Search

Aims: Posterior column plating through the single anterior approach reduces the morbidity in acetabular fractures that require stabilization of both the columns. The aim of this study is to assess the effectiveness of posterior column plating through the anterior intrapelvic approach (AIP) in the management of acetabular fractures. Methods: We retrospectively reviewed the data from R G Kar Medical College, Kolkata, India, from June 2018 to April 2023. Overall, there were 34 acetabulum fractures involving both columns managed by medial buttress plating of posterior column. The posterior column of the acetabular fracture was fixed through the AIP approach with buttress plate on medial surface of posterior column. Mean follow-up was 25 months (13 to 58). Accuracy of reduction and effectiveness of this technique were measured by assessing the Merle d’Aubigné score and Matta’s radiological grading at one year and at latest follow-up. Results: Immediate postoperative radiological Matta’s reduction accuracy showed anatomical reduction (0 to 1 mm) in 23 cases (67.6%), satisfactory (2 to 3 mm) in nine (26.4%), and unsatisfactory (> 3 mm) in two (6%). Merle d’Aubigné score at the end of one year was calculated to be excellent in 18 cases (52.9%), good in 11 (32.3%), fair in three (8.8%), and poor in two (5.9%). Matta’s radiological grading at the end of one year was calculated to be excellent in 16 cases (47%), good in nine (26.4%), six in fair (17.6%), and three in poor (8.8%). Merle d’Aubigné score at latest follow-up deteriorated by one point in some cases, but the grading remained the same; Matta’s radiological grading at latest follow-up also remained unchanged. Conclusion: Stabilization of posterior column through AIP by medial surface plate along the sciatic notch gives good stability to posterior column, and at the same time can avoid morbidity of the additional lateral window. Cite this article: Bone Jt Open 2024;5(2):147–153.

Purpose: Recent publications emphasized the role of dorsomedial metaphyseal extension of humeral head as predictor of ischemia after complex proximal humerus fractures (PHFs). We evaluated on preoperative 3D CT scan of PHFs the surface of this metaphyseal extension and its prognostic value on the occurrence of avascular necrosis (AVN). Methods: We followed a series of 25 fixations of complex PHF which had a preoperative 3D CT scan and measured the surface area of the posterior metaphyseal extension (PME) of the head. Using approximations, we calculated the ratio between the PME surface area (PMS) and the articular surface area of the head (HS). The PMS/HS ratio was analyzed against the risk of AVN. Results: The measurement of the PMS/HS ratio emphasizes the significance of PME. The incidence of AVN is correlated with the magnitude of PME. Therefore, we include the PME as a fifth element in the characterization of complex PHFs and we propose a 4-stage prognostic classification based on the number of extensions of the humeral head. The head may have 3 extensions: posteromedial (PME), lesser tuberosity (LTE) and greater tuberosity (GTE). The risk of AVN decreases with the number of extensions of the head. Conclusion: Our study demonstrates a correlation between the occurrence of AVN and the size of PME in complex PHF cases. We propose a four-stage classification system to facilitate treatment decision-making between fixation and prosthesis. [ABSTRACT FROM AUTHOR]

Objective: In surgical correction of frontoethmoidal encephalocele with transcranial approach, advanced facilities are required. While with extracranial approach, though deemed as a safe option in area with limited facilities, procedure was associated with cerebrospinal fluid (CSF) leakage. In this case series, we evaluate the results of transcele reconstruction of frontoethmoidal encephalocele, our approach to reduce the incidence of CSF leaks by focusing on the closure of layers by its embryological derivatives, by its bone fusion. Methods: A case series of 14 patients with various types of frontoethmoidal encephalocele who underwent surgery for defect closure using transcele approach between June 2015 and December 2018 was carried out. Surgery was done by a single surgeon in the Department of Neurosurgery of Cipto Mangunkusumo Hospital in Jakarta, Indonesia. We collected the data of intraoperative blood loss and any signs of infection and CSF leak during the patients' one-year follow up. Bone fusion in the defect was evaluated from 3D rendering of head CT scan that was performed before and in 1 year after surgery. Results: The median percentage of intraoperative blood loss was 5.9% (0.5-18.7%). All 3D rendering of head CT post-surgery during 1 year follow up showed bone fusion and no patient experienced CSF leaks or CNS infections. Conclusions: This study showed that using transcele approach in frontoethmoidal reconstruction could give good bone fusion with minimal blood loss and no CSF leaks. We assumed that closure of the layers by its embryological derivative played an important part in bone fusion and in reducing the incidence of CSF leaks, although this finding has to be validated with large-scale studies. [ABSTRACT FROM AUTHOR]

