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Australian Cattle Dogs (ACD) are medium-sized animals widely used in fieldwork for managing cattle and sheep. There needs to be more information about the conditions these dogs can develop despite being well-characterized animals since the beginning of the 20th century. Hip dysplasia (HD) is a developmental abnormality between the femoral head and the acetabular fossa, which can be debilitating. However, the available literature has no studies on the prevalence of this condition in dogs of this breed. This study aimed to evaluate radiographs of ACD qualitatively and quantitatively. For this purpose, 49 dogs considered healthy without clinical signs of HD were radiographically assessed, and the animals were classified as dysplastic (D) and non-dysplastic (ND). A frequency of 46.9% of dysplastic dogs was observed, with males being more affected. The cortical index (CI) and angle of inclination (AI) could not differentiate D from ND animals; only the Norberg angle (NA) was effective in this differentiation. No correlation was observed between AI, CI, and AN.

Aims: The distal radius is a major site of osteoporotic bone loss resulting in a high risk of fragility fracture. This study evaluated the capability of a cortical index (CI) at the distal radius to predict the local bone mineral density (BMD). Methods: A total of 54 human cadaver forearms (ten singles, 22 pairs) (19 to 90 years) were systematically assessed by clinical radiograph (XR), dual-energy X-ray absorptiometry (DXA), CT, as well as high-resolution peripheral quantitative CT (HR-pQCT). Cortical bone thickness (CBT) of the distal radius was measured on XR and CT scans, and two cortical indices mean average (CBTavg) and gauge (CBTg) were determined. These cortical indices were compared to the BMD of the distal radius determined by DXA (areal BMD (aBMD)) and HR-pQCT (volumetric BMD (vBMD)). Pearson correlation coefficient (r) and intraclass correlation coefficient (ICC) were used to compare the results and degree of reliability. Results: The CBT could accurately be determined on XRs and highly correlated to those determined on CT scans (r = 0.87 to 0.93). The CBTavg index of the XRs significantly correlated with the BMD measured by DXA (r = 0.78) and HR-pQCT (r = 0.63), as did the CBTg index with the DXA (r = 0.55) and HR-pQCT (r = 0.64) (all p < 0.001). A high correlation of the BMD and CBT was observed between paired specimens (r = 0.79 to 0.96). The intra- and inter-rater reliability was excellent (ICC 0.79 to 0.92). Conclusion: The cortical index (CBTavg) at the distal radius shows a close correlation to the local BMD. It thus can serve as an initial screening tool to estimate the local bone quality if quantitative BMD measurements are unavailable, and enhance decision-making in acute settings on fracture management or further osteoporosis screening. Cite this article: Bone Joint Res 2021;10(12):820–829.

BackgroundAlthough proximal humerus strength/quality can be assessed using cortical thickness measurements (eg, cortical index), there is no agreement where to make them. Tingart and coworkers used measurements where the proximal endosteum becomes parallel, while Mather and coworkers used measurements where the periosteum becomes parallel. The new circle-fit method (CFM) makes 2 metaphyseal (M1-M2) and 6 diaphyseal (D1-D6) measurements referenced from humeral head diameter (HHD). However, it is unknown whether these locations correlate to humeral length (HL). Accordingly, we asked: (1) Does HHD, Tingart distance, and Mather distance correlate with HL? (2) What is the location of HHD, Tingart distance, and Mather distance as a percentage of HL? and (3) Which CFM D1-D6 locations correlate with Tingart and Mather distances?Materials and methodsMeasurements made on cortical thickness (CT) scout views of 19 humeri (ages: 16-73 years) included HHD, distances from the superior aspect of the humerus to proximal Tingart and Mather locations, and HL.ResultsIntraclass correlation was excellent for CFM-HHD, poor for Tingart, and moderate for Mather. The CFM-HHD had a stronger correlation to HL than Tingart and Mather. Mean HHD was 15.5% (0.9%) of HL while Tingart was 27.0% (4.1%) and Mather was 23.2% (3.8%). Tingart distance corresponded to D2/D3 CFM locations while the Mather distance was similar to D1/D2.DiscussionThe CFM reliably correlates with HL and provides a stronger correlation and less variance between specimens than the Tingart or Mather Methods.ConclusionsBecause the CFM produces reliable percent of HL locations, it should be used to define locations for obtaining biomechanically relevant CT measurements such as cortical index. Stronger correlations of these CFM-based measurements with proximal humerus strength will be important for developing advanced algorithms for fracture treatment.

