibial shaft fractures was performed. During four years, our service treated 179 fractures, 132 in male, 47 in female, aged 14 to 83 years. The 21 to 30-year-old patiens were the more injured. Of these, 120 were open and 59 close fractures of which prevailing cause was road traffic accident. The study based on patients promptuaries analyses and radiographs. The fractures occurred 97 times in the middle third (54.18%; 102 times (56.98% presented simple fragments, and 57 (31.38% oblique lines. We treated close and open fractures, respectively, 48 and 38 cases with plaster cast immobilization; 3 and 67 with external fixation after plaster cast immobilization; 5 and 12 with osteosynthesis by means of plate and screws, and 2 and 3 with external fixation only. In both close and open fractures, respectively, 7 and 20 cases of pseudarthrosis and 1 and 11 of infections have occurred. With the data obtained we verified an actual validity of the epidemiological studies as a contribution for better identifying lesions features and their treatment and complications. This allows proceedings and apprenticeship refinement.

  9. Assessment of Radiographic Image Quality by Visual Examination of Neutron Radiographs of the Calibration Fuel Pin

    DEFF Research Database (Denmark)

    Domanus, Joseph Czeslaw

    1986-01-01

    Up till now no reliable radiographic image quality standards exist for neutron radiography of nuclear reactor fuel. Under the Euratoro Neutron Radiography Working Group (NRWG) Test Program neutron radiographs were produced at different neutron radiography facilities within the European Community...... of a calibration fuel pin. The radiographs were made by the direct, transfer and tracketch methods using different film recording materials. These neutron radiographs of the calibration fuel pin were used for the assessement of radiographic image quality. This was done by visual examination of the radiographs...

  10. Imaging of implants on chest radiographs: a radiological perspective

    Energy Technology Data Exchange (ETDEWEB)

    Burney, K. [Department of Clinical Radiology, Bristol Royal Infirmary (United Kingdom)]. E-mail: kburney@doctors.org.uk; Thayur, N. [Department of Clinical Radiology, Bristol Royal Infirmary (United Kingdom); Husain, S.A. [Department of Respiratory Medicine, Bristol Royal Infirmary (United Kingdom); Martin, R.P. [Department of Cardiology, Bristol Royal Hospital for Children, Bristol (United Kingdom); Wilde, P. [Department of Clinical Radiology, Bristol Royal Infirmary (United Kingdom)

    2007-03-15

    Endovascular and percutaneous techniques have emerged as alternatives to surgical management in the treatment for a wide range of congenital and acquired cardiac, non-vascular and vascular conditions. Consequently, there has been an increasing use of implants such as closure devices, vascular stents (coronary, aortic, pulmonary and superior vena cava) and non-vascular stents like oesophageal and tracheo-bronchial stents. A large number of percutaneously sited implants are used for treating congenital cardiac anomalies such as atrial septal defects (ASD), ventricular septal defects (VSD), and patent ductus arteriosus (PDA). These implants take many shapes and forms. The aim of this review is to demonstrate the radiographic appearances of the various types of cardiovascular, bronchial and oesophageal implants that are visible on plain films. A brief outline of the aims and indications of various implant procedures, the general appearance of the commonest types of implants, and the radiological procedures are discussed. All radiologists are likely to come across implanted devices in plain film reporting. Imaging can be useful in identifying the device, assessing the position, integrity, and for the identification of complications related directly to the implant.

  11. Short-term Results of Muscle-Pedicle Bone Grafting with Tensor Fascia Lata for Delayed Femoral Neck Fractures; Case Series and Literature Review

    Science.gov (United States)

    Salgotra, Kuldip; Kohli, Sarabjeet; Vishwakarma, Nilesh

    2016-01-01

    Neglected, untreated and delayed femur neck fractures are commonly encountered and the treatment dilemma arises especially when the patient is physiologically young and osteosynthesis is the preferred option. Controversy exists in the current literature as the various head salvage surgeries like valgus subtrochanteric osteotomy, non-vascularized fibular bone grafting, muscle pedicle bone grafting (Tensor fascia lata and Quadratus femoris graft) and vascularized bone grafting do not have clear lines of indications. The current study is a case series of 7 patients with femur neck fractures with delayed presentation beyond the vascular emergency period who were treated with osteosynthesis with muscle pedicle bone graft (MPBG) using tensor fascia lata muscle pedicle graft. Patients were followed clinical and radiologically at 6 weeks, 3 and 6 months, 1 year and 3 years and patients were regularly followed. The mean age of the patients was 47 ± 1.1 ranging from 38 to 55 years. There were 6 (85.7%) men and 1 (14.3%) women among the patients. Overall 5 (71.5%) patients had transcervical and 2 (28.5%) had subcapital fractures. At the end of 6 months, 6 (85.7%) patients were pain free and on plain radiographs fracture union was noted. One (14.3%) patient developed collapse and persistent nonunion. Younger group less than 50 years presenting with neglected fracture neck femur should always be give an option of head salvage surgery in selected cases. Muscle pedicle bone grafting has been proven although inconsistently as a valid option for fracture neck femur. We encourage osteosynthesis with the use of tensor fascia lata muscle pedicle grafting along with cancellous cannulated screws as a first option in selected cases of neglected femur neck fractures. PMID:27331067

  12. Phalangeal bone mineral density predicts incident fractures

    DEFF Research Database (Denmark)

    Friis-Holmberg, Teresa; Brixen, Kim; Rubin, Katrine Hass

    2012-01-01

    This prospective study investigates the use of phalangeal bone mineral density (BMD) in predicting fractures in a cohort (15,542) who underwent a BMD scan. In both women and men, a decrease in BMD was associated with an increased risk of fracture when adjusted for age and prevalent fractures....... PURPOSE: The aim of this study was to evaluate the ability of a compact and portable scanner using radiographic absorptiometry (RA) to predict major osteoporotic fractures. METHODS: This prospective study included a cohort of 15,542 men and women aged 18-95 years, who underwent a BMD scan in Danish Health...... Examination Survey 2007-2008. BMD at the middle phalanges of the second, third and fourth digits of the non-dominant hand was measured using RA (Alara MetriScan®). These data were merged with information on incident fractures retrieved from the Danish National Patient Registry comprising the International...

  13. True oblique axis fracture associated with congenital anomalies of the upper cervical spine: Case report of an unusual fracture pattern

    Science.gov (United States)

    Robles, Luis A.

    2017-01-01

    Background: Acute traumatic axis fractures are common cervical spine injuries often caused by road accidents or falls. They are usually classified into three different types, namely, odontoid fractures, Hangman's fractures, and miscellaneous fractures. Congenital malformations of the craniovertebral junction (CVJ), although typically asymptomatic, may result in neural compression or instability, especially following trauma. Here, the authors present an unusual oblique axis fracture occurring in conjunction with several malformations of the upper cervical spine. Case Description: Following a motor vehicle accident, a 25-year-old female's radiographic studies showed an oblique axis fracture involving both the anterior and posterior elements along with an anterior and posterior Klippel–Feil syndrome (KFS) anomaly. Following treatment in a halo vest, the patient maintained alignment, and ultimately the fracture was fused. Conclusions: True oblique fractures of the axis are rare, as in the case presented, and may occasionally occur in conjunction with KFS of the upper cervical spine. PMID:28217386

  14. Prognostic radiographic aspects of spondylolisthesis

    Energy Technology Data Exchange (ETDEWEB)

    Saraste, H.; Brostroem, L.A.; Aparisi, T.

    1984-01-01

    A series of 202 patients (133 men, 69 women) with lumbar spondylolysis were examined radiographically on two occasions, first at the time of diagnosis and later at a follow-up, after an observation period of 20 years or more. The films from patients in groups without and with moderate and severe olisthesis were evaluated with respect to variables describing lumbosacral lordosis, wedging of the spondylolytic vertebra, lengths of the transverse processes and iliolumbar ligaments, disk height, progression of slipping, and influence on measured olisthesis of lumbar spine flexion and extension at the radiographic examination. The evaluation was made with special attention to possible signs which could be predictive for the prognosis of vertebral slipping. Progression of slipping did not differ between patients diagnosed as adults or adolescents. Reduction of disk height was correlated to the degree of slipping present at the initial examination and to the progression of olisthesis. Flexion and extension of the lumbar spine did not modify the degree of olisthesis. Data concerning the lengths of the transverse processes and the iliolumbar ligaments, and lumbar lordosis, cannot be used for prognostic purposes. The lumbar index reflecting the degree of wedge deformity of the spondylolytic vertebra was shown to be the only variable of prognostic value for the development of vertebral slipping.

  15. Clinical Risk Factors for the Presence and Development of Vertebral Fractures in Patients With Ankylosing Spondylitis

    NARCIS (Netherlands)

    Maas, Fiona; Spoorenberg, Anneke; van der Slik, Boukje P. G.; van der Veer, Eveline; Brouwer, Elisabeth; Bootsma, Hendrika; Bos, Reinhard; Wink, Freke R.; Arends, Suzanne

    IntroductionTo investigate the prevalence and incidence of radiographic vertebral fractures and the association with patient characteristics, clinical assessments, and medication use in a large prospective cohort of patients with ankylosing spondylitis (AS) in daily clinical practice.

  16. Recognizing and reporting vertebral fractures: reducing the risk of future osteoporotic fractures

    Energy Technology Data Exchange (ETDEWEB)

    Lentle, B.C. [Univ. of British Columbia, Dept. of Radiology, Vancouver, British Columbia (Canada); Brown, J.P. [Laval Univ., Dept. of Medicine, Sainte-Foy, Quebec (Canada); Khan, A. [McMaster Univ., Dept. of Medicine, Hamilton, Ontario (Canada)]. E-mail: blentle@shaw.ca (and others)

    2007-02-15

    Given the increasing evidence that vertebral fractures are underdiagnosed and not acted on, Osteoporosis Canada and the Canadian Association of Radiologists initiated a project to develop and publish a set of recommendations to promote and facilitate the diagnosis and reporting of vertebral fractures. The identification of spinal fractures is not uniform. More than 65% of vertebral fractures cause no symptoms. It is also apparent that vertebral fractures are inadequately recognized when the opportunity for diagnosis arises fortuitously. It is to patients' benefit that radiologists report vertebral fractures evident on a chest or other radiograph, no matter how incidental to the immediate clinical indication for the examination. The present recommendations can help to close the gap in care in recognizing and treating vertebral fractures, to prevent future fractures and thus reduce the burden of osteoporosis-related morbidity and mortality, as well as fracture-related costs to the health care system. Several studies indicate that a gap exists in regard to the diagnosis of vertebral fractures and the clinical response following such diagnosis. All recommendations presented here are based on consensus. These recommendations were developed by a multidisciplinary working group under the auspices of the Scientific Advisory Council of Osteoporosis Canada and the Canadian Association of Radiologists. Prevalent vertebral fractures have important clinical implications in terms of future fracture risk. Recognizing and reporting fractures incidental to radiologic examinations done for other reasons has the potential to reduce health care costs by initiating further steps in osteoporosis diagnosis and appropriate therapy. Physicians should be aware of the importance of vertebral fracture diagnosis in assessing future osteoporotic fracture risk. Vertebral fractures incidental to radiologic examinations done for other reasons should be identified and reported. Vertebral

  17. Specific yield, High Plains aquifer

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This raster data set represents specific-yield ranges in the High Plains aquifer of the United States. The High Plains aquifer underlies 112.6 million acres (176,000...

  18. Vertebral Geometry Parameters Can Predict Fractures

    Directory of Open Access Journals (Sweden)

    P Tofighi

    2007-08-01

    Full Text Available Background: The aim of this study was to investigate vertebral geometry changes and determine cutoff value of vertebral height to predict fractures. Methods: In a cross-sectional study, 280 postmenopausal women recruited .In all subjects bone mineral density and radiog¬raphy of the lumbar spine performed. Lateral radiographs were evaluated for identification of vertebral fractures, using a validated semiquantitative method. T-score of vertebral height was calculated based on data extracted from Iranian Multi¬center Osteoporosis Study. ROC curve used to determine cut off value of vertebral height T-score to predict fractures. Results: The mean of age and BMI were 55.34±8.7 years and 27.73±5 kg/m2, respectively. Among osteoporotic women, 59.8% had one or more vertebral fractures and 23.8% had at least 2 fractures. In fracture group the T-score of spine and femur BMD was lower than the others. The mean of vertebral height in women without fractures was 12.94±0.6 cm, and in the patient with 4 or more fractures was12.3, thus every fracture accompany with 1.2% decreases in the height of vertebrae. The prevalence of vertebral fracture in osteoporotic patients was 71.4% and in healthy cases 39.5%. Better estimation of vertebral height T score in ROC curve was less than -0.7.The sensitivity and specificity of the cut off value were 81.3% and 52.9%, respectively. Conclusion: Vertebral fractures are common fractures in postmenopausal women. There was a correlation between verte¬bral height and fractures. Vertebral geometric parameters especially height T score can be used for fracture screening.