Background Intervertebral foramen is the doorway of nerve root, and it plays an important role of radiculopathy and surgical treatment of intervertebral foramen diseases. Objectives the aim of this study was to determine the effect of side-lying with same side rotation and opposite side bending trunk position on patient with posterior and posterior-lateral disc prolapse at T12 -L1 level. Subjects and methods This study was conducted on 20 male participants. The study was conducted in radiology center specialized in the spine under the supervision of teaching staff member of the radiology department. Participants were divided into two equal groups of 10. The first group (A) were patients with discogenic lesion and the second group (B) was for normal individuals. Both groups were scanned using 3D CT scan at two positions: supine position and oblique position. The measurements taken were the intervertebral foramen (IVF) length (L), width (W) and cross sectional area (A). Results Mixed design MANOVA revealed that there was no significant difference between supine and oblique groups in diseased group regarding L, W and A. The IVF dimensions (L and W) did not significantly change with changing the spine position, while (A) was significantly higher in group A compare with group B whether in supine position or oblique position. Conclusion Changing the spine position from supine to oblique rotation position had no significant effect on length and width dimensions of intervertebral foramen. Oblique position had a significant influence on increasing the IVF cross sectional area in patients with discogenic lesion. [ABSTRACT FROM AUTHOR]

Posterior sternoclavicular joint dislocation is a rare condition. In this paper, we present a 51-year-old male patient who was admitted to the emergency department in our hospital after he was hit by a mining railway wagon in the chest. A diagnosis of posterior sternoclavicular dislocation was confirmed after performing a CT scan. Following necessary preparations, the sternoclavicular joint was stabilized with two wire cerclage techniques during open reduction. During control at the postoperative 4th week, the range of motion at the shoulder was satisfactory, but the patient had mild pain at the joint level and was sent to physical therapy to improve the range of motion and to minimize the pain. [ABSTRACT FROM AUTHOR]

Limited information about the skeletal anatomical features of the European pond turtle (Emys orbicularis), one of the species of turtles in Iran, is available. Given that performing clinical examinations as well using imaging techniques require complete anatomical information of the animal, it is essential to study these features in various researches. This study was done to provide complete anatomical information of the vertebrae and different shell parts in European pond turtles, as well as their normal three-dimensional computed tomographic (3D CT)-Scan images in both flexed and extended neck positions. This study was performed on 10 European pond turtles. CT-Scan images were taken from each sample and in the 3D reconstruction of the images, different patterns were used. 8 cervical vertebrae, 10 dorsal vertebrae, 2 sacral vertebrae, and 25 caudal vertebrae were observed in European pond turtles. The cervical vertebrae were highly mobile and there were no cervical ribs. Due to the fusion of the dorsal vertebrae, there were no intervertebral foramina in this section, but very small lateral vertebral foramina were visible. These foramina were formed in the last four dorsal vertebrae at the fusion site and they were larger than the foramina of the cranial vertebrae. According to the results of this study, it can be concluded that the use of diagnostic techniques such as a 3D CT-Scan is very useful in the study of skeletons. The correct direction and position of the bones can be easily determined using this technique. Part of the turtle`s ability to contract the neck is due to the special structure of the articular processes of the last two cervical vertebrae and the first dorsal vertebra. One of the most important adaptations in the evolution of the special structure of the seventh and eighth vertebrae of the neck and the way they are articulated.

Aims: The aim of this study was to describe a quantitative 3D CT method to measure rotator cuff muscle volume, atrophy, and balance in healthy controls and in three pathological shoulder cohorts. Methods: In all, 102 CT scans were included in the analysis: 46 healthy, 21 cuff tear arthropathy (CTA), 18 irreparable rotator cuff tear (IRCT), and 17 primary osteoarthritis (OA). The four rotator cuff muscles were manually segmented and their volume, including intramuscular fat, was calculated. The normalized volume (NV) of each muscle was calculated by dividing muscle volume to the patient’s scapular bone volume. Muscle volume and percentage of muscle atrophy were compared between muscles and between cohorts. Results: Rotator cuff muscle volume was significantly decreased in patients with OA, CTA, and IRCT compared to healthy patients (p < 0.0001). Atrophy was comparable for all muscles between CTA, IRCT, and OA patients, except for the supraspinatus, which was significantly more atrophied in CTA and IRCT (p = 0.002). In healthy shoulders, the anterior cuff represented 45% of the entire cuff, while the posterior cuff represented 40%. A similar partition between anterior and posterior cuff was also found in both CTA and IRCT patients. However, in OA patients, the relative volume of the anterior (42%) and posterior cuff (45%) were similar. Conclusion: This study shows that rotator cuff muscle volume is significantly decreased in patients with OA, CTA, or IRCT compared to healthy patients, but that only minimal differences can be observed between the different pathological groups. This suggests that the influence of rotator cuff muscle volume and atrophy (including intramuscular fat) as an independent factor of outcome may be overestimated.