Foram avaliadas 386 radiografias da articulação coxofemoral, sendo 220 de cães da raça Pastor Alemão, 112 machos e 108 fêmeas, e 166 da raça Labrador Retriever, 69 machos e 97 fêmeas. As radiografias foram classificadas segundo o grau de displasia coxofemoral (DCF), e foram mensurados o ângulo de inclinação, o ângulo de Norberg, o índice cortical e o percentual de cobertura da cabeça femoral de ambos os lados. As variáveis foram associadas mediante análise estatística multivariada de componentes principais. As variáveis índice cortical e ângulo de inclinação foram inversamente associadas. A raça Pastor Alemão apresentou valores de índice cortical e graus de DCF mais baixos em relação à raça Labrador Retriever. Maior ângulo de inclinação foi associado a menor ângulo de Norberg e menor percentual de cobertura. Animais mais velhos apresentaram menor ângulo de Norberg, menor porcentagem de cobertura e maior grau de DCF. Nas fêmeas, foram observados menor porcentagem de cobertura, menor ângulo de Norberg e maior grau de DCF. Pode-se concluir que o ângulo de inclinação e o índice cortical não demonstraram associação com a DCF.A total of 386 radiographs of the pelvis were evaluated, being 220 of German Shepherd dogs (112 males and 108 females) and 166 of Labrador Retrievers (69 males and 97 females). The radiographs were degree classified regarding the of hip dysplasia (DHD). The Norberg and inclination angles, the cortico-medullary index, and the percentage coverage of the femoral head were measured and associated using multivariate statistical technique (principal component analysis). The cortico-medullary index and the inclination angle were inversely associated. The results indicated that German Shepherd Dogs showed lower cortico-medullary index and DHD compared with Labrador Retrievers. The higher the inclination angle, the lower the Norberg angle and percentage coverage of the femoral head. It was observed that with age, animals showed lower Norberg angles and percentage coverage of the femoral head, thus more hip dysplasia severity. Females were associated to lower femoral head coverage and Norberg angles, and more severe DHD. Femoral inclination angle and cortico-medullary index did not demonstrate a correlation to DHD.

Background: We evaluated the mid-term results of previously cemented hip arthroplasties revised with uncemented modular femoral components. Methods: The study included 40 patients (36 females (90 %) and 4 males (10 %), mean age 67.6 years, range 39-87 years) who underwent revision of a previously cemented hip prosthesis with an uncemented modular femoral stem between 2005 and 2009. The indications for revision were femoral aseptic loosening in 38 (95 %) cases and acetabular protrusion in 2 (5 %). According to the Paprosky classification, the femoral defect was type 1 in 10 (25 %) patients, type 2 in 16 (40 %), type 3a in 11 (27.5 %), type 3b in 2 (5 %) and type 4 in 1 (2.5 %). The Harris hip score was used for the clinical evaluation. Femoral vertical subsidence, the cortical index and femoral stem stability were assessed radiologically. The mean follow-up period was 84 months (range 61-95 months). Results: The mean Harris hip score was 41.4 (range 35.4-44.4) preoperatively and 80.9 (range 65.6-98.3) at the final follow-up examination (p < 0.05). Mean vertical subsidence was 5.7 mm (range 2.5-10.5 mm) in seven (17.5 %) patients. Stable bone fixation was observed in 38 (95 %) patients, fibrous stable fixation in 2 (5 %) and no instability in any patient. Radiographs taken during the early postoperative period revealed that the cortical index was a mean of 1.34 (range 1.11-1.73) and a mean of 1.55 on the final follow-up radiographic examinations (range 1.16-1.91) (p < 0.01). Conclusions: Satisfactory results were achieved using uncemented modular femoral components during revision of previously cemented femoral components. Many modular femoral stems provide primary stability by filling femoral bone losses and help determine stem length, offset and anteversion. [ABSTRACT FROM AUTHOR]