  19. A radiographic analysis of implant component misfit.

    LENUS (Irish Health Repository)

    Sharkey, Seamus

    2011-07-01

    Radiographs are commonly used to assess the fit of implant components, but there is no clear agreement on the amount of misfit that can be detected by this method. This study investigated the effect of gap size and the relative angle at which a radiograph was taken on the detection of component misfit. Different types of implant connections (internal or external) and radiographic modalities (film or digital) were assessed.

  20. Fracture healing: direct magnification versus conventional radiography

    Energy Technology Data Exchange (ETDEWEB)

    Link, T.M. [Dept. of Clinical Radiology, Westfaelische Wilhelms-Univ., Muenster (Germany); Kessler, T. [Dept. of Traumatic and Hand Surgery, Westfaelische Wilhelms-Univ., Muenster (Germany); Lange, T. [Dept. of Clinical Radiology, Westfaelische Wilhelms-Univ., Muenster (Germany); Overbeck, J. [Dept. of Traumatic and Hand Surgery, Westfaelische Wilhelms-Univ., Muenster (Germany); Fiebich, M. [Dept. of Clinical Radiology, Westfaelische Wilhelms-Univ., Muenster (Germany); Peters, P.E. [Dept. of Clinical Radiology, Westfaelische Wilhelms-Univ., Muenster (Germany)

    1994-08-01

    The aim of the study was to evaluate the potential of magnification radiography in diagnosing fracture healing and assessing its complications. Seventy-three patients with fractures or who had undergone osteotomy were radiographed with both conventional (non-magnified) and magnification (5-fold) techniques. Since 10 patients were radiographed twice and 1 three times, 83 radiographs using each technique were obtained. All radiographs were analysed and the findings correlated with the patients` follow-up studies. The microfocal X-ray unit used for magnification radiography had a focal spot size of 20-130 {mu}m. As an imaging system, digital luminescence radiography was employed with magnification, while normal film-screen systems were used with conventional radiography. Magnification radiography proved superior to conventional radiography in 47% of cases: endosteal and periosteal callus formations were seen earlier and better in 26 cases, and osseous union could be evaluated with greater certainty in 33 cases. In 49% of cases magnification radiography was equal and in 4% inferior to conventional radiography. Additionally an ``inter-observer analysis`` was carried out. Anatomical and pathological structures were classified into one of four grades. Results were significantly (P < 0.01) better using magnification radiography. We conclude that the magnification technique is a good method for monitoring fracture healing in its early stages. (orig.)

  1. Radiographic examination for successful dental implant

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sam Sun; Choi, Soon Chul [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2005-06-15

    Recently implant has become an important field in dental clinic. Radiographic examination of pre- and post-operation is essential for successful treatment. Clinicians should have knowledge about the purpose of the radiographic examination, suitable imaging modality for the cases, anatomic landmarks of tooth and jaw bone, advantage and limitation of panoramic radiographic examination for implant, principle and interpretation of cross-sectional imaging, bone mineral density, post-operative radiographic examination. This paper will be helpful to get above information for dentists who want to do dental implant successfully.

  2. Reference Neutron Radiographs of Nuclear Reactor Fuel

    DEFF Research Database (Denmark)

    Domanus, Joseph Czeslaw

    1986-01-01

    Reference neutron radiographs of nuclear reactor fuel were produced by the Euraton Neutron Radiography Working Group and published in 1984 by the Reidel Publishing Company. In this collection a classification is given of the various neutron radiographic findings, that can occur in different parts...... of pelletized, annular and vibro-conpacted nuclear fuel pins. Those parts of the pins are shown where changes of appearance differ from those for the parts as fabricated. Also radiographs of those as fabricated parts are included. The collection contains 158 neutron radiographs, reproduced on photographic paper...

  3. Measurement of hemothorax amount in patients with non-penetrating chest trauma by supine chest AP radiograph

    Energy Technology Data Exchange (ETDEWEB)

    Han, Heon; Yang, Joo Hyun; Na, Myung Hoon; Baik, Hee Jong [Chung-Ang Gil Hospital, Incheon (Korea, Republic of)

    1994-10-15

    To evaluate the predictability of amount of hemothorax in the patients with blunt chest trauma, supine chest AP radiographs of 66 patients were reviewed and statistically analyzed. In 66 patients, rib fractures were present in 53 patients, hemothorax in 46 patients, pneumothorax in 25 patients, and pulmonary contusions in 18 patients. Width and length of hemothorax were measured on supine chest AP radiograph, and were correlated with known drained amount of hemothorax. The presence and number of rib fracture, pulmonary contusion, subcutaneous emphysema, fracture of scapula and clavicle, and total opacification of hemithorax were also correlated with the drained amount of hemothorax. In multiple logistic regression analysis, width of hemothorax had the highest correlation with drained amount of hemothorax(regression coeffcient 0.718, p value 0.00005). The presence and number of rib fracture, scapular fracture, subcutaneous emphysema were also correlated with drained amount of hemothorax. But length of hemothorax, pulmonary contusion, clavicular fracture, total opacification of hemithorax were not correlated with drained amount of hemothorax. Measured width of hemothorax in supine chest AP radiograph is the most reliable predictor for estimation of the amount of hemothorax, and may also be used as an indication for the application of closed thoracostomy in the treatment of hemothorax.

  4. The factors influencing the decision making of operative treatment for proximal humeral fractures

    NARCIS (Netherlands)

    Hageman, M.G.; Jayakumar, P.; King, J.D.; Guitton, T.G.; Doornberg, J.N.; Ring, D.; Poelhekke, L.M.S.J.

    2015-01-01

    BACKGROUND: The factors influencing the decision making of operative treatment for fractures of the proximal humerus are debated. We hypothesized that there is no difference in treatment recommendations between surgeons shown radiographs alone and those shown radiographs and patient information. Sec

  5. Use of an acrylic mold for mortise view improvement in ankle fractures: a feasibility study

    NARCIS (Netherlands)

    Donken, C.C.; Verhofstad, M.H.J.; Edwards, M.J.R.; Schoemaker, M.C.; Laarhoven, C.J.H.M. van

    2011-01-01

    We investigated an acrylic mold for use in obtaining ankle radiographs in 31 consecutive patients with ankle fracture. The radiologic examination consisted of routine lateral and mortise views, with the same views procured with the use of the acrylic mold to position the ankle. Radiographic evidence

  6. Use of an acrylic mold for mortise view improvement in ankle fractures: a feasibility study

    NARCIS (Netherlands)

    Donken, C.C.; Verhofstad, M.H.J.; Edwards, M.J.R.; Schoemaker, M.C.; Laarhoven, C.J.H.M. van

    2011-01-01

    We investigated an acrylic mold for use in obtaining ankle radiographs in 31 consecutive patients with ankle fracture. The radiologic examination consisted of routine lateral and mortise views, with the same views procured with the use of the acrylic mold to position the ankle. Radiographic evidence

  7. Thrombin related peptide TP508 promoted fracture repair in a mouse high energy fracture model

    Directory of Open Access Journals (Sweden)

    Pan Xiao-Hua

    2009-01-01

    Full Text Available Abstract Background Thrombin related peptide (TP508 is a 23 amino-acid synthetic peptide that represents a portion of the receptor-binding domain of thrombin molecule. Previous studies have shown that TP508 can accelerate musculoskeletal tissue repair including fracture healing. Objectives The aim of this study was to investigate the effect of TP508 on fracture healing in a murine fracture model representing high energy fracture situation. Methods Eighty CD 1 mice underwent controlled quadriceps muscle crush and open transverse mid diaphyseal femoral fracture that was then fixed with an external fixator. Animals were randomised into four groups to receive an intra-operative dose of either 100 μg TP508 into the fracture gap; 100 μg TP508 into the surrounding damaged muscle tissues; 10 μg TP508 into the fracture gap, or control equal amount of saline into the fracture gap. Radiographic assessment was performed weekly for 5 weeks; histological analysis was at 3 and 5 weeks post fracture and biomechanical testing of the fractured bone was performed at 5 weeks post fracture. Results Mechanical testing data showed that the fracture stiffness was significantly higher in the group receiving 100 μg TP508 into the fracture gap than other groups. Histological and radiographic analysis revealed a trend of increase in bone formation in the 100 μg TP508 injected into the fracture gap group compared to the saline control group. It was noted that the scar tissues was significantly less in Group II comparing with the saline control group and there was increased blood vessel formation in the crushed muscles and fracture gap areas in the groups receiving TP508 comparing to the saline control group. Conclusion The results from this study demonstrated the use of thrombin related peptide TP508 in the situation of a high energy fracture can promote fracture healing and reduce the potential complications such as muscle fibrosis and fracture delayed or non-union.

  8. Iliac hyperdense line: a new radiographic sign of gluteal muscle contracture

    Energy Technology Data Exchange (ETDEWEB)

    Cai, Jin-Hua; Gan, Lan-Feng; Zheng, He-Lin; Li, Hao [Chongqing Medical University, Department of Radiology, Children' s Hospital, Chongqing (China)

    2005-10-01

    A hyperdense line on the ilium that runs roughly parallel to the sacroiliac joint (we called it ''iliac hyperdense line sign'') was frequently observed on pelvic radiographs of patients with gluteal muscle contracture (GMC). A literature search revealed no description of this sign. To determine the relationship between the iliac hyperdense line sign and GMC and to explore how this sign is formed. Pelvic plain films of 103 cases of GMC and those of 200 control individuals were reviewed for the presence or absence of the iliac hyperdense line sign. Pelvic CT scans in 8 of 103 cases and 13 of 200 controls were analyzed with relation to the plain films. The iliac hyperdense line sign was visualized in 85 of 103 (82.5%) cases of GMC and none of the 200 controls. In the GMC group, pelvic CT scans showed a deformity of the posterior ilium. The lateral cortex of the posterior ilium took on a partly or completely anteroposterior course, while in the control group the course appeared as an oblique orientation from posteromedial to anterolateral. The iliac hyperdense line on pelvic plain film can be used as a radiographic sign to suggest a diagnosis of GMC. This sign might be a result of the long and persistent pulling effect of the contracted gluteus maximus muscle, which deforms the lateral cortex of the posterior ilium from an oblique course to an anteroposterior course tangential to the X-ray beam. (orig.)

  9. Distal fibula fracture diagnosed with ultrasound imaging.

    Science.gov (United States)

    Kardouni, Joseph R

    2012-10-01

    The patient was a 31-year-old man serving in a military special forces unit at a remote location. He presented to a physical therapist with a chief complaint of worsening right lateral ankle pain that limited his ability to bear weight. Because the patient met the Ottawa ankle rules and there was concern for a fracture, radiographs were indicated. However, the nearest facility with radiographic capabilities was only available through air medical evacuation. Therefore, the physical therapist assessed the patient's ankle with an onsite portable ultrasound imaging unit, which demonstrated cortical irregularity along the distal fibula.

  10. [Acetabular fractures].

    Science.gov (United States)

    Gänsslen, A; Oestern, H J

    2011-12-01

    Treatment of acetabular fractures requires extensive knowledge of the bony anatomy, the amount of possible exposure of the bone with the selected approaches and fracture type-dependent indications of operative treatment. Classification of the fracture with detailed analysis of the fracture morphology is the basis for decision making and planning. The primary treatment aim is the anatomic reconstruction of the acetabulum which results in optimal long-term results.The basis of this overview is the presentation of standard treatment concepts in acetabular fracture surgery. Beside characteristics of the acetabular bony anatomy, biomechanical and pathomechanical principles and the relevant radiological anatomy, the treatment options, both conservative and operative and basic principles of the indications for standard surgical approaches will be discussed.The special fracture type is discussed in detail regarding incidence, injury mechanism, concomitant injuries, options for conservative and operative treatment, quality of operative reduction and long-term results.Furthermore, epidemiological data on typical postoperative complications are evaluated.

  11. Double Plating of Distal Fibula Fractures.

    Science.gov (United States)

    Vance, Danica D; Vosseller, J Turner

    2017-02-01

    Distal fibula fractures are common orthopaedic injuries that often require open reduction internal fixation (ORIF) to anatomically reduce the fracture and minimize the risk of posttraumatic arthritis. In certain clinical situations, stouter fixation may be advantageous to decrease the risk of fixation failure. In this study, the authors report on 12 patients who underwent distal fibula ORIF with 2 one-third tubular plates. Twelve consecutive patients who underwent distal fibula ORIF with 2 one-third tubular plates were retrospectively reviewed. Clinical and radiographic outcomes were reviewed, and functional outcomes were obtained using the Foot and Ankle Outcome Score (FAOS). Institutional review board approval was obtained. All 12 fractures healed clinically and radiographically. One patient was lost to follow-up after healing of the fracture. One patient had removal of fibular hardware at 15 months after surgery. Ten patients had no hardware related pain and good ankle function. FAOS scores were obtained at a mean of 25.6 months after surgery and were as follows: pain (87.6, SD = 9.5), activities of daily living (90.4, SD = 14.5), symptoms (93.3, SD = 9.5), sports (89.5, SD = 18.1), and quality of life (57.4, SD = 21.3). Double plating of distal fibula fractures is a viable technique for problem fractures that potentially provides a readily accessible, low-cost alternative to other means of enhancing fixation. Level IV.