Knowledge of radiological diagnostic capabilities and application of the principles designed to minimize exposure to radiation nowadays are the basics of qualified dentistry. At the present stage, radiographic methods occupy a leading place in the complex of patient examination to diagnose dental diseases. The aim of the work is to optimize the diagnosis of maxillofacial anomalies by a comprehensive examination of anatomical structures and parameters of the skull using 3D computed tomography. Materials and methods. In total, 39 patients aged 10 to 23 years with maxillofacial anomalies were examined. The study used clinical and radiographic methods of examination. Radiography included only orthopantomogram and lateral teleradiography in 28 patients, 3D CT scanning of the skull was performed in 11 patients. Results. The conducted study has revealed that 3D CT imaging of the skull can be used for the most complete diagnosis of maxillofacial anomalies, reveal sensitive differential diagnostic signs of pathological conditions as well as allow the principle of continuity between specialists to be adhered to at the stage of planning individual complex treatment for patients with maxillofacial anomalies. Conclusions. 3D CT scanning of the skull is an integrated imaging technique that allows obtaining a complete image of the jaws, teeth, temporal-mandible joints, sinuses in one single examination, assessing the respiratory tract and chewing apparatus state as a whole, as well as carrying out cephalometric measurements of lateral and frontal teleradiography. This method is the most informative as it provides the possibility to precisely diagnose dental anomalies and choose an optimal treatment plan.

Rotator cuff fatty infiltration (FI) is one of the most important parameters to predict the outcome of certain shoulder conditions. The primary objective of this study was to define a new computed tomography (CT)–based quantitative 3-dimensional (3D) measure of muscle loss (3DML) based on the rationale of the 2-dimensional (2D) qualitative Goutallier score. The secondary objective of this study was to compare this new measurement method to traditional 2D qualitative assessment of FI according to Goutallier et al and to a 3D quantitative measurement of fatty infiltration (3DFI). 102 CT scans from healthy shoulders (46) and shoulders with cuff tear arthropathy (21), irreparable rotator cuff tears (18), and primary osteoarthritis (17) were analyzed by 3 experienced shoulder surgeons for subjective grading of fatty infiltration according to Goutallier, and their rotator cuff muscles were manually segmented. Quantitative 3D measurements of fatty infiltration (3DFI) were completed. The volume of muscle fibers without intramuscular fat was then calculated for each rotator cuff muscle and normalized to the patient's scapular volume to account for the effect of body size (NV fibers). 3D muscle mass (3DMM) was calculated by dividing the NV fibers value of a given muscle by the mean expected volume in healthy shoulders. 3D muscle loss (3DML) was defined as 1 – (3DMM). The correlation between Goutallier grading, 3DFI, and 3DML was compared using a Spearman rank correlation. Interobserver reliability for the traditional 2D Goutallier grading was moderate for the infraspinatus (ISP, 0.42) and fair for the supraspinatus (SSP, 0.38), subscapularis (SSC, 0.27) and teres minor (TM, 0.27). 2D Goutallier grading was found to be significantly and highly correlated with 3DFI (SSP, 0.79; ISP, 0.83; SSC, 0.69; TM, 0.45) and 3DML (SSP, 0.87; ISP, 0.85; SSC, 0.69; TM, 0.46) for all 4 rotator cuff muscles (P <.0001). This correlation was significantly higher for 3DML than for the 3DFI for SSP only (P =.01). The mean values of 3DFI and 3DML were 0.9% and 5.3% for Goutallier 0, 2.9% and 25.6% for Goutallier 1, 11.4% and 49.5% for Goutallier 2, 20.7% and 59.7% for Goutallier 3, and 29.3% and 70.2% for Goutallier 4, respectively. The Goutallier score has been helping surgeons by using 2D CT scan slices. However, this grading is associated with suboptimal interobserver agreement. The new measures we propose provide a more consistent assessment that correlates well with Goutallier's principles. As 3DML measurements incorporate atrophy and fatty infiltration, they could become a very reliable index for assessing shoulder muscle function. Future algorithms capable of automatically calculating the 3DML of the cuff could help in the decision process for cuff repair and the choice of anatomic or reverse shoulder arthroplasty. [ABSTRACT FROM AUTHOR]

Objective: To assess the quality of applied pelvic binders using three dimensional computer tomography (3D CT).Methods: A local trauma registry was used to identify patients with pelvic fractures after high-energy trauma during 2011-2015. A 3D CT reconstruction was made from the initial trauma computer tomography images to assess the level of application, symmetricity of the binder and achieved fracture reduction. An acceptable application of the pelvic binder was deemed if it was at the trochanteric level, symmetric and minimized residual displacement.Results: We found 73 patients with a pelvic fracture and a pelvic binder on the initial trauma CT-scan. The mean (±SD) age of the patients was 46±17 years and 40% (n=29) were females. The median ISS score was 38 (IQR;29-50), the mean systolic blood pressure on arrival was 106±46 mmHg and the median GCS on arrival was 14 (IQR;7-15). We found that 59% (n=43) of the binders were correctly applied (symmetric at the trochanteric level, symmetrical and with acceptable residual displacement of the fracture). The 30-day mortality was higher in patients with non-correct application 17% (n=5/30) compared to patients with correct application of the pelvic binder 9.3% (n=4/43) however this was not statistically significant (p=0.562).Conclusion: A substantial number of patients had non-correct application of pelvic binders. Future studies using 3D technique are encouraged to further investigate clinical impacts of non-appropriate application of pelvic binders.

Three-dimensional (3D) geometry of the normal glenohumeral bone anatomy and relations is poorly documented. Our aims were (1) to determine the 3D geometry of the normal glenohumeral joint (GHJ) with reference to the scapular body plane and (2) to identify spatial correlations between the orientation and direction of the humeral head and the glenoid. Computed tomographies (CTs) of the normal, noninjured GHJ were collected from patients who had undergone CTs in the setting of (1) polytrauma, (2) traumatic head injury, (3) chronic acromioclavicular joint dislocations, and (4) unilateral trauma with a contralateral normal shoulder. We performed 3D segmentation and measurements with a fully automatic software (Glenosys; Imascap). Measurements were made in reference to the scapular body plane and its transverse axis. Geometric measurements included version, inclination, direction, orientation, best-fit sphere radius (BFSR), humeral subluxation, critical shoulder angle, reverse shoulder angle, glenoid area, and glenohumeral distance. Statistical correlations were sought between glenoid and humeral 3D measurements (Pearson correlation). A total of 122 normal GHJs (64 men, 58 women, age: 52 ± 17 years) were studied. The glenoid BFSR was always larger than the humerus BFSR (constant factor of 1.5, standard deviation = 0.2). The mean glenoid version and inclination were –6° ± 4° and 7° ± 5°, respectively. Men and women were found to have significantly different values for inclination (6° vs. 9°, P =.02), but not for version. Humeral subluxation was 59% ± 7%, with a linear correlation with glenoid retroversion (r = –0.70, P <.001) regardless of age. There was a significant and linear correlation between glenoid and humeral orientation and direction (r = 0.72 and r = 0.70, P <.001). The 3D geometry of the glenoid and humeral head present distinct limits in normal shoulders that can be set as references in daily practice: version and inclination are –6° and 7°, respectively, and humeral posterior subluxation is 59%; interindividual variations, regardless of the size, are relative to the scapular plane. There exists a strong correlation between the position of the humeral head and the glenoid orientation and direction. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to comprehensively evaluate the deformation of the skull base and fronto-temporal soft tissue in the patients with anterior plagiocephaly over 1 year of age by three-dimensional (3D) imaging after fronto-orbital advancement (FOA).Methods: We quantitatively analyzed the surgical results and outcome of FOA performed in 10 patients with anterior plagiocephaly. The measurements of the skull base and fronto-temporal soft tissue were performed based on 3D computed tomography (CT) scan. We assessed symmetry of the skull base and fronto-temporal soft tissue change.Results: The mean age of patients at FOA was 38.9 months. A significant asymmetry of the skull base was found in all the patients. The growth of the anterior and middle fossae was restricted and the deformation of the fronto-temporal region was marked by soft tissue measurements in different grades. On the follow-up CT images 23.6 months after surgery, there was prominent change (p < 0.05) between the two hemibases (CSO^ ratio) and between the lengths and angles of the anterior and middle cranial hemi-fossae (CX, CSX^, XSM^, XM ratio), especially in grade IIA. Anterior cranial vault asymmetry index obviously decreased to − 1.2 from 12% after surgery (p < 0.05). What’s more, ACA^ was also proved to be less after surgical correction (19.91° versus 8.29°, p < 0.01) in grade IIA. The change of fronto-temporal soft tissue was significant such as the frontal angle, the angle of the frontal plane, the fontal-temporal angle, and the angle of the temporal plane in different grades.Conclusions: The asymmetry of the skull base and the deformation of the fronto-temporal region can be presented by intracranial view at over 1 year of age in different grades. FOA can correct the skeletal malformation of the fronto-temporal region as well as soft tissue and the asymmetry of the skull base was improved after surgical treatment. [ABSTRACT FROM AUTHOR]

Purpose of Review: The purpose of this study is to provide an update to the orthopedic field in regard to treatment of the Hill-Sachs lesion and anterior shoulder instability. The review highlights the most current knowledge of epidemiology, clinical evaluation, and surgical methods used to treat Hill-Sachs lesions. It also details the relevant clinical and surgical findings that have been made throughout the literature in the past couple of years. Recent Findings: The most recent literature covering the Hill-Sachs lesion has focused on the relatively new and unexplored topic of the importance of concomitant injuries while treating a humeral head defect. The glenoid track concept has been clinically validated as a method to predict engagement. 3D-CT has become the 'gold standard' for Hill-Sachs imaging; however, it has been noted that 3D-MRI produces results that are not significantly different from CT. Also, it has been found that when the arm is in a position of abduction during the primary injury, there is a higher risk of engagement and subsequent dislocation. Recent studies have demonstrated successful results stemming from purely arthroscopic procedures in treating Hill-Sachs lesions. Summary: Anterior shoulder instability, specifically the Hill-Sachs lesion, is an area of orthopedic study that is highly active and constantly producing new studies in an attempt of gaining the best outcomes for patients. The past few years have yielded many excellent discoveries, but there is still much more work to be done in order to fully understand the role of the Hill-Sachs lesion in anterior shoulder instability. [ABSTRACT FROM AUTHOR]

Purpose: To assess whether there is a significant difference between the alignment of the individual femoral and tibial components (in the frontal, sagittal and horizontal planes) as calculated pre-operatively (digital plan) and the actually achieved alignment in vivo obtained with the use of patient-specific positioning guides (PSPGs) for TKA. It was hypothesised that there would be no difference between post-op implant position and pre-op digital plan.Methods: Twenty-six patients were included in this non-inferiority trial. Software permitted matching of the pre-operative MRI scan (and therefore calculated prosthesis position) to a pre-operative CT scan and then to a post-operative full-leg CT scan to determine deviations from pre-op planning in all three anatomical planes.Results: For the femoral component, mean absolute deviations from planning were 1.8° (SD 1.3), 2.5° (SD 1.6) and 1.6° (SD 1.4) in the frontal, sagittal and transverse planes, respectively. For the tibial component, mean absolute deviations from planning were 1.7° (SD 1.2), 1.7° (SD 1.5) and 3.2° (SD 3.6) in the frontal, sagittal and transverse planes, respectively. Absolute mean deviation from planned mechanical axis was 1.9°. The a priori specified null hypothesis for equivalence testing: the difference from planning is >3 or <-3 was rejected for all comparisons except for the tibial transverse plane.Conclusion: PSPG was able to adequately reproduce the pre-op plan in all planes, except for the tibial rotation in the transverse plane. Possible explanations for outliers are discussed and highlight the importance for adequate training surgeons before they start using PSPG in their day-by-day practise.Level Of Evidence: Prospective cohort study, Level II. [ABSTRACT FROM AUTHOR]

The purpose of this report is to discuss the diagnosis of Jaw cyst basal cell nevus syndrome. Two components of the syndrome are multiple odontogenic keratocysts and basal cell carcinomas. The discovery of multiple keratocysts is usually the first manifestation of the syndrome. In the case discussed, 3D CT scan taken to evaluate a diagnosed odontogenic keratocyst revealed more than one keratocysts. This led to the closer evaluation and diagnosis of Jaw cyst basal cell nevus syndrome.

Background Correction of posterior humeral subluxation, measured by the humeral subluxation index (HSI) according to Walch, is necessary in total shoulder arthroplasty to prevent early loosening. The 3-dimensional (3D) measurement of the shoulder is becoming well accepted and common practice as it overcomes positional errors to which 2-dimensional (2D) glenohumeral measurements are prone. The first objective was to describe the HSI in a nonpathologic population with the 2D HSI according to Walch and a newly described 3D HSI method. The second objective was to compare both measuring methods with each other. Methods In 151 nonpathologic shoulders, the 2D HSI was measured on the midaxial computed tomography scan cut of the scapula. The 3D HSI, based on the native glenoid plane, was defined as X + R 2 R 100 % , in which X is the projection of the center of the humeral head to the anteroposterior axis of the glenoid fossa and R is the radius of the humeral head. Both measuring methods were compared with each other. Correlation was determined. Interobserver and intraobserver reliability of the 3D HSI was measured. Results The mean 3D HSI (51.5% ± 2.7%) was significantly ( P < .001) more posterior than the mean 2D HSI (48.7% ± 5.2%), with a mean difference of 2.9% ± 5.6%. No correlation was found between the 2D and 3D HSI. The interobserver and intraobserver reliability was excellent. Conclusion The 2D HSI seems to underestimate the humeral subluxation compared with a 3D reliable equivalent. [ABSTRACT FROM AUTHOR]

Background: We hypothesized that a sphere mapped to specific preserved nonarticular landmarks of the proximal humerus can accurately predict native humeral head radius of curvature (ROC) and head height (HH) in the osteoarthritic, deformed humeral head. Methods: Three consistent nonarticular landmarks were defined with a 3-dimensional sphere (and 2-dimensional circle in midcoronal plane) placed along the articular surface in 31 normal cadaveric humeri. Side-to-side differences in ROC and HH were determined in 22 pairs of normal shoulders. Using the nonarticular landmarks and sphere method, 3 independent blinded observers performed 2 sets of measurements in 22 pairs of shoulders with unilateral glenohumeral osteoarthritis. The predicted native ROC and HH in the pathologic shoulder were compared with the normal side control. Results: The mean side-to-side difference in normal shoulders was 0.2 mm (ROC) and 0.6 mm (HH). In the unilateral osteoarthritis cases, the intraobserver mean differences for the normal side were 0.3 mm (ROC) and 0.9 mm (HH). The pathologic side ROC and HH, defined by the sphere, exhibited intraobserver differences of 0.5 mm (ROC) and 1.0 mm (HH). The mean side-to-side differences between the normal and pathologic sides were 0.5 mm (ROC) with concordance correlation coefficient of 0.95 and 1.3 mm (HH) with concordance correlation coefficient of 0.66. Conclusion: A sphere mapped to preserved nonarticular bone landmarks can be used for accurate preoperative measurement of premorbid humeral head size and therefore the selection of an anatomically sized prosthetic head. This is applicable postoperatively, as is a circle method for 2-dimensional assessment of anatomic humeral reconstruction in the coronal plane. [Copyright &y& Elsevier]

Background: Type B glenoids according to Walch are subclassified into a group with no posterior erosion (B1) and a group with important posterior erosion (B2) based on 2-dimensional axial computed tomography (CT) scan images. Three-dimensional (3D) CT scan reconstruction seems to improve the accuracy of the measurement of erosion because of its independence from positional errors. The aim is to quantify the direction and amount of posterior erosion of type B glenoids using a reproducible 3D measuring technique. Methods: We performed 3D reconstruction of 72 type B glenoids (24 type B1 glenoids and 48 type B2 glenoids) using Mimics (Materialise, Haasrode, Belgium). The native glenoid plane and intermediate glenoid plane were determined by use of 3-Matic (Materialise). The normal glenoid version, eroded retroversion, and difference in retroversion were measured. Next, the maximum erosion and its orientation were quantified. Results: There was always minimum erosion of 1.7 mm, and the mean erosion was 4.2 mm. There was a significant difference between the mean erosion in type B1 glenoids (3.5 mm) and type B2 glenoids (4.5 mm) (P = .019). The mean orientation of the erosion was mostly to the posteroinferior side (119°; SD, 26.8). There was a significant difference between the mean orientation in type B1 glenoids (132°; SD, 25.2) and type B2 glenoids (113°; SD, 25.5) (P = .004). Conclusions: With the use of this newly developed reproducible measuring technique, the maximum erosion in type B glenoids can be adequately quantified. All glenoids showed signs of important erosion. Because the orientation of the maximum erosion in type B1 glenoids is situated more inferiorly, the 2-dimensional CT scan technique can be insufficient to evaluate this erosion. [Copyright &y& Elsevier]

Objective: Knowledge of the normal and pathological three-dimensional glenohumeral relationship is imperative when planning and performing a total shoulder arthroplasty. There is, however, no consensus on which references should be used when studying this relationship. The purpose of the present study was to define the most suitable glenoid plane with normally distributed parameters, narrowest variability, and best reproducibility. Materials and methods: Three-dimensional reconstruction CT scans were performed on 152 healthy shoulders. Four glenoid planes, each determined by three surgically accessible bony reference points, were determined. Two planes were triangular, with the same base defined by the most anterior and posterior point of the glenoid. The most inferior and the most superior point of the glenoid, respectively, define the top of Saller's inferior plane and the Saller's superior plane. The two other planes are formed by best-fitting circles. The circular max plane is defined by the superior tubercle, and two points at the distal third of the glenoid. The circular inferior plane is defined by three points at the rim of the inferior quadrants of the glenoid. Results: The parameters of all four planes behave normally. The humeral center of rotation is identically positioned for both the circular max and circular inferior plane (X = 91.71°/X = 91.66° p = 0.907 and Y = 90.83°/Y = 91.7° p = 0.054, respectively) and different for the Saller's inferior and Saller's superior plane ( p ≤ 0.001). The circular inferior plane has the lowest variability to the coronal scapular plane ( p < 0.001). Conclusions: This study provides arguments to use the circular inferior glenoid plane as preferred reference plane of the glenoid. [ABSTRACT FROM AUTHOR]

To assess the clinical effectiveness of immediate non-functional loading of single-tooth implant placed into avulsed tooth socket following ridge augmentation in the anterior maxilla with bioglass bone substitute and biocollagen membrane. The clinical outcome of immediate non-functional loaded implants up to 24 months after placement into avulsed tooth sockets in anterior maxilla were evaluated in 15 patients. Implants were immediately restored with acrylic resin provisional crowns. Post-operative follow-up and intraoral radiographs were obtained at 6, 12, 18 and 24 months. Survival rate, implant threads exposure immediately after placement and at 6 month interval using CT 3D reconstruction was assessed. Marginal bone loss did not extend beyond the first thread and 3D CT scan showed adequate bone mineral density with no signs of radiolucent lesion around the implant during 24 months follow-up having survival rate of 100 %. Within the limits of the present study, immediate non-functional loading of single tooth implant placed into avulsed tooth socket following augmentation with bioglass bone substitute and biocollagen membrane in the anterior maxilla is one of the viable treatment alternatives for rehabilitation of immediate loading implant. [ABSTRACT FROM AUTHOR]

Background: Reconstruction of the native plane in biconcave eroded glenoids is difficult. Nevertheless, accurate reconstruction of this plane is imperative for successful total shoulder arthroplasty. This study aims to determine guidelines that can increase the accuracy of glenoid component positioning. Methods: Three different circular planes were determined on 3-dimensional computed tomography (CT) scans of 152 healthy shoulders. First, the circular max (CM) plane is formed with the superior tubercle and 2 points, 1 anterior and 1 posterior, at the rim of the inferior third of the glenoid. Second, the circular inferior (CI) plane is formed by 3 points at the inferior 2 quadrants of the glenoid rim. Third, the circular minima (Cm) plane is formed with 3 points situated at the noneroded sector of the anterior glenoid. The angulation of the spinal scapular axis (SSA), the line between the most medial point of the scapular spine and the center of the three different glenoid planes, and the correlation coefficient between the radius of the circle and the length of SSA are calculated. Results: Angle SSA in the x-axis were 94°, 93°, 93° and in the y-axis were 95°, 111°, and 111° for CM, CI, and Cm, respectively. Correlation coefficient between the radius of the circle and the length of SSA: r = 0.69 for CM, r = 0.75 for CI, and r = 0.75 for Cm. Conclusion: Three points situated at the native anterior glenoid can reconstruct, within 2° accuracy (95% confidence interval, 1.8°-2.3°), the CI plane. A relationship exists between the radii of the 3 glenoid circles and the width of the scapula (SSA length). [ABSTRACT FROM AUTHOR]

Background: During a pancreatectomy, the left gastric vein (LGV) has an important role in the venous drainage of the stomach (total pancreatectomy, left splenopancreatectomy, pancreatoduodenectomy with venous resection and pylorus-preserving pancreaticoduodenectomy). Pre-operative knowledge of the LGV's termination is necessary for adequate protection of this vein during dissection. The objective of the present study was to analyse the location of the LGV's termination in a patient population and facilitate its identification in at-risk situations. Materials and methods: Abdominal computed tomography (CT) images of 86 pancreatic tumour patients (20 of whom underwent surgery), who were treated in our institution between October 2009 and October 2010, were reviewed. Arterial-phase and portal-phase helical CT with three-dimensional reconstruction was performed in all cases. The location of the termination of the LGV was determined and (when the LGV merged with the splenic vein or the splenomesenteric trunk) the distance between the termination and the origin of the portal vein (PV). The correlation between CT imaging data and intra-operative findings was studied. Results: The LGV was identified on all CT images. In 65% of cases ( n= 56), the LGV terminated in the PV (upstream of the liver in nine of these cases). The LGV terminated at the splenomesenteric trunk in 4.7% of cases ( n= 4) and in the splenic vein in 30.3% of cases ( n= 26). When the LGV terminated upstream of the origin of the PV, the distance between the two was always greater than 1 cm. The average distance between the termination of the LGV and the origin of the PV was 14.34 mm (10.2 to 21.1). The anatomical data from CT images agreed with the intra-operative findings in all cases. Conclusion: Pre-operative analysis of the LGV is useful because the vein can be identified in all cases. Knowledge of the termination's anatomic location enables the subsequent resection to be initiated in a low-risk area. [ABSTRACT FROM AUTHOR]

Following anatomic double-bundle anterior cruciate ligament (ACL) reconstruction with hamstring tendon autografts, 38 consecutive patients were evaluated with high-speed three-dimensional computed tomography. Scans were performed within 3 days following surgery. The length and width of the reconstructed ACL footprint were measured on axial images. Then, 3D images were converted into 2D with radiologic density for measurement purposes. Tunnel orientation was measured on AP and lateral views. In the sagittal plane, the center of the anteromedial (AMB) and posterolateral bundle (PLB) tibial attachment positions was calculated as the ratio between the geometric insertion sites with respect to the sagittal diameter of the tibia. In addition, the length from the anterior tibial plateau to the retro-eminence ridge was measured; the relationship of this line with the centers of the AM and PL tunnels was then measured. The AP length of the reconstructed footprint was 17.1 mm ± 1.9 mm and the width 7.3 mm ± 1.2 m. The distance from retro-eminence ridge to center of AM tunnel was 18.8 mm ± 2.8 mm, and the distance from RER to center of PL tunnel was 8.7 mm ± 2.6 mm. The distance between tunnels center was 10.1 mm ± 1.7 mm. There were no significant differences between the intra- and inter-observer measurements. The bone bridge thickness was 2.1 mm ± 0.8 mm. In the sagittal plane, the centers of the tunnel apertures were located at 35.7% ± 6.7% and 53.7% ± 6.8% of the tibia diameter for the AMB and PLB, respectively. The surface areas of the tunnel apertures were 46.3 mm ± 4.4 mm and 36.3 mm ± 4.0 mm for the AM and PL tunnels, respectively. The total surface area occupied by both tunnels was 82.6 mm ± 7.0 mm. In the coronal plane, tunnel orientation showed the AM tunnel was more vertical than the PL tunnel with a 10° divergence (14.8° vs. 24.1°). In the sagittal plane, both tunnels were almost parallel (29.9° and 25.4° for the AM and PL tunnels, respectively). When using anatomic aimers, the morphometric parameters of the reconstructed tibial footprint in terms of length and distances to the surrounding bony landmarks were similar to the native ACL tibial footprint. However, the native footprint width was not restored, and the surface area of the two tunnel apertures was in the lower range of the published values for the native footprint area . [ABSTRACT FROM AUTHOR]

Snapping shoulder syndrome could be effectively treated with scapulothoracic arthroscopy. The excision of the scapular superomedial corner is assumed to help lower the recurrence rate. However, the amount of resection is still controversial. Furthermore, we lack a technique to measure if the resected amount was adequate based only on arthroscopy evaluation. We describe a 47-year-old man who suffered from severe snapping shoulder syndrome as a consequence of a deformity of the left superomedial scapular corner. The patient had endoscopic bursectomy and superomedial corner resection. Intraoperative three-dimensional CT scans (3D-CT) were used to evaluate the amount of resection. The patient recovered without incident and resumed his usual activities within 30 days following surgery. At the six-month follow-up, there were no recurrent symptoms. Intraoperative 3D imaging significantly enhances the safety and efficacy of scapulothoracic arthroscopy. This is a novel technique that, to our knowledge, has not been reported previously in the literature. • The scapular superomedial corner excision may help reduce recurrence rates of treatment for snapping shoulder syndrome. • The lack of anatomical landmarks makes estimating the resected volume by arthroscopic vision challenging. • This is the first report of the application of intra-operative 3D imaging for scapulothoracic arthroscopy. • Intraoperative 3D imaging significantly enhances the safety and effectiveness of scapulothoracic arthroscopy. • Intraoperative 3D imaging help in the precise identification of anatomical landmarks in small or complex regions. [ABSTRACT FROM AUTHOR]

Abstract: Sagittal split ramus osteotomy (SSRO) of the mandible is one of the most common surgical techniques to correct mandibular deformities. Measurement of nerve position using conventional methods has been reported in the literature, but surgeons have found that further investigation of the anatomical relationship is needed. The aim of this study was to attempt to increase the accuracy of treatment by using 3-dimensional computed tomography scan measurements. From the normal population, 20 females and 20 males were enrolled during planning of denture implants in Taiwan. The mean age was 28±6, ranging from 20 to 39 years old. Using 3D tomography data, nerve position at osteotomy sites was measured and the geometric relationship examined between the antilingula and mandibular foramen. The results gave the mean distance from buccal plate to mandibular canal at the second molar, from mandibular canal to inferior border of the mandibular body, from the mandibular foramen to the highest tip of the lingula, and from the mandibular foramen to the anterior margin of the oblique ridge. When applied to SSRO operations, the anatomic data provided by this study may help surgeons gain more understanding of nerve position during surgery. [Copyright &y& Elsevier]

Three-dimensional computed tomography (CT) is the method of choice in understanding the morphological changes after periacetabular osteotomy in children. We studied different parameters and compared aspects of operated hip (OH) with non-operated hip (NOH) to define the maneuver that promotes normalization of the hip during repositioning of the acetabulum. A total of 22 patients with 25 OHs underwent CT control scans an average of 4 years after surgery. The patients, with a mean age of 6.8 years, had either Legg-Calvé-Perthes disease (12 cases) or dysplasia (10 cases).The measurements included the anterior and posterior coverage angles of the hip and version of the acetabulum on axial CT views. The 3D reconstructed images measured the inclination of the antero– and postero–lateral lips, the external rotation and the anterior inclination of the acetabulum. The mean anterior coverage angle was 27° for OHs, 31° for NOHs, and 12° versus 10.3° for the posterior coverage angle. Acetabular anteversion was 2° for OHs (6.3° in the dysplastic OHs) and 6° for NOHs. The mean angle of inclination of the antero–lateral lip was 37° for OHs, 47° for NOHs, and the postero–lateral lip inclination was 56° for OHs and 67° for NOHs. Inferior 3D views showed a mean internal acetabular rotation of 1.5° (4.8° in the dysplastic OH), 3° for NOH. The anterior acetabular inclination angle measured with lateral 3D views was 6° for OHs, 11° for NOHs. Our analysis demonstrated a mean anteversion of the acetabulum despite normalization of the anterior coverage of the hip, particularly in the dysplastic group, in which the osteotomized fragments had anteversion superior to NOH. The unexpected external rotation used to improve anterior coverage of a coax magna in Legg-Calvé-Perthes disease was responsible for the retroversion and the decrease of the posterior coverage. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this investigation was to assess the feasibility of building a virtual human face digitally by superimposing a photo-realistic three-dimensional (3D) soft-tissue surface on bone in the correct relationship and evaluating the registration errors associated with this method. The 3D soft-tissue surface of the face was captured using a fast stereophotogrammetry method and the underlying bone was recorded using a 3D computed tomography (CT) scanner. Using the Procrustes registration method, the outer surface of the 3D CT scan and the photo-realistic soft-tissue surfaces were merged into a single Virtual Reality Modelling Language (VRML) file and displayed using a standard VRML viewer. Quantitative measurements of registration errors were calculated in the reconstructed human head models using the signed closest point distance from the photo-realistic skin surface to the transformed CT skin surface. The registration errors between most parts of the aligned surfaces were within ±1.5mm. The errors were relatively large around the eyebrows, eyelids and cheeks. Simultaneous recording of the face and skull may reduce this error. [Copyright &y& Elsevier]