Objective To evaluate the impact of prenatal myelomeningocele repair on fetal head biometry. Methods Fifty fetuses underwent open fetal myelomeningocele repair at our institution between January 1998 and July 2002. All had serial head circumference (HC) and lateral ventricular diameter (VD) measurements taken preoperatively and weekly for 8 weeks after repair. Cortical index (CI) was defined as HC/VD. Measurements were compared with gestational age-matched values from nomograms. One-sample t-test, ANOVA and repeated measures analysis were used to assess HC, VD and CI after fetal repair. Results Preoperatively, the HC in fetuses with myelomeningocele was smaller than control values (186.4 vs. 198.8 mm, P = 0.0004). Eight weeks' postoperatively this difference had resolved (293 vs. 301.6 ram, P = 0.76). The mean increase in CI after repair was 20% (P = 0.02) compared with the predicted 51% in normal cases. The average increase in VD was 3.9 mm (38.8%, P < 0.001). Conclusions Mid-gestational repair of myelomeningocele alters fetal head growth. Increased CI suggests HC changes are not due to ventriculomegaly alone. [ABSTRACT FROM AUTHOR]

Background: The Dorr classification is widely used to evaluate femoral bone quality, but it has no clear quantitative criteria. This study aimed to evaluate the reproducibility of the Dorr classification and examine its quantitative indices on plain radiographs, which are suitable for objective classification., Hypothesis: Reproducibility of the Dorr classification is influenced by the clinical experience of the examiners, and radiographic indices are required for this classification., Materials and Methods: One hundred and one patients were examined using their preoperative plain antero-posterior and lateral radiographs. To evaluate the reproducibility of the Dorr classification, the Dorr type of each patient was judged twice each by three expert hip surgeons and three junior hip surgeons. Indices measured using the plain radiographs were canal-to-calcar ratio, cortical index (CI), and canal flare index. A receiver operating characteristic curve was used to evaluate which measured parameters were suitable as indices for the Dorr classification which was determined by the consultation among three expert hip surgeons., Results: Regarding intra-examiner reproducibility, kappa coefficients for the three junior hip surgeons were 0.36, 0.62, and 0.65, whereas those for the three expert hip surgeons were 0.70, 0.86, and 0.87. Regarding inter-examiner reproducibility, the kappa coefficient for the junior hip surgeons was 0.32, whereas that for the expert hip surgeons was 0.52. The CI on the lateral radiograph had the largest area under the curve (AUC) between types A and B, whereas the CI on the anteroposterior radiograph had the largest AUC between types B and C. The respective cutoff points of the CI on the anteroposterior radiograph were 0.58 between types A and B and 0.49 between types B and C. The respective cutoff points of CI on the lateral radiograph were 0.45 between types A and B and 0.28 between types B and C., Conclusion: The intra-examiner reproducibility of the Dorr classification ranged from "fair" to "almost perfect", whereas the inter-examiner reproducibility ranged from "fair" to "moderate". Both were influenced by the level of clinical experience of the examiners. The most suitable index for classification using plain radiographs of the hip is the CI on anteroposterior and lateral radiographs., Level of Evidence: IV, retrospective study., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Background: Although proximal humerus strength/quality can be assessed using cortical thickness measurements (eg, cortical index), there is no agreement where to make them. Tingart and coworkers used measurements where the proximal endosteum becomes parallel, while Mather and coworkers used measurements where the periosteum becomes parallel. The new circle-fit method (CFM) makes 2 metaphyseal (M1-M2) and 6 diaphyseal (D1-D6) measurements referenced from humeral head diameter (HHD). However, it is unknown whether these locations correlate to humeral length (HL). Accordingly, we asked: (1) Does HHD, Tingart distance, and Mather distance correlate with HL? (2) What is the location of HHD, Tingart distance, and Mather distance as a percentage of HL? and (3) Which CFM D1-D6 locations correlate with Tingart and Mather distances?, Materials and Methods: Measurements made on cortical thickness (CT) scout views of 19 humeri (ages: 16-73 years) included HHD, distances from the superior aspect of the humerus to proximal Tingart and Mather locations, and HL., Results: Intraclass correlation was excellent for CFM-HHD, poor for Tingart, and moderate for Mather. The CFM-HHD had a stronger correlation to HL than Tingart and Mather. Mean HHD was 15.5% (0.9%) of HL while Tingart was 27.0% (4.1%) and Mather was 23.2% (3.8%). Tingart distance corresponded to D2/D3 CFM locations while the Mather distance was similar to D1/D2., Discussion: The CFM reliably correlates with HL and provides a stronger correlation and less variance between specimens than the Tingart or Mather Methods., Conclusions: Because the CFM produces reliable percent of HL locations, it should be used to define locations for obtaining biomechanically relevant CT measurements such as cortical index. Stronger correlations of these CFM-based measurements with proximal humerus strength will be important for developing advanced algorithms for fracture treatment., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: The goal of this study is to investigate the relation between indicators of osteoporosis (i.e., bone mineral density (BMD), and Cortical Index (CI)) and the complexity of a fracture of the proximal humerus as a result of a low-energy trauma., Methods: A retrospective chart review of 168 patients (mean age 67.2 years, range 51 to 88.7) with a fracture of the proximal humerus between 2007 and 2011, whose BMD was assessed at the Fracture Liaison Service with Dual Energy X-ray Absorptiometry (DXA) measurements of the hip, femoral neck (FN) and/or lumbar spine (LS), and whose CI and complexity of fracture were assessed on plain anteroposterior radiographs of the proximal humerus., Results: No significant differences were found between simple and complex fractures of the proximal humerus in the BMD of the hip, FN or LS (all p > 0.3) or in the CI (p = 0.14). Only the body mass index was significantly higher in patients with a complex fracture compared with those with a simple fracture (26.9 vs 25.2; p = 0.05)., Conclusion: There was no difference in BMD of the hip, FN, LS or CI of the proximal humerus in simple compared with complex fractures of the proximal humerus after a low-energy trauma. Factors other than the BMD and CI, for example body mass index, may play a more important role in the complexity of this fracture.Cite this article: J.W.A.M. den Teuling, B.S. Pauwels, L. Janssen, C.E. Wyers, H. M. J. Janzing, J.P.W. van den Bergh, J. W. Morrenhof. The Influence of bone mineral density and cortical index on the complexity of fractures of the proximal humerus. Bone Joint Res 2017;6:584-589. DOI: 10.1302/2046-3758.610.BJR-2017-0080., Competing Interests: Conflicts of Interest Statement: None declared, (© 2017 Teuling et al.)