  12. Gout: radiographic findings mimicking infection

    Energy Technology Data Exchange (ETDEWEB)

    Rousseau, I.; Raymond-Tremblay, D. [Dept. of Diagnostic Radiology, Centre Hospitalier de l' Univ. de Montreal, Que. (Canada); Cardinal, E. [Dept. of Radiology, Centre Hospitalier de l' Univ. de Montreal, Que. (Canada); Beauregard, C.G. [Dept. of Diagnostic Radiology, Hopital du Sacre-Coeur de Montreal,Que. (Canada); Braunstein, E.M. [Dept. of Radiology, Indiana University Hospital (United States); Saint-Pierre, A. [Rheumatology Unit, Centre Hospitalier de l' Univ. de Montreal, Que. (Canada)

    2001-10-01

    Objective: To describe radiographic features of gout that may mimic infection. Design and patients: We report five patients with acute bacterial gout who presented with clinical as well as radiological findings mimicking acute bacterial septic arthritis or osteomyelitis. Three patients had delay in the appropriate treatment with the final diagnosis being established after needle aspiration and identification of urate crystals under polarized light microscopy. Two patients underwent digit amputation for not responding to antibiotic treatment and had histological findings confirming the diagnosis of gout. Conclusion: It is important for the radiologist to be aware of the radiological manifestations of acute gout that can resemble infection in order to avoid inappropriate diagnosis and delay in adequate treatment. The definitive diagnosis should rely on needle aspiration and a specific search for urate crystals. (orig.)

  13. Radiographic study of the odontoma

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Hyung Kyu [Department of Oral Radiology, College of Dentistry, Seoul National University, Seoul (Korea, Republic of)

    1983-11-15

    The author studied clinically and radiologically 55 cases which had been diagnosed as odontoma in SNUDH. The obtained results were as follows: 1. In sex distribution, there was no prevalence in both sexes. And the incidence was the highest in the 2nd decade (16 patient, 29%). 2. There were 42 cases of compound odontoma (76%) and 13 cases of complex odontoma (24%). In most cases, compound odontoma was located at the anterior portion (34 cases, 81%) and complex odontoma at the posterior portions (9 cases, 69%). 3. There was no apparent clinical symptom in compound odontoma (83%), but in complex odontoma, 80% of cases show swelling. 4. The adjacent root resorption was not observed in any case. 5. Five cases radiographically diagnosed as cystic odontoma were not confirmed histopathologically.

  14. Biological Plating in Comminuted Subtrochanteric Fractures

    Directory of Open Access Journals (Sweden)

    MR Aghamirsalim

    2012-05-01

    Full Text Available Background: Comminuted subtrochanteric fractures have been a challenge for orthopedic surgeons in terms of appropriate reduction and stable fixation. Numerous methods have been used for the fixation of comminuted subtrochanteric fractures among which some are accompanied with technical difficulties and complications of their own. Regarding the results of previous studies, we decided to evaluate the biological fixation method in comminuted subtrochanteric fractures. Methods: In this prospective study, we evaluated 20 men with comminuted subtrochanteric femoral fractures. The patients underwent indirect reduction with dynamic hip screw (DHS or dynamic condylar screw (DCS fixation within one week of injury. The patients were evaluated clinically for pain, hip and knee range of motion, leg-length discrepancy and angular and rotational deformities, in addition the radiographic assessment of the union. Results: According to Seinsheimer's classification of subtrochanteric fractures, four patients had type III, nine had type IV and seven had type V fractures. Fracture fixation was performed by DCS in eight and by DHS in 12 cases. The average time of the operations was 79.4 (ranging from 60-125 minutes. Mean blood loss was 634 (ranging from 340-1160 milliliters. Uneventfully, union occurred in all patients with no clinical pain or dysfunction. Conclusion: Submuscular plating with either DCS or DHS is a viable option to treat comminuted subtrochanteric fractures. The results of this study highly suggest use of submuscular plating in the treatment of comminuted subtrochanteric fractures, especially in the third world countries.

  15. Sports fractures.

    OpenAIRE

    DeCoster, T. A.; Stevens, M. A.; Albright, J. P.

    1994-01-01

    Fractures occur in athletes and dramatically influence performance during competitive and recreational activities. Fractures occur in athletes as the result of repetitive stress, acute sports-related trauma and trauma outside of athletics. The literature provides general guidelines for treatment as well as a variety of statistics on the epidemiology of fractures by sport and level of participation. Athletes are healthy and motivated patients, and have high expectations regarding their level o...

  16. Hamate fractures.

    Science.gov (United States)

    Sarabia Condés, J M; Ibañez Martínez, L; Sánchez Carrasco, M A; Carrillo Julia, F J; Salmerón Martínez, E L

    2015-01-01

    The purpose of this paper is to present our experience in the treatment of the fractures of the hamate and to make a review of the literature on this topic. We retrospectively reviewed 10 patients treated in our clinic between 2005-2012 suffering from fractures of the hamate. Six cases were fractures of the body and four were fractures of the hamate. Five cases were of associated injuries. Diagnostic delay ranged from 30 days to 2 years. Patient follow-up ranged from 1 to 10 years. Patient satisfaction was evaluated using the DASH questionnaire. Five patients with a fracture of the body underwent surgery, and one was treated conservatively. Two patients with fracture of the hook of the hamate were treated with immobilization, and two more patients had the fragment removed. The grip strength and the digital clip were reduced in 2 cases. Flexion and extension of the wrist was limited in 3 cases. The mobility of the fingers was normal in all the cases, except in one. The results obtained from the DASH questionnaire were normal in all the cases, except in one case of fracture of the hamate, and in two cases of fracture of the body. The surgical treatment should reduce the dislocation and stabilize the injuries with osteosynthesis. The fractures of the hamate are usually diagnosed late, and the most recommended treatment is removal of the fragment, although it cannot be deduced from this study. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  17. Colles Fracture

    OpenAIRE

    Sánchez León, Belisario; Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú

    2014-01-01

    Our expertise is the study of more than 2,000 cases of Colles' fractures. Colles name should in this case to synthesize the type of fractures of the lower end of the radius. There have been various proposed classifications according to the different fracture lines can be demonstrated radiologically in the region of the wrist. We believe that these ratings should only be retained if the concept of the articular fracture or not in the classical sense, since it has great value in the functional ...

  18. Pneumothorax Caused by an Isolated Midshaft Clavicle Fracture

    Directory of Open Access Journals (Sweden)

    Najla Feriani

    2016-01-01

    Full Text Available Patients with isolated clavicle fractures are frequent in the emergency department. However, unusual clavicle fractures complications, such as pneumothorax, are rare. Previous reports indicated that all pneumothorax cases were treated via performing thoracostomy. Conservatively, the treatment of the clavicle fracture, like in our case, was successful. Despite the fact that isolated clavicle fractures rarely cause complications and generally heal with immobilization, serious complications may occur requiring urgent treatment. It has been proven that physical examinations, with particular attention to the neurovascular and chest examinations, and radiographs of the clavicle are necessary to prevent overlooking these potentially dangerous complications.

  19. Radiographic simulations and analysis for ASCI

    Energy Technology Data Exchange (ETDEWEB)

    Aufderheide, M.; Stone, D.; VonWittenau, A.

    1998-12-18

    In this paper, the authors describe their work on developing quantitatively accurate radiographic simulation and analysis tools for ASCI hydro codes. they have extended the ability of HADES, the code which simulates radiography through a mesh, to treat the complex meshes used in ASCI calculations. The ultimate goal is to allow direct comparison between experimental radiographs and full physics simulated radiographs of ASCI calculations. They describe the ray-tracing algorithm they have developed for fast, accurate simulation of dynamic radiographs with the meshes used in ALE3D, an LLNL ASCI code. Spectral effects and material compositions are included. In addition to the newness of the mesh types, the distributed nature of domain decomposed problems requires special treatment by the radiographic code. Because of the size of such problems, they have parallelized the radiographic simulation, in order to have quick turnaround time. presently, this is done using the domain decomposition from the hydro code. They demonstrate good parallel scaling as the size of the problem is increased. They show a comparison between an experimental radiograph of a high explosive detonation and a simulated radiograph of an ALE3D calculation. They conclude with a discussion of future work.

  20. Automatic cobb angle determination from radiographic images

    NARCIS (Netherlands)

    Sardjono, Tri Arief; Wilkinson, Michael H.F.; Veldhuizen, Albert G.; Ooijen, van Peter M.A.; Purnama, Ketut E.; Verkerke, Gijsbertus J.

    2013-01-01

    Study Design. Automatic measurement of Cobb angle in patients with scoliosis. Objective. To test the accuracy of an automatic Cobb angle determination method from frontal radiographical images. Summary of Background Data. Thirty-six frontal radiographical images of patients with scoliosis. Met

  1. Automatic Cobb Angle Determination From Radiographic Images

    NARCIS (Netherlands)

    Sardjono, Tri Arief; Wilkinson, Michael H. F.; Veldhuizen, Albert G.; van Ooijen, Peter M. A.; Purnama, Ketut E.; Verkerke, Gijsbertus J.

    2013-01-01

    Study Design. Automatic measurement of Cobb angle in patients with scoliosis. Objective. To test the accuracy of an automatic Cobb angle determination method from frontal radiographical images. Summary of Background Data. Thirty-six frontal radiographical images of patients with scoliosis. Methods.

  2. Automatic cobb angle determination from radiographic images

    NARCIS (Netherlands)

    Sardjono, Tri Arief; Wilkinson, Michael H.F.; Veldhuizen, Albert G.; van Ooijen, Peter M.A.; Purnama, Ketut E.; Verkerke, Gijsbertus Jacob

    2013-01-01

    Study Design. Automatic measurement of Cobb angle in patients with scoliosis. Objective. To test the accuracy of an automatic Cobb angle determination method from frontal radiographical images. Summary of Background Data. Thirty-six frontal radiographical images of patients with scoliosis. Methods.

  3. Chest radiographic findings in acute paraquat poisoning

    Energy Technology Data Exchange (ETDEWEB)

    Na, Gyeong Gyun; Lee, Mi Sook; Kim, Hee Jun; Sun, In O [Presbyterian Medical Center, Jeonju (Korea, Republic of)

    2016-01-15

    To describe the chest radiographic findings of acute paraquat poisoning. 691 patients visited the emergency department of our hospital between January 2006 and October 2012 for paraquat poisoning. Of these 691, we identified 56 patients whose initial chest radiographs were normal but who developed radiographic abnormalities within one week. We evaluated their radiographic findings and the differences in imaging features based on mortality. The most common finding was diffuse consolidation (29/56, 52%), followed by consolidation with linear and nodular opacities (18/56, 32%), and combined consolidation and pneumomediastinum (7/56, 13%). Pleural effusion was noted in 17 patients (30%). The two survivors (4%) showed peripheral consolidations, while the 54 patients (96%) who died demonstrated bilateral (42/54, 78%) or unilateral (12/54, 22%) diffuse consolidations. Rapidly progressing diffuse pulmonary consolidation was observed within one week on follow-up radiographs after paraquat ingestion in the deceased, but the survivors demonstrated peripheral consolidation.

  4. Missed Medial Malleolar Fracture Associated With Achilles Tendon Rupture: A Case Report and Literature Review.

    Science.gov (United States)

    Nakajima, Koji; Taketomi, Shuji; Inui, Hiroshi; Nakamura, Kensuke; Sanada, Takaki; Tanaka, Sakae

    2016-01-01

    A 45-year-old man sustained an Achilles tendon rupture while playing futsal. A concomitant medial malleolar fracture was not diagnosed until the patient underwent an operation for Achilles tendon repair. A routine postoperative radiograph showed a minimally displaced medial malleolar fracture. Conservative treatment was chosen for the fracture. The function of the Achilles tendon recovered well, and the fracture was united. A medial malleolar fracture can be missed when an Achilles tendon rupture occurs simultaneously. Thus, surgeons should consider the possibility of medial malleolar fracture associated with an Achilles tendon rupture. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Computer-aided system for measuring the mandibular cortical width on panoramic radiographs in osteoporosis diagnosis

    Science.gov (United States)

    Arifin, Agus Zainal; Asano, Akira; Taguchi, Akira; Nakamoto, Takashi; Ohtsuka, Masahiko; Tanimoto, Keiji

    2005-04-01

    Osteoporotic fractures are associated with substantial morbidity, increased medical cost and high mortality risk. Several equipments of bone assessment have been developed to identify individuals, especially postmenopausal women, with high risk of osteoporotic fracture; however, a large segment of women with low skeletal bone mineral density (BMD), namely women with high risk of osteoporotic fractures, cannot be identified sufficiently because osteoporosis is asymptomatic. Recent studies have been demonstrating that mandibular inferior cortical width manually measured on panoramic radiographs may be useful for the identification of women with low BMD. Automatic measurement of cortical width may enable us to identify a large number of asymptomatic women with low BMD. The purpose of this study was to develop a computer-aided system for measuring the mandibular cortical width on panoramic radiographs. Initially, oral radiologists determined the region of interest based on the position of mental foramen. Some enhancing image techniques were applied so as to measure the cortical width at the best point. Panoramic radiographs of 100 women who had BMD assessments of the lumbar spine and femoral neck were used to confirm the efficacy of our new system. Cortical width measured with our system was compared with skeletal BMD. There were significant correlation between cortical width measured with our system and skeletal BMD. These correlations were similar with those between cortical width manually measured by the dentist and skeletal BMD. Our results suggest that our new system may be useful for mass screening of osteoporosis.

  6. Southeastern Coastal Plain aquifer system

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This data set represents the extent of the Southeastern Coastal Plain aquifer system in Kentucky, Tennessee, Mississippi, Alabama, Georgia, and South Carolina.

  7. An occult cervical spine fracture.

    Science.gov (United States)

    Khosla, R

    1997-12-01

    A 16-year-old athlete developed neck pain after being dropped on his head with his neck flexed while recreationally wrestling. Initial cervical spine radiographs were negative, but he continued to have neck and arm pain, especially after heading a wet soccer ball. Two months after the initial injury, he had a positive Spurling test; cervical spine CT then revealed a parasagittal linear fracture through the body of C-7. The patient avoided contact and collision activities and had no further physical problems. For patients who suffer cervical spine trauma, adequate visualization of the cervical spine can help prevent catastrophic outcomes.

  8. Fracture Mechanics

    CERN Document Server

    Zehnder, Alan T

    2012-01-01

    Fracture mechanics is a vast and growing field. This book develops the basic elements needed for both fracture research and engineering practice. The emphasis is on continuum mechanics models for energy flows and crack-tip stress- and deformation fields in elastic and elastic-plastic materials. In addition to a brief discussion of computational fracture methods, the text includes practical sections on fracture criteria, fracture toughness testing, and methods for measuring stress intensity factors and energy release rates. Class-tested at Cornell, this book is designed for students, researchers and practitioners interested in understanding and contributing to a diverse and vital field of knowledge. Alan Zehnder joined the faculty at Cornell University in 1988. Since then he has served in a number of leadership roles including Chair of the Department of Theoretical and Applied Mechanics, and Director of the Sibley School of Mechanical and Aerospace Engineering.  He teaches applied mechanics and his research t...

  9. Imaging suspected cervical spine injury: Plain radiography or computed tomography? Systematic review

    Energy Technology Data Exchange (ETDEWEB)

    Cain, Gavin [Diagnostic Radiographer, Colchester Hospital University NHS Foundation Trust, Colchester General Hospital, Turner Road, Colchester, CO4 5JL Essex (United Kingdom)], E-mail: gavincain8@hotmail.com; Shepherdson, Jane; Elliott, Vicki; Svensson, Jon [Faculty of Health and Social Care, Anglia Ruskin University, East Road, Cambridge, CB1 9PT Cambridgeshire (United Kingdom); Brennan, Patrick [UCD School of Medicine and Medical Sciences, Health Science Building, Belfield, Dublin 4 (Ireland)

    2010-02-15

    Aim: (1) to establish which modality offers the greatest accuracy in the detection of cervical spine injury (CSI) Following trauma: plain radiography or computed tomography (CT), and (2) make an evidence-based recommendation for the initial imaging modality of choice. Method: A systematic literature review was performed to identify primary research studies which compare the diagnostic accuracy of plain radiography and CT with the results of a reference standard in the detection of CSI. A search of MEDLINE, EMBASE, CINAHL, Science Direct and Pubmed Central databases was conducted. Results: Ten studies were identified. Critical appraisal identified limitations among all studies. There was heterogeneity in the sensitivity estimates for plain radiography, whereas estimates for CT were consistently high. Examination of the reported sensitivities shows that CT outperforms plain radiography in the detection of CSI. Conclusion: CT is superior to plain radiography in the detection of CSI. However, the optimal imaging strategy depends on the patients' relative risk of injury. If at high-risk cervical CT is indicated. If at low-risk the increased cost and radiation exposure mean that screening CT may not be warranted, good-quality plain radiographs are sufficient.

  10. DEMOGRAPHIC VULNERABILITIES IN TECUCI PLAIN

    Directory of Open Access Journals (Sweden)

    Iulian Adrian ŞORCARU

    2013-06-01

    Full Text Available The study focuses on analyzing and mapping 8 indicators considered to best reflect the demographic vulnerability in Tecuci Plain in the year 2010 and proposes a model of aggregation which finally allows us to distinguish three major types of demographic vulnerability (low, medium and high. Mapping the final values also shows significant disparities in the territorial administrative units that broadly overlap the plain, the most vulnerable being Tecuci city and the peripheral communes, towards Vrancea and Vaslui Counties.

  11. Radiographic changes in Thoroughbred yearlings in South Africa

    Directory of Open Access Journals (Sweden)

    C. Furniss

    2011-05-01

    Full Text Available This study involves the evaluation of pre-purchase radiographic studies of South African Thoroughbred yearlings. Radiographic changes were recorded and compared with similar international studies. The study differs from other studies in that a lower prevalence of pedal osteitis (1.26 %, dorsal osteochondral fragmentation of the metatarsophalangeal joint (1.60 %, distal metacarpal sagittal ridge changes (15.7 %, ulnar carpal bone lucencies (8.33 %, carpal osteophytes (1.19 %, distal intertarsal and tarsometatarsal joint radiographic changes (9.92 %, tarsal osteochondrosis lesions (4.40 % and stifle osteochondrosis lesions (0.4 % was found. The prevalence of dorsal osteochondral fragments in the metacarpophalangeal joint was similar to other studies (1.60 %. A higher prevalence of vascular channels as well as irregular borders and lucencies was evident in the proximal sesamoid bones. There was a higher prevalence of palmar metacarpophalangeal and plantar metatarsophalangeal osteochondral fragments (2 % and 7.10 % respectively. Palmar metacarpal disease, metacarpal supracondylar lysis, proximal sesamoid bone fractures and carpal osteochondral fragmentation were absent in the current study. Additional findings recorded in the current study were proximal interphalangeal joint hyperextension (left front 15.13 %, right front 18.91 %, the solar angle (right front 2.38°, left front 2.79°, the prevalence of carpal bone 1 (30.95 % and carpal bone 5 (1.59 %. Management, nutrition and genetics in the various groups of Thoroughbred yearlings should be further investigated in order to explain the reasons for the differences recorded in the current study.

  12. Are upright lateral cervical radiographs in the obtunded trauma patient useful? A retrospective study

    Directory of Open Access Journals (Sweden)

    Bolles Gene

    2007-02-01

    Full Text Available Abstract Background The best method for radiographic "clearance" of the cervical spine in obtunded patients prior to removal of cervical immobilization devices remains debated. Dynamic radiographs or MRI are thought to demonstrate unstable injuries, but can be expensive and cumbersome to obtain. An upright lateral cervical radiograph (ULCR was performed in selected patients to investigate whether this study could provide this same information, to enable removal of cervical immobilization devices in the multiple trauma patient. Methods We retrospectively reviewed our experience with ULCR in 683 blunt trauma victims who presented over a 3-year period, with either a Glasgow Coma Score Results ULCR was performed in 163 patients. Seven patients had studies interpreted to be abnormal, of which six were also abnormal, by either CT or MRI. The seventh patient's only abnormality was soft tissue swelling; MRI was otherwise normal. Six patients had ULCR interpreted as normal, but had abnormalities on either CT or MRI. None of the missed injuries required surgical stabilization, although one had a vertebral artery injury demonstrated on subsequent angiography. ULCR had an apparent sensitivity of 45.5% and specificity of 71.4%. Conclusion ULCR are inferior to both CT and MRI in the detection of cervical injury in patients with normal plain radiographs. We therefore cannot recommend the use of ULCR in the obtunded trauma patient.

  13. Abdominal Plain Film Findings in Acute Ischemic Bowel Disease Differ with Age

    Energy Technology Data Exchange (ETDEWEB)

    Wadman, M.; Syk, I.; Elmstaahl, B.; Ekberg, O.; Elmstaahl, S. [Malmoe Univ. Hospital (Sweden). Dept. of Health Sciences

    2006-04-15

    Purpose: To evaluate the use and findings of abdominal plain film in acute ischemic bowel disease (AIBD) in different age subsets, and to correlate the clinical findings. Material and Methods: Eighty-nine radiographically examined patients with AIBD at Malmoe University Hospital, Sweden between 1987 and 1996. Results: In 89%, the plain film displayed pathologic signs. Bowel dilatation was more common in the elderly. Of 68 patients aged <71 years, 19 (28%) had colon gas/fluid levels with/without colon dilatation, and of 19 patients >84 years 16 (84%) had small-bowel dilatation. Of 20 patients aged P P P = 0.001). Of the patients with diarrhea, 13 of 33 (40%) had colon gas/fluid levels with/without colon dilatation compared to 2 of 29 (7%) without (P = 0.003). In the elderly (>71 years), 48 of 53 (91%) patients with bowel dilatation on plain film died, compared to 11 out of 16 (69%) without this finding (P <0.05). Conclusion: Abdominal plain film findings differed with age. Bowel dilatation was more frequent in the elderly with AIBD, whereas gasless abdomen was more common in younger patients. The radiographic findings were associated with clinical symptoms and mortality.

  14. Agreement between radiographic and photographic trabecular patterns

    Energy Technology Data Exchange (ETDEWEB)

    Korstjens, C.M.; Geraets, W.G.M.; Stelt, P.F. van der [Dept. of Oral Radiology, Academic Centre for Dentistry, Amsterdam (Netherlands); Spruijt, R.J. [Div. of Psychosocial Research and Epidemiology, Netherlands Cancer Inst., Amsterdam (Netherlands); Mosekilde, L. [Dept. of Cell Biology, Univ. of Aarhus (Denmark)

    1998-11-01

    Purpose: It has been hypothesized that photographs can facilitate the interpretation of the radiographic characteristics of trabecular bone. The reliability of these photographic and radiographic approaches has been determined, as have various agreements between the two approaches and their correlations with biomechanical characteristics. Material and Methods: Fourteen vertebral bodies were obtained at autopsy from 6 women and 8 men aged 22-76 years. Photographs (n=28) and radiographs (n=28) were taken of midsagittal slices from the third lumbar vertebra. The radiographs and photographs were digitized and the geometric properties of the trabecular architecture were then determined with a digital images analysis technique. Information on the compressive strength and ash density of the vertebral body was also available. Results: The geometric properties of both radiographs and photographs could be measured with a high degree of reliability (Cronbach`s {alpha}>0.85). Agreement between the radiographic and photographic approaches was mediocre as only the radiographic measurements showed insignificant correlations (p<0.05) with the biomechanical characteristics. We suggest that optical phenomena may result in the significant correlations between the photographs and the biomechanical characteristics. Conclusion: For digital image processing, radiography offers a superior description of the architecture of trabecular bone to that offered by photography. (orig.)

  15. Radiographic markers - A reservoir for bacteria?

    Energy Technology Data Exchange (ETDEWEB)

    Tugwell, Jenna, E-mail: jenna.tugwell@googlemail.co [Department of Radiology, Ysbyty Gwynedd Hospital, Bangor, North Wales (United Kingdom); Maddison, Adele [Nuffield Health, Shrewsbury Hospital (United Kingdom)

    2011-05-15

    Introduction: Amongst the most frequently handled objects in the radiology department are radiographic markers. They are personal accessories used with every patient, and are kept in the radiographers pockets when not utilised. Upon enquiry it was discovered that many radiographers disregarded the potential of these accessories to become a vector for cross-contamination thus never or rarely clean them. The aims of this study were therefore to identify if radiographic markers are a reservoir for bacteria and to establish an effective cleaning method for decontaminating them. Methodology: 25 radiographers/student radiographers were selected for this study. Swabbing of their markers prior and post cleaning took place. The microbiology laboratory subsequently analyzed the results by quantifying and identifying the bacteria present. The participants also completed a closed questionnaire regarding their markers (e.g. frequency of cleaning and type of marker) to help specify the results gained from the swabbing procedure. Results: From the sample swabbed, 92% were contaminated with various organisms including Staphylococcus and Bacillus species, the amount of bacteria present ranged from 0 to >50 CFU. There were no significant differences between disinfectant wipes and alcohol gel in decontaminating the markers. Both successfully reduced their bacterial load, with 80% of the markers post cleaning having 0 CFU. Conclusion: The results indicated that radiographic markers can become highly contaminated with various organisms thus serve as a reservoir for bacteria. In addition, the markers need to be cleaned on a regular basis, with either disinfectant wipes or alcohol gel to reduce their bacterial load.

  16. Sacroiliitis in Ankylosing Spondylitis: Comparison with Multidetector Row CT and Plain Radiography

    Energy Technology Data Exchange (ETDEWEB)

    Yu, Ji Youn; Joo, Kyung Bin; Choi, Byeong Kyoo; Ryu, Jeong Ah; Kim, Tae Hwan; Choi, Woo Jung [Hanyang University Hospital, Seoul (Korea, Republic of)

    2009-03-15

    The objective of our study was to compare multidetector row CT and the plain radiographs for making the diagnosis and grading the sacroiliitis that accompanies ankylosing spondylitis. We wanted to determine the role of multidetector row CT for the evaluation of the sacroilitis in patients with ankylosing spondylitis. One hundred ninety two patients with clinically suspected ankylosing spondylitis were evaluated by conventional radiography and multidetector row CT. Two musculoskeletal radiologists retrospectively analyzed the images, and they graded the sacroiliitis using the modified New York Criteria. Multidetector row CT demonstrated a significantly higher sensitivity (74.5%, 83.3%) than did plain radiography (59.9%, 66.7%) for detecting early sacroiliitis (p<0.05). Multidetector row CT showed a higher grade of sacroiliitis in 114 and 127 of 384 sacroiliac joints. Performing multidetector row CT rather than plain radiography for making the diagnoses of accompanying ankylosing spondylitis allows an early start of treatment with a subsequently improved prognosis

  17. Clinical and radiographic sequelae to primary teeth affected by dental trauma: a 9-year retrospective study.

    Science.gov (United States)

    Costa, Vanessa Polina Pereira; Goettems, Marilia Leão; Baldissera, Elaine Zanchin; Bertoldi, Andréa Dâmaso; Torriani, Dione Dias

    2016-08-18

    This retrospective study aimed at determining the predicted risks of clinical and radiographic complications in primary teeth following traumatic dental injuries, according to injury type, severity and child's age. Data were collected from records of children treated at a Dental Trauma Center in Brazil for nine years. Records of 576 children were included; clinical sequelae were assessed in 774 teeth, and radiographic sequelae, in 566 teeth. A total of 408 teeth (52.7%) had clinical sequelae and 185 teeth (32.7%), radiographic sequelae. The type of injury with the highest number of clinical sequelae was the crown-root fracture (86.4%). Clinical sequelae increased with injury severity (p teeth with enamel fracture, and 26.0% (95%CI 14-40) for teeth with enamel dentin fracture as well as enamel dentin pulp fracture. Risk of periapical radiolucency was higher for teeth with enameldentinpulp fracture (61.1% 95%CI 35-82) and those with subluxation (15.8% 95%CI 10-22). Risk of premature loss was 27.3% (95%CI 13-45) for teeth with extrusive luxation, and 10.2% (95%CI 5-17) for those with intrusive luxation. The assessment of predicted risks of sequelae showed that teeth with hard tissue trauma tended to present color change, periapical radiolucency and premature loss, whereas teeth with supporting tissue trauma showed color change, abnormal position, premature loss and periapical radiolucency as the most common sequelae. Knowledge about the predicted risks of complications may help clinicians establish appropriate treatment plans.

  18. Rapid display of radiographic images

    Science.gov (United States)

    Cox, Jerome R., Jr.; Moore, Stephen M.; Whitman, Robert A.; Blaine, G. James; Jost, R. Gilbert; Karlsson, L. M.; Monsees, Thomas L.; Hassen, Gregory L.; David, Timothy C.

    1991-07-01

    The requirements for the rapid display of radiographic images exceed the capabilities of widely available display, computer, and communications technologies. Computed radiography captures data with a resolution of about four megapixels. Large-format displays are available that can present over four megapixels. One megapixel displays are practical for use in combination with large-format displays and in areas where the viewing task does not require primary diagnosis. This paper describes an electronic radiology system that approximates the highest quality systems, but through the use of several interesting techniques allows the possibility of its widespread installation throughout hospitals. The techniques used can be grouped under three major system concepts: a local, high-speed image server, one or more physician's workstations each with one or more high-performance auxiliary displays specialized to the radiology viewing task, and dedicated, high-speed communication links between the server and the displays. This approach is enhanced by the use of a progressive transmission scheme to decrease the latency for viewing four megapixel images. The system includes an image server with storage for over 600 4-megapixel images and a high-speed link. A subsampled megapixel image is fetched from disk and transmitted to the display in about one second followed by the full resolution 4-megapixel image in about 2.5 seconds. Other system components include a megapixel display with a 6-megapixel display memory space and frame-rate update of image roam, zoom, and contrast. Plans for clinical use are presented.

  19. Assessment of vertebral scalloping in neurofibromatosis type 1 with plain radiography and MRI

    Energy Technology Data Exchange (ETDEWEB)

    Tsirikos, A.I.; Ramachandran, M.; Lee, J.; Saifuddin, A. E-mail: asaifuddin@aol.com

    2004-11-01

    AIM: To evaluate vertebral scalloping in patients with neurofibromatosis type 1 (NF-1) and spinal deformity using plain radiographs and magnetic resonance imaging (MRI), and to determine the possible aetiological association with neurofibromas, dural ectasia and lateral meningocoeles. MATERIAL AND METHODS: Nineteen patients with NF-1, who had full spine radiographs and whole-spine MRI, were retrospectively reviewed. Dystrophic features and their relationship to the curve were recorded from radiographs. A comparison was then made between the dystrophic features evident on radiographs and adjacent soft-tissue abnormalities identified on MRI. RESULTS: Dystrophic changes were documented in 16 patients on plain radiographs and in all patients on MRI. Rib pencilling was the most common finding on radiographs. In 80% of the cases with scoliosis, scalloping was seen on the concavity of the curvature. In all patients with kyphoscoliosis, scalloping was contiguous to the apex of kyphosis. Twenty-four areas of scalloping were identified on MRI. Scalloping usually developed in the concavity of the scoliotic curve or at levels unrelated to the curve. Scalloping was evident in combination with dural ectasia or neurofibroma in 15 cases. The presence of dural ectasia was confirmed in 75% of the cases of posterior scalloping and in 25% of those of lateral scalloping. The presence of neurofibromas was recognized in 25% of the cases of anterior or lateral scalloping. Dural ectasia was identified in two patients without associated scalloping. Lateral meningocoeles were not related to the development of scalloping. CONCLUSION: Whereas posterior scalloping was commonly associated with dural ectasia, anterior and lateral scalloping were commonly the result of primary mesodermal dysplasia.

  20. Mastitis, a Radiographic, Clinical, and Histopathologic Review.

    Science.gov (United States)

    Cheng, Lin; Reddy, Vijaya; Solmos, Gene; Watkins, Latanja; Cimbaluk, David; Bitterman, Pincas; Ghai, Ritu; Gattuso, Paolo

    2015-01-01

    Mastitis is a benign inflammatory process of the breast with heterogeneous histopathological findings, which clinically and radiographically may mimic a mammary carcinoma. We undertook a retrospective study on 37 cases of mastitis in our institution to correlate the radiographic imaging features and the clinical presentation with the histopathological findings. Histologically, there were 21 granulomatous, 7 fibrous, 3 plasma cell, 3 lupus, 2 lymphocytic, and 1 case of acute mastitis. Radiographically, 16/25 (64%) patients with ultrasound studies showed irregular hypoechoic masses suspicious for malignancy. Clinically, 38% of patients had an associated systemic disease. © 2015 Wiley Periodicals, Inc.

  1. Rib fractures in coronary bypass patients: radionuclide detection.

    Science.gov (United States)

    Greenwald, L V; Baisden, C E; Symbas, P N

    1983-08-01

    Sternal retraction can cause the first rib to be fractured posteriorly, injuring the brachial plexus. The authors conducted bone scans of 24 consecutive open-heart surgery patients and found an unexpectedly high number of rib fractures which in all but one case had not been seen on the chest radiograph. Bone scans are recommended whenever there is unexplained non-incisional pain in a patient who has undergone sternal retraction.

  2. Minimal Invasive Percutaneous Fixation of Thoracic and Lumbar Spine Fractures

    Directory of Open Access Journals (Sweden)

    Federico De Iure

    2012-01-01

    Full Text Available We studied 122 patients with 163 fractures of the thoracic and lumbar spine undergoing the surgical treatment by percutaneous transpedicular fixation and stabilization with minimally invasive technique. Patient followup ranged from 6 to 72 months (mean 38 months, and the patients were assessed by clinical and radiographic evaluation. The results show that percutaneous transpedicular fixation and stabilization with minimally invasive technique is an adequate and satisfactory procedure to be used in specific type of the thoracolumbar and lumbar spine fractures.

  3. Post-traumatic cortical cysts in paediatric fractures: is it a concern for emergency doctors?

    DEFF Research Database (Denmark)

    Houshian, Shirzad; Pedersen, Niels Wisbech; Torfing, Trine

    2007-01-01

    fracture in the femur, which is not previously published in the literature. The cyst-like lesion appeared as an oval radiolucency proximal to the previous fracture site on radiograph films. These lesions can cause concern for the on-call teams as they can mimic an infection or a tumour of the bone. We...

  4. Abnormalities of the lumbar spine in the coronal plane on plain abdominal radiographs

    OpenAIRE

    Kilshaw, Michael; Baker, Richard P; Gardner, Richard; Charosky, Sebastian; Harding, Ian

    2010-01-01

    The main objective of this study is to determine the prevalence of coronal abnormalities of the lumbar spine in a large population of patients with respect to their age and sex. Lumbar degenerative disease is associated with degenerative scoliosis. Degenerative scoliosis and lateral listhesis are important features to identify before decompressive surgery as deformity may not be seen on magnetic resonance imaging scans. Scoliosis and lateral listhesis may be important in the development of sy...

  5. Alfacalcidol versus plain vitamin D in the treatment of glucocorticoid/inflammation-induced osteoporosis.

    Science.gov (United States)

    Ringe, Johann D; Faber, Herbert; Fahramand, Parvis; Schacht, Erich

    2005-09-01

    Treatment with plain vitamin D is a nutritional substitute, while the application of alfacalcidol is an active hormonal therapy. Due to strong feedback regulation, plain vitamin D is not activated in the kidney in vitamin-replete patients, while alfacalcidol, having been hydroxylated at position 1, bypasses regulation and increases available amounts of active D-hormone in different target tissues. Nevertheless, a majority of physicians still prescribe plain vitamin D plus calcium as a first-step prevention or even as therapy for glucocorticoid (GC) induced osteoporosis. This article summarizes results of our previous study comparing the therapeutic efficacy of the D-hormone analog alfacalcidol to plain vitamin D in patients with established GC induced osteoporosis with or without vertebral fracture. Patients taking longterm GC therapy were included as well-matched pairs to receive randomly either 1 microg alfacalcidol plus 500 mg calcium per day (group A, n = 103) or 1000 IU vitamin D3 plus 500 mg calcium (group B, n = 101). The mean bone mineral density (BMD) values at baseline for the 2 groups for alfacalcidol and vitamin D3, respectively, were: lumbar spine T score -3.26 and -3.25; femoral neck -2.81 and -2.84. Rates of prevalent vertebral and nonvertebral fractures were not different between groups. In the 3 year study we observed in the alfacalcidol group as compared with the plain vitamin D group, respectively: a 3 year median percentage increase of BMD at the lumbar spine of 2.4% versus -0.8% (p vitamin D group, respectively: a 3 year rate of patients with > or = 1 new vertebral fracture of 9.7% versus 24.8% (risk reduction: 0.61; 95% CI 0.24 to 0.81; p = 0.005); a 3 year rate of patients with > or = 1 new nonvertebral fracture of 15% versus 25% (risk reduction: 0.41; 95% CI -0.06 to 0.68; p = 0.081); a 3 year rate of patients with > or = 1 new fracture of any kind of 19.4% versus 40.6% (risk reduction: 0.52; 95% CI 0.25 to 0.71; p = 0.001). In accordance

  6. Mycetoma revisited. Incidence of various radiographic signs.

    Science.gov (United States)

    Abd El-Bagi, Mohamed E; Fahal, Ahmed H

    2009-04-01

    To define and quantitate various radiographic signs of mycetoma infection. A retrospective study of 516 randomly selected patients seen between December 1996 and December 2004 at the Mycetoma Research Centre of Khartoum University, Khartoum, Sudan. All cases were confirmed by clinical examination, initial pretreatment radiographs, and histopathology. The most common abnormalities in these 516 patients were soft tissue swelling (93%), bone sclerosis (56%), bone cavities (32%), and periosteal reaction (27%). The incidence of bone expansion (22%), extrinsic cortical scalloping (22%), and fanning of the rays in 10% were reported. Osteoporosis was seen in 19%. Only 3% of the patients had normal radiographs. Maximal scrutiny of radiographs alone by experienced radiologists is vital, as other imaging techniques are not available where mycetoma is prevalent.

  7. Limbus lumbar and sacral vertebral fractures.

    Science.gov (United States)

    Mendez, Jorge S; Huete, Isidro L; Tagle, Patricio M

    2002-03-01

    We evaluated the fractures of the lumbar and sacral vertebral limbus by disc impingement at the peripheral ring apophysis in 23 adults associated with trauma in 16 of them. Lumbalgia, radicular pain and narrow canal symptoms are the presenting forms of this underdiagnosed pathology. CT is the best method of examination, while plain roentgenograms and MR are usually negative. Accurate diagnosis and surgical technique with larger exposure are needed to resect the fractured fragments and protruded disc material for decompressing the roots and the dural sac. Our results were very good on the majority of cases.

  8. Fracture mechanics

    CERN Document Server

    Perez, Nestor

    2017-01-01

    The second edition of this textbook includes a refined presentation of concepts in each chapter, additional examples; new problems and sections, such as conformal mapping and mechanical behavior of wood; while retaining all the features of the original book. The material included in this book is based upon the development of analytical and numerical procedures pertinent to particular fields of linear elastic fracture mechanics (LEFM) and plastic fracture mechanics (PFM), including mixed-mode-loading interaction. The mathematical approach undertaken herein is coupled with a brief review of several fracture theories available in cited references, along with many color images and figures. Dynamic fracture mechanics is included through the field of fatigue and Charpy impact testing. Explains computational and engineering approaches for solving crack-related problems using straightforward mathematics that facilitate comprehension of the physical meaning of crack growth processes; Expands computational understandin...

  9. Fracture mechanics

    Science.gov (United States)

    Shannon, John L., Jr.

    1986-01-01

    The application of fracture mechanics to the design of ceramic structures will require the precise measurement of crack growth and fracture resistance of these materials over their entire range of anticipated service temperatures and standardized test methods for making such measurements. The development of a standard test for measuring the plane strain fracture toughness is sought. Stress intensity factor coefficients were determined for three varieties of chevron-notch specimens, and fracture toughness measurements were made on silicon nitrides, silicon carbides, and aluminum oxides to assess the performance of each specimen variety. It was determined that silicon nitride and silicon carbides have flat crack growth resistance curves, but aluminum oxide does not. Additionally, batch-to-batch differences were noticed for the aluminum oxide. Experiments are continuing to explain the rising crack growth resistance and batch-to-batch variations for the aluminum oxide.

  10. Intraradicular Splinting with Endodontic Instrument of Horizontal Root Fracture

    Directory of Open Access Journals (Sweden)

    Ersan Çiçek

    2015-01-01

    Full Text Available Introduction. Root fractures, defined as fractures involving dentine, cementum, and pulpal and supportive tissues, constitute only 0.5–7% of all dental injuries. Horizontal root fractures are commonly observed in the maxillary anterior region and 75% of these fractures occur in the maxillary central incisors. Methods. A 14-year-old female patient was referred to our clinic three days after a traffic accident. In radiographic examination, the right maxillary central incisor was fractured horizontally in apical thirds. Initially, following local infiltrative anesthetics, the coronal fragment was repositioned and this was radiographically confirmed. Then the stabilization splint was applied and remained for three months. After three weeks, according to the results of the vitality tests, the right and left central incisors were nonvital. For the right central incisor, both the coronal and apical fragments were involved in the endodontic preparation. Results. For the right central tooth, both the coronal and apical root fragments were endodontically treated and obturated at a single visit with white mineral trioxide aggregate whilst the fragments were stabilized internally by insertion of a size 40 Hedstrom stainless-steel endodontic file into the canal. Conclusion. Four-year follow-up examination revealed satisfactory clinical and radiographic findings with hard tissue repair of the fracture line.

  11. Clinical and Radiologic Predictive Factors of Rib Fractures in Outpatients With Chest Pain.

    Science.gov (United States)

    Zhang, Liang; McMahon, Colm J; Shah, Samir; Wu, Jim S; Eisenberg, Ronald L; Kung, Justin W

    2017-05-30

    To identify the clinical and radiologic predictive factors of rib fractures in stable adult outpatients presenting with chest pain and to determine the utility of dedicated rib radiographs in this population of patients. Following Institutional Review Board approval, we performed a retrospective review of 339 consecutive cases in which a frontal chest radiograph and dedicated rib series had been obtained for chest pain in the outpatient setting. The frontal chest radiograph and dedicated rib series were sequentially reviewed in consensus by two fellowship-trained musculoskeletal radiologists blinded to the initial report. The consensus interpretation of the dedicated rib series was used as the gold standard. Multiple variable logistic regression analysis assessed clinical and radiological factors associated with rib fractures. Fisher exact test was used to assess differences in medical treatment between the 2 groups. Of the 339 patients, 53 (15.6%) had at least 1 rib fracture. Only 20 of the 53 (37.7%) patients' fractures could be identified on the frontal chest radiograph. The frontal chest radiograph had a sensitivity of 38% and specificity of 100% when using the rib series as the reference standard. No pneumothorax, new mediastinal widening or pulmonary contusion was identified. Multiple variable logistic regression analysis of clinical factors associated with the presence of rib fractures revealed a significant association of trauma history (odds ratio 5.7 [p rib fractures in this population demonstrated a significant association of pleural effusion with rib fractures (odds ratio 18.9 [p rib fractures received narcotic analgesia in 47.2% of the cases, significantly more than those without rib fractures (21.3%, p rib fractures have a higher association with a history of minor trauma and age ≥40 in the adult population. Radiographic findings associated with rib fractures include pleural effusion. The frontal chest radiograph alone has low sensitivity in

  12. Radiographic signs and diagnosis of dental disease.

    Science.gov (United States)

    Bellows, J

    1993-08-01

    Dental radiographs are critical for the complete assessment and treatment of dental diseases. Dental radiography is commonly used to evaluate congenital dental defects, periodontal disease, orthodontic manipulations, oral tumors, endodontic treatments, oral trauma, and any situation where an abnormality is suspected. Although standard radiographic equipment and film can be used to produce dental radiographs, dental X-ray equipment and film provide superior quality images and greater convenience of animal patient positioning. An understanding of normal dental radiographic anatomy is important when interpreting dental radiographs. Stage III periodontitis is the earliest stage of periodontal disease at which radiographic abnormalities become apparent. Bone loss associated with periodontal disease can be classified as either horizontal or vertical. Periapical radiolucencies can represent granulomas, cysts, or abscesses, whereas periapical radiodensities may represent sclerotic bone or condensing osteitis. Lytic lesions of the bone of the jaw often represent oral neoplasms. Neoplasms also can displace or disrupt teeth in the dental arch. Resorptive lesions can be external or internal and appear as radiolucent areas involving the external surface of the root or the pulp cavity, respectively. Feline dental resorptive lesions, also known as odontoclastic resorptions, are a specific form of dental resorptive lesions unique to cats.

  13. Early characteristic radiographic changes in mucolipidosis II

    Energy Technology Data Exchange (ETDEWEB)

    Lai, Lillian M. [Lucile Packard Children' s Hospital and Stanford University, Pediatric Radiology, Palo Alto, CA (United States); Lachman, Ralph S. [Lucile Packard Children' s Hospital and Stanford University, Pediatric Radiology, Palo Alto, CA (United States); University of California, International Skeletal Dysplasia Registry, Los Angeles, CA (United States)

    2016-11-15

    Although mucolipidosis type II has similar metabolic abnormalities to those found in all the mucopolysaccharidoses and mucolipidoses, there are distinctive diagnostic radiographic changes of mucolipidosis II in the perinatal/newborn/infant period. To describe the early characteristic radiographic changes of mucolipidosis II and to document when these changes manifest and resolve. We retrospectively reviewed radiographs and clinical records of 19 cases of mucolipidosis II from the International Skeletal Dysplasia Registry (1971-present; fetal age to 21/2 years). A radiologist with special expertise in skeletal dysplasias evaluated the radiographs. The most common abnormalities were increased vertebral body height (80%, nonspecific), talocalcaneal stippling (86%), periosteal cloaking (74%) and vertebral body rounding (50%). Unreported findings included sacrococcygeal sclerosis (54%) and vertebral body sclerosis (13%). Rickets and hyperparathyroidism-like (pseudohyperparathyroidism) changes (rarely reported) were found in 33% of cases. These changes invariably started in the newborn period and resolved by 1 year of age. The conversion from these early infantile radiographic features to dysostosis multiplex changes occurred in 41% of cases, and within the first year after birth. Several findings strongly suggest the diagnosis of mucolipidosis II, including cloaking in combination with one or more of the following radiographic criteria: talocalcaneal stippling, sacrococcygeal or generalized vertebral body sclerosis, vertebral body rounding, or rickets/hyperparathyroidism-like changes in the perinatal/newborn/infancy period. These findings are not found in the other two forms of mucolipidosis nor in any of the mucopolysaccharidoses. (orig.)

  14. MRI of radiographically occult ischial apophyseal avulsions

    Energy Technology Data Exchange (ETDEWEB)

    Meyers, Arthur B. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, MLC 5031, Cincinnati, OH (United States); Children' s Hospital of Wisconsin, Milwaukee, WI (United States); Laor, Tal; Zbojniewicz, Andrew M.; Anton, Christopher G. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, MLC 5031, Cincinnati, OH (United States)

    2012-11-15

    Acute avulsions of unossified ischial apophyses in children may go undetected on radiography. Therapy includes rest and rehabilitation; however, substantial displacement may require surgery. Our purpose is to illustrate the utility of MRI in the detection of these radiographically occult injuries in skeletally immature children. This retrospective study of more than 5 years included children with ischial avulsions who were evaluated with both radiography and MRI within 3 weeks of acute injury. Initially, radiographs were reviewed to identify those children with unossified ischial apophyses. Subsequently, their MRI examinations were assessed for physeal disruption, bone/soft tissue edema, periosteal/perichondrial elevation and disruption. Initial and follow-up radiographs (if available) were reviewed. Patient age, symptoms and offending activity were determined from clinical records. Five children met inclusion criteria. All initial radiographs were normal. MRI showed: edema (n = 5), periosteal elevation (n = 4), periosteal/perichondrial disruption (n = 4), >5.5 mm displacement (n = 0). Follow-up radiographs in two children (2 and 2.5 months from MRI) showed osseous ischial irregularity. The apophyses remained unossified. Acute unossified ischial apophyseal avulsions in children may be radiographically undetected. In the setting of correlative clinical symptoms, MRI can be used to identify these injuries and to help direct appropriate therapy. (orig.)

  15. Qualitative versus quantitative radiographic analysis of foot deformities in children with hemiplegic cerebral palsy.

    Science.gov (United States)

    Westberry, David E; Davids, Jon R; Roush, Thomas F; Pugh, Linda I

    2008-01-01

    Qualitative assessments of standing plain radiographs are frequently used to determine treatment strategies and assess outcomes for the management of a wide range of foot and ankle conditions in children. A quantitative technique for such analyses would presumably be more precise and reliable. The goal of this study was to compare qualitative and quantitative techniques for the assessment of plain radiographs of the foot and ankle in children with hemiplegic type cerebral palsy (CP). Standing anteroposterior and lateral radiographs of the foot and ankle of the involved side for 49 children with hemiplegic CP were analyzed qualitatively by 2 pediatric orthopaedists, based upon a 3-segment (hindfoot, midfoot, and forefoot) foot model. Quantitative assessment of the same radiographs was performed by 2 examiners, using 6 radiographic measurements developed to describe the alignment of the foot based upon the same 3-segment model. Intraobserver and interobserver reliability was determined for both the qualitative and the quantitative techniques. The qualitative and quantitative techniques were compared to determine agreement. The qualitative technique demonstrated poor-to-fair interobserver reliability (percent agreement range, 23%-31%; weighted kappa range, 0.291-0.568). The quantitative technique demonstrated good-to-excellent intraobserver (correlation coefficient range, 0.81-0.99) and interobserver (correlation coefficient range, 0.81-0.97) reliability. Percent agreement between the quantitative and the qualitative techniques for the assessment of foot segmental alignment for each examiner ranged from 22.2% to 100% (mean agreement for examiner 1 was 51% [correlation coefficient range, 0.04-0.48]; mean agreement for examiner 2 was 65.3% [correlation coefficient range, 0.22-0.85]). Percent agreement between the quantitative technique and both observers ranged from 11.1% to 83.3% (mean agreement was 36.7% [correlation coefficient range, 0.17-0.94]). Reliable

  16. Digital x-ray radiogrammetry identifies women at risk of osteoporotic fracture: results from a prospective study

    DEFF Research Database (Denmark)

    Bach-Mortensen, Pernille; Hyldstrup, Lars; Appleyard, Merete

    2006-01-01

    Using digital X-ray radiogrammetry (DXR) on hand radiographs from a large population-based study, 1,370 postmenopausal women were evaluated in a prospective fashion; fracture occurrence was compared with DXR measurements of historic radiographs. Further, the aim of the study was to evaluate facto...

  17. Are radiographs needed when MR imaging is performed for non-acute knee symptoms in patients younger than 45 years of age?

    Energy Technology Data Exchange (ETDEWEB)

    Braak, Bert P.M. ter; Vincken, Patrice W.J.; Erkel, Arian R. van; Bloem, Johan L. [Leiden University Medical Center, Department of Radiology, P.O. Box 9600, Leiden (Netherlands); Bloem, Rolf M. [Leiden University Medical Center, Department of Orthopaedic Surgery, Leiden (Netherlands); Napoleon, L.J.; Coene, M.N. [HAGA Hospital, Department of Orthopaedic Surgery, The Hague (Netherlands); Luijt, Peter A. van [Leiden University Medical Center, Department of Traumatology, Leiden (Netherlands); Lange, Sam de [Medical Center Haaglanden, Department of Orthopaedic Surgery, The Hague (Netherlands); Department of Orthopaedic Surgery, Delft (Netherlands)

    2007-12-15

    The objective was to determine the value of radiographs in young adults with non-acute knee symptoms who are scheduled for magnetic resonance imaging (MRI). Nine hundred and sixty-one consecutive patients aged between 16 and 45 years with knee symptoms of at least 4 weeks' duration were prospectively included in three participating hospitals. After applying exclusion criteria, 798 patients remained. Exclusion criteria were previous knee surgery (including arthroscopy) or MRI, history of rheumatoid arthritis, clinical diagnosis of retropatellar chondromalacia, contra-indication for MRI and recent trauma. We identified two groups: group A with no history of trauma (n = 332), and group B with an old (>4 weeks) history of trauma (n = 466). Patients had a standardized history taken, and underwent a physical exam, antero-posterior (AP) and lateral radiographs and MRI. We evaluated the radiographs and MRI for osseous lesions, articular surface lesions, fractures, osteoarthritis, loose bodies, bone marrow edema and incidental findings. Subsequently, patients with osseous abnormalities (Kellgren grade 1 and 2 excluded) on radiographs and a matched control group was evaluated again using MRI without radiographs. Median duration of symptoms was 20 weeks. In group A, radiographs showed 36 osseous abnormalities in 332 patients (10.8%). Only 13 of these, all Kellgren grade 1 osteoarthritis, were not confirmed on MRI. MRI showed 72 (21.7%) additional abnormalities not confirmed on radiographs. In group B, radiographs showed 40 osseous abnormalities (8.6%) in 466 patients. Only 15 of these, all Kellgren grade 1 osteoarthritis, were not confirmed on MRI. MRI showed 194 (41.6%) additional abnormalities not confirmed on radiographs. The second evaluation of MRI without radiographs in 34 patients was identical to the first MRI evaluation. Common lesions were significantly more often diagnosed with MRI than with radiographs. Radiographs should not be obtained routinely when MRI is

  18. Clinical effects of internal fixation for ulnar styloid fractures associated with distal radius fractures: A matched case-control study.

    Science.gov (United States)

    Sawada, Hideyoshi; Shinohara, Takaaki; Natsume, Tadahiro; Hirata, Hitoshi

    2016-11-01

    Ulnar styloid fractures are often associated with distal radius fractures. However, controversy exists regarding whether to treat ulnar styloid fractures. This study aimed to evaluate clinical effects of internal fixation for ulnar styloid fractures after distal radius fractures were treated with the volar locking plate system. We used prospectively collected data of distal radius fractures. 111 patients were enrolled in this study. A matched case-control study design was used. We selected patients who underwent fixation for ulnar styloid fractures (case group). Three control patients for each patient of the case group were matched on the basis of age, sex, and fracture type of distal radius fractures from among patients who did not undergo fixation for ulnar styloid fractures (control group). The case group included 16 patients (7 men, 9 women; mean age: 52.6 years; classification of ulnar styloid fractures: center, 3; base, 11; and proximal, 2). The control group included 48 patients (15 men, 33 women; mean age: 61.1 years; classification of ulnar styloid fractures: center, 10; base, 31; and proximal, 7). For radiographic examination, the volar tilt angle, radial inclination angle, and ulnar variance length were measured, and the union of ulnar styloid fractures was judged. For clinical examination, the range of motions, grip strength, Hand20 score, and Numeric Rating Scale score were evaluated. There was little correction loss for each radiological parameter of fracture reduction, and these parameters were not significantly different between the groups. The bone-healing rate of ulnar styloid fractures was significantly higher in the case group than in the control group, but the clinical results were not significantly different. We revealed that there was no need to fix ulnar styloid fractures when distal radius fractures were treated via open reduction and internal fixation with a volar locking plate system. Copyright © 2016 The Japanese Orthopaedic Association

  19. Ipsilateral femoral neck and shaft fractures: An overlooked association

    Energy Technology Data Exchange (ETDEWEB)

    Daffner, R.H. (Dept. of Diagnostic Radiology, Allegheny General Hospital, Pittsburgh, PA (USA) Medical Coll. of Pennsylvania, Pittsburgh, PA (USA)); Riemer, B.L.; Butterfield, S.L. (Dept. of Orthopedic Surgery, Allegheny General Hospital, Pittsburgh, PA (USA) Medical Coll. of Pennsylvania, Pittsburgh, PA (USA))

    1991-05-01

    A total of 304 patients with injuries to the femoral shaft and ipsilateral hip presented between 1984 and 1990. Some 253 of them suffered fractures of the femoral shaft and dislocated hips or fractures of the acetabulum, and 51 of these sustained fractures of the femoral shaft and neck or trochanteric region. All of the trochanteric injuries were demonstrated on the initial radiographs. However, in 11 of the patients with combined femoral shaft and neck fractures, the diagnosis was delayed by as much as 4 weeks. This delay related to the fact that these fractures tended not to separate in the initial evaluation period and that there was external rotation of the proximal femoral fragment due to the femoral shaft fracture. (orig./GDG).

  20. Fracture Behavior and Properties of Functionally Graded Fiber-Reinforced Concrete

    Science.gov (United States)

    Roesler, Jeffery; Bordelon, Amanda; Gaedicke, Cristian; Park, Kyoungsoo; Paulino, Glaucio

    2008-02-01

    In concrete pavements, a single concrete mixture design is selected to resist mechanical loading without attempting to adversely affect the concrete pavement shrinkage, ride quality, or noise attenuation. An alternative approach is to design distinct layers within the concrete pavement surface which have specific functions thus achieving higher performance at a lower cost. The objective of this research was to address the structural benefits of functionally graded concrete materials (FGCM) for rigid pavements by testing and modeling the fracture behavior of different combinations of layered plain and synthetic fiber-reinforced concrete materials. Fracture parameters and the post-peak softening behavior were obtained for each FGCM beam configuration by the three point bending beam test. The peak loads and initial fracture energy between the plain, fiber-reinforced, and FGCM signified similar crack initiation. The total fracture energy indicated improvements in fracture behavior of FGCM relative to full-depth plain concrete. The fracture behavior of FGCM depended on the position of the fiber-reinforced layer relative to the starter notch. The fracture parameters of both fiber-reinforced and plain concrete were embedded into a finite element-based cohesive zone model. The model successfully captured the experimental behavior of the FGCMs and predicted the fracture behavior of proposed FGCM configurations and structures. This integrated approach (testing and modeling) demonstrates the viability of FGCM for designing layered concrete pavements system.

  1. Mandibular symphysis fracture associated with the displacement of a fractured genial segment: An unusual case report with review

    Directory of Open Access Journals (Sweden)

    Krishnaveni Buduru

    2015-01-01

    Full Text Available Fractures and displacement of fragments involving the genial tubercles due to trauma are rarely seen in patients with a full complement of teeth although spontaneous fractures of the genial tubercles in edentulous atrophic mandible are not uncommon. These are usually displaced and may be missed during routine clinical and radiographic examinations owing to superimposition of the features of a fractured mandible. Very few cases have been reported till date. Their implications lie in functional alterations that occur as a consequence of loss of attachment of the geniohyoid and genioglossus muscles. There is no universal opinion on the treatment of fractures involving the genial tubercles. Possible treatments include no surgical intervention, excision of the avulsed bone fragments, and muscular repositioning. We present a case of mandibular fracture associated with the fracture and displacement of a fragment involving the genial tubercles in a dentate patient where in the finding was incidental and a review of literature.

  2. River diversions, avulsions and captures in the Tortuguero coastal plain

    Science.gov (United States)

    Galve, Jorge Pedro; Alvarado, Guillermo; Pérez Peña, José Vicente; Azañón, José Miguel; Mora, Mauricio; Booth-Rea, Guillermo

    2016-04-01

    The Tortuguero area is a coastal plain that forms part of the North Limón sedimentary basin, the back-arc region of the Caribbean side of Costa Rica. This coastal plain is characterised by an abnormal drainage pattern with river captures, diversions and shifts in channel directions. We are analyzing this anomalous drainage network adopting a classical geomorphological approach combined with geomorphometric techniques. The SRTM DEM at 1 arc-second of resolution (~30 m) from NASA, topographic maps 1:50,000, satellital images and the digital cartography of the drainage network have been used for inventorying the channel pattern anomalies. River segments were categorized according to sinuosity, orientation, slope changes and incision using GIS tools. Initially, anomalies in the analyzed river courses suggested that buried thrust fronts could disrupt their natural pattern. However, we have not identified any evidence to link the activity of buried structures with the disruption of natural drainage. Blind thrusts detected through seismic subsurface exploration in the SE sector of the Tortuguero plain do not seem to produce changes in the sinuosity, orientation, slope and incision of rivers as those observed in the deeply studied tectonically active area of the Po Plain (Italy). The identified river pattern anomalies have been explained due to other alternative causes: (1) the migration of the mouths of Reventazón, Pacuare and Matina rivers is produced by sand sedimentation in the coast because of a successive ridge beach formation. This migration to the SE has the same direction than the main ocean currents those deposited the sand. (2) The anomalous course of Parismina river is most probably conditioned by the fracturation of the dissected volcanic apron of Turrialba volcano. (3) Channel migration and capture of Barbilla river by Matina river can be triggered by the tectonic tilting of the coastal plain towards the SE. The subsidence of the SE sector of the plain was

  3. fibular osteosynthesis of neglected femoral neck fracture in a young ...

    African Journals Online (AJOL)

    Where there are no facilities for microvascular surgery, non- ... fixation of a neglected femoral neck fracture associated with aseptic necrosis of femoral head in ... After a follow-up of two years, he had a Harris hip ... applied on the fifth postoperative day and patient was ... radiographic features that suggested aseptic necrosis.

  4. Concordance in the radiological diagnosis of thoracolumbar spine fractures.

    Science.gov (United States)

    Hirschfeld, M; Rodriguez, M; Cerván, A M; Ortega, J A; Rivas-Ruiz, F; Guerado, E

    2015-01-01

    Thoracolumbar spine fractures are frequent and severe. Early diagnosis and appropriate treatment to obtain good clinical results is essential, with many classifications being proposed for this purpose. To determine the external validity of radiographic and computed tomography (CT) measurements for the most used classifications, and decide on the type of treatment required. The working hypothesis is the existence of external validity of radiographic measurements. A sample of patients with thoracolumbar fracture was selected. Three spine specialists and a resident performed measurements on anteroposterior and lateral radiographic images as well as coronal, sagittal and axial CT slices. Fractures were classified as stable or unstable, evaluating the degree of intra-and interobserver agreement based on a standard observer. Sagittal index of Farcy, lateral wedging, Beck Index, traumatic regional angulation and channel occupancy were studied. All indicators studied, except the lateral wedging, showed a high degree of concordance. Instability determinants studied with radiographs and CT, which had obtained statistical significance, are reliable and accurate for the classification of thoracolumbar fractures and, therefore, to indicate an appropriate treatment. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  5. The yield of high-detail radiographic skeletal surveys in suspected infant abuse

    Energy Technology Data Exchange (ETDEWEB)

    Barber, Ignasi [Hospital Vall d' Hebron, Universitat Autonoma de Barcelona, Pediatric Radiology Department, Barcelona (Spain); Perez-Rossello, Jeannette M.; Kleinman, Paul K. [Boston Children' s Hospital, Radiology Department, Boston, MA (United States); Wilson, Celeste R. [Boston Children' s Hospital, Division of General Pediatrics, Boston, MA (United States)

    2014-07-06

    Skeletal surveys are routinely performed in cases of suspected child abuse, but there are limited data regarding the yield of high-detail skeletal surveys in infants. To determine the diagnostic yield of high-detail radiographic skeletal surveys in suspected infant abuse. We reviewed the high-detail American College of Radiology standardized skeletal surveys performed for suspected abuse in 567 infants (median: 4.4 months, SD 3.47; range: 4 days-12 months) at a large urban children's hospital between 2005 and 2013. Skeletal survey images, radiology reports and medical records were reviewed. A skeletal survey was considered positive when it showed at least one unsuspected fracture. In 313 of 567 infants (55%), 1,029 definite fractures were found. Twenty-one percent (119/567) of the patients had a positive skeletal survey with a total of 789 (77%) unsuspected fractures. Long-bone fractures were the most common injuries, present in 145 children (26%). The skull was the site of fracture in 138 infants (24%); rib cage in 77 (14%), clavicle in 24 (4.2%) and uncommon fractures (including spine, scapula, hands and feet and pelvis) were noted in 26 infants (4.6%). Of the 425 infants with neuroimaging, 154 (36%) had intracranial injury. No significant correlation between positive skeletal survey and associated intracranial injury was found. Scapular fractures and complex skull fractures showed a statistically significant correlation with intracranial injury (P = 0.029, P = 0.007, respectively). Previously unsuspected fractures are noted on skeletal surveys in 20% of cases of suspected infant abuse. These data may be helpful in the design and optimization of global skeletal imaging in this vulnerable population. (orig.)

  6. Multidisciplinary Management of Complicated Crown-Root Fracture of an Anterior Tooth Undergoing Apexification

    OpenAIRE

    Merve Mese; Merve Akcay; Bilal Yasa; Huseyin Akcay

    2015-01-01

    The purpose of this case report was to present the multidisciplinary management of a subgingival crown-root fracture of a patient undergoing apexification treatment. A 12-year-old male patient was referred to the pediatric dentistry clinic with an extensive tooth fracture of the right permanent maxillary lateral incisor. Clinical and radiographic examinations revealed the presence of a complicated crown-root fracture, which had elongated to the buccal subgingival area. The dental history disc...

  7. Transurgical re-attachment of coronal fragment in anterior-fractured tooth

    Directory of Open Access Journals (Sweden)

    Josué Martos

    2013-01-01

    Full Text Available Esthetic and functional rehabilitation is the primary goal of the treatment of crown-root-fractured tooth. A 14-year-old male patient that fractured her maxillary left canine with biologic width violation is presented. Transurgical exposures of the fracture remnant were performed to possibility the rubber dam isolation followed by crown re-attachment using bonding system and a resin composite. Clinical and radiographic examination 5 months after trauma showed good esthetics, pulp normality, and periodontal health.

  8. Short incomplete sagittal fractures of the proximal phalanx in ten horses not used for racing.

    Science.gov (United States)

    Kuemmerle, Jan M; Auer, Jörg A; Rademacher, Nathalie; Lischer, Christoph J; Bettschart-Wolfensberger, Regula; Fürst, Anton E

    2008-02-01

    To describe short incomplete sagittal fractures of the proximal phalanx (type Ia P1 fractures) in horses not used for racing and report outcome. Retrospective study. Horses (n=10) with type Ia P1 fractures. Retrieved data of horses with type Ia P1 fractures were signalment, history and results of orthopedic examination. Radiographs were re-evaluated for position and length of the fracture line, presence of osteoarthritis or subchondral cystic lesions (SCL), periosteal new bone formation and subchondral sclerosis. Conservative treatment (n=4) included box confinement for 2 months followed by 1 month of hand walking. Surgical therapy (n=6) consisted of internal fixation by screws inserted in lag fashion in 5 horses. Concurrent SCL were debrided by curettage via a transcortical drilling approach. In 1 horse, only SCL curettage but not internal fixation was performed. Outcome was assessed on a clinical and radiographic follow-up examination in all horses. Mean follow-up time was 27 months (median, 13.5 months; range, 9 months to 9 years). All horses treated with internal fixation were sound at follow-up and had radiographic fracture healing. Of the 4 horses managed conservatively, 3 remained lame and only 1 horse had radiographic evidence of fracture healing. Catastrophic fracture propagation occurred in 2 horses not treated by internal fixation, 20 and 30 months after diagnosis, respectively. Horses with a type Ia P1 fracture treated surgically had a better outcome than those managed conservatively and lack of fracture healing seemingly increases the risk of later catastrophic fracture. Surgical repair of type Ia P1 fractures should be considered to optimize healing and return to athletic use.

  9. OCCULT MANUBRIOSTERNAL JOINT INJURY ASSOCIATED WITH FRACTURE OF THE THORACIC SPINE

    OpenAIRE

    2015-01-01

    The authors report the occurrence of an occult manubriosternal joint injury in the initial evaluation on a patient with a thoracic spine fracture (T9). This T9 fracture was diagnosed in a 37-year-old man and was associated with a partial neurological deficit. At the initial evaluation, the radiographs produced did not show the manubriosternal joint injury. During rehabilitation, after surgical stabilization of the thoracic spine fracture, the patient suddenly felt an intense pain accompanied ...

  10. Minimally Invasive Surgical Approach to Distal Fibula Fractures: A Technique Tip

    Directory of Open Access Journals (Sweden)

    Tyler A. Gonzalez

    2017-01-01

    Full Text Available Wound complications following ankle fracture surgery are a major concern. Through the use of minimally invasive surgical techniques some of these complications can be mitigated. Recent investigations have reported on percutaneous fixation of distal fibula fractures demonstrating similar radiographic and functional outcomes to traditional open approaches. The purpose of this manuscript is to describe in detail the minimally invasive surgical approach for distal fibula fractures.

  11. Internal fixation for coronal shear fracture of the capitellum with polylactide resorbable fixation

    Science.gov (United States)

    Kraan, Gerald A; Krijnen, Matthijs R; Eerenberg, Jan Peter

    2013-01-01

    A 24-year-old woman with pain in the right elbow after a fall demonstrated a coronal shear fracture on radiographic studies. Perioperative a coronal shear fracture was seen and treated successfully with a polylactide Rigid fix resorbable pin. The operative correction resulted in normal function at 6 months follow-up. We state that a capitellum shear fracture can be fixated with a single resorbable pin, leading to successful fusion. PMID:23378544

  12. [The appearances of chondropathia patellae on plain films (author's transl)].

    Science.gov (United States)

    Schumacher, K A; Glöckler, W T; Mutschler, W; Rittmeyer, K

    1979-12-01

    The ability to diagnose chondropathia patellae on plain radiographs was studied in 64 patients in whom the disease had been confirmed either by operation or arthroscopy. All cases of stage III chondropathia were diagnosable by radiological examination; in stage I, 67%, and in stage II, 73% could be diagnosed. The diagnosis depends on the co-existence of marginal irregularities, irregularities of the subchondral bone lamellae, spotty diffuse demineralisation, marginal osteophytes, irregularities at the insertion of the quadriceps tendon and soft tissue changes such as joint effusions. These changes are best identified on the so-called "defilée" view. Disalignment of the axis of the patella and post-traumatic defects are of particular importance for the development of chondropathia, but in the present clinical material, the existence of dysplasia of the patella or of the femoral condyle was not associated with a demonstrable increase of chondromalacia.

  13. Circummandibular Wiring of Symphysis Fracture in a Five-Year-Old Child

    Directory of Open Access Journals (Sweden)

    Krishna Priya Vellore

    2013-01-01

    Full Text Available The treatment of pediatric maxillofacial fractures is unique due to the psychological, physiological, developmental, and anatomical characteristics of children. Method. This case report describes the management of symphysis fracture of mandible in a 5-year-old boy. The fracture was treated by acrylic splint with circummandibular wiring. Results. The splint was removed after 3 weeks. The patient had no complaints, and radiograph revealed a healed fracture. Conclusion. The clinical outcome in the present case indicates the management of mandibular fractures in pediatric patients using acrylic splint with circummandibular wiring.

  14. Influence of patient axial malpositioning on the trueness and precision of pelvic parameters obtained from 3D reconstructions based on biplanar radiographs

    Energy Technology Data Exchange (ETDEWEB)

    Ghostine, Bachir; Assi, Ayman [Institut de Biomecanique Humaine Georges Charpak, Arts et Metiers ParisTech, Paris (France); University of Saint-Joseph, Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Beirut (Lebanon); Sauret, Christophe; Skalli, Wafa [Institut de Biomecanique Humaine Georges Charpak, Arts et Metiers ParisTech, Paris (France); Bakouny, Ziad; Khalil, Nour [University of Saint-Joseph, Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Beirut (Lebanon); Ghanem, Ismat [University of Saint-Joseph, Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Beirut (Lebanon); University of Saint-Joseph, Hotel-Dieu de France Hospital, Beirut (Lebanon)

    2017-03-15

    Radiographs are often performed to assess pelvic and hip parameters, but results depend upon correct pelvis positioning. Three-dimensional (3D) reconstruction from biplanar-radiographs should provide parameters that are less sensitive to pelvic orientation, but this remained to be evaluated. Computerized-tomographic scans of six patients were used both as a reference and for generating simulated frontal and lateral radiographs. These simulated radiographs were generated while introducing axial rotations of the pelvis ranging from 0 to 20 . Simulated biplanar-radiographs were utilized by four operators, three times each, to perform pelvic 3D-reconstructions. These reconstructions were used to assess the trueness, precision and global uncertainty of radiological pelvic and hip parameters for each position. In the neutral position, global uncertainty ranged between ± 2 for pelvic tilt and ± 9 for acetabular posterior sector angle and was mainly related to precision errors (ranging from 1.5 to 7 ). With increasing axial rotation, global uncertainty increased and ranged between ± 5 for pelvic tilt and ± 11 for pelvic incidence, sacral slope and acetabular anterior sector angle, mainly due to precision errors. Radiological parameters obtained from 3D-reconstructions, based on biplanar-radiographs, are less sensitive to axial rotation compared to plain radiographs. However, the axial rotation should nonetheless not exceed 10 . (orig.)

  15. Radiographic diagnosis of rotator cuff tear based on the supraspinatus muscle radiodensity

    Energy Technology Data Exchange (ETDEWEB)

    Stallenberg, B.; Rommens, J.; Metens, T.; Gevenois, P.A. [Dept. of Radiology, Univ. de Bruxelles (Belgium); Legrand, C.; De Maertelaer, V. [Statistical Unit, Univ. Libre de Bruxelles, Brussels (Belgium)

    2001-01-01

    Objective. To evaluate the supraspinatus muscle radiodensity on the outlet view as an indication of a tendon tear.Design and patients. Plain radiographs and magnetic resonance imaging (MRI) examinations were obtained on both shoulders of 40 subjects aged 23-70 years, including 13 asymptomatic volunteers and 27 patients. Two readers analyzed the superior contour and the heterogeneity of the supraspinatus muscle radiodensity and compared them with the MRI findings.Results and conclusion. Significant concordances (P<0.001) were found between the assessments of the superior contour and the heterogeneity of the muscle radiodensity, respectively, on plain radiographs and MR images. For the diagnosis of a full-thickness tear, the analysis of the superior contour and the heterogeneity of the muscle radiodensity reached an accuracy of 85% and 80% respectively. Stepwise discriminant analyses showed low to moderate benefit of considering the contour and the heterogeneity simultaneously. The inter- and intraobserver agreement ranged from moderate to good. We conclude that on the outlet view, modifications in the superior contour and heterogeneity of the supraspinatus muscle radiodensity suggest a full-thickness tear. (orig.)

  16. Intracolonic multiple pebbles in young adults: Radiographic imaging and conventional approach to a case

    Institute of Scientific and Technical Information of China (English)

    Mehmet Eryilmaz; Orkun Ozturk; Oner Mentes; Kenan Soylu; Murat Durusu; K(o)ksal Oner

    2006-01-01

    Most of the foreign bodies detected in adult gastrointestinal systems are accidentally swallowed pins. In this study, we presented a case with intracolonic multiple pebbles. A 20-year-old man was admitted to emergency surgery policlinic for abdominal pain for 2 d without any alleviation or aggravation. His upright plain abdominal radiographic imaging revealed about 30-40 overt dense opacities in lumen of colonic segments, with oval and well shaped contours, each approximately 1cm x 1cm in size. The multiplanar reconstructions and threedimensional images combined with sectional screening showed that all pebbles had passed completely into the colon and no foreign bodies had remained in the ileal segments. On psychiatric assessment, he was found to have immature personality features, difficulty in overcoming stressors and adaptation disorder. He recovered by conservative management and radiographic monitoring applied during his follow-up. Thus, it can be concluded that, in differential diagnosis of abdominal pain in adult ages, though less frequently seen than in children,gastrointestinal system foreign bodies should always be kept in mind and it should be considered that ingestion of pebbles may be one of the factors contributing to abdominal pain particularly in young adults with psychiatric problems. In such cases suspected of having foreign bodies which cannot be detected by plain films, abdominal tomography can be an alternative for diagnostic imaging.

  17. Saturated thickness, High Plains