Objectives: This investigation sought to advance the work published in our prior biomechanical study (Journal of Orthopaedic Research, 2016). We specifically sought to determine whether there are additional easy-to-measure parameters on plain radiographs of the proximal humerus that correlate more strongly with ultimate fracture load, and whether a parameter resembling the Dorr strength/quality characterisation of proximal femurs can be applied to humeri., Materials and Methods: A total of 33 adult humeri were used from a previous study where we quantified bone mineral density of the proximal humerus using radiographs and dual-energy x-ray absorptiometry (DEXA), and regional mean cortical thickness and cortical index using radiographs. The bones were fractured in a simulated backwards fall with the humeral head loaded at 2 mm/second via a frustum angled at 30° from the long axis of the bone. Correlations were assessed with ultimate fracture load and these new parameters: cortical index expressed in areas ("areal cortical index") of larger regions of the diaphysis; the canal-to-calcar ratio used analogous to its application in proximal femurs; and the recently described medial cortical ratio., Results: The three new parameters showed the following correlations with ultimate fracture load: areal cortical index (r = 0.56, p < 0.001); canal-to-calcar ratio (r = 0.38, p = 0.03); and medial cortical ratio (r = 0.49, p < 0.005). These correlations were weaker when compared with those that we previously reported: mean cortical thickness of the proximal diaphysis versus ultimate fracture load (r = 0.71; p < 0.001); and mean density in the central humeral head versus ultimate fracture load (r = 0.70; p < 0.001)., Conclusion: Simple-to-measure radiographic parameters of the proximal humerus reported previously are more useful in predicting ultimate fracture load than are areal cortical index, canal-to-calcar ratio, and medial cortical ratio.Cite this article: J. G. Skedros, C. S. Mears, W. Z. Burkhead. Ultimate fracture load of cadaver proximal humeri correlates more strongly with mean combined cortical thickness than with areal cortical index, DEXA density, or canal-to-calcar ratio. Bone Joint Res 2017;6:1-7. DOI: 10.1302/2046-3758.61.BJR-2016-0145.R1., Competing Interests: ICMJE Conflicts of Intrest: None declared, (© 2017 Skedros et al